Kava risks
Kava is heavily regulated in the United Kingdom, Australia, Canada and beyond. And though it’s legal in the U.S., that doesn’t necessarily mean it’s safe.
- Only thing to change here is that kava is not only “regulated” in UK, it’s outright prohibited for human consumption. Also agree that just because something is titled as “Natural” absolutely does not automatically ascribe it any value of safety. Nightshade is natural.
Kava comes with significant risks, especially if you’re taking medication to treat depression and/or anxiety, or if you have other medical conditions.
- Not necessarily. Kava is limited to isozyme activity at CYP1A2. Medications that use this pathway singularily may have their metabolism times modulated. This blanket statement does more to cause fear and misunderstanding considering how small the issue really is. There are not many drugs which are pure substrates of CYP1A2. Not saying there’s none, because there are some like ropinirole and zanaflex which use this pathway only, and, at least with ropinirole we’ve seen one or two adverse event reports with the combination of kavalactone extraction products. Again it should be kept in mind that these reports of interaction are well old enough to drive, vote, and some of them can even drink in the United States. Logic would beg the question: If these interactions are so regular, why are we not seeing them today?
Dr. Goldman explains some of the risks associated with kava.
- Dr. Goldman works for the Cleveland Clinic at the Parkland Florida Branch. This is situated about halfway between Boca Raton and Pompano Beach on the Atlantic side of the southern Florida Coast. There are around 17 kava bars within a 20 minute drive from this location.
Because kava works similarly to alcohol and NDRIs, it’s dangerous to combine them. You shouldn’t take kava with any of the following:
Alcohol: Both kava and alcohol are depressants, so taking them together raises your risk of mood changes and cognitive impairment and increases your risk of liver toxicity.
Anxiety medications: Benzodiazepines and barbiturates are also depressants, so if you take them to quell your anxiety, it’s best to stay away from kava. “Taken together, kava may add to the depressant effects on the central nervous system,” Dr. Goldman cautions. “This may be because kava interferes with the liver’s ability to metabolize various enzymes.” When taken alongside Xanax®, for example, kava has been found to cause “a semi-comatose state.”
Parkinson’s medication: Dopamine loss contributes to symptoms of Parkinson’s disease. But kava inhibits dopamine reuptake, which can prevent your meds from working properly.
Kava may interact with other substances, too. Before trying kava, be sure to tell your healthcare provider about any other medication or supplements you’re taking.
- To date there is no research that would suggest an increase in toxicity when consuming alcohol and kava together at standard consumption dosages. It’s just not there. They have to ramp up the dosage levels to obscene amounts to elucidate any actual negative consequence. The image below represents the most recent study on alcohol combination with kavalactones in rats in regards to toxicity. Here you can say “Look! It’s true! 800mg/kg combined with ethanol is much more toxic!”. I would then ask, in what universe are people consuming anywhere near 800mg of kavalactones per single kilogram of body weight? This, for humans, would be equivalent to consuming ~11,000mg of kavalactones per day every day (consumed at ONCE) combined with being blind drunk for a solid 21 days. The author of the paper also calls this dosage level “Moderate”. Here you can see why I say there continues to be a paucity of research showing any direct toxicity at commonly consumed traditional amounts. It’s just research paper after research paper of authors raising dosage levels UNTIL they see something, completely disregarding what is actually consumed during a kava session in any context.
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- Abdulabbas Hasan, Mohammed, Syam Mohan, Heshu Sulaiman Rahman, Hemn Hasan Othman, Shirwan Hamasalih Omer, and Abdullah Farasani. 2022. “The Sub-Acute Toxicity of Kavalactone in Rats: A Study of the Effect of Oral Doses and the Mechanism of Toxicity in Combination with Ethanol.” Drug and Chemical Toxicology, May, 1–9. https://doi.org/10.1080/01480545.2022.2069803.
- I do agree with the author in regards to mood changes and cognitive impairment. Many studies, as well as copious empirical data have shown that the combination causes excessive sedation and impairment.
- I see this paper cited almost as much as I see Lebot cited, and it's just a steaming pile for a paper. There is a well known pharmacokinetic interaction between alprazolam (Xanax) and cimetidine (Tagamet) which drastically slows the elimination time of alprazolam. With continual consumption of both, levels could get to the point of causing this "coma" type interaction. Cimetidine coadministration with alprazolam increased max plasma concentration of Xanax by 86%, decreased clearance by 42% and increased half-life by 16% (FDA Xanax)
- NDRI? No, simply no. Ki Values for kavain @ NE were around 48-59µM. Real NDRIs like Focalin (Dexmethylphenidate) have Ki values in the nanograms (see picture below). We absolutely cannot call kava an NDRI in any stretch of the word. While it may have some affinity here, it’s not enough to be clinically significant at any traditional consumption volume. If anything, this may only contribute to the psychotropic actions of kavalactones, not explain them.
- In regards to Parkinson’s: There isn’t enough research to actually say this, just a few case reports (total of 4) where kava just happened to be in the mix. It should be understood that these "parkinson's-like" effects were found solely with the preparation "Laitan". This formulation is no longer available and possibly caused a range of other issues for people as well. Kavalactones have shown a possibility of even preventing dopaminergic toxicity in rodent models of Parkinson’s disease. This, again, is a bunch of nothing blown up to astronomical proportions, especially when considering how many people were consuming kava at the time as a regular scheduled addition to their pharmaceutical regimine. There has yet to be a convincing relation between the use of kava products and cases of Parkinson’s.
- Meseguer, Elena, Rocio Taboada, Vicenta Sánchez, María Angeles Mena, Victor Campos, and Justo García De Yébenes. 2002. “Life-Threatening Parkinsonism Induced by Kava-Kava.” Movement Disorders: Official Journal of the Movement Disorder Society 17 (1): 195–96. https://doi.org/10.1002/mds.1268.
- Schmidt, N., and B. Ferger. 2001. “Neuroprotective Effects of (+/-)-Kavain in the MPTP Mouse Model of Parkinson’s Disease.” Synapse 40 (1): 47–54. https://doi.org/10.1002/1098-2396(200104)40:1<47::AID-SYN1025>3.0.CO;2-S.
Can cause liver toxicity
Some of the components in kava are known to be hepatotoxic, or toxic to the liver.
Surveys of Australian Aboriginal communities, where kava is heavily used, haven’t found any evidence of long-term liver damage there. But Europe and the United States have both reported cases of kava-induced liver issues, which is what led the U.K. to ban the substance in 2003.
- This entire paragraph needs to be explained more. I would contend that this alone speaks to a product quality issue with kavalactone products being produced in Europe at the time. The Aboriginal communities were consuming powdered traditional kavas, where the EU was importing and extracting products to make pills and tinctures. Another common theme?
“There have been numerous reports of severe liver toxicity and/or liver failure from both Europe and the U.S., occurring within weeks and up to two years after ingesting kava,” Dr. Goldman states.
- Here they quote “Numerous” however their definition here doesn't match mine.
- **Gestures broadly at everything** Kava bars, kavalactone products, kava extract beverages, shots, candies, all of it, and yet….no increased rate of adverse event reports. No liver failure, no hospital stays. It seems you can only say this “liver toxicity” in the face of current evidence for as long as you feel accustomed to looking dumb. Sadly though, some people don’t mind it at all.
