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How long of break to reset liver?

Thomas2060

Kava Curious
I've been consuming kava close to two years now. I had a CBC/metabolic panel for unrelated reasons about a year into use, and things were all normal. But a few months ago I had my cholesterol tested and it was extremely, dangerously high - I wrote another long post about that in this forum. I convinced the doctor to let me try to lower cholesterol on my own without statins, which I know many people dislike and can be a "life sentence" once you're on them.

Anyway, along with making a lot of other positive lifestyle changes, I decided to take an extended break from kava, because there does seem to be evidence kava can raise cholesterol. It was surely not the only thing doing that but likely a part of the puzzle. I didn't stop immediately but rather tapered off for a week or so. One valuable thing that came of this is, I realized I was using too much. I was getting a better experience from 4-5 tbsp than I was from 8 or more, which I realize now was kind of just overloading me and blunting the effects (and putting unnecessary strain on my body).

I've now been off kava for 6 weeks, along with a pretty drastically changed diet...mostly eliminating red meat and focusing more on fish and vegetarian protein sources, way less saturated fat and sodum, consuming lots of soluble fiber (fruits/veggies/nuts etc) and also taking plant sterol supplements, omega 3 and NOW Liver Refresh. Also was able to resume running after a broken toe healed so I'm now running/biking several days a week. I've already lost 5 pounds and should continue to lose weight.

Interestingly, I had an extended dermopathy flare after stopping kava. This has happened to me before when I took a break and usually resolved within several days. This time, it took about 3 weeks to calm down. This suggests my liver really was more impacted than I probably realized.

Now at the 6 week mark, I'm feeling really good and healthy. I'm starting to entertain the idea of starting kava again, but at more reasonable levels and with more frequent breaks (I'm thinking a week's break after every pound consumed). Of course I will continue all the other lifestyle changes until cholesterol is at healthy levels. After that I may not be quite as stringent and monk-like with my diet but will certainly keep healthier habits than I used to.

Do you think a break of 6 weeks from kava, along with a lot of other healthy lifestyle changes, is enough to have "reset" my liver?
 
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The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
I've been consuming kava close to two years now. I had a CBC/metabolic panel for unrelated reasons about a year into use, and things were all normal. But a few months ago I had my cholesterol tested and it was extremely, dangerously high - I wrote another long post about that in this forum. I convinced the doctor to let my try to lower cholesterol on my own without statins, which I know many people dislike and can be a "life sentence" once you're on them.

Anyway I decided to take a break from kava, along with all the other lifestyle changes I made, because there does seem to be evidence kava can raise cholesterol. It was surely not the only thing doing that but likely a part of the puzzle. I didn't stop immediately but rather tapered off for a week or so. One valuable thing that came of this is, I realized I was using too much. I was getting a better experience from 4-5 tbsp than I was from 8 or more, which I realize now was kind of just overloading me and blunting the effects.

I've now been off kava for 6 weeks, along with a pretty drastically changed diet...way less saturated fat and sodum, consuming lots of soluble fiber (fruits/veggies/nuts etc) and also taking plant sterol supplements, omega 3 and NOW Liver Refresh. Also was able to resume running after a broken toe healed so I'm now running/biking several days a week.

Interestingly, I had a dermopathy flare after stopping kava. This had happened to me before when I took a break and usually resolved within several days. This time, it took about 3 weeks to calm down. This suggests my liver really was more impacted than I probably realized.

However after 6 weeks I feel very healthy. I'm starting to entertain the idea of starting kava again, but at more reasonable levels and with more frequent breaks (I'm thinking a week's break after every pound consumed). Of course I will continue all the other lifestyle changes until cholesterol is at healthy levels. After that I may not be as stringent but will certainly keep healthier habits than I used to.

Do you think a break of 6 weeks from kava, along with a lot of other healthy lifestyle changes, is enough to have "reset" my liver?
We always look at the liver because of the warnings, but the truth of the matter is that kava only increases GGT and has those cholesterol modifying properties. Your liver was never toxified in order to be "reset".

If you just can't stand the thought of that liver warning, add NAC to your diet. NAC is a powerful antioxidant that is given at the hospital in cases of acetaminophen overdose, and has extremely beneficial effects on protection of the liver. It's also available as a supplement.

I wish the liver warning were rescinded. It causes unnecessary fear about a situation that hasn't even been proven to exist.

Also about the dermo, that uptick in symptoms when quitting is seen as quite normal.
 

Thomas2060

Kava Curious
We always look at the liver because of the warnings, but the truth of the matter is that kava only increases GGT and has those cholesterol modifying properties. Your liver was never toxified in order to be "reset".

Also about the dermo, that uptick in symptoms when quitting is seen as quite normal.
I guess the GGT increase is what I am concerned with and hoping to "reset." I knew dermo symptoms were normal when quitting, it was the extended length that bothered me. Was only a few days in the past but several weeks this time.
 

