Kava

Piper methysticum

Amanda Thorndyke and Heather Rhyne

Description:

The kava plant is a robust, well-branching, and erect perennial shrub. It grows well in altitudes 150-300 meters above sea level in stony ground. It prefers warm, humid conditions with a lot of sunlight and can grow up to nine feet tall. The leaves are heart shaped, green, smooth, pointed, and about 4- 10 inches wide. The heavy, knotted mass of root grows about 60 cm below the ground and is used medicinally. Kava meaning "intoxicating drink,",grows in the South Pacific in Polynesia, Indonesia, Melanesia, and Micronesia which makes up Oceania. It is also found in Hawaii where it means "bitter," "sour," "sharp," and "pungent."

Chemical composition:

• 43% Starch
• 3.2% Minerals (mostly potassium)
• 12% Water
• 3.2% Simple sugars
• 3.6% Proteins
• 15% kavalactones which are responsible for the pharmacological activities and found in the fat soluble resin of the root (content can vary between 3-20% in oral preparations)

Clinical applications:

Anxiety

• increases vigilance, memory reaction time, relaxation, restful sleep, muscle relaxation,
• decreases feelings of nervousness, somatic complaints such as heart palpitations, chest pains, headache, dizziness, and feelings of gastric irritation

Analgesia

• reduces pain.

Ischemia

• protects against brain damage due to ischemia

Pharmacology:

• Kavalactones modify receptor domains rather than interacting specifically with receptor binding sites causing sedation.  Kava may promote sedation by altering the limbic system in the brain which is responsible for the emotions
• Kava reduces pain unlike aspirin, morphine, or any other pain reliever and it does not bind to opiate receptors. We know this by using kava in patients where non-opiate analgesics like aspirin and other NSAIDs are ineffective.
• Kava protects against brain damage due to ischemia due to kavalactones' ability to limit the infarct area as well as provide an anticonvulsant effect. It may help in recovery from a stroke.

History and Folk Use:

Kava is a "magical drink" used in ceremonies and celebrations because of its calming effect and ability to promote sociability. It is still used today in the Pacific Islands where people are referred to as the happiest and friendliest in the world. In 1992 during a presidential campaign visit to Hawaii, Hillary Clinton participated in a kava ceremony conducted by the Samoan community on O'ahu.

The Samoans take credit for spreading kava because a Samoan girl saw a rat chewing on a plant that made him go to sleep and she decided to bring it from Fiji to Samoa. She exchanged some of the plant to a neighboring island for some hens.

In Tonga, a great chief named Loau who lived on the island of Euaiki went to visit his servant. The servant wanted to have a feast in honor of the chief, however it was during a time of famine. The servant and wife were desperate and decided to kill and cook their only daughter for the feast. The chief recognized the food was human flesh and would not eat it. The chief told the servant to plant the food and bring him the plant when the food matured. When the plant grew, the chief instructed everyone to prepare a drink from the plant, consume it with due ceremony.

Types of Kava Ceremonies:

1. Full ceremony--on every formal occasion

2. Meeting of village elders, chiefs, and nobles, and for visiting chiefs and dignitaries

3. Less formal—social occasions

Preparation for ceremony:

Originally to prepare the kava drink, a young boy or girl would cut the root, chew, and spit the macerated mass into a bowl where some milk of coconuts was poured on top. The coconuts were then strained, and the chips were squeezed until all the juices are mixed with the coconut milk. The whole liquor was decanted into another bowl and drank as fast as possible. Now a more sanitary preparation is required since the previous method is unsanitary, and therefore illegal. The new method involves grinding and grating instead of chewing and spitting.

After the preparation, a group of young men dressed in ceremonial attire carry the kava bowl and deliver it to the chief guest. If the whole bowl is drank without stopping everyone yells "a maca" (pronounced "a matha"), meaning "it is empty" and then claps three times. The kava bowl is then served to the next person of importance or rank.

It is the drink of pleasure for chiefs and essential on occasions of hospitality and feasting. Commoners were subject to penalty of death if caught drinking kava at one time, and therefore the sacred nature of the drink warrants that its preparation and use are always done with respect.

Effects of the Drink:

The drink gives the person a state of happy, unconcern, well-being, and contentment. Limbs may become tired and the person usually wants to lie down and sleep, however the mental status is not altered. Kava never exerts an angry or unpleasant state. There are no morning hangovers with kava unlike alcohol and other sedatives. It gives a numbing effect at first and may taste bitter, or sour. Drinking about half coconut (100-150 ml) will put most people in deep, dreamless sleep in about 30 minutes.

