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A scientist's review of the evidence for Kava's safety

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kalmia_latifolia

Dad, scientist, gardener, living in the SE USA
Hey everyone,

I’m relatively new to kava, but like many out there I’m looking for something that relaxes without blurring my mind, as alcohol does. I’m a tenure-track research professor in biological sciences at a major US university where I run a research lab. I don’t know much about chemistry or medicine, but I know how to read papers and evaluate scientific evidence. Before embarking on the Kava journey, I, like many others, wanted to figure out if it is safe. I found many reassurances on the forums (you folks are awesome!), but I’m, at heart, a scientist, and I wasn’t satisfied until I’d gone through the peer reviewed literature with a fine-toothed comb. Rather than keep this information to myself, I decided to take the time to write up my scientific journey for those of you that are interested. Important disclaimer: I am not a medical doctor and I am not qualified to give medical advice, so nothing here should be construed as medical advice. This is just my personal analysis of kava's safety after reading dozens of scientific papers on the topic. Of course you’re going to want to consult your doctor before making any medical decisions.

My top line takeaway is that aqueous extracts of high quality kava (noble cultivars, peeled rhizome and root only, free from contamination by microbes, pesticides, and heavy metals) should be reasonably safe for healthy adults when used in moderation without other drugs or alcohol. If this sounds familiar, it is because it is also the position held by many on this board- but I wanted to know how the scientific community reached this result. So, if you’re interested in how I got to that conclusion, read on. My review focuses only on the hepatotoxic (liver injury) effects of kava- while there are other side effects (e.g., rashes, dehydration, headaches, etc.), they are considered minor and typically resolve quickly after the cessation of kava consumption.

As we’re all aware, kava has been linked to severe hepatotoxic reactions in a small number of people about 20 years ago (less than 70 people, more than 10- the numbers vary depending on if you exclude people for things like the use of alcohol or concomitant medication). However, fairly strong evidence exists that liver injury occurred in people with all forms of consumption, mainly with organic extracts but a couple with aqueous extract. This is understandably worrying.

Yet the statistics on use are reassuring: in Europe, 14 cases of liver injury were deemed to be have had kava as a ‘probable’ cause. For context, this is after the use of 60–125 million doses (Ernst, 2007). Monitoring studies following 7078 patients taking daily doses of 120-150mg of organically extracted Kava for a few months showed no signs of hepatotoxicity. Note, however, that this does not mean that rare severe reactions can’t occur, one would need a much larger dataset to make inference about rare events. As far as I’m aware, the cases of severe hepatotoxicity occurred in the late 1990s / early 2000s, and haven’t continued, despite hundreds of thousands of people using kava daily (if I’m wrong here, please let me know). All of the case reports I could find reference to in the literature are from about 20 years ago, but that could be due to the fact that these cases spurred regulatory action in Europe which provided the motivation for the scientific community to study kava. Ethnographic data suggests that Kava does not cause liver damage in the descendants of the indigenous people who domesticated kava, and contemporary populations of heavy kava drinkers (some of whom are estimated to consume 100,000 bowls of kava in their lifetimes, and often consume more than 2.5g of kavalactones in one night) in the south pacific do not seem to have an elevated rate of liver damage. Oh, and there are also rodent studies: Singh and Devkota (2003) fed rats super high doses of aqueous kava extract (500 mg kavalactones / kg of body weight per day- that would be 35g of kavalactones for an average adult male human per day!), which didn’t cause liver injury after short-term use (2-4 weeks). Rats fed lower doses of organically extracted kava for a longer time period (3 months) had no liver issues (DiSilvestro et al, 2007). Both of these studies had relatively small numbers of animals, and in general these rodents come from highly inbred lines, so we can’t assess whether between-animal genetic differences might contribute to rare adverse reactions. Still, this is all strong evidence that kava is reasonably safe.

Should we be scared of organic extracts? Possibly- I’m avoiding them out of an abundance of caution. Kavalactones aren’t very soluble in water, so lot of companies extract them with organic solvents, primarily ethanol and acetone. These extracts are super popular and millions of people have taken them without issue. However, I think they may be a risk factor for liver injury, but we just don’t have enough data yet to know. There are two things I worry about with extracts:

1) You don’t know what the source material was, and it seems to me that market forces would favor the use of cheap, low quality kava for extracts that cannot be sold as the more expensive ground root.

