Herb: Kava

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. 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. A description of the classic process was given in 1777 by George Forster, a young naturalist on Captain James Cook's second Pacific voyage:
[Kava] is made in the most disgustful manner that can be imagined, from the juice contained in the roots of a species of pepper-tree. This root is cut small, and the pieces chewed by several people, who spit the macerated mass into a bowl, where some water (milk) of coconuts is poured upon it. They then strain it through a quantity of fibers of coconuts, squeezing the chips, till all their juices mix with the coconut-milk; and the whole liquor is decanted into another bowl. They swallow this nauseous stuff as fast as possible; and some old topers value themselves on being able to empty a great number of bowls. I assure you that the kava extract that will be described below is not produced via this traditional method of preparation. In fact, because the traditional method of preparing kava beverage was so disgusting to colonial governments and missionaries, they made it illegal for the natives to prepare it that way and forced them to prepare the beverage by grinding or grating the rootstock.

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. A more recent description is provided by researcher R. J. Gregory, who writes from his own experience:

Kava seizes one's mind. This is not a literal seizure, but something does change in the processes by which information enters, is retrieved, or leads to actions as a result. Thinking is certainly affected by the kava experience, but not in the same ways as are found from caffeine, nicotine, alcohol, or marijuana. I would personally characterize the changes I experienced as going from lineal processing of information to a greater sense of "being" and contentment with being. Memory seemed to be enhanced, whereas restriction of data inputs was strongly desired, especially with regard to disturbances of light, movements, noise and so on. Peace and quiet were very important to maintain the inner sense of serenity.
My senses seemed to be unusually sharpened, so that even whispers seemed to be loud while loud noises were extremely unpleasant. The difference between the effect noted by these pharmacologists consuming kava kava beverage and the effect of the kava extract that will be described here is a matter of dosage. During the traditional kava ceremony an individual will usually ingest much higher amounts of kava components compared with the levels commonly used in the treatment of depression and anxiety. The kava extract could produce the same type of effects as kava beverage if taken at high levels (not recommended).

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., Germany, 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. These approved kava preparations are extracts standardized for kavalactone content (usually 30 to 70 percent).
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.
A study in animals demonstrated another impressive advantage, the brain uptake of kavalactones from a kava extract is two to twenty times higher than that achieved with isolated kavalactones . Because the kavalactones content in crude preparations can vary between 3 and 20 percent, it is essential, when medicinal effects are desired, to utilize extracts standardized for kavalactone content. These standardized extracts provide the synergistic benefits along with a consistent therapeutic response because of the guaranteed level of kavalactones.
The majority of the studies with standardized kava extracts have featured a special kava extract standardized to contain 70 percent kavalactones. However, this high percentage of kavalactones may be sacrificing some of the other constituents that may contribute to the pharmacology of kava. Extracts standardized to contain 30 percent kavalactones may prove to be more effective than the 70 percent extract.
Before scientists knew of the benefits of using kava extracts standardized for kavalactones in anxiety and depression. These studies demonstrated that isolated kavalactones were quite effective in relieving anxiety and depression. For example, 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.
More recent studies have utilized standardized kava kava extracts. For example, in one double-blind study fifty-eight patients suffering from anxiety were assigned to receive either 100 mg of the kava kava extract containing 70 percent kavalactones or a placebo three times daily for four weeks. The group taking the kava kava extract exhibited significant improvements in several standard psychological assessments including the Hamilton Anxiety Scale. Symptoms of anxiety, such as feelings of nervousness, and somatic complaints, such as heart palpitations, chest pains, headache, dizziness, and feelings of gastric irritation, were either totally eliminated or greatly reduced. What is even more phenomenal than the excellent results that were obtained was the fact that they were obtained without 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 menopaus-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? UP 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 tspecific 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

Although no sides effects 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.

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