What's new

Arginine supplementation for non-topical treatment of kava dermopathy

jonaspmd

found kava
Apologies for a longer post, but this has been on my mind for a while now. Just want to share my experience with those who struggle with dermopathy
I have been drinking kava on and off (mostly on ::chugger::) for the last three years, so probably qualify as "somewhat" experienced drinker. Dermopathy is an issue for me if I overdo kava, which I view as a positive thing actually. It is pretty much the only mechanism that self regulates the intake of kava (taste and nausea aside). I have found many info on dermopathy on this great forum and have done fair amount of research online. My understanding is that there is no clear understanding how kava affects the life cycle of the skin. I also suspect that similar mechanism affects mucous membranes, which would explain aggravation of my heartburn and the need to cut morning coffee when drinking kava. I would describe my dermopathy pretty much the same way as many members did. Moderate doses of kava are fine, but if I overdo, then it starts with dry eyes, itchy neck and the goes all the way down to feet eventually leading to cracked, scally skin.

I did not spend much time on topical options, as skin hydration with lotions or exfoliating with acids is just a mechanical treatment and does affect the systemic problem. There are many theoretical attempts to explain the physiology of kava and a few intervention studies that tried to find the cure that can be found out there, but with no definitive answers.

After lots of research and trying lots of different supplements, vitamins and nutrients, I found this article:
Kava ichthyosis: a nitric oxide synthase inhibition? (psu.edu)

They proposed that kava dermopathy results from nitric oxide (NO) synthase inhibition (they call it kava ichthyosis or acquired ichthyosis; classic ichthyosis is an inheritable disease with similar symptoms as kava dermopathy; not sure whether there is an actual connection between kava dermopathy and ichthyosis). NO is a well known molecule in cardiology, which acts as vasodilator. Lack or disturbance in the production of NO leads to vasoconstriction, which in case of an underlying heart disease can lead to ischemia (heart attack). Apparently, as they describe in the same article, there were a few cases of sudden death after a kava session. Sudden death in medicine is a nick name when they don't really know what happened, but likely it was related to cardiovascular issues. So, if you read the article, don't think that kava caused sudden death. Most likely these were guys with heavily clogged arteries, they overdosed kava, which led to vasocontraction, which in turn was "the last drop" and caused heart attack. I suspect cold feet and chills, that kava drinkers can feel sometimes, are a result of this phenomenon, but in no way this should cause a heart attack in otherwise healthy individuals.

Without going into too many details, the authors tried to increase substrate availability (arginine, they did not try ornithine nor citrulline, which all affect the same pathway to my knowledge) and the availability of intracellular calcium with glutamate (I am not familiar with this particular mechanism, but I am sure it makes sense, just never spent time researching that). This is what they did:

- "we decided to try to increase intracellular Ca2+ by giving oral glutamate to kava drinker volunteers. Arginine was also given per os as a substrate for NO synthesis (2.5 g arginine-glutamate twice daily for twenty days to two volunteers who continued their kava consumption; this dosage being classically used as antiasthenic medication without any side effects)."

The results was no "marked improvement of the skin’s appearance".

I was somewhat familiar with arginine use in wound healing:
- this is a very old approach, eg from 2001 Arginine and Wound Healing | Article | NursingCenter;
- more recent source Arginine and Wound Healing Evidence | WoundSource ,
- although the "trustworthy" WebMd disagrees.

What I liked on top of that is that arginine supplementation is fairly well researched in liver diseases of all kinds:
- eg in obstructive liver failure here The Effects of L-Arginine on Liver Damage in Experimental Acute Cholestasis an Immunohistochemical Study (nih.gov)
- eg in liver regeneration after partial removal of liver here Effect of L-arginine supplement on liver regeneration after partial hepatectomy in rats | World Journal of Surgical Oncology | Full Text (biomedcentral.com)
Both these examples are in animals. It is always more complicated to prove the usefulness in humans and no one will pay for a randomised clinical trial with a cheap generic, non-patentable amino acid.

Caveat here is that the authors included a warning at the end of the article:
- "An induction of CYP1A2 by a vegetable diet (Brussels sprouts, broccoli, etc.) could be tried to reverse possible NOS inhibition and high GGT blood levels; but as some kava-related toxic compounds (quinones) are probably synthesised by the CYP1A2 isoenzyme, inducing CYP1A2 under a kava regimen could be hazardous (possible hepatotoxicity). "
Basically they are saying that dermopathy is a consequence of the alteration in a biochemical pathway meant to protect from the production of hepatotoxic compounds!!! Unfortunately they do not elaborate on that.

I would not trust the experimental part at all
- The dose was fairly low and it is not clear what they mean by "2.5 g arginine-glutamate" - this sounds like a mix of the two, so arginine dose is very low then. Bodybuilders can use up to 20g per day of arginine - The acute effects of a low and high dose of oral L-arginine supplementation in young active males at rest - PubMed (nih.gov)
- In addition, the combo was given to only to two subjects, who continued to drink kava. If arginine supplementation alleviated the dermopathy, then my best guess is that these subjects would just increase the consumption of kava as they feel better (at least that is what I would do).

