Don’t Mix That Kava Supplement! New Articles Spotlight Risk of Kava Dermopathy

New Articles Highlight Risk of Kava DermopathyAloha, kava lovers, Kava Guru here! Over the past couple weeks, kava has been appearing in the news in a rather uncomfortable way: two recently published news articles drew attention to the possibility that kava may cause rashes, especially in combination with other herbal supplements or with medications [1]. This condition is called “kava dermopathy”, and while uncomfortable and unsightly it is also completely reversible by ceasing use of kava for a time. Kava dermopathy is much more likely to occur with long-term use of kava at higher doses, such as those typically consumed socially in the South Pacific. These amounts of kava are far above the therapeutic doses used in the West, and the majority of kava users will never have to worry about kava dermopathy at all.

Why mention kava dermopathy since it’s so rare? Well, the story behind these recent articles piqued my interest: the reports center around a man who experienced a rash characteristic of kava dermopathy after he started taking a kava supplement to help him quit smoking [1]. This in itself I found interesting! While kava supplements have not been marketed as smoking cessation aids, research has been done on kava’s potential to help soothe nicotine cravings due to kava’s calming and stress-relieving properties [2]. The recent reports also indicated that the man had only been using kava for three weeks, and not at the higher doses that would put him at risk of developing kava dermopathy. On top of that, he stopped using kava when the rash first appeared—which reversed the condition—only to have the rash reappear as soon as he resumed using kava!

So what’s going on here? As it turns out, when the man went to his doctor after the second rash appeared, he revealed in his patient interview that he had been taking citalopram (Celexa), an anti-anxiety medication, concurrently with the kava supplement. In a bit of medical detective work, the doctors hypothesized that since kava kava is metabolized by the same enzyme pathway as citalopram, it likely interacted with the medication, causing an adverse reaction in the man’s sebaceous (oil-producing) skin glands [1]. A second article also noted that the man had a history of high cholesterol [3], a fact that my guru wisdom found especially telling—one of the hypothesized causes of kava dermopathy is that kavalactones, when taken at high doses over long periods of time, may interfere with the body’s ability to metabolize cholesterol. It’s quite possible that besides the kava supplement-medication combination, this man may have been predisposed to developing kava dermopathy as well.

To me, the takeaway from this story is that it’s very important to tell your doctor or holistic healthcare practitioner all the medications, herbal supplements, and other kinds of supplements or vitamins (such as fish oils) you are taking. Informing your doctor is especially important when you’re considering adding a new supplement such as kava kava to your daily regimen; your doctor can help you navigate the pros and cons of many supplements and how they might interact with what you’re already taking. Supplements can be a great way to boost your health and enjoy a better quality of life. Being honest about your medical history, as well as other medications and supplements you’re taking, can help ensure that you enjoy the greatest benefit while minimizing the risks. And you wouldn’t want to miss out on all the great benefits kava has to offer!

Mahalo,

Kava Guru

REFERENCES

1. Gilette, Hope. “Skin Rash? Stop Taking That Kava Supplement!” Saludify. October 3rd, 2014. http://voxxi.com/2014/10/03/kava-kava-skin-rash?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+voxxi+VOXXI.

2.Steiner Laboratories. “Kava As an Anti-Craving Agent. Preliminary Studies.” Pacific Health Dialogue.

3. Boxe, Agata Blaszczak. “Popular Supplement Is Culprit in Itchy Rash”. Fox News. October 2nd, 2014. http://www.foxnews.com/health/2014/10/02/popular-supplement-is-culprit-in-itchy-rash/.

4. Castillo, Stephanie. “Mixing Kava With Other Meds Gave One Man an Itchy Rash; How to Eat Your Supplements and Medicate, Too”. Medical Daily. October 4th, 2014. http://www.medicaldaily.com/mixing-kava-other-meds-gave-one-man-itchy-rash-how-eat-your-supplements-and-medicate-too-306260.

Emerging Controversy Around Tudei Kava

PrintAh, Tudei kava. Perhaps no varietal of kava is getting more attention or press at the moment. Unfortunately a lot of it is currently bad press, as some distinguished kava researchers such as Vincent Lebot have come forward with recommendations against drinking kava made from Tudei varieties. I was frankly shocked at how quickly Tudei kava rose in notoriety as being somehow harmful, even though the science on why it might be so is still in its initial stages. I don’t think I was alone, either: many growers, retailers and connoisseurs in the kava community were blindsided by the emerging controversy surrounding Tudei kava strains. Over the past year I’ve seen two rough camps develop, divided between those who have sworn off Tudei kava and those who are still skeptical of the supposed evidence against Tudei kava. But before I can get into the controversy, I should probably break down a few things for our readers. Like what is Tudei kava?

What is Tudei Kava?

