Kava Science A new study fails to confirm the effectivness of kava in the treatment of anxiety

[TheKavaSociety]

Dr Sarris et al are veterans of kava research and definetely know what they are doing. We have every reason to suspect that Sarris wants kava to succeed (he's joined Fiji Kava Ltd as their scientific advisor) and yet his new flash, well funded study failed to prove that kava can indeed reduce long term anxiety.
See the paper here: https://www.ncbi.nlm.nih.gov/pubmed/31813230

I have a couple small issues with this study.

1. 120mg of kavalactones is a fairly small dose. a small shell of weak kava.
2. The participants were supposedly consuming booze while "under treatment ". This may explain the liver abnormalities, but generally I am shocked this isn't considered as a big variable that might have affected the results of this study.

But in general the conculsion of this study is not necessarily bad or even at odds with my own personal take on kava:

"While extant data show that standardised Kava (containing either 120, 240 or 250mg of kavalactones) is an effective short-term treatment for generalised and, potentially more so, ‘situational’ anxiety, the results of our study indicate that it is not effective as a psychotropic medication for diagnosed GAD. Aside from Kava’s valued social, cultural and recreational use, based on our findings and previous data, the plant’s therapeutic application may more appropriately extend to its use as an anxiolytic prior to a potential situational anxiogenic event, or for intermittent use in the additional management of non-clinical anxiety and stress."

 

[TheKavaSociety]

For those who might be interested, see the attached pdf

 

[Nickavalas Turtle]

For those who might be interested, see the attached pdf

I by no means want to come off sexist but from what I see this trial appears to be roughly 75% female. I am not claiming to be an intelligent guy but the sexes have different balances of chemicals in their bodies possibly including medications not specified and that may also play a role. I would think that a more even split of the sexes gives a more accurate representation of Kavas benefits.

 

[fait]

Take this as you will since this is purely anecdotal, but I have issues falling asleep lately and I get anxiety when I struggle to fall asleep. The borongoru I drank Monday night took the anxiety right out of the equation. I'm a kava light weight compared to others, but I definitely had more than 120mg of kavalactones in me that night. I still had a hard time falling asleep but I felt less miserable waking up than I normally do. I've noticed too on heavy kava nights, if I had enough heavy kavalactones in me, the next morning tends to be more "dreamy" like the opposite of a rude awakening.

 

[Mo'iety]

The liver function table is interesting. It shows that ~7% of participants in the kava group developed elevations in GGT, and ~14% developed elevated ALT. And though the p-values were low (suggesting a low probability that the elevations were not due to kava), the actual (mean) elevations were relatively small. It would be interesting to see more studies on kava and the liver to understand the mechanisms that underlie the elevations. The 2016 WHO report does acknowledge elevated GGT (and ALT too, I forget) is not uncommon among kava users, but that the enzyme elevation is reversible and doesn't appear to be associated with any liver injury.

I highly suspect that the elevated levels are not actually indicative of liver injury or inflammation, but instead due to some benign effect (like kavalactones simply inducing expression of the genes that code for those enzymes), based on the long and large safety record of noble kava. A study into the actual underpinning mechanism though would help quell the fears around kava and liver injury that are still quite present outside of us regular kava drinkers.

 

[TheKavaSociety]

The liver function table is interesting. It shows that ~7% of participants in the kava group developed elevations in GGT, and ~14% developed elevated ALT. And though the p-values were low (suggesting a low probability that the elevations were not due to kava), the actual (mean) elevations were relatively small. It would be interesting to see more studies on kava and the liver to understand the mechanisms that underlie the elevations. The 2016 WHO report does acknowledge elevated GGT (and ALT too, I forget) is not uncommon among kava users, but that the enzyme elevation is reversible and doesn't appear to be associated with any liver injury.

I highly suspect that the elevated levels are not actually indicative of liver injury or inflammation, but instead due to some benign effect (like kavalactones simply inducing expression of the genes that code for those enzymes), based on the long and large safety record of noble kava. A study into the actual underpinning mechanism though would help quell the fears around kava and liver injury that are still quite present outside of us regular kava drinkers.

