Nearly 50% of the adult population in North America, integrate some form of complementary medicine as an essential part of personal health caring. This includes using natural food supplements each highlights a specific value in relieving certain complaints. In a survey carried out by the Canadian College of Naturopathic Medicine, 3.1% of participants were using Kava Kava as a nutritional supplement (Busse and others p. 618). With increasing tendency to go for alternative or complementary food patterns, it is pressing to provide proper information about the supplement foods (Lam and Szmitko, p. 63). The aim of this essay is to provide a brief yet a comprehensive review of Kava Kava as a nutritional supplement applying proper nutrition knowledge.
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Kava Kava is also famous as Awa, Ava, or Yagona, and scientifically as Piper methysticum. The plant is a strong, tall (2-2.5 meters), erect, barricading, and well branching shrub. The leaves are characteristically heart shaped, green, and smooth on either side. Its flowers are long and lean growing at the points of meeting between the stem and branches. The plant is uniquely uncultivable as it does not produce female flowers, and produces no seeds. Recultivation is through using roots’ rhizomes. It grows all the year-round mainly in south pacific islands including Hawaii and becomes mature after 3-5 years from cultivation. People use its root extract as a supplement food. It is also available as tea, pills, and capsules, typically, the root is chewed or adding the root pulp to cold water and drinking the resulting decoction (Food Standards Australia and New Zealand, Pp. 6-7).
Kava is a central part of the culture, beliefs, and society heritage of the people of Polynesia, a group of islands in the South Pacific, and people of Micronesia, Western Pacific self-ruled island country in free association with the US. Kava has long consecrated and cherished history practices of use in ritual and ceremonial celebrations. A drink made from the root (Kava) is the start of all known social or national ceremonies and is a welcome to all visiting royals or honored guests. Kava is currently used in nearly all activities of life in these islands (, such as preparing for an ocean hunting journey, at the beginning or end of work). Religiously, islands’ natives think that it removes curses this is the reason the rituals of making Kava is holey and respectful. The drink initially caused the mouth to go numb, followed by a placid, calm, and jovial attitude, with the kava drinker reaching a satisfaction state and greater feeling of well-being. The first European reported to have used Kava is Captain James Cook, suggested from readings in his records of expedition of the South Seas in 1768. Following explorers and anthropologists experienced its relaxing, and soothing effects (Rouse, Pp. 1-2).
Kava kava main active ingredients are 15 alkaloids collectively named kava pyrones and lactones. The ratio of active ingredients varies depending on the root’s age and the kava type because each plant breed has a different ratio of active alkaloids. These alkaloids act on the Gamma-Amino Butyric (an amino acid acting as a CNS neurotransmitter) receptors known as GABA receptors in different ways. They act through dopamine antagonism on the GABA binding site that mediates the outcomes of agonists and competing antagonists. However, they do not affect benzodiazepines GABA receptor sites, possibly because of the amino acids responsible for benzodiazepines binding. They alkaloids may have a direct muscle sedating action excluding the respiratory muscles (Malani, Pp.1-2).
In 2000, a report from the Department of Family Medicine, University of Washington School of Medicine discussed the proposed uses of kava kava. The report suggested, based on many clinical studies, that kava kava is useful in controlling mild anxiety and insomnia. Other less studied uses are managing epilepsy, musculoskeletal pains, migraines, infections of the urinary tract, respiratory tract, uterine infections, and in managing menstrual disorders, especially postmenopausal discomforts. However, increasing reports on its side effects especially on the liver cell warrants caution, and healthcare professional supervision while using it. Later, in 2007, a report from the Medical Center, University of Maryland, reviewed by Ernest B. Hawkins, and Steven D. Ehrlich, inferred that kava kava was successful in reducing anxiety in seven-research studies equivalent to diazepam (in one study). Three other studies found insignificant effects of kava kava on anxious patients, one more study in 2004 suggested improvement in cognitive and mood functioning in individual taking kava kava. However, this study agreed with the previous that kava kava should not be taken for recreational purposes because of potential side effects (after University of Maryland Medical Center, 2007). Bardia and colleagues (Pp. 561-566) used the Natural Standard database to put together evidence-based indications for kava kava among other herbs. They surveyed 30617 adults for herbs use. They inferred, based on evidence, kava kava principal use is in anxiety, and the percentage of use based on evidence was 36.1%.