With all this in mind I decided to start arginine supplementation (on demand, not chronically). Increasing substrate availability seems to me much milder intervention than forced activation of an enzyme as they authors suggested (also not a huge fan of broccoli). I almost always reject anecdotal results, ie from one or two subjects, so even to this day I am not completely convinced, but after a couple years of "experimentation" with different arginine doses and regimens (and related acids ornithine and citrulline), this is what I cay say:

- I settled to using a combo of arginine, ornithine and lysine. Lysine is here simply because this is the most accessible supplement for me, all-in-one pill I can by at a nearby store, I could not bother regularly purchasing three bottles on Amazon and calculating dosages. If you would google NO production pathway, there is a lot of info about how those three acids complement each other (arginine, ornithine and citrulline). But I believe simple standalone arginine is fine to try.
- After many cycles of using this combo on demand whenever I feel the start of dermopathy symptoms, I find that skin symptoms start rapidly improving by third day. If I stop kava drinking, skin symptoms resolve rapidly. If I continue drinking, skin symptoms improve, but the progression re-starts if continue drinking moderate to high doses, although they progress at a much slower pace.
- One of my KEY findings, or at least impressions as we are still talking about anecdotal experience, is that this is NOT a way to increase kava consumption - cannot emphasize that enough. Increasing substrate availability does not alter the inhibition mechanism (whatever enzymes kava inhibits). It feels like arginine supplementation acts as a "rescue", which means that if you abruptly discontinue the use of arginine, the dermopathy comes roaring back. And that is true in my experience. When the symptoms alleviate on arginine and you start feeling better, it is very easy to increase the consumption of kava. Then if for whatever reason you discontinue arginine, you can find yourself in a deep hole (happened to me in the early days, could not understand what was happening).

So, if you will decide to try, my best advice would be to do as follows:
- Ideally it would be interesting to hear from experienced drinkers as this requires pretty good understanding of the pattern of your dermopathy, you literality have to know what will happen with your skin over the next five days.
- Whenever you feel it coming, on the FIRST day start arginine 2.5g twice per day (5g in total on the first day)
- If no side effects (which is mainly diarrhoea due to osmotic presume I presume, although this was never an issue for me), then on the SECOND day increase to a total of 7-8g per day split in two or three doses;
- on the THIRD day increase to a total of 10g
- continue same dosage for the FOURTH and FIFTH day and then stop

- I used higher doses and for longer (up to two weeks), with no side effects. I find that doses lower than 5g do nothing or the improvement is not that noticeable.
- Whether to continue drinking kava or not depends on what you do normally when you start feeling kava side affects (dermo and lethargy) - the whole point of this exercise is to see whether arginine supplementation improves your sides effects during your normal kava consumption, as this is the only way you can compare with you previous experience.
- From my experience, there should be a clear noticeable effect on day THREE. It's a bit like you cut your finger, the wound can still bleed on the second day, but on third and fourth day it starts to heal rapidly.
- When you abruptly stop on fifth day, observe if your side effects come back rapidly on sixth and seventh day.

Final notes,
- It could work for somebody but probably not everybody. As it is clear that dermopathy is a big issue for some, but seems like almost non existing for others.
- Larger doses of arginine are known to promote the herpes virus. I develop cold sores every now and then, and can confirm that arginine can reactive herpes virus, sometimes not always, but this has not been a big issue for me.

I'll stop now ;)
 

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
@jonaspmd

Welcome! Glad to have you with us :)

You don't have to stop. In fact, I could read things like this all day long.

Had you posted this a few hours earlier I would have slapped the "Fact of the day" tag on this post and called it a morning. What a fantastic post.

I do the daily "patch up" job with lotions after my shower, but it would be rather liberating to not have to deal with that. I'm gonna try this.
 

Zaphod

Kava Lover
Apologies for a longer post, but this has been on my mind for a while now. Just want to share my experience with those who struggle with dermopathy
I have been drinking kava on and off (mostly on ::chugger::) for the last three years, so probably qualify as "somewhat" experienced drinker. Dermopathy is an issue for me if I overdo kava, which I view as a positive thing actually. It is pretty much the only mechanism that self regulates the intake of kava (taste and nausea aside). I have found many info on dermopathy on this great forum and have done fair amount of research online. My understanding is that there is no clear understanding how kava affects the life cycle of the skin. I also suspect that similar mechanism affects mucous membranes, which would explain aggravation of my heartburn and the need to cut morning coffee when drinking kava. I would describe my dermopathy pretty much the same way as many members did. Moderate doses of kava are fine, but if I overdo, then it starts with dry eyes, itchy neck and the goes all the way down to feet eventually leading to cracked, scally skin.

I did not spend much time on topical options, as skin hydration with lotions or exfoliating with acids is just a mechanical treatment and does affect the systemic problem. There are many theoretical attempts to explain the physiology of kava and a few intervention studies that tried to find the cure that can be found out there, but with no definitive answers.

After lots of research and trying lots of different supplements, vitamins and nutrients, I found this article:
Kava ichthyosis: a nitric oxide synthase inhibition? (psu.edu)

They proposed that kava dermopathy results from nitric oxide (NO) synthase inhibition (they call it kava ichthyosis or acquired ichthyosis; classic ichthyosis is an inheritable disease with similar symptoms as kava dermopathy; not sure whether there is an actual connection between kava dermopathy and ichthyosis). NO is a well known molecule in cardiology, which acts as vasodilator. Lack or disturbance in the production of NO leads to vasoconstriction, which in case of an underlying heart disease can lead to ischemia (heart attack). Apparently, as they describe in the same article, there were a few cases of sudden death after a kava session. Sudden death in medicine is a nick name when they don't really know what happened, but likely it was related to cardiovascular issues. So, if you read the article, don't think that kava caused sudden death. Most likely these were guys with heavily clogged arteries, they overdosed kava, which led to vasocontraction, which in turn was "the last drop" and caused heart attack. I suspect cold feet and chills, that kava drinkers can feel sometimes, are a result of this phenomenon, but in no way this should cause a heart attack in otherwise healthy individuals.

