Nutrition Beyond the Trends: Kava — much ado about relaxation

Looking for an alternative to traditional spirits for a little relaxation, some are turning to a beverage called kava kava. Kava (Piper methisticum, a relative of the pepper plant) is an ancient crop native to the western Pacific islands — Hawaii, Micronesia, Fiji, the Samoas, Vanuatu and Tonga. The name refers to both the plant and (though often “doubled”) to the beverage prepared from it. The beverage has a reputation for inducing relaxation.

Kava is a swamp-loving shrub that sports big leaves and grows from two to three or more meters. In its native clime, where Kava is a ceremonial beverage, the beverage is prepared from the root. The traditional method of preparation is to grind or pound the root, and mix it with water to produce a thick, slightly greenish, pungent starchy suspension, rich in kavalactone droplets.

Kava is said to be relaxing, to elevate mood and to produce a sense of well being — much like a glass of wine, only without alcohol. The beverage is celebrated and used for many purposes, from medicinal to religious, political and cultural (again, much like the use of alcohol). This has led to multiple studies into the effectiveness of kava as a treatment for insomnia, anxiety, depression and related health problems, with many positive results.

For a time, kava was looked upon as a safe, non-addictive treatment for nervous anxiety, tension, restlessness and even menopausal symptoms. It’s popularity waned for a generation but it’s making something of a comeback, advertised as an herbal drink that can safely elevate mood and confer a calming effect, relax muscles and increase mental awareness for those stressful times. There is even a new kava beverage called Malava Relax, by Newport Beach, Calif.-based Malava LLC (www.malavabeverages.com). The company bills its beverage line of half a dozen flavors as “The World’s First "Anti-Energy Drink.”

The psychoactive components of kava are called kavalactones, of which there are at least 18 identified in the roots, stems and leaves. The amount of kavalactones winding up in the beverage depends somewhat on the variety of plant, but mostly on the method of extraction.

A psychoactive beverage without a downside seems too good to be true, and it is. The traditional preparation — pounding and grinding and mixing with water — yields fewer kavalactones than the modern, solvent-extraction method. This relies on processing the root, and sometimes the whole plant, with an organic solvent such as methanol, acetone or hexane.

In 2001, reports of liver damage among kava users began to trickle in. Although liver damage appeared to be a rare occurrence, regulatory agencies in Germany, Switzerland, France, Canada and the U.K. began to take action that ranged from warning consumers about the potential risks to temporarily removing kava-containing products from the market. In the United States, in March of 2002, the FDA issued a consumer advisory that kava products may be associated with severe liver injury, and warned physicians to look for symptoms. While some of the dust has settled, all of the questions have not.

In a 2006 paper on kava in the Journal of Agricultural and Food Chemistry, a research team led by Jin-Woo Jhoo, Ph.D., isolated potentially toxic compounds. The implications were that certain of these compounds might be responsible for the reported liver damage, at least under some circumstances.

What’s interesting about this report is that there were a greater number of cytotoxic compounds in the organic solvent fractions than in the water fractions. Solvent extraction allows a higher yield than the traditional “pound and grind” method. Also, in the study, the leaves and stem peelings were extracted as well as the root.

A 2003 report in the journal Phytochemistry established that traditional aqueous infusions of kava contained glutathione, a natural liver defender that is absent in the solvent extracted fractions. Taken together, in the context of the natural use of kava, the implication is that the method of preparation could be a factor in the way kava affects the liver.

Genetics could also play a factor: Most of the reported liver failures linked to kava use have occurred in persons from Western cultures consuming herbal preparations of kava. Among this population there is a reported 5-10 percent deficiency in the liver enzyme cytochrome P450 2D6 (CYP2D6) responsible for metabolizing drugs. This enzyme deficiency has never been reported in Pacific Islanders, among whom only a few cases of liver toxicity have been reported.

It’s also been reported that long-term users of kava may experience a condition called "kawanism.” Its symptoms include dry, flaking, discolored skin; reddened eyes; a scaly skin rash; puffy face; muscle weakness; blood abnormalities; and feelings of poor health.

So what’s the best advice for using kava as a relaxing beverage? Start with a healthy liver and the advice of a health-care professional. Then use moderately — it is, after all, traditionally a ceremonial beverage. Remember also that the FDA has not evaluated kava for safety, effectiveness or purity, and there are no regulated manufacturing standards in place for this plant.

Finally, don’t take kava for more than three months without a doctor’s guidance. Of course, you also can fly to Hawaii or another Pacific island and use kava in the traditional manner. It would probably be safer and a lot more fun and — relaxing.