Kava root for stress and anxiety, side effects, safety, risks, toxicity and effect on liver by Ray Sahelian, M.D.

What you will find on this page:
Benefit, dosage, and research information
Kava capsules and liquid supplements
Good Night Rx, a natural herbal product for occasional sleepless nights
 

Kava is the term used for both the plant and the beverage made from it. The beverage is prepared from the root of a shrub called the pepper plant, Piper methysticum, found in Polynesia, Melanesia, and Micronesia. The kava root is ground to a powder, and it has a brownish color. The brownish powder is then mixed with water and drank as a beverage, without being fermented. Extracts from the root are placed in capsules and sold as kava supplements.
   Additional herbs and nutrients involved in relaxation, stress relief and anxiety reductions include Passion-Flower extract, tryptophan, 5-HTP, ashwagandha, lemon balm, theanine, and valerian. See the link at the top of this page for an index. I don't recommend the use of kava in children or by teenagers. Kava should only be used by healthy adults, and only occasionally.

CAUTION: Kava is not the type of supplement, like vitamin C, that you take every day. At most use one kava capsule three times a week and take a full week off each month. In fact, it is preferable to use this herb no more than two times a week. Kava use on a daily basis may harm the liver in some individuals. In very rare cases, daily kava use can lead to severe liver harm that may result in total liver failure. Good Night Rx is a sleep formula that has kava and should not be taken together with other kava products the same day. Do not take a kava supplement if you are taking medications that can harm the liver, such as acetaminophen (Tylenol) or statin drugs for cholesterol such as Lipitor, Zocor. Do not take a kava supplement if you have any kind of liver disease or you are a moderate to heavy alcohol user. Do not take kava if you drink alcohol daily.

Suggested Use: One kava tablet or capsule a day or as needed. Do not exceed 2 kava capsules a day. It's best not take kava more often than 3 days a week. Take a week off each month. Some people open the capsules to make a kava tea or drink in a kava bowl, but it doesn't taste that good. Discontinue use if unusual symptoms occur

Warning: Ask a health care professional before use if you have or have had liver problems, frequently use alcoholic beverages, or are taking any medication including acetaminophen (Tylenol). Stop and see a doctor if you develop symptoms that may signal liver problems (e.g., unexplained fatigue, abdominal pain, loss of appetite, fever, vomiting, dark urine, pale stools, yellow eyes or skin). Not for use by persons under 18 years of age, or by pregnant or breastfeeding women. Not for use with alcoholic beverages. Excessive use, or use with products that cause drowsiness, may impair your ability to operate a vehicle or heavy equipment. Kava should not be taken on a daily basis. Take frequent breaks from use. Short term side effect with high doses include disorientation and ataxia (loss of balance while walking).

Now Foods Kava Extract Liquid Net 2 fl oz (60 ml)

Serving Size 2 Droppers full (1.6 ml)
Amount Per Serving:
Kava Root - 1.6 ml *
(Piper methysticum) Extract
Vanuatuan and Fijian

What's in kava root?
As with any herbal medicine, a number of compounds contribute to its medical effects. The active compounds are concentrated in the root of the plant. Kava contains a variety of chemicals known as pyrones or kavalactones. Specific names of the six major kavalactones include kawain, dihydrokawain, methysticin, dihydromethysticin, yangonin, and desmethoxyyangonin.
   The water-soluble extract of kava contains different compounds than the fat-soluble extract. The central nervous activity of the water-soluble extract was determined in mice to have mild pain-killing ability, but did not induce sleep. The fat-soluble extract had sleep inducing and marked pain-killing properties. The pharmacological effects of kava ingestion appear to be due to the activity of the compounds present in the fat-soluble fraction.
   Many of the studies done with kava used a standardized extract, called WS 1490, from a German manufacturer. The kava products you find over the counter are likely to contain the active ingredients.

Alternatives to kava herb
There are several other herbs and nutrients that have relaxing properties and may be alternatives to kava. These include 5-HTP, valerian, hops, passionflower, and tryptophan.