2) Organic extracts pull out some chemicals much more efficiently than water. The main focus here been on flavokavains. To review, flavokavains are a class of chalcones which naturally exist in kava roots. Kava contains 3 different flavokavains (called flavokavain A, B and C); B is the one most people worry about since it’s the most abundant and cytotoxic. Cells grown in tissue culture (so in test tubes, not in animals) are very sensitive to flavokavain B, where it causes cell death by triggering cellular suicide (Zhou et al, 2010). These researchers also found that mice given a really large dose of flavokavain B (25 mg / kg) for a week had acute liver damage. While scary, this is not a realistic dose for human consumption. According to Lebot (2011), 25 mg/kg represents a minimum of 250 times more than humans would consume, assuming a ‘worst case scenario’ in which they consumed 120mg of kavalactones derived from an ethanolic extract of a tudei variety with a lot of flavokavain B. Of course, many people take much more than 120mg kavalactones, but we’re usually not drinking organic extracts of tudei varieties, so I think this ballpark number is reasonable. Unfortunately, Zhou et al, 2010 didn’t test lower doses of flavokavain B in mice, so we don’t know what the threshold concentration for liver toxicity is in living animals.

I personally don’t want to mess with flavokavains, and they’re greatly enriched in organic extracts relative to water. Here’s a nice graph showing differences between water and ethanol extraction, from Martin et al, 2014. Note that organic extraction of flavokavain B is much higher than aqueous (bottom subfigure). Similarly, Zhou et al (2010) estimate that 95% ethanol and 100% acetone are ~160-times better at extracting flavokavain B than water. One thing that makes me somewhat reassured that flavokavain B isn’t very scary at typical rates of intake is the fact that that acute liver toxicity is a very rare issue, even with organic kava extracts. If typical organic extracts of kava had enough flavokavain B to cause acute liver injury, we’d expect to see it more often with those taking organic extracts.

So, what caused people to have acute liver failure after taking kava? We currently don’t know. The number of cases is low, and we didn’t have Dr. House go and test their exact batch of kava to see if it was contaminated with mold aflatoxins, etc. It’s likely one of three explanations: 1) An idiosyncratic allergic reaction. 2) Bad kava, contaminated with either toxic mold, aerial plant parts which can contain a toxic alkaloid not found in the roots, or even other plant species entirely. 3) Use by people with pre-existing liver issues or stress placed on the liver via concomitant use with other drugs or alcohol.

Fortunately, you have control over many of these factors. You can source good kava root from one of the main, trusted vendors out there that have a reputation for knowing their farmers (or growing it themselves) and getting high quality root. This should greatly reduce your chances of getting contaminated or mislabeled kava. I’d avoid organic extracts for the reasons outlined above. You can be sure you have a healthy liver prior to taking kava, and avoid taking kava with alcohol or other drugs. And you can go easy, giving your body plenty of time to recover from any stress caused by kava (this is probably good advice for all intoxicants, by the way!). Unfortunately, there’s a bit of a stochiastic element in all this that you may not have much control over: if a very low proportion of people have an allergic reaction to kava that causes acute liver failure, and there’s no way of predicting this ahead of time (note that this is just a hypothesis right now, we don’t know if this is true), that’s legitimately scary. For me, I’ve decided to go light on kava in my first month of use, seeing if it has any negative physical side-effects. If it does, I will go get my liver function tested by my doctor before continuing use. Better safe than sorry.

One thing I’d love to hear from the community is whether acute hepatotoxic reactions continue to occur every year, or whether they occurred 20 years ago and haven’t occurred again since then. After all, hundreds of thousands of people take kava every day, and thus we can make a pretty powerful statistical inference from the long-term incidence rate (I mean, this is epidemiology 101). If contemporary hepatotoxic reactions are virtually nonexistent, then I think this provides pretty strong inferential evidence that the cases which occurred 20 years ago were caused by something other than kava itself (e.g., toxins other those naturally found in kava that got introduced into the supply chain through poor quality control).

Anyway, I hope this is helpful to some of you who want a bit more data to go with your reassurances that kava is safe for human use when basic precautions are taken. Also, big thanks to Mike at @Kalm with Kava for the great kava, for answering my questions, and for encouraging me to write this up for the boards.
 