That's what Dr Barguil from NC argued. The elevated GGT is just a sign of adaptation to kava ("liver stimulation" as he put it), rather than any kind of injury.
He spent 3 years studying chronic kava drinkers and concluded that for the vast majority of people kava is simply not toxic to the liver. He was a bit clumsy with his language here: ""People who are chronic kava drinkers are not going to be ill. I mean there is no liver toxicity for chronic kava drinkers. Sometimes there are rare liver accidents which are due to susceptability. Only a few rare people could do these sorts of accidents."" But what he meant was a rare genetic predisposition may render kava unsafe for certain individuals, but those who have been fine drinking kava won't suddenly develop any illness.

 

[Edward]

So kava won't "cure" you of anxiety long term. Presumably that means if you stop drinking if the the anxiety will come back. Well that's not too much of a shock anyway is it.

 

[TheKavaSociety]

So kava won't "cure" you of anxiety long term. Presumably that means if you stop drinking if the the anxiety will come back. Well that's not too much of a shock anyway is it.

It's a bit more complicated. What the study suggests is that if you actually suffer from clinical GAD, kava (or at least 1 shell of kava per day) won't just "cure" you, but it might not even alleviate the symptoms of your condition. The authors note that in all likelihood actually no pharmacological agent can do this, psychotherapy is the right response in such cases. However, kava may potentially be useful for situational anxiety (e.g. you being stressed before giving a speech) or as an additional aid used as part of a more complex treatment.

 

[verticity]

That looks like a good study. I always appreciate it when scientists go ahead and publish negative results rather than bury them, because that is useful information even if it's disappointing for those of us who are rooting (pun intended) for a particular outcome.

I wonder if they would have gotten better results with a 'heavier' cultivar such as Melo Melo. In the Discussion, the authors mention that the cultivar they used (Borogu) is different from what they used in previous studies (Vanuatu Mystery Blend), and they also acknowledge that KL doses higher than 240 mg (the total daily dose they used) might have been more effective. The reason for that limitation was probably because higher doses would not have been okayed by the ethics committees that have to approve human studies like this.

It's also a good to keep in mind that even approved pharmaceutical treatments for GAD such as SSRIs that are supposedly the gold standard are not that much better than placebo. The placebo effect is always larger than the effect of the medication, even for meds proven to have some effect. For example, this meta analysis of one such drug, paroxetine, concluded that "The available empirical evidence indicates that paroxetine provides only a modest advantage over placebo in treatment of anxiety and depression." Using the same Hamilton anxiety scale as Sarris's paper it found the following:

Paroxetine: 11.11 point improvement
Placebo: 8.77 point improvement​

The difference between the drug and the placebo is only 2.31 points, but it is significant (barely). The discussion in Sarris's paper also mentions another meta analysis of several medications, all with an effect of less than 4 points difference between placebo and drug.
Compare this with Sarris's kava results:

Kava: 7.56 point improvement
Placebo: 8.93 point improvement​

The 1.37 point difference between kava and placebo is not significant..

Another interesting aspect of that paroxetine meta-analysis was that it talks about how the studies the drug company had originally submitted to the FDA presented somewhat more favorable numbers than were uncovered after after the company was required to disclose all of the studies it had done... which gets back to my point above about how I appreciate it when scientists publish negative as well as positive results. In the case of pharma companies they will only publish the negative ones when it's legally mandated..

 

[Edward]

Yes @verticity there do seem to be some variables not covered. I find heady kava gives me more anxiety than it eases but a good, heavy kava will stay with me into the next day.

 

[The Kap'n]

pshh as if science can teach us anythi....oh wait.

It actually makes sense that it's more of a "beta blocker" in terms of anxiety than a real long-term solution. I'm all in the camp of "See a professional" for long term life affecting issues such as GAD. "Mild Intoxicant" would be a better term for our beloved root than "anxiety reducer" now it seems. I mean, it's being served at bars, so it's probably best it's just seen as something you can unwind with at the end of the day instead of a life saving treatment. I think it garners a different type of attention in that light. Probably a double edged sword in a way.

Thank you for sharing this with us @Henry

 

[Kojo Douglas]

I have always seen and promoted Kava as something that can relieve anxiety for certain people. I don’t feel that it can be successfully used to treat GAD. Nothing can do that except personal transformation

 

[Alia]

pshh as if science can teach us anythi....oh wait.