Use for anxiety
Australian researchers tested the effects of a particular water-soluble kava extract currently sold in that country. Some supplements are alcohol-based extracts that contain plant parts not used in traditional kava preparations. The water-soluble, or "aqueous," extract used in the current study was derived from the peeled rootstock of a medicinal cultivar of kava. Jerome Sarris, a doctoral candidate at the University of Queensland, asked 60 adults with chronic anxiety symptoms to take either the kava pills or placebo pills for one week. During the second treatment week, placebo patients were switched to kava and kava patients to placebo.
Patients' anxiety symptoms declined on the kava extract, as did depression symptoms in some. There were no signs of liver toxicity or other serious side effects, according to Jerome Sarris. Psychopharmacology, online May 9, 2009. Warwick, Australia-based MediHerb Pty Ltd supplied the kava extract.

Kava side effects
Tiredness and decreased sex drive or sensation are some kava side effects that have been reported with frequent use. In the Pacific islands, daily consumption of kava kava liquid for several years or decades leads to a skin condition. A kava kava side effect from daily use is lowered sex drive. If you have a lowered libido from kava use, or for other reasons, consider Passion Rx.

Kava Caution, safety, danger and risks
Do not drive a vehicle if you have ingested a high dose of kava or have drank many cups of kava kava juice. The simultaneous regular use of kava and St. John's wort is discouraged.
   In the last few years there have been several reports of individuals in Europe with liver damage while consuming kava on a regular basis. A few reports of liver damage occurring in kava users in the US have also been mentioned in the media. As of now, there have not been any scientific published studies that have proven liver damage occurs in subjects consuming kava. There are many individuals in the Pacific islands who consume kava on a daily basis for almost a lifetime with no apparent liver damage reported. Drinking kava has been part of their culture for hundreds of years. Kava, traditionally consumed in the Pacific as kava juice or water extracts, has been found to contain far less kavalactones than what is present in kava capsules.
   My preliminary assessment is that it is possible that the liver damage in some individuals was due to kava. However, it is possible that kava kava did not cause this side effect and was not the culprit, or the only culprit. Some of those who have been found with liver damage were taking other medicines along with the kava, or were very very old. Perhaps kava is harmful to the liver if combined with certain medicines. Maybe some of them abused alcohol or had a history of hepatitis. It is also possible that the extraction method to make kava capsules in Europe is different than that in the US which explains more cases reported in Europe than in the states. Europeans extract the kavalactones by hexane or acetone, and make their product contain 70% kavalactones while in the US, most products are 30 to 55% kavalactones. Another possibility is that there may be individuals who have a genetic predisposition to have an unusual liver toxic reaction to kava. Research done in Hawaii indicates a toxic chemical (pipermethystine) may be present in the stem peelings and leaves of the kava plant but not the root. As the demand for kava increased a few years ago, companies started buying the stem peelings and leaves along with the root while traditional kava users on the islands only used the root. This chemical is apparently toxic to liver cells whereas kavalactones found in the root are not.
   Until we know the full details, it is best to restrict the use of kava to no more than 2 days a week. Those with any kind of liver disease should not take kava, nor those who are taking medicines or have a chronic medical condition, unless they are supervised by a health care professional. The interaction of kava with pharmaceutical medicines or other supplements has not been tested. Caution is advised when mixing kava with other medicines, alcohol, or drugs.  
   Even if it is eventually found that regular, long-term kava use was responsible for the liver damage or other kava side effects in these few individuals, we must keep things in perspective. There are thousands of deaths and hospitalizations each year from the use of aspirin and acetaminophen (Tylenol), yet they are available without a prescription and we don't hear sensational stories in the news about these fatalities. Overdoses of acetaminophen, the active ingredient in and other over-the-counter pain and fever relievers, is now the leading cause of acute liver failure in the US.
   I personally take kava a few evenings a month when I wish to relax after a long day. I plan to continue doing so, since, at this time, I believe that kava, when used occasionally, has few side effects and is safer than alcohol or pharmaceutical anti-anxiety drugs.

