Kava for stress and
anxiety, side effects, safety, risks, toxicity and effect on liver -
Benefit, dosage, and research information along with a review of safety,
toxicity, and potential risk if misused,
Kava capsules and liquid supplements for sale
July 26 2017 by
Ray Sahelian, M.D.
Kava is the term used for both the root 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, including the islands of Vanuatu, Fiji, and Tonga. 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 supplements. I don't recommend the use of kava in children or by teenagers. This stress reducing herb should only be used by healthy adults, and only occasionally.
Additional herbs and nutrients involved in relaxation, stress relief and anxiety reductions include passion flower extract, tryptophan, 5-HTP, ashwagandha, lemon balm, theanine, GABA amino acid, and valerian herb.
Natural sleep products with natural herbs and
nutrients can help you sleep better
If
you are planning to use a kava supplement for sleep or relaxation at night, consider
natural sleep inducing products with theanine, passionflower, 5-HTP,
melatonin, and other sleep
inducing nutrients.
How will kava make you feel, what you may notice
when you take the pills
Not everyone reacts exactly the same way to
this herb. This is due to the fact that each one of us has a different biochemistry.
Furthermore, different products on the market have different amounts of constituents
within them, depending on the time of year of the harvest, which island it's
from, how's its processed, etc. The form of kava, whether liquid, tincture, or capsule, may also make a
difference on how you feel, or how quickly you feel the effects. However, most of the
time, the effects are noticed within an hour or two.
As a rule, the following are some common feelings that most users report after
taking kava either as a capsule or in liquid form:
A state of relaxation, without feeling drugged
Muscle tenseness is less
Peacefulness and contentment
More sociable, especially with the right company
Mild euphoria, sometimes
Mental alertness is often not effected, except on high doses
Initial alertness followed by drowsiness which comes on after a few hours, so
kava can be taken in the evening, a few hours before bedtime.
Warning: 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 pregnant or breastfeeding women. Excessive use, or use with products that cause drowsiness, may impair your ability to operate a vehicle or heavy equipment. Take frequent breaks from use. Short term side effect with high doses include disorientation and ataxia (loss of balance while walking).
Email
Q. I'm reading your book on Kava from the 1990s. It's a bit old, but I wonder if you still feel
the same way about using it? I believe the book mentions that it could block
dopamine receptors? So, if someone were to use it regularly whether for one
month or six months, would it cause your brain dopamine levels to drop?
A. I think this plant has a role to play in medicine in terms of
relaxation and offering some anxiety relief but I do not think it should be
taken more than twice a week. At this level of use I would not expect it to
cause any harm to the body or mind.
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 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 appear to
be due to the activity of the compounds present in the fat-soluble fraction.
Many of the studies 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.
Kavalactones
are not measured in routine drug tests.
I'm not sure exactly what the half-life of kavalactones are, but the clinical
effects, i.e., what a person will notice, only last a few hours.
I just bought a bottle of 30 capsules
of kava from GNC. On the back of the GNC bottle it
says per serving 250 mg of kava root extract 4:1. What is that mean?
It should also say on the bottle what percent kavalactones it contains. For
instance, it has 250 mg of kava root extract, and most products are about 30 percent kavalactones (the active constituents), hence you would be getting about 75 mg of
kavalactones. A range between 50 and 100 mg per pill is usually adequate
to help induce relaxation.
Use for anxiety and tension
relief
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, 2009.
Warwick, Australia-based MediHerb Pty Ltd supplied the kava extract.
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.
Patients received either 400 mg
Kava LI 150, 10 mg Buspirone or 100 mg Opipramol daily for 8 weeks. The product
was well tolerated
and as effective as Buspirone and Opipramol in the acute treatment of
out-patients suffering from GAD.
Kava treatment in patients with anxiety.
Phytother Res. 2004 Apr.
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.
Addiction
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.
Beta blockers
I have been prescribed beta blockers to take during a flight, as I suffer panic attacks
during these. Can I also take kava at the same time to reduce my anxiety. I do get
very anxious before flying.