It actually makes sense that it's more of a "beta blocker" in terms of anxiety than a real long-term solution. I'm all in the camp of "See a professional" for long term life affecting issues such as GAD. "Mild Intoxicant" would be a better term for our beloved root than "anxiety reducer" now it seems. I mean, it's being served at bars, so it's probably best it's just seen as something you can unwind with at the end of the day instead of a life saving treatment. I think it garners a different type of attention in that light. Probably a double edged sword in a way.

Thank you for sharing this with us @Henry

Yes, I think that is supported (by far) in historic, cultural uses--"...unwind at the end of the day". So many of the oral history records support this. And/Or end of the day planning, discussion, story telling around the kava bowl, before evening meal. In the modern corporate or academic world...back in the day when I actually lectured or testified at Hearings I'd never do it without a drink of 'awa beverage. Folks I knew in stressful postions at the University?--same thing--and it always worked. As @Henry quotes from Sarris et. al.--- "its use as an anxiolytic prior to a potential situational anxiogenic event," . That's quite enough.

 

[kastom_lif]

I by no means want to come off sexist but from what I see this trial appears to be roughly 75% female. I am not claiming to be an intelligent guy but the sexes have different balances of chemicals in their bodies possibly including medications not specified and that may also play a role. I would think that a more even split of the sexes gives a more accurate representation of Kavas benefits.

I usually get krunk in a fairly even mix of genders. It hits us all equally.

For the sake of good science, re-doing the test with a sample group who’s not 75% female is a fine idea. Though... my XY chromosome, penis havin’ ass feels just as wise after a session as the XX peepz I shell with.

 

[Saghloqh]

So straight away I would agree that alcohol consumption is an amazingly confounding factor. I'd also posit that even if this was "as usual" consumption, something to consider is that alcohol withdrawal, even from infrequent use, does carry with it a pretty hefty rebound anxiety component. In someone who was a semi-regular drinker, "no change" in anxiety with kava use could even be an indication that kava consumption is actually combating rebound anxiety.

I don't have time to dive into the nuts and bolts of the study right now, but just something that popped out at me right away.

Even without any of that considered, I've often felt myself that "anxiolytic" isn't exactly what I would categorize kava as. I think that perception comes from both its semi-mythological action as either a GABAa agonist and/or upregulator, as well as the fact that it is a "replacement" for alcohol (and I would emphasize that a replacement is not a stand-in). As someone who suffers from anxiety, both "GAD" (I'll explain the quotes later) and situational anxieties such as social anxiety, too much kava is basically a guaranteed panic attack. This is especially prominent with kavas that I suspect are kavain-heavy, as subjectively the theory that norepinephrine-reuptake inhibition is a mode of action of kavain makes sense to me. There's certainly an adrenal quality to the headiness of kavain that I can't help but recognize as both a component of "natural" panic attacks as well as certain medications which are either selective or nonselective NRI's.

For me kava is a strange mix of mental stimulation and muscle relaxation, and both of those lend themselves to a sort of secondary anxiolysis. Your headspace and bodily condition are incredibly linked, so just the same way that a deep meditation session really loosens up my body and allows me to breathe deeper, kava also gives similar effects. There is a ton of unconscious muscle stiffening and shallow breathing that comes along with the endless deluge that is GAD, and this is part of a positive feedback loop that I find incredibly straining over long periods of time. Muscle tension -> more anxiety -> more muscle tension -> more anxiety etc. etc.

In a similar manner, a lot of my anxiety isn't really GAD as such, but rather the fact that I also have comorbid ADHD. My life is literally never under control, and I often suffer from depression that stems from the fact that my inattentiveness makes it hard to feel like I'm progressing in life. My personal universe is surrounded by the steady hum of a sort of cosmic microwave background of perpetual failure to do anything of worth. While this perception can be attacked temporatily with tricks like meditation or positive self-talk, the only reliable way to dissipate it altogether is simply to have my life in order. That's where the mental stimulant component of kava comes in for me - in the right dose (not too high) the heady feeling of kavain, as well as the subtle euphoria of all the other effects is usually enough to focus me beyond what I'm normally capable of. This doesn't give anxiolysis right away, but in the long term it allows me to actually finish enough tasks to feel like I am making positive strides in my life.

This is my personal experience with kava, and why it is anxiolytic for me specifically. But with a pretty decent knowledge of kava's pharmacology, I can easily see how it could be ineffective for some, or even many, people if it's used in the same way that a benzo is used.

