What Is It?
A member of the pepper family, kava (or kava-kava) is a natural tranquilizer that soothes jangled nerves and eases anxiety with few of the mind-dulling effects of prescription relaxants. Its Latin name, Piper methysticum, means “intoxicating pepper,” and indeed, on the South Pacific islands where it is grown, kava is made into a traditional beverage that is drunk at ceremonies and on social occasions–as alcohol is in other societies–to relax people and induce a sense of well-being.
That said, the recent news about kava has not been good. In Europe, approximately forty reports of liver damage among kava users appeared during the past two years, six of which required liver transplants. Ultimately, three deaths were attributed to kava use. This was sufficient evidence for the governments of Germany and Switzerland to call for an immediate ban on kava products, shortly to be followed by Canada and Great Britain.
Doctors in Europe had been prescribing kava for years as a safe alternative to prescription tranquilizers. However, in Europe, herbal therapies are carefully monitored by governmental agencies comparable to our own Food and Drug Administration. This situation is quite different in the U.S. Here, most herbs are taken without physician supervision, and problems may never get reported at all. Because the FDA classifies kava as a nutritional supplement rather than a drug, it can’t act on ‘adverse event’ reports from physicians by recalling it. Rather the FDA will issue a ‘warning,’ as it has done in the case of kava.
This lack of medical supervision regarding herbal therapies is being reflected in the U.S. data on kava. Basically only a single case, a woman who developed liver failure while using kava, has been reported. Statistically, given the widespread use of kava, it is likely that more patients had or even have kava-induced liver toxicity but remain unaware of it. Fortunately, when most abnormalities in liver function do occur with kava, they usually clear up within weeks after discontinuing the herb.
Other reasons have been proposed for the low number of liver reports in the United States. First, because herbs are taken without physician supervision, there is a general tendency among herb users to take smaller doses than recommended on the bottle. Second, problems with kava developed among three groups of people: those with pre-existing liver damage, such as cirrhosis and hepatitis; those who used kava with alcohol or other liver damaging substances, and those who took kava in higher than recommended doses for long periods of time. None of these profiles are typical of the health food store customer.
Currently, herbalists in the United States seem to be divided equally about the kava situation. One group recommends no official withdrawal of the herb, but rather carefully supervised use. This would include taking the herb for no more than one month, not exceeding the dosage recommendations, avoiding it altogether if there is pre-existing liver disease or if drinking alcohol or taking any medication associated with liver toxicity. They agree that for example, a combination of kava, Tylenol and alcohol would be an extremely dangerous mix.
Other herbalists believe that different nutritional supplements are available whose tranquilizing effect is so comparable to kava that they are willing to abandon it altogether. These include valerian, passion flower, chamomile and the amino acid GABA (gamma aminobutyric acid)
Kava’s active ingredients are found in the plant’s dense, fleshy roots (some weigh up to 22 pounds), which contain kavalactones and other components that can have a therapeutic effect. Scientists believe that kava works by acting on the limbic system, an ancient part of the brain that controls emotions, among its other functions. Unlike prescription tranquilizers, kava doesn’t appear to dull the mind, and, according to some studies, it can even improve alertness and reaction time. The herb had been recommended by European physicians because it was generally not addictive, and those who took it weren’t likely to build up a tolerance to it.
Specifically, kava had been shown to: :
· Ease stress-induced anxiety and panic. Several studies have shown that kava is very useful for relieving anxiety and the symptoms associated with it, such as nervousness, restlessness, and dizziness. It can also relieve the heart palpitations and the intense periods of anxiety associated with panic attacks.
· Combat anxiety associated with depression. Kava can be used alone, or with St. John’s wort, ginkgo biloba, or 5-HTP to relieve anxiety in those with mild to moderate depression.
· Induce sleep in people with insomnia. Insomniacs often find that kava relaxes them sufficiently to enable them to fall asleep. Kava is often rotated with other sedating herbs, such as chamomile, passionflower, and valerian.
· Relieve muscle aches and chronic pain. Kava can soothe muscle aches as well as chronic pain in any part of the body. It is also thought to have muscle-relaxing properties, and may therefore help reduce muscle spasms. Proponents suggest it can be useful in treating the chronic muscle pain and stiffness associated with fibromyalgia.
· Calm those trying to stop smoking or drinking. Kava has a relaxing effect on those trying to stop tobacco or alcohol.
