Kava for relaxation and reduction of anxiety

Kava is the term used for both the plant and the beverage made from it. The beverage is prepared from the root of a shrub called the pepper plant, Piper methysticum, found in Polynesia, Melanesia, and Micronesia. The kava root is ground to a powder, and it has a brownish color. The brownish powder is then mixed with water and drank as a beverage, without being fermented. Extracts from the kava root are now placed in capsules and sold as kava or kava kava.
   Kava may safely ease anxiety symptoms in some people, a small study suggests. Kava, a member of the pepper family, is native to the islands of the South Pacific, where the dried roots of the plant have long been used to make a traditional beverage. In the West, kava extracts have been promoted as a way to reduce anxiety, promote sleep and relax the muscles. However, reports of liver damage linked to kava supplements led the UK, Europe and Canada to ban the herb in 2002. In the U.S., the Food and Drug Administration warned consumers to be cautious about using kava-containing products.

Alternatives to Kava - Supplements that may be useful for anxiety
5-HTP  works by increasing levels of serotonin.
Valerian is able to reduce anxiety in some people.
Theanine may be helpful in some people at a dosage of 100 or 200 mg when used at night.

Click here to buy Kava product

Side Effects of Kava
Tiredness and decreased sex drive or sensation have been reported with frequent use. If you have a lowered libido from kava use, or for other reasons, consider a new product called Passion Rx. Rare cases of liver damage has occurred with the intake of kava. Those who take Tylenol or statin drugs, or who drink more than one glass of alcohol a few times a week should not take kava.

Kava and liver
Most studies show regular kava use can harm the liver.

Kava feeding in rats does not cause liver injury nor enhance galactosamine-induced hepatitis.
Food Chem Toxicol. 2007 July. DiSilvestro RA, Zhang W, DiSilvestro DJ. Human Nutrition, The Ohio State University, 345 Campbell Hall, 1787 Neil Avenue, Columbus, OH 43210-1295, United States.
Kava, like a number of herbals, has been associated with causing liver damage based on limited evidence. In contrast, the present study found that in rats, 3 months feedings of two types of kava extracts (an acetone extract and an ethanol extract of the Samoan kava cultivar Ava Laau) at three different doses (31.25, 62.5 and 133 mg/kg diet) produced no liver injury based on serum markers of liver damage (sorbitol dehydrogenase activities, bile acid concentrations, and beta-glucuronidase activities) and serum lipid peroxide readings. In fact, for some measurements and some kava doses, the injury marker readings were below control values. Moreover, for these same parameters, kava feeding did not enhance the effects of the hepatotoxin galacatosamine; some kava doses even showed modest protection against liver injury. Liver histology analysis showed no signs of kava causing or enhancing liver injury. Thus, this study does not support the concept that kava produces or aggravates liver injury.

Hepatic injury due to traditional aqueous extracts of kava root in New Caledonia.
Russmanna S, Barguilb Y, Cabalionc P, et al.  Eur J Gastroenterol Hepatol 15:1–4
Traditional aqueous kava extracts were the most probable cause of hepatitis in two patients presenting with markedly elevated transaminases and hyperbilirubinemia. A consequent survey of 27 heavy kava drinkers in New Caledonia showed elevated gamma glutamyl transferase in 23/27 and minimally elevated transaminases in 8/27. We conclude that not only commercially available, but also traditionally prepared kava extracts may rarely cause liver injury. The increased activity of gamma glutamyl transferase in heavy kava consumers in the presence of normal or minimally elevated transaminases is probably not a sign of liver injury, but rather reflects an induction of CYP450 enzymes.

