CHAPTER II THE COCA LEAVES: SCIENTIFIC ASPECTS

The Coca shrub (Erythroxylon Coca) is a plant originally from the Andes mountain range. It contains, in addition to the well known cocaine alkaloid, about a dozen other alkaloids according to research conducted by Harvard University.1 5 "Coca leaves may, however, contain 0.25 to 2.25% toxic alkaloids, including benzoylecgonine, benzoyltropine, cinnamyl-cocaine, cocaine, cuscohygrine, dihydroxy tropane, hygrine, hygroline, methyl cocaine, methyl ecgonidine, nicotine, tropa cocaine, and A- and B-truxilline".

The "Instituto Boliviano de Biologia de la Altura" (IBBA) (Bolivian institute for high altitude studies) confirms having found only four alkaloids: cocaine, nor-cocaine and the derivatives cis- and trans-cinnamyl cocaine. The remaining alkaloids found by Harvard would probably be substances produced during the chemical analysis process due to the techniques used.

The details shown below appear in the same report from Harvard University on their studies of the coca leaves. It also contains findings about a series of vitamins, minerals and protein, in addition to comparing coca to more than 50 species of nutrients.

Ten cereals:

Amaranthus Caudatus, Oriza Sativa, Avena Sativa, Chenopodium Pallidicaule, Chenopodium Quinoa, Hordeum Vulgare, Sccale Cereale, Coix Lachrima Jobi, Zea Mays and Triticum Aesticum.

Ten vegetables:

Canna Edulis, Caapsicum spp., Alliem Saticum, Arracacha Xanthorriza, lpomoca Batatas, Cyclanthera Pedata, Cucurbita Maxima, Alliem Cepa; Brasica Oleracea and Tropacolum Tuberosum, and...

Ten Fruits:

Persea Americana, Ananas Cosmosus, Musa Sapientum, Cocos Nucifera, Passiflora Mollissima, Annona Cherimolia, Prunus Persica, Fregaria spp., Annona Muricata, and Ficus Carica

"The ingestion of 100 grams of the Bolivian Coca studied is equivalent to the recommended daily intake of calcium, iron, phosphor, Vitamin A, B2, and E" according to this report prepared in 1975 by Messrs. Duke, Oulik, and Plowman of Harvard University.

DISPENSING; FORM

Coca was and , continues to be chewed by the Aymaras and Quechuas of Bolivia; Peru and other Andean countries. The leaves are not chewed but sucked. The term chewing is not an appropriated one, but as its commonly used, we will use this term throughout this book. This is a technique developed over centuries. It consists in taking a mouthful of coca leaves without swallowing them. These are previously stripped of the veins to avoid traumatic action by these hard parts of the leaf on the mouth lining. Chewing is done softly, trying not to crush them totally, only enough to break the cell membranes and then let them dissolve slowly in the saliva. The bolus thus formed (about 8-10 grams), is left to repose in the gums and the mouth lining, just below the outlet of the excreting duct of the parotid salivary gland. When the half crushed leaves are sufficiently moistened (10-15 minutes), the chewer adds the llijta or any other alkaline agent (such as sodium bicarbonate). The llijta is a preparation made of several types of vegetal ashes, such as quinoa and plantain. Its purpose is to provide an alkaline medium to maximize the action of the alkaloids of the leaf. A few minutes later, there is an intense anesthetic effect on the mucosa next to the bolus and also in the cheeks, throat and tongue. It is certain that the ingestion of the juice exerts an anesthetic effect on the lower intestinal tract and at the systemic level. This would explain the custom in Andean countries to chew coca leaves or take coca infusion to alleviate pain over a wide range: headaches, toothaches, intestinal cramps, etc. Its use is frequent as a dressing topically applied on the painful areas, for instance in the area of a broken bone or arthritis.

According to my own observations, the absorption of alkaloids is rapid and the elimination of fatigue, a feeling of euphoria or antidepressant action is felt within 15 to 20 minutes, with the appearance of an increase of psychomotor action, a state of tension typical of alertness, there is an increase in activity or the desire to do something. Sensorial functions become more intense. The higher intellectual activities are faster, there is a slight feeling of consciousness expansion (which could explain its use during religious rituals).

In the emotional area, the effect is stimulating, the individual feels euphoric, happy, optimistic, and willing to undertake action. Corporal needs, such as hunger, sleepiness, and restful are postponed by the energetic impulse of the time. The capacity and yield during work improve noticeably , although the study conducted by IBBA only reports that it increases work endurance.

