Vol.3, # 16
April 29, 2006

Q: What is Kava Kava and what is it good for? - Layperson

A:
Kava
Scientific classification
Kingdom: Plantae
Division: Magnoliophyta
Class: Magnoliopsida
Order: Piperales
Family: Piperaceae
Genus: Piper
Species: P. methysticum
Binomial name
Piper methysticum
G.Forst.
A:  Kava (Piper methysticum) is an ancient crop of the western Pacific. Other names for kava include `awa (Hawaii), 'ava (Samoa), yaqona (Fiji), and sakau (Pohnpei). Kava is related to the black pepper; both have heart-shaped leaves and flowers similar to the flower spike of the anthurium. Kava also has a peppery taste. Kava has long been a part of religious, political, and cultural life throughout the Pacific.

Kava (Piper methysticum) is an age-old herbal drink that was the beverage of choice for the royal families of the South Pacific. Believed to originate from Melanesia, kava grows abundantly in the sun-drenched islands of Polynesia. Although drank for centuries by the islanders, it was only during Captain Cook’s voyage to the Pacific in 1768-1771 when white man first encountered the plant and its consumption in sacred ceremonies. According to Cook’s account, natives chewed or pounded the root and mixed it with water to produce a brownish, often bitter brew which they then consumed for its psychoactive properties.

Pharmacology

Pharmacologically, kava is not addictive. Its active principal ingredients are the kavalactones, of which there are six major ones used to identify the chemotype of a particular variety. While kava has been considered to be relatively safe, some kava herbal supplements may contain pipermethystine from aerial stem peelings which may contribute to rare but severe hepatotoxic reactions to kava.

Chemical Composition: Analysis of the composition of kava rootstock indicates that fresh material on average is 80 percent water. When dried, rootstock consists of approximately 43 percent starch, 20 percent fibers, 12 percent water, 3.2 percent sugars, 3.6 percent proteins, 3.2 percent minerals and 15 percent kavalactones, although the kavalactone component can vary between 3 percent and 20 percent of rootstock dry weight depending on the age of the plant and the cultivar. The active principles of kava rootstock are mostly, if not entirely, contained in the lipid-soluble resin. The isolates of kava resin fall into three general categories: arylethylene-a pyrones, chalcones and other flavanones, and conjugated diene ketones. The compounds of greatest pharmacological interest are the substituted a -pyrones or kava pyrones, commonly called kavalactones. Fifteen lactones have been isolated from kava rootstock. The following six compounds are present in the highest concentrations and account for approximately 96 percent of the lipid resin: yangonin, methysticin, dihydromethysticin, kavain, dihydrokavain, and demethoxyyangonin (5,6-dehydrokavain).

All kavalactones are physiologically active, though it is the fat-soluble kavalactones derived from kava resin that have the greatest effect on the central nervous system. Kava also has a direct effect on muscle tension similar to tranquilizers. The activity of the kava rhizome is related to several arylethylene pyrones similar in structure to myristicin, which is found in nutmeg.

Kava is mildly narcotic and produces mild euphoric changes characterized by elevated mood, fluent and lively speech and increased sense of sound. Numerous clinical studies of Kava have shown it to be an effective natural remedy for helping to relieve anxiety and depression symptoms. In double-blind, placebo controlled clinical trials, a majority of users reported a lowered HAM-A (Anxiety Test) and HAM-D (Depression Test) scores as a result of taking Kava for 1 to 8 weeks. 58% of those taking Kava Kava reported feeling much better within 2 weeks!Higher doses can lead to muscle weakness, visual impairment, dizziness and drying of the skin. Long term use of the herb can contribute to hypertension, reduced protein levels, blood cell abnormalities, or liver damage. Alcohol consumption increases the toxicity of the pharmacological constituents. It is not recommended for those who intend on driving or where quick reaction time is required.