First of all, the term Tudei or Tuday kava doesn’t refer to just one strain, but actually a group of kava strains that are classified as “ignoble” according to Vanuatu’s kava export laws [1]. Tudei kava strains tend to have dark green stems and leaves, often with lighter green spots on the leaves. They also usually grow and mature quickly compared to other kava strains. Some people prize Tudei kava varieties for their perceived long-lasting effects—the effects can reportedly last as long as two days, hence the name—which are probably due to higher levels of large, slow-to-metabolize kavalactones such as dihydromethysticin in the kava root [2]. However, the longer-lasting effects can sometimes also be accompanied by undesirable side effects such as nausea and drowsiness [1], so the kava community is really split on whether the enjoyable parts of the Tudei experience outweigh the less pleasant aspects!

In Vanuatu, Tudei kava cultivars such as Isa and Palisi are actually banned from export by law (although one can still find them, or kava vendors claiming to sell them, online). This is because only “noble” kava cultivars with a specific chemotype are legal to export or process into kava supplement products. The explanation indigenous ni-Vanuatu people give for this is that Tudei or ignoble strains like Isa are reserved for ritual and medicinal use, and are considered too potent to be everyday drinking kavas [1]. There has even been a persistent rumor in some kava circles that Tudei kava is actually Piper wichmannii, the wild form of kava, and some vendors have exploited this hearsay to add an air of potency and exoticism to the the kava they sell. However, no genetic or morphological evidence has ever substantiated the claim that Tudei kava is P. wichmannii [2]. The Tudei strains may be chemically close to P. wichmannii in their ratios of kavalactones though, which could be where this claim originated.

The Emerging Tudei Kava Controversy:

I first became aware of the doubts surrounding Tudei kava from a post made on Kava Lounge by Andrew Procyk, owner of Vanuatu Kava Bar in Asheville, North Carolina and the recently opened Noble Kava Bar in Boone, North Carolina. He linked to a video featuring semi-famous kava luminary Vincent Lebot, in which Lebot recommends against drinking Tudei kava strains such as Isa and Palisi on the basis that they contain significant amounts of flavokavain B. His recommendation was based on data that suggest flavokavain B can be cytotoxic to human liver cells in lab tests [3].

Sigh. I thought the kava liver safety scares were over after the World Health Organization determined kava to be safe back in 2007 [4], but apparently not. The good news, though, is that Lebot and other kava researchers agree there is no detectable flavokavain B in the roots of noble kava cultivars [3]—those traditionally consumed nightly in the South Pacific as part of kastom—so even if flavokavain B turns out to be something to avoid, you don’t have to swear off noble kavas bought from scrupulous vendors. So, what’s the big deal with flavokavain B?

Flavokavains A, B, and C (also spelled flavokavins or flavokawains) are not kavalactones but are actually chalconoid compounds; precursors to the flavonoids found in many pigmented food plants like dark berries and dark orange or green vegetables [5]. Flavonoids have become darlings in the nutrition science world because research has shown that many of them provide significant health benefits like lowering inflammation in tissues and acting as antioxidants. Similarly, there is evidence the flavokavains in Tudei kava might be antifungal, antibacterial, and antioxidant [5]; Dr. Xiaolin Zhi at University of California Irvine has even discovered a tumor-preventive potential of flavokavain A in lab tests on mice [6]!

Seems good so far, doesn’t it? Unfortunately, the research also suggests there are two big problems specifically with flavokavain B. First, Dr. Chris Xing of the University of Minnesota has stated that flavokavain B may deplete glutathione, an antioxidant, liver-protective enzyme [7]. In a recent video interview featured on Natural Products Insider, Xing said, “[T]hat compromises liver function for detoxification… which may contribute to the observed hepatotoxicity among kava users”. As an antioxidant, glutathione plays a crucial role in scavenging free radicals produced by mitochondria (the organelles responsible for cellular respiration), and a severe enough deficit of glutathione can be fatal for cells [8].

Even more troubling, this 2010 paper [9] found that flavokavain B also has direct toxic effects on two human liver cell lines: I’ll try not to get too technical, but the researchers found that adding flavokavain B to cultured liver cells inhibits a protein signaling pathway regulated by nuclear factor kappa B (NF-κ B) that is involved in preventing cell death caused by tumor necrosis factor alpha (TNF-α). Under healthy conditions, these two signaling pathways balance each other, but when flavokavain B is added it knocks out the NF-κ B pathway, leading to apoptosis (death) of the treated liver cells.

Two things about this study stood out to me. One was that the researchers experimented with altering different parts of this process and discovered that adding exogenous glutathione rescued the liver cells from flavokavain B-induced cell death, even when the process had already been set in motion in the treated cells [9]. I couldn’t help but be reminded of studies of kava I’ve come across stating that brews prepared using traditional cold water steeping were found to extract glutathione into the water along with the kavalactones [10]. The Kava Guru finds it hard to believe that these two pieces of data are a coincidence!