Traditional kava kava use by natives and liver health
Traditional kava beverage consumption and liver function tests in a predominantly Tongan population in Hawaii.
Clin Toxicol (Phila). 2007 Jun-Aug. Brown AC, Onopa J, Holck P, Kaufusi P, Kabasawa D, Craig WJ, Dragull K, Levine AM, Baker JD. Department of Complementary & Alternative Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA.
To determine the effects of traditionally prepared kava beverages on the liver function tests of regular kava beverage consumers in a population of Tongan and non-Tongan residents of Hawaii (Oahu). The liver function tests of 31 healthy adult kava drinkers were compared against a control group of 31 healthy adult non kava drinkers. Subjects were recruited from the general population, a kava bar, and Tongan kava drinking circles. The liver function profile included AST, ALT, ALP, GGT, and bilirubin (total and direct). Other tests included total protein, albumin, and screens for viral hepatitis and hemochromatosis when indicated. Chronic kava beverage consumption was associated with elevation of GGT in 65% of the kava drinkers versus 26% in the controls. ALP was elevated in 23% of kava drinkers versus 3% in the controls. Heavy kava beverage consumption was associated with significantly elevated GGT levels.

Kava Kava liver toxicity study
In vitro cytotoxicity of nonpolar constituents from different parts of kava plant (Piper methysticum).
J Agric Food Chem. 2006 Apr 19;54(8):3157-62. Jhoo JW, Freeman JP, Heinze TM, Moody JD, Schnackenberg LK, Beger RD, Dragull K, Tang CS, Ang CY. National Center for Toxicological Research, U.S. Food and Drug Administration, HFT-230, 3900 NCTR Road, Jefferson, Arkansas
To investigate the key kava components potentially responsible for the liver toxicity, bioassay-guided fractionation was carried. Kava roots, leaves, and stem peelings were extracted with methanol, and the resulting residues were subjected to partition with a different polarity of solvents (hexane, ethyl acetate, n-butanol, and water). Organic solvent fractions displayed a much stronger cytotoxicity than water fractions for all parts of kava. The hexane fraction of the root exhibited stronger cytotoxic effects than fractions of root extracted with other solvents or extracts from the other parts of kava. The compound responsible for the cytotoxicity was flavokavain B.

Kava Kava : Tales of the South Pacific
"When we sip kava tea or kava juice, we forget there's a class system. There are no longer Ph.D.s, princes, preachers, nor paupers. Everyone opens up, sings, and dances together."
   This was my introduction to a kava kava ceremony that was held at the National Nutritional Foods Association convention in Las Vegas, Nevada, in July of 1997. One of the companies marketing a kava product had invited natives of the country Tonga (a small island in the South Pacific) to share with the attendees an actual kava ceremony. A group of curious vitamin store managers were seated in a circle on a wide piece of green artificial turf facing a group of 6 Tongans in native costumes. The set was decorated with small palm trees and tropical flowers, providing a pacific island-like atmosphere. A large wooden kava bowl was placed on the green turf filled with a brownish liquid. A middle-aged Tongan woman with a serene smile was gently stirring this liquid with a wooden spatula. Next to her was the emcee of the ceremony, Sione Ika, a small, chubby, and jocular man embracing a small guitar and singing enchanting songs from the South Pacific. He occasionally would stop singing, stand up, and do an unusual dance with sudden movements of the arms and legs while muttering one syllable sounds such as "umph, ah, hoo, pi, ka," and so on. Then, he would sit back down and continue explaining the purpose of the kava kava ceremony.
   "With dusk approaching, and the palm trees swaying in the wind, the villagers round up around the kava tea bowl. Kava, to us, is a symbol of the covenant. It is important to us in many ways-- socially, culturally, and religiously. We relax, tell stories, feel good, and lose our cares in the approaching night. People with good voices, and not so good voices, share of themselves through their songs. The kava helps everyone feel part of the community and the village."
   I had known about kava kava for many years but had long been a skeptic. Having been trained at Thomas Jefferson Medical School, a very traditional institution in Philadelphia, I always thought that herbs were a fun distraction for many in the alternative field to play with, but these herbs had no serious role in medicine. They certainly could not compete with a pharmaceutical drug. Over the years, though, I have come to respect the power and benefits that many herbal products can provide.
   I sat on the green turf while one of the Tongans offered me a cup with the brown kava liquid. He graciously bowed as he offered me the kava drink. It was quite obvious that he delighted in introducing skeptical Westerners to what South Pacific islanders had known for centuries. I sipped from the cup, swirled the brown liquid in my mouth, and could tell it had some active ingredient since my mouth went slightly numb. As I continued sipping, Sione proceeded, "Kava is a healthy, natural way of relaxing. We don't need television. All of the villagers sit around and we tell stories. We share our thoughts and our hopes. We encourage each other. Cares and worries disappear--carried away by the warm ocean wind."
   Sione was right. Studies have shown that the kava culture of the islands helps provide better social integration and a deepened sense of community (Lemert, 1976). One study even found that a community-based smoking cessation program combining kava ceremonies and group pledge was successful in helping almost everyone in the village give up their tobacco habit.
   The experience of that afternoon convinced me to look further into the kava story. The two cups that I drank did help me relax. The Tongans were kind enough to offer a plastic bag of the root powder and when I returned home, I continued experimenting with it. I offered it to many friends and family members who also reported feeling the relaxing effects of this root. In addition, I bought kava pills from a health food store and a bottle of the tincture. I started recommending kava to patients as an alternative to tranquilizers. The results were very promising.
   However, I wasn't completely convinced until I came across the conclusions of a kava study published in 1997 in the journal Pharmacopsychiatry. The title of the article was "Kava kava extract WS 1490 versus placebo in anxiety disorders--A randomized placebo-controlled 25-week outpatient trial." Previous to this kava study, the longest published one was an eight-week trial. But, before I go on explaining the results of this study, let me tell you some of the basics of this highly cherished South Pacific plant.