What's in Kava?
As with any herbal medicine, a number of compounds contribute to its medical effects. The active compounds are concentrated in the root of the plant. Kava kava contains a variety of chemicals known as pyrones or kavalactones. Specific names of these kavalactones include kawain, methysticin, and yangonin.
   The water-soluble extract of kava contains different compounds than the fat-soluble extract. The central nervous activity of the water-soluble extract was determined in mice to have mild pain-killing ability, but did not induce sleep (Jamieson, 1989). The fat-soluble extract had sleep inducing and marked pain-killing properties. The researchers state, "The pharmacological effects of kava ingestion appear to be due to the activity of the compounds present in the fat-soluble fraction."
   Many of the studies done with kava used a standardized extract, called WS 1490, from a German manufacturer. The kava products you find over the counter will contain the active ingredients.

Anxiety and mood
A clinical trial found a water-soluble extract of Kava was effective in treating anxiety and improving mood. Jerome Sarris, a doctoral candidate at the University of Queensland, conducted a placebo-controlled study that found kava to be an effective and safe treatment option for people with chronic anxiety and varying levels of depression. The trial, published in the journal Psychopharmacology in 2009, found anxiety levels decreased dramatically for participants taking five tablets of kava per day as opposed to the group that took placebos. The three-week trial raised no major health concerns regarding the kava extract used. Jerome Sarris says, "Ethanol and acetone extracts, which sometimes use the incorrect parts of the Kava, were being sold in Europe. That is not the traditional way of prescribing Kava in the Pacific Islands. Our study used a water-soluble extract from the peeled rootstock of a medicinal cultivar of the plant, which is approved by the Therapeutic Goods Administration of Australia and is currently legal in Australia for medicinal use."

Kava in generalized anxiety disorder
Kava in generalized anxiety disorder: three placebo-controlled trials.
Int Clin Psychopharmacol. 2006 Sep;21(5):249-53. Connor KM, Payne V, Davidson JR.
Duke University Medical Center, Durham, North Carolina Private Practice, Pelican Rapids, Minnesota, USA.
In this study, we evaluated the efficacy and safety of kava kava (Piper methysticum) in generalized anxiety disorder. Data were analyzed from three randomized, double-blind, placebo-controlled trials of kava, including one study with an active comparator (venlafaxine), in adult outpatients with DSM-IV generalized anxiety disorder. The pooled sample (n=64) included the following number of participants: kava, n=28; placebo, n=30; and venlafaxine, n=6. Given the comparability of the study designs, the data comparing kava and placebo were then pooled for further efficacy and safety analyses. No significant differences were observed between the treatment groups in any of the trials. In the pooled analyses, no effects were found for kava, while a significant effect in favor of placebo was observed in participants with higher anxiety at baseline. No evidence of hepatotoxicity was found with kava, and all of the treatments were well tolerated. Findings from these three controlled trials do not support the use of kava in DSM-IV generalized anxiety disorder.

Treatment of anxiety, tension and restlessness states with Kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trial.
Gastpar M, Klimm HD. Rheinische Kliniken, Essen, Germany.
Phytomedicine. 2003 Nov;10(8):631-9.
The efficacy and tolerability of 150 mg/d Kava special extract WS 1490 were investigated in a randomized, placebo-controlled, double-blind multicenter study in patients suffering from neurotic anxiety (DSM-III-R diagnoses 300.02, 300.22, 300.23, 300.29, or 309.24). 141 adult, male and female out-patients received 3 x 1 capsule of 50 mg/d WS 1490 or placebo for four weeks, followed by two weeks of observation without study-specific treatment. During randomized treatment the total score of the Anxiety Status Inventory (ASI) observer rating scale showed more pronounced decreases in the WS 1490 group than in the placebo group. Although a treatment group comparison of the post-treatment ASI scores was not significant (p > 0.05), an exploratory analysis of variance across the differences between treatment end and baseline, with center as a second factor, showed superiority of the herbal extract over placebo (p < 0.01, two-sided). 73% of the patients treated with WS 1490 exhibited ASI score decreases > 5 points versus baseline, compared to 56% for placebo. Significant advantages for WS 1490 were also evident in a structured well-being self-rating scale (Bf-S) and the Clinical Global Impressions (CGI), while the Erlangen Anxiety, Tension and Aggression Scale (EAAS) and the Brief Test of Personality Structure (KEPS) showed only minor treatment group differences. Although the results show consistent advantages for WS 1490 over placebo in several psychiatric scales and indicate significant improvements in the patients' general well-being, the differences versus placebo were not as large as in previous trials which employed 300 mg/d of the same extract. WS 1490 was well tolerated, with no influence on liver function tests and only one trivial adverse event (tiredness) attributable to the study drug.

