Boston—The Drug-Induced Liver Injury Network (DILIN) is raising concerns about patients presenting with severe liver disease after consuming kratom, a botanical product with opioid-like effects that has become increasingly popular in the wake of the opioid epidemic.
Derived from Mitragyna speciosa, an evergreen indigenous to Southeast Asia, kratom triggers opioid receptors, acting as a stimulant in low doses but a sedative–hypnotic agent in higher doses. In 2018, the DILIN database included at least five people who had experienced liver injury after consuming kratom. That was up from one in 2016, researchers reported.
“I think that all providers and consumers should be aware that this product is out there and is quite accessible,” said Victor J. Navarro, MD, the chief of hepatology at the Einstein Healthcare Network, in Philadelphia, who presented the findings at the 2019 Liver Meeting of the American Association for the Study of Liver Diseases (abstract 212). “From the perspective of the DILIN, we feel this is a bellwether that not only are we seeing increased use of kratom but [also] that liver injury might be one characteristic of its use.”
To help describe kratom-associated hepatotoxicity, Dr. Navarro and his colleagues examined 404 cases of herbal and dietary supplement–associated liver injury in the DILIN database between 2004 and 2018. Of these, eight were associated with products containing kratom: two in 2008, one in 2016 and five in 2018. A causal association with kratom was established in seven of the eight cases (median age, 46 years; range, 25-70 years). Six cases occurred in men.
In five of the eight cases, patients reported having used kratom for its psychotropic effects; one said they took it for joint pain. The products were used for a median of 22 days (range, 15-49 days) before the onset of liver injury. Five patients had jaundice, six had itching, five had abdominal pain and three had fever; none had rash.
Median laboratory values among the eight patients were as follows:
Two of the patients underwent biopsy, which demonstrated cholestasis. Although six patients were hospitalized, all recovered without a transplant. Three products underwent chemical analysis; all three had kratom compounds and no other toxins.
“I think the importance of disseminating this is very timely with the opioid epidemic,” said Meena B. Bansal, MD, a professor of medicine at Mount Sinai Medical Center, in New York City. “[Clinicians] may be seeing an increased incidence of this and really need to be watchful.”
Data Mining U.S. Poison Control Centers
C. Michael White, PharmD, the head of the Department of Pharmacy Practice at the University of Connecticut School of Pharmacy, in Storrs, is well versed in the potential adverse reactions associated with kratom, having published a review of the herb in 2017, which he updated late last year.
“In my latest review of kratom’s efficacy and safety [Am J Health Syst Pharm
2019;76:1915-1925], liver dysfunction was one of the bigger areas of concern with the use of this herb,” he told Pharmacy Practice News.
Dr. White’s review included an assessment of U.S. poison control center calls from 2011 to 2017. The review determined that liver-related issues of concern (defined as an AST or ALT concentration of >100 units/L) occurred in 59 individuals; 30 also had increased bilirubin concentrations. “This was in addition to the eight individual cases of liver dysfunction reported in the literature, with only one of these occurring before 2017,” Dr. White said. Symptoms of kratom-induced liver injury in these cases, he noted, included upper gastrointestinal quadrant pain and light-colored stools.
As for why kratom can be hepatotoxic, “there are two potential explanations,” he noted. “Basic animal data support kratom’s ability to damage the liver, and, like many dietary supplements, some kratom [products] have not been produced with good manufacturing practices.”
Although the new cases reported by Dr. Navarro “support the body of evidence that kratom products can and do damage the liver, the big missing piece of the puzzle [is] the utilization rates,” Dr. White said. “With the potential for millions of users, the incidence of liver injury could still be quite low. We desperately need a better way to track utilization of this product and patient outcomes.”
Not a Fan of a Ban
The risks posed by kratom have led to calls for the substance to be banned in the United States—a course of action that Dr. White cautioned against. Such a move “might increase the use of heroin or other illicit opioid products and increase deaths from respiratory depression,” he said. “I have called for a ban of sales to minors, only allowing products certified by outside laboratories as free from contamination or adulteration, and placing the products behind the pharmacy counter like decongestants to enhance patient safety as we await further research on ... benefits and risks.”