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kalmia_latifolia

Dad, scientist, gardener, living in the SE USA
Super cool. That's really reassuring! You know what would be really helpful? If someone wrote a follow-up paper that does the legwork to really substantiate this. I think it would be hugely influential.
 

Alia

'Awa Grower/Collector
Hey everyone,

I’m relatively new to kava, but like many out there I’m looking for something that relaxes without blurring my mind, as alcohol does. I’m a tenure-track research professor in biological sciences at a major US university where I run a research lab. I don’t know much about chemistry or medicine, but I know how to read papers and evaluate scientific evidence. Before embarking on the Kava journey, I, like many others, wanted to figure out if it is safe. I found many reassurances on the forums (you folks are awesome!), but I’m, at heart, a scientist, and I wasn’t satisfied until I’d gone through the peer reviewed literature with a fine-toothed comb. Rather than keep this information to myself, I decided to take the time to write up my scientific journey for those of you that are interested. Important disclaimer: I am not a medical doctor and I am not qualified to give medical advice, so nothing here should be construed as medical advice. This is just my personal analysis of kava's safety after reading dozens of scientific papers on the topic. Of course you’re going to want to consult your doctor before making any medical decisions.

My top line takeaway is that aqueous extracts of high quality kava (noble cultivars, peeled rhizome and root only, free from contamination by microbes, pesticides, and heavy metals) should be reasonably safe for healthy adults when used in moderation without other drugs or alcohol. If this sounds familiar, it is because it is also the position held by many on this board- but I wanted to know how the scientific community reached this result. So, if you’re interested in how I got to that conclusion, read on. My review focuses only on the hepatotoxic (liver injury) effects of kava- while there are other side effects (e.g., rashes, dehydration, headaches, etc.), they are considered minor and typically resolve quickly after the cessation of kava consumption.

As we’re all aware, kava has been linked to severe hepatotoxic reactions in a small number of people about 20 years ago (less than 70 people, more than 10- the numbers vary depending on if you exclude people for things like the use of alcohol or concomitant medication). However, fairly strong evidence exists that liver injury occurred in people with all forms of consumption, mainly with organic extracts but a couple with aqueous extract. This is understandably worrying.

Yet the statistics on use are reassuring: in Europe, 14 cases of liver injury were deemed to be have had kava as a ‘probable’ cause. For context, this is after the use of 60–125 million doses (Ernst, 2007). Monitoring studies following 7078 patients taking daily doses of 120-150mg of organically extracted Kava for a few months showed no signs of hepatotoxicity. Note, however, that this does not mean that rare severe reactions can’t occur, one would need a much larger dataset to make inference about rare events. As far as I’m aware, the cases of severe hepatotoxicity occurred in the late 1990s / early 2000s, and haven’t continued, despite hundreds of thousands of people using kava daily (if I’m wrong here, please let me know). All of the case reports I could find reference to in the literature are from about 20 years ago, but that could be due to the fact that these cases spurred regulatory action in Europe which provided the motivation for the scientific community to study kava. Ethnographic data suggests that Kava does not cause liver damage in the descendants of the indigenous people who domesticated kava, and contemporary populations of heavy kava drinkers (some of whom are estimated to consume 100,000 bowls of kava in their lifetimes, and often consume more than 2.5g of kavalactones in one night) in the south pacific do not seem to have an elevated rate of liver damage. Oh, and there are also rodent studies: Singh and Devkota (2003) fed rats super high doses of aqueous kava extract (500 mg kavalactones / kg of body weight per day- that would be 35g of kavalactones for an average adult male human per day!), which didn’t cause liver injury after short-term use (2-4 weeks). Rats fed lower doses of organically extracted kava for a longer time period (3 months) had no liver issues (DiSilvestro et al, 2007). Both of these studies had relatively small numbers of animals, and in general these rodents come from highly inbred lines, so we can’t assess whether between-animal genetic differences might contribute to rare adverse reactions. Still, this is all strong evidence that kava is reasonably safe.

Should we be scared of organic extracts? Possibly- I’m avoiding them out of an abundance of caution. Kavalactones aren’t very soluble in water, so lot of companies extract them with organic solvents, primarily ethanol and acetone. These extracts are super popular and millions of people have taken them without issue. However, I think they may be a risk factor for liver injury, but we just don’t have enough data yet to know. There are two things I worry about with extracts:

1) You don’t know what the source material was, and it seems to me that market forces would favor the use of cheap, low quality kava for extracts that cannot be sold as the more expensive ground root.

