This is a timely posting, considering the ongoing discussion on what we can do to help the liver (I made mention in the dandelion thread of the importance of sparing the liver from exposure to toxic substances).

Kava use has been linked with severe liver damage, documented for instance in this report in which people taking kava products (including root-derived kava) suffered such catastrophic liver damage that they had to have liver transplants to survive.

Your Wikipedia source seems to be taking liberties with the conclusion by the Cochrane Collaboration in its comprehensive review of kava's effectiveness. The Wiki entry states:

"A Cochrane Collaboration systematic review of its evidence concluded that it was likely to be more effective than placebo at treating short-term social anxiety."

What the Cochrane researchers actually said was:

"These data imply that, compared with placebo, kava extract might be an effective symptomatic treatment for anxiety although, at present, the size of the effect seems to be small. Rigorous trials with large sample sizes are needed to clarify the existing uncertainties. Particularly long-term safety studies of kava are needed.

Does the small effect of this herb justify the risks associated with using it?

I think Awa has a fascinating history and have seen no proof that used properly it is damaging unless used in excess.

"Since 1999, health-care professionals in Germany, Switzerland, and the United States have reported the occurrence of severe hepatic toxicity possibly associated with the consumption of products containing kava (i.e., kava kava or Piper methysticum). A total of 11 patients who used kava products had liver failure and underwent subsequent liver transplantation (1--7).

Of those eleven cases they highlighted two. One of the two they could not find the labels for so had no idea what else could be in the supplements that the patient took.

This is hardly compelling evidence against kava or awa. As you said many times before, supplements are not regulated and there is no telling how many other materials went into the production and whether or not leaves and stems were used which could have increased toxicity.

It can stain the teeth, and cause "alligator skin", neither of which are appealing to me.

But as with anything put into ones body, I think one should weigh the risks and benefits.

I'm interested to hear what others think about this plant.

"As you said many times before, supplements are not regulated and there is no telling how many other materials went into the production and whether or not leaves and stems were used which could have increased toxicity."

This doesn't vastly increase one's confidence in consuming a kava supplement. I'm glad to see others are thinking about this problem.

"But as with anything put into ones body, I think one should weigh the risks and benefits."

On the one hand, a possible small anti-anxiety benefit. On the other hand a risk of injury to the liver, potentially devastating and fatal (liver transplantation is not a risk-free procedure). Yup, decision making in this instance will be tough...

More food for thought from the CDC link: "FDA research suggests that

"On the one hand, a possible small anti-anxiety benefit. On the other hand a risk of injury to the liver, potentially devastating and fatal (liver transplantation is not a risk-free procedure). Yup, decision making in this instance will be tough..."

Glad to know your opinion. It has been noted that you do not believe herbal supplements are safe. Anyone else want to discuss Kava, the plant and its medicinal properties?

I like the occasional coconut shell of kava brew. One thing I like in particular is that when I drink kava, I hear music. It sounds better when I listen to it, and when I lay down to sleep, my mind often replays music with great detail. Ordinarily, my brain is not so musical.

I think it is reasonably safe. Most of the cases that were possibly linked to liver failure were clustered in space and time, which is consistent with a bad batch of supplements. The stem and leaves have a significant dose of toxins; the stem and leaves are not used traditionally, but were used for making extracts around the time that the European cluster was observed. Wasn't long ago when 5 people died from eating spinach, and 677 cases of Salmonella have been linked to peanut butter ... there are always going to be issues with food preparation, but we can't stop eating.

I also think it is more than 'possibly' effective, and that the effect is not always small. That is certainly my response. The Cochrane review was for social anxiety, which is different than generalized anxiety. Social anxiety and phobias involve specific learned responses, and I consider 'unlearning' them to be the best choice. Not that a cup of kava would hurt with that unlearning.

You took my questioning right where I was meaning for it to go. Honestly I didn't know there were Kava supplements until this thread. I grew up with people drinking Kava/Awa ceremoniously and think it's a pretty neat plant. And very pretty to look at too.

I found what you said to be very interesting... "Social anxiety and phobias involve specific learned responses, and I consider 'unlearning' them to be the best choice." I'm interested in hearing more if you care to elaborate?

