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Kava (Piper Methysticum), a member of the pepper family, is one of the most fascinating of medicinal plants. Native to the South Pacific, a beverage (also called Kava) made from the rootstock of the plant has been used for centuries in ceremonies and celebrations because of its calming effect and ability to promote sociability. The kava beverage is still used today by inhabitants of the island communities of the Pacific including Micronesia, Melanesia, and Polynesia.
It is thought that the frequent consumption of kava is partially why these people are referred to as the happiest and friendliest in the world. The Kava Ceremony Traditionally kava was only consumed during ceremonies. The ceremonies ranged from the full ceremonial enacted on every formal occasion to the kava circle common for less-formal social gatherings. The first thing to do with any kava ceremony was the preparation of the beverage. Kava kava induces a pleasant sense of tranquility and sociability after it is consumed.
Over the years many scientists have consumed kava kava in an attempt to describe its effects in more scientific terms. One of the first such descriptions of kava was offered by the noted phamacologist Louis Lewin in 1886. Lewin must have enjoyed studying kava kava, because what became his classic description of kava kava's effects was written in 1927, over forty years after his initial investigation. Here is Lewin's classic description. When the mixture is not too strong, the subject attains a state of happy unconcern, well-being and contentment, free of physical or psychological excitement.
At the beginning conversation comes in a gentle, easy flow and hearing and sight are honed, becoming able to perceive subtle shades of sound and vision. Kava soothes temperaments. The drinker never becomes angry, unpleasant, quarrelsome or noisy, as happens with alcohol. Both natives and whites consider kava as a means of easing moral discomfort. The drinker remains master of his conscious and his reason.
When consumption is excessive, however, the limbs become tired, the muscles seem no longer to respond to the orders of control of the mind, walking becomes slow and unsteady and the drinker looks partially inebriated. He feels the need to lie down....He is overcome by somnolence and finally drifts off to sleep. Kava Kava Extract in Anxiety and Depression Like St. John's wort, kava kava extracts are gaining in popularity in Europe in the treatment of anxiety and depression.
Several European countries (e.g., United Kingdom, Switzerland, and Austria) have approved kava kava preparations in the treatment of nervous anxiety, insomnia, and restlessness on the basis of detailed pharmacological data and favorable clinical studies. The kavalactones were deemed the active compounds in kava kava based on detailed scientific investigations over the past 110 years. However, although the kavalactones are the primary active components, other components appear to possess activity as well. Studies have shown that the relaxing and anti anxiety effects of a crude kava preparation were more pronounced than those of the isolated kavalactones.
Studies have also shown that kavalactones are more rapidly absorbed when given in the kava extract rather than the isolated kavalactones. For example in one study the absorption of the kavalactones was shown to be three to five times higher from the extract compared with an equal amount of isolated kavalactones. In one double-blind placebo-controlled study eighty four patients with anxiety symptoms were either given D, L-kavain, a purified kavalactone, at a dose of 400 mg per day or a placebo. The group receiving the purified kavalactone demonstrated improvements in anxiety symptoms and memory.
In another double-blind study thirty-eight patients were given either D, L-kavain or oxazepam, a drug similar to Valium (diazepam), for four weeks. Both groups demonstrated improvements in two different anxiety scores (Anxiety Status Inventory and the Self-Rating Anxiety Scale), however, while oxazepam and similar drugs are associated with being addictive, as well as possessing side effects, kavain was non addictive and was free of side effects. Kava kava and Menopause One group of patients who appear to respond extremely well to kava kava extract are women going through menopause, a time often associated with increased nervousness and anxiety. In a double-blind study forty menopausal women with menopause-related symptoms were given either 100 mg of the kava extract standardized to contain 70 percent kavalactones or a placebo three times daily for eight weeks.
The beneficial effects of the kava extract were almost immediate, as after one week there was a significant improvement in scores on the Hamilton Anxiety Scale in the group receiving the kava extract. As the trial continued, the scores continued to improve in the kava group. in addition to improvement in symptoms of stress and anxiety, the group receiving kava kava also noted improvements in feelings of well-being, mood, and menopausal symptoms including hot flashes. Again, these positive effects were gained without side effects. One of the major drawbacks of benzodiazepines, besides their addictiveness, is that they impair mental function. That is the reason for the warning not to drive or operate heavy equipment while on these drugs. In contrast, according to results of studies in humans and animals, kava kava does not impair mental function. Instead it actually enhances it. In one study, twelve healthy volunteers were tested in a double-blind crossover manner to assess the effects of oxazepam (a benzodiazepine), the extract of kava standardized at 70 percent kavalactones (200 mg three times daily for five days), and a placebo on behavior and brain activity in a recognition memory task. The subjects task was to identify within a list of visually presented words those that were shown for the first time and those that were being repeated. Consistent with other benzodiazepines, oxazepam inhibited the recognition of both new and old words. In contrast kava kava showed a slightly increased recognition rate and a larger brain response between old and new words. The results of this study once again demonstrate the uncharacteristic effects of kava. in this case, it improves anxiety, but unlike standard anxiety-relieving agents, kava actually improves mental function and, at recommended levels, does not promote sedation. How does kava kava work?
