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Pharmacy school and liver damage.

Hello all,

I have a friend at work whose friend is in pharmacy school. They are teaching him that Kava is bad for the liver and told my friend at work that I should stop drinking Kava. His teacher mentioned over 50 cases of reported liver disease... ect ect ect. Well, I mentioned that alot of the studies have been debunked. Well, needless to say, I simply tried to explain that just because a teacher says something, doesn't make it true. He disagreed and basically told him to tell me, "Good luck with my liver." Do we have a succinct list or page that details all the information that counters the liver information? It's been along time and I already did the research and left that notion along time ago. Because, I never discovered anything to convince me to stop. But, I should have collected all the information for exact things such as this.
Also, they are teaching him that it had the same effects as placebo in a blind study for it's effects on anxiety? Man, I want to find this study. :) Also, I do not think it bodes well that pharmacy students are being taught that Kava is toxic to the liver. I can't imagine this doing any good for the future of Kava.
 

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
Hello all,

I have a friend at work whose friend is in pharmacy school. They are teaching him that Kava is bad for the liver and told my friend at work that I should stop drinking Kava. His teacher mentioned over 50 cases of reported liver disease... ect ect ect. Well, I mentioned that alot of the studies have been debunked. Well, needless to say, I simply tried to explain that just because a teacher says something, doesn't make it true. He disagreed and basically told him to tell me, "Good luck with my liver." Do we have a succinct list or page that details all the information that counters the liver information? Also, they are teaching him that it had the same effects as placebo in a blind study for it's effects on anxiety? Man, I want to find this study. :) Also, I do not think it bodes well that pharmacy students are being taught that Kava is toxic to the liver. I can't imagine this doing any good for the future of Kava.
Honestly, the fact that they're teaching about kava at all is surprising.

I would suggest the teacher pull up the actual adverse reports that are on file with the FDA. Once they start reading, it's pretty obvious there are some massive issues with them.

https://www.fda.gov/Drugs/GuidanceC...Surveillance/AdverseDrugEffects/ucm070093.htm

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Edward

Aluballin' in the UK
Kava Vendor
Hello all,

I have a friend at work whose friend is in pharmacy school. They are teaching him that Kava is bad for the liver and told my friend at work that I should stop drinking Kava. His teacher mentioned over 50 cases of reported liver disease... ect ect ect. Well, I mentioned that alot of the studies have been debunked. Well, needless to say, I simply tried to explain that just because a teacher says something, doesn't make it true. He disagreed and basically told him to tell me, "Good luck with my liver." Do we have a succinct list or page that details all the information that counters the liver information? It's been along time and I already did the research and left that notion along time ago. Because, I never discovered anything to convince me to stop. But, I should have collected all the information for exact things such as this.
Also, they are teaching him that it had the same effects as placebo in a blind study for it's effects on anxiety? Man, I want to find this study. :) Also, I do not think it bodes well that pharmacy students are being taught that Kava is toxic to the liver. I can't imagine this doing any good for the future of Kava.
Also you could show them the liver test results from a number of people on here including myself. All of them show the same thing... drinking kava over longer or shorter periods does not harm the liver. I'm on 3 years with no issues but shakas has been drinking a lot longer than me and posts his test results fairly frequently I believe?
 

verticity

I'm interested in things
The best discussion I know of that is in this book. There is a chapter by Dr. Schmidt (Ch. 12: "Kava: a Risk Benefit Assessment") with a detailed discussion of all the liver case reports. It used to be available online, but unfortunately no longer is, so I would recommend tracking down a paper copy.. The TL/DR version is that after going through all the evidence and case reports, he concludes that the incidence of liver disease caused by kava is very rare and idiosyncratic, and comparable to the incidence from common pharmaceutical meds such as benzos.

The Essential Guide to Herbal Safety, edited by Simon Mills and Kerry Bone
Amazon product
 

sɥɐʞɐs

Avg. Dosage: 8 Tbsp. (58g)
Review Maestro
Here's a snap from the FDA reports. Notice the combinations.

View attachment 9702
I had to look up Ropinirole (Parkinson's Drug)...that's kinda scary that taking it with kava appears to create delirium and psychotic hallucination. Imagine being the people that are on their daily Ropinirole dose and take kava thinking the've found some mild natural relaxant and then bo0m ::wow2::::jawdrop2::
 

sɥɐʞɐs

Avg. Dosage: 8 Tbsp. (58g)
Review Maestro
I thought we had compiled all the best studies and data regarding this topic, to have a quick place to send people like Atticus' friend, I guess we haven't though. I know threads have been started in the past with the same request and reason as this one and the replies probably have most of the info.

The simplest yet very informative piece of data to me is that the experiment has been running for decades in real life, in Vanuatu. There, almost every adult male drinks strong kava daily or at least very often. So where is the massive epidemic of liver disease in Vanuatu? It doesn't exist, yet, if kava were a blatant hepatotoxin that would surely be the place where it would be found.