Final Verdict—Should You Avoid Tudei Kava?

Well… it’s complicated. The paper described above reports the mechanism of toxicity for flavokavain B extracted from kava kava root using an organic solvent. It’s important to remember that the amount of flavokavain B present in the extract used does not necessarily match the amount that would be found in a traditionally prepared aqueous kava brew, or a kava extract prepared using a modern solvent such as supercritical cold CO2. It’s well known that ethanol and acetone, two once-common solvents used to extract kava, extract everything in the root, not just the kavalactones, and that could include much higher levels of potentially harmful flavokavain B [8].

In fact, on page 5, table 1 of the paper, the researchers compare concentrations of flavokavain B in aqueous kava brews versus acetone- and ethanol-extracted kava extracts: kava extracts made with a 60% acetone extract contained 26 mg of flavokavain B per 1 gram of kava used, while a pure acetone extract contained 33.7 mg/g, and a 95% ethanol extract contained 32.3 mg/g [9]. How much flavokavain B did a traditional water-based Tudei kava brew contain? 0.2 mg/g [9]! What surprises me most about this outcome is that it suggests solvent-extracted kava extracts may actually have had a role in some of the liver toxicity cases of the early 2000s, a theory I thought had been debunked until now.

The very small amount of flavokavain B in an aqueous Tudei kava brew should, I think, at least give one pause before totally condemning Tudei kava as unsafe. Furthermore, in a co-op paper with Samuel X. Qiu and Rolf Teschke, Vincent Lebot explored three possible explanations for the idiosyncratic liver toxicity found in some kava users in the early 2000s [11]. One of those possible mechanisms was the presence of flavokavain B from Tudei kava, and the other two were the presence of pipermethystine from the aerial parts of kava, and possible contamination of kava roots with mold toxins (aflatoxins). In their results, the researchers noted that although both flavokavain B and pipermethystine have been shown to kill liver cells in lab tests, neither compound was detected in the commercial kava extracts tested at levels that would be of concern to human health [11]. They couldn’t detect pipermethystine at all in the extracts they tested. As for flavokavain B, even in the kava extracts where it was present, Lebot et al report that the concentration was much too low to cause harm in their experimental tests on liver cells. The conclusion of the paper states that contamination with mold aflatoxins due to poor storage conditions of the kava tested is actually the most likely explanation for the liver toxicity seen in 2002 and earlier cases [11].

Of course, no one should ignore that flavokavain B has been shown to have a detrimental effect on liver cells. But rather than state unequivocally that Tudei kavas are dangerous to consume, we have to look at all the factors in their preparation in order to make an informed choice about consuming them. A Tudei kava that has been solvent extracted and probably contains significant levels of flavokavain B might be wise to avoid. While Tudei kavas are consumed in the South Pacific, these cultures have traditionally only steeped the roots in water, and restricted them to occasional ceremonial and medicinal use rather than everyday drinking. It seems now that there is sound science behind the tradition.

REFERENCES

1. “Kava Definitions”. Kava Forums: Connecting Kava Lovers Around the World. Last modified May 30th, 2014. http://www.kavaforums.com/forum/wiki/kava-definitions/.

2. “Tudei Kava”. Kona Kava Farm. Accessed July 2nd, 2014. http://www.konakavafarm.com/kava-tudei.html.

3. Procyk, Andrew. “Drinking Tudei? Someone thinks you should probably stop.” The Kava Lounge: Science of Kava. Posted August 25th, 2013. http://kavalounge.yuku.com/topic/1576/Drinking-tudei-Someone-thinks-you-should-probably-stop#.U6iUeBZBm1A.

4. “WHO says Kava is Safe!” Kona Kava Farm Blog. Accessed July 2nd, 2014. http://www.konakavafarm.com/blog/kava-news/who-says-kava-is-safe/.

5. “Simple Test for Checking if your Kava is Tudei”. Kava Forums: Connecting Kava Lovers Around the World. Last modified May 26th, 2014. http://www.kavaforums.com/forum/threads/simple-test-for-checking-if-your-kava-is-tudei-please-read-if-youre-new-to-kava.2451/.

6. Vasich, Tom. “Can Kava Kava Cure Cancer?” UC Irvine News. Accessed June 29th, 2014. http://news.uci.edu/features/can-kava-cure-cancer/.

7. “New Science May Boost Kava Market” Insider TV: Natural Products Insider. Accessed July 2nd,2014. http://www.naturalproductsinsider.com/videos/2014/05/insider-tv-new-science-may-boost-kava-market.aspx.

