The calming power of kava

On my place in Montana, I try to grow many of the botanicals about which I write. We've got hawthern, gingko, elder, mullein, lavender, sage, thyme, echinacea, borage, yarrow and plenty of pine trees. But one plant I don't try to grow is Piper methysticum, the increasingly well-known kava kava.

Kava is a tropical shrub, native to the Pacific Island region, a climate distinctly different from the American Northern Rockies where I live. Kava is a member of the pepper family, Piperaceae, a plant group that contains over 1,000 species, including the familiar culinary spice, black pepper.

The kava plant grows as tall as 20 feet in rich, fertile soil, though it is more often found at a height of 6 feet. Its leaves are bright green, heart shaped, and themselves grow up to 8 inches in length. The stems are succulent, and have dark green to black distended nodes. However, it is the root of the kava plant which is held in high esteem, and the focus of modern botanical interest.
What's in kava?

Kava root contains a group of compounds known as lactones, or more specifically "kava-lactones." Kava lactones are similar in chemical structure to a compound known as myristicin found in nutmeg. At this point in time, 15 lactones have been isolated from kava. As a group, lactones make up between 3 to 20 percent of the kava root.

Of particular interest are four compounds known as kavain, dihydrokavain, methysticin and dihydromethystin. According to researchers, these lactones have significant pain-reducing properties.
Historic beverage

The geographic region known as the Pacific Islands includes such places as Melanesia, Papua New Guinea, the Solomon Islands and Vanuatu. In those areas, indigenous people have been using kava for thousands of years.

Traditional use ranges from the formal to the informal, occasions to honor royalty and private gatherings of family and friends. Kava was and is traded and exchanged as gifts, with the most potent and special kava reserved for special persons. The prime age for the most prized kava root is four to six years.

The indigenous method of consuming kava is as an infusion made by chewing the root until it is mashed into a pulp-like substance, then placing the masticated kava in cold water and steeping it until a strong tea forms.

The intusion is then served in cups or bowls, sometimes strained, and sometimes served with the mashed root still mixed in. Certain kava users prefer the latter since drinking the tea and simultaneously chewing root remnants results in an even more potent kava effect.
Modern Use

While for thousands of years, kava has been used as a ceremonial and social herb, its modern use is as an anxiolytic, or anti-anxiety, agent.
Natural relief for anxiety

Anxiety is one of today's most common psychiatric conditions. It effects almost 1 in 20 adults, two-thirds of whom are women. In addition to feelings of terror, overwhelming dread and looming catastrophe, those suffering with anxiety can also experience unpleasant, even frightening physical symptoms: heart palpitations, cold sweats, dizziness and nausea, Insomnia is another common problem for anxious people.

In many cases, anxiety can be crippling. Repetitious, chronic anxiety can debilitate its sufferers, marring friendships, job opportunities and family relationships.

A category of drugs known as benzodiazepines (Xanax, Vahum and Halcion are examples of these drugs) are most commonly used in the treatment of anxiety. While these drugs do work to temporarily stem anxiety, the adverse effects of benzodiazepines are well known, and fairly significant.

They include memory impairment, sedation and dependence. For this reason, effective, non-toxic alternatives to drug therapy for anxiety are eagerly sought by both patients and their healthcare providers.

A variety of studies on the use of kava kava in the treatment of anxiety indicate that it is an effective alternative to certain prescription medications. A review and meta-analysis of the efficacy of kava for the treatment of anxiety was published in the February 2000 issue of the Journal of Clinical Psychopharmacology. The authors, working under the auspices of the Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences at the University of Exeter, Exeter, United Kingdom, did extensive literature searches and consulted with a variety of experts on kava.

These researchers looked at 14 studies on kava, then narrowed their review to 7 of the 14 studies which met their stringent criteria for quality and reliability. According to these researchers, the "superiority of kava extract over placebo was suggested by all seven reviewed trials." In three of the studies, participants taking kava extract demonstrated significant decreases in anxiety symptoms measured on the standardized "Hamilton Anxiety Scale." Like many conventional medical doctors investigating botanical medicine, these authors hedge their bets slightly, noting that none of the studies they examined were "completely flawless" and call for "further and more rigorous investigations." Nonetheless, the authors do acknowledge that the research they examined is conclusive: kava works well in the treatment of anxiety. It is an herb worth taking seriously.
Other uses for kava