The effect of chewing is strong at the start but it disappears progressively and it is necessary to increase the intake slowly to maintain the effect. According to Carter and Mamani, intensive users of coca, such as miners and farmers, chew the leaf two or three times a day, sometimes even four, when work is hard. It amounts to thirteen ounces a week (390 grams). When the habitual chewer does not undertake any activity, generally he/she does not consume coca or very little of it. Consumption can be easily abandoned indefinitely without any undesirable effects. Even, when the user is chewing coca and is offered a nutritious and appetizing meal, he will stop chewing to eat. In general, the desire to chew coca can be abandoned indefinitely, without suffering physical or psychological effects, or the appearance of compulsive behavior to alleviate the desire.

I have seen many habitual coca consumers, who for reason beyond their control, such as an incapacitating accident, have been forced to remain several months in a hospital without possibilities to continue their habit, which had to be interrupted suddenly, show no signs of withdrawal symptoms.

"...until now, we have not been able to detect withdrawal symptoms when the dispensation of cocaine has been interrupted. Animals feel pleasure when injected with cocaine and show appetite for the drug in every possible form, but if the substance is suspended no ill effects are observed in animal physiology. Therefore, cocaine depends on other substances to produce the so called habit. In animals, these are evident only when injected parentally. It is then the pharmacology of cocaine that has caused and continues to cause the adverse reaction against coca leaves. This is a risky and, to a large extent, artificial association between the chemically pure alkaloid, and injected directly in the veins at large doses, and the coca leaves, whose effects may be the same but of different intensity and undoubtedly at a much smaller risk than some would like to attribute to coca." This was asserted by Fernando Cabies, a Peruvian researcher.

When, at the end of 1982, I decided to take charge of the Industrialization of Coca Leaves Project for pharmacological purposes, which had been submitted to fanner unions still unorganized such as the Coca Producers Federation, I did not imagine that I would be spending most of the following three years in coca producing areas of Bolivia. The installation of the first Pilot Plant for the industrialization of coca in Coripata, 100 kilometers north of La Paz on the slopes of the Andes called the Yungas and the frustrated attempt to install a similar plant in the Chapare, the tropical forest of the Department of Cochabamba, implied nevertheless, a scientific technical effort conducted by the members of SMIMFA and an organizational work which was called ANAPCOCA and ADEPCOCA to legally and financially support the industrialization projects.

This forced me to spend long periods of time in 1983, 1984, and 1985, living with the farmer coca producers. I could not avoid practicing the psychiatric analysis by which I had been conditioned after several years of practice of my profession. I met thousands of coca chewers, descendants of Aymara and Quechua parents and grandparents who also were coca consumers. And even though it was not an in-depth analysis, nor did I make systematic notes because I was primarily preoccupied with the technical and organizational aspects of the project, I had a very close general impression, from the inside, on the effects of coca chewing on the human body.

I found the higher intellectual functions, such as abstraction, concentration, attention, discrimination or memory, to be normal; like those of other individuals of the same racial origin but who did not have the habit. In no case did I find physical or moral derangement, typical of consumers of cocaine sulfate or pasta. Their emotional response was healthy and without distortion. Medullar symptoms, such as social and economical ill adaptation which are typical of cocaine sulfate abusers, were absent in the case of the leaf chewer. Moreover, we can affirm that coca chewing is a fundamental element for adaptation, for instance, to the semi-slave labor of the Bolivian miners, who cannot work if they do not chew coca. This is a fact recognized during the many years of the Conquest, which after prohibiting its use, not only allowed, but in fact, promoted its use. The same thing is happening now within the mining industry.

During the almost 20 years I have been practicing psychiatry, I have seen hundreds of mentally ill patients, as a psychiatrist at the hospitals of the National Health Fund, the Drivers Complementary Fund and the Railroad Social Security (who have a regular incidence of habitual coca chewers). Paranoiac psychosis, which is the type of reaction produced by the abuse of cocaine sulfate, was in no way related to the consumption of coca leaves. I will return to this matter farther ahead when I detail the acullico as a regulator mechanism of the maximum dose.