8. “Dr. Xing: ‘Hepatotoxic Risk due to wrong cultivar […] and that Cultivar is Tudei Kava”. Kava Forums: Connecting Kava Lovers Around the World. Last modified May 28th, 2014. http://www.kavaforums.com/forum/threads/dr-xing-hepatotoxic-risk-due-to-wrong-cultivar-and-that-cultivar-is-tudei-kava.2557/.

9. Ping Zhou, Shimon Gross, Ji-Hua Liu, Bo-Yang Yu, Ling-Ling Feng, Jan Nolta, Vijay Sharma, David Piwnica-Worms, and Samuel X. Qiu. December 2010. “Flavokawain B, the hepatotoxic constituent from kava root, induces GSH-sensitive oxidative stress through modulation of IKK/NF-kB and MAPK signaling pathways”. Federation of American Societies for Experimental Biology Journal 24 (12): 4722-4732.

10. Whitton, PA, A Lau, A Salisbury, J Whitehouse, and CS Evans. October 2003. “Kavalactones and the kava kava controversy”. Phytochemistry 64 (3): 673-9.

11. Teschke, Rolf, Samuel X. Qiu, and Vincent Lebot. September 2011. “Herbal hepatotoxicity by kava: update on pipermethystine, flavokavain B, and mould hepatotoxins as primarily assumed culprits”. Digestive and Liver Disease 43 (9): 676-81.

German Kava Victory – Ban Repeal!

silhouette of a happy pregnant womanVery recently there has been a beautiful transition within the kava community! The decision to place a ban on kava kava and kava-containing products was overturned by Germany’s Federal Administrative Court!!

A ban was placed in 2002 on kava kava and products containing kava, throughout Germany. What could initiate such a ridiculous ban in the first place you may ask – well, the answer has a lot to do with studies done by the German Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, or “BfArM”). BfArM published a series of studies back in the mid 2000’s that propelled a ton of dramatized media and the circulation of misinformation surrounding the topic of kava and liver toxicity. The studies published findings that were said to evidence the claims that kava causes liver toxicity. Sadly, the conclusions of these studies were taken at face value and many countries invoked bans on the import and sale of kava and kava-containing products.

It’s pretty remarkable that these studies did have such an influence, considering the rapidly increasing body of research and case studies that were proving kava to be a wonderful natural option for remedying anxiety symptoms. These negative studies were almost simultaneously surfacing alongside studies declaring the benefit and need for kava in the European world, and yet many bans were emplaced. At the time this odd simultaneity caused conspiracy theories to circulate about the possible influence of pharmaceutical giants who had an interest in suppressing the kava market. While those theories have been neither proven nor disproven, it is certainly very possible considering how very natural, non-chemical and beneficial kava was proving to be; at the time, kava was already starting to put quite a dent in the pharmaceutical money pool.

Of course, many kava enthusiasts were incredibly unhappy about these bans – and doctors, researchers and health practitioners went to work to fight for the restored image of kava kava. One pressing point that encouraged these researchers and enthusiasts was how Vanuatans and other island populations had been drinking daily doses of kava for centuries and had no reported issues relating to the problems that the BfArM studies were declaring. Many studies have been done, and are still being done, that point out areas of flawed research practice and inconclusive evidence within the BfArM and related studies; and thank the kava gods for that – most of the bans that had been emplaced have since been lifted!

I’ve done a bit of tinkering around on the worldwide web and it seems that the ban was partially repealed in Germany back in 2005. At that time Mathias Schmidt, PhD, a kava researcher and scientist, said the following: “We are glad that the discussion is now re-opened, and we hope to finally come to a constructive dialogue with the BfArM”.

So, given all of the recent news circulating about a current repeal of the ban on kava in Germany – this does leave me a bit confused. My guess is that there has been further development in the repeal and that now residual aspects of the initial ban that lingered after the first repeal have now also been lifted; residual aspects that likely made the sale and import of kava quite problematic.

Dr. Vincent Lebot – an author and researcher on kava – states that the battle for the import and sale of kava in the US and EU, which has greatly affected exports in Vanuatu, has lasted twelve years! So, it does seem that this fight for kava has been an ongoing and transitional phenomenon, with the most recent victory happening in the Federal Administrative Court of Germany: “The court found the risk of using kava was not unusually high and mere doubts over a medicinal product did not justify it being banned.”

As Dr. Lebot says, “it’s a clear victory for all of us who know that when kava is properly used with the right varieties cultivated with the right agricultural practices in a reasonable way, we know that it’s not a dangerous product.”

