What Is It?
Health Benefits
Dosage Information
Guidelines for Use
General Interaction
Possible Side Effects

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.

Doctors in Europe had long prescribed kava as a gentle alternative to prescription tranquilizers. But things changed quickly starting in 2003 and continuing through 2005. In Europe, approximately 40 reports of liver damage among kava users surfaced over those two years. Six of these people required liver transplants, and the three died. That was sufficient evidence for the governments of Germany and Switzerland to call for an immediate ban on kava products; Canada and Great Britain shortly followed suit.

In Europe, herbal therapies are carefully monitored by governmental agencies comparable to the Food and Drug Administration (FDA). This situation is quite different in the United States. Here, most herbs can be 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, the agency can't act on "adverse event" reports from physicians by recalling it. Rather the FDA simply issues a "warning," which it has done in the case of kava.

The lack of medical supervision regarding herbal therapies is currently reflected in the U.S. data on kava, with only a single case reported so far:a woman who developed liver failure while using the herb. Given the widespread use of kava, it is statistically quite likely that more people had or even still have kava-induced liver toxicity but remain unaware of it. When abnormalities in liver function do occur with kava, they usually clear up within weeks of discontinuing the herb. When drug companies test their products for safety, there is an attempt to determine whether particular liver enzymes can be altered or damaged by drug being tested, so that proper dosing and safe prescribing practices can be advised. Given the regulatory status of kava as an herbal agent which cannot be patented by a drug company, such studies of kava are unlikely to be funded in the US or Europe.

Herbalists in the United States seem to be divided equally about the use of kava. One group recommends no official withdrawal of the herb, but carefully considered use instead. Cautions would include taking the herb for no more than one month, not exceeding dosage recommendations, and avoiding it altogether if there is pre-existing liver disease or if drinking alcohol or taking any medication associated with liver toxicity. They contend that combining kava, acetaminophen(Tylenol), and alcohol would be an extremely dangerous mix, for example. Other herbalists are willing to abandon kava altogether and recommend alternative relaxing herbs such as valerian, passionflower, chamomile, and the amino acid GABA (gamma aminobutyric acid).

Health Benefits

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. Before the current warnings, European physicians prescribed it frequently because it's generally not addictive, and those who take it aren't likely to build up a tolerance to it.

Specifically, kava may help 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 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 is 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 use.

  • 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.

  • Forms

    • tincture
    • tablet
    • softgel
    • liquid
    • dried herb/tea
    • capsule

    Dosage Information

    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).

    --Use only products made solely from kava root. And avoid products that contain any other parts of the kava plant--leaves, stem, and so on. Manufacturers of kava products believe liver toxicity occurred because either the whole plant was used (the aboveground 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, takendaily. 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.

  • Pay attention to 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.

  • Consider alternatives for long-term use. 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.

  • General Interaction

  • 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.

  • Nutritionally oriented doctors in the United States sometimes recommend a short course of kava to take in combination with the antidepressant herb, St. John's wort, an herb that takes about four weeks to start working against depression. The kava, which is immediately effective for anxiety-related depression, can be stopped at this point.

    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.

  • Discontinue kava immediately if you notice any signs of liver toxicity, such as increased fatigue, nausea, loss of appetite, pain over the right upper abdomen, darkening of the urine, and yellowness in the eyes. See your doctor immediately 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 (more than 100 capsules a week) include shortness of breath, blurred vision, bloodshot eyes, difficulty walking, disorientation, and intoxication. If you experience any of these reactions, stop taking kava.

  • Cautions

  • If you have been taking kava on a daily basis for more than four weeks, consult your doctor, who may recommend routine blood tests to check 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.

  • Date Published: 04/18/2005
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