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People native to the South Pacific islands use this kava kava drink during cultural and religious ceremonies to create a state of altered consciousness. People can also make powder or tablets from the dried roots.
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At the end of the study, they found that kava had a small but significant effect on reducing anxiety symptoms. Aside from headaches, the participants did not report liver problems or other side effects.
A review study from 2011 reports that kava kava may improve stress and anxiety. However, the authors say that more research about the safety and effectiveness is needed before it becomes a recommended therapy.
Kava kava is still legal in the U.S. due to its possible uses as a treatment. However, in 2002, the FDA directly warned consumers that kava-based products could cause liver damage. Some of this damage, such as that caused by hepatitis and liver failure, can be severe.
Despite efforts by researchers to develop safe methods of using kava, scientists are still not sure how kava damages the liver. Without this knowledge, it is difficult to know for certain whether kava is safe.
According to a 2002 review of studies involving seven clinical trials and 645 people, kava was deemed to be an "effective symptomatic treatment option for anxiety," even though the effect was considered "small" by the researchers.
Lehrl S. Clinical efficacy of kava extract WS 1490 in sleep disturbances associated with anxiety disorders. Results of a multicenter, randomized, placebo-controlled, double-blind clinical trial. J Affect Disord. 2004;78(2):101-110. doi:10.1016/s0165-0327(02)00238-0
Shimoda LM, Park C, Stokes AJ, Gomes HH, Turner H. Pacific island 'Awa (Kava) extracts, but not isolated kavalactones, promote proinflammatory responses in model mast cells. Phytother Res. 2012;26(12):1934-41. doi:10.1002/ptr.4652
Kava was introduced to the communities in the north of Australia in the 1980s as a substitute for alcohol, to reduce alcohol-related harms in the community. The kava drink is often used for sedative, hypnotic and muscle-relaxant effects, in much the same way that alcohol is used.11
Manufactured products such as herbal remedies that contain kava extract have been linked to irreversible liver damage. Kava has been shown to cause liver damage when taken in an alcoholic or acetonic extract. For this reason water based extracts of Kava ( as a drink or tablet) should not be consumed with alcohol, especially if there is a history of liver damage or disease.5,6
The importation of kava, for food use, is prohibited unless the importer holds a permit issued by the office of Drug Control. A number of regulations must be followed to comply with Imported Food Control Act 1992.8
There is no evidence that people who regularly use kava become dependent on the drug, so if you stop taking it, you are unlikely to experience withdrawal symptoms. However, if you have health problems seek medical advice.5
The most serious concern stems from reports of liver damage in a few people who took kava. In 2002, the FDA released a consumer advisory that warned about the risk of liver disease with the supplements. The herb was linked to cirrhosis (liver scarring), hepatitis (irritation of the liver), and liver failure (this led to a liver transplant or death in a few patients).
It's not clear whether kava caused the liver damage, or if other medications or herbs the people took caused it. Most of the time, the damage improved within a few months after they stopped taking the kava.
In addition to its ceremonial uses, kava is best known for its relaxing qualities. Kava is said to elevate mood, well being, and contentment, and produce a feeling of relaxation. Several studies have found that kava may be useful in the treatment of anxiety, insomnia, and related nervous disorders.
However, there is serious concern that kava may cause liver damage. More than 30 cases of liver damage have been reported in Europe. However, researchers have not been able to confirm that kava is toxic to the liver. It is not clear whether kava itself causes liver damage, or whether taking kava in combination with other drugs or herbs is responsible. It is also not clear whether kava is dangerous at previously recommended doses, or only at higher doses. Some countries have taken kava off the market. It remains available in the United States. But the Food and Drug Administration (FDA) issued a consumer advisory in March 2002 regarding the "rare" but potential risk of liver failure associated with kava-containing products.