Kava kava extract LI 150 is as effective as Opipramol and Buspirone in Generalised Anxiety Disorder--an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients.
Boerner RJ,. Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.
Phytomedicine. 2003;10 Suppl 4:38-49.
An 8-week randomized, reference-controlled, double-blind, multi-centre clinical trial investigated Kava-Kava LI 150 in Generalized Anxiety Disorder (GAD; ICD-10: F41.1). 129 out-patients received either 400 mg Kava LI 150, 10 mg Buspirone or 100 mg Opipramol daily for 8 weeks. At week 9, subjects were seen to check for symptoms of withdrawal or relapse. Primary outcome measures comprised the HAMA scale and the proportion of responders at week 8. Secondary measures were the Boerner Anxiety Scale, SAS, CGI, a self-rating scale for well-being (Bf-S), a sleep questionnaire (SF-B), a quality-of-life questionnaire (AL) and global judgements by investigator and patients. In 127 patients (ITT) no significant differences could be observed regarding all efficacy and safety measures. About 75% of patients were classified as responders (50% reduction of HAMA score) in each treatment group, about 60% achieved full remission. Kava-Kava LI150 is well tolerated and as effective as Buspirone and Opipramol in the acute treatment of out-patients suffering from GAD.

Kava herb does not affect CYP3A activity
Supplementation With Goldenseal (Hydrastis canadensis), but not Kava Kava (Piper methysticum), Inhibits Human CYP3A Activity In Vivo.
Clin Pharmacol Ther. 2007 May. Gurley BJ, Swain A, Hubbard MA, Hartsfield F, Thaden J, Williams DK, Gentry WB, Tong Y. 1Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
The effects of goldenseal (Hydrastis canadensis) and kava kava (Piper methysticum) supplementation on human CYP3A activity were evaluated. Sixteen healthy volunteers were randomly assigned to receive either goldenseal or kava kava for 14 days. Our findings suggest that significant herb-drug interactions may result from the concomitant ingestion of goldenseal and CYP3A substrates, but not with kava herb.

Kava supplement questions

Q. I am presently taking oxycontin prescribed by my doctor for leg and back pain from failed back surgery and nerve damage. Can I take the Kava while taking the Oxy or can I take the Kava to help with withdrawals while I try to cut back on the Oxy?
     A. Kava should not be taken the same day as oxycontin or other pain meds, liver harm is a concern, especially with the use of kava and acetaminophen. Kave may help relax muscles.

Q. I was wondering if there is any correlations of Kava effecting (raising) the level of blood alcohol count. I have heard it may and could give a false reading, is this possible?
   A. We are not aware of kava raising blood alcohol lever, however, kava can make a person have less control over neuromuscular function when used the same time as alcohol.

Q. I’ve struggled with anxiety (GAD) most of my life, in bouts. I’ll have long periods of time when I feel fine but then will experience a modulator; some uncontrollable event that my mind convinces me is much, much worse than it is and I become extremely fearful and worrisome. I’ve used Kava in the past because it allowed me to tackle these periods (usually lasting a few days) without having to be on some pharmaceutical SSRI or anxiolytic drug full time. I’ve been a bit worried (ironic) about Kava the last couple years due to the negative reports coming out of Europe (so I quit using it). I also noticed that GNC took it off the shelves and the Arizona Tea company took it out of their RX Stress tea. Can you give me any up to date info on Kava?
   A. Kava is an herb that appears to be fine when used once or twice a week. Other options for anxiety include 5-HTP, small amounts of ashwagandha, tryptophan, passionflower. Perhaps alternating different herbs and nutrients could be an option to prevent relying too much on one anti anxiety herb and thus reducing the potential side effects.

