GYMNEMA SYLVESTRE (Gurmar): Ayurvedic Formulations, Recipes, Health Benefits, Uses of Shardunika

Table of Content

1. Post Introduction
2. What is Gymnema Sylvestre (Gurmar)? 
3. Morphology And Chemical Constituent of Indian Gurmar.
4. Nutritional Value of Gymnema Sylvestre.
5. Habitat of Gymnema.
6. Ayurvedic Properties of Shardunika.
7. What are the Health Benefits of Gymnema?
8. How to use Gurmar?
9. Ayurvedic Formulations for Dosha Balance.
10. Ayurvedic Formulations for General Use.
11. Gymnema Sylvestre Ayurvedic Recipes.
12. What Is the Recommended Dose of Gymnema Sylvestre? 
13. General Timings for Intake of Shardunika. 
14. Timings for Intake of Gymnema for Specific Purposes.
15. Ayurvedic Guidelines for Using Gymnema Sylvestre Safely.
16. Side Effects of Gymnema.
17. Potential Interactions with Medications
18. Frequently Asked Questions

1. Post Introduction

Welcome to the world of Ayurveda, an ancient Indian system of medicine that emphasizes the harmony between mind, body, and spirit. In this article, we will explore the incredible benefits of Gymnema Sylvestre, also known as Gurmar, and how it can be combined with other herbs in Ayurvedic formulations and recipes to balance the three doshas: Vata, Pitta, and Kapha. Additionally, it explores the medicinal benefits of Gymnema Sylvestre, including its uses, and potential side effects. Get ready to delve into the wisdom of Ayurveda and unlock the secrets of nature's healing power!

2. What is Gymnema Sylvestre (Gurmar)?

It is a medicinal herb native to the tropical regions of India, Africa, and Australia. It has a long history of traditional use in Ayurvedic medicine, where it is known as "Gurmar," meaning "sugar destroyer." Gymnema Sylvestre is revered for its potential benefits in managing blood sugar levels and supporting overall health.

Scientific & Common Names of Gurmar

Gurmar

This is the most widely used name for Gymnema Sylvestre in India. It translates to "destroyer of sugar" in Hindi and reflects its traditional use in managing sugar cravings and supporting healthy blood sugar levels.

Meshashringi

This name is commonly used in Ayurvedic medicine, particularly in India. It translates to "ram's horn" and refers to the shape of the leaves of Gymnema sylvestre.

Periploca of the woods

This is an English common name for Gymnema sylvestre, referring to its classification within the Periploca plant genus.

Miracle fruit

Although less common, it is sometimes referred to as "miracle fruit" due to its potential benefits in blood sugar regulation and sugar cravings management.

History and Traditional Uses of Gymnema 

Throughout history, it has been highly regarded for its medicinal properties. In Ayurvedic practices, it has been used to support various aspects of health, particularly in relation to blood sugar regulation, digestion, and weight management. 

3. Morphology And Chemical Constituent of Indian Gurmar

Morphology

It is a climbing, woody, and perennial shrub that can grow up to 10 meters in length. It has oval-shaped leaves that are around 4-8 cm in length and are arranged opposite each other along the stem. The plant produces small yellow flowers, followed by woody fruit capsules containing seeds.

Chemical Constituents

The leaves of Gymnema contain a variety of active compounds, including gymnemic acids, which are believed to be responsible for the plant's medicinal properties. Other chemical constituents include saponins, flavonoids, alkaloids, and tannins.

Gymnemic acids are triterpene glycosides that are structurally similar to saponins. They are thought to work by blocking the absorption of sugar molecules in the intestine and increasing insulin secretion from the pancreas, which helps to regulate blood sugar levels.

Flavonoids and tannins are known for their antioxidant properties, while alkaloids have been shown to have a variety of biological effects, including antimicrobial and anti-inflammatory properties.

Overall, the combination of these chemical constituents is thought to give its potential medicinal benefits.

4. Nutritional Value of Gymnema 

It is not typically consumed as a food; therefore, it does not have a significant nutritional value. However, the plant has been used in traditional medicine for its potential to regulate blood sugar levels and to support overall health.

Its leaves are rich in active compounds, such as gymnemic acids, which are believed to have hypoglycemic effects, meaning they can help to lower blood sugar levels. Additionally, some studies suggest that the plant has antioxidant and anti-inflammatory properties, which support overall health.