Without going into too many details, the authors tried to increase substrate availability (arginine, they did not try ornithine nor citrulline, which all affect the same pathway to my knowledge) and the availability of intracellular calcium with glutamate (I am not familiar with this particular mechanism, but I am sure it makes sense, just never spent time researching that). This is what they did:

- "we decided to try to increase intracellular Ca2+ by giving oral glutamate to kava drinker volunteers. Arginine was also given per os as a substrate for NO synthesis (2.5 g arginine-glutamate twice daily for twenty days to two volunteers who continued their kava consumption; this dosage being classically used as antiasthenic medication without any side effects)."

The results was no "marked improvement of the skin’s appearance".

I was somewhat familiar with arginine use in wound healing:
- this is a very old approach, eg from 2001 Arginine and Wound Healing | Article | NursingCenter;
- more recent source Arginine and Wound Healing Evidence | WoundSource ,
- although the "trustworthy" WebMd disagrees.

What I liked on top of that is that arginine supplementation is fairly well researched in liver diseases of all kinds:
- eg in obstructive liver failure here The Effects of L-Arginine on Liver Damage in Experimental Acute Cholestasis an Immunohistochemical Study (nih.gov)
- eg in liver regeneration after partial removal of liver here Effect of L-arginine supplement on liver regeneration after partial hepatectomy in rats | World Journal of Surgical Oncology | Full Text (biomedcentral.com)
Both these examples are in animals. It is always more complicated to prove the usefulness in humans and no one will pay for a randomised clinical trial with a cheap generic, non-patentable amino acid.

Caveat here is that the authors included a warning at the end of the article:
- "An induction of CYP1A2 by a vegetable diet (Brussels sprouts, broccoli, etc.) could be tried to reverse possible NOS inhibition and high GGT blood levels; but as some kava-related toxic compounds (quinones) are probably synthesised by the CYP1A2 isoenzyme, inducing CYP1A2 under a kava regimen could be hazardous (possible hepatotoxicity). "
Basically they are saying that dermopathy is a consequence of the alteration in a biochemical pathway meant to protect from the production of hepatotoxic compounds!!! Unfortunately they do not elaborate on that.

I would not trust the experimental part at all
- The dose was fairly low and it is not clear what they mean by "2.5 g arginine-glutamate" - this sounds like a mix of the two, so arginine dose is very low then. Bodybuilders can use up to 20g per day of arginine - The acute effects of a low and high dose of oral L-arginine supplementation in young active males at rest - PubMed (nih.gov)
- In addition, the combo was given to only to two subjects, who continued to drink kava. If arginine supplementation alleviated the dermopathy, then my best guess is that these subjects would just increase the consumption of kava as they feel better (at least that is what I would do).

With all this in mind I decided to start arginine supplementation (on demand, not chronically). Increasing substrate availability seems to me much milder intervention than forced activation of an enzyme as they authors suggested (also not a huge fan of broccoli). I almost always reject anecdotal results, ie from one or two subjects, so even to this day I am not completely convinced, but after a couple years of "experimentation" with different arginine doses and regimens (and related acids ornithine and citrulline), this is what I cay say:

- I settled to using a combo of arginine, ornithine and lysine. Lysine is here simply because this is the most accessible supplement for me, all-in-one pill I can by at a nearby store, I could not bother regularly purchasing three bottles on Amazon and calculating dosages. If you would google NO production pathway, there is a lot of info about how those three acids complement each other (arginine, ornithine and citrulline). But I believe simple standalone arginine is fine to try.
- After many cycles of using this combo on demand whenever I feel the start of dermopathy symptoms, I find that skin symptoms start rapidly improving by third day. If I stop kava drinking, skin symptoms resolve rapidly. If I continue drinking, skin symptoms improve, but the progression re-starts if continue drinking moderate to high doses, although they progress at a much slower pace.
- One of my KEY findings, or at least impressions as we are still talking about anecdotal experience, is that this is NOT a way to increase kava consumption - cannot emphasize that enough. Increasing substrate availability does not alter the inhibition mechanism (whatever enzymes kava inhibits). It feels like arginine supplementation acts as a "rescue", which means that if you abruptly discontinue the use of arginine, the dermopathy comes roaring back. And that is true in my experience. When the symptoms alleviate on arginine and you start feeling better, it is very easy to increase the consumption of kava. Then if for whatever reason you discontinue arginine, you can find yourself in a deep hole (happened to me in the early days, could not understand what was happening).

So, if you will decide to try, my best advice would be to do as follows:
- Ideally it would be interesting to hear from experienced drinkers as this requires pretty good understanding of the pattern of your dermopathy, you literality have to know what will happen with your skin over the next five days.
- Whenever you feel it coming, on the FIRST day start arginine 2.5g twice per day (5g in total on the first day)
- If no side effects (which is mainly diarrhoea due to osmotic presume I presume, although this was never an issue for me), then on the SECOND day increase to a total of 7-8g per day split in two or three doses;
- on the THIRD day increase to a total of 10g
- continue same dosage for the FOURTH and FIFTH day and then stop

- I used higher doses and for longer (up to two weeks), with no side effects. I find that doses lower than 5g do nothing or the improvement is not that noticeable.
- Whether to continue drinking kava or not depends on what you do normally when you start feeling kava side affects (dermo and lethargy) - the whole point of this exercise is to see whether arginine supplementation improves your sides effects during your normal kava consumption, as this is the only way you can compare with you previous experience.
- From my experience, there should be a clear noticeable effect on day THREE. It's a bit like you cut your finger, the wound can still bleed on the second day, but on third and fourth day it starts to heal rapidly.
- When you abruptly stop on fifth day, observe if your side effects come back rapidly on sixth and seventh day.

