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What Is Kava Kava?

Kava Kava Root (the root of the Piper Methylsticum plant) has been used both ceremonially and casually in many south Pacific islands, such as Tahiti, Hawaii, Fiji, the Micronesian Islands, and Samoa Extract, since well before the first European contact. Traditional preparation involves chewing the rhizome, spitting the masticated root into a bowl, filtering it and drinking it in one gulp. If you're like us, right now you're thinking that you would probably prefer encapsulated Kava over the traditional preparation.

Studies show that Kava Kava has the unique ability to promote a calming effect while increasing mental acuity. Kava appears to act on the brain's limbic system, an altogether different mode of action from typical anxiolytic drugs, which bind to the brain's GABA receptors. Kava's more general mode of action probably explains its wide variety of effects on the body. Much more on this appears below.

Kava Kava and Anxiety



Today Kava has been tested against placebo and traditional benzodiazepines for use in controlling anxiety--and it has fared well.4,13,14,15 One oft-cited study showed results comparable to oxazepam (Serax), but without the common benzodiazepine-like side-effects of drowsiness and impaired mental function.4 In fact, as shown in this study, Kava has the unique ability to promote a calming effect while increasing mental acuity. Perhaps one of the most exciting recent discoveries is that Kava has been shown to have anti-convulsant effects which have led to studies attempting to determine its usefulness in treating epilepsy.2 Other studies have shown Kava to exert a protective effect on the brain during periods of ischemia (periods of low blood flow which lead to poor oxygen supply), leading to speculation that it may be useful as a pre-treatment for patients going in for operations in which they will be put under anesthesia.1

How Does Kava Kava Work?

Kava appears to act on the brain's limbic system, an altogether different mode of action from typical anxiolytic drugs, which bind to the brain's GABA receptors. Kava's more general mode of action probably explains its wide variety of effects on the body.

Side Effects



Kava Kava Use and Precautions
At the optimal therapeutic level, which is standardized Kava extract totaling 45 to 70 mg kavalactones, taken 3 times daily, there should be few or no side effects. For people seeking relief from insomnia it should all be taken just before bedtime; again, no problems with side-effects should arise. Some people develop a rash when using Kava and these people should experience symptom remission upon stopping it. Excessive use (in the amount of several grams per day) over a period of months often leads to what islanders call "kani kani", or "kava dermopathy". This condition is characterized by dry scaly lesions on the skin, usually beginning on the palms of the hands; skin also becomes tinted yellow. Stopping Kava intake results in direct remission of these conditions.

Recently, concern has arisen about the effects of Kava Kava on liver function.10,11 Specifically, Canada banned the sale of the herb in 2000 and Germany did the same in 2001, with several European countries following suit. The United States Food and Drug Administration also issued a consumer advisory on the product, the text of which is included in the consumer advisory below. The concern is that Kava Kava may harm liver function. There have been identified instances of liver health problems and in four instances (as far as we know), the need for liver transplant. This must be balanced, of course, against 3,000 plus years of safe usage by South Pacific Islanders. Also, there are recent initiatives underway in Europe, starting in Germany, the European leader in herbal analysis and licensing, to review and possibly reverse the ban. Based on the available information and when proper dosage guidelines are followed, we believe Kava Kava to be a safe, natural product but we urge you to read up on the product and consider its usage prudently. For more information we suggest you review the Food and Drug Administration Consumer Advisory text below. Given the concerns on liver damage, people with liver diseases or known liver problems should avoid use of this product. If taken in large doses, Kava Kava can cause excessive drowsiness and it should not be used during pregnancy, nursing, or while driving or operating machinery. Commission E warns against using Kava Kava with alcohol, antidepressants and other substances that act on the central nervous system. Patients with Parkinson's disease are advised not to take Kava Kava because it may make their symptoms worse. Finally, as a general guideline, most instances of hepatotoxicity or elevated liver enzymes have arisen when Kava Kava users have used high dosages for extended periods of time. Follow the recommended dosage and do not take the product continuously for longer than 30 days at a time.

As always, tell your physician about, and discuss, any food supplement products that you are taking, or plan on taking.

