Anxiety Over Kava 

Anxiety Over Kava 
Posted by FoM on January 21, 2002 at 21:42:12 PT
By Judy Packer-Tursman
Source: Washington Post
If kava truly relieves anxiety with milder side effects than prescription drugs, then makers and sellers of the popular herb could soon be raiding stores of their own product. That's because the U.S. Food and Drug Administration (FDA), citing concern over European reports linking the herb to liver toxicity -- including hepatitis, cirrhosis and liver failure -- is investigating whether kava's use in dietary supplements poses a public health risk. 
Representatives from FDA and the herbal industry met last week to discuss liver failure reports from Germany and Switzerland as well as incoming case reports solicited last month from the U.S. medical community. Earlier this month, the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health, announced that it had put on hold two NCCAM-sponsored research studies on kava at Duke University, "pending further guidance from the FDA." Researchers at Duke could not be reached for comment.With little to guide them at this point, consumers are finding signs popping up at Fresh Fields and other places where kava is sold, suggesting that kava should not be taken by anyone with liver problems or by anyone taking any drug product, such as acetaminophen, with known adverse effects on the liver or by anyone who consumes alcohol on a regular basis. In addition, since early reports of adverse effects appeared to be associated with chronic use, many health professionals familiar with botanicals are also recommending that people avoid taking kava on a daily basis for more than four weeks. This advice is endorsed by the American Botanical Council, a nonprofit education and research organization that publishes HerbalGram, a peer-reviewed journal on herbal medicine.Also seeking guidance is the herbal industry, which has a lot to lose if kava is taken off the market. Kava, which has steadily gained popularity in the United States over the past several years, had U.S. sales totaling $53 million in in 2000, ranking seventh among herbal supplements, according to the San Diego-based Nutrition Business Journal. (Ginkgo biloba topped the list at $250 million; St. John's wort followed at $170 million.)The American Herbal Products Association (AHPA), a Silver Spring-based trade group representing about 250 major manufacturers, distributors, importers and retailers of botanicals, has hired its own toxicologist to sift through all the case reports on kava from the United States and Europe. "At this point, the evidence is inconclusive in terms of kava being associated with adverse effects," says Robin Gellman, the group's spokeswoman.Kava, known botanically as Piper methysticum, is a member of the pepper family. Native to Polynesia and other islands in the South Pacific, it has been used there for thousands of years as a ceremonial herb, pounded and made into a drink to soothe the nerves and aid in relaxation. A few studies, mostly European, have shown stress reduction after short-term use. Scientists have identified so-called kavalactones in the plant's roots as the main calming ingredients, which relax the body and induce sleep.But as with most drugs and dietary supplements, the product has side effects -- only some of which have been fully documented. Short-term side effects include skin discoloration and scaling. Reports also document possible adverse interactions between kava and prescription drugs, including the tranquilizer Xanax (alprazolam). Clinicians warn people not to mix kava with alcohol or barbiturates because the combination may cause excessive sedation.The FDA's concerns over potential liver toxicity are not limited to kava. Prompted by findings that the herb comfrey contains chemicals that can harm the liver, the agency last summer asked the supplement industry to voluntarily stop marketing comfrey for internal use -- something many herbalists had already done.Since September 1997 the AHPA has called on members to adopt dosage and labeling policies for kava, said Gellman. Products containing kava, she said, are supposed to be formulated and labeled to limit consumption of total kavalactones to 300 mg. daily. Labels for kava products should state: "Caution: Not for use by persons under the age of 18. If pregnant, nursing or taking a prescription drug, consult a health care practitioner prior to use. Do not exceed recommended dose. Excessive consumption may impair ability to drive or operate heavy equipment. Not recommended for consumption with alcoholic beverages."Jonathan Davidson, principal investigator on the NCCAM-funded studies at Duke University, has spent years exploring various botanical treatments, including use of St. John's wort, for anxiety disorder. Last month the Journal of Psychopharmacology published preliminary findings from Davidson's research team that suggest kava may enhance the heart's ability to adapt to stress in people with generalized anxiety disorder. "I think kava has been fairly well-studied," says John Pan, an obstetrician-gynecologist who directs the George Washington University Center for Integrative Medicine in the District. "Essentially, it's a feel-good kind of herb" for treating mild conditions, he says. Pan says he occasionally recommends kava to his patients, including