Q. What is your position on all these noise about the liver toxicity of kava kava?
   A. There is a possibility that high doses of kava could be harmful to the liver if used daily in some individuals. Hence, we suggest using kava no more than 3 days a week and take a full week off each month. We have not seen any problems or toxicity with kava use when done so 3 days a week.

Q. I am a woman in my 40s who bought a kava product from a vitamin company on the internet. I took the kava daily for about three weeks. In the meantime I took a few other herbal products for more energy and for allergies. I also drink a glass or two of wine in the evenings and sometimes a shot or two of vodka with soda. I occasionally take Aleve or Tylenol, but not regularly. I am not on statin drugs or other medications. Never had liver problems. About 3 weeks after starting the kava, I went to my doctor who did blood studies and found my liver enzymes were very high. I stopped all the herbs and alcohol but my liver went into failure a couple of weeks thereafter and I ended with a liver transplant. I email you this so that other people become aware of liver problems that can occur with kava use.

Q. I recently purchased a bottle of Kava Kava by GAIA Herbs. This kava product was recommended to me by a friend to deal with my anxiety. I have asthma and I have found when I am really anxious that I have a hard time breathing.
My question to you is: My child's school had an epidemic of hepatitis about 33 years ago. The school recommended that all the children and parents take an injection to prevent the spread of hepatitis. We had the injection and my niece and I were the only two in our family to get the jaundice. I was sick, no food or drink for 15 days, lost weight of course and had yellow skin and dark stools. Is this considered to be Liver Damage and is it safe for me to take the Kava Kava?
   A. It is impossible for us to say whether the liver condition you had was completely resolved or there is still residual liver damage or malfunction. One way to tell is for your doctor to do liver enzyme tests. Even if your liver is perfectly normal, we suggest not using kava more than 3 days a week and to take a full week off each month.

I recently came across your website while researching natural alternative treatments for my anxiety. I'm a man in my mid-thirties who has been suffering from anxiety for the past few months and have turned to drinking alcohol. I usually drink 1-2 drinks daily (sometimes more sometimes less) including occasional social drinking. It helps but I do not want to become alcohol dependant. I read there is a link between kava and alcohol use that can cause serious liver damage. There are a few things that are still unclear: Does this damage happen over time or is it something instant that could occur after one use? Have I used too much alcohol in recent months to consider trying kava. what sort of negative reaction might occur if i drink a cup of kava tea? Am I putting myself in immediate danger or is this safe? Also what if I consumed kava while under the influence of alcohol what is the risk? Will kava cause me to freak-out or affect my nervous system and/or stress and anxiety negatively. I recently purchased a box of kava tea but have been afraid to try it because of the above mentioned reasons. The warning label was serious sounding, unclear and raises serious questions. do you recommend I try the tea or is there a better application of kava I should consider (pills or liquid extract). My goal is to overcome the anxiety and stop drinking without risking my health I'm hoping kava can be helpful in achieving this but I need medical reassurance that it is safe enough to try. One other thing how does kava react when combined with other natural relaxers such as valerian root, chammomile, passion flower, catnip, skullcap, etc.
   Liver harm from kava is a rare occurrence and often happens in those who have used it daily for many months or years. However, there have been reports of liver damage occurring in extremely rare cases after the daily use of this herb for 3 weeks. It is not possible for us to know how kava will influence your health or liver. When herbs are combined in high dosages, side effects can occur. The side effects are much less common on low dosages.