Final notes,
- It could work for somebody but probably not everybody. As it is clear that dermopathy is a big issue for some, but seems like almost non existing for others.
- Larger doses of arginine are known to promote the herpes virus. I develop cold sores every now and then, and can confirm that arginine can reactive herpes virus, sometimes not always, but this has not been a big issue for me.

I'll stop now ;)
Excellent work my friend! I see no reason not to give this a go....and increased NO has some other good benefits ;) .
 

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
Here's my schedule. I've ordered the Arginine :)

MorningNoon NightTotal
Day 1
2.5​
X​
2.5​
5​
Day 2
3​
2.5​
2.5​
8​
Day 3
4​
3​
3​
10​
Day 4
4​
3​
3​
10​
Day 5
4​
3​
3​
10​
Total Grams/Tablets
43​
Product:
Natures Bounty L-Arginine 1000mg 50 tabs
Total L-Arginine: 50 grams
Price: $6.75 Amazon Prime
Link:
Amazon product
 

jonaspmd

found kava
@jonaspmd

Welcome! Glad to have you with us :)

You don't have to stop. In fact, I could read things like this all day long.

Had you posted this a few hours earlier I would have slapped the "Fact of the day" tag on this post and called it a morning. What a fantastic post.

I do the daily "patch up" job with lotions after my shower, but it would be rather liberating to not have to deal with that. I'm gonna try this.
Glad to join your crew, Kaptain!
 

jonaspmd

found kava
Here's my schedule. I've ordered the Arginine :)

MorningNoonNightTotal
Day 1
2.5​
X​
2.5​
5​
Day 2
3​
2.5​
2.5​
8​
Day 3
4​
3​
3​
10​
Day 4
4​
3​
3​
10​
Day 5
4​
3​
3​
10​
Total Grams/Tablets
43​
Product:
Natures Bounty L-Arginine 1000mg 50 tabs
Total L-Arginine: 50 grams
Price: $6.75 Amazon Prime
Link:
Amazon product
wow, that's way more organised than anything I've done. Now I am nervous that you will disprove my theory in no time :) For what it's worth, I trained as a medical doctor years ago, but now doing something else. I try my best not to give a reckless advice, safety is top priority. Doses like that should be very much fine. I tried much larger doses and for longer periods of time.
 

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
Now I am nervous that you will disprove my theory in no time :) For what it's worth, I trained as a medical doctor years ago, but now doing something else. I try my best not to give a reckless advice, safety is top priority. Doses like that should be very much fine. I tried much larger doses and for longer periods of time.
We'll learn something one way or another! :)
 

DaManTheyCallB

Kava Curious
Apologies for a longer post, but this has been on my mind for a while now. Just want to share my experience with those who struggle with dermopathy
I have been drinking kava on and off (mostly on ::chugger::) for the last three years, so probably qualify as "somewhat" experienced drinker. Dermopathy is an issue for me if I overdo kava, which I view as a positive thing actually. It is pretty much the only mechanism that self regulates the intake of kava (taste and nausea aside). I have found many info on dermopathy on this great forum and have done fair amount of research online. My understanding is that there is no clear understanding how kava affects the life cycle of the skin. I also suspect that similar mechanism affects mucous membranes, which would explain aggravation of my heartburn and the need to cut morning coffee when drinking kava. I would describe my dermopathy pretty much the same way as many members did. Moderate doses of kava are fine, but if I overdo, then it starts with dry eyes, itchy neck and the goes all the way down to feet eventually leading to cracked, scally skin.

I did not spend much time on topical options, as skin hydration with lotions or exfoliating with acids is just a mechanical treatment and does affect the systemic problem. There are many theoretical attempts to explain the physiology of kava and a few intervention studies that tried to find the cure that can be found out there, but with no definitive answers.

After lots of research and trying lots of different supplements, vitamins and nutrients, I found this article:
Kava ichthyosis: a nitric oxide synthase inhibition? (psu.edu)

They proposed that kava dermopathy results from nitric oxide (NO) synthase inhibition (they call it kava ichthyosis or acquired ichthyosis; classic ichthyosis is an inheritable disease with similar symptoms as kava dermopathy; not sure whether there is an actual connection between kava dermopathy and ichthyosis). NO is a well known molecule in cardiology, which acts as vasodilator. Lack or disturbance in the production of NO leads to vasoconstriction, which in case of an underlying heart disease can lead to ischemia (heart attack). Apparently, as they describe in the same article, there were a few cases of sudden death after a kava session. Sudden death in medicine is a nick name when they don't really know what happened, but likely it was related to cardiovascular issues. So, if you read the article, don't think that kava caused sudden death. Most likely these were guys with heavily clogged arteries, they overdosed kava, which led to vasocontraction, which in turn was "the last drop" and caused heart attack. I suspect cold feet and chills, that kava drinkers can feel sometimes, are a result of this phenomenon, but in no way this should cause a heart attack in otherwise healthy individuals.

Without going into too many details, the authors tried to increase substrate availability (arginine, they did not try ornithine nor citrulline, which all affect the same pathway to my knowledge) and the availability of intracellular calcium with glutamate (I am not familiar with this particular mechanism, but I am sure it makes sense, just never spent time researching that). This is what they did:

- "we decided to try to increase intracellular Ca2+ by giving oral glutamate to kava drinker volunteers. Arginine was also given per os as a substrate for NO synthesis (2.5 g arginine-glutamate twice daily for twenty days to two volunteers who continued their kava consumption; this dosage being classically used as antiasthenic medication without any side effects)."