Kava Kava References / Additional Resources

Backhauss C., Krieglstein J. "Extract Of Kava (Piper Methysticum) And Its Methysticin Constituents Protect Brain Tissue Against Ischemic Damage In Rodents". European Journal Of Pharmacology 215(2-3):265-9, 1992.
Gleitz J., Friese J., Beile A., Ameri A., Peters T. "Anticonvulsive Action Of (+/-)-Kavain Estimated From Its Properties On Stimulated Synaptosomes And Na+ Channel Receptor Sites". European Journal Of Pharmacology 315(1):89-97, 1996.
Keledjian J, Duffield PH, Jamieson DD. Uptake into mouse brain of four compounds present in the psychoactive beverage kava. J Pharm Sci 1988;77: 10003-6.
Lindenberg, D. and Pitule-Schodel, H. "D,L-kavain in Comparison with Oxazepam in Anxiety Disorders: A Double-Blind Study of Clinical Effectiveness". Forschr Med 108: 49-55, 1990.
Meyer HJ. Pharmacology of kava. From: Holmstedt B, Kline NS, eds. Ethnopharmacological search for psychoactive drugs. New York: Raven Press. 1979,p 133-40.
Muller B, Komorek R. [Treatment with Kava--the root to combat stress]. [Article in German]. Wien Med Wochenschr 1999;149(8-10):197-201.
Norton SA, Ruze P. Kava dermopathy. J Am Acad Dermatol 1994 Jul;31(1):89-97.
Scherer J. Kava-kava extract in anxiety disorders: an outpatient observational study. Adv Ther 1998 Jul-Aug;15(4):261-9.

Double-Blind Placebo-Controlled Trials

Herberg, K. W. (1993). "[Effect of Kava-Special Extract WS 1490 combined with ethyl alcohol on safety-relevant performance parameters]." Blutalkohol 30(2): 96-105.
Kinzler, E., J. Kromer and E. Lehmann (1991). "[Effect of a special kava extract in patients with anxiety-, tension-, and excitation states of non-psychotic genesis. Double blind study with placebos over 4 weeks]." Arzneimittelforschung 41(6): 584-8.
Malsch, U. and M. Kieser (2001). "Efficacy of kava-kava in the treatment of non-psychotic anxiety, following pretreatment with benzodiazepines." Psychopharmacology (Berl) 157(3): 277-83.
Neuhaus, W., Y. Ghaemi, T. Schmidt and E. Lehmann (2000). "[Treatment of perioperative anxiety in suspected breast carcinoma with a phytogenic tranquilizer]." Zentralbl Gynakol 122(11): 561-5.
Pittler, M. H. and E. Edzard (2001). "Kava extract for treating anxiety." Cochrane Database Syst Rev 4.
Pittler, M. H. and E. Ernst (2000). "Efficacy of kava extract for treating anxiety: systematic review and meta-analysis." J Clin Psychopharmacol 20(1): 84-9.
Volz, H. P. and M. Kieser (1997). "Kava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo-controlled 25-week outpatient trial." Pharmacopsychiatry 30(1): 1-5.
Warnecke, G. (1991). "[Psychosomatic dysfunctions in the female climacteric. Clinical effectiveness and tolerance of Kava Extract WS 1490]." Fortschr Med 109(4): 119-22.

We Stand Together!
Kava Kava has been banned in several European countries as well as Canada and Australia. The ban is a result of liver problems being reported from users of kava kava along with other side effects that have come to surface from extreme use. Below you'll find some excerpts relating to the reasoning behind the ban. You make up your mind as to whether the ban has sufficient backing, medical or moral. We here at D&T Bargain Source are advocates of Kava Kava use for mental acuity and stress relief. All things must be done in moderation and Kava Kava is no different. We are interested in your opinion on the topic, please leave comments.

Skin rashes
Chronic and heavy use of kava for a period of three months or more has occasionally been reported to cause a scaly, yellow skin rash and eye irritation that disappears after discontinuation of the herb. The rash resembles one brought on by a niacin (Vitamin B3) deficiency; however, a double-blind, placebo-controlled study showed no change in the rash after niacin supplementation. The 29 Tonga islanders who presented with the rash after heavy kava consumption--more than 900 g/week--were given either 100 mg of oral niacinamide or placebo. No statistically significant improvement was seen in the supplementing group, suggesting niacin deficiency may not cause the rash, which is more characteristic of an acquired ichthyosis. Until more is known, however, people taking kava regularly may also wish to take a multivitamin with at least 50 to 100 mg of niacin daily.