While it is not a significant source of macronutrients, such as protein, fat, or carbohydrates, it is sometimes used as a dietary supplement to support health and well-being.

5. Habitat of Gymnema Sylvestre

It is native to tropical regions of India, Africa, and Australia. The plant prefers a warm and humid climate and thrives in moist, well-drained soils. It can be found growing in various habitats, including forests, hillsides, and rocky terrain.

In India, it is commonly found in the southern and central parts of the country, growing in the wild or cultivated in home gardens. In Africa, the plant is found in regions with tropical and subtropical climates, including South Africa, Zimbabwe, and Nigeria. In Australia, Gymnema Sylvestre is found in the country’s northern parts, growing in rainforests and along the eastern coast.

Today, it is also cultivated in other parts of the world, including the United States, where it is grown as an ornamental plant or for its medicinal properties. However, the plant still thrives best in its native tropical habitats.

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6. Ayurvedic Properties of Shardunika

It is a well-known herb in Ayurveda for its unique properties, here are its Ayurvedic properties and uses.

Ayurvedic Properties

1. Rasa (Taste): It is primarily known for its unique taste. The leaves of this herb are astringent (Kashaya) and bitter (Tikta) in taste. The sweetness (Madhura) taste receptors on the tongue get temporarily blocked when Gymnema is chewed, causing a reduction in the perception of sweetness.

2. Virya (Potency): It is cooling in nature (Shita Virya).

3. Vipaka (Post-digestive taste): The post-digestive taste is pungent (Katu Vipaka).

4. Dosha Effects: It is generally considered balancing for Kapha dosha and Pitta dosha. Its cooling and astringent properties help balance excess heat and dampness in the body.

Ayurvedic Uses:

  1. Blood Sugar Management: It is renowned for its ability to support healthy blood sugar levels. It works by reducing the absorption of sugar in the intestines and enhancing insulin function. This makes it valuable for individuals with diabetes or those at risk of developing the condition.

  2. Appetite Management: Due to its ability to suppress the perception of sweetness, Gymnema may help reduce sugar cravings and manage appetite. This can be useful for weight management.

  3. Digestive Health: It can aid in digestion. It is traditionally used for various digestive issues, including indigestion, flatulence, and stomach discomfort.

  4. Anti-inflammatory: It possesses mild anti-inflammatory properties, which can be beneficial for inflammatory conditions.

  5. Cholesterol Management: Some studies suggest that Gymnema may help lower LDL (bad) cholesterol levels, contributing to heart health.

7. What are the Health Benefits of Gymnema?

It has been traditionally used in Ayurvedic medicine to treat various health conditions, and recent scientific studies have shown that the plant has several health benefits. Some of the potential health benefits of Gymnema Sylvestre are:

Blood Sugar Regulation and Diabetes Management

One of the most notable benefits of Gymnema Sylvestre lies in its ability to regulate blood sugar levels and assist in diabetes management. It contains active compounds, such as gymnemic acids, which have been shown to have hypoglycemic effects, meaning they can help lower blood sugar levels. By supporting insulin production and enhancing its effectiveness, it plays a vital role in controlling diabetes, empowering individuals to lead healthier and more balanced lives.

Weight Management and Appetite Suppression

Struggling with weight management can be an arduous journey for many. Gymnema Sylvestre offers a helping hand in this pursuit by aiding in appetite suppression and weight control. Some studies suggest that it has anti-obesity effects, as it can help reduce sugar cravings and suppress appetite. By suppressing the sweet taste receptors on the tongue, this herb can naturally curb sugar cravings and reduce overall appetite. Incorporating Gymnema Sylvestre into your wellness routine may support your weight management goals and foster a healthier relationship with food.

Digestive Health and Improved Gut Function

A healthy digestive system forms the foundation of overall well-being, gymnema sylvestre has been traditionally used to treat digestive problems, such as constipation, stomach ulcers, and indigestion. It assists in soothing common digestive issues, such as indigestion and constipation while promoting a healthy balance of gut bacteria, by nurturing your digestive health.

Cholesterol and Lipid Control

Maintaining healthy cholesterol and lipid levels is crucial for overall cardiovascular well-being. Gymnema Sylvestre has shown promise in this area by promoting the reduction of bad cholesterol (LDL) and triglyceride levels while increasing good cholesterol (HDL) levels. With its natural lipid-lowering properties, this herb becomes an ally in the fight against heart disease, supporting your cardiovascular health.