 The effect on the nerve centres is at first stimulating, then depressing, ending with paralysis of the respiratory centre. The irritant action and insolubility of the resin has lessened its use as a local anesthetic, but for over 125 years Kava root has been found valuable in the treatment of gonorrhoea both acute and chronic, vaginitis, leucorrhoea, nocturnal incontinence and other ailments of the genitourinary tract. It resembles pepper in local action. A 20 per cent oil of Kava resin in oil of Sandalwood, called gonosan, is used internally for gonorrhoea. Being a local anaesthetic it relieves pain and has an aphrodisiac effect; it has also an antiseptic effect on the urine. The capsules contain 0.3 gram; two to four can be given several times per day. As Kava is a strong diuretic it is useful for gout, rheumatism, bronchial and other ailments, resulting from heart trouble.

Kava is the most relaxing botanical herb with exception of the opium poppy. Pharmacological studies show kava kava's active ingredients, kavalactones, produce physical and mental relaxation and a feeling of well being. It has also been used in the treatment of ailments of the genitourinary tract including vaginitis, gonorrhea and menstrual cramps. Kava is a diuretic and an anti-inflammatory, thus useful for gout, rheumatism, bronchial congestion, cystitis and prostatis. It is an effective local anesthetic and pain reliever when applied externally as a liniment. The relaxed state and sharpening of senses also contribute to aphrodisiac effect.

Preparation

Kava root drying in Lovoni village, Ovalau, Fiji
Kava root drying in Lovoni village, Ovalau, Fiji

Kava is traditionally consumed as a herbal tea; that is, an infusion made from straining a mixture of water and shredded, pounded, dried, or fresh root and/or stump. The plant may also be chewed as part of preparing kava; this will affect the final product due to the enzymes in saliva. The extract is an emulsion, consisting of suspended kavalactone droplets in a starchy suspension. The taste is slightly pungent, while the distinctive aroma varies if prepared from dry or fresh material, and by variety. The color is grey to tan to greenish opaque.

Perhaps the simplest method of making the tea is to put two or more heaped tablespoons of kava root powder per person into a clean sock or stocking, tie a knot in it, and squeeze it repeatedly in a bowl of cold water. An even easier method is to whisk up root powder and cold water in a blender. In the west, it is often taken in pill form.

Kava can also be combined with coffee to produce kavajava, the effects of which are said to combine the most pleasant qualities of each.

Medicinal kava

In the Western world, kava is used as a herbal remedy to ease the symptoms of stress, anxiety, and depression.

On 15 February 2006, the Fiji Times and Fiji Live both reported that researchers at the University of Aberdeen in Scotland, and the Laboratoire de Biologie Moleculaire du Cancer in Luxembourg had discovered kava was effective in the treatment of ovarian cancer and leukaemia. Kava compounds inhibited the activation of a nuclear factor that led to the growth of cancer cells. Aberdeen University had published its findings in the journal, The South Pacific Journal of Natural Science, that kava methanol extracts had been shown to kill leukaemia and ovarian cancer cells in test tubes. The kava compounds were shown to work selectively, passing healthy cells by and targeting only cancerous cells.

Fiji Kava Council Chairman Ratu Josateki Nawalowalo welcomed the findings, saying that they would boost the kava industry. For his part, Agriculture Minister Ilaitia Tuisese called on the researchers to help persuade members of European Union to lift their ban on kava imports.

Effects

The effects of drinking kava, in order of sensation, are slight tongue and lip numbing caused by the contraction of the blood vessels in these areas (the lips and skin surrounding may appear unusually pale); mildly talkative and euphoric behavior; calming, sense of well-being, clear thinking; and relaxed muscles. Sleep is restful and there are no after-effects the next day.

Other interesting uses of kava include dispensation to military personnel (Fiji) to aid in vigilance and anxiety reduction; to provide concentration, focus, and muscle control before sports and music performances; to reduce the anxiety associated with public speaking and other public performances; use in corporate board rooms to aid in mental clarity, sociability and improved decision making.

Some indigenous communities in Australia have encouraged the use of kava as a safer alternative to alcohol. Many of these communities have problems with alcohol abuse and related violence.