2) Organic extracts pull out some chemicals much more efficiently than water. The main focus here been on flavokavains. To review, flavokavains are a class of chalcones which naturally exist in kava roots. Kava contains 3 different flavokavains (called flavokavain A, B and C); B is the one most people worry about since it’s the most abundant and cytotoxic. Cells grown in tissue culture (so in test tubes, not in animals) are very sensitive to flavokavain B, where it causes cell death by triggering cellular suicide (Zhou et al, 2010). These researchers also found that mice given a really large dose of flavokavain B (25 mg / kg) for a week had acute liver damage. While scary, this is not a realistic dose for human consumption. According to Lebot (2011), 25 mg/kg represents a minimum of 250 times more than humans would consume, assuming a ‘worst case scenario’ in which they consumed 120mg of kavalactones derived from an ethanolic extract of a tudei variety with a lot of flavokavain B. Of course, many people take much more than 120mg kavalactones, but we’re usually not drinking organic extracts of tudei varieties, so I think this ballpark number is reasonable. Unfortunately, Zhou et al, 2010 didn’t test lower doses of flavokavain B in mice, so we don’t know what the threshold concentration for liver toxicity is in living animals.

I personally don’t want to mess with flavokavains, and they’re greatly enriched in organic extracts relative to water. Here’s a nice graph showing differences between water and ethanol extraction, from Martin et al, 2014. Note that organic extraction of flavokavain B is much higher than aqueous (bottom subfigure). Similarly, Zhou et al (2010) estimate that 95% ethanol and 100% acetone are ~160-times better at extracting flavokavain B than water. One thing that makes me somewhat reassured that flavokavain B isn’t very scary at typical rates of intake is the fact that that acute liver toxicity is a very rare issue, even with organic kava extracts. If typical organic extracts of kava had enough flavokavain B to cause acute liver injury, we’d expect to see it more often with those taking organic extracts.

So, what caused people to have acute liver failure after taking kava? We currently don’t know. The number of cases is low, and we didn’t have Dr. House go and test their exact batch of kava to see if it was contaminated with mold aflatoxins, etc. It’s likely one of three explanations: 1) An idiosyncratic allergic reaction. 2) Bad kava, contaminated with either toxic mold, aerial plant parts which can contain a toxic alkaloid not found in the roots, or even other plant species entirely. 3) Use by people with pre-existing liver issues or stress placed on the liver via concomitant use with other drugs or alcohol.

Fortunately, you have control over many of these factors. You can source good kava root from one of the main, trusted vendors out there that have a reputation for knowing their farmers (or growing it themselves) and getting high quality root. This should greatly reduce your chances of getting contaminated or mislabeled kava. I’d avoid organic extracts for the reasons outlined above. You can be sure you have a healthy liver prior to taking kava, and avoid taking kava with alcohol or other drugs. And you can go easy, giving your body plenty of time to recover from any stress caused by kava (this is probably good advice for all intoxicants, by the way!). Unfortunately, there’s a bit of a stochiastic element in all this that you may not have much control over: if a very low proportion of people have an allergic reaction to kava that causes acute liver failure, and there’s no way of predicting this ahead of time (note that this is just a hypothesis right now, we don’t know if this is true), that’s legitimately scary. For me, I’ve decided to go light on kava in my first month of use, seeing if it has any negative physical side-effects. If it does, I will go get my liver function tested by my doctor before continuing use. Better safe than sorry.

One thing I’d love to hear from the community is whether acute hepatotoxic reactions continue to occur every year, or whether they occurred 20 years ago and haven’t occurred again since then. After all, hundreds of thousands of people take kava every day, and thus we can make a pretty powerful statistical inference from the long-term incidence rate (I mean, this is epidemiology 101). If contemporary hepatotoxic reactions are virtually nonexistent, then I think this provides pretty strong inferential evidence that the cases which occurred 20 years ago were caused by something other than kava itself (e.g., toxins other those naturally found in kava that got introduced into the supply chain through poor quality control).