Anti-inflammatory and Antioxidant Properties

Inflammation and oxidative stress are at the root of numerous health conditions, gymnema sylvestre contains flavonoids, tannins, and alkaloids, which have been shown to have anti-inflammatory and antioxidant properties. These properties may help to reduce inflammation and oxidative stress, which can lead to chronic diseases.

Other Possible Benefits

Beyond the benefits above, it has been associated with many other potential advantages. These include improved liver function, enhanced cognitive function, alleviation of anxiety and stress, and support for respiratory health. 

8. How to use Gurmar?

It can be used in different forms, including as a dietary supplement, tea, or tincture. However, it is generally advised to follow the manufacturer's instructions or consult with a healthcare professional.

Here are some ways to use Gymnema Sylvestre:

Dietary Supplement

It is available in supplement forms, such as capsules, tablets, or powder. The recommended dosage may vary depending on the supplement and the intended use.

Tea

It can be brewed as a tea by steeping the dried leaves in hot water for several minutes. The tea can be consumed once or twice a day and may help to regulate blood sugar levels, aid in digestion, and reduce inflammation.

Tincture

It can also be taken as a tincture, which is an alcohol-based liquid extract. The tincture can be added to water or juice and taken once or twice a day.

9. Ayurvedic Formulations for Dosha Balance.

Ayurveda, an ancient system of medicine, focuses on achieving balance within the body and mind to promote optimal health. Gymnema sylvestre, commonly known as Gurmar, is a herb used in Ayurveda that is believed to have various health benefits, including its effect on balancing the doshas.

Ayurveda has three doshas: Vata, Pitta, and Kapha. Each dosha represents different qualities and governs specific functions in the body. When a dosha becomes imbalanced, it can lead to various health issues. Gymnema sylvestre can help balance the doshas, and different Ayurvedic formulations incorporate it to target specific doshic imbalances. Here are a few examples:

Vata Balancing Formulation:

Gymnema sylvestre is combined with warming and grounding herbs such as Ashwagandha and Shatavari. This formulation helps calm an aggravated Vata dosha, which is associated with symptoms like anxiety, restlessness, and digestive issues.

Ingredients:
  • Gymnema sylvestre powder: 1 part
  • Ashwagandha powder: 2 parts
  • Shatavari powder: 1 part
Instructions:
  • Take the specified parts of each herb and mix them thoroughly.
  • Store the mixture in an airtight container.
  • Consume 1 teaspoon of the mixture with warm water or milk twice a day, preferably after meals.

Pitta Balancing Formulation:

Gymnema sylvestre is combined with cooling and soothing herbs such as Aloe vera and Licorice. This formulation helps pacify an aggravated Pitta dosha, which is associated with symptoms like inflammation, acidity, and irritability.

Ingredients:
  • Gymnema sylvestre powder: 1 part
  • Aloe vera powder: 2 parts
  • Licorice powder: 1 part
Instructions:
  • Combine the specified parts of each herb and mix them thoroughly.
  • Store the mixture in a tightly sealed container.
  • Take 1 teaspoon of the mixture with water or aloe vera juice twice a day, preferably before meals.

Kapha Balancing Formulation:

Gymnema sylvestre is combined with warming and stimulating herbs such as Ginger and Cinnamon. This formulation helps balance an aggravated Kapha dosha, which is associated with symptoms like sluggishness, weight gain, and respiratory congestion.

Ingredients:
  • Gymnema sylvestre powder: 1 part
  • Ginger powder: 2 parts
  • Cinnamon powder: 1 part
Instructions:
  • Thoroughly mix the specified parts of each herb.
  • Store the mixture in an airtight container.
  • Take 1 teaspoon of the mixture with warm water or herbal tea twice a day, preferably before meals.

4. Ayurvedic formulations for General Use.

Ayurveda, the ancient system of holistic medicine, emphasizes the balance of the three doshas: Vata, Pitta, and Kapha. It can be combined with other herbs to create Ayurvedic formulations for general use. Let's explore some of these formulations:

For Digestion & Metabolism :

Triphala is a blend of three fruits: Amalaki (Indian Gooseberry), Bibhitaki (Terminalia bellirica), and Haritaki (Terminalia chebula). It is known for its cleansing and detoxifying properties. When combined with Gymnema Sylvestre, it can support healthy digestion and maintain balanced blood sugar levels.

