Case report: Toxic Hepatitis After Consumption of Traditional Kava Preparation

[Mo'iety]

So I came across this case report, which seems to suggest that traditional noble kava consumed in Samoa was linked to acute hepatitis in a 42-year-old healthy male. This one is interesting, since as far as I've found at least, it's the only case report where the "kava" is actually traditional noble[1] kava beverage, and not some extract or kava product with unknown quality control. Obviously this is one case out of many millions of kava beverages consumed, so if the kava is actually to blame here, this is an incredibly, incredibly rare occurrence. But still I wonder what's going on here. Might this suggest that there may indeed be some rare genetic immunologic, enzymatic, or other physiological idiosyncrasy that may render certain individuals susceptible to toxic reactions to kava?

[1] IIRC, Samoa does not cultivate any tudei cultivars.

 

[kasa_balavu]

He had 2-3 litres of kava over three weeks (basically a small amount of weak kava). Then he had three weeks over which he was also drinking small amounts of alcohol. Then he got toxic hepatitis.
I'd argue that the title of the case report would be more correct if it were: Toxic Hepatitis After Consumption of Alcohol

IIRC, Samoa does not cultivate any tudei cultivars.

Correct. However, aerial parts of noble kava plants also contain hepatotoxic compounds, which is why even when buying kava sourced from noble-only countries, it's important to stick with reputable vendors.

 

[TheKavaSociety]

It probably only confirms the rather widely accepted thesis that hepatotoxicity is idiosyncratic and likely linked to a rare genetic susceptibility. Dr Barguil estimates that 1 in 200,000 people might be genetically unable to metabolise kava and in their case kava causes an autoimmune reaction that can lead to a liver failure.

 

[Alia]

Blame it on the kava. Or what is the Tylenol/Liver chances?
If you are old enough you may recall Kris Kristoffersons' song- "Blame it on the Stones"
Interesting lyrics. It could be re-written.

 

[verticity]

I saw this one a while ago when trying to look up how many liver case reports there have been since the big liver scare around 2000. That one from 2009 was one of the few in the literature after 2003:
http://kavaforums.com/forum/threads...nce-for-kavas-safety.12882/page-2#post-145969

I repeated that search just now and there have been a couple of case reports in the literature since then. There was the Brazilian extract case that we have discussed here before:
http://kavaforums.com/forum/threads/what-do-you-guys-think-of-this-study.16054
and also this one from late 2017 that I haven't seen before:
Bartnik, Catherine, and Ram Subramanian. "Kava Kava, Not for the Anxious: A Case of Fulminant Hepatic Failure After Kava Kava Supplementation: 2373." American Journal of Gastroenterology 112 (2017): S1292.
about a 28-year old woman (presumably an American) with liver failure requiring transplantation, who had been drinking "kava tea" daily for a year prior. Sounds like it was powder, not some extract product, but the brief article doesn't say if it was noble or not. It also says she hadn't been drinking alcohol at all.

So, three cases of serious liver disease possibly linked to kava after 2003 (that I know of). Something like what @Henry suggested might well be true, that kava sometimes can cause serious liver issues, but only in extremely rare cases of people who are somehow predisposed, or possibly when combined with other risk factors.

 

[Alia]

As you write, the article is brief with lots of missing information. "kava tea" could mean traditional dry kava which she strained and made into beverage.
But it could also mean a pre-made , bag of kava tea , it could even be an extract which is lumped in to mean "kava tea". Just saying it is too sketchy to have much meaning in my view. Kava-Kava Supplementation? Why Also-I wonder did it take a year if the Kava?