I think it’s probably the grandest victory of all for the South Pacific Island communities, many of whom rely on international kava trade and export to survive.  As product sales in the EU, United States of America, Canada, and elsewhere continue to escalate and become more fluid and less legally problematic, export out of the South Pacific Islands will increase and the island communities will greatly benefit in so, so, so many ways! Not only are the loving benefits of kava being spread worldwide – but also, pressing financial needs and socioeconomic conditions in the island nations will be significantly appeased.

On that note, I will once again send many thanks to the kava spirits and mythical gods for these victories and can only hope for many more to come!!

Mahalo,

Kava Guru

Sources:

Radio New Zealand: http://www.radionz.co.nz/international/pacific-news/246963/german-court-overturns-kava-ban

Kona Kava Farm: http://www.konakavafarm.com/kava-germany-banned.html

Richter’s Website: http://www.richters.com/show.cgi?page=Issues/kava.html

More Evidence Suggests Kava Does not Cause Liver Problems When Used Correctly

KG-Kava Studies 211X300We have all heard of and are plagued by the infamous “German Study”, and others studies, that indicate that kava kava might cause liver problems (hepatotoxicity) – but, I am pleased to yet again offer some new insight into the fallible nature of those studies. Recently, at an Oxford annual conference on the ‘science of botanicals’, a presentation was given on new research findings about Kava that offer further evidence to suggest that pure kava kava, used correctly, does not cause liver damage! And furthermore, that Kava is actually a healthy and desirable dietary supplement, when used correctly.

At the annual Oxford conference – the International Conference on the Science and Regulation of Botanicals (ICSB), hosted by the National Center for Natural Product Research (NCNPR) – Chris Xing, Ph.D, an assistant professor at the University of Minnesota, gave a presentation on recent research findings with regard to Kava that outlined just how the German studies could have been wrong [4].

In an interview with Steve Myers – Senior Editor of Natural Products INSIDER – Dr. Xing discusses the highlights of the presentation at some length. According to Dr. Xing, it’s possible that those studies used a strain or cultivar called “Tudai Kava”. This particular strand carries a high amount of a chemical that “compromises liver function or detoxification function that may contribute to the observed hepatotoxicity among kava users” [4].

Dr. Xing and his associates, believe that the hepatotoxic cultivar “… got into the market mainly because it grows faster and offered a higher yield” [4], which stands as a warning to all of us to always do research about a product before using it! It is important to realize that, like with anything, companies will always find ways to make money faster and sometimes the ways companies choose to do this might not always be beneficial to the consumer, and can sometimes even be damaging!

According to Dr. Xing the hepatotoxicity reports then, which were very few as it is, are “probably due to a wrong cultivar, not recommended for traditional use” [4].   This information is consistent with other studies and findings on Kava that indicate the failings of the German studies. For example, an article in the Journal of Toxicology – “Liver function test abnormalities in users of aqueous Kava extracts” – discusses how island populations that have been using kava kava for centuries have no reports of problems with liver function directly related to kava use [2].

We are all very fortunate that these findings are surfacing and the reputation of Kava is being rectified, as it does provide many benefits to people, such as relaxation and anxiety relief. As Dr. Xing says, “We believe that Kava, with proper standardization, removing its hepatotoxic species…will benefit humans as an anxiolytic and dietary supplement”.

“Kava kava had a rise and a fall, and right now it looks like it’s coming back”, says Dr. Xing in his interview with Myers of INSIDER [4]. And this is wonderful news for everyone, because kava kava provides a wonderful alternative to harmful pharmaceuticals used to combat anxiety and stress-related symptoms.

Some sources, such as statisticbrain.com and the American Psychology Association (APA), indicate a rise in stress, anxiety and other related symptoms, as well as that over 70% of the United States of America’s population suffers from such symptoms [1]. Many people turn to medicinal means to combat the pain and suffering they experience as a result of mental health problems – like stress, anxiety and related symptoms. In the Western world these medicinal means have traditionally been pharmaceutical or at the very least synthesized chemical solutions. But, these solutions are damaging people’s bodies and minds! There have been reports of pharmaceuticals, like Prozac, causing brain damage that results in the development of tics and other neurological disorders [3]. Yuck, how terrible!

Fortunately, the scientific and medical community is coming to terms with the real problems that pharmaceutical and chemical solutions can cause, and more and more people are turning to natural alternatives like kava kava as an answer to their problems. I am so grateful that a better understanding of Kava is being brought to the forefront of the scientific community by Dr. Xing and others like him, so that people can see and experience just how wonderful Kava is as a healthy supplement option!