Safety

Recently, concerns have been raised about the safety of kava. There have been several reports of severe liver toxicity, including liver failure in some people who have used dietary supplements containing kava extract. While a conclusive link to kava has not been established, the severity of liver damage have prompted action of many regulatory agencies. Regulatory drug agencies in Germany, France, and Switzerland have outlawed kava completely. The health agency of Canada issued a stop-sale order for kava in 2002; however, subsequent legislation in 2004 renders the legal status of kava in question. The United States CDC has released a report expressing reservations about the use of kava and its possibly adverse side effects (specifically severe liver toxicity), as has the FDA. Some counter that the cases resulting in the liver toxicity included concomitant use of alcohol or other drugs. Another claim is that kava extracts used by patients experiencing liver toxicity were made with solvents other than the traditional water and that the whole plant was used rather than just the roots. The issue is controversial and debate is fuelled by economic interests of kava-exporting nations of the Pacific Islands as well as disagreements between the medical establishment and proponents of herbal and natural medicine.

There is ongoing research into the causes of kava liver toxicity and why it apparently does not affect traditional kava users. One study at the University of Hawaii at Manoa found that an alkaloid called pipermethystine may be responsible for the liver toxicity cases, based on its effects on liver cells in vitro. This alkaloid is found primarily in stem peelings and leaves of the plant, but is not present in the roots; users of kava in the South Pacific have traditionally discarded the peelings and leaves, using only the roots for the consumed product. However industrial production of kava extracts encouraged the use of these peelings and leaves because of their higher concentrations of the psychoactive kavalactones. Industrial use of peelings and leaves was aided by the fact that traditional producers considered them a waste product and sold them inexpensively as compared to the roots. Since traditional users avoided consumption of these parts of the plant, this may explain the extensive use of kava in the Pacific with no ill effects, whereas the novel use in Europe and America witnessed cases of liver toxicity due to improper use of the plant.

Heavy use of kava is associated with kava dermopathy, a scaly eruption of the skin which is reversible by discontinuing its use. It is considered to be a harmless curiosity. Ancient Hawaiians would drink copious amounts of kava to encourage this in order to bring about a smoother layer of new skin. With normal use kava dermopathy is non-existent.

Dr. Ifereimi Waqainabete of the Fiji School of Medicine told the a conference of the Pacific Islands Surgeons Association on 7 March 2006 that kava adversely affected a person's nervous system. Students under the influence of Kava had proved unable to correctly complete a symbol test, he claimed.

The Australian Therapeutic Goods Administration has recommended that no more than 250mg of kavalactones be taken in a 24 hour period.

Anxiety and Insomnia

Also for nervousness, stress, and restlessness. Kava-lactones may have anti-anxiety, analgesic (pain relieving), muscle relaxing, and anticonvulsant effects. Studies suggest that kava directly influences the limbic system, the ancient part of the brain associated with emotions and other brain activities.

Whereas benzodiazepine tranquilizers can be addictive, impair memory, and worsen a depression, kava improves mental functioning and mood and is not addictive. 

In a 1996 randomized, placebo-controlled, double-blind study, two groups of 29 patients with anxiety syndromes were treated with 100 mg of kava extract standardized to 70- percent kavalactones three times a day for four weeks. The symptoms of anxiety were significantly reduced in patients taking kava as compared to placebo. No adverse reactions were observed in the kava group. 

In a 1997 multi-center, randomized, placebo-controlled study, a total of 101 outpatients were given one capsule of a kava extract containing 70 mg of kavalactones or placebo three times daily. In this twenty-five-week study, all the patients suffered from moderate to severe anxiety, including agoraphobia, generalized anxiety disorder, specific phobia, and social phobia. The results showed that the short- and long-term effectiveness of kava was superior to that of placebo. After twenty-four weeks, over half of the kava group were rated as "very improved": anxiety, fear, tension, and insomnia decreased steadily with treatment. Kava was well tolerated, and adverse reactions were mild and rare. The researchers concluded that kava was a treatment alternative to both benzodiazepines and synthetic antidepressants for anxiety disorders. 

