Is Kava Safe?

Overview

Yes. Kava, as defined by the Kava Act of 2002 (an aqueous extract of the root) has been used for centuries safely and modern scientific literature is growing in support for its safety. However, it is important to know that 90% of the products one would find at the health food store, vitamin store or online have the potential for adverse effects. These products are usually extracted with strong nonpolar solvents that extract far more compounds than water, some of which may be toxic. Also, many of these companies have been found to use leaves and stems from harvested crops that have been discarded as waste in order to save cost. Above-ground parts of the plant have been shown to have compounds not found in the root that may cause adverse effects.

Introduction

Regarding Kava's safety, I will outline what we know so far. Only experts (researchers with a PhD who have authored peer reviewed research) will be included as experts.

Dr. Vincent Lebot
Dr. Lebot's name will come up quite a bit in the coming article. Therefore, take a little bit of time to read about him below.

For those who aren't familiar with Dr. Lebot, he is a (if not, the) leading researcher and authored the book "Kava: The Pacific Elixir". He has a PhD and is a botanical geneticist and has authored 15 peer-reviewed articles, seven of which are related to kava. This link will show you all of his articles:
[https://www.ncbi.nlm.nih.gov/pubmed/?term=lebot, vincent]

He has helped to write a piece of legislation called the "Kava Act of 2002" which remains as the only piece of legislation (other than interdictions) for kava.
This can be found here: https://faolex.fao.org/docs/html/van38473.htm

Noble, Tudei, ISA, Explanation and Information

Now, when the word "noble" comes up, that means "suitable for everyday drinking". They are interchangeable.

While the Kava Act of 2002 (above) outlines what "noble" kava is, that was referring to Vanuatu specifically.

Please keep in mind that the word noble does not refer only to Kava from Vanuatu, as we have as a community, agreed upon. Many kavas outside of Vanuatu are suitable for daily drinking and Dr. Lebot has confirmed this:
Dr. Vincent Lebot said:
there are many other good varieties outside vanuatu

A Standard for Kava

Safety of Kava

Dr. Vincent Lebot:
Dr. Vincent Lebot said:
Water extraction, conducted since thousands of years in the Pacific, is the safest way to go
These studies confirm that kava, as outlined and described by Dr. Lebot above, is completely safe to drink every day.
https://www.ncbi.nlm.nih.gov/pubmed/22585547
https://www.ncbi.nlm.nih.gov/pubmed/21112196
https://www.ncbi.nlm.nih.gov/pubmed/21756963
https://www.ncbi.nlm.nih.gov/pubmed/21377431
Kava Historically Safe “As A Water Extractâ€

This from the World Health Organization (found in Codex linked above)
"The kava drink, has been consumed in Pacific Island Countries for centuries without any reported ill-effects on the liver [4], is made from a water extract of the root and/or rhizome of Piper methysticum. A recent WHO risk assessment concluded that “clinical trial of kava have not revealed hepatoxicity as a problem [5] suggesting that “water extracts are devoid of toxic effects†[6] and recommending that “products should be developed from water-based suspensions of kava†[7]. The safety of water based kava drinks is supported by long-term ethno-pharmacological observations [8]."

[4.] WHO (2007): Assessment of the risk of hepatotoxicity with kava products, p.4
[5.] WHO (2007): Assessment of the risk of hepatotoxicity with kava products, p. 62
[6.] WHO (2007): Assessment of the risk of hepatotoxicity with kava products, p. 59
[7.] WHO (2007): Assessment of the risk of hepatotoxicity with kava products, p. 62
[8]. Loew & Gaus (2002) in:WHO (2007):, p.11

Regarding Flavokavain B (FKB)

As you can see from the abundance of information above, there is no reason to worry. You might, however, have heard of recent discussions about Flavokavain B, or FKB for short.

This article is meant only to inform consumers as to the possible risks so that they can make informed decisions about their purchases and consumption of kava.
Right now, there is a possible risk with higher than normal amounts of FKB (such as found in tudei/ISA kava). Noble, daily drinking kava has been shown to be safe when consumed daily as the research above documents.

As of now, research has shown both in vivo (in living organisms) and in vitro (in isolated cells)

This article documents the hepatotoxicity of FKB in vivo.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992378/

These articles demonstrate FKB to be a potent cytotoxin (something that kills cells) in vitro, in isolated cancerous cell lines. This means that they are effective at killing cancerous cells, but doesn't study any other effect they have:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681603/
https://www.ncbi.nlm.nih.gov/pubmed/22729748
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405181/
https://www.ncbi.nlm.nih.gov/pubmed/21377431

Currently, there is not enough evidence to prove if FKB is safe or dangerous in the amount found in normal daily drinking amounts of tudei/ISA kava.
However, there is research being conducted currently, as well as work that experts have already finished and is awaiting publication that will shed much more light on this subject.