Toxicity:

High doses consumed over a long period of time (few months-1 year)

• "Kava dermopathy": dry, scaly skin especially on palms of hands, soles of feet, forearms, back and shins
• Biochemical abnormalities: decreased serum albumin, bilirubin, urea, protein, platelet and lymphocyte counts, increased RBC volume, hematuria, and shortness of breath
• Loss of appetite, disordered sleep, or bloodshot eyes

Drug Interactions:

Potentiation of kava effectiveness is possible if given in concomitant with alcohol, barbiturates, psychopharmacological agents, and melatonin

Contraindications:

Pregnancy, lactation, or endogenous depression

Dosing:

• Anxiolytic dose: 45-70 mg kavalactones by mouth three times a day
• Sedative dose: 180-210 mg kavalactones by mouth 1 hour before bedtime

Cost

• 500 mg $14.99 for 100 tablets
• 400 mg $10.99 for 100 tablets

(directions on box: Take two tablets three times a day with food)

Duration: Do not take more than 3 months without medical advice.

Clinical Trials:

1. LehmanW E., et al study (1996) A double-blind placebo controlled trial was carried out in 58 patients with anxiety syndromes not caused by mental disorders. The patients received either placebo or 100 mg kava extract (standardized to 70 mg of kavalactones) three times a day for four weeks. The treatment outcomes were evaluated through standard psychometric assessment including the Hamilton Anxiety Scale at 7, 14, and 28 days. After seven days anxiety symptoms improved and there were no adverse reactions. Investigators concluded a positive risk/benefit profile demonstrated by the kava extract makes it suitable for general practitioners in treating states of anxiety, tension, and excitedness.

2. Lindenberg, D. And Pitule-Schodel, H. Study (1990) The study compared kava to oxazepam in 38 patients with anxiety symptoms in a double-blind placebo controlled study. Both groups showed improvement in the Anxiety Status Inventory Scale and the Self-rating Anxiety Scale over a four week period. However, oxazepam, like other benzodiazepams may be addictive and cause side effects, while kava is free of these complications.

3. Kinzler, E., Kromer, J., and Lehmann, E. Study (1991) In this double-blind study, 29 patients with anxiety were given 100 mg of kava extract (70% kavalactones) three times a day while the other 29 patients received a placebo. This study proved that the patients given the kava had a decrease in symptoms such as nervousness, anxiety, heart palpitations, chest pain, headache, dizziness, and gastric irritation.

4.Warnecke, G. Study (1991) In a double-blind study, two groups of 20 women with menopause-related symptoms were treated for eight weeks with 70% kavalactone extract (100 mg TID) or a placebo. The outcomes were measured on the Hamilton Anxiety Scale. After the first week symptoms improved and continued to improve over the eight week period. The patients' mood and overall well-being improved, as well as some of their menopause symptoms, such as hot flashes. None of the patients experienced any side effects.

References

1. Blumenrithal, M. Herbalgram. 'Kava: An Overview." American Botanical Council and the Herb Research Foundation: Austin, Tx. No. 39, pp. 34-56.

2. Kinzler, E., Kromer, J. And Lehmann, E. Clinical Efficacy of a Kava Extract in Patients with Anxiety Syndrome: Double-blind Placebo Controlled Study over 4 weeks. Arzneim Forsch 41: 584-588, 1991.

3. Lehmann, E., et al. Herbalgram. ';Efficacy and Tolerability of Kava in Anxiety." American Botanical Council and the Herb Research Foundation: Austin, Tx. No. 39, pp. 18.

4. Lindenberg, D. And Pitule-Schodel, H. D,~-kavain in Comparison with Oxazepam in Anxiety Disorders. A Double-blind Study of Clinical Effectiveness. Forschr Med. 108: 49-50, 53-54, 1990.

5. Pissano and Mullay. ATextbook of Natural Medicine. Bothell,WA: Bastyr University Publishing 1994, pp. V:Piper M1-M4.

6. Warnecke, G. Neurovegetative Dystonia in the Female Climacteric. Studies on the Clinical Efficacy and tolerance of Kava Extract WS 1490. Forsch Med. 109: 120-122, 1991.

Web sites:

http://www.goodnet.com/~namaste/405-9.htm

http://www.kauaisource.com/f2more.html

http://www.tbe.net/~rtannerduly.htm

http://www.top.net/ddunning/kavakava.htm