Blue-green algae, chlorella, and spirulina are all advertised as being beneficial, but they could be harmful because they are often contaminated with algal toxins.
The Benefits and Side Effects of Spirulina
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Spirulina is a microscopic blue-green algae whose carotenoid pigments are responsible for the orange-pink hue of flamingos. At high-enough doses, it can also turn us orange too––like if we eat too many carrots. But it’s considered benign, and goes away on its own when you cut back. The strangest color change I ran across was this: “Green Breast Milk Following Ingestion of Blue-Green Algae.” Whoa! But thankfully, that also disappears after stopping.
Spirulina is said to have various promising health effects. At the same time, on the contrasting note, there are toxins that might contribute to acute poisoning, cancer, liver damage, and gastrointestinal disturbances, with long-term consumption potentially leading to Alzheimer’s and Parkinson’s disease. Okay, then. And those purported promised health effects, like playing “a positive role in treating muscle cramps,” are based on a study in which mice were injected with formaldehyde and vinegar.
What can spirulina actually do in people? Spirulina can improve long-term blood sugar control in rats, but, apparently, not in humans. It’s also disappointing when it comes to anti-inflammatory or antioxidant effects. Spirulina may help lower cholesterol, though, perhaps due to reducing fat absorption, and lower blood pressures by four or five points. There was a recent trial where mild-to-moderate Alzheimer’s patients were randomized to a gram a day of spirulina or placebo for 12 weeks, and appeared to end up slightly better off cognitively than those in the control group. So those are some of the potential upsides. The concern is that, although algae supplements like blue-green algae, chlorella, and spirulina are all advertised as being beneficial, they might be harmful because they may contain algal toxins.
Though most toxins are found contaminating the Klamath lake AFA blue-green algae, some toxins are found in some spirulina supplements as well. Spirulina samples tested from markets around the world have shown highly variable results, ranging from non-detection to alarming levels of toxins. The presence of toxin-producing algae contaminants is the most likely explanation for the presence of toxins in spirulina products, because producers cultivate spirulina in open outdoor ponds, which are vulnerable to contamination with toxin-producing species.
There have been calls for strict quality control and monitoring, but that doesn’t seem to have panned out. This study examined what was growing in five commercial spirulina products, including pills and powders. Several potentially pathogenic bacteria were detected in the products, and algae toxins were found in all of the products at levels that could lead to consumers exceeding the recommended daily limits. One study of five protein powders with spirulina found that four of them even contained BMAA, which is a neurotoxin linked to some progressive neurodegenerative diseases like ALS, which I’ve talked about before.
Yet spirulina products continue to be advertised as detoxifiers. Though spirulina is commonly contaminated, the level of toxins is significantly lower than has been found in other blue-green algae supplements. Nevertheless, there’s a concern that long-term exposure to even very low levels of these toxins may increase the risk of liver cancer, for example. There are also case reports of acute liver damage tentatively tied to spirulina intake, as well as acute muscle damage and rare autoimmune reactions to spirulina, AFA blue-green algae, or both, including blistering disorders too disturbing to display.
Please consider volunteering to help out on the site.
- Constantinescu SM, Morelle J. A young man with orange hands. Eur J Intern Med. 2019;68:76.
- Naor N, Fridman E, Kouadio F, Merlob P, Linder N. Green breast milk following ingestion of blue-green algae: a case report. Breastfeed Med. 2019;14(3):203-204.
- Gogna S, Kaur J, Sharma K, et al. Spirulina- an edible cyanobacterium with potential therapeutic health benefits and toxicological consequences. J Am Nutr Assoc. 2023;42(6):559-572.
- Neekhra S, Jain S, Jain SA, et al. Antinociceptive activity of spirulina platensis in mice. IJP. 2014;1(8):507-10.
- Ghanbari F, Amerizadeh A, Behshood P, Moradi S, Asgary S. Effect of microalgae arthrospira on biomarkers of glycemic control and glucose metabolism: a systematic review and meta-analysis. Curr Probl Cardiol. 2022;47(10):100942.
- Mohiti S, Zarezadeh M, Naeini F, et al. Spirulina supplementation and oxidative stress and pro-inflammatory biomarkers: a systematic review and meta-analysis of controlled clinical trials. Clin Exp Pharmacol Physiol. 2021;48(8):1059-1069.