Description:

Kava is a member of the pepper family and is native to many Pacific Ocean islands. The rhizome (root stock) is used.

Dosage:

Take extract supplying 140-210 mg of kava-lactones per day. Alternatively, 1-3 ml of fresh liquid kava tincture can be taken.

Kava pills come in different strengths, usually from 100 to 250 mg, and the percentage of kavalactones (the active chemicals in kava) in the extract can vary from 50 to 70 percent. The dosage used in most clinical studies for anxiety is three daily 100-mg doses of kava extract standardized to 70- percent kavalactone content, which research has shown can be as effective as the benzodiazepine drug Serax (oxazepam), 15 mg daily. A 70-percent kava extract is not yet commercially available in the United States. 

Enzymatic Therapy has a 150-mg capsule of a 55-percent kava extract, which would contain 82.5 mg of kavalactones.  It is best to begin with a total daily dosage of 70 to 85 mg of kavalactones, taken in the evening. Stay on one capsule if it effectively reduces anxiety. If it is not enough, you can add a second pill in the morning. Remain on this twice daily dosage for at least a week. If you still feel tense or fearful after that, add a third capsule in the middle of the day. When you consistently feel more relaxed, gradually decrease your dosage by one pill every few days. 

Do not take kava on a daily basis for longer than twenty-five weeks (four to six months). When used in small amounts on an occasional basis, it can be used longer, if necessary. If 70 to 85 mg of kavalactones three times a day is not effective for your anxiety, see your doctor for a reevaluation to see if taking more kava is indicated or if you may require a prescription drug. 

Safety:

March 25, 2002: The US Food and Drug Administration has warned consumers that kava may be linked to serious liver injury.

FDA recommends that kava users should consult a doctor if they experience any possible symptoms of liver disease. These include jaundice, or yellowing of the skin or eyes; brown urine; nausea or vomiting; light-colored stool; unusual tiredness or weakness; stomach or abdominal pain; or loss of appetite. People who already have liver problems should ask a doctor before taking kava. Due these complications of Kava, it has been banned in some countries such as Canada.

Serious toxic reactions can develop when kava is not used with care. High doses can cause:

bullet Visual and skin problems
bullet Muscle weakness
bullet Disorders of complex movement, accompanied by undisturbed consciousness
bullet Tiredness
bullet Sleepiness
bullet Central nervous system depression
bullet Breathing problems

If kava is used over extended periods of time, a syndrome referred to as "kawaism" or "kawa dermopathy" may develop, with such symptoms as:

bullet Reddened eyes
bullet Scaly skin eruptions
bullet Yellowish discoloration of skin, hair, and nails

Heavy users of kava are likely to experience health problems such as:

bullet Rashes
bullet Puffiness in the face
bullet Weight loss
bullet Blood in the urine
bullet Blood abnormalities

These may be aggravated by the heavy use of alcohol and cigarettes. 

At ten times the recommended dosage, consumed for many months, some heavy drinkers of kava root in the Polynesian islands have developed a scaly eruption or yellowing of the skin associated with muscle spasms, biochemical abnormalities, vision disturbances, and even shortness of breath. These disturbances go away quickly when kava is discontinued. Large intake of kava is unnecessary and strongly discouraged. At the recommended therapeutic levels, no such side effects have been reported. 

In recommended doses, some people may experience mild gastrointestinal disturbances. Do not take kava if you are taking other medication or substances that also act on the central nervous system, such as alcohol, barbiturates, antidepressants, and antipsychotic drugs.

Unless you are under medical supervision, do not combine kava with benzodiazepine tranquilizers. It has been reported that a patient became disoriented and lethargic after combining Xanax ( alprazolam ) and kava, requiring brief hospitalization. If you are taking a synthetic tranquilizer, you should be gradually withdrawn from it under medical supervision before beginning kava. 