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.
Birth control pills
I am not aware of any studies that indicate it reduces the effectiveness
of birth control pills.
Children and
adolescents
Why is it not recommended that children and teenagers use this product?
Since there is a very small chance that kava could be harmful
to the liver in some adults when used regularly, it is possible the same could
occur in children. Since there is little research done with this root in
children or teenagers, we don't know if their liver is more, or less, sensitive
to its effects. Therefore caution is advised.
Diabetes
Diabetics may use
this herb only
occasionally since no studies have been done on its safety in those who have
diabetes.
Pregnancy
I was wondering if it is safe to take kava while pregnant.
I was taking one capsule daily prior to my pregnancy. Once I found out I was pregnant
I stopped taking it.
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.
Public speaking
I am someone who has a very difficult time with
giving oral presentations. I was wondering if kava would help me if I were to take a pill on the
day I am supposed to give a presentation? Would this perhaps lower my fear?
Kava may help you relax, but it could also
make your mind not as sharp. In my experience a
small dose of 20 to 40 mg of the pharmaceutical medicine propranolol works better.
Sleep
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, occasional
use helps me sleep at night but not always.
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.
Surgery
I have been taking kava for anxiety for about
2 months. 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.
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.
Withdrawal symptoms
There does not appear to be any significant withdrawal symptoms that I am aware
of.
Kava side effects, adverse
events, risk, safety and danger
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 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.
Sexual side effect, reduced
libido
I have been taking four 200 mg tablets of 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.
My boyfriend is 43 years old and been drinking kava tea and taking pills to reduce anxiety. He is now experiencing problems ejaculating. Previously he was on Celexa and experienced the same problem.
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.
About a couple of years back, I took
kava almost every
day, about 60 mg/day for 6 months. I took it to
cope with anxiety related premature ejaculation. I have not taken it in the last
year but I have also noticed a drastic
drop in libido, and a recent visit to the endocrinologist and a hormone assay revealed
secondary hypogonadism. Could a long term use of high doses caused my pituitary to
shut down?
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. The use of sexual
enhancing herbs could potentially reverse this process.
Skin
I've been taking kava on and
off for a three years at higher than average doses. Originally I started using it 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 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.
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 an allergic
reaction did occur. It's an interesting case history.
Driving caution, also do not use with alcohol
Do not drive a vehicle or operate heavy machinery if you have ingested a high
dose of kava or have drank many cups of the juice or drank more than a couple of
ounces of wine with it. A small glass of wine or a little amount of
alcohol should be fine, as long as you are staying at home and not driving and
not making this a regular habit.
There is a possible increase in car crashes
PLoS One. 2016. Driving following Kava Use and Road Traffic Injuries: A Population-Based Case-Control Study in Fiji. In this study conducted in a setting where recreational kava consumption is common, driving following the use of kava was associated with a significant excess of serious-injury involved road crashes.
Liver harm and potential toxicity
There have been reports of individuals in Europe with liver damage
while consuming kava on a regular basis. A few reports of liver damage in the US have also been mentioned. There are many individuals in the Pacific islands who consume kava on a
regular basis for almost a lifetime with no apparent liver damage reported. Drinking
it
has been part of their culture for hundreds of years. Kava,
traditionally consumed in the Pacific as juice or water extracts, has been found to contain far
less kavalactones than what is present in capsules.
It is possible that liver damage in some individuals is due to
kava. However, it is possible in others that it it not the culprit, or the only
culprit. Some of those with liver damage were taking other medicines along with the kava, or were very old.
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, or not as much.
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 it, nor
those who are taking medicines or have a chronic medical condition. The interaction of kava with pharmaceutical
medications or
other supplements has not been tested.
Even if it is eventually found that regular,
long-term use is responsible for liver damage, 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, when used occasionally, it has few side effects
and is safer than alcohol
or pharmaceutical anti-anxiety drugs.