How does your friend feel about Tylenol (Acetominophen)? It's an incredibly dangerous hepatotoxin...I've read a study that said by the early 2000's it accounted for about 50% of all accute liver failure cases, half were intentional (suicide) the other half (~25%) were unintentional overdoses on an every day, over the counter, mild painkiller. That's crazy! I never understood why Dr were prescribing Tylenol to my friend who died of liver failure, while she was in late stage liver failure?!
 
Honestly, the fact that they're teaching about kava at all is surprising.

I would suggest the teacher pull up the actual adverse reports that are on file with the FDA. Once they start reading, it's pretty obvious there are some massive issues with them.

https://www.fda.gov/Drugs/GuidanceC...Surveillance/AdverseDrugEffects/ucm070093.htm

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So true. I think it will be a great idea if we compile something to have for situations like this. I really think that a time is coming where Kava is going to be challenged more and more. I hope not. But, it sure does seem like it's coming.
 
I thought we had compiled all the best studies and data regarding this topic, to have a quick place to send people like Atticus' friend, I guess we haven't though. I know threads have been started in the past with the same request and reason as this one and the replies probably have most of the info.

The simplest yet very informative piece of data to me is that the experiment has been running for decades in real life, in Vanuatu. There, almost every adult male drinks strong kava daily or at least very often. So where is the massive epidemic of liver disease in Vanuatu? It doesn't exist, yet, if kava were a blatant hepatotoxin that would surely be the place where it would be found.

How does your friend feel about Tylenol (Acetominophen)? It's an incredibly dangerous hepatotoxin...I've read a study that said by the early 2000's it accounted for about 50% of all accute liver failure cases, half were intentional (suicide) the other half (~25%) were unintentional overdoses on an every day, over the counter, mild painkiller. That's crazy! I never understood why Dr were prescribing Tylenol to my friend who died of liver failure, while she was in late stage liver failure?!
https://www.ncbi.nlm.nih.gov/pubmed/18181414 study on Vanuatu.
 

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
I had to look up Ropinirole (Parkinson's Drug)...that's kinda scary that taking it with kava appears to create delirium and psychotic hallucination. Imagine being the people that are on their daily Ropinirole dose and take kava thinking the've found some mild natural relaxant and then bo0m ::wow2::::jawdrop2::
Yes, 100%. Parkinson's medication is a no-go with kava. The dopamine interaction apparently is enough to cause some serious issues. Whenever I went researching looking for drugs not to combine, dopaminergic drugs for parkinson's were always at the very top.

I'm down for a repository. If everyone just posts the links here I'll combine them into the "Kava Essentials" section.
 
That is a terrifying warning. But is kava as dangerous as it sounds?

According to the NIH, “Reports from health authorities in Germany, Switzerland, France, Canada, and the United Kingdom have linked kava supplement use to at least 25 cases of liver toxicity, including hepatitis, cirrhosis, and liver failure, prompting some of these countries to remove kava from the market.” The NIH liver toxicity database reports that number to be slightly higher, citing 50 to 100 cases of kava-related liver injuries mentioned in scientific literature.

If these don’t sound like very big numbers, you are right. The NIH concludes that the risk of liver damage from taking a kava supplement is less than one in one million. You are more likely to be struck by lightning! To put that in perspective, consider that prescription drugs cause over 100,000 deaths per year in the U.S. Kava or prescription drugs — which do you think has a better record of safety?
 
The AAFP Recommends Kava

In August 2007 American Family Physician, the journal of the American Academy of Family Physicians, published an article on “Herbal and Dietary Supplements for Treatment of Anxiety Disorders.”

They concluded that

St. John’s wort, valerian, and omega-3 fatty acids have little therapeutic value for anxiety disorders, and their use should be discouraged.

But they recommended kava. Not only that, they gave it the highest quality-of-evidence rating: A. They said,

Short-term use of kava is recommended for patients with mild to moderate anxiety disorders who are not using alcohol or taking other medicines metabolized by the liver, but who wish to use “natural” remedies.


In an accompanying table, they admitted that “Cases of liver toxicity have been reported, some requiring organ transplants; kava preparations withdrawn from the market in many countries; the FDA issued an advisory” – but they more or less dismissed these warnings by adding “later, research SUGGESTED [my emphasis] that nonstandard inclusion of the kava plant’s bark in kava preparations increased toxicity level.” And they went on to say, “Researchers concluded that liver toxicity is rare and idiosyncratic, with the majority of reported cases resulting from the combination of kava with other hepato-active agents; the benefits of kava seem to outweigh its risks.”