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
I guess the GGT increase is what I am concerned with and hoping to "reset." I knew dermo symptoms were normal when quitting, it was the extended length that bothered me. Was only a few days in the past but several weeks this time.
"However, ongoing clinical observations from the 1990s in Arnhem Land indicate that abnormal liver function tests (GGT) return to normal after 1 to2 months abstinence from kava with no evidence for long-term effects"

Clough, Alan R., Ross S. Bailie, and Bart Currie. 2003. “Liver Function Test Abnormalities in Users of Aqueous Kava Extracts.” Journal of Toxicology. Clinical Toxicology 41 (6): 821–29. https://doi.org/10.1081/clt-120025347

Edit: I would say you're officially cleared.
 
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Alia

'Awa Grower/Collector
I have to wonder about these elevated numbers and if there is a connection with kava drinkers who also (ever) consume alcohol.
The 2003 study cited mentions--"In those who were not heavy alcohol users, only those who used kava within the previous 24 hr showed GGT levels higher than nonusers ...". This implies the kava drinkers also consumed alcohol and how much is unknown when they say "not heavy" . I would like to see a study where the subjects drink no alcohol, ever...or say in the last few years. I am convinced there is a multiplying factor in folks who drink both, even if at significantly separate times.
 

Thomas2060

Kava Curious
I've not had any alcohol since shortly after starting kava. I never had alcohol and kava at the same time and usually put a buffer between them of a day or so to be safe. But no alcohol at all in the last 18 months. Not because I've ever had a "problem," I just found it unsatisfactory and feel less and less well after drinking as I get older. I do like the taste of red wine so I'll probably have some again, someday.

I was familiar with the study you cite and that's one reason I felt okay about consuming relatively high amounts of kava. If I'm not drinking alcohol and I'm taking occasional breaks I assumed I'd be okay. I'm not ready to rule out kava's role in my high cholesterol and that's just not something anyone should mess with...just stop all the potential offenders. But it does make me feel better about returning to kava whether I do it soon or down the road.
 
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The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
I have to wonder about these elevated numbers and if there is a connection with kava drinkers who also (ever) consume alcohol.
The 2003 study cited mentions--"In those who were not heavy alcohol users, only those who used kava within the previous 24 hr showed GGT levels higher than nonusers ...". This implies the kava drinkers also consumed alcohol and how much is unknown when they say "not heavy" . I would like to see a study where the subjects drink no alcohol, ever...or say in the last few years. I am convinced there is a multiplying factor in folks who drink both, even if at significantly separate times.
Same here. I'd love to see this study ran on those who haven't consumed alcohol in at least a year. I would volunteer as I haven't touched a drop in over 6 years (drinking just has never appealed to me), but I take a couple of prescriptions too, so I wouldn't be the best.
 

KavaKween

Kava Curious
FWIW, I've been drinking Kava (35-70g) nightly with few breaks (usually due to travel) for about 4 years and haven't had any liver issues. I take Milk Thistle daily because I use a number of other herbal supplements but, fortunately, no prescription meds. I rarely drink alcohol and never on the same day as Kava.

My experience is subjective, but I'm not convinced that a negative impact of Kava on the liver is guaranteed. Still, a break never hurts and is usually helpful with most herbs IME.

Does instant/micro vs. traditional grind or the prep method make a difference?
 

jonaspmd

found kava
It's a good question, but probably also rightly corrected by @Kapmcrunk - how long does it take for all kava induced changes to reverse? (especially relevant if you want to take out health or life insurance for example).

I am pretty sure four weeks are max for even the worst dermo to reverse (I am defiantly not surprised it took more than several days). That's because skin regeneration cycle is four weeks. I think that worsening dermo after kava discontinuation is a bit of an "optical illusion". The dermopathy cycle seems to follow a certain pattern, from eyes to toes for whatever reason. If you overdo kava, the cycles seem to start overlap, eg you can have dry hands and itchy eyes at the same time, so if you stop kava at this moment, your hands get better, then the eyes get better, then the hands get worse again, then better, and you're back to normal. This is obviously can vary from person to person, so not all can relate to this. I am sure it also heavily depends on the daily kava dose, so it's pretty big mess to figure it out. Following this logic, however, if you seriously overdo kava then there could be several cycles in different stages. So, when you suddenly stop, those cycles resolve gradually one after the another which gives an impression that the dermopathy is worsening for some time after the discontinuation. No matter what the truth is, by the end of the fourth week you will have a new layer of radiant epidermis. Amino acid arginine is a known supplement that improves wound (and skin) healing. I am quite convinced from my own experience it works, but the doses are enormous. I had a post on this forum somewhere about it, but dialled down the dose. I think I said try sub 10g of arginine daily for several days, while in reality doses up to 15g are needed for a noticeable effect (it's pretty safe supplement and used in medicine, doses at this level can cause diarrhoea though and hypotension, ie just sleepiness..)

Now what is happening with liver enzymes and cholesterols seems to be even bigger mystery. There seems to be a documented effect on GGT, but not the standard acute inflammatory markers AST and ALT. To make matters more confusing, GGT also increases in chronic alcoholism (not specific nor sensitive to it though). So, the question from @Alia weather GGT in those studies was increased due kava alone or alcohol co-consumption is a very valid one. These studies are usually based on retrospective questionnaires. If I would be participating in such a study and an investigator would be asking how much I drank (kava or alcohol or both), I would lie at least a bit, or a lot. The quality of these studies is an issue.