Sources:

1. American Psychological Association – American Institute of Stress, NY.  July 28, 2013. Online: http://www.statisticbrain.com/stress-statistics/

2. Clough AR, Bailie RS, Currie B.  “Liver function test abnormalities in users of aqueous kava extracts”.  Journal of Toxicology. 2003. 41(6):821-9. http://www.ncbi.nlm.nih.gov/pubmed/14677792

3. Lamvert, Craig. “The Downsides of Prozac”. Harvard Magazine, June 2000. Online: http://harvardmagazine.com/2000/05/the-downsides-of-prozac-html

4. INSIDER T.V. “New Science May Boost Kava Market”. Online: http://www.naturalproductsinsider.com/videos/2014/05/insider-tv-new-science-may-boost-kava-market.aspx

I’m Pregnant – Can I Take Kava?

Dear Kava Guru,

I’m pregnant, can I take Kava?

Marissa, Denver, CO

Dear Marissa,

This is quite a common question, and I will give you the stock answer first:  “The Kava Guru is not a doctor and cannot dispense medical advice.  Please seek the advice of your family doctor if you want to take Kava during your pregnancy.”

And now, the answer that has been gathered from doctor’s opinions, research papers, and stories taken directly from the people of Oceania who have used this amazing plant safely for thousands of years:

 Unfortunately, the short answer is that not enough is known about kava’s safety in pregnancy to recommend it. To give you a better idea of why this is, let’s take a look at kava kava’s common effects: kava is used as a sedative and anxiolytic because of its tranquilizing and antispasmodic properties. In other words, kava calms the central nervous system and also acts as a muscle relaxant. It has been suggested that kava’s relaxant properties could have a negative effect on uterine tone [1].

When questions of kava safety arise, the first thing to look at is the anecdotal evidence. Kava’s history stretches back thousands of years: in the South Pacific, the root has been used medicinally for pain relief, insomnia, urinary infections, and other conditions. According to Principles and Practice of Phytotherapy, kava kava has also been used to help women more easily give birth and to correct displacement of the womb [4]. However, the book goes on to say that a combination of kava and other pepper species has also been used to induce miscarriage. In Hawaii and Polynesia, the kava leaf was used topically for the same purpose [4]. However, the Kava Guru would like to point out that kava leaf is known to be poisonous to humans. In contrast, the kava root has been proved safe for human consumption by thousands of years of traditional use.

The American Pregnancy Association has given kava a rating of possibly unsafe for use in pregnancy, mostly because there isn’t enough known about the effect of kavalactones on a developing baby. It isn’t known whether kavalactones can be transmitted to the fetus in the womb, and the same kavalactones that are perfectly harmless in an adult might still be harmful for fetuses whose livers and brains are developing [1]. Many prescription anti-anxiety medications such as Valium are listed as unsafe for use in pregnancy because they can harm the developing fetus [2].

It’s also possible that kava kava may weaken the muscles around the uterus, which could lead to miscarriage or premature delivery [3]. Finally, kava’s sedating effects could amplify the effect of anesthesia if a mother must be sedated during labor for any reason [2]. Physicians recommend that patients stop use of any herbal supplement with sedative effects (such as passionflower, valerian, or kava) 2 weeks before any medical procedure involving anesthesia.

While there are few definitive studies of kava’s safety in pregnancy, a good starting place for herbal safety in pregnancy can be found in this 2002 literature review [3]. Based on the research, it is the Kava Guru’s opinion that kava should not be used in pregnancy. In those times when anxiety or stress becomes an issue during pregnancy, it may be possible to consult a holistic health care practitioner about herbs that are definitively safe in pregnancy, or about other stress-busting techniques such as prenatal yoga and meditation that can help you feel calm and ready for this change.

Mahalo,

Kava Guru

REFERENCES

1. The American Pregnancy Association. “Herbs and Pregnancy”. Last modified January 2013. http://americanpregnancy.org/pregnancyhealth/naturalherbsvitamins.html 

2. Livestrong.com. “Kava Kava and Pregnancy”. Last modified February 7th, 2014. http://www.livestrong.com/article/184996-kava-kava-pregnancy/

3. Ernst, E. March 2002. “Herbal medicinal products: are they safe during pregnancy?” British Journal of Gynaecology 109 (3): 227-235.

4. Bone, Kerry and Simon Mills. Principles and Practice of Phytotherapy: Modern Herbal Medicine, 2nd ed. Churchill Livingstone, 2013: pg. 711.

 

 

How Much Kava To Take?

Dear Kava Guru,

How much Kava is the right amount of Kava for a relatively healthy 185lb man in his 30’s?

Chris, Austin, TX

Kava dosage and how much kava you take has everything to do with the type of kava you’re taking, as well as your body type and weight.  To answer your questions, first, we always suggest following the directions on each individual package of kava that you purchase.  On that package, if it’s from a legitimate kava company or farm, will be the standard “Supplement Information” panel on the package, giving serving suggestions.

But I understand that these instructions don’t always cover you! This dietary supplement has so many methods of ingestion that it can get quite confusing quite quickly.  At least know that there is no single dangerous kava dosage.

