Liver Tests
We routinely see people reporting what they feel are liver issues when drinking kava, however the reality is that few if any of these self-reports are actually due to liver issues in conjunction with drinking kava. We usually see this as due to either gas pains or digestive issues which may or may not have anything to do with kava consumption.
How would you identify actual liver damage?
Without exception, no matter where you feel that pain or ache, no matter what color your urine is, you must get a metabolic test to claim any type of liver issue. This test is one that tests for levels of Alanine Aminotransferase (ALT), and Aspartate Aminotransferase (AST) in your blood. This is a test where they draw a blood sample and send it to the lab. See attached sample comprehensive metabolic test [1].
As you can see by the sample metabolic test, that among the other values listed they also show AST/ALT. In this sample test these values are slightly elevated, but at what point are they an issue? When interpreting a liver test, it’s generally thought that ALT values >3 times the upper limit of normal will indicate liver damage (or around 165) [2]. ALT and AST will be the indicators of liver damage if any has occurred. It’s important to understand that this is necessary as visual and pain indicators are not a good way to determine liver function issues. These values can be altered by a vast number of over the counter and prescription medicines.
Kava has endured a legacy of intense scrutiny and of this scrutiny only a handful of cases were more than likely tied back to kava usage. Another important aspect to understand is that these findings apply specifically to the use of ethanolic and acetonic extracts. The use of kava as a traditional social beverage has not been implicated in similar ways except for one case. There were two reports of injury from aqueous kava in New Caledonia, however all of these reports included extreme elevations in AST values [4] which is not only uncommon, but unheard of in standard kava drinking. GGT/ALP are the values most often seen altered by kava. It is more than likely these instances were due to either co-medication, alcohol consumption or other unknown factors. It is also well known that at the time of the injury reports the kava being imported into New Caledonia from Vanuatu was of the non-noble or non-beverage grade type. This poor quality product may be the “unknown factor” in these cases.
In summary if you think you have a liver issue, do go to the doctor, but it should be understood how rare these issues actually happen. We’re still being held up by cases that happened 23 years ago. The likelihood of having a liver issue now due to kava is extremely rare, however if you have any question as to whether your liver is in good health a metabolic test is the only way to tell. Without a test it is impossible to say if you’ve experienced injury. My personal opinion, and what I do myself, is for my yearly physical I ask for a metabolic test. So far my AST/ALT values have not moved outside the normal range in over 16 years of daily traditional kava drinking at 40g/day. This is a sample size of one, so by no means do I personally make a perfect representation of kava consumption, however you’ll find many long time kava drinkers with the same story.
[1] Health and wellness testing example results | health testing centers. (n.d.). Retrieved June 1, 2021, from https://www.healthtestingcenters.com/health-and-wellness-testing-example-results/
[2] Fancher, Tonya, Amit Kamboj, and John Onate. 2017. “Interpreting Liver Function Tests.” Current Psychiatry 6 (5): 61–68. https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/0605CP_MedPsych.pdf
[3] “Re: Critical Analysis of Suspected Cases of Kava Hepatotoxicity: Kava Taken as Directed Is Rarely Hepatotoxic - American Botanical Council.” n.d. Accessed May 10, 2021. https://www.herbalgram.org/resources/herbclip/issues/bin_368/review120381-368/.
[4] Russmann, Stefan, Yann Barguil, Pierre Cabalion, Marina Kritsanida, Daniel Duhet, and Bernhard H. Lauterburg. 2003. “Hepatic Injury due to Traditional Aqueous Extracts of Kava Root in New Caledonia.” European Journal of Gastroenterology & Hepatology 15: 1033–36. https://doi.org/10.1097/01.meg.0000085464.12407.7b.
We routinely see people reporting what they feel are liver issues when drinking kava, however the reality is that few if any of these self-reports are actually due to liver issues in conjunction with drinking kava. We usually see this as due to either gas pains or digestive issues which may or may not have anything to do with kava consumption.
How would you identify actual liver damage?
Without exception, no matter where you feel that pain or ache, no matter what color your urine is, you must get a metabolic test to claim any type of liver issue. This test is one that tests for levels of Alanine Aminotransferase (ALT), and Aspartate Aminotransferase (AST) in your blood. This is a test where they draw a blood sample and send it to the lab. See attached sample comprehensive metabolic test [1].
As you can see by the sample metabolic test, that among the other values listed they also show AST/ALT. In this sample test these values are slightly elevated, but at what point are they an issue? When interpreting a liver test, it’s generally thought that ALT values >3 times the upper limit of normal will indicate liver damage (or around 165) [2]. ALT and AST will be the indicators of liver damage if any has occurred. It’s important to understand that this is necessary as visual and pain indicators are not a good way to determine liver function issues. These values can be altered by a vast number of over the counter and prescription medicines.
Kava has endured a legacy of intense scrutiny and of this scrutiny only a handful of cases were more than likely tied back to kava usage. Another important aspect to understand is that these findings apply specifically to the use of ethanolic and acetonic extracts. The use of kava as a traditional social beverage has not been implicated in similar ways except for one case. There were two reports of injury from aqueous kava in New Caledonia, however all of these reports included extreme elevations in AST values [4] which is not only uncommon, but unheard of in standard kava drinking. GGT/ALP are the values most often seen altered by kava. It is more than likely these instances were due to either co-medication, alcohol consumption or other unknown factors. It is also well known that at the time of the injury reports the kava being imported into New Caledonia from Vanuatu was of the non-noble or non-beverage grade type. This poor quality product may be the “unknown factor” in these cases.
In summary if you think you have a liver issue, do go to the doctor, but it should be understood how rare these issues actually happen. We’re still being held up by cases that happened 23 years ago. The likelihood of having a liver issue now due to kava is extremely rare, however if you have any question as to whether your liver is in good health a metabolic test is the only way to tell. Without a test it is impossible to say if you’ve experienced injury. My personal opinion, and what I do myself, is for my yearly physical I ask for a metabolic test. So far my AST/ALT values have not moved outside the normal range in over 16 years of daily traditional kava drinking at 40g/day. This is a sample size of one, so by no means do I personally make a perfect representation of kava consumption, however you’ll find many long time kava drinkers with the same story.
[1] Health and wellness testing example results | health testing centers. (n.d.). Retrieved June 1, 2021, from https://www.healthtestingcenters.com/health-and-wellness-testing-example-results/
[2] Fancher, Tonya, Amit Kamboj, and John Onate. 2017. “Interpreting Liver Function Tests.” Current Psychiatry 6 (5): 61–68. https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/0605CP_MedPsych.pdf
[3] “Re: Critical Analysis of Suspected Cases of Kava Hepatotoxicity: Kava Taken as Directed Is Rarely Hepatotoxic - American Botanical Council.” n.d. Accessed May 10, 2021. https://www.herbalgram.org/resources/herbclip/issues/bin_368/review120381-368/.
[4] Russmann, Stefan, Yann Barguil, Pierre Cabalion, Marina Kritsanida, Daniel Duhet, and Bernhard H. Lauterburg. 2003. “Hepatic Injury due to Traditional Aqueous Extracts of Kava Root in New Caledonia.” European Journal of Gastroenterology & Hepatology 15: 1033–36. https://doi.org/10.1097/01.meg.0000085464.12407.7b.
