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
) 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
I have been drinking kava on and off (mostly on
) 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