Q. I read your page on kava info but did not see anything about cortisol levels. Do you happen to know if kava lowers cortisol levels? I can't take anything that does this because mine are too low already. I take Cortef early morning and noon. I have noticed l-theanine capsules or green tea make me very agitated and shaky. A product called Trancor by Metagenics had the identical effect on me. If kava doesn't lower cortisol it might be the ideal stress reliever for me in addition to cortef and the dessicated thyroid I take.
   A. We could not find any research that looked into the role of kava and its influence on cortisol levels. People who are sensitive to herbs or medicines may, at first, consider taking a third of a capsule of a supplement. Side effects such as agitation or shakiness are not necessarily due to influencing cortisol levels. There are many brain chemicals and hormones that are influenced by herbs and supplements.

Q. Is kava herb effective for erectile dysfunction?
   A. kava may actually inhibit sexual function. There are potent aphrodisiac herbs that work well for sexual enhancement and impotence.

Q. I was wondering if it is safe to take Kava while pregnant. I was taking one Kava capsule daily prior to my pregnancy. Once I found out I was pregnant I stopped taking it, however I am now 30 weeks pregnant and have been feeling quite a bit of anxiety lately.
   A. The safety of kava has not been evaluated thoroughly in pregnant humans and to be on the safe side, it would be best not to take it although you may consider consulting with your obgyn doctor regarding the occasional use of this herb such as a few times a month in case the anxiety is severe enough to otherwise necessitate the use of pharmaceutical medicines. Kava, in this case, would be a good alternative to these drugs.

Q. How Will Kava Make Me Feel?
   A. Having talked to quite a number of kava users recommended it to patients, and having taken it myself, I have discovered that not everyone reacts exactly the same way to this herb. This is due to the fact that each one of us has a different biochemistry. Furthermore, different products on the market may have different amounts of constituents within them. The form of kava, whether liquid, tincture, or capsule, may also make a difference on how you feel, or how quickly you feel the effects. However, most of the time, the effects are noticed within a half-hour.

As a rule, the following are some common feelings that most users report after taking kava kava:
A state of relaxation, without being drugged
Muscle tenseness is less
Peacefulness and contentment
More sociable, especially with the right company, although higher doses may induce a state of withdrawal
Mild euphoria, sometimes
Mental alertness is not effected, except on high doses
Sleepiness, which comes on after a few hours.

Q. About a couple of years back, I took Kava almost every day, about 60 mg/day for 6 months.  I did not cycle it at all. I took it to cope with anxiety related premature ejaculation. I have not taken Kava in the last one-and-half years.  But in the last one-and-half years I have also noticed a drastic drop in libido, and a recent visit to the endocinologist and a hormone assay revealed secondary hypogonadism. Could a long term use of high doses of Kava caused my pituitary to shut down?
   A. It is unlikely that kava shuts down the pituitary gland (this hasn't yet been reported in the medical literature) but little is known about the long term effects of this, and many other herbs and supplements. Hence, cycling (i.e. taking breaks) is important. It is possible though, that kava can anesthetize nerves and reduce sexual sensation, but this would be temporary.

Q.  After years of insomnia and bad side effects from Buspar I have been enjoying an increased quality of
life beyond belief on the kava herb. However i note in your books some concern about the long term effects.  I hope to continue on no more than 70mg per day with week breaks once a month. Also i will try to substitute with other anti anxiety herbs periodically as you suggest. Should one receive regular liver/kidney tests ?
   A. Since the recent news about the possible connection between kava and liver damage, it would be cautious to take  kava less frequently than you mention. A regular CBC and metabolic panel that includes liver and kidney function tests is a good idea. But taking long breaks is the best thing to do.

Q. Does kava have any addictive qualities?
   A. Most everyone who uses kava does not find it to be addictive. However, there may be rare individuals who have have a tendency to overuse it.