I think I read here on this forum that in the South Pacific islands kava effect on GGT is recognised by GPs as a compensatory reaction and they do nothing. I want to say this was posted by Henry, but I may be mis-remembering, it was a while ago. I have not done my blood works recently, but if I were to see elevated cholesterol, I would definitely do not start taking statins right away (I trained as a medical doctor, but don't practice anymore, so that's only semi professional opinion; that is if your professional GP knows about kava). I will not go here into the whole debate about bad versus good cholesterol, which one is actually bad and which one is actually good and whether high cholesterol is really that bad at all. This feels like an ever evolving area. I would do like Thomas2060 has done, but in a more structured way - stop kava, consume your normal diet and supplements and exercise the same amount, ie you only want to change one variable. Then do the blood works at the end of the period, six weeks seem reasonable. That's the only way to be certain that this particular variable (kava) caused the cholesterol increase. Eg, it could be the case that your cholesterol increased "naturally" as it happens for many of us and with supplements you beat it down, while kava has nothing to do with it, you will simply won't know. I liked your dedication, but for the sake of science, if you were to do the same exercise again, please only remove kava, keep all else equal, do the blood works again at the end, and above all report back here. I would do it my self, but it's such a hassle.

One question that still bothers me on this topic is whether kava has any effect on slow burn liver fibrosis and the development of cirrhosis. Remember that acute hepatitis (eg caused by heavy prolonged drinking) and chronic liver condition leading to cirrhosis (eg long term moderate overdosing of alcohol) have very different in clinical pictures. In acute hepatis case you can be cured as long as you survive it. In case of terminal cirrhosis, you feel no symptoms for years until you suddenly turn yellow and then it's the end (or liver transplant). The widely quoted epidemiological data that the mortality from liver disease in the South Pacific is no higher than elsewhere is the only (and big one) reassuring factor for me in this regard. All this liver tox scandal was based on acute hepatitis, which mostly was disproven by now. I wish I could find more papers on effects on fibrosis though, at least in animals. The only I could find was this one
Yangonin protects against non-alcoholic fatty liver disease through farnesoid X receptor - PubMed (nih.gov)
In other words, drink more kava ::chugger::::shaka::

Sorry for the long post, did not have time to edit it. As Mark Twain said “I apologize for such a long letter - I didn't have time to write a short one.” :)
 

Jacob Bula

Nobody
"The widely quoted epidemiological data that the mortality from liver disease in the South Pacific is no higher than elsewhere is the only (and big one) reassuring factor for me in this regard."

This is good enough for me to make a decision to keep going, and I'm one who's very scared of cirrhosis. Uncle had in his 20s from alcoholism. Dad died at 50 from alcoholism. Grandpa had alcoholism, etc. There are so many factors to consider, including ethical, that would make creating an experimental study difficult. They don't even have a causal experimental study to prove smoking causes lung cancer because you would have to randomly assign people to be smokers vs. NONsmokers; however the correlation is pretty well established.
 

jonaspmd

found kava
"The widely quoted epidemiological data that the mortality from liver disease in the South Pacific is no higher than elsewhere is the only (and big one) reassuring factor for me in this regard."

This is good enough for me to make a decision to keep going, and I'm one who's very scared of cirrhosis. Uncle had in his 20s from alcoholism. Dad died at 50 from alcoholism. Grandpa had alcoholism, etc. There are so many factors to consider, including ethical, that would make creating an experimental study difficult. They don't even have a causal experimental study to prove smoking causes lung cancer because you would have to randomly assign people to be smokers vs. NONsmokers; however the correlation is pretty well established.
Luckily liver is very forgiving organ and can completely reverse the damage it you let it rest.

On the ethical dilemma to conduct prospective trials when the intervention can be harmful, that's a problem. These studies are either retrospective observational (least reliable as based on surveys) or prospective observational (better, but takes decades to observe a cohort of people). They managed to do human challenge studies in the UK (infected young adults with COVID to see how vaccination protects them), but that was before long COVID was proven. Wonder whether this study will come back to haunt the investigators (and the government, which commissioned the study) if some of these volunteers will develop long COVID.

Here's somewhat more amusing example :)
Malaghan Institute seeking volunteers for hookworm therapy clinical study | Malaghan
The pay a small fee to volunteers to attend these trials, a nice gig for students. I always wonder how much they would need to pay me to take experimental drugs, but getting infected with worms...
 

Valyn

Kava Curious
What's amazing is how my grandfathers and uncles were drinking 12-24 cans of beer a day and died of liver failure while I, a person with health anxiety, panic over drinking too much Kava which rarely exceeds five tablespoons.
 

Jacob Bula

Nobody
What's amazing is how my grandfathers and uncles were drinking 12-24 cans of beer a day and died of liver failure while I, a person with health anxiety, panic over drinking too much Kava which rarely exceeds five tablespoons.
I drank 24 beers a day for a while and my liver numbers were elevated. I infrequently drink 1/2 a pound of medium grind over the course of 3 day and my liver numbers are now perfect; although, I feel like complete crap when I'm drinking kava at this level.
 
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