Kava kava root research studies
Composition and biological activity of traditional and commercial kava extracts.
Biochem Biophys Res Commun. 2004 Sep 10;322(1):147-52.
For centuries the South Pacific islanders have consumed kava (Piper methysticum) as a ceremonial intoxicating beverage. More recently, kava kava root in capsule form has been made available to the Western consumer. Several cases of liver harm have been reported following consumption of the commercial preparations. A detailed comparison of commercial kava extracts (prepared in acetone, ethanol or methanol) and traditional kava (aqueous) reveals significant differences in the ratio of the major kavalactones. To show that these variations could lead to differences in biological activity, the extracts were compared for their inhibition of the major drug metabolizing P450 enzymes. In all cases (CYP3A4, CYP1A2, CYP2C9, and CYP2C19), the inhibition was more pronounced for the commercial preparation. These results suggest that the variations in health effects reported for the kava extracts may result from the different preparation protocols used.

Kava treatment in patients with anxiety.
Phytother Res. 2004 Apr;18(4):297-300.
In several clinical trials, mainly conducted with a dose of 300 mg kava extract per day, kava has been employed successfully for the treatment of anxiety disorders. The goal of this placebo-controlled double-blind outpatient trial was to obtain more information on the dosage range and efficacy of a kava special extract WS 1490 in patients with non-psychotic anxiety. 50 patients were treated with a daily dose of 3 x 50 mg kava extract during a 4-week treatment period followed by a 2-week safety observation phase. In the active treatment group, the total score of the Hamilton anxiety scale (primary efficacy variable), showed a therapeutically relevant reduction in anxiety versus placebo. Kava extract WS 1490 was well tolerated and showed a safety profile with no drug-related adverse events or post-study withdrawal symptoms. It can be concluded that the applied 150 mg kava extract  per day is an effective and safe treatment of non-psychotic anxiety syndromes in the described population.

Hepatic injury due to traditional aqueous extracts of kava root in New Caledonia.
Eur J Gastroenterol Hepatol 15:1–4
Traditional aqueous kava extracts were the most probable cause of hepatitis in two patients presenting with markedly elevated transaminases and hyperbilirubinemia. A consequent survey of 27 heavy kava drinkers in New Caledonia showed elevated gamma glutamyl transferase in 23/27 and minimally elevated transaminases in 8/27. We conclude that not only commercially available, but also traditionally prepared kava extracts may rarely cause liver injury. The increased activity of gamma glutamyl transferase in heavy kava consumers in the presence of normal or minimally elevated transaminases is probably not a sign of liver injury, but rather reflects an induction of CYP450 enzymes.

