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Kava Fact of the Day Liver Toxicity - Where we stand.

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
Liver toxicity. Where we stand.

The longer one sticks around the various pages and forums on the internet, the more likely they are to run across user concerns related to liver toxicity. Generally, this is a concern of new users just beginning to venture into the kava world. These concerns are thought to stem entirely from the 2001-2002 FDA safety alert issued for kava. Interestingly, the pages from the national institute of mental health currently led to error pages when researching and following links for this information [1].

Between the late 1990s and early 2000s just over 100 hepatoxic cases were reported to be associated with kava consumption, with the majority of users consuming them as an anxiolytic agent. We’ll go ahead and point out here how it is questionable that these issues only spring from a specific period in time. Since then, scientists have been attempting to discover what the cause of this issue has been. They’ve looked at several possible causes. These causes include pipermethystine, flavokavain B, yangonin, methysticin, kavain, ethanol, co-medicated drugs, and mold hepatotoxins. Currently substantiated evidence is lacking for all of these [3]. Currently, research has liver injury from kava separated into two types.

Unpredictable, idiosyncratic types, and predictable intrinsic types [2].

Idiosyncrasy:
  • A characteristic, habit, mannerism, or the like, that is peculiar to an individual.
  • The physical constitution peculiar to an individual.
  • A peculiarity of the physical or the mental constitution, especially susceptibility toward drugs, food, etc.
The metabolic idiosyncratic type of hepatotoxicity seems to be related to an individual’s inability to process certain chemicals through enzymatic metabolism. In this respect the person in question’s genes may not have expressed in a way that allows them to process kavalactones at all. This type of reaction is extremely rare. If all cases related to liver injury were indeed from kava, the estimated risk would still be less than .3 cases per 1 million doses daily [4]. This reaction would represent even far less than this.

Intrinsic:
  • belonging to a thing by its very nature

The predictable, intrinsic type of hepatotoxicity are toxicities that essentially can be preventable through appropriate measures. Here we get into the realm of poor-quality kava products and mold hepatotoxins, flavokavain B, kava varieties, and past liver injury or issues. Something to keep in mind is that during this time, a few batches of poor-quality kava extracts may have been sufficient to cause a limited number of individuals dose dependent hepatotoxic reactions of this predictable intrinsic type (Teschke 2011). In other words, just a small amount of contaminated product could have fired off the whole issue of liver toxicity.

The reality is we may actually never know what caused these liver issues back in the early 2000s. Researchers missed the chance to analyze the kava products taken by the patients with toxic liver disease reportedly connected to or had a high probability of being caused by kava. As such, we can only speculate as to the culprits during this time. With this in mind we should also keep in context the recent studies on individual constituents of kava. It’s interesting in that kava research has identified many compounds as possibly toxic in the kava plant, however they require doses far greater than any taken by kava consumers to reach this level. Many of these studies were run in vitro and compounds were added directly to cells or cell cultures. These conditions are not necessarily relevant to whole kava extracts commonly used in humans, and virtually any chemical compound used at untherapeutic amounts may produce cytotoxicity in a dose-dependent way [3].

In conclusion we’re closer, but we’re still far from understanding what happened 20 years ago, however we can say that through these attempts at finding it, we’ve discovered traditional kava presents an impressive safety profile tracing back thousands of years. As long as noble “beverage” grade kavas are selected for daily consumption, only below ground parts of the plant are used, and the rhizomes and roots are peeled, issues are extremely rare, being limited only to idiosyncratic reactions in healthy individuals.

[1] Kava. (n.d.). Retrieved January 26, 2021, from https://ods.od.nih.gov/HealthInformation/kava.aspx

[2] Teschke R, Qiu SX, Lebot V. Herbal hepatotoxicity by kava: update on pipermethystine, flavokavain B, and mould hepatotoxins as primarily assumed culprits. Dig Liver Dis. 2011 Sep;43(9):676-81. doi: 10.1016/j.dld.2011.01.018. Epub 2011 Mar 4. PMID: 21377431.

[3] Teschke R, Sarris J, Lebot V. Contaminant hepatotoxins as culprits for kava hepatotoxicity--fact or fiction? Phytother Res. 2013 Mar;27(3):472-4. doi: 10.1002/ptr.4729. Epub 2012 May 14. PMID: 22585547.

[4] Bian T, Corral P, Wang Y, Botello J, Kingston R, Daniels T, Salloum RG, Johnston E, Huo Z, Lu J, Liu AC, Xing C. Kava as a Clinical Nutrient: Promises and Challenges. Nutrients. 2020 Oct 5;12(10):3044. doi: 10.3390/nu12103044. PMID: 33027883; PMCID: PMC7600512.
 

Krunkie McKrunkface

Kava Connoisseur
I just had a HIDA scan of my liver on Monday and it’s in perfect shape and function after 4 years of daily drinking kava, all day every day. And as everyone knows I get my liver panels done every three months and they are always good. I drink a lot of kava.
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The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
I just had a HIDA scan of my liver on Monday and it’s in perfect shape and function after 4 years of daily drinking kava, all day every day. And as everyone knows I get my liver panels done every three months and they are always good. I drink a lot of kava. View attachment 11384
Of course! Kava would never hurt itself, and seeing as somehow kava managed to shape-shift itself into human form as Krunky McKrunkface it makes total sense!
 
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