Leafy Greens & Injured Beans: Natures Nephrotoxins – A Poison Lab & NephMadness Collaboration
The Poison LabShow Notes
In this special collaboration with NephMadness, we're diving into the world of nephrotoxins with an expert panel from Virginia Commonwealth University. NephMadness is an educational competition modeled after March Madness, and this year, one of the featured regions focuses on plant-based nephrotoxins. Together, with our expert panel we break down the competing nephrotoxin teams: Tubular Toxins vs. Oxalate Offenders. Joining us are Dr. Anna Vinnokova (Nephrologist), Dr. Rachel Khan PharmD (Neph pharmacist), Dr. Ethan Downes (Nephrology fellow), and the legendary nephrotoxicologist, Dr. Josh King (Board certified Nephrologist and Toxicologist). We ALMOST named this episode "Getting Downe with the Mad Neph King and the Bean Queens"... but we didn't, your welcome. After the show, go to the blog and vote for your favorite! Expect irreverent musings, deep dives into toxic plant exposures, and a mystery case reveal that will leave you questioning your diet. Topics and Timeline of Episode: Intro Listener Guesses With Josh and Ryan– 8:30 Listener Winner – 25:42 NephMadness and Guest Introductions – 28:07 Toxin Reveal – 33:41 NEJM Case report
Tubular Toxins – 35:46 Aristolochic Acid & the Belgian Weight-Loss Clinic Outbreak – 40:30 Black Licorice & Its Surprising Toxic Effects – 47:16
The Oxalate Offenders Team: How Dietary Oxalates Harm the Kidneys – 52:00 Historical Context: First recognized through sheep die-offs when herds grazed on Halogeton glomeratus, a high-oxalate plant, leading to fatal poisoning. Oxalate in Plants: Functions to bind excess calcium in the soil. Impact on the Body: Plants high in oxalate but low in calcium can contribute to oxalate accumulation, this leads to binding calcium in the blood, creating calcium oxalate crystals and acute renal calculi. Chronic inflammation from excess oxalate deposition leads to CKD progression. High-Oxalate Foods: Spinach, Swiss chard, rhubarb, cashews. Everything in moderation!
Practical Advice for Clinicians & Patients on Herbal Medicine Use – 1:00:00 Resources for identifying nephrotoxic herbal products Talk to your patients non judgmentally, open conversations, discuss efficacy (or lack there of, see resources below) and safety Herbal medicines are not FDA approved and may not contain what they claim to
Herbals may not all be safe: Josh King Discovering Contaminants– 1:01:11 Wrap up– 1:08 Key Takeaways: Aristolochic acid is a direct nephrotoxin, associated with progressive kidney damage and urothelial cancers. Black licorice toxicity results from 11β-hydroxysteroid dehydrogenase inhibition, leading to excess cortisol activity, hypertension, potassium wasting, and rhabdomyolysis. Regulatory gaps in herbal supplements can lead to unexpected toxicities, making consumer awareness essential. High dietary oxalate intake increases the risk of kidney stone formation and chronic kidney disease. NephMadness is open to everyone—vote for your favorite nephrotoxin team and join the conversation!
Resources Mentioned: NephMadness: Follow along and fill out your bracket! AJKD Blog National Kidney Foundation Herbal Medicine Guide National Center for Complementary and Integrative Health (NCCIH) Poison Control Center (Available 24/7 for toxicology questions): 1-800-222-1222
Follow The Poison Lab: Twitter: @LabPoison Instagram: @tox_talk Website: www.ThePoisonLab.com
Don’t forget to rate and review the podcast on Apple Podcasts, Spotify, or your preferred platform. Share this episode with your fellow nephrology and toxicology enthusiasts! Thanks for tuning in, and remember: If it sounds too good to be true, it might just be nephrotoxic. Stay safe and stay curious!
More from The Poison Lab
A quick Poison Lab update: new episodes are in the works, including a forthcoming NACCT research episode—though Ryan is briefly buried under mushroom-poisoning programming, NACCT, travel, and the start of a new academic year. In the meantime, revisit the back catalog, including outbreak episodes, Toxicologists Versus the Internet, and favorites such as “Should We Give Naloxone in Cardiac Arrest?” and “Leafy Greens and Injured Beans: Nature’s Nephrotoxins.” As a bonus, this episode includes Ryan’s interview with the podcast from the journal Addiction, discussing his recent study on kratom regulation and medical outcomes. For a more informal companion conversation, check out the “Co-Broadcast with the Kratom Sobriety Podcast” episode. A Morel Dilemma Support the show Review the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game
After weeks of investigation, the Bozeman outbreak is contained, but the questions it raised are much harder to close. In the final episode of A Morel Dilemma, we return to Montana to understand how investigators traced the mushrooms, looked for additional cases, communicated risk to the public, and worked to prevent another outbreak. But the ending is not as simple as naming a culprit. Morels have now been linked to severe illness and death, yet we still do not know the toxin, why some people are more vulnerable, or exactly how much cooking is enough. Episode 7 brings the story back to what matters most: what we know, what we still do not know, and what has to happen next so this does not happen again. A Morel Dilemma Support the show Review the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game
When someone eats a mushroom and starts to feel sick, the first instinct is often to figure out exactly what mushroom it was. But mushroom identification is harder, riskier, and more specialized than most people realize. In this bonus episode of A Morel Dilemma, we look at what actually happens after a possible mushroom exposure: who to call, why online apps and social media can be dangerous, and how poison centers work with trained mycologists and mushroom identification experts when the stakes are high. Because in a mushroom emergency, the answer is not to keep scrolling. It is to call the Poison Center at 1-800-222-1222.
The Bozeman outbreak was the first loud signal, but it was not the only one. After the CDC report, toxicologists in other countries started looking back through their own poison center data and found something unsettling: more patients with severe illness after eating morels, including cases of shock, gastrointestinal bleeding, and death. And it did not stop there. In Episode 6 of A Morel Dilemma, we follow that signal beyond Montana and ask whether this was truly an isolated outbreak, or whether morels have been causing severe poisonings for years without anyone recognizing the pattern. We also meet the researchers now trying to answer the harder question: if morels are responsible, what exactly is happening inside this mushroom? The mystery is no longer confined to one restaurant. It is starting to spread. Select referecnces: Dr. Vodovar's Study Swiss Poison Center Study Peter Dayton
Hey everyone, it’s Ryan. I know many of you are patiently waiting for Episode 6 of A Morel Dilemma, and it is coming next week. I genuinely cannot wait for you to hear this one. But it is actually available right now for supporter members. You can go to www.thepoisonlab.com/support and get every single episode right now for as little as $1 a month. And full disclosure, I only get about half of that. It does not go to profit. It just helps repay some of the very real costs of making this show: the interviews, editing, sound design, hosting, and the absurd amount of time that went into producing it. So if you have been enjoying the series, becoming a supporter is an incredible way to help make work like this possible. And if you are already supporting the show, thank you. Truly. It helps more than you know. And for everyone else listening, thank you for being here and for sharing the series. But for today, I wanted to give everyone a small glimpse into the supporter bonus episodes that have been available to members throughout the series. See the episode here https://the-poison-lab.captivate.fm/episode/a-morel-dilemma-preview-supporting-member-bonus-episodes A Morel Dilemma Support the show Review the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game