Dr. White added that pharmacists can play a role as well. Specifically, “I would ask all pharmacists to recommend that patients without opioid use disorder or chronic pain who were previously treated with opioids avoid starting kratom products.” Patients who do use the herb “should be monitored for moderate upper gastric pain and light-colored stools.” If a patient develops such symptoms, they should report them to their physician “as soon as possible to reduce the risk of irreversible liver injury.”
Kratom has become extremely popular for treating a variety of conditions like opiate withdrawal, anxiety, and pain. Even with so many benefits, the taste of kratom is not desirable to many. Some also say that kratom has a characteristic bitter taste that is no less than hideous. As kratom is found majorly in the powdered form, people use it to prepare tea, which makes it way more intense.
In order to help you out with the taste of kratom, we are going to mention a few recipes of smoothies where you can incorporate kratom for good.
You can prepare these smoothies at your home to gain all the benefits kratom has to offer without having to compromise on the taste. The amount of kratom you wish to add would depend on your preference. However, discuss with your healthcare professional before deciding on the dosage.
Yogurt and Fruit Smoothies Yogurt and fruit would be the most preferred options for making a smoothie because they are easy to prepare and have a pleasant taste. When you plan on making kratom smoothies, it is best to use vanilla yogurt. However, you can also experiment with yogurts of different flavors, as per your choice. You can have these smoothies for breakfast or in the form of light dinner.
We would always encourage you to experiment with the juices and fruits you wish to add until you find a recipe that is perfect for your taste buds. Let’s check out some of the common ones that people tend to like –
Avocado and mango Kratom Smoothie Ingredients –
Banana Kratom Smoothie Ingredients –
Green Smoothies Many people may make a very disgusted face when they think about green smoothies. But, many people actually love the idea of having green smoothies. You can also add a few extra ingredients to the veggies in a green smoothie to make it tasty and healthy at the same time. We are going to mention some of the green smoothies that are beneficial and tasty.
Fruit and Spinach Kratom Smoothie Ingredients –
If you do not like the taste of spinach, you can still enjoy the benefits by adding the fruits mentioned in the ingredients.
If you would like to buy kratom powder to prepare this delicious smoothie, check out the elaborate gallery of kratom crazy to find the right product for your kitchen.
Pineapple and Cucumber Kratom Smoothie Ingredients –
Chocolate Kratom Smoothies Chocolate smoothies are the best because they are so flavorsome. Plus, bu adding kratom, you make it very nutritious.
Blueberry and Chocolate Kratom Smoothie Ingredients –
Closing Thoughts Through these recipes, you can understand that making kratom smoothies can be so easy. All you have to do it try out these recipes and include extra ingredients of your choice to find a drink that is perfect for you.
Found in smoke shops and some corners of the internet, this leafy natural remedy is growing in popularity to self-treat a host of conditions.
Kratom is a tropical tree native to South Asia. Its leaves or extract from its leaves are harvested and made into a variety of forms (think tablets or drinkable doses) to help with chronic pain, opioid dependence and withdrawal, and — since you’re here — symptoms of depression or anxiety.
Although some evidence exists about kratom’s effectiveness, there’s also plenty out there about the dark side of this natural remedy. More research is needed to really be sure, so take suggested benefits with a grain of salt, and try not to gloss over the risks.
The Food and Drug Administration (FDA) hasn’t blessed kratom with approval just yet. It’s *technically* a dietary supplement (get the 411 on the FDA’s recommendations here).
While it’s not considered an illegal drug at the federal level, it has been banned in six states. So if you’re thinking about jumping on the kratom train, proceed with caution.
Let’s dive into the risks, supposed benefits, and multiple varieties of kratom.
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Here’s how kratom worksKratom is sometimes referred to as a “natural opioid.” Since actual opioids can become a problem real quick, it’s no wonder some people in pain turn to kratom to get the same pain relief.
The secret sauce here is called mitragynine. At low doses, mitragynine can have energizing properties. At higher doses, it can feel like a sedative. It binds to opioid receptors in your brain, relieving pain — which may explain the antidepressant and anti-anxiety effects.
TBH, there isn’t a ton of research on kratom’s effects on mood.
One 2017 review confirmed that among some users, kratom enhances mood and relieves anxiety. This review cites an older study in mice that showed a reduction in corticosterone (in humans, that’s your stress hormone, cortisol).