The IBBA, an agency of the Universidad Mayor de San Andres, (the main Bolivian university) in cooperation with the Center for Botanical and Ecological Research of the Universidad Mayor de San Simon in Cochabamba, and the French Institute of Scientific Research for Development in Cooperation, have developed a joint project on several scientific topics, in which they state:

"In the field of physiology, with respect to muscular exercise, we have noted that the capacity to do more work does not increase with coca chewing, but it does increase work tolerance. In relation to respiratory sensitivity, we could observe that chewing does have a stimulating effect on respiratory centers. Both findings could be related to the increase of catecholamine, found after chewing. On the other hand, the results achieved show that the chewing of coca leaves acts on hemoglobin and inhibits platelet aggregation. The results obtained indicate that coca exerts a moderating effect on general consumption of glucose. Finally, coca chewing does not influence the daily nutrient intake. The results obtained show a positive effect of coca use on the adaptation processes to life at high altitudes".

Most importantly, may be the increase of respiratory frequency with the resulting increase in blood oxygenation. (We should not forget that the highest incidence of chewers takes place at high altitudes, where about 75% of the population chew coca, while at 2,000 meters above sea level only 20% are habitual chewers and only 3% at sea level).

The Andean inhabitants must endure altitudes of 4,000 meters above sea level, where oxygen concentrations are very poor. The analeptic or stimulating effect on respiration is the perfect complement to offset this chronic lack of oxygen, this is why the altitude sickness (sorojche) is traditionally cured with the classic coca infusion, very well known by high altitude travelers.

The chronic lack of oxygen is considered the major cause of erythrocytosis, a widely known blood disease in which the organism, in an attempt to overcome the lack of oxygen, produces ever increasing amounts of red cells, thereby increasing blood viscosity, circulatory difficulties and the associated thrombosis risks. The decrease of platelet aggregation found by the investigators of the IBBA, would explain this other interesting complement which allows life at 4,000 meters a.s.l. The decrease of hematocrites or red cell concentrations in chronic coca consumers was already demonstrated by Buck, Sasaki, Hewitt and Macrae in their article Coca Chewing and Health. 1 6

It appears to me that the decrease in cholesterol levels in the blood of chronic chewers, another valuable effect of coca which was found by the same investigators, should be studied in more detail because the mentioned article apparently does not take into account other factors which could explain this effect.

From this perspective, coca would play an indispensable role in adaptation to high altitude. This would explain why coca became an instrument for survival when the Spaniards imposed slavery. Or when the Industrial Era demanded from the Bolivian tin miners a second period of slavery spent below ground. This would also explain how Potosi, and the boom of the European Crowns was made possible. And now the growing consumption (and abuse) of its concentrated chemical, cocaine, in the modem Western World.

The above, however, does not help us to understand the damaging effects manifested by the abuse of cocaine sulfate or pasta as we shall see when looking into the problems of drug dependence.

Why the radical difference with the consumption of coca leaves? Why this contradictory benevolence as compared against the abuse of its chemical derivatives?

ARE THERE COMPENSATING ELEMENTS IN COCA LEAVES?

As the famous botanist Paracelsus said: "Every element in nature has its own poison and its antidote as well." Therefore, the need and the new trend to revert to the natural and more complete remedies.

The case of coca is more specific. It is an important source of vitamins and minerals, particularly phosphorous and vitamin B complex, quite beneficial for the brain. If we compare the contents of coca leaves with the composition of known geriatric compounds, such as Zellaforte as an example, we notice a similarity with coca leaves, because in addition to containing the same vitamins and minerals of this geriatric tonic, Zellaforte contains the so called potion of youth or procaine (KH3). That is a synthetic derivative from cocaine. The coca leaf in this case, would contain the original substance, or natural cocaine.

It has been argued that the coca chewer only absorbs the alkaloid, and not the natural nutrients. I have personally looked into this matter, analyzing under the microscope the residues of chewing, which are

usually discarded or eliminated, finding only whitish fibrous residues. Due to the technique used, it is impossible to absorb only one chemical dissolved in the juices resulting from the rupture of vegetal cells, which is also ingested in full. Cuiffardi, another researcher of the leaf, found that 80% of the leaf contents had been extracted. As for the capacity of human digestive tract to absorb the proteins contained in the leaf, I have no evidence to evaluate its role in the feeding habits of the Andean inhabitant.

