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Another theory is the chronic compression hypothesis

All the statistical analyses were performed with GraphPad Prism 10.0 (GraphPad, Inc.)

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[DOI] [PMC free article] [PubMed] [Google Scholar] Kamble SH, Sharma A, King TI, Len F, McCurdy CR, Avery BA (2019) Metabolite profiling and identification of enzymes responsible for the metabolism of mitragynine, the major alkaloid of Mitragyna speciosa (kratom)

Short-course studies report no overt toxicity at commonly used doses, but programs should include organ-system panels, cardiovascular telemetry where relevant, and pathology review for chronic exposures