I think kava is honestly a holistic remedy that goes beyond just its pharmacology, as well. Kava is something that, if you let it, will change your life, not just through protein binding, but also through the various rituals, the breadth of the traditional and ever-growing knowledgebase, and maybe most importantly, community. Not everyone needs to have their lives changed, but I think it's pretty self-evident here that many do, have, and are thriving.

 

[Go Krunk Yourself]

Anyone who wants to turn Kava into a daily usage should at some point get your liver checked, if not just for the validation of it being fine to others, but just for 100% peace of mind. I am on a statin, ssri, and daily Kava user with my last liver results (following a night of Kava usage) was perfectly fine, and has been fine for years. I've have to monitor my liver enzymes due to my statin usage (26 years old, genetic LDL problems) and the fact my LDL tends to go up and down even with a statin.

I would never consider Kava a full time, long term treatment for anxiety of my level (health anxiety / somatic symptoms) but it works in great comorbidity with other treatment I have.

 

[TrevC]

Anyone who wants to turn Kava into a daily usage should at some point get your liver checked, if not just for the validation of it being fine to others, but just for 100% peace of mind. I am on a statin, ssri, and daily Kava user with my last liver results (following a night of Kava usage) was perfectly fine, and has been fine for years. I've have to monitor my liver enzymes due to my statin usage (26 years old, genetic LDL problems) and the fact my LDL tends to go up and down even with a statin.

I would never consider Kava a full time, long term treatment for anxiety of my level (health anxiety / somatic symptoms) but it works in great comorbidity with other treatment I have.

It is always at least a little encouraging to read things like this. I got my liver checked a couple years ago, as part of an overall wellness visit. Enzymes looked good. It has been a couple years, and I've since used Kava daily. So I'm almost afraid to know what things look like now.

Kava for me is usually an end-of-day thing, but sometimes I'll drink a shell or two before lunch.
These days, I'm having weird abdominal feelings, so I've switched back to knead-and-strain. Tradeoff is, I don't get the heady effects as much as I do from Aluball prep, but my stomach feels SOMEWHAT better. I've switched back and forth over a couple months and can tell a difference.

So now there's just a nagging feeling that daily Kava use has to be doing something to my body.

Pacific islanders... do those guys just partake of Kava during a standard work-week? I hate to say it, but it's hard for me to even miss a day, I look forward to it so much. :/

 

[Mo'iety]

Just to give another data point, I got my liver function checked as part of my yearly physical last summer, and my numbers were normal (ALT and AST, but not GGT, were on the panel). I had been drinking kava regularly for at least half a year before that point, and also drinking alcohol a few times a week (1-3 drinks on those occasions, never the same night as kava). Since then my alcohol consumption has gone down and my kava consumption has gone up, so I'd be curious if they've changed at all. Might be able to get them checked again next physical. I drink 3-6 tbsp kava on most evenings now, usually at the lower end of that range, and the only side effects I've experienced are a bit of tiredness/lethargy the morning after a heavier session, and occasional dry/itchy eyes while drinking kava. Oh, and also more vivid dreams on the nights of heavier kava sessions too. No nausea, and no dermo.

 

[kavamehameha]

In my opinion, as long as you don't take any medications which could interfere with daily consumed kava, have reduced liver function, or are chronically ill otherwise, there is no need to get your liver checked. Kava is safe for the liver. That's a fact proven over the course of the past 3000 years or so.

But I really like hearing from your test results! I think it's a great way to personally prove the safety of kava.

 

[Saghloqh]

I've had my liver checked a number of times throughout the years, and it's always been perfect regardless of kava intake (probably longest was about 6 months daily usage, numbers were better even than the previous check).

I've never personally seen a case of liver issues and kava that hasn't either had other complicating factors (other meds for example) or questionable kava (pills/extracts/non-noble/aerial parts). Heck, even with all of those considered, there have been a handful of cases among probably millions who have used kava. At a certain point any ailment is just going to be statistical noise - or in other words, people have liver issues without any extenuating circumstances. At some point there's going to be someone who had completely unrelated liver issues, and when asked "have you taken anything recently" kava will be an answer. Given how few liver/kava cases there are, I almost get the gut feeling that kava users might actually be *less likely* than the general population to have liver issues, if for no other reason than the fact that many who have switched to kava no longer drink alcohol.