Klemens (Pp. 1-3) reviewed the evidence for kava kava interactions and contraindications and inferred although it showed success in managing anxiety; yet, it is wiser not use it for every day anxiety but keep it for times of high anxiety. Kava kava interacts with other relaxing herbs as passionflower, alcohol, and prescription sedatives. In some cases its use with Xanax (alprazolam, a tranquilizer used to induce short-term anxiety relief) resulted in coma. The drug’s contraindications are professional driving, pregnant and lactating females, in cases of Parkinson’s disease and below 12 years of age. Monitoring kava kava use by bilirubin and liver enzymes’ estimation is advisable for fear of liver toxicity. Kava kava dispensation should be with high caution in patients with renal disease, decreases platelets or neutrophils count (thrombocytopenia or neutropenia). It is better to avoid kava kava use with other psychotropic drugs and alcohol (Klemens, Pp. 1-3).
In 2002, Professor Waller (University of Illinois) reviewed 5 US hepatotoxicity case reports and 30 others from German and Swiss authorities, Waller inferred in his report in many of the cases the reason for hepatotoxicity was concomitant use of alcohol and or other drugs. In the cases where hepatotoxicity links to kava kava, the reason may hypersensitivity rather than kava kava toxicity. His final remarks were there is no clear evidence that links hepatotoxicity (liver damage) with kava kava neither in US case reports nor in European reports (Gruenwald and others, Pp.40-41). However, because of reports of liver damage related to kava kava, the FDA maintains advising customers and healthcare professionals of the possible risks associated with kava kava use (Centers of Disease Control and Prevention, CDC, Pp. 36-37).
The 2003 Gruenwald and others reviewed 76 cases of kava kava side effects and suggested that the preparation is well tolerated. Side effects because of kava kava are uncommon and placid occurring in less than 1% of those who use it.
Evidence-based studies point that kava kava is useful in anxiety and stress conditions, about safety there no enough or at least low evidence to link it to liver damage. Research still lacks benefit-risk ratio studies, although many authorities recommend its use under professional health supervision.
- Bardia, Aditya, Nisly, Nicole, L., Zimmerman, Bridget, M., Gryzlak, Brian, M., and Wallace, Robert, B. “Use of Herbs Among Adults Based on Evidence-Based Indications: Finding From the National Health Interview Survey.” Mayo Clin Proc. vol 82 (5) 2007. p. 561-566.
- Busse, Jason, W., Heaton, Graham, Wu, Ping, Wilson, Kumanan, R., and Mills, Edwards. “Disclosure of Natural Product Use to Primary Care Physicians: A Cross-sectional Survey of Naturopathic Clinic Attendees.” Mayo Clin Proc vol 80 (5) 2005. p. 616-623.
- Centers of Disease Control and Prevention (CDC). “Hepatic Toxicity Possibly Associated with Kava-Containing Product-United State, Germany, and Switzerland, 1999-2002.” JAMA vol 289 (1) 2003. p. 36-37.
- Department of Family Medicine. Dept. home page. University of Washington School of Medicine.
- Food Standards Australia New Zealand. Food Standards Australia New Zealand. KAVA A Human Health Risk Assessment. Technical Report Series No. 30. 2004.
- Gruenwald, Jeorge, Mueller, Cordula, and Skrabal, Juergen. KAVA REPORT 2003: In-Depth Investigation into EU Member States Market Restrictions on Kava Products. Berlin: Center For The Development Of Enterprise, 2003.
- Klemens, Jonathan. “Herbs Used for Psychotropic or Behavior Modifying Activity.” JAAIM-Online (2006): 1-9.
- Lam, Jason and Szmitko, Paul, E. “Naturopathy: Complementary or Rudimentary Medicine?” University of Toronto Medical Journal vol 80 (1) 2002. p. 63-65.
- Malani, Joji. “Evaluation of the effects of Kava on the liver.” Secretariat of the Pacific Community. 2004.
- Rouse, James. “Kava: A South Pacific Herb for Anxiety, Tension, and Insomnia.” Clinical Nutrition Insights vol 6 (10) 1998. p. 1-2.
- University of Maryland Medical Center. “Kava kava.” Complementary and Alternative Medicine Index (CAM). Hawkins, Ernest, B., and Ehrlich, Steven, D. 2007. University of Maryland.