First, there’s good old fashioned kava root.  This typically comes as a powder, and needs to be extracted. Most of the kava recipes we’ve found use a ratio of 1 tablespoon of powdered kava root to 1 cup of water [1]. Sometimes a vegetable fat is added, such as a teaspoon of soy lethicin or vegetable oil [3]. This will act as an emulfisier to help extract the kavalactones into the water. Alternatively, you can substitute some of the water for a fatty liquid such as coconut milk—one effective recipe calls for 2 cups of water and 1 cup of coconut or another nut milk. Since some kavalactones are soluble in fats and others in water, combining the two will help you make a stronger kava drink.

The usual serving of prepared kava in the South Pacific is 2 to 4 fluid ounces. Depending on how it’s prepared, a bilo (coconut shell bowl) of kava can contain anywhere from 150 to 500 mg of kavalactones, and indigenous islanders often consume several bilos in a kava drinking session [2]. In other words, although the Kava Committee has issued an advisory upper limit of 300 mg of kavalactones per day, many Pacific Islanders consume far higher doses of this wondrous plant daily without ill effects. If you’re planning to make kava the traditional way from powdered root, the Kava Guru suggests starting with the standard recipe and seeing how it works for you. You can always adjust the ratio of kava to water, and thus the strength of your brew, until you achieve a satisfying result.

I know that the imprecision of the traditional method will not appeal to everyone. If you want to know the precise amount of kavalactones in your serving of kava, consider a supplement that contains a kava extract, such as an instant drink mix, kavalactone paste, or capsule. For most people, the smallest effective dose of kavalactones is about 70 milligrams. One of the Kava Guru’s favorite kava-related blogs offers this rubric for determining how many milligrams of kavalactones to take: in general, 70-210mg of kavalactones is the average effective dose for reducing stress and anxiety [2]. Between 150 and 250 milligrams is more useful for addressing insomnia, especially if it is taken an hour to 30 minutes before bed [2].

Note that some kava supplements list kavalactones as a percentage rather than in milligrams. In this case, you’ll have to calculate the milligrams of kavalactones per serving based on the total number of grams or milligrams in one serving of the supplement. For instance, a kava capsule that is 30% kavalactone will contain 30mg of kavalactone per 100mg of material. To reach the average threshold dose of 70mg of kavalactone, you must take 230 mg of the supplement. However, should you choose a supplement that combines kava with other relaxing herbs such as chamomile, lemon balm, or valerian, the required dosage of kavalactones may be less because the other herbal ingredients will contribute to the supplement’s relaxing effects.

It’s true that every body is different, and you may find yourself needing a larger (or smaller) kava dosage for satisfying effects. Where it gets tricky is that kava can sometimes have reverse tolerance, meaning that the new kava drinker won’t feel any effects the first few times they try kava [2]. Some people interpret reverse tolerance to mean that kava doesn’t work on them. The Kava Guru’s advice is to be patient with kava, as reverse tolerance usually goes away after a few kava sessions. With patience and a little experimentation, the Kava Guru is confident you will find the right amount of kava for your individual constitution.

Mahalo,
Keith

REFERENCES

1. “Kava Recipes for Kava Drinks.” Kona Kava Farm. Accessed March 4th, 2014. www.konakavafarm.com/recipes.html.

2. “Kavalactones Dosage”. Kava.com. Accessed March 4th, 2014. http://www.kava.com/?p=587.

3. “Kava Brew Recipe”. The Vaults of Erowid. Last modified February 5th, 2011. https://www.erowid.org/plants/kava/kava_recipe1.shtml.

Can I Combine Alcohol And Kava?

Can I Combine Alcohol and Kava?There isn’t an affirmative “yes” or “no” answer to this question.   Will it kill you to combine alcohol and kava kava? No – unless of course you ingest more than you should of either kava or alcohol.  However, there is a body of scientifically backed information that would suggest that you should never combine alcohol and kava.  Furthermore, many people prefer kava kava to alcohol, and it is used quite widely as a complete alternative to drinking alcohol.

Now for some lengthier Kava Guru wisdom on the topic of combining alcohol and kava kava (Piper Methysticum):

Many people enjoy drinking alcohol and kava at the same time because of the heightened effect of each and the quicker onset of their sought-after effects. Of course quantity is of key importance here – it would never be recommended that one drink either kava kava or alcohol in high quantities, either alone or in combination with each other.  It would be no different than the recommendation not to combine anything else that is mind-altering or medicinal with each other, or specifically with alcohol.