Studies in the 1950s and 1960s showed that the kavalactones exhibit sedative, analgesic, nticonvulsant, and muscle relaxant effects in laboratory animals. More recent studies have confirmed and/or elaborated on these effects. However, exactly how kava kava produces these effects is largely unknown. Kava kava exerts many of its effects by nontraditional mechanisms. For example, most sedative drugs, including the benzodiazepines (e.g., Valium, Halcion, Tranxene, etc.), work by binding to specific receptors (benzodiazepines or GABA receptors) in the brain, which then leads to the neurochemical changes (potentiation of GABA effects), which promote sedation.
Studies in animals have shown hat the kavalactones do not bind to benzodiazepine or GABA receptors). Instead, the kavalactones are thought to somehow modify the area near the receptor site in a way that enhances GABA binding. However, there are other explanations. For example, studies have indicated that the kavalactones appear to act primarily on the limbic system, the primitive part of the brain that affects all other brain activities and is the principal seat of the emotions and of instinct). It is thought that kava may promote its anxiety-relieving and mood-elevating effects by altering the way in which the limbic system influences emotional processes. Kava kava is truly a unique anti anxiety agent. An interesting effect of kava compared with many anxiolytic drugs is that unlike the drugs, kava does not lose effectiveness with time. Loss of effectiveness of a drug is know as tolerance. Kavalactones, even when administered in huge amounts in animal studies, demonstrated absolutely no loss of effectiveness.
Dosage The dosage of kava kava preparations is based on the level of kavalactones. Based on clinical studies using pure kavalactones or kava extracts standardized for kavalactones, the dosage recommendation for anxiolytic effects is 45 to 60 mg of kavalactones three times daily.
For sedative effects, a dosage providing 180 to 210 mg of kavalactones can be taken as a single dose one hour before retiring. To put the therapeutic dosage in perspective, it is important to point out that a standard bowl of traditionally prepared kava drink contains approximately 250 mg of kavalactones and that several bowls may be consumed at one sitting.
Safety Issue: On November 8th, 2001, the German government stated that in the past several years, there have been 24 adverse event reports (AERs) of hepatotoxicity reportedly associated with oral use of kava preparations in Germany and five in Switzerland. They also stated, however, that in 18 cases, conventional prescription or over-the-counter pharmaceutical drugs with known or potential liver toxicity were also being used. No reports of adverse liver effects of kava have been published in the U.S., said Mark Blumenthal, founder and executive director of ABC, a non-profit herbal research and education organization. He noted that the U.S. Food and Drug Administration has now indicated that there are a small number of adverse events in its unpublished database.
Based on the limited information made available to date, Blumenthal stated that consumers of kava should consider the following if they are using kava products: -- Kava should not be used by anyone who has any liver problems, or by anyone who is taking any drug products with known adverse effects on the liver, or anyone who is a regular consumer of alcohol. -- In addition, Blumenthal noted that consumers should discontinue use if symptoms of jaundice (e.g., dark urine, yellowing of the eyes) occur. -- Consumers should consult their primary health care provider if they have a history of liver problems or suspect possible liver problems before using kava or continuing its use. Although no sideseffects have been reported using standardized kava extracts at recommended levels in the clinical studies, several case reports have been presented indicating that kava may interfere with dopamine and worsen Parkinson's disease, a condition of decreased dopamine activity in the brain characterized by impaired motor (muscle) function and involuntary muscle twitches). Until this issue is cleared up, kava should not be used in Parkinson's patients.
At a very high dosage (e.g., ten times the dosage recommended), it is possible that kava extracts may produce the same side effects of high kava beverage consumption. High dosages of kava beverage consumed daily over a prolonged period (a few months to a year or more) are associated with kava dermopathy--a condition of the skin characterized by a peculiar generalized scaly eruption known as kani). The skin becomes dry and covered with scales, especially the palms of the hands, soles of the feet, forearms, the back, and the shins. It was thought at one time that kava dermopathy may be due to interference with niacin. However, in a double-blind palcebo-controlled study no therapeutic effect with niacin amide (100 mg daily) could be demonstrated.) It appears the only effective treatment for kava dermopathy is reduction or cessation of kava consumption.
Again, no reported cases of kava dermopathy have been noted in individuals taking standardized kava extracts at recommended levels. Other adverse effects of extremely high doses of kava (e.g. greater than 310 grams per week) for prolonged periods include biochemical abnormalities (low levels of serum albumin, protein, urea, and bilirubin), presence of blood in the urine, increased red blood cell volume, decreased platelet and lymphocyte counts, and shortness of breath.) The presence of these adverse effects is questionable because the subjects also reported heavy alcohol and cigarette usage. Nonetheless, high doses of kava are unnecessary and should not be encouraged.
Final Word on Kava Kava. Kava kava may one day replace benzodiazepines in the pharmacological treatment of anxiety. Kava kava is able to produce anxiety-relieving effects comparable to benzodiazepines, but is free from the common and expected side effects of these highly addictive drugs. If an individual's depression is associated with a great deal of anxiety, kava extract at the recommended levels can be extremely effective in relieving symptoms.
FDA Consumer Advisory: Kava kava (Piper methysticum) root is a common dietary supplement ingredient. Although rare, products containing kava have been associated with liver-related injuries. Consumers are advised to use caution when using supplements containing kava.
Piper methyisticum root cut and sifted