- Rahnama I, Arabi SM, Chambari M, et al. The effect of Spirulina supplementation on lipid profile: GRADE-assessed systematic review and dose-response meta-analysis of data from randomized controlled trials. Pharmacol Res. 2023;193:106802.
- Karizi SR, Armanmehr F, Azadi HG, et al. A randomized, double-blind placebo-controlled add-on trial to assess the efficacy, safety, and anti-atherogenic effect of spirulina platensis in patients with inadequately controlled type 2 diabetes mellitus. Phytother Res. 2023;37(4):1435-1448.
- Machowiec P, Ręka G, Maksymowicz M, Piecewicz-Szczęsna H, Smoleń A. Effect of spirulina supplementation on systolic and diastolic blood pressure: systematic review and meta-analysis of randomized controlled trials. Nutrients. 2021;13(9):3054.
- Tamtaji OR, Heidari-Soureshjani R, Asemi Z, Kouchaki E. The effects of spirulina intake on clinical and metabolic parameters in Alzheimer’s disease: a randomized, double-blind, controlled trial. Phytother Res. 2023;37(7):2957-2964.
- Sánchez-Parra E, Boutarfa S, Aboal M. Are cyanotoxins the only toxic compound potentially present in microalgae supplements? Results from a study of ecological and non-ecological products. Toxins (Basel). 2020;12(9):552.
- Roy-Lachapelle A, Solliec M, Bouchard MF, Sauvé S. Detection of cyanotoxins in algae dietary supplements. Toxins (Basel). 2017;9(3):76.
- Pinchart PE, Leruste A, Pasqualini V, Mastroleo F. Microcystins and cyanobacterial contaminants in the French small-scale productions of spirulina (Limnospira sp.). Toxins (Basel). 2023;15(6):354.
- Rhoades J, Fotiadou S, Paschalidou G, et al. Microbiota and cyanotoxin content of retail spirulina supplements and spirulina supplemented foods. Microorganisms. 2023;11(5):1175.
- Grosshagauer S, Kraemer K, Somoza V. The true value of spirulina. J Agric Food Chem. 2020;68(14):4109-4115.
- Glover WB, Baker TC, Murch SJ, Brown PN. Determination of β-n-methylamino-l-alanine, n-(2-aminoethyl)glycine, and 2,4-diaminobutyric acid in food products containing cyanobacteria by ultra-performance liquid chromatography and tandem mass spectrometry: single-laboratory validation. J AOAC Int. 2015;98(6):1559-1565.
- Manolidi K, Triantis TM, Kaloudis T, Hiskia A. Neurotoxin BMAA and its isomeric amino acids in cyanobacteria and cyanobacteria-based food supplements. J Hazard Mater. 2019;365:346-365.
- Manali KM, Arunraj R, Kumar T, Ramya M. Detection of microcystin producing cyanobacteria in Spirulina dietary supplements using multiplex HRM quantitative PCR. J Appl Phycol. 2017;29(3):1279-1286.
- Jiang Y, Xie P, Chen J, Liang G. Detection of the hepatotoxic microcystins in 36 kinds of cyanobacteria Spirulina food products in China. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2008;25(7):885-894.
- Iwasa M, Yamamoto M, Tanaka Y, Kaito M, Adachi Y. Spirulina-associated hepatotoxicity. Am J Gastroenterol. 2002;97(12):3212-3213.
- Mazokopakis EE, Karefilakis CM, Tsartsalis AN, Milkas AN, Ganotakis ES. Acute rhabdomyolysis caused by Spirulina (Arthrospira platensis). Phytomedicine. 2008;15(6-7):525-527.
- Lee AN, Werth VP. Activation of autoimmunity following use of immunostimulatory herbal supplements. Arch Dermatol. 2004;140(6):723-727.
- Kraigher O, Wohl Y, Gat A, Brenner S. A mixed immunoblistering disorder exhibiting features of bullous pemphigoid and pemphigus foliaceus associated with Spirulina algae intake. Int J Dermatol. 2008;47(1):61-63.
- Kim J, Condie D, Vasquez R. Pemphigus foliaceus following use of herbal supplement containing Aphanizomenon flos-aquae. Int J Dermatol. 2020;59(5):e171-e173.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Spirulina is a microscopic blue-green algae whose carotenoid pigments are responsible for the orange-pink hue of flamingos. At high-enough doses, it can also turn us orange too––like if we eat too many carrots. But it’s considered benign, and goes away on its own when you cut back. The strangest color change I ran across was this: “Green Breast Milk Following Ingestion of Blue-Green Algae.” Whoa! But thankfully, that also disappears after stopping.