The results was no "marked improvement of the skin’s appearance".

I was somewhat familiar with arginine use in wound healing:
- this is a very old approach, eg from 2001 Arginine and Wound Healing | Article | NursingCenter;
- more recent source Arginine and Wound Healing Evidence | WoundSource ,
- although the "trustworthy" WebMd disagrees.

What I liked on top of that is that arginine supplementation is fairly well researched in liver diseases of all kinds:
- eg in obstructive liver failure here The Effects of L-Arginine on Liver Damage in Experimental Acute Cholestasis an Immunohistochemical Study (nih.gov)
- eg in liver regeneration after partial removal of liver here Effect of L-arginine supplement on liver regeneration after partial hepatectomy in rats | World Journal of Surgical Oncology | Full Text (biomedcentral.com)
Both these examples are in animals. It is always more complicated to prove the usefulness in humans and no one will pay for a randomised clinical trial with a cheap generic, non-patentable amino acid.

Caveat here is that the authors included a warning at the end of the article:
- "An induction of CYP1A2 by a vegetable diet (Brussels sprouts, broccoli, etc.) could be tried to reverse possible NOS inhibition and high GGT blood levels; but as some kava-related toxic compounds (quinones) are probably synthesised by the CYP1A2 isoenzyme, inducing CYP1A2 under a kava regimen could be hazardous (possible hepatotoxicity). "
Basically they are saying that dermopathy is a consequence of the alteration in a biochemical pathway meant to protect from the production of hepatotoxic compounds!!! Unfortunately they do not elaborate on that.

I would not trust the experimental part at all
- The dose was fairly low and it is not clear what they mean by "2.5 g arginine-glutamate" - this sounds like a mix of the two, so arginine dose is very low then. Bodybuilders can use up to 20g per day of arginine - The acute effects of a low and high dose of oral L-arginine supplementation in young active males at rest - PubMed (nih.gov)
- In addition, the combo was given to only to two subjects, who continued to drink kava. If arginine supplementation alleviated the dermopathy, then my best guess is that these subjects would just increase the consumption of kava as they feel better (at least that is what I would do).

With all this in mind I decided to start arginine supplementation (on demand, not chronically). Increasing substrate availability seems to me much milder intervention than forced activation of an enzyme as they authors suggested (also not a huge fan of broccoli). I almost always reject anecdotal results, ie from one or two subjects, so even to this day I am not completely convinced, but after a couple years of "experimentation" with different arginine doses and regimens (and related acids ornithine and citrulline), this is what I cay say:

- I settled to using a combo of arginine, ornithine and lysine. Lysine is here simply because this is the most accessible supplement for me, all-in-one pill I can by at a nearby store, I could not bother regularly purchasing three bottles on Amazon and calculating dosages. If you would google NO production pathway, there is a lot of info about how those three acids complement each other (arginine, ornithine and citrulline). But I believe simple standalone arginine is fine to try.
- After many cycles of using this combo on demand whenever I feel the start of dermopathy symptoms, I find that skin symptoms start rapidly improving by third day. If I stop kava drinking, skin symptoms resolve rapidly. If I continue drinking, skin symptoms improve, but the progression re-starts if continue drinking moderate to high doses, although they progress at a much slower pace.
- One of my KEY findings, or at least impressions as we are still talking about anecdotal experience, is that this is NOT a way to increase kava consumption - cannot emphasize that enough. Increasing substrate availability does not alter the inhibition mechanism (whatever enzymes kava inhibits). It feels like arginine supplementation acts as a "rescue", which means that if you abruptly discontinue the use of arginine, the dermopathy comes roaring back. And that is true in my experience. When the symptoms alleviate on arginine and you start feeling better, it is very easy to increase the consumption of kava. Then if for whatever reason you discontinue arginine, you can find yourself in a deep hole (happened to me in the early days, could not understand what was happening).

So, if you will decide to try, my best advice would be to do as follows:
- Ideally it would be interesting to hear from experienced drinkers as this requires pretty good understanding of the pattern of your dermopathy, you literality have to know what will happen with your skin over the next five days.
- Whenever you feel it coming, on the FIRST day start arginine 2.5g twice per day (5g in total on the first day)
- If no side effects (which is mainly diarrhoea due to osmotic presume I presume, although this was never an issue for me), then on the SECOND day increase to a total of 7-8g per day split in two or three doses;
- on the THIRD day increase to a total of 10g
- continue same dosage for the FOURTH and FIFTH day and then stop

- I used higher doses and for longer (up to two weeks), with no side effects. I find that doses lower than 5g do nothing or the improvement is not that noticeable.
- Whether to continue drinking kava or not depends on what you do normally when you start feeling kava side affects (dermo and lethargy) - the whole point of this exercise is to see whether arginine supplementation improves your sides effects during your normal kava consumption, as this is the only way you can compare with you previous experience.
- From my experience, there should be a clear noticeable effect on day THREE. It's a bit like you cut your finger, the wound can still bleed on the second day, but on third and fourth day it starts to heal rapidly.
- When you abruptly stop on fifth day, observe if your side effects come back rapidly on sixth and seventh day.

Final notes,
- It could work for somebody but probably not everybody. As it is clear that dermopathy is a big issue for some, but seems like almost non existing for others.
- Larger doses of arginine are known to promote the herpes virus. I develop cold sores every now and then, and can confirm that arginine can reactive herpes virus, sometimes not always, but this has not been a big issue for me.

I'll stop now ;)
Would Agmatine work? I ask becuase I take Agmatine and know arginine will null Agmatine . If so I wonder what that would translate as far as dosage goes.
 