Treatment of anxiety, tension and restlessness states with Kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trial.
Phytomedicine. 2003 Nov;10(8):631-9.
The efficacy and tolerability of 150 mg/d Kava special extract WS 1490 were investigated in a randomized, placebo-controlled, double-blind multicenter study in patients suffering from neurotic anxiety. 141 adult, male and female out-patients received 50 mg kava kava root or placebo three times a day for four weeks, followed by two weeks of observation. During treatment the total score of the Anxiety Status Inventory (ASI) observer rating scale showed more pronounced decreases in the kava kava root group than in the placebo group. Although the results show consistent advantages for kava over placebo in several psychiatric scales and indicate significant improvements in the patients' general well-being, the differences versus placebo were not as large as in previous trials which employed 300 mg/d of the same extract. Kava kava root was well tolerated, with no influence on liver function tests and only one trivial adverse event (tiredness).

Kava-Kava extract LI 150 is as effective as Opipramol and Buspirone in Generalised Anxiety Disorder--an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients.
Phytomedicine. 2003;10 Suppl 4:38-49.
An 8-week randomized, reference-controlled, double-blind, multi-centre clinical trial investigated Kava-Kava LI 150 in Generalized Anxiety Disorder (GAD). METHOD: 129 out-patients received either 400 mg Kava LI 150, 10 mg Buspirone or 100 mg Opipramol daily for 8 weeks. At week 9, subjects were seen to check for symptoms of withdrawal or relapse. CONCLUSION: Kava-Kava root is well tolerated and as effective as Buspirone and Opipramol in the acute treatment of out-patients suffering from GAD.

Kava email questions and comments
Thank you for a VERY informative website.  I have taken Kava occasionally for depression. I suffer from SAD and adult ADD. It really helps with the calming overall, and seems to help me sleep through the night. (With ADD there is a tendency to wake up and channel surf a couple times a night!).

I have been taking four 217 mg tablets of kava kava complex per day for a few months now and have noticed a diminished sex drive and erections that either are not full at the start or diminish after a short time. This is not the normal situation for me. I am sixty five and in good health.

Just want to add that my libido has been all but eliminated since taking Kava. Might be a good herbal for prison inmates. I do not find this reduced need to be a problem as it can be a wonderful relief to be free of a very strong sex drive for awhile. Many of my male friends have mentioned that sometimes they wish they could get a break form nature's desire to make more of itself at their almost constant expense.....it's a kind of serenity. ( Also a great drink for my 18 Yr. old daughters boyfriends!) Thanks for a great rundown...

Q. If kava may cause liver damage would it be helpful to take milk thistle with it?
     A. Perhaps, but I do not know at this time if kava does cause liver problems what the mechanism of that damage is, and whether milk thistle would help. The best approach is not to take kava too frequently.

Q. I've been taking kava on and off for a three years at higher than average doses. The kind of doses that get one "buzzed". Originally I started using kava in capsule form, and then moved to a milled
product that was mixed with warm water and literally caused me to vomit. Later I prepared my own brew with raw kava powder, but kept most of the pulp aside - the traditional method. Well, about a year ago I noticed my face getting really red the day after ingesting kava. I took a year or so off, and recently brewed some more. The next morning I noticed the same reaction - and analyzed my symptoms more closely: a very red face, including scalp, ears, throat and neck. The redness felt warm and was most significant on the facial area of the nose and cheeks, but actually extended on to my upper chest (collar bone area) upper central back, and a bit of an itchy feeling on the chest area.  I came across this information recently : The long-term use of kava has reportedly lead to "kawanism", which is characterized by dry, flaking, discolored skin; reddened eyes; a scaly skin rash; puffy face; muscle weakness; blood abnormalities; and feelings of poor health.
     A. We are familiar with a skin reaction that occurs in the Pacific islands in people who drink kava daily for many years. However, since your kava reaction occurred even after a year of absence on repeat exposure, it is difficult to say why it happened, perhaps a kava allergic reaction did occur. It's an interesting case history.