The same research also suggests kratom can have sedative effects. Researchers have yet to dive into whether side effects such as sedation interfere with the benefits.
What else can it do?Beyond depression and anxiety, kratom is said to help with:
Some research also describes an appetite-suppressing effect, but (once more for the people in the back) more research is needed to confirm any of these benefits.
But like, what is it?Kratom (scientific name Mitragyna speciosa) is a tree found in parts of Southeast Asia, including Thailand and Malaysia, and that sweet, sweet mitragynine nectar is in its leaves.
People in some parts of Southeast Asia have been using kratom for centuries. You might see it called:
In fact, the FDA has confiscated more than $5 million worth of kratom and kratom products since 2014.
Kratom’s many formsPlayer’s choice! Kratom comes in a bunch of different forms, including:
The method of ingestion may influence kratom’s effects. However, there’s currently no research identifying which method is preferable in treating depression and anxiety.
Kratom’s many strainsMuch like that other green plant stuff, kratom comes in a variety of strains. They’re named after where they came from, and each strain is said to produce a different vibe.
There really isn’t any research about the effects of different strains of kratom, so keep in mind these descriptions are based solely on anecdotal reports.
Another FYI: The effects of each strain might vary from one supplier to another.
Maeng daMaeng da is a blanket term for several strains of strong, long-lasting kratom.
This strain can be green, white, or red and is primarily from Thailand, but Indonesian and Malaysian maeng da strains exist too.
Some describe maeng da as a stimulant, giving you an energy boost while also reducing pain. Other effects: feeling talkative and increased feelings of well-being.
Green MalayThis strain of kratom comes from Malaysia and is characterized by its dark green color.
This is a strain commonly thought to help with anxiety. At low doses, it’s said to give a boost of energy and focus (along with the standard pain relief). Take a little more, and it may act more like a sedative.
IndoIndo kratom comes from — you guessed it — Indonesia. It can be red, white, or green and is known to be less stimulating than other strains.
Indo is known for relaxation, pain relief, and feeling good, happy vibes. With all that in mind, it’s no surprise, this is another common go-to for anxiety.
ThaiThere are three types of Thai kratom — red, green, and white vein — and each is said to have a different effect.
The green and white vein strains are thought to feel stimulating and create a euphoric “high,” while red vein Thai kratom is said to relieve pain. As the name suggests, this strain comes from Thailand.
MalaysianMalaysian strains are said to provide a balance between the sedative and stimulating natures of kratom. Users report pain relief, increased energy and focus, and a lift in mood from Malaysian strains, which come in green, red, and white vein varieties.
Bali/red veinThis Indonesia-born strain is said to be the most opiate-like of all the kratom strains. This reddish strain may help relieve pain-related conditions, including depression and chronic pain.
BorneoBorneo kratom, with its eponymous origins, is considered one of the more sedative strains of kratom. It comes in red, green, and white vein varieties, and may be used to treat anxiety and stress thanks to its mellow effects.
How much should you take?Honestly, there’s not a ton of solid kratom dosage info for depression and anxiety.
In a 2017 study based on a survey of 8,049 people who use kratom, most people reported that a dose of up to 5 grams of powder taken up to 3 times a day was enough to feel the effects, whether that be energizing, sedative, or somewhere in between.
Like most medications, the best dose depends on your age, sex, and general health. It’s recommended that you start with a low dose, gradually increasing the amount until you feel what (and how strongly) you want to feel.
Low to moderate1 to 5 gramsincreased energy and focus
High5 to 15 gramspain relief
increased risk of side effects
Use caution> 15 gramssedation
increased risk of serious side effectsFrom there, how you take kratom and which strain you go for can affect how much (or little) you feel it. For example, kratom extract is said to pack more punch than the powder form.
What to expect: The good, the bad, and the dangerousKratom can be a bit of a wild card — what you feel (and how much you feel) depends on how much you take, what kind you take, and possibly other factors. Research into this is ongoing, so keep your wits about you.
These effects are based on a mix of available research and feedback from online users, but know that this is likely not the complete list of potential ~feels~.
Emotional, mental, and behavioral effects include:
Although kratom seems to be simpatico with some people, like any drug it can have its share of side effects.
In a 2016 CDC report, out of 660 poison control center calls about kratom exposure, most reported side effects were minor or moderate.