Liver Damage Incidents and Regulation
In 2001 concerns were raised about the safety of commercial kava products. [8] There have been allegations of severe liver toxicity, including liver failure in some people who had used dietary supplements containing kava extract (but not in anyone who had drank kava the traditional way). Out of the 50 people worldwide taking kava pills and extracts that have had some type of problem, almost all of them had been mixing them with alcohol and pills that could have effects on the liver.[8] The fact that different kava strains have slightly different chemical composition made testing for toxicity difficult as well.

The possibility of liver damage consequently prompted action of many regulatory agencies in European countries where the legal precautionary principle so mandated. In the UK, the Medicines for Human Use (Kava-kava) (Prohibition) Order 2002 prohibits the sale, supply or import of most derivative medicinal products. Kava is banned in Switzerland, France and The Netherlands[9]. The health agency of Canada issued a stop-sale order for kava in 2002. But legislation in 2004 made the legal status of kava uncertain. The United States CDC has released a report[10] expressing reservations about the use of kava and its possibly adverse side effects (specifically severe liver toxicity), as has the Food and Drug Administration (FDA).[11] The Australian Therapeutic Goods Administration has recommended that no more than 250 mg of kavalactones be taken in a 24 hour period.[12] According to the Medicines Control Agency in the U.K., there is no safe dose of kava, as there is no way to predict which individuals would have adverse reactions.[13]

Toxicology of Pill Form Kava Extracts with Stems and Leaves
The legal intervention of several countries stimulated research, and hepatotoxic substances were found in the stems and leaves of the plant. Researchers from the University of Hawaii at Manoa found that an alkaloid called pipermethystine (formula 1), contained in stem peelings and leaves but not in the roots, had toxic effects on liver cells in vitro[14] and in vivo.[15] In rats fed with 10 mg/kg pipermethystine for two weeks, indications of hepatic toxicity were found. Comparable signs of toxicity were not detected with kava rhizome extracts (100 mg/kg, 2 weeks)[15], (73 mg/kg, 3 months).[16]

Flavokavain B, found in the plant's rhizome (large horizontal underground stem), may also contribute to toxic effects.[17] And, it is known that some of the kavapyrones block several subtypes of the enzyme cytochrome P450[18], which can result in adverse interactions with other drugs used concomitantly.

Hawaiian researchers learned from a trader in Fijian kava that European pharmaceutical companies eagerly bought up the stem and leaves peelings when demand for kava extract soared in Europe in 2000 and 2001. Before 2002, substantial amounts of aerial parts of the kava plant were being exported to North America and Europe and obviously used for the production of commercial pill extracts. For traditional use in the South Pacific, stem peelings and leaves are discarded, and only the rhizomes are used and extracted with water. This may explain why native populations that make heavy use of kava experience side effects that are mild, temporary, and confined to the skin, whereas industrialized countries that have newly adopted kava occasionally show severe, acute responses.

A medical conference in Fiji determined that the high concentrations of kava resins in pill form extracts alone could have been the culprit for the liver damage incidents.

Toxicity of Traditional Kava Beverage Preparations



Kava has been consumed heavily as a beverage in the south Pacific for around 3000 years with no reports of liver problems. One study has reported that when kava preparations are made with the root of the plant no toxicity is found.[19] However, in one study some changes in liver function are noticed. The effects are temporary and reversible when discontinuing kava use.[20] Although kava root does not cause liver toxicity, there is evidence of health concerns among heavy drinkers, including poor nutrition and a rise in liver enzymes.[21]

The plant also contains glutathione. In extracts its concentration varies depending on the lipophilicity of the applied solvent; the amount is higher in aqueous extracts. Glutathione in kava beverage preparations is able to provide a certain protection of liver cells.[22] However, kava extracts in pill form will not have the glutathione in it to help protect the liver.