Q. I have been prescribed beta blockers to take during a flight, as I suffer panic attacks during these. Can I also take Kava Kava at the same time to reduce my anxiety. I do get very anxious before flying.
     A. As long as the dosages are kept low, and you have no medical problems or taking other medicines, the combination should be okay. Propranolol, a beta blocker should be limited to 40 mg when combined with 70 mg of kavalactones. Also, get approval from your private physician before using this combination.

Q. Does kava reduce the effectiveness of the birth control pills?
     A. I am not aware of any studies that indicate kava reduces the effectiveness of birth control pills.

Q. Does Kava affect serotonin levels? I have read that it might be dangerous to take Kava with SSRIs, due to the potential of serotonin overdose syndrome, though I have done so with no noticeable ill effects.
    A. Kava does not seem to influence serotonin levels to any significant degree as would, of course, 5-HTP. However, one should always be cautious when combining herbs and pharmaceutical drugs, and dosages should be kept as low as possible.

Q. I was wondering if it is safe to take Kava while pregnant. I was taking one Kava capsule daily prior to my pregnancy. Once I found out I was pregnant I stopped taking it, however I am now 30 weeks pregnant and have been feeling quite a bit of anxiety lately.
     A. The safety of kava has not been evaluated thoroughly in pregnant humans and to be on the safe side, it would be best not to take it although you may consider consulting with your obgyn doctor regarding the occasional use of this herb such as a few times a month in case the anxiety is severe enough to otherwise necessitate the use of pharmaceutical medicines. Kava, in this case, would be a good alternative to these drugs.

Q. I just bought a bottle of 30 capsules of Kava kava from GNC. I notice this stuff is pretty popular. I plan on using it quite sparingly to improve my mood when needed...I noticed that the bottle I bought is 1000mg capsules. This seems a bit much, I notice one's online are 150 and 250mg's. The directions say use 1 to two a day. I certainly don't plan on using it everyday. Probably not even once a week, depending on how it works for me maybe 3-5 times a month.
        My question is is 1000mg's too high I notice on the back it says per serving 250 mg of kava kava root extract 4:1 (like I know what that means??)
     A. It should also say on the bottle what percent kavalactones it contains. For instance, it has 250 mg of kava root extract, and most kava products are about 30 percent kavalactones (the active constituents), hence you would be getting about 75 mg of kavalactones. Any range between 50 and 100 mg of kavalactones per pill is usually adequate to help induce relaxation.

Q. I have read that you should not drink alcohol when taking it. Does this mean none at all or is a glass of red wine with my evening meal still safe?
     A. A glass of wine should be fine, as long as you are staying at home and not driving and not making this a regular habit.

Q. About a couple of years back, I took Kava almost every day, about 60 mg/day for 6 months.  I did not cycle it at all. I took it to cope with anxiety related premature ejaculation. I have not taken Kava in the last one-and-half years.  But in the last one-and-half years I have also noticed a drastic drop in libido, and a recent visit to the endocinologist and a hormone assay revealed secondary hypogonadism. Could a long term use of high doses of Kava caused my pituitary to shut down?
     A. It is unlikely that kava shuts down the pituitary gland (this hasn't yet been reported in the medical literature) but little is known about the long term effects of this, and many other herbs and supplements. Hence, cycling (i.e. taking breaks) is important. It is possible though, that kava can anesthetize nerves and reduce sexual sensation, but this would be temporary.

Q.  After years of insomnia and bad side effects from Buspar I have been enjoying an increased quality of life beyond belief on the kava herb. However i note in your books some concern about the long term effects.  I hope to continue on no more than 70mg per day with week breaks once a month. Also i will try to substitute with other anti anxiety herbs periodically as you suggest. Should one receive regular liver/kidney tests ?
     A. Since the recent news about the possible connection between kava and liver damage, it would be cautious to take  kava less frequently than you mention. A regular CBC and metabolic panel that includes liver and kidney function tests is a good idea. But taking long breaks is the best thing to do.