Alia

'Awa Grower/Collector
Apologies for a longer post, but this has been on my mind for a while now. Just want to share my experience with those who struggle with dermopathy
I have been drinking kava on and off (mostly on ::chugger::) for the last three years, so probably qualify as "somewhat" experienced drinker. Dermopathy is an issue for me if I overdo kava, which I view as a positive thing actually. It is pretty much the only mechanism that self regulates the intake of kava (taste and nausea aside). I have found many info on dermopathy on this great forum and have done fair amount of research online. My understanding is that there is no clear understanding how kava affects the life cycle of the skin. I also suspect that similar mechanism affects mucous membranes, which would explain aggravation of my heartburn and the need to cut morning coffee when drinking kava. I would describe my dermopathy pretty much the same way as many members did. Moderate doses of kava are fine, but if I overdo, then it starts with dry eyes, itchy neck and the goes all the way down to feet eventually leading to cracked, scally skin.

I did not spend much time on topical options, as skin hydration with lotions or exfoliating with acids is just a mechanical treatment and does affect the systemic problem. There are many theoretical attempts to explain the physiology of kava and a few intervention studies that tried to find the cure that can be found out there, but with no definitive answers.

After lots of research and trying lots of different supplements, vitamins and nutrients, I found this article:
Kava ichthyosis: a nitric oxide synthase inhibition? (psu.edu)

They proposed that kava dermopathy results from nitric oxide (NO) synthase inhibition (they call it kava ichthyosis or acquired ichthyosis; classic ichthyosis is an inheritable disease with similar symptoms as kava dermopathy; not sure whether there is an actual connection between kava dermopathy and ichthyosis). NO is a well known molecule in cardiology, which acts as vasodilator. Lack or disturbance in the production of NO leads to vasoconstriction, which in case of an underlying heart disease can lead to ischemia (heart attack). Apparently, as they describe in the same article, there were a few cases of sudden death after a kava session. Sudden death in medicine is a nick name when they don't really know what happened, but likely it was related to cardiovascular issues. So, if you read the article, don't think that kava caused sudden death. Most likely these were guys with heavily clogged arteries, they overdosed kava, which led to vasocontraction, which in turn was "the last drop" and caused heart attack. I suspect cold feet and chills, that kava drinkers can feel sometimes, are a result of this phenomenon, but in no way this should cause a heart attack in otherwise healthy individuals.

Without going into too many details, the authors tried to increase substrate availability (arginine, they did not try ornithine nor citrulline, which all affect the same pathway to my knowledge) and the availability of intracellular calcium with glutamate (I am not familiar with this particular mechanism, but I am sure it makes sense, just never spent time researching that). This is what they did:

- "we decided to try to increase intracellular Ca2+ by giving oral glutamate to kava drinker volunteers. Arginine was also given per os as a substrate for NO synthesis (2.5 g arginine-glutamate twice daily for twenty days to two volunteers who continued their kava consumption; this dosage being classically used as antiasthenic medication without any side effects)."

The results was no "marked improvement of the skin’s appearance".

I was somewhat familiar with arginine use in wound healing:
- this is a very old approach, eg from 2001 Arginine and Wound Healing | Article | NursingCenter;
- more recent source Arginine and Wound Healing Evidence | WoundSource ,
- although the "trustworthy" WebMd disagrees.

What I liked on top of that is that arginine supplementation is fairly well researched in liver diseases of all kinds:
- eg in obstructive liver failure here The Effects of L-Arginine on Liver Damage in Experimental Acute Cholestasis an Immunohistochemical Study (nih.gov)
- eg in liver regeneration after partial removal of liver here Effect of L-arginine supplement on liver regeneration after partial hepatectomy in rats | World Journal of Surgical Oncology | Full Text (biomedcentral.com)
Both these examples are in animals. It is always more complicated to prove the usefulness in humans and no one will pay for a randomised clinical trial with a cheap generic, non-patentable amino acid.

Caveat here is that the authors included a warning at the end of the article:
- "An induction of CYP1A2 by a vegetable diet (Brussels sprouts, broccoli, etc.) could be tried to reverse possible NOS inhibition and high GGT blood levels; but as some kava-related toxic compounds (quinones) are probably synthesised by the CYP1A2 isoenzyme, inducing CYP1A2 under a kava regimen could be hazardous (possible hepatotoxicity). "
Basically they are saying that dermopathy is a consequence of the alteration in a biochemical pathway meant to protect from the production of hepatotoxic compounds!!! Unfortunately they do not elaborate on that.

I would not trust the experimental part at all
- The dose was fairly low and it is not clear what they mean by "2.5 g arginine-glutamate" - this sounds like a mix of the two, so arginine dose is very low then. Bodybuilders can use up to 20g per day of arginine - The acute effects of a low and high dose of oral L-arginine supplementation in young active males at rest - PubMed (nih.gov)
- In addition, the combo was given to only to two subjects, who continued to drink kava. If arginine supplementation alleviated the dermopathy, then my best guess is that these subjects would just increase the consumption of kava as they feel better (at least that is what I would do).