Additionally, some traditional ceremonial procedures involving kava kava actually include the ingestion of alcoholic beverages before or after the process.   There has also been a recent development of  “kava bars” in the Western world and some of these kava bars serve alcohol along with kava kava drinks.  For example, some people enjoy sipping on kava kava beverages while taking a shot of alcohol at various points in between [4].  Furthermore, ethanol is used in the process of commercial kava kava extraction at percentages upwards of 60% and Western herbal medicine traditionally uses 25% ethanol to 75% water as the solvent base for tinctures [6, p.674].  However, just because many people choose to combine alcohol and kava kava does not mean that it is the wisest thing to do.

True to my Guru nature, I would like to bring to your attention all relevant bits of knowledge I am privy to, and would like to tell you a bit about the evidence that suggests the combination of alcohol with kava kava could increase the risk of liver damage or toxicity.

Many of the cases that have surfaced regarding kava kava and liver damage have been proven to be unsubstantiated, strictly because it was proven that alcohol could have played a role.  The kava kava used in these studies was commercially extracted and, as noted above, commercial extracts often carry ethanol in their solvent bases.   Whereas studies conducted with the use of pure kava kava (with no alcohol) have not surfaced any evidence of liver toxicity. Although there is some indication to suggest that the addition of glutathione (an organic chemical that helps with the metabolization of kavalactones) may have a levelling effect that prevents hepatotoxicity [6, p. 676]. This could then suggest that the alcohol may have been the variable responsible for liver damage, or that the combination of kava kava and alcohol was responsible.

This brings us to a discussion of what actually happens to the liver when kava kava and alcohol are used in combination.  The liver makes use of the enzyme CYP 2E1 for the metabolizing of alcohol.   There have been studies that suggest CYP 2E1 is also used in the metabolizing of kavalactones (kava kava compounds) [3, p.476].   If both substances are metabolized by the same enzyme or altogether have a similar enzymatic pathway – then it is quite possible that when used in combination, the metabolic pathways become stressed and hepatotoxicity (toxic liver damage) may be more likely to occur.

Furthermore, kavalactones do temporarily alter the functioning of various liver enzymes, including gamma-glutamyl transferase and alkaline phosphatase [7].  Some of the affected enzymes may be used during the metabolic processes of breaking down ethanol (alcohol) [3, p. 475-477].  As a result, it is possible that enzymes used in the metabolization of alcohol are temporarily affected while the liver processes kava kava.  If this is the case, then it is likely that when kava kava is in the system, the liver may not be able to properly metabolize alcohol and could then experience hepatotoxicity if the substances are combined.

In an entirely different vein of discussion with regard to the combination of alcohol and kava kava – kava kava is actually widely used as a preferred alternative to drinking alcohol and has been recommended by physicians to patients with alcoholic substance abuse problems [6]. Given the many similar side effects that kava kava and alcohol share – relaxation, mood elevation, release of inhibition, anesthesia, muscle relaxation, and more – many people enjoy kava kava as a valuable alternative to drinking alcohol [1].   Kava kava is not a central nervous system depressant, and in this way varies from alcohol.  Furthermore, kava kava is not physically addictive, like alcohol [2] – which would explain its use in the therapeutic treatment of alcoholism [6].

Kava Guru thinks it breaks down to this: no, it won’t kill you to combine alcohol with kava kava, nor will your system be greatly damaged with small doses of the combined substances.  However, given the studies discussed above – it is perhaps best to avoid the combination as much as possible.  Additionally, kava kava provides all of the pleasant effects of alcohol consumption with the added benefit of nonaddiction. So really, it’s no wonder that kava kava is growing in popularity as a complete alternative to alcohol!

Mahalo,

Kava Guru

REFERENCES

1. Cassileth, Barrie, PHD.  “Oncology”. United Business Media LLC, San Francisco: April 15, 2011. Vol. 25-4 p. 384-385.

2. Craig, Winston J.  “Kava kava: Antidote for Anxiety”. Vibrant Life, Hagerstown: January, 2002. Vol. 18-1 p. 42-43.

3. Li and I. Ramzan. “Role of Ethanol in Kava Hepatotoxicity”.  University of Sydney – Faculty of Pharmacy, Sydney: November 26, 2009.  Phytotherapy Research 24: p. 475-480.

4. Makaira. “Do Kava and Alcohol Combine?”  Makaira’s Kava Kava Blog: January 1, 2010. http://www.konakavafarm.com/blog/?p=231

5. Mcdonald, Jim. “Kava kava – Piper Methysticum”.  http://www.herbcraft.org/kava.html

6. Whitton, Lau, Salisbury, Whitehouse and Christine S. Evans. “Kava Lactones and the Kava-Kava Controversy”. Pergamon: June 5, 2003. Phytochemistry 64: p. 673-679.

7. Wikipedia. “Kava-Toxicity and Safety”. Last modified: February 21, 2014. http://en.wikipedia.org/wiki/Kava#Toxicity_and_safety