Method
  • Triphala churna: 1/2 teaspoon
  • Gymnema Sylvestre: 1/4 teaspoon

Combine the Triphala churna and Gymnema Sylvestre in a glass of warm water. Mix well and consume it once daily before bedtime or as directed by an Ayurvedic practitioner. This formulation supports digestion, and metabolism, and helps maintain balanced blood sugar levels.

For Immune Health and Detoxification:

Guduchi (Tinospora cordifolia) and Neem (Azadirachta indica) are renowned for their immune-boosting and detoxifying properties. When combined with Gymnema Sylvestre, these herbs create a formulation that helps support the immune system, purify the body, and maintain overall health.

Method:
  • Guduchi powder: 1/2 teaspoon
  • Neem powder: 1/2 teaspoon
  • Gymnema Sylvestre: 1/4 teaspoon

Mix the Guduchi powder, Neem powder, and Gymnema Sylvestre together. Consume this formulation with warm water, preferably after meals or as an Ayurvedic practitioner recommends. It supports immune health, detoxification, and helps maintain overall well-being.

For Weight Management:

Trikatu is a blend of three spices: Ginger, Black Pepper, and Long Pepper. It is known for its digestive benefits, promoting healthy metabolism, and supporting weight management. When combined with Gymnema Sylvestre, it can aid digestion, improve nutrient absorption, and maintain a healthy weight.

Method:
  • Trikatu: 1/4 teaspoon
  • Triphala: 1/4 teaspoon
  • Gymnema Sylvestre: 1/4 teaspoon

Combine the above measurements of Trikatu, Triphala, and Gymnema Sylvestre. You can take this formulation once daily with warm water or as directed by an Ayurvedic practitioner. It helps support digestion, metabolism, and blood sugar balance.

For Inflammation & Digestion:

Haridra, or Turmeric, is a potent herb with anti-inflammatory and antioxidant properties. When combined with Gymnema Sylvestre, it creates a formulation that supports a healthy inflammatory response, aids digestion and maintains balanced blood sugar levels.

Method:
  • Haridra (Turmeric) powder: 1/2 teaspoon
  • Gymnema Sylvestre: 1/4 teaspoon

Mix the Haridra powder and Gymnema Sylvestre together. You can consume this mixture once daily with warm milk or water. It helps promote a healthy inflammatory response, aids digestion, and supports balanced blood sugar levels.

Important Note: These are for educational purposes only, it's crucial to consult an Ayurvedic practitioner for appropriate dosages and guidance.

5. Gymnema Sylvestre Ayurvedic Recipes 

In addition to Ayurvedic formulations, Gymnema Sylvestre can be incorporated into daily recipes to harness its benefits. Here are a few simple yet delicious Ayurvedic recipes:

Gurmar-Infused Herbal Tea:

Ingredients:
  • 1 teaspoon Gymnema Sylvestre leaves
  • 1 teaspoon fennel seeds
  • 1 teaspoon dried mint leaves
  • 2 cups water
Instructions:
  • Boil water in a pot.
  • Add Gymnema Sylvestre leaves, fennel seeds, and dried mint leaves.
  • Let it simmer for 5 minutes.
  • Strain and enjoy this refreshing herbal tea.

Gurmar Tea for Blood Sugar Balance:

Ingredients:
  • 1 teaspoon Gurmar leaves or powder
  • 1 teaspoon Cinnamon powder
  • 1 teaspoon Fenugreek seeds
  • 2 cups water
Instructions:
  • Boil the water in a saucepan.
  • Add Gurmar leaves or powder, cinnamon powder, and fenugreek seeds to the boiling water.
  • Let it simmer for about 5 minutes.
  • Strain the tea into a cup.
  • Drink this tea once or twice daily to support healthy blood sugar levels. You may add a natural sweetener like stevia if desired.

Gurmar Churna (Powder) for Digestive Support:

Ingredients:
  • 1 part Gurmar powder
  • 1 part Trikatu powder (a blend of ginger, black pepper, and long pepper)
  • 1 part Ajwain (carom seeds) powder
Instructions:
  • Thoroughly mix the specified parts of each herb.
  • Store the mixture in an airtight container.
  • Take 1/2 to 1 teaspoon of this churna with warm water after meals to support digestion and metabolism.

