Kratom, a tropical evergreen tree native to Southeast Asia, has leaves traditionally used for centuries in countries like Thailand, Malaysia, and Indonesia. Historically, laborers often chewed kratom leaves to manage fatigue and improve endurance. It also played a role in traditional medicine for various ailments. In recent years, kratom has gained global attention.
Kratom Basics and Liver’s Role
Kratom contains various active compounds called alkaloids, with mitragynine and 7-hydroxymitragynine being the most studied. These alkaloids interact with the body’s opioid receptors, which can result in a range of effects depending on the dosage. The liver plays a central role in processing these compounds, as it is the primary organ responsible for metabolizing substances and detoxifying the body.
Mitragynine, the most abundant alkaloid in kratom, undergoes metabolic conversion in the liver. It is metabolized into 7-hydroxymitragynine, a more potent compound. This process primarily involves liver enzymes, such as cytochrome P450 (CYP) enzymes, particularly CYP3A4. The liver’s continuous work in breaking down kratom alkaloids helps to eliminate them from the body.
Evidence of Kratom-Related Liver Injury
While the liver efficiently processes many compounds, documented cases of liver injury associated with kratom use exist. These instances are rare and often described as idiosyncratic, meaning they are unpredictable and specific to certain individuals. The exact mechanism by which kratom might cause liver injury is not fully understood.
Kratom-associated liver injury typically manifests as a cholestatic or mixed pattern, affecting the liver’s bile flow. The onset of symptoms usually occurs within one to eight weeks of consistent kratom use. Most individuals recover without a liver transplant, though severe cases have required hospitalization. Various databases and reviews have identified cases linking kratom to liver problems.
Identifying Potential Liver Problems
Recognizing signs of potential liver problems is important for kratom users. Common symptoms of liver injury include persistent tiredness, weakness, nausea, and abdominal pain, particularly in the upper right side.
Jaundice, characterized by yellowing of the skin or eyes, is a noticeable sign of liver distress. Other indicators include dark urine, light stools, and itchy skin. If any of these symptoms appear after using kratom, seek medical attention.
Factors Affecting Liver Risk
Several factors can influence an individual’s susceptibility to kratom-induced liver problems. Higher doses and more frequent use may increase the potential strain on the liver. However, due to the idiosyncratic nature of some reported injuries, direct dose-dependent toxicity is not always observed.
Individual biological differences, such as genetic predispositions or pre-existing liver conditions, can make some people more vulnerable to adverse effects. Using kratom alongside other substances, including alcohol, prescription medications, or other supplements, can also heighten the burden on the liver and increase injury risk. The quality of kratom products varies, and some may be adulterated or contaminated with harmful compounds.