As opposed to the now popular chemical extract, extraction by mouth allows for the assimilation of all of the elements contained in the leaf; it is possible that the combination of all, in addition to other factors which we will see below, counteract the toxicity attributed to cocaine abuse. Chemical processing destroys 98% of the leaf's contents and obtains a single alkaloid, cocaine. Because of this point of view, I am in agreement with the statement that coca is not cocaine, because the true value of this plant resides precisely in cocaine and its medicinal value which we will analyze further ahead.

The actual effects of coca leaves can only be deduced from the examination of chronic chewers. Currently, all scientific investigations on , the abuse of stimulants derived from coca were made starting with cocaine, which does not give license by any means, to generalize these results and attribute them to the leaf itself.

These facts would suffice to explain the basis for the benevolence of the leaf and its chewing on the human body. There is, however, another factor which I consider to be important and which would explain the phenomenon.

CHEWING AS AN AUTOMATIC AND PRACTICAL REGULATOR OF THE MAXIMUM THERAPEUTIC DOSE

From a pharmacological point of view, we know that the effectiveness of a pharmaceutical is in direct proportion to the dosage and the regularity of its dispensation. On the other hand, we cannot deny the relationship existing between high and rapid doses and toxicity.

In this respect, the mouth extraction done through chewing is a very important factor. Physics will have us know that the yield of a machine is determined by several factors: size, quality of the mechanism, materials employed, energy used, etc. In our case, the mouth is our processing machine of coca contents. By reasons of space, it can only process 8-10 grams of leaves at a time. Since, in addition to crushing the leaves, it must also let them stand for a while in the weak acids of saliva, the mouth extraction is slow and relatively inefficient. For analytical purposes, we will assume a fantastic coca user who will chew 24 hours a day without rest, and who will use the maximum theoretical capacity of his buccal cavity. That is about 10 grams of coca leaves every 60 minutes, the minimal time estimated to extract the alkaloid contained in 10 grams of leaves. We will also assume that his buccal cavity is 100% efficient.

Chewing all day and night, without rest, in 24 hours he would process 240 grams of coca leaves. If we consider that the leaves contain a percentage of between 0.5% and 2% of alkaloids, and that extraction is 100% efficient, we will conclude that our imaginary (and super efficient) chewer would be capable of extracting between 1.2 and 4.8 grams of alkaloid, depending on the leaves, in 24 hours of continuous chewing.

It is important to remember that an extraction process of this nature, forces the consumer to self-dispense the drug in controlled form, the dosage and frecuency must be always the same. In the past few years, the modem medication called deposit medication (Controlled Release Drugs) attempted to fulfill this requirement more effectively.

Carter and Mamani have demonstrated, through a study of over 3,000 leaf users, that mine workers, the largest consumers, chew an average of 13 ounces a week, i.e. extracts an average of 3.9 net grams of alkaloids per week. Therefore, the THEORETICAL MAXIMUM DOSE IS HALF A GRAM, IN A PERIOD OF 24 HOURS (always assuming 100% efficiency in mouth extraction). Recent investigation conducted by IBBA disclose that after chewing about 30 grams of leaves, blood cocaine contents can be traced to around 98 nanograms using High Pressure Liquid Chromatography. That is 0.000000098 grams!

This observation shows that coca chewing, due to the physical and chemical reasons analyzed, does not allow to exceed a minimal daily dose of the alkaloid. Second, individual doses will almost always be the same, as well as time spacing.

To summarize:

Through coca chewing, the basic requirements of a sound dispensing of pharmaceuticals, adequate dosage and chronologically regulated are fulfilled to achieve maximum efficiency.

From all of the above, we can deduce that the leaves consumed through chewing are not only a stimulant but also a rapid action antidepressant, (natural and healthy), which contributes minerals, vitamins, and possibly proteins. Coca is self-regulating preventing overdosing, it does not strike the pleasure centers of the hypothalamus nor cause the resulting compulsive search of pleasure as we will see in the analysis of dependence. The coca leaves only provide an energetic increase. The alkaloids contained are absorbed in their natural form, without the addition of foreign chemicals. Coca does not cause physical dependence nor withdrawal symptoms and prolonged use, through entire generations, does not leave negative sequels in the human organism.

... The perception that coca chewing can effectively relieve fatigue, help withstand cold and extend the time endured in work has increased for the better. Ethnographic facts deny that continuous use of coca over many years will lead to physical and mental deterioration of the person. Habitual chewers continue producing very well until an advanced age", as stated by Carter and Mamani in their final conclusions.