Gurmar Herbal Infusion for Weight Management:

Ingredients:
  • 1 tablespoon Gurmar leaves
  • 1 tablespoon Nettle leaves
  • 1 tablespoon Fennel seeds
  • 2 cups water
Instructions:
  • Boil the water in a saucepan.
  • Add Gurmar, nettle, and fennel seeds to the boiling water.
  • Let it simmer for about 10 minutes.
  • Strain the infusion into a cup.
  • Drink this herbal infusion once or twice daily to support healthy weight management and metabolism.

Gurmar Smoothie for Blood Sugar Balance

Add a nutritional boost to your smoothies with Gymnema Sylvestre. Blend together your favorite fruits, leafy greens, a touch of Gymnema Sylvestre powder, and a dash of cinnamon for a delicious and blood sugar-balancing treat. The natural sweetness of the fruits pairs harmoniously with the herb, creating a refreshing and nourishing beverage.

Gymnema Salad Dressing

Elevate your salads with a homemade Gymnema Sylvestre salad dressing. Mix Gymnema Sylvestre powder with olive oil, lemon juice, garlic, and a pinch of salt to create a tangy and flavorful dressing. Drizzle it over your fresh greens for a healthy and vibrant salad that supports your well-being.

Note: These recipes serve as a starting point, but it's important to consult with an Ayurvedic practitioner to ensure the suitability of these recipes for your specific needs, health conditions, and dosha imbalances.

12. What is the Recommended Dose of Gymnema Sylvestre?

The recommended dose of Gymnema Sylvestre can vary depending on the intended use, the form of the supplement, and the individual's age, weight, and health status.

As a general guideline, the typical dose range for Gymnema Sylvestre in supplement form is 200-800 mg per day, taken in divided doses before meals. For tea, the recommended amount is 1-2 teaspoons of dried leaves per cup of boiling water, steeped for 5-10 minutes, up to two times a day.

13. General Timings for Intake of Shardunika.

When it comes to taking Gymnema Sylvestre, timing plays a crucial role in optimizing its effectiveness. Understanding the significance of timing allows us to harness the herb's potential and make the most out of its beneficial properties. From an Ayurvedic standpoint, timing is considered an essential aspect of achieving balance and supporting optimal digestion. Ayurveda recognizes that our bodies have specific rhythms and cycles throughout the day, and consuming herbs like Gymnema Sylvestre in harmony with these rhythms can enhance their absorption and assimilation.

Best Times for Gymnema Sylvestre Intake

Before Meals:

Taking Gymnema Sylvestre before meals can help prepare the body for food intake. It may help stimulate the digestive system, promote healthy metabolism, and support blood sugar regulation when consumed in advance.

During Meals:

Consuming Gymnema Sylvestre alongside meals can provide support during the digestion process. It may assist in maintaining balanced blood sugar levels and promoting healthy nutrient absorption.

After Meals:

Some individuals find benefits in taking Gymnema Sylvestre after meals. It may aid in curbing post-meal sugar cravings and supporting overall satiety.

14. Timings for Intake of Gymnema for Specific Purposes

Gymnema Sylvestre, with its remarkable properties, can be tailored to specific purposes by adjusting the timing and frequency of its intake. By understanding how to adapt the consumption of Gymnema Sylvestre, we can optimize its benefits and address various health goals in a more personalized manner.

For Blood Sugar Regulation

When aiming to regulate blood sugar levels, it is generally recommended to take Gymnema Sylvestre before meals. This allows the herb to work synergistically with the body's natural insulin response. The frequency of consumption can vary based on individual needs, and it is advisable to start with a lower dose and gradually increase as necessary.

For Weight Management

When using Gymnema Sylvestre to support weight management, taking it before meals can help reduce cravings and promote a sense of satiety. The frequency of consumption may vary, but it is recommended to start with a lower dose and adjust as needed.

For Digestive Health

Gymnema Sylvestre can be taken before or during meals to support digestive health. The herb's bitter properties can aid in stimulating digestion and optimizing nutrient absorption. The frequency of consumption can be adjusted based on individual digestive concerns.

