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Correcting Misinformation Google Link #5 - Better Health Channel (Australian Govt)

The Kap'n

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
Google Link #5 - Better Health Channel (Australian Government)

Article Source: https://www.betterhealth.vic.gov.au/health/healthyliving/kava

Process:
Open incognito window in chrome
Google search for “Kava”
Result # 5

Hello kava lovers, I’m skipping number 4 on our list because it’s the wikipedia article on kava. I fully intend on sitting down and editing that, but the scope of work involved requires me to skip that one for right now. Today’s article comes to us from Australia again. It seems the interest in kava is quite high there for our search results to feature an Australian Government page not once, but twice so far in the top ten results. As usual we see the normal culprits being spoken about here such as liver damage, apathy and such. Let’s dig in to get this article on the same page.


Section 1:

  • “Kava is a drug made from the ground roots of the plant Piper methysticum, a member of the pepper family that also includes black pepper. It is a native plant found in the South Pacific.”
    • Correct, but again we should keep ourselves from making these analogies to common food items. Kava, the drink, shares nothing about black pepper in common other than the family name.
  • “Kava can be taken as a drink or as a supplement or extract. Traditionally the root is crushed, ground or powdered and soaked in water to be drunk as a tea. This tea is often consumed socially and as part of traditional ceremonies and cultural practices throughout the South Pacific Islands.”
    • No issues here. This is well known.
  • “In small doses, the effects of kava include muscle relaxation, sleepiness and feelings of wellbeing. However, long-term use of kava can lead to a range of health problems, including malnutrition, weight loss and apathy”
    • Kava doesn’t interfere with the absorption of nutrients in the diet, so this “malnutrition” claim is likely wrapped into the “weight loss” claim. This thought comes from a paper from 1988 by Mathews et al. This research is old, its conclusions are inaccurate, and it has been refuted to the moon and back. The population of people that this study was performed on had many comorbidities that heavily influenced the results of this study. Take any paper that is sourcing this with a salt grain the size of Mt. Everest.

      Mathews, J.D., M.D. Riley, L. Fejo, E. Munoz, N. R. Milns, I. D. Gardner, J. R. Powers, E. Ganygulpa, and B. J. Gununuwawuy. 1988. “Effects of the Heavy Usage of Kava on Physical Health: Summary of a Pilot Survey in an Aboriginal Community.” The Medical Journal of Australia 148 (11): 548–55. https://doi.org/10.5694/j.1326-5377.1988.tb93809.x
    • Another issue I have with this statement is how they’re defining “long term”. What they really meant to say there was “long term very heavy use”. “Very Heavy” here refers to consumption of ~1lb of dry powder per week. Normal daily kava consumption (<100-300g/week) even for extremely long periods of time don’t seem to be experiencing these negative effects. Basically the more heavy the use, the more likely the occurrence of side effects, as with most substances.

      Clough, Alan. 2003. “Enough! Or Too Much. What Is ‘Excessive’ Kava Use in Arnhem Land?” Drug and Alcohol Review 22 (1): 43–51. https://doi.org/10.1080/0959523021000059820
    • “Apathy”. Clinically this is defined as “a lack of drive or motivation, a lack of responsiveness to stimuli, or a lack of initiation or a reduction in self-generated, purposeful behavior”[1]. This is one of those ethereal effects that you could never physically put your finger on with kava. Kava is a relaxing beverage, as such it turns you away from the things that are causing you stress. If you drink kava during a time when you need to be attentive, then “apathy” could play a part. Apathy or ‘Amotivational Syndrome’ in regards to kava consumption has not been studied systematically in Australia as of 2019 [2], so using this as a “harm” is not viable.

      [1] Kreutzer J., DeLuca J., Caplan B. 2011. Encyclopedia of Clinical Neuropsychology. Springer Refrence.
      [2] Butt, Julia. 2019. Kava Usage in Aboriginal and Pacific Islander Communities in Australia. National Drug Research Institute.
Section 2: “Australian laws and kava imports”
  • “Kava can only be imported into Australia for medical or scientific purposes.”
    • No issues here.
  • “People aged over 18 years entering Australia can bring in up to four kilograms of kava in their accompanied baggage (although local restrictions mean that kava cannot be brought into Western Australia or the Northern Territory).”
    • Wish it weren’t this way, but it is.
Section 3: “Kava – effects on the body”
  • The active chemicals in kava are known as kavalactones. Variations in growing conditions (such as soil type and the amount of sunlight and water available) and different varieties of plant mean that the strength of kavalactones can vary widely.
    • Correct.
  • The strength of a dose of kava also depends on how the drink is prepared and how much powdered kava is added to the water.
    • Also Correct
  • Kava is a central nervous system depressant. Even though there is no alcohol in kava, it can produce similar symptoms to drunkenness, including difficulty with balance, and slurred speech.
    • This is true.
The effects of kava on your body can depend on:

