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Correcting Misinformation Google Link #3 - NIH - Kava

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
Hello, kava lovers, today we go for link # 3 on google’s kava menu.

Process:
Opened incognito window in google chrome
Google searched for “Kava”
This is the 3rd Link after The Australian Alcohol & Drug Foundation link.

Article Link: https://www.nccih.nih.gov/health/kava

Today’s link is from the National Institutes of Health’s National Center for Complementary and Integrative Health. There are only 5 sections to address, but much to unpack. Our old friend “liver damage” pops its head up here, unsurprisingly. We’ll tackle that though.

Section 1:
Kava

  1. “Common Names: kava, kava kava, ava pepper, ava root, kawa”
    • Pretty short. Definitely not an exhaustive list, but suffices for this article.
  2. “Latin Names: Piper methysticum”
    • Correct.

Section 2:
Background

  1. “Kava is native to the islands of the western Pacific and is a member of the pepper family.”
    • This is correct, but I would rather say it’s in the Piperaceae family. This is technically splitting hairs, as they both mean the same thing, I just caution against making those analogies with common foods, as kava the drink shares little to no similarities with Piper Nigrum or black pepper, the spice.
  2. “Pacific islanders have used kava for thousands of years as a medicine and for ritual purposes.”
    • No arguments. This is correct and has been for thousands of years.
  3. “Today, kava is promoted as a dietary supplement for anxiety, insomnia, and other conditions.”
    • This is true in America. We see kava touted for its anti-anxiety and stress relieving properties.

Section 3:
How much do we know?

  1. “There has been a fair amount of research in people on the use of kava for anxiety, but few studies have been done on other conditions.”
    • Incorrect. See work by Dr. Sarris and Dr. Aparosa and others. I think they’re referring to the monograph studies put forth by the German Commission E that included double blinded, placebo controlled studies in a medical setting on kava extracts. If you limit your research to that, then this would be somewhat correct, but this is but a tiny view-point of kava and while important, doesn’t stand alone as the only research in vivo in human participants.

      Aporosa, Apo S., Martin Atkins, and Richard Brunton. 2020. “Kava Drinking in Traditional Settings: Towards Understanding Effects on Cognitive Function.” Human Psychopharmacology 35 (2): e2725. https://doi.org/10.1002/hup.2725.

      Aporosa, S. 2019. “Cognitive Functions Associated with Consumption of Traditional Volumes of Kava (Piper Methysticum): A Feasibility Study.” In British Association for Psychopharmacology. researchcommons.waikato.ac.nz. https://researchcommons.waikato.ac.nz/handle/10289/12780.

      Thomsen, Michael, and Mathias Schmidt. 2021. “Health Policy versus Kava (Piper Methysticum): Anxiolytic Efficacy May Be Instrumental in Restoring the Reputation of a Major South Pacific Crop.” Journal of Ethnopharmacology 268 (March): 113582. https://doi.org/10.1016/j.jep.2020.113582
Section 4:
What Have We Learned?

  1. “Kava supplements may have a small effect on reducing anxiety, but they have been linked to a risk of severe liver injury.”
    • Kava most certainly has more than a “small effect” on reducing anxiety. There have been many studies related to this, and all found significant reduction in HAMA anxiety rating scores.

      Bousman, C. A., G. Murray, and K. M. Savage. 2012. “Kava for the Treatment of Generalized Anxiety.” Journal of Clinical Psychopharmacology. https://www.academia.edu/download/4...t_of_Generalized_An20160501-19740-1mzgl6u.pdf

      De Leo, V., A. la Marca, G. Morgante, D. Lanzetta, P. Florio, and F. Petraglia. 2001. “Evaluation of Combining Kava Extract with Hormone Replacement Therapy in the Treatment of Postmenopausal Anxiety.” Maturitas 39 (2): 185–88. https://doi.org/10.1016/s0378-5122(01)00197-9

      Lehrl, Siegfried. 2004. “Clinical Efficacy of Kava Extract WS 1490 in Sleep Disturbances Associated with Anxiety Disorders. Results of a Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial.” Journal of Affective Disorders 78 (2): 101–10. https://doi.org/10.1016/s0165-0327(02)00238-0

      Sarris, Jerome, A. Scholey, Isaac Schweitzer, Chad Bousman, Emma LaPorte, Chee Ng, Greg Murray, and C. Stough. 2012. “The Acute Effects of Kava and Oxazepam on Anxiety, Mood, Neurocognition; and Genetic Correlates: A Randomized, Placebo-Controlled, Double-Blind Study.” Human Psychopharmacology: Clinical and Experimental 27 (3): 262–69. https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.2216

    • Let’s address this “risk of severe liver injury” that’s spoken so much about. Let’s put that directly into perspective. Schmidt & Nahrstedt in 2002 stated that approximately 450 million daily doses of kava containing products were sold between 1991 and 2001 in German speaking countries. This is 45 million doses per year, or over 120,000 doses per day. When the number of instances are calculated to the number of doses we come up with a hepatic adverse events occurrence of .008 cases in one million daily doses. This is based on the clearly exaggerated number of cases and if we were to take actual RUCAM scores into account, this would be far FAR lower than even .008 cases per million. Let’s look at another drug to compare this number to. Benzodiazepines are among the most safe and tolerable medications (not taking into account addiction issues) in regards to liver injury. Valium, or diazepam, was calculated to have 2.12 liver injury cases per million daily doses and is still considered very safe. Even taking ALL instances into account, isn’t this warning blown completely out of proportion?