With all this in mind I decided to start arginine supplementation (on demand, not chronically). Increasing substrate availability seems to me much milder intervention than forced activation of an enzyme as they authors suggested (also not a huge fan of broccoli). I almost always reject anecdotal results, ie from one or two subjects, so even to this day I am not completely convinced, but after a couple years of "experimentation" with different arginine doses and regimens (and related acids ornithine and citrulline), this is what I cay say:

- I settled to using a combo of arginine, ornithine and lysine. Lysine is here simply because this is the most accessible supplement for me, all-in-one pill I can by at a nearby store, I could not bother regularly purchasing three bottles on Amazon and calculating dosages. If you would google NO production pathway, there is a lot of info about how those three acids complement each other (arginine, ornithine and citrulline). But I believe simple standalone arginine is fine to try.
- After many cycles of using this combo on demand whenever I feel the start of dermopathy symptoms, I find that skin symptoms start rapidly improving by third day. If I stop kava drinking, skin symptoms resolve rapidly. If I continue drinking, skin symptoms improve, but the progression re-starts if continue drinking moderate to high doses, although they progress at a much slower pace.
- One of my KEY findings, or at least impressions as we are still talking about anecdotal experience, is that this is NOT a way to increase kava consumption - cannot emphasize that enough. Increasing substrate availability does not alter the inhibition mechanism (whatever enzymes kava inhibits). It feels like arginine supplementation acts as a "rescue", which means that if you abruptly discontinue the use of arginine, the dermopathy comes roaring back. And that is true in my experience. When the symptoms alleviate on arginine and you start feeling better, it is very easy to increase the consumption of kava. Then if for whatever reason you discontinue arginine, you can find yourself in a deep hole (happened to me in the early days, could not understand what was happening).

So, if you will decide to try, my best advice would be to do as follows:
- Ideally it would be interesting to hear from experienced drinkers as this requires pretty good understanding of the pattern of your dermopathy, you literality have to know what will happen with your skin over the next five days.
- Whenever you feel it coming, on the FIRST day start arginine 2.5g twice per day (5g in total on the first day)
- If no side effects (which is mainly diarrhoea due to osmotic presume I presume, although this was never an issue for me), then on the SECOND day increase to a total of 7-8g per day split in two or three doses;
- on the THIRD day increase to a total of 10g
- continue same dosage for the FOURTH and FIFTH day and then stop

- I used higher doses and for longer (up to two weeks), with no side effects. I find that doses lower than 5g do nothing or the improvement is not that noticeable.
- Whether to continue drinking kava or not depends on what you do normally when you start feeling kava side affects (dermo and lethargy) - the whole point of this exercise is to see whether arginine supplementation improves your sides effects during your normal kava consumption, as this is the only way you can compare with you previous experience.
- From my experience, there should be a clear noticeable effect on day THREE. It's a bit like you cut your finger, the wound can still bleed on the second day, but on third and fourth day it starts to heal rapidly.
- When you abruptly stop on fifth day, observe if your side effects come back rapidly on sixth and seventh day.

Final notes,
- It could work for somebody but probably not everybody. As it is clear that dermopathy is a big issue for some, but seems like almost non existing for others.
- Larger doses of arginine are known to promote the herpes virus. I develop cold sores every now and then, and can confirm that arginine can reactive herpes virus, sometimes not always, but this has not been a big issue for me.

I'll stop now ;)
An interesting fact regarding the nutritional content of kava being a source for both Arginine and glutamic acid (1):
(1) "Glutamic acid (symbol Glu or E; the ionic form is known as glutamate) is an α-amino acid that is used by almost all living beings in the biosynthesis of proteins. It is non-essential in humans, meaning the body can synthesize it."
While I'm not arguing the cause of the dry skin issue I think it is interesting that kava actually has some of this at all.
As a drinker of fresh kava beverage for a few decades, I can say that the dry-skin has only been a mild, rare issue
with one exception being maybe not attributed to kava. As a farmer I value trace elements in fertilizer, as do
my 'awa plants. Trace amounts in food can be beneficial even though small . If this study is right, however, then maybe kava
just doesn't have enough.
 
Last edited:

fueledbykava

Kava enthusiast
This is super interesting research. If we compile this with what we know in the exercise nutrition supplement science realm, we can experiment with using kava and citrulline mallate to see how it affects dermopathy.

"Excess citrulline, a number of studies have shown, increases the amount of arginine in the blood"
https://www.bodybuilding.com/content/citrulline-malate-the-fatigue-fighter.html

"L-Citrulline dose-dependently increased AUC and Cmax of plasma L-arginine concentration more effectively than L-arginine (P < 0.01)."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291275/
 

jonaspmd

found kava
This is super interesting research. If we compile this with what we know in the exercise nutrition supplement science realm, we can experiment with using kava and citrulline mallate to see how it affects dermopathy.

"Excess citrulline, a number of studies have shown, increases the amount of arginine in the blood"
https://www.bodybuilding.com/content/citrulline-malate-the-fatigue-fighter.html

"L-Citrulline dose-dependently increased AUC and Cmax of plasma L-arginine concentration more effectively than L-arginine (P < 0.01)."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291275/
yes, exactly, also ornithine. And there are other ways how to affect NO homeostasis. The big if is, however, if this works at all. Remember the experimental part of the study failed, so my hope was that a simple protocol I describe with appropriate dose would help most who try to decide as objectively as possible whether there is something here or not, crowdsourced clinical trial in a way
 

jonaspmd

found kava
An interesting fact regarding the nutritional content of kava being a source for both Arginine and glutamic acid (1):
(1) "Glutamic acid (symbol Glu or E; the ionic form is known as glutamate) is an α-amino acid that is used by almost all living beings in the biosynthesis of proteins. It is non-essential in humans, meaning the body can synthesize it."
While I'm not arguing the cause of the dry skin issue I think it is interesting that kava actually has some of this at all.
As a drinker of fresh kava beverage for a few decades, I can say that the dry-skin has only been a mild, rare issue
with one exception being maybe not attributed to kava. As a farmer I value trace elements in fertilizer, as do
my 'awa plants. Trace amounts in food can be beneficial even though small . If this study is right, however, then maybe kava
just doesn't have enough.
Interesting. It would be a rational assumption that throughout centuries of kava plant selection, the amino acid content was intuitively increased by farmers if it alleviates the side effects. Or it could be just a coincidence. I haven't seen what amount of acids one would consume during a normal kava session, but my guess would be way below the doses I was talking about (10g per day).
 