A number of clinical studies, though not all, have found kava to be effective in treating symptoms associated with anxiety. In a review of 7 scientific studies, researchers concluded that a standardized kava extract was significantly more effective than placebo in treating anxiety. Another study found that kava substantially improved symptoms after only 1 week of treatment. Other studies show that kava may be as effective as some prescription antianxiety medications. According to one study, kava and diazepam (Valium) cause similar changes in brain wave activity, suggesting they may work in the same ways to calm the mind.
A 2004 study found that 300 mg of kava may improve mood and cognitive performance. That is significant because some prescription drugs used to treat anxiety, such as benzodiazepines (like Valium and alprazolam or Xanax), tend to decrease cognitive function.
Preliminary evidence suggests that kava may help improve sleep quality and decrease the amount of time needed to fall asleep. Due to concerns about kava's safety, and the fact that other herbs can treat sleeplessness, kava is not the best choice for treating insomnia.
The main active ingredients in kava root are called kavalactones (kavapyrones). These chemicals (including kawain, dihydrokawain, and methysticum) have been extensively studied in laboratory and animal studies. They have been found to reduce convulsions, promote sleep, and relax muscles in animals. They also have pain-relieving properties, which may explain why chewing kava root tends to cause a temporary numbness and tingling sensation on the tongue.
Because some people have developed severe liver damage, even liver failure, after taking kava, you should only take it under a doctor's close supervision. If you have liver disease (such as cirrhosis or hepatitis), you should not take kava at all.
The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine. This is particularly true for kava, because there is evidence it may cause liver damage.
Reports in the United States and Europe have linked kava with severe liver problems. Kava-containing products have been associated with at least 25 reports of liver-related injuries (including hepatitis, cirrhosis, liver failure, and death).
We don't know much about kava's effect on the liver. It may be that the kava supplements some people took were contaminated with other substances that caused liver damage. Or it is possible that some people already had liver problems before taking kava, or that they took a combination of kava and other prescription medications or herbs that damaged their livers. It is also possible that the doses generally recommended for kava affect people differently. So a dose that would cause liver damage in one person might have no effect on the liver in another person.
Levodopa.There has been at least one report that kava may reduce the effectiveness of levodopa, a medication used to treat Parkinson's disease. You should not take kava if you are taking any medications containing levodopa or if you have Parkinson's disease.
Medications metabolized by the liver. Because it works on the liver, kava may affect medications that are metabolized by the liver. Speak to your doctor about any medication you are taking before taking kava.
Lehrl S. Clinical efficacy of kava extract WS 1490 in sleep disturbances associated with anxiety disorders. Results of a multicenter, randomized, placebo-controlled, double-blind clinical trial. J Affect Disord. 2004;78(2):101-110.
Wainiqolo I, Kool B, Nosa V, Ameratunga S. Is driving under the influence of kava associated with motor vehiclee crashes? A systematic review of the epidemiological literature. Aust N Z J Public Health. 2015;39(5):495-499.
When it comes to kava, variety matters. There are over 200 different varieties of Piper methysticum, some cultivated and many wild. Yet, only one variety dominates the world markets: noble kava. But, other kava varieties may be a little too potent for regular consumption. In 2002, in fact, the island of Vanuatu banned the export of any kava apart from the noble variety. Noble kava is safe enough to drink in moderation.
Noble kava is cultivated for recreational use in several Pacific Island countries. This variety contains kavalactones and other synergistic compounds, but it is mild enough to drink in moderation. Typically, roots from the noble kava plant are peeled and dried before being made into a drink.
So, why were so many falling ill from kava in the West? Well, quantity and concentration may be part of the answer. The traditional way to prepare kava uses the whole dried root and water. However, in the 1990s, kava preparation became a lot more technical. Supplements and medical products were often made by extracting kava compounds, which removes them from the root and enables consumers to take very concentrated doses of kavalactones.
In a 2016 report, the World Health Organization (WHO) summarized over two decades of research on the health effects of kava. The WHO found that kava extracts and medical products are correlated with greater health risks than traditionally prepared kava, based on the available evidence at the time. 041b061a72