Not everyone reads the details in tables. In the body of the article, the text only said, “side effects reported with long-term use include a reversible skin rash or lesion and a yellow tint to the skin, but these reports have not been routine. Despite the absence of long-term data on safety and effectiveness, the evidence shows that short-term use (i.e., up to 24 weeks) can lead to small improvements in generalized
anxiety, and that short-term risks do not outweigh the benefits.”
 
https://www.psychologytoday.com/us/.../kava-is-effective-and-safe-treatment-anxiety

Kava is generally well tolerated even at doses significantly above usual therapeutic doses. Uncommon adverse effects include gastrointestinal upset, rash, headaches and dizziness (Schulz 2001). In recent decades there have been reports of Kava inebriation (Matthews 1988), although this social phenomenon has not been observed in Europe where Kava preparations are used medicinally to treat anxiety. Rare case reports suggest that Kava may potentiate the action of benzodiazepines resulting in increased sedation (Almeida 1996), but Kava does not potentiate the effects of alcohol consumption in humans. Rare case reports of hepatitis (Escher 2001) and fulminent liver failure (Kraft 2002) have led to restrictions in the sale of Kava products in many European countries and a warning by the FDA. However, independent experts have concluded that most reported cases of liver failure were associated with a processing mistake resulting in potentially toxic levels of alkaloids in a single batch of Kava (Waller 2002; Dragull 2003). Nevertheless, it is judicious to advise patients against taking Kava (Bone 1993) when there is a question of alcohol abuse or heavy use of conventional sedative-hypnotics. One case report suggests that Kava may interfere with anti-Parkinsonian drugs (Izzo 2001).
 
One of the articles mentioned above also talks about its effectiveness if that argument arises.

https://www.psychologytoday.com/us/.../kava-is-effective-and-safe-treatment-anxiety

Kava compares favorably to benzodiazepines (e.g. lorazepam, clonazepam, alprazolam) and other prescription anti-anxiety medications. The findings of a small double-blind controlled trial suggest that generally anxious patients who gradually increase their daily dose of kava (up to 300mg/day of a standardized extract) while tapering off a benzodiazepine do not experience worsening anxiety or benzodiazepine withdrawal (Malsch 2001). A randomized placebo-controlled multi-center study enrolling 129 outpatients concluded that a standardized Kava preparation (LI 150) was as effective as two commonly prescribed anti-anxiety agents (Buspirone™ and Opipramol™) in the treatment of generalized anxiety (Boerner 2003). Three fourths of patients in both the Kava group and the conventional drug group were classified as “treatment responders,” and experienced 50% or greater reductions in HAM-A.
 

Chronophan

Kava Curious
Having worked in medicine the past thirty years I've seen that while pharmacists generally are some of the best at medical institution operational analysis, their understanding of both commercial and noncommercial pharmaceutical products is based on pharmaceutical company literature and studies funded or otherwise supported by drug companies. I understand that the issue with kava liver cases stem from one or more supplement and nonprescription drugs being manufactured using the leftovers from kava bars and using whole plant extracts. Part of the reason that we use traditional prep and discard the makas is because that harmful constituents remain in the maka fibers while the good stuff is carried into the grog by the root starches. Whole plan extracts have a broad range of dangerous constituents not present in the roots. Misrepresentation of the safety of kava is a protective move by the pharmaceutical industry in general because it blames the plant rather than their business practices for the harm done by their former kava products, and since they cannot seem to understand safe commercial use of kava its more profitable for their competitive synthetic products to demonize what they may view as a competitor.

Regarding a pharmacist knowledge of exact usages of substances, pharmacists depend on a licensed medical doctor's order to dispense drugs. Having worked with high level PharmDs in government I know that the NIH inadvertently calls on their expertise rather than on the expertise of actual medical doctors because while the PharmDs are less skilled in the practice of medicine they are often more skilled in data analysis. While nurses and pharmacists have basic knowledge in their fields, they work in an ancillary capacity assisting a licensed practitioner of medicine in their care of patients. Even licensed medical doctors are limited in their overall knowledge of medicine which is why there are physicians who specialize in different aspects of medicine. Even then, correct practice of medicine is best done with individual patients because of everyone's unique physical differences.

However, all this concern about kava seems to be mostly due to people thinking of kava as a medical drug rather than a food. It’s been long known that the leaves and green parts of tomato plants are toxic, and there was a time when individuals and cultures didn't eat tomato because it’s in the same plant family as deadly nightshade. Potatoes are another plant in the same plant family as deadly nightshade, and we only eat the below ground starchy tuber because the rest of the plant is toxic. A properly cooked potato still has some wonderfully sedating effects and I'd say is one of the chief contributors to that dreamy feeling after a ritual Thanksgiving or Christmas dinner. But the main difference between potatoes and kava is that the culture partaking of potatoes is much larger than the culture partaking of kava, so if the pharmaceutical industry ever made a whole plant potato extract with toxic results, they would never be able to demonize the potato as they have done with kava.
 
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