A Review of Kratom Product Evolution and Its Associated Health Outcomes.

Khat (Catha edulis) is a perennial stimulant shrub native to Ethiopia, widely cultivated and consumed across Yemen and the Horn of Africa. Its fresh leaves are chewed daily for their energizing effects, primarily due to the presence of alkaloids such as cathinone, cathine, and norephedrine. Cathinone, a potent central nervous system stimulant structurally similar to amphetamine, is considered the primary active component. Typical side effects of khat consumption include mydriasis, eating disorders, sleeplessness, hyperthermia, and hormonal imbalances. The liver is a primary target for khat-induced toxicity. Experimental models using animals fed C. edulis leaves for both short- and long-term periods have documented significant disruptions in hepatic function and architecture. Furthermore, khat use is associated with various systemic health outcomes, including cardiovascular disease, hypertension, gastrointestinal malignancies, and stunted fetal growth. Clinical presentations of hepatotoxicity range from asymptomatic transaminitis to severe injury. In extreme cases, consumption has been linked to an autoimmune hepatitis-like pathology characterized by jaundice and acute liver failure, likely driven by direct cytotoxic effects and oxidative stress. Emerging evidence highlights a significant association between chronic khat use and liver disease. In Eastern Ethiopia, nearly 50% of hospitalizations for decompensated chronic liver disease are of unclear etiology; however, follow-up investigations revealed a positive, dose-dependent connection to khat consumption. Case reports over the last 20 years have documented severe acute hepatitis in regular users, with some cases progressing to liver failure requiring transplantation. Studies in Yemen have further corroborated these findings, reporting abnormal hepatic scans and significantly elevated plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) among both male and female consumers.