Anyway, I hope this is helpful to some of you who want a bit more data to go with your reassurances that kava is safe for human use when basic precautions are taken. Also, big thanks to Mike at @Kalm with Kava for the great kava, for answering my questions, and for encouraging me to write this up for the boards.
Impressive write-up, thank you for taking the time. Another good way to be sure you are getting quality 'awa is to grow it and prepare it yourself. Living in a tropical climate helps! Education and knowing the traditionally used, daily cultivars can become a way of life. Also, if you can locate the Codex alimentarius write-ups on kava you might find them interesting. A new draft is coming out soon but somewhere in the past Kava Forums you should be able to locate earlier versions.
 

kalmia_latifolia

Dad, scientist, gardener, living in the SE USA
I'd love to be able to grow my own Kava, but unfortunately it gets too cold here in the winter. Gardening is my main hobby, actually, and I'd really love to be able to grow a collection of different varieties. Alas...

I'll check out the Codex, thanks for the tip!
 

Zaphod

Kava Lover
Excellent write up and review. The take on extracts and mixing kava with other substances is also pretty much in-line with the majority of kava forums users. Which brings up another question that the community has shunned away from, possibly because of annoying vendors, if we recommend against organic extracts then we logically have to recommend against using microgrind kava as well....
 

kalmia_latifolia

Dad, scientist, gardener, living in the SE USA
Thanks Zaphod! That's a good point about microgrind. I'd be curious about how much FKB comes out of well-ground root particles in the acidic environment of your stomach. It might be a lot, or it may largely remain insoluble, allowing you to poop most if it right out. Do you know of any data relevant to this?

I hadn't intended this to be a scientific brainstorming session, but we're rapidly compiling a list of the critical questions about kava safety that should be addressed (above we had 'have rare hepatotoxic effects of kava stopped occurring?').
 

kalmia_latifolia

Dad, scientist, gardener, living in the SE USA
This is a fantastic breakdown. Thank you so much for posting!
Thanks Kapm'!

Hey man, there's something I was meaning to ask you. Did you ever keep on making your own instant kava (you had a really cool thread a few years back on that!), or did you give up on that project? If you stopped doing it, how come? I'm considering trying making some myself for fun, and convenience.
 

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
Thanks Kapm'!

Hey man, there's something I was meaning to ask you. Did you ever keep on making your own instant kava (you had a really cool thread a few years back on that!), or did you give up on that project? If you stopped doing it, how come? I'm considering trying making some myself for fun, and convenience.
The good ole' instant machine. It's actually still in my garage (minus the hot water heater). I reached the conclusion that making instant is a bit over my pay-grade. I think I managed to get 10-15 grams per 3-4 hours worth of effort. I'd rather leave it to the real experts :)
 

kalmia_latifolia

Dad, scientist, gardener, living in the SE USA
The good ole' instant machine. It's actually still in my garage (minus the hot water heater). I reached the conclusion that making instant is a bit over my pay-grade. I think I managed to get 10-15 grams per 3-4 hours worth of effort. I'd rather leave it to the real experts :)
Fair enough- sounds like it was a fun project though! I might try my hand at it for kicks.
 

Krunkie McKrunkface

Kava Connoisseur
Thanks Kapm'!

Hey man, there's something I was meaning to ask you. Did you ever keep on making your own instant kava (you had a really cool thread a few years back on that!), or did you give up on that project? If you stopped doing it, how come? I'm considering trying making some myself for fun, and convenience.
I regularly produce instant kava now just as a by-product of my kava consumption and not wasting anything. It's great, wonderful stuff, and very different in effect from drinking grog. Basically, any of that fine silky sediment from the grog that is left at the bottom of a shell, glass or mason jar gets spread out on a plate and dried in a sunny window, scraped off and milled in a blender or coffee grinder. 1 TBS mixed with a cup of milk and some flavouring, like a syrup or chocolate powder, and it makes a beverage that hits instantly and feels very pleasantly mellow for a half hour. And I find that the greater number of varieties of grog it is made from, the better it is. Also fine just stirring in a glass of water and chugged. In my household it is now a criminal offense to throw out any kava sediment. There's gold in that thar mud.
 

kalmia_latifolia

Dad, scientist, gardener, living in the SE USA
Good thinking. This actually gets to a question I had about drinking that sediment. I've had some issues with stomach aches when drinking grog (I always mix before sipping to resuspend fine particles) and I was wondering if it had to do with root particles. Do you avoid drinking those on purpose, or do you just not bother to mix before drinking sometimes?