  • your body size
    • Lean body weight has a marked effect on drug clearance and pharmacokinetics of drugs.

      Mc Leay, Sarah C., Glynn A. Morrish, Carl M. J. Kirkpatrick, and Bruce Green. 2012. “Systematic Review and Meta-Analysis of the Literature Published from 2000 to 2007.” S YSTEMATIC R EVIEW Clin Pharmacokinet 51 (5): 319–30.
  • your general health
    • Isn’t this true for basically anything? If you’re feeling good, kava will accentuate it. If you’re not, kava could exacerbate it.
  • if you have taken kava before
    • I’m thinking this may be suggesting having broken through “initial tolerance”, because there is no tolerance factor at play with kava.
  • the strength and amount taken
    • Similar to most substances. Nothing strange here.
  • if you are taking other drugs at the same time.
    • Correct. Kava has main inhibitory properties at the CYP1A2 enzyme, with lesser effects at CYP2C19, and CYP2E1. Consuming caffeine while drinking kava can cause an increase in stimulation from the caffeine due to this 1A2 inhibition. List of drugs that use the CYP1A2 pathway can be found here.

      Russmann, Stefan, Bernhard H. Lauterburg, Yann Barguil, Erwan Choblet, Pierre Cabalion, Katharina Rentsch, and Markus Wenk. 2005. “Traditional Aqueous Kava Extracts Inhibit Cytochrome P450 1A2 in Humans: Protective Effect against Environmental Carcinogens?” Clinical Pharmacology and Therapeutics. https://doi.org/10.1016/j.clpt.2005.01.021
Common effects include:

  • for small doses – relaxed muscles, sleepiness, feelings of wellbeing and relaxation, mild loss of feeling in the throat and mouth, appetite loss
    • No issue here.
  • for larger doses – dilated pupils, reddened eyes, nausea, drowsiness, reduced muscle control (ataxia).
    • Looks good here as well. These are well known side effects of large doses of kava. Dilated pupils is one people don’t normally notice except for when they say “colors seem brighter”.
Section 4: “Kava is dangerous for some people”

  • It’s dangerous to take kava in combination with other psychoactive drugs or alcohol. There is little information on how kava interacts with other medications, so it's best to avoid kava if you are taking any prescription medicine.
    • See my comments above on CYP1A2. If you’re on pharmaceutical drugs while drinking kava, have a yearly metabolism test. Honestly, this isn’t even due to the kava. Prescription drugs are some strange beasts, and can work fine and are safe for years and then they aren’t. Best to get a blood test and know things are working like they should be.
    • Alcohol is a hot topic in regards to kava. There are theories that kava interacts with alcohol metabolism. Alcohol metabolism relies on three enzymes. These are alcohol dehydrogenase, catalase, and CYP2E1. Recent studies have shown CYP2E1 to play a significant role in ethanol oxidation in the brain [1]. At low alcohol concentrations this pathway is minimally used, however when large doses of alcohol are consumed CYP2E1 accounts for more than 40% of oxidation [2]. In lieu of this, we should say that this pathway is usually only used in cases of large quantities of alcohol consumption, or alcoholism. Now, this is where we get into the contention of differing research results. Shord et al. 2009 concluded that kava extracts likely interfere with 2E1 by up to 40% [3] where Russman et al. 2005 found some, but very little inhibition at this pathway in vivo [4]. There is also a theory that the combination of the two can cause a type of runaway histamine reaction due to mast cell degranulation and competition between kavalactones and alcohol’s use of histamine degrading DAO [5].

      [1] Heit, Claire, Hongbin Dong, Ying Chen, David C. Thompson, Richard A. Deitrich, and Vasilis K. Vasiliou. 2013. “The Role of CYP2E1 in Alcohol Metabolism and Sensitivity in the Central Nervous System.” Sub-Cellular Biochemistry 67: 235–47. https://doi.org/10.1007/978-94-007-5881-0_8.

