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Research to chew on

Research coordinator Tiffany Cragin and Mustafa al'Absi, Ph.D., discuss "tastants," flavored liquids given to subjects in a smoking and stress program that help researchers determine how stress levels affect how strong a substance tastes. (Photo: Bob King, Duluth News Tribune)

First-of-its-kind research explores the health effects of khat

The scene might look something like this: A small group of immigrant men has gathered in Minneapolis to smoke tobacco, talk, and chew a sour-tasting, leafy green plant. The plant, known as khat (pronounced cot), gives users a sense of euphoria — and is illegal in the United States.

Commonly used and legal in East African and Middle Eastern countries — and an emerging problem in some immigrant communities in the United States — khat has been linked to a variety of health problems and can lead to serious financial hardship for users who spend excessive amounts of money on the substance. Still, many people defend chewing khat as a harmless social activity and cultural tradition.

A pioneering study

Wanting to help clear up this debate is University of Minnesota stress and addiction expert Mustafa al’Absi, Ph.D., who has launched a first-of-its kind program on khat’s impact on health and behavior with collaborators from Yemen, Kenya, Germany, and Minnesota.

“I’m originally from Yemen. I am very familiar with the khat problem,” says al’Absi, who directs the Medical School’s Duluth Medical Research Institute. “There are a lot of misunderstandings about khat. We need information grounded in objectivity and science to help understand the use of this substance.”

The study, which officially kicked off in late 2009, is investigating the cognitive, affective, and biobehavioral consequences of longtime khat use.

In Yemen, al’Absi’s team is studying three groups of adults: those who have used khat for extended periods, those who have used both khat and tobacco, and those who have not used either substance. The researchers are comparing brain function and behavior — inhibition, concentration, memory, and responses to acute stress — in all three groups. Data collection is under way, but results are a ways off, says al’Absi. The team also is studying how khat use relates to addiction to other substances, such as tobacco and alcohol. “In some of these developing countries, khat is the gateway to using tobacco,” al’Absi says.

Chewing khat releases cathinone — an amphetamine-like stimulant that can cause a feeling of euphoria as well as a loss of appetite and an increased heart rate, he says. “It’s somewhere between a cigarette and having a high dose of caffeine.

“Clinically, there are extensive observations of khat being associated with increased risk of various health problems — from GI [gastrointestinal] problems to heart disease and oral cancer,” he adds.

A local public health perspective

Mohamed Duale, a consultant with the Minnesota Prevention Resource Center of the Minnesota Institute of Public Health and a senior community health worker for Hennepin County, works with East African immigrant communities in the Twin Cities, hosting focus groups and giving presentations on substance abuse, including the effects of khat use.

Duale has firsthand experience with khat. He earned his bachelor’s degree in agriculture and natural science at Somali National University, where he studied plants, including khat. “I had my own farm and grew khat. I chewed myself at that time,” he says. “It’s very, very addictive.”

Khat can create financial problems for immigrant families because it is expensive in the United States and mostly purchased through dealers, Duale says. “The habitual chewers buy khat instead of feeding their children. A lot of families break up and divorce over khat.”

It is also known to cause sleeping problems, including “dubaabs,” a Somali term for bad or scary dreams.

Findings to guide treatment

Al’Absi says his khat research will help better inform medical and public health professionals about the health effects of khat, its connection to addiction, and how treatment models might be used to address other addictive substances.

“We hope that this will develop into a larger program in the next few years and involve other scientists from other countries.”

Closer to home, al’Absi collaborates with Harry Lando, Ph.D., a member of the Masonic Cancer Center and a professor in the Division of Epidemiology and Community Health on the University of Minnesota’s Twin Cities campus.

Lando, whose work is focused on tobacco and smoking, says he’s eager to see how khat use relates to his research. “All the work I’ve done on nicotine dependence could be relevant to dependence on khat,” he says. “Some people chew it virtually constantly.”

Concludes al’Absi, “Combating this problem will significantly benefit the health, social, and economic conditions in many countries.”

By Robyn White, associate director of Editorial Services, Minnesota Medical Foundation

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