What we know from Dr. Xing regarding the possible hepatotoxicity of tudei/ISA kava is, so far in this statement he made in a recent video interview which can be found here:
https://www.kavaforums.com/forum/th...ultivar-and-that-cultivar-is-tudei-kava.2557/
Taken from transcript compiled from video:
Dr. Chennguo (Chris) Xing said:
[...] recently it was found that, the kava was demonstrated to have very strong anxiolytic activity in recent clinical trials, double blinded randomized trials, and it’s hepatotoxic risk is probably due to a wrong cultivar, not recommended for traditional use, and that cultivar is called, "Tudei kava".
Dr. Lebot on tudei kava and FKB:
Dr. Vincent Lebot said:
The current approach is to avoid taking risks as we suppose that the problems in Germany resulted from extracts obtained from two day kavas

We don't know at which rate, intake levels, ... etc... FKB can be dangerous, nobody knows, we do not have enough data
Dr. Vincent Lebot said:
"Based on the conclusions of this study [https://www.ncbi.nlm.nih.gov/pubmed/24423570], two days kava are very rich in F[lavo] K[avain]s compared to nobles... so why take the risk to expose ourselves to potential side effects.... especially as we know that they are not very pleasant to drink! the hangover, fatigue, and nausea are terrible"
There has been no research as to the comparative toxicity of tudei kava to substances like Acetaminophen or alcohol. This information is not available because of the lack of published studies that examine the specific, relative and quantitative dangers of FKB.

Consumers can decide if the risk is worth the benefit based on the evidence outlined above.

Explanation by Dr. Lebot

"Dr. Lebot is the foremost expert on kava. He lives and works in Vanuatu. This is his response. It cannot be explained any better than this.

Common Interactions

_________________________________________________________________
Ropinirole
Common brands: Requip, Requip XL

  • Absolutely do not combine kava with Ropinirole as this may cause a serious interaction.
__________________________________________________________________


Diuretics
Interaction rating: Major. Do not combine with kava.
Kava is a diuretic by nature, meaning that it will cause your body to release excess water, causing dehydration. When combined with other diuretic drugs, this can cause a dangerous situation where depletion of electrolytes can cause serious issues such as irregular heartbeat, fast heart rate, fatigue, lethargy, convulsions or seizures, nausea, vomiting, diarrhea or constipation due directly to dehydration. Do not combine these when drinking kava.

Sedative medications (CNS depressants)
Interaction Rating: Major Do not take this combination.
Kava might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking kava along with sedative medications might cause too much sleepiness.

Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.


Alprazolam (Xanax)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Kava can cause drowsiness. Alprazolam (Xanax) can also cause drowsiness. Taking kava along with alprazolam (Xanax) may cause too much drowsiness. Avoid taking kava and alprazolam (Xanax) together.


Levodopa
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Levodopa affects the brain by increasing a brain chemical calleddopamine. Kava might decrease dopamine in the brain. Taking kava along with levodopa might decrease the effectiveness of levodopa.


Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are changed by the liver might increase the effects and side effects of some medications. Before taking kava, talk to your healthcare provider if you take any medications that are changed by the liver.

Some of these medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.


Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of your medication. Before taking kava, talk to your healthcare provider if you take any medications that are changed by the liver.

Some of these medications changed by the liver include amitriptyline (Elavil), clomipramine (Anafranil), cyclophosphamide (Cytoxan), diazepam (Valium), lansoprazole (Prevacid), omeprazole (Prilosec), lansoprazole (Protonix), phenytoin (Dilantin), phenobarbital (Luminal), progesterone, and others.


Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking kava, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen(Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.


Medications changed by the liver (Cytochrome P450 2E1 (CYP2E1) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are changed by the liver can increase the effects and side effects of your medication. Before taking kava, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include acetaminophen, chlorzoxazone (Parafon Forte), ethanol, theophylline, and drugs used for anesthesia during surgery such as enflurane (Ethrane), halothane (Fluothane), isoflurane (Forane), and methoxyflurane (Penthrane).


Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking kava, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.


Medications moved by pumps in cells (P-Glycoprotein Substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Some medications are moved by pumps in cells. Kava might make these pumps less active and increase how much of some medications get absorbed by the body. This might increase the amount of some medications in the body, which could lead to more side effects. But there is not enough information to know if this is a big concern.

Some medications that are moved by these pumps include etoposide, paclitaxel, vinblastine, vincristine, vindesine, ketoconazole, itraconazole, amprenavir, indinavir, nelfinavir, saquinavir, cimetidine, ranitidine, diltiazem, verapamil, corticosteroids, erythromycin, cisapride (Propulsid), fexofenadine (Allegra), cyclosporine, loperamide (Imodium), quinidine, and others.


Medications that can harm the liver (Hepatotoxic drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.
Kava might harm the liver. Taking kava along with medication that might also harm the liver can increase the risk of liver damage. Do not take kava if you are taking a medication that can harm the liver.

Some medications that can harm the liver include acetaminophen (Tylenoland others), amiodarone (Cordarone), carbamazepine (Tegretol),isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.


Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.
Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are changed by the liver can increase the effects and side effects of your medication. Before taking kava, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor,Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.""


RxList - https://www.rxlist.com/kava-page3/supplements.htm

FDA Disclaimer
These statements have not been evaluated by the Food and Drug Administration.These products are not intended to diagnose, treat, cure or prevent any disease."

Is kava antimicrobial?

We've seen many people state over time that kava contains antimicrobial properties which cause it to be acceptable to leave out for an extended time. This is false. Kava contains many starches and fibers which bacterium love to feast on. Even in refrigeration the stated safety time is <2 days.

https://sfamjournals.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1472-765X.2009.02739.x

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