Spirulina is said to have various promising health effects. At the same time, on the contrasting note, there are toxins that might contribute to acute poisoning, cancer, liver damage, and gastrointestinal disturbances, with long-term consumption potentially leading to Alzheimer’s and Parkinson’s disease. Okay, then. And those purported promised health effects, like playing “a positive role in treating muscle cramps,” are based on a study in which mice were injected with formaldehyde and vinegar.
What can spirulina actually do in people? Spirulina can improve long-term blood sugar control in rats, but, apparently, not in humans. It’s also disappointing when it comes to anti-inflammatory or antioxidant effects. Spirulina may help lower cholesterol, though, perhaps due to reducing fat absorption, and lower blood pressures by four or five points. There was a recent trial where mild-to-moderate Alzheimer’s patients were randomized to a gram a day of spirulina or placebo for 12 weeks, and appeared to end up slightly better off cognitively than those in the control group. So those are some of the potential upsides. The concern is that, although algae supplements like blue-green algae, chlorella, and spirulina are all advertised as being beneficial, they might be harmful because they may contain algal toxins.
Though most toxins are found contaminating the Klamath lake AFA blue-green algae, some toxins are found in some spirulina supplements as well. Spirulina samples tested from markets around the world have shown highly variable results, ranging from non-detection to alarming levels of toxins. The presence of toxin-producing algae contaminants is the most likely explanation for the presence of toxins in spirulina products, because producers cultivate spirulina in open outdoor ponds, which are vulnerable to contamination with toxin-producing species.
There have been calls for strict quality control and monitoring, but that doesn’t seem to have panned out. This study examined what was growing in five commercial spirulina products, including pills and powders. Several potentially pathogenic bacteria were detected in the products, and algae toxins were found in all of the products at levels that could lead to consumers exceeding the recommended daily limits. One study of five protein powders with spirulina found that four of them even contained BMAA, which is a neurotoxin linked to some progressive neurodegenerative diseases like ALS, which I’ve talked about before.
Yet spirulina products continue to be advertised as detoxifiers. Though spirulina is commonly contaminated, the level of toxins is significantly lower than has been found in other blue-green algae supplements. Nevertheless, there’s a concern that long-term exposure to even very low levels of these toxins may increase the risk of liver cancer, for example. There are also case reports of acute liver damage tentatively tied to spirulina intake, as well as acute muscle damage and rare autoimmune reactions to spirulina, AFA blue-green algae, or both, including blistering disorders too disturbing to display.
Please consider volunteering to help out on the site.
- Constantinescu SM, Morelle J. A young man with orange hands. Eur J Intern Med. 2019;68:76.
- Naor N, Fridman E, Kouadio F, Merlob P, Linder N. Green breast milk following ingestion of blue-green algae: a case report. Breastfeed Med. 2019;14(3):203-204.
- Gogna S, Kaur J, Sharma K, et al. Spirulina- an edible cyanobacterium with potential therapeutic health benefits and toxicological consequences. J Am Nutr Assoc. 2023;42(6):559-572.
- Neekhra S, Jain S, Jain SA, et al. Antinociceptive activity of spirulina platensis in mice. IJP. 2014;1(8):507-10.
- Ghanbari F, Amerizadeh A, Behshood P, Moradi S, Asgary S. Effect of microalgae arthrospira on biomarkers of glycemic control and glucose metabolism: a systematic review and meta-analysis. Curr Probl Cardiol. 2022;47(10):100942.
- Mohiti S, Zarezadeh M, Naeini F, et al. Spirulina supplementation and oxidative stress and pro-inflammatory biomarkers: a systematic review and meta-analysis of controlled clinical trials. Clin Exp Pharmacol Physiol. 2021;48(8):1059-1069.
- Rahnama I, Arabi SM, Chambari M, et al. The effect of Spirulina supplementation on lipid profile: GRADE-assessed systematic review and dose-response meta-analysis of data from randomized controlled trials. Pharmacol Res. 2023;193:106802.
- Karizi SR, Armanmehr F, Azadi HG, et al. A randomized, double-blind placebo-controlled add-on trial to assess the efficacy, safety, and anti-atherogenic effect of spirulina platensis in patients with inadequately controlled type 2 diabetes mellitus. Phytother Res. 2023;37(4):1435-1448.