I regularly produce instant kava now just as a by-product of my kava consumption and not wasting anything. It's great, wonderful stuff, and very different in effect from drinking grog. Basically, any of that fine silky sediment from the grog that is left at the bottom of a shell, glass or mason jar gets spread out on a plate and dried in a sunny window, srcaped off and milled in a blender or coffee grinder. 1 TBS mixed with a cup of milk and some flavouring, like a syrup or chocolate powder, and it makes a beverage that hits instantly and feels very pleasantly mellow for a half hour. And I find that the greater number of varieties of grog it is made from, the better it is. Also fine just stirring in a glass of water and chugged.
 

Krunkie McKrunkface

Kava Connoisseur
Good thinking. This actually gets to a question I had about drinking that sediment. I've had some issues with stomach aches when drinking grog (I always mix before sipping to resuspend fine particles) and I was wondering if it had to do with root particles. Do you avoid drinking those on purpose, or do you just not bother to mix before drinking sometimes?
there's really two parts to the root (Chris of GHK did a really good post on this some time back). The outer coating of the root, much like the phloem of a tree, it's the thin soft squishy live stuff around the bigger fibrous centre, has most of the kavalactones and is pretty harmless to your stomach and is what makes up that sediment at the bottom of your shell. The stuff that hurts your stomach, for most people, unless you are especially sensitive, is not the outer part, it's the tough fibrous inner part (which is also, somewhat confusingly, called "makas" which is simply the Bislama word for "garbage" or more literally "the part of something good that you don't use but throw away, e.g.a banana peel, etc, so this part of the root is literally makas and the stuff we throw out after prepping is metaphorically makas, because it is garbage, although that makas is made up almost entirely out of makas. Clear?) and that is the stuff that ends up in your strainer bag or AluBall. There is kavalactones in both parts but far far more is in that outer part.

So, there's really two sediments, one good, one bad, one based on the outer part of the root, one that is the inner part.

Now, you can chew that inner part, and I do, when I consume raw roots from their dried state. But I only eat the outer part. The inner part I chew until it's played out and then spit it out.
 

kalmia_latifolia

Dad, scientist, gardener, living in the SE USA
there's really two parts to the root (Chris of GHK did a really good post on this some time back). The outer coating of the root, much like the phloem of a tree, it's the thin soft squishy live stuff around the bigger fibrous centre, has most of the kavalactones and is pretty harmless to your stomach and is what makes up that sediment at the bottom of your shell. The stuff that hurts your stomach, for most people, unless you are especially sensitive, is not the outer part, it's the tough fibrous inner part (which is also, somewhat confusingly, called "makas" which is simply the Bislama word for "garbage" or more literally "the part of something good that you don't use but throw away, e.g.a banana peel, etc, so this part of the root is literally makas and the stuff we throw out after prepping is metaphorically makas, because it is garbage, although that makas is made up almost entirely out of makas. Clear?) and that is the stuff that ends up in your strainer bag or AluBall. There is kavalactones in both parts but far far more is in that outer part.

So, there's really two sediments, one good, one bad, one based on the outer part of the root, one that is the inner part.

Now, you can chew that inner part, and I do, when I consume raw roots from their dried state. But I only eat the outer part. The inner part I chew until it's played out and then spit it out.
Awesome- that is super helpful. Thanks! And I'll go find Chris's post on the matter- he seems to have a real depth of botanical knowledge.
 

Krunkie McKrunkface

Kava Connoisseur
Awesome- that is super helpful. Thanks! And I'll go find Chris's post on the matter- he seems to have a real depth of botanical knowledge.
It was in reference to his micronised kava. He claims that his is made only from that outer part of the root whereas other micronised formulations grind both together, accounting for stomach problems in some users. Disclaimer: I know nothing about micronised kava and have never used it. This is just from memory and I might have got it wrong.
 

Zac Imiola (Herbalist)

Kava Connoisseur
Excellent write up and review. The take on extracts and mixing kava with other substances is also pretty much in-line with the majority of kava forums users. Which brings up another question that the community has shunned away from, possibly because of annoying vendors, if we recommend against organic extracts then we logically have to recommend against using microgrind kava as well....
Not necessarily glutathione is in the micro but not an alcohol extract
 
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