Q. Does kava have any addictive qualities?
     A. Most everyone who uses kava does not find it to be addictive. However, there may be rare individuals who have have a tendency to overuse it.

Q. I have been reading about how this herb Kava can help reduce anxiety and promote more social behavior. I am someone who has a very difficult time with giving oral presentations, I get so nervous in fact that I have since refused to do them, as a result my school work has at times suffered. However, I was wondering if a herb like kava would help me with this problem, for example, if I were to take a kava pill on the day I am supposed to give a presentation? Would this perhaps lower my anxiety to a degree that I wouldn't mind the fact that I am standing up in front of a large group of people? 
     A. Kava may help in this situation, but in my experience a small dose of 20 to 40 mg of the pharmaceutical medicine propranolol works better.

Q. Is there a downside to taking kava to help me sleep?
     A. Kava does not induce sleep consistently and you may have to, with trial and error, find the best time to take it in the evening. Some people sleep better taking kava in the early evening, while others do better taking it an hour or two before bed. It also depends on the product.

Q. Is Kava safe for an insulin-dependent diabetic? I have not been able to find an answer to this question and think it would be useful for your readers.
    A. Probably, if used only occasionally, but no studies have been done. It would be worthwhile to try this herbal anti-anxiety agent while being monitored by a health care provider.

Q. Does kava raise the serotonin level as does 5-HTP?
     A. Kava does not seem to influence serotonin levels to any significant degree.

Q. I have been taking kava for anxiety for about 1 1/2 months (a dosage of 6 pills/day at 250mg/pill). I have also been taking a sleep aid that contains 5 htp, choline, valerian, and melatonin. I have recently learned that I am going to have gallbladder surgery. Is there any chance of any of these nutrients reacting with the anesthesia and if so, how long will they stay in my system? I also take a long list of other nutrients including coq10 and vinpocetine. Can any of these react with the anesthesia? Thank you!
     A. These nutrients should be out of your system within a few days. So, just stop taking them a few days or better yet a week before surgery.

Q. I have been taking kava for about three months and have found it really helpful in easing my anxiety symptoms. However, I have also found that it has made my insomnia worse. I tend to wake up during the night for one or two hours, or else if I sleep through the night I will wake up very early in the morning. It feels as if I feel more energetic and alive on kava, which is good, but this also continues through the night leading to restless and interrupted sleep. I take one 150mg tablet, giving 45mg kavalactones, with breakfast. I want to take the lowest dosage possible but is it possible Has anyone else reported these effects?
      A. I would be surprised taking kava in the morning is influencing your sleep at night. Sometimes when people take kava near bedtime it could interfere with sleep but I can't really see how taking it in the morning would do that. Try some kind of physical activity during the day, such as a walk for at least 30 minutes. Exercise helps one sleep better at night.

Q. My boyfriend is 43 and been drinking kava tea and taking kava pills for reduced anxiety. He is now experiencing problems ejaculating. Do you think this could be a side effect of kava kava. Previously he was on celexa and experienced the same problem.
     A. It's quite possible that taking too much kava can reduce sexual performance.

Q. What is the current info on testability of kavalactones (or other related chemicals) from kava consumption? I have had reluctance in prescribing without confirmed knowledge of a negative drug test in individuals routinely tested.
     A. Kava or kavalactones are not measured in routine drug tests.

Q. I purchased a kava extract with 30% kavaclotones..and on the label it says kava dietary supplement. Did i get the wrong one if it says dietary supplement cause its been an hour and i dont feel a thing. please help me.
     A. You purchased the right product. Sometimes the effects come on after taking kava a few times or a higher dose.

Q. I plan to try some Kava herb and would like to know the half-life of this product. Any information you may provide would be appreciated.
     A. I'm not sure exactly what the half-life of kavalactones are, but the clinical effects, i.e., what you will notice, only last a few hours.

Q. Can you put the liquid kava kava in a cup of regular tea, juice or water?
A. Yes, but kava kava does not taste that great.