- Machowiec P, Ręka G, Maksymowicz M, Piecewicz-Szczęsna H, Smoleń A. Effect of spirulina supplementation on systolic and diastolic blood pressure: systematic review and meta-analysis of randomized controlled trials. Nutrients. 2021;13(9):3054.
- Tamtaji OR, Heidari-Soureshjani R, Asemi Z, Kouchaki E. The effects of spirulina intake on clinical and metabolic parameters in Alzheimer’s disease: a randomized, double-blind, controlled trial. Phytother Res. 2023;37(7):2957-2964.
- Sánchez-Parra E, Boutarfa S, Aboal M. Are cyanotoxins the only toxic compound potentially present in microalgae supplements? Results from a study of ecological and non-ecological products. Toxins (Basel). 2020;12(9):552.
- Roy-Lachapelle A, Solliec M, Bouchard MF, Sauvé S. Detection of cyanotoxins in algae dietary supplements. Toxins (Basel). 2017;9(3):76.
- Pinchart PE, Leruste A, Pasqualini V, Mastroleo F. Microcystins and cyanobacterial contaminants in the French small-scale productions of spirulina (Limnospira sp.). Toxins (Basel). 2023;15(6):354.
- Rhoades J, Fotiadou S, Paschalidou G, et al. Microbiota and cyanotoxin content of retail spirulina supplements and spirulina supplemented foods. Microorganisms. 2023;11(5):1175.
- Grosshagauer S, Kraemer K, Somoza V. The true value of spirulina. J Agric Food Chem. 2020;68(14):4109-4115.
- Glover WB, Baker TC, Murch SJ, Brown PN. Determination of β-n-methylamino-l-alanine, n-(2-aminoethyl)glycine, and 2,4-diaminobutyric acid in food products containing cyanobacteria by ultra-performance liquid chromatography and tandem mass spectrometry: single-laboratory validation. J AOAC Int. 2015;98(6):1559-1565.
- Manolidi K, Triantis TM, Kaloudis T, Hiskia A. Neurotoxin BMAA and its isomeric amino acids in cyanobacteria and cyanobacteria-based food supplements. J Hazard Mater. 2019;365:346-365.
- Manali KM, Arunraj R, Kumar T, Ramya M. Detection of microcystin producing cyanobacteria in Spirulina dietary supplements using multiplex HRM quantitative PCR. J Appl Phycol. 2017;29(3):1279-1286.
- Jiang Y, Xie P, Chen J, Liang G. Detection of the hepatotoxic microcystins in 36 kinds of cyanobacteria Spirulina food products in China. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2008;25(7):885-894.
- Iwasa M, Yamamoto M, Tanaka Y, Kaito M, Adachi Y. Spirulina-associated hepatotoxicity. Am J Gastroenterol. 2002;97(12):3212-3213.
- Mazokopakis EE, Karefilakis CM, Tsartsalis AN, Milkas AN, Ganotakis ES. Acute rhabdomyolysis caused by Spirulina (Arthrospira platensis). Phytomedicine. 2008;15(6-7):525-527.
- Lee AN, Werth VP. Activation of autoimmunity following use of immunostimulatory herbal supplements. Arch Dermatol. 2004;140(6):723-727.
- Kraigher O, Wohl Y, Gat A, Brenner S. A mixed immunoblistering disorder exhibiting features of bullous pemphigoid and pemphigus foliaceus associated with Spirulina algae intake. Int J Dermatol. 2008;47(1):61-63.
- Kim J, Condie D, Vasquez R. Pemphigus foliaceus following use of herbal supplement containing Aphanizomenon flos-aquae. Int J Dermatol. 2020;59(5):e171-e173.
Motion graphics by Avo Media
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The Benefits and Side Effects of Spirulina
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Content URLDoctor's Note
This is the third in a three-video series. If you missed the previous videos, check out Toxins in Blue-Green Algae, Like Klamath Lake AFA (Aphanizomenon flos-aquae) and The Benefits and Dangers of Chlorella.
I mentioned the videos The Risks of Shark Cartilage Supplements and Infant Seizures Linked to Mother’s Spirulina Use, as well as the link to ALS. See ALS (Lou Gehrig’s Disease): Fishing for Answers and Diet and Amyotrophic Lateral Sclerosis (ALS).
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