For Cholesterol Management 

If you are incorporating Gymnema Sylvestre for cholesterol management, it is advisable to take it before meals. This allows the herb to interact with dietary fats and potentially contributes to healthy lipid profiles.

15. Ayurvedic Guidelines for Using Gymnema Sylvestre Safely

While Gymnema Sylvestre is generally considered safe, it's important to follow Ayurvedic guidelines to ensure its safe and effective use. Ayurveda emphasizes the importance of proper dosage, timing, and combination with other herbs to maximize benefits and minimize potential risks. Consulting an Ayurvedic practitioner or qualified healthcare professional can provide personalized guidance and ensure that Gymnema Sylvestre is utilized safely within the context of your unique health needs.

16. Side Effects of Gymnema

Like any natural supplement Gymnema Sylvestre may have potential side effects. While it is generally considered safe when taken in appropriate doses, some individuals may experience side effects. Here are some potential side effects of Gymnema Sylvestre:

Hypoglycemia

Gymnema Sylvestre lowers blood sugar levels, which can cause hypoglycemia in some individuals. People who are taking medications for diabetes should be cautious when taking Gymnema Sylvestre and should monitor their blood sugar levels regularly.

Interactions with Medications

Gymnema Sylvestre may interact with certain medications, including diabetes medications, insulin, and blood-thinning medications. Therefore, people who are taking these medications should consult with a healthcare professional before taking Gymnema Sylvestre.

17. Potential Interactions with Medications

Gymnema Sylvestre can interact with certain medications, it's important to be aware of these potential interactions, particularly for individuals with preexisting medical conditions or those taking prescription medications. Here are some common interactions to consider.

Diabetes Medications

Gymnema Sylvestre may lower blood sugar levels, so concurrent use with diabetes medications such as insulin or oral hypoglycemic agents could lead to hypoglycemia (low blood sugar). Individuals with diabetes should monitor their blood sugar levels closely when using Gymnema Sylvestre alongside prescribed diabetes medications.

Blood Pressure Medications

Gymnema Sylvestre has been reported to have hypotensive (blood pressure-lowering) effects if individuals taking antihypertensive medications such as ACE inhibitors, beta-blockers, or calcium channel blockers should exercise caution when using Gymnema Sylvestre.

Immunosuppressants

Gymnema Sylvestre has been reported to possess immunomodulatory properties, if individuals are taking immunosuppressant medications should exercise caution when using Gymnema Sylvestre.

18. Frequently Asked Question

Q - What is Gymnema sylvestre good for?

Gymnema sylvestre is primarily known for its potential benefits in blood sugar regulation and diabetes management. It may help support healthy blood glucose levels by reducing sugar cravings, promoting insulin production, and enhancing insulin sensitivity. Additionally, Gymnema sylvestre has been associated with weight management, appetite suppression, cholesterol control, digestive health, antioxidant and anti-inflammatory properties, potential anti-cancer effects, and other possible health benefits. However, further research is needed to fully understand and validate these potential benefits.

Q - What is Gymnema called in India?

In India, Gymnema sylvestre is commonly known as "Gurmar," which translates to "destroyer of sugar" in Hindi. The name reflects its traditional use in Ayurvedic medicine to help manage sugar cravings and support healthy blood sugar levels.

Q - Is Gymnema toxic to the liver?

There is limited scientific evidence suggesting that Gymnema sylvestre is toxic to the liver. However, it is important to note that individual responses to any substance can vary. As with any supplement, it is advisable to use Gymnema sylvestre in moderation and consult with a healthcare professional if you have any pre-existing liver conditions or concerns.

Q - Can gurmar cure diabetes?

While Gymnema sylvestre (Gurmar) has shown potential in supporting blood sugar regulation, it is important to note that it is not a cure for diabetes. Gymnema sylvestre may help manage diabetes by supporting healthy blood glucose levels, enhancing insulin production, and reducing sugar cravings.

Q - Is Gymnema good for PCOS?

Gymnema sylvestre may have some potential benefits for individuals with PCOS due to its effects on blood sugar regulation and weight management.

Q - What are the risks of Gymnema sylvestre?

Gymnema sylvestre is generally considered safe for most people when used appropriately. However, like any supplement, it may have potential side effects, although they are typically mild and infrequent. Some individuals may experience gastrointestinal discomfort, such as nausea or diarrhea, initially.


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