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Although this increase in systemic exposure to the metabolites seems counterintuitive with respect to CYP3A inhibition, the inhibition of their secondary metabolism via UGT2B4/2B7 by kratom is a potential explanation

This corresponds with recent studies demonstrating that MIAs can become responsive to mechanical stimuli under conditions of inflammation

Additionally, vitamin D deficiency may trigger telogen effluvium by disrupting normal hair follicle cycling, causing premature transition of hair follicles from the growth phase to the resting phase, resulting in diffuse hair shedding