Food Chem Toxicol. 2011. Liver toxicity and carcinogenicity in F344/N rats and B6C3F1 mice exposed
to Kava Kava. National Toxicology Program, National Institute of Environmental
Health Sciences, Research Triangle Park, NC, USA.
In these studies rats and mice were administered kava extract
orally by gavage in corn oil for two weeks, thirteen weeks or two years. Results
from prechronic studies administered Kava at 0.125 to 2g/kg body weight revealed
dose-related increases in liver weights and incidences of hepatocellular
hypertrophy. In the chronic studies, there were dose-related increases in the
incidences of hepatocellular hypertrophy in rats and mice administered up to
1g/kg body weight. This was accompanied by significant increases in incidences
of centrilobular fatty change. There was no treatment- related increase in
carcinogenic activity in the livers of male or female rats in the chronic
studies. Male mice showed a significant dose-related increase in the incidence
of hepatoblastomas. In female mice, there was a significant increase in the
combined incidence of liver adenoma and carcinoma in the low and mid
dose groups but not in the high dose group.
In vitro cytotoxicity of nonpolar constituents from different parts of
kava plant (Piper methysticum).
J Agric Food Chem. 2006s
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. The
compound responsible for the cytotoxicity was flavokavain B.
Hepatic injury due to traditional aqueous
extracts of kava root in New Caledonia.
Eur J Gastroenterol
Hepatoly.
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.
Traditional kava beverage consumption and liver function tests in a
predominantly Tongan population in Hawaii.
Clin Toxicol. 2007.
The liver function tests of 31 healthy
adult kava drinkers were compared against a control group of 31 healthy adult
non drinkers. Subjects were recruited from the general population, a kava
bar, and Tongan 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 beverage consumption was associated with elevation of GGT in 65% of the drinkers versus 26% in the controls. ALP was elevated in
23% of drinkers versus 3% in the controls.
If kava may cause liver damage would it be helpful to
take milk thistle with it or
acetyl cysteine?
A. Perhaps, but I do not know what the mechanism of that damage is, and whether
milk thistle or acetylcysteine would help. The best approach is not to take the
herbal product too frequently.
Driving under kava influence
Aust N Z J Public Health. 2015. Is
driving under the influence of kava associated with motor vehicle crashes? A
systematic review of the epidemiological literature. Kava is marketed as a
herbal anxiolytic in several countries and is consumed recreationally in high
doses in many indigenous Pacific and Australian Aboriginal communities. We
reviewed the published literature examining the association (if any) between
kava use and motor vehicle crashes (MVCs), MVC-related injuries or driving
performance. No studies quantifying the effects of kava on MVCs or related
injury were located.
Interactions with drugs and prescription
medications
Prim Care Companion CNS Disorders. 2013.
Toxic effects of psychotropics related to possible p450 enzyme inhibition by
kava: report of 2 cases. Two cases of patients seen on the psychiatric emergency
and consult service who developed severe side effects from psychotropic
medications in the context of kava use are presented. In both cases, kava use
may have affected the metabolism of the psychotropic medications, leading to
serious side effects. Growing research indicates that kava most likely alters
concentrations of coadministered psychotropics possibly by inhibiting cytochrome
P450 enzymes.
Testimonial
I have taken kava
supplement 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!
Natrol, buy Kava Kava, 200 mg, 30 Capsules
CAUTION:
Kava is not the type of supplement, like vitamin C, that you take every day. At
most use one 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. Use on
a daily basis may harm the liver in some individuals. In very rare cases, daily use can lead to
severe liver harm that may result
in total liver failure.
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 and Zocor. Do
not take it if you are a heavy alcohol drinker.
Kava does not seem to influence serotonin levels to any significant degree.
However, one should always be cautious when combining herbs and pharmaceutical
drugs, such as SSRIs, and dosages should be kept as low
as possible.
Supplement Facts | ||
Serving Size: 1 Capsule | ||
Amount Per Serving | % Daily Value | |
Kava Kava Extract (Piper methysticum) (root) | 200 mg | * |
Kavalactones 30% | 60 mg | * |
*Daily Value not established. |