Most kratom-related hospitalizations, adverse effects, and overdoses are linked to using kratom with other substances, according to various reports.
Mild side effects include:
Even if you get nothing but good vibes from kratom, you should know it may cause dependence and physical withdrawal symptoms when you stop taking it. In fact, some report developing an addiction, according to the National Institute on Drug Abuse (NIDA).
The risks here are real. A 2017 review concluded that the potential side effects of using kratom may outweigh the benefits, and more researchers are hinting at the same. One 2019 article suggests putting kratom behind the pharmacy counter, at the very least.
Kratom has been shown to negatively interact with other substances and could create potentially life-threatening complications. Alcohol and kratom are a particularly bad duo, and the CDC reported a death related to a bad mix of antidepressants, mood stabilizers, and kratom.
Yes, kratom use has been shown to contribute to multiple deaths. In 2018, the FDA identified 44 deaths, many finding kratom mixed with other substances.
Another 2019 paper using data from the National Poison Data System identified 11 deaths between 2011 and 2017, nine of which involved kratom plus other drugs.
tl;drIf you’re thinking about jumping on the kratom train for depression or anxiety, just take a minute to educate yourself on the risks.
Kratom may help quell certain symptoms like pain and anxiety. But for some, the juice ain’t worth the squeeze.
Smaller doses have been found less likely to trigger negative effects.
Don’t forget kratom can interact with medications, booze, and other substances. There have been several deaths reported involving kratom plus other substances, including antidepressants.
Don’t wreck yourself. If you’re having severe side effects, put the kratom down and seek medical attention — stat. Your mental health professional can work with you to find effective treatment options.
Even after Colorado's April 16 stay-at-home order over COVID-19 is lifted, many businesses in the state will remain closed, Governor Jared Polis reported during an April 20 news conference, including bars, clubs and restaurants outside of to-go and delivery service. But Clean Kratom Wellness Center, at 1520 Simms Street in Lakewood, will be open — even though it received a notification last week that it would have to shut its doors.
Clean Kratom owner Faith Day vowed to fight this edict, and within days, the notice from Jefferson County Public Health was rescinded — but not because the sale of kratom, a controversial herbal substance of Southeast Asian origin, was deemed essential. Instead, the center was allowed to continue operating because it also sells CBD products that Jeffco considers food.
There's no shortage of irony over this determination. After all, the Clean Kratom Wellness Center branch in Portland, Oregon, has been licensed to package and sell kratom by the Oregon Department of Agriculture — a designation that Day believes is the first of its kind in the United States. And that agency, unlike its equivalent in Colorado, treats kratom like food.
The federal government displays even more antipathy toward kratom, regularly issuing warnings about the product's alleged addictive qualities even as advocates tout it as both a pain reliever and a tool to help opioid users kick infinitely more dangerous habits. Indeed, the Food and Drug Administration specifically targeted Day's business in early 2018, during a campaign that included the seizure of a kratom shipment to a Denver company the next year.
Even before this conflict, Day was careful to follow all regulations for packaging and distribution of kratom — and she stresses how much closing the store would hurt her customers. "Our sales haven't slowed down at all" since the stay-at-home order, she says. "There's a huge demand for this product."
One possible reason: Kratom is among the many items being touted for its alleged ability to stave off COVID-19. While Day makes no such claims about kratom, she reveals that "we've got people coming to us who are visibly sick. It's very hard for us to just turn away people who are in dire need."
And she won't have to do so now. Corresponding via email, Nicole Work, a spokesperson for Jefferson County Public Health, writes that the Colorado Department of Public Health "has declared CBD to be food and recommended the reopening of businesses selling it. Clean Kratom was one of them, and they have been approved to reopen."
Even so, Work notes that the Clean Kratom Wellness Center is "not licensed with JCPH. The FDA does not recognize kratom as food, so we do not allow it any of our retail food establishments." The takeaway: Kratom in and of itself won't allow a business to stay open, but neither will it automatically result in it being prevented from doing so if it sells other essential items.
Day, who holds a standard retail license for Clean Kratom, finds Jeffco's rationale confusing. "We were told that the few CBD items we have for sale were the determining factors for us remaining open," she allows. "I'm definitely not upset about it, but I'm hoping that the viewpoint on kratom changes."