· Control epileptic seizures. In cases where stress and anxiety are known to trigger epileptic attacks, kava may serve to prevent seizures as effectively as certain prescription anticonvulsants. Never stop or reduce the dosage of a prescription medication without consulting your doctor first, however.
· Improve recovery from stroke. Very early studies indicate that kava may help stroke patients recover by minimizing the amount of permanent brain damage that can occur.
Note: Kava has also been found to be useful for a number of other disorders, many of which have been linked to anxiety and stress. For a complete list of these ailments, see our Dosage Recommendations Chart for Kava.
Special tips: Buy kava extracts standardized to contain at least 30% of the herb’s primary active ingredient, kavalactones.
· Look for products extracted from the root of the plant rather than kava with only purified kavalactones (some herbalists believe that the root extracts contain other beneficial substances in addition to kavalactones).
· Avoid products containing any part of the kava plant other than the root. Producers of kava believe the liver toxicity occurred because either the whole plant was used (the above ground parts are toxic) or because of chemicals added to the root during processing.
· For the ailments mentioned: Take 250 mg of a standardized extract two or three times a day.
Be sure to check our our Dosage Recommendations Chart for Kava, which lists therapeutic dosages for specific ailments at a glance.
Guidelines for Use
· Always look for a standardized product. The kava should contain the amount of active compound–kava pyrones–used in most studies to date: 60 to 120 mg daily. Or look for products containing 30% kavalactones, which is how the active compound is identified by some sources.
· Consider fresh, freeze-dried kava. Some herbalists believe that flash freeze-drying fresh kava root is the best way to capture all of the plant’s healing compounds without adding any chemicals in the processing. They also believe some benefits of kava may be lost when extracting the so-called active ingredients. Keep in mind that the milligrams of kava root in each freeze-dried capsule will be numerically larger than what you’ll find in extract products; after all, the capsule contains a condensed version of the root.
· Because of the issue of liver toxicity, don’t take more than the recommended dose. .
· Take kava only on a short-term basis (less than one month) or only use it intermittently–as needed–for anxiety.
· Most people begin to feel kava’s relaxant effect almost immediately. A major study conducted at several European medical centers showed, however, that patients who suffered from severe and long-term anxiety required up to eight weeks before experiencing any significant benefit. Because of this eight week effect, if you have especially severe anxiety, you’re better off selecting a different herb or having your doctor prescribe conventional medications.
· Drugs that affect the central nervous system could cause excessive drowsiness if taken with kava. These include antidepressants, psychiatric drugs (such as antipsychotics or buspirone), sedatives, and tranquilizers.
· Definitely do not use kava if you are drinking alcohol or taking any medication known to effect liver function. The most well known of these is acetaminophen (Tylenol®) but ask your doctor about others
· Kava is, however, sometimes recommended for a short course by nutritionally oriented doctors in combination with the antidepressant herb St. John’s wort or other herbal supplements that affect the brain. This is because St. John’s wort takes about four weeks to work, at which time the kava can be discontinued.
Note: For information on interactions with specific generic drugs, see our WholeHealthMD Drug/Nutrient Interactions Chart.
Possible Side Effects
· The most common side effect is stomach upset.
· Slight morning tiredness may occur at the beginning of therapy.
· Signs of liver toxicity include increased fatigue, nausea, loss of appetite, pain over the right upper abdomen, darkening of the urine and yellowness in the eyes. Discontinue the herb immediately if you notice any of these and see your doctor for liver testing.
· In rare cases, taking very high doses (greater than 310 grams per week) for extended periods (as short a period as three months, but usually much longer) can result in dry, scaly, yellowish skin. This starts on the face, then spreads to the rest of the body. Some people also develop allergic skin rashes.
· Other reported side effects with high doses kava (greater than 100 capsules a week) shortness of breath, blurred vision, bloodshot eyes, difficulty walking, disorientation, and intoxication. If you experience any of these, stop taking kava.
· If you have been taking kava for more than three months, consult your doctor who may recommend routine testing of your liver. Using the herb for long periods increases the chance of developing side effects.
· Again, AVOID kava altogether if you have a liver disease, such as hepatitis or cirrhosis, or if you regularly take drugs with known adverse effects on the liver, such as acetaminophen.
· Don’t take kava if you’re on other drugs that affect the central nervous system (antidepressants, psychiatric drugs, sedatives, tranquilizers) without consulting your doctor first.
· Women who are pregnant or breast-feeding should not take kava.
· Don’t take kava if you have Parkinson’s disease; it can aggravate symptoms.
· Avoid drinking alcohol while taking kava.
David Edelberg, MD