Don't take Kava if you are suffering from Parkinson's disease, because it might worsen muscular weakness and twitching. Some people suffer an allergic reaction to kava. Care should be taken when driving or operating machinery. People who are elderly or medically ill should take smaller doses of kava and only under a doctor's supervision. Kava is not recommended during pregnancy or breast-feeding or for severe anxiety disorders and depression. 

Do not take kava if you are diagnosed with clinical depression; it increases the danger of suicide.

Secondary substances and other effects

Kava contains several other purportedly psychoactive substances which are not appreciably soluble in alcohol or water, but are soluble in fats. Extractions of these into various vegetable oils with lecithin added are possible. Even though kava is usually an acquired taste, the taste of the resulting mixture is reportedly horrendous. The potential for use of kava as an hallucinogen therefore seems low.

Kava botany & agronomy

There are several cultivars of kava, with varying concentrations of both primary and secondary psychoactive substances. The Republic of Vanuatu is recognised as the 'home' of kava because it hosts the largest number of cultivars. The kava plant has historically been grown only in the Pacific islands of Hawaii, Federated States of Micronesia, Vanuatu, Fiji, the Samoas and Tonga. In modern times (i.e., since WW2) there has been some kava grown in the Solomon Islands, but most kava used in that country is imported. Kava is a cash crop in Vanuatu and Fiji.

The kava plant, a shrub, thrives in sandy well-drained soils and it grows well as an understory crop (i.e., too much sunlight, especially in early growth, is deleterious). It grows naturally where rainfall is plentiful (over 2,000mm/yr). Traditionally, plants were not harvested until they were at least 5 years of age, as older plants have higher concentrations of kavalactones. However, over the past two decades farmers have been harvesting younger and younger plants--even as young as eighteen months. Older plants are not much taller (around 2m.) than younger plants; growth adds diameter to the culm and more stalks than height.

Kava culture and mythology

Main article: Kava culture

A sign showing a "Kava licence area" at Yirrkala, in the Northern Territory of Australia
A sign showing a "Kava licence area" at Yirrkala, in the Northern Territory of Australia

Kava is used for a variety of purposes, medicinal, religious, political, cultural and social throughout the Pacific. These cultures have a great respect for the plant and place a high importance on it.

The Tongans have a story about the origin of kava:

In the place of Fa?imata on the island of ?Eueiki, close to Tongatapu, there lived a man and his wife. Fevanga and Fefafa were their names. They had a baby daughter called Kava?onau, who had a scaly skin disease (possibly leprosy).

Then once upon a time it happened that an important envoy of the Tu?i Tonga king, Lo?au, came to ?Eueiki, and landed his canoe at the house of Fevanga and Fefafa. Customs required that such a high chief was to be received with an abundant meal. But a famine was over the land, and only a kape (Alocasia macrorrhiza) plant was available with no meat at all. In despair the parents killed their little daughter and baked her as a pig in the same oven as the kape.

Lo?au was impressed by the sacrifice the poor people had made for him. He said that he could not eat from their daughter, and that instead she was to be buried as a chief. He ordered her head to be buried on one place, and her body on another place. And then he left. After a time two new, unknown plants grew from the parts. Fevanga tended them until they were mature. Then a rat came and chewed from the plant which was growing from the head, and was as scaly as the skin of Kava?onau had been. The rat became partly paralysed. Next it chewed from the other plant, growing from the girl's intestines, and the animal recovered and ran away.

Fevanga harvested the plants and brought them to Lo?au's residence in Ha?amea on Tongatapu. There Lo?au announced that the first plant was to be called kava, being the daughter of Fevanga and Fefafa, and that it would be the beverage of chiefs from now on. But like the rat, they would also consume in conjunction the second plant, which was to be called sugar cane, to balance the influence of the kava. This myth symbolizes the importance of Kava within the Tongan culture in terms of peace-making, sacrifice, diplomacy and loyalty.

As usual, if  pregnant or having any  health conditions affecting the heart, liver, lungs, or psychological makeup, consult a healthcare professional familiar with kava kava useage.



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