      [2] Li, X. Z., and I. Ramzan. 2010. “Role of Ethanol in Kava Hepatotoxicity.” Phytotherapy Research: PTR 24 (4): 475–80. https://doi.org/10.1002/ptr.3046

      [3] Shord, Stacy S., Kanan Shah, and Alvina Lukose. 2009. “Drug-Botanical Interactions: A Review of the Laboratory, Animal, and Human Data for 8 Common Botanicals.” Integrative Cancer Therapies 8 (3): 208–27. https://doi.org/10.1177/1534735409340900

      [4] Russmann, Stefan, Bernhard H. Lauterburg, Yann Barguil, Erwan Choblet, Pierre Cabalion, Katharina Rentsch, and Markus Wenk. 2005. “Traditional Aqueous Kava Extracts Inhibit Cytochrome P450 1A2 in Humans: Protective Effect against Environmental Carcinogens?” Clinical Pharmacology and Therapeutics. https://doi.org/10.1016/j.clpt.2005.01.021

      [5] Kava fact of the day - why we suggest 24 hours between alcohol and kava. Kava Forums. (n.d.). Retrieved November 16, 2021, from https://kavaforums.com/forum/threads/why-we-suggest-24-hours-between-alcohol-and-kava.18342
Do not take kava if you:

  • are pregnant
    • I will always err on the side of caution when addressing this topic, but we can’t ignore the fact that after 3000 years of consumption there are no reports of birth defects or abnormalities in regards to kava drinking populations.
  • are breastfeeding
    • This is based on the fact that kavalactones are lipophilic and as such readily disperse in fats. This would likely mean that kavalactones are carried over in breastmilk. Again, there is no evidence that this can cause problems, but we always say to be cautious.
  • are driving or operating heavy machinery
    • Agreed, however there is conflicting research on medicinal doses of kava and driving impairment, as low doses likely do not cause impairment [1]. The safest way to go about this is by just taking an uber/lyft if you have absolutely any question as to your own ability to operate a vehicle. There have been cases of driver impairment seen with excessive consumption [2].

      [1] Sarris, J., E. Laporte, A. Scholey, R. King, A. Pipingas, I. Schweitzer, and C. Stough. 2013. “Does a Medicinal Dose of Kava Impair Driving? A Randomized, Placebo-Controlled, Double-Blind Study.” Traffic Injury Prevention 14 (1): 13–17. https://doi.org/10.1080/15389588.2012.682233

      [2] Berry, Jonna, Ashley Gilbert, and Justin Grodnitzky. 2019. “Cases of Kava Impairment in Iowa Drivers.” Journal of Forensic Sciences 64 (6): 1943–49. https://doi.org/10.1111/1556-4029.14130
  • are currently taking pharmaceutical medicine
    • See notes on CYP1A2 inhibition caused by kava in this regard.
  • drink large quantities of alcohol
    • See notes on alcohol consumption with kava above.
  • have a pre-existing heart, lung or liver condition.
    • This feels like it’s just been thrown in here “for good measure”. There is NO evidence that kava can cause heart or lung issues, and liver issues are hotly contested, so this is likely just a “to cover our ass” statement.
  • Children should not take kava.
    • I don’t necessarily disagree with this statement, and it doesn’t seem that tradition disagrees either. Kava in Polynesia has been a prerogative of older men and children being at the Nakamal was seen as a source of discontent among kava drinkers. Also developing brains should be free of unnecessary chemicals.

      Lemert, E. M. 1967. “Secular Use of Kava in Tonga.” Quarterly Journal of Studies on Alcohol 28 (2): 328–41. https://www.ncbi.nlm.nih.gov/pubmed/6049173
Section 5: “Problems from long-term use of kava”
In the long term, kava use can cause a wide range of problems including:

  • breathing difficulties
    • This one comes from the Mathews study from 1988 again. They cite “shortness of breath” as being a common side effect of kava drinking. Again this study draws wildly incorrect conclusions based on what they see. The population studied statistically had a markedly reduced lung volume in comparison to the non-indigenous people.
  • visual changes, including sensitivity to light (photophobia)
    • This is due to the dilation of pupils
  • slight alterations to blood cells, including white and red blood cells, and platelets
    • Again drawing from the Mathews 1988 study. They really like this one. And again, the study was performed on a population with decreased lung volumes, a high rate of hepatitis B, and other morbidities.
  • liver damage
    • Since this study has such a preference for Mathews et al 1988 I’ll go ahead and nip this one in the bid right here. They use GGT increases as evidence for “liver damage”. GGT changes without accompanying AST/ALT changes DO NOT indicate hepatocellular damage. It indicates a condition known as “adaptation”.