      Schmidt, M., A. Nahrstedt, and N. P. Lupke. 2002. “Piper Methysticum (Kava) in Der Diskussion: Betrachtungen Zu Qualitat, Wirksamkeit Und Unbedenklichkeit.” Wiener Medizinische Wochenschrift 152 (15-16): 382–88. https://doi.org/10.1046/j.1563-258x.2002.02058.x

      HerbalGram. 2002. “Kava: Safety Questioned due to Case Reports of Liver Toxicity.” The Journal of The American Botanical Council, no. 55: 28–34. https://www.herbalgram.org/media/11996/issue55.pdf

      Schulze H, Meng G, Siegers C-P. Safety assessment of kavalactone-containing herbal drugs in comparison to other psychotropics: presented at Annual Meeting Swiss Society of Pharmacology, September 2001.

  1. “There isn’t enough evidence to show whether kava is helpful for any other conditions.”
    • Quite incorrect. Kava has been researched for a vast variety of conditions including but not limited to cancer, epilepsy, sleep, depression, and believe it or not, strychnine poisoning.

      Bian, Tengfei, Pedro Corral, Yuzhi Wang, Jordy Botello, Rick Kingston, Tyler Daniels, Ramzi G. Salloum, et al. 2020. “Kava as a Clinical Nutrient: Promises and Challenges.” Nutrients 12 (10). https://doi.org/10.3390/nu12103044

Section 5:
What do we know about safety?


  1. “The use of kava has been linked to liver injury that is sometimes serious or even fatal. The exact cause and frequency of the liver damage are unclear.”
    • “Sometimes serious or even fatal” for an event occurrence of .008 cases per million daily doses. The word “sometimes” belongs nowhere within a light-year of this statement. See my statements on Part B in section 4. Idiosyncratic immunologic reactions are, currently, what they believe to be the reason for the tiny number of actual cases that seem to be linked to kava. Again, we must stress that this reaction is extraordinarily rare and is not linked to any intrinsic toxicity of kava or its constituents.

      Teschke, Rolf, Samuel X. Qiu, and Vincent Lebot. 2011. “Herbal Hepatotoxicity by Kava: Update on Pipermethystine, Flavokavain B, and Mould Hepatotoxins as Primarily Assumed Culprits.” Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 43 (9): 676–81. https://doi.org/10.1016/j.dld.2011.01.018
  2. “Kava can cause digestive upset, headache, dizziness, and other side effects. The use of kava may affect the ability to drive or operate machinery. Long-term use of high doses of kava may cause kava dermopathy, a condition that involves dry, scaly, flaky skin with a yellow discoloration.”
    • No issues with this paragraph. Headache, along with digestive upset seem to be the most commonly reported side effects with headache being more rare. Personally I’ve found kava to be excellent in preventing headaches, but your mileage may vary.
  3. “Kava may have special risks if taken during pregnancy or while breastfeeding because of the presence of harmful pyrone constituents.”
    • The “pyrone constituents” they speak of here are referring to kavalactones, and they’re not intrinsically harmful. They are lipophilic which means they dissolve in fats which means they may carry on into breastmilk. We have very scant research in regards to kava in pregnancy however Dr. Lebot does make mention in 1988 of kava being consumed during pregnancy. It was shown that in certain tribes of PNG women they would drink kava heavily during pregnancies just before delivery in order to, what they believed, help stimulate milk production.

      Lebot Vincent, Cabalion Pierre. 1988. KAVAS OF VANUATU Cultivars of Piper Methysticum Forst. South Pacific Commission Technical Paper. https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers14-07/26842.pdf

Article References

  1. Becker MW, Lourençone EMS, De Mello AF, et al. Liver transplantation and the use of kava: case report. Phytomedicine. 2019;56:21-26.
  2. Kava kava. LiverTox: clinical and research information on drug-induced liver injury. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; 2018.
  3. Kava. Natural Medicines website. Accessed at naturalmedicines.therapeuticresearch.com on January 22, 2020. [Database subscription].
  4. Kim J, Lee SL, Kang I, et al. Natural products from single plants as sleep aids: a systematic review. Journal of Medicinal Food. 2018;21(5):433-444.
  5. Pittler MH, Ernst E. Kava extract for treating anxiety. Cochrane Database of Systematic Reviews. 2003;(1):CD003383 [edited 2010]. Accessed at www.thecochranelibrary.com on March 6, 2020.
  6. Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytotherapy Research. 2018;32(7):1147-1162.
  7. Sarris J, Stough C, Bousman CA, et al. Kava in the treatment of generalized anxiety disorder. A double-blind, randomized, placebo-controlled study. Journal of Clinical Psychopharmacology. 2013;33(5):643-648.
  8. Smith K, Leiras C. The effectiveness and safety of kava kava for treating anxiety symptoms: a systematic review and analysis of randomized clinical trials. Complementary Therapies in Clinical Practice. 2018;33:107-117.
  9. White CM. The pharmacology, pharmacokinetics, efficacy, and adverse events associated with kava. Journal of Clinical Pharmacology. 2018;58(11):1396-1405
 
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