Q. I have been reading about how this herb Kava can help reduce anxiety and promote more social behavior. I am someone who has a very difficult time with giving oral presentations, I get so nervous in fact that I have since refused to do them, as a result my school work has at times suffered. However, I was wondering if a herb like kava would help me with this problem, for example, if I were to take a kava pill on the day I am supposed to give a presentation? Would this perhaps lower my anxiety to a degree that I wouldn't mind the fact that I am standing up in front of a large group of people? 
   A. Kava may help in this situation, but in my experience a small dose of 20 to 40 mg of the pharmaceutical medicine propranolol works better.

Q. Is there a downside to taking kava to help me sleep?
   A. Kava does not induce sleep consistently and you may have to, with trial and error, find the best time to take it in the evening. Some people sleep better taking kava in the early evening, while others do better taking it an hour or two before bed. It also depends on the product.

Q. Is Kava safe for an insulin-dependent diabetic to use on a daily basis? I have not been able to find an answer to this question and think it would be useful for your readers.
   A. Probably, but no studies have been done. It would be worthwhile to try this herbal anti-anxiety agent while being monitored by a health care provider.

Q. Does kava raise the serotonin level as does 5-HTP?
   A. Kava does not seem to influence serotonin levels to any significant degree.

Q. I have been taking kava for anxiety for about 1 1/2 months (a dosage of 6 pills/day at 250mg/pill). I have also been taking a sleep aid that contains 5 htp, choline, valerian, and melatonin. I have recently learned that I am going to have gallbladder surgery. Is there any chance of any of these nutrients reacting with the anesthesia and if so, how long will they stay in my system? I also take a long list of other nutrients including coq10 and vinpocetine. Can any of these react with the anesthesia? Thank you!
   A. These nutrients should be out of your system within a few days. So, just stop taking them a few days or better yet a week before surgery.

Q. I have been taking kava for about three months and have found it really helpful in easing my anxiety symptoms. However, I have also found that it has made my insomnia worse. I tend to wake up during the night for one or two hours, or else if I sleep through the night I will wake up very early in the morning. It feels as if I feel more energetic and alive on kava, which is good, but this also continues through the night leading to restless and interrupted sleep. I take one 150mg tablet, giving 45mg kavalactones, with breakfast. I want to take the lowest dosage possible but is it possible Has anyone else reported these effects?
   A. I would be surprised taking kava in the morning is influencing your sleep at night. Sometimes when people take kava near bedtime it could interfere with sleep but I can't really see how taking it in the morning would do that. Try some kind of physical activity during the day, such as a walk for at least 30 minutes. Exercise helps one sleep better at night.

Q. I went to GNC and bought their standardized kava kava and it did nothing for me. Can you please tell me which kava is more effective? should i buy it in the liquid form instead? please help me, i really want to experience the kava relaxing anti-stress feeling.
   A. Unfortunately, there is a great deal of difference between different kava products. Sometimes it takes a trial of three or four products before you find one that works. And some people need a higher dose than others.

Q. My boyfriend is 43 and been drinking kava tea and taking kava pills for reduced anxiety. He is now experiencing problems ejaculating. Do you think this could be a side effect of kava kava. Previously he was on celexa and experienced the same problem.
   A. It's quite possible that taking too much kava can reduce sexual performance.

Q. What is the current info on testability of kavalactones (or other related chemicals) from kava consumption? I have had reluctance in prescribing without confirmed knowledge of a negative drug test in
individuals routinely tested.
   A. Kava is not hardly ever tested in drug tests.

Q. I purchased a kava extract with 30% kavaclotones..and on the label it says kava dietary supplement. Did i get the wrong one if it says dietary supplement cause its been an hour and i dont feel a thing. please help me.
   A. You purchased the right product. Sometimes the effects come on after taking kava a few times or a higher dose.

Q. I plan to try some Kava and would like to know the half-life of this product. Any information you may provide would be appreciated.
   A. I'm not sure exactly what the half-life of kavalactones are, but the clinical effects, i.e., what you will notice, only last a few hours.

Q. Can you put the liquid kava in a cup of regular tea, juice or water?
   A. Yes, but kava does not taste that great.

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