While relaxation and socialization have always been kava's primary use, it does have a long history as a medicinal herb. In indigenous cultures, kava was used to treat gonorrhea, headache, menstrual problems, asthma and insomnia. In 1914, kava was listed as a medicine in the British Pharmacopoeia; in 1950, kava was listed in the US Dispensary as a treatment for gonorrhea and nervous disorders; and recent studies indicate that kava is a useful antifungal. Dihydrokavain, a kava lactone, has been found to block the growth of Apergillus niger, a pathogenic mold which can cause otomycosis, an refection of the external ear canal.
Dosage

Most kava consumed in the United States today is taken for anti-anxiety purposes, and is delivered in capsule form. The daily dose is best determined by the amount of kava lactones present in the product. Most published studies have used kava extracts standardized to contain 70 percent kava lactones. In these products, the recommended adult dose is 100 mg three times a day. In products with a lower concentration of kava lactones, the recommended daily dose is higher. For example, in a formula with a 30 percent kava lactone concentration, the adult daily dose would be approximately 200 mg three times daily. If it is your preference to experience kava in the traditional infused form, this author suggests you do so with the aid of a Pacific Island citizen, or with an herbalist experienced in the use and the proper preparation of harvested kava root.
Safety

The most common adverse effect of kava is a skin rash known as "kava dermopathy," a dry, scaly condition that resembles fish skin. Kava dermopathy typically begins in the face, and moves down the body toward the feet. The skin gets irritated, yellowed, scaly and cracked. At the same time, the eyes may develop an increased sensitivity to the sun.

Kava dermopathy is most typical in those who consume large amounts of beverage kava over long periods of rune. However, there are reports of patients experiencing a kava skin reaction when taking 300 to 800 mg daily of the isolated lactone dihydromethysticin. Anyone with extreme sensitivity to medications should use caution if taking kava, and should report any skin changes to their physician.

Kava can also increase the action of medications such as barbiturates and benzodiazepines, particularly the drug Xanax. For this reason, and because the herb has a powerful relaxing effect, kava should never be taken by anyone who is already taking tranquilizers or any anti-anxiety or anti-depressant medication. People who want to substitute kava for a currently used prescription medicauon should only do so with their doctor's assistance.
Tropical Essence

Perhaps the best treatment for anxiety might be an extended trip to the Pacific Islands, far from the cares of urban America, and surrounded day and night by tropical air, warm sun and the salty ocean. But since such an extravagant treatment approach isn't possible for most, kava offers an affordable and effective alternative. And we can hope that the gentle, healing essence of the tropics might somehow be brought along through the herb itself.

Anxiety is one of today's most common psychiatric conditions. It effects almost 1 in 20 adults, mostly women.

It is the root of the kava plant that is the focus of modern botanical interest.
REFERENCES

Bruggemann F, et al "Die analgetische wirkung der kawa-inhaltsstoffe dihydrokawain und dihydromethistizin," Azneimmitelforschung 13:407-409, 1963 (Article in German).

Brunton R. The Abandoned Narcotic Kava and cultural instability in Melanesia Cambridge, England: Cambridge University Press, 1989.

Cauffield JS, et al. "Dietary supplements used in the treatment of depression, anxiety and sleep disorders," Lippincotts Primary Care Practice 3(3) 290-304, 1999.

Piscopo G. "Kava Kava: Gift of the Islands," Alternative Medicine Review 2(5): 335-364, 1997.

Pittler M. and Ernst E. "Efficacy of Kava Extract for Treating Anxiety Systematic Review and Meta-Analysis," Journal of Clinical Psychopharmacology 20(1): 84-89, 2000. Volz HP. "Kava-kava extract WS 1490 versus placebo in anxiety disorders - a randomized placebo controlled 25 week outpatient trial," Pharmocopsychiatry 30(1): l-5, Jan. 1997.

Monograph Piper methysticum (kava kava), Alternative Medicine Review 3(6): 458-460, 1998.

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By J. Jamison Starbuck, J.D., N.D.

Adapted by J.D., N.D.

J. Jamison Starbuck, J.D., N.D., is a licensed naturopathic and homeopathic physician. Her family practice treats the whole person via constitutional homeopathy, botanical medicine, nutrition, counseling and other natural modalities.

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