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Common causes include: Pernicious anaemia Malabsorption disorders (e.g., coeliac disease, Crohns) Chronic alcohol abuse Long-term use of antacids or metformin Vegan or vegetarian diet without supplementation 3

Data from analyses of samples collected from rats and humans revealed that kratom alkaloids including mitragynine, speciogynine, paynantheine, speciociliatine, mitraciliatine, and isopaynantheine were extensively metabolized to multiple phase I and phase II metabolites

[DOI] [Google Scholar] 61.Wischik C.M., Harrington C.R., Storey J.M.D

Fang H, Kang J, Zhang D