jonaspmd

found kava
Would Agmatine work? I ask becuase I take Agmatine and know arginine will null Agmatine . If so I wonder what that would translate as far as dosage goes.
I am not familiar with this one. Looks like a metabolite of arginine, but it is a question for medicinal chemist whether the metabolism of arginine and agmatine overlap. A lot of what I described in the original post comes from practical insights in using arginine in certain patients. A lot of old drugs were approved that way, ie they see an effect, but do not really understand the mechanism of action. So, I am afraid only a clinical trial or wide spread use of agmatine in clinical practice could answer your specific questions.

Agmatine is not the most common supplement out there. I have never heard about it before and I know my supplements. Back in the day I was into what is now called self-hack (not anymore though). You clearly use it for a specific reason and probably know the right dosage. If there is any benefit on dermopathy, then you already are experiencing it.
 

Alia

'Awa Grower/Collector
Interesting. It would be a rational assumption that throughout centuries of kava plant selection, the amino acid content was intuitively increased by farmers if it alleviates the side effects. Or it could be just a coincidence. I haven't seen what amount of acids one would consume during a normal kava session, but my guess would be way below the doses I was talking about (10g per day).
In the book, Kavas of Vanuatu (KV) 1986, Lebot and Cabalion, there is a nutritional content list of dry kava powder.
To see the entire list of minerals, amino acids, etc. check page 63 of Hawaiian 'Awa, Views of an Ethnobotanical Treasure
(Association for Hawaiian 'Awa website)- "publications";
the read is interersting because we see kava as something beyond kavalactones.
The problem is-- how much weight did they analyze?
The chart in the original edition of KV says-- 1 spl powder.
What is spl?
I can find out but it may take a few days.
 

DaManTheyCallB

Kava Curious
I am not familiar with this one. Looks like a metabolite of arginine, but it is a question for medicinal chemist whether the metabolism of arginine and agmatine overlap. A lot of what I described in the original post comes from practical insights in using arginine in certain patients. A lot of old drugs were approved that way, ie they see an effect, but do not really understand the mechanism of action. So, I am afraid only a clinical trial or wide spread use of agmatine in clinical practice could answer your specific questions.

Agmatine is not the most common supplement out there. I have never heard about it before and I know my supplements. Back in the day I was into what is now called self-hack (not anymore though). You clearly use it for a specific reason and probably know the right dosage. If there is any benefit on dermopathy, then you already are experiencing it.
I am not familiar with this one. Looks like a metabolite of arginine, but it is a question for medicinal chemist whether the metabolism of arginine and agmatine overlap. A lot of what I described in the original post comes from practical insights in using arginine in certain patients. A lot of old drugs were approved that way, ie they see an effect, but do not really understand the mechanism of action. So, I am afraid only a clinical trial or wide spread use of agmatine in clinical practice could answer your specific questions.

Agmatine is not the most common supplement out there. I have never heard about it before and I know my supplements. Back in the day I was into what is now called self-hack (not anymore though). You clearly use it for a specific reason and probably know the right dosage. If there is any benefit on dermopathy, then you already are experiencing it.
Yeah Agmatine isn't common except for bodybuilders and nootropic world. We apparently have Agmatine in our bodies I believe in our guts. People use it to help reduce tolerance to substanances as well as increase Nitric Oxide in the body that's why the body builders use it to get better pumps. Here's a good site on it . One thing I've noticed is it stops dopaminergic euphoria from substances if taken during using these substanances. Also dulls K@ euphoria. It has mood stabilizer properties I believe as well. Some love it and gives them an antidepressant effect while others it just makes them feel weird. I was just asking you if it would work becuase I know it increases Nitric Oxide and that Arginine will block it's effects as well so thought maybe it had atleast partly similar actions. Appreciate your reply though.

 

marksmyspot

Kava Curious
I just bought some Nutraulline powder which as 4grams of citrulline, 1gram of arginine and other NO precursors i will see how it works
 

PurimGrogger

Because "Shell Silverstein" was already taken
They proposed that kava dermopathy results from nitric oxide (NO) synthase inhibition (they call it kava ichthyosis or acquired ichthyosis; classic ichthyosis is an inheritable disease with similar symptoms as kava dermopathy; not sure whether there is an actual connection between kava dermopathy and ichthyosis). NO is a well known molecule in cardiology, which acts as vasodilator.
So I wonder, accordingly, if supplementing kava sessions with some natural nitric oxide sources will help to head off dermopathy and related symptoms. Beet juice, for example, is a great source that I have used to naturally control blood pressure. If dermo is also related somewhat to dehydration as many people believe, then some beet juice might work on both fronts. If beet juice sounds not so tasty to you, let's remember that we got here by drinking something not so acclaimed for its taste. But people with hypotension (low blood pressure) should probably be careful with vasodilators like beet juice.

I also wonder if kava or its core constituents could be used as a treatment or supplement for minor hypotension.
 

Ellviis

Kava Curious
I know this may be more of a stretch, but since you’re talking small molecules, peptide KPV came to mind. Based on this PubMed article:


It references KPV having possible nitric oxide disposition properties.

I work at a compounding pharmacy, and just thought this association with nitric oxide is cool. Another possible thing that could help dermopathy?
 
Top