I would compare social anxiety and phobias to Pavlov's dogs, the bell rings, the dog salivates because it associates the bell with food. Social anxieties and phobias are linked to specific situations or thoughts - an initial fearful experience becomes ingrained in the brain, and our response to that becomes stronger with time until it is dysfunctional. We learned it, I think we can usually unlearn it.

Another thing about kava I just thought of - in some ways, I would compare the experience to buspar (buspirone), which I took as a prescription for generalized anxiety. I looked up the molecular diagram for buspirone, and it has some structural similarities to the kavapyrones. ... Ok, found some articles that show some overlap in molecular activity between kava pyrones and the azapirones (incl buspirone) - in terms of specific serotonin receptors they both act on. I prefer kava to buspar.

I agree with you wholeheartedly on the learned response with anxiety. I know people who have made the decision early on that they were afraid of something or that they didn't "do" something and that was that. All of a sudden they have handicapped themselves into this little box they call "me".

I don't prefer to go in large crowds but I refuse to let that turn into such a great fear that I can't do it. I don't put myself in situations where I will be packed in with people but I'm able to breathe with my anxiety when on occasion I am stuffed in somewhere and generally manage to get through it without unduly stressing myself.

That you found that information about Kava and Buspar is very interesting. I'm interested in how people drug themselves. I know people who are on prescribed anti-anxiety/depression etc. pills daily. For some people, they truly need them and it's great. But I think for the majority there are other options that will decrease dependency and get them out of the loop you speak of.

Hello, apollog,

I've recently started treatment with kava for generalized anxiety, and have had fair results (anxiety reduced in about 50% over the last couple of weeks). I wanted to ask you about your personal experience using buspirone and kava for treatment.
I assumed kava and buspirone had some similarity due to the active kava compounds being called kavapyrones: I thought the "suffix" wouldn't be the same for no reason, given also the fact that they are both anxiolytic substances.
So I'd love to hear some feedback on your part.
Hope you get to read this, since I see this discussion took place on March.
Best regards.

Buspar was a bit strange - about 1/2 to 1 hour after taking it, I could feel something in my brain down-shift in a whirring or buzzing way. It was something that happened for a few seconds, and then stopped. Not painful or bad, just very strange. After that few seconds, information was being processed differently (less anxiety).

Kava never announced itself in such an obvious way ... it tended to work more gradually, but was also effective. High doses of kava interfered with arithmetic abilities - columns of numbers didn't make sense, and didn't seem to be worth wrestling with.

To follow up on a couple of things:

apollog: "I think (kava) is reasonably safe. Most of the cases that were possibly linked to liver failure were clustered in space and time, which is consistent with a bad batch of supplements."

Actually, reports have come in from a number of different countries, and there's been no indication that a "bad batch of supplements" was to blame - rather that the plant itself can have toxic effects. The issue of not knowing exactly what's in an unregulated supplement goes beyond precise ingredients, and includes dose (Health Canada found much greater levels of active ingredients in some supplements than have been tested in clinical trials).

Several pharmacologic effects of kava have been observed, including platelet inhibition, difficulties with visual accommodation and photosensitivity, and possible dopaminergic antagonist activity. It was therefore recommended that kava not be used in conjunction with anticoagulants, antiplatelets or antipsychotics, or in patients with Parkinson's disease. Kava may also enhance the effects of other centrally acting agents such as benzodiazepines and alcohol.
Long-term use of kava, especially in high doses (400 mg of kava pyrones daily), has been associated with the development of flaky, dry, yellow skin (kava dermopathy) through an unknown mechanism; the effect may be reversible upon cessation of the drug. Other possible adverse effects include ataxia, hair loss, hearing loss and anorexia.

We already have a pretty good basis on which to judge the benefit/risk ratio with standard anti-anxiety drugs; we're still accumulating evidence with regards to kava.

"The Cochrane review (which found a possible, small benefit for kava and recommended long-term safety studies) was for social anxiety, which is different than generalized anxiety."

No, it covered studies on anxiety in general.

"One thing I like in particular is that when I drink kava, I hear music."
"Buspar was a bit strange - about 1/2 to 1 hour after taking it, I could feel something in my brain down-shift in a whirring or buzzing way."

What happens when you drink alcohol? :)