      Fancher, Tonya, Amit Kamboj, and John Onate. 2017. “Interpreting Liver Function Tests.” Current Psychiatry 6 (5): 61–68.
  • compromised immune function
    • Again, this Mathews 1988 study needs to disappear. For real, Clough did this same study years later and found totally different results. Kava does not cause a compromised immune function. There are many studies showing preliminary evidence that kava constituents can support many immune functions including the killing of cancer cells, so this is just false.
  • kidney damage
    • Sorry, I just don’t see any evidence that would support this. Again, they’re pulling this from Mathews 1988 study. Getting tired of this one yet? You would be rather amazed at just how many research papers use this old, outdated, and flawed research to support their claim of organ damage.
  • contact dermatitis – causing scaly, flaky rash on the skin
    • Yep, it does cause this.
  • appetite loss, leading to malnutrition and weight loss
    • This is an interesting one. We have Tongans and Samoan’s who drink kava heavily on a regular basis, and none of them could be considered “skinny” or “malnourished”. It is a known effect of kava to reduce appetite, however seeing malnutrition and excessive weight loss is more of a rarity and may be more weighted towards those predisposed to other comorbidities. We have to take this “risk” along with the others here that are from Mathews 1988 study with the proverbial grain of salt (seems like I say that frequently).
  • loss of drive and motivation
    • Kava is a sedative. Sedatives don’t exactly make you get up off your chair and clean the house. If you drink kava heavily all day every day you’re likely to not be very motivated. “Amotivational Syndrome” has not been studied in kava, and therefore cannot be applied.
  • worsened symptoms of pre-existing mental illnesses such as schizophrenia.
    • Krum et al (2021) investigated the use of kava extract as an adjuvant that can be applied in the treatment of schizophrenia using the model of amphetamine-induced psychosis in rodents, so this statement does not hold up. Consequently many of the drugs prescribed for schizophrenia are metabolized by the pathway CYP1A2 and as such combining them with kava could possibly cause an unfavorable condition.

      Krum, Bárbara Nunes, Catiuscia Molz de Freitas, Ana Paula Chiapinotto Ceretta, Caroline Pilecco Barbosa, Elizete de Moraes Reis, Rahisa Scussel, Emily da Silva Córneo, Ricardo Andrez Machado-de-Ávila, Aline Augusti Boligon, and Roselei Fachinetto. 2021. “Kava Decreases the Stereotyped Behavior Induced by Amphetamine in Mice.” Journal of Ethnopharmacology 265 (January): 113293. https://doi.org/10.1016/j.jep.2020.113293
Section 6: “Kava withdrawal risk is low”

  • There is no evidence to suggest people who regularly drink large doses of kava become dependent. Because of this there doesn't seem to be a risk of withdrawal if a person suddenly stops taking kava. However, medical supervision is recommended.
    • Agreed here. No withdrawal seen in empirical evidence or scientific literature.

Section 7: “Medicinal uses of kava”
  • In 2003, products containing kava were banned in most European countries, because of concerns about its possible toxic effects on the liver. In Australia, all products containing kava were temporarily withdrawn, following the death of one person from liver failure.
    • This is partly true. In regards to the “one person” in Australia report, it doesn’t exist. In fact as of 2019 there were no known cases of deaths attributed to kava for the last 10 years in Australia.

      Aporosa, S. Apo. 2019. “De-Mythologizing and Re-Branding of Kava as the New ‘world Drug’ of Choice.” Drug Science, Policy and Law 5 (January): 2050324519876131. https://doi.org/10.1177/2050324519876131
  • This restriction was withdrawn after a review by the Therapeutic Goods Administration in 2005. As a result of that review, products with standardised amounts of kava, such as in supplements and teabags, are available in Australia.
    • This is correct.


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