Allergy
Literature suggests that <0.5% of people that take kava have an allergic reaction to it.[citation needed] Allergic reactions are usually mild and include itchy skin or itchy throat, and hives on the skin usually prevalent on the user's belly region. If someone has an allergy to any relative of the pepper family, such as black pepper, they have a higher chance of having a kava allergy.[citation needed]

Outlook
The issue has long been controversial and the debate fuelled by conflicting economic interests of monopoly-driven pharmaceutical companies, concerned with competition in anti-anxiety drug sales, and kava-exporting nations of the Pacific Islands as well as disagreements between the medical establishment and proponents of herbal and natural medicine. The German Federal Institute for Drugs and Medical Devices (BfArM), which in 2002 temporarily inactivated kava registrations, asked the producers to provide new clinical data by June 2007, in which case a reinstitution of the kava products on the market might again be possible.[23]

A New Zealand committee from the New Zealand Association of Medical Herbalists that considered the issue commented in its summary: "A comparison with paracetamol-associated hepatotoxicity, results in the conclusion that these potential risks for kava are dramatically less than that of a popular non prescription drug widely sold through grocery outlets."[24][25] The NZ government is currently only considering requiring a suitable warning label standard to go on kava products

References
8.^ a b Blumenthal, Mark (2002). "Kava safety questioned due to case reports of liver toxicity". American Botanical Council (55): 26-32. Retrieved on 2008-03-23.
9.^ C.I.J.M. Ross-van Dorp (2003). Besluit van 23 april 2003, houdende wijziging van het Warenwetbesluit Kruidenpreparaten (verbod op Kava kava in kruidenpreparaten). Sdu Uitgevers. Staatsblad van het Koninkrijk der Nederlanden. Retrieved on 2007-02-07.
10.^ United States Centers for Disease Control and Prevention (2002). "Hepatic Toxicity Possibly Associated with Kava-Containing Products --- United States, Germany, and Switzerland, 1999-2002". Morbidity & Mortality Weekly Report 51(47): 1065-1067. Retrieved on 2005-09-16.
11.^ Center for Food Safety and Applied Nutrition (2002). "Kava-Containing Dietary Supplements May Be Associated with Severe Liver Injury". United States Food and Drug Administration. Retrieved on 2005-06-16.
12.^ Kava fact sheet. Therapeutic Goods Administration, Government of Australia (April 2005). Retrieved on 2006-07-10. (Download PDF 44KB)
13.^ Kava: A supplement to avoid. Consumer Reports (March 2003). Retrieved on 2006-07-17. )
14.^ Pratibha V. Nerurkar et al. (2004): "In Vitro Toxicity of Kava Alkaloid, Pipermethystine, in HepG2 Cells Compared to Kavalactones", Toxicological Sciences 79, 106-111. Fulltext.
15.^ a b Lim ST et al. (2007): "Effects of Kava Alkaloid, Pipermethystine, and Kavalactones on Oxidative Stress and Cytochrome P450 in F-344 Rats." Toxicol Sci. PMID 17329236
16.^ Sorrentino L et al. (2006): "Safety of ethanolic kava extract: Results of a study of chronic toxicity in rats", Phytomedicine, 13(8):542-549. PMID 16904878
17.^ Jhoo JW et al. (2006): "In vitro cytotoxicity of nonpolar constituents from different parts of kava plant (Piper methysticum)", J. Agric. Food Chem. 54(8):3157-62. PMID 16608246
18.^ a) J.M. Mathews et al. (2005): "Pharmacokinetics and disposition of the

Kava Kava can easily be made into a drinking beverage. It has been reported to not always be the tastiest of drinks, so here are some recipes to remedy that problem. This information was found at kickbackwithkava.com

KAVA MILK SHAKE
Here's a Kava recipe I tried and liked: Take Kava powder and mix it through a strainer bag into milk, just like you do with water. Then, put this milk into your blender and add your favorite ice cream. You could add anything else you want, too. Mix it up and you have a Kava milk shake! It is very refreshing, especially if you use mint chocolate chip ice cream (my favorite kind). Hope you like it!
R. Nelson (Provo, UT)

FIZZY KAVA
Wish I had a neat recipe to contribute, but I've gotten to like the taste of Kava. Occasionally I'll use seltzer water for fizzy kava, but that's not particularly imaginative.
G. Crowley (Washington, DC)

LEMON KAVA
I mix about one half cup of kava with 32 oz of water and flavor it with just a touch of lemon flavored crystal light(it has to be lemon). The secret is to NOT make it taste like lemonade, but just to mask and add a hint of lemon to the natural kava taste.(approx. 1 tsp, and it has to be sugar free).
L. Mitchell (Gilbert, AZ)