peri-menopausal women, who show routine anxiety and are "worried about little things." He said last week that the FDA's kava investigation hadn't led him to change this practice, adding, "You can't react to every report that comes out."The bottom line, according to Pan, is that kava, similar to other botanicals, should be taken only when its use is indicated, despite seemingly mild side effects compared with anti-anxiety pharmaceuticals. People with a history of liver disease "always need to be careful," he says. For others, he advises, "Don't take it with the idea that a little is good, more is better. Stick to the recommended dose." And wait for further word from FDA. In New York, Roberta Lee, a board-certified internist who is medical director of the Beth Israel Center for Health and Healing, also uses kava "regularly in my practice," along with breathing exercises and yoga, for patients with generalized anxiety or chronic low back pain. While noting she has never seen a case of toxic hepatitis arise in five years of suggesting kava to patients, Lee said, "Currently, I think we need to be cautious." She recommends using kava for no more than four months -- and only with the supervision of a physician or other health-care practitioner who can pick up on a liver problem before jaundice sets in. She also suggests a maximum daily dose not to exceed 45 mg. to 110 mg. of kavalactones.As scientists continue to investigate the matter, the European response has varied. Sales of kava products have been suspended voluntarily in Great Britain and halted by the French government, while the German government -- whose now-defunct panel of herbal experts known as Commission E approved the use of kava for "nervous anxiety, stress and restlessness" in 1990 -- has not yet pulled kava products off the shelf.In the United States, an FDA spokeswoman last week said the agency had gotten 62 reports on MedWatch, its online surveillance system, in response to a Dec. 19 letter asking physicians to report any cases of health problems that may be related to kava-containing supplements. She cautioned that the inquiry -- subsequently narrowed down to 26 cases of suspected association between kava and health problems -- is in its early stages, and FDA has not documented a direct link between kava and incoming reports of hepatitis, nausea, sleepiness and other adverse effects. "We'll take a look at the data to determine the next step," the FDA spokeswoman says.Judy Packer-Tursman is a Washington area freelance writer.Note: FDA, Others Investigate Reports Of Liver Toxicity. Source: Washington Post (DC)Author: Judy Packer-Tursman, Special To The Washington PostPublished: Tuesday, January 22, 2002; Page HE01 Copyright: 2002 The Washington Post Company Contact: letterstoed washpost.comWebsite: Related Articles & Web Site:Handbook of Psychotropic Herbs Answers of Psychotropic Herbs
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Comment #4 posted by Ethan Russo MD on January 22, 2002 at 14:06:26 PT:
Kava is a traditional convivial beverage in the Pacific Islands, and where used, the incidence of alcoholism is considerably lower. It has a fascinating history.Some people do like it. Otherss find it wanting as a "recreational drug." Properly used, a standardized extract will just block anxiety without affecting other emotions. It is the closest thing I have ever used to being an anti-anxiety agent without acute side effects. I recommend Kava Pro, by MMS, the parent company of Nature's Way.
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Comment #3 posted by CorvallisEric on January 22, 2002 at 11:48:48 PT
Not a recreational drug
A few years ago I tried kava just out of curiosity (like teenage experimentation, except I was about 52). Once with recommended dose, once with 4 times as much. The effect: think about being "turned on" by cannabis or caffeine, this was like being "turned off" the same way, worse than small amounts of alcohol. The whole world just seemed less interesting. So, maybe there are things best left for when you need them.
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Comment #2 posted by FoM on January 22, 2002 at 09:30:53 PT
I took Kava for the month before and a few months after my son's death. I took high doses of extract. I was calm but clear headed. After those few months of using Kava extract I developed a small rash on my arm. I stopped using it and the rash went away. I can't begin to know how I would have coped without Kava. I would have needed drugs but I don't take drugs. When you give up legal narcotic type drugs you can't go back or you might start using them again and Kava was a Godsend.
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Comment #1 posted by Ethan Russo MD on January 22, 2002 at 06:08:22 PT:
A Shame
Kava is a wonderful herbal agent for anxiety. It is as effective as benzodiazepine (Valium and the like) with fewer side effects. The German Kommission E has always recommended avoiding use over 3 months. It is superb for acute anxiety, such as fear of flying. Details are available in my Handbook of Psychotropic Herbs.My main problem with this is hypocrisy and conflicts of interest. Look at the hysterical hand-wringing attendant with a few reports of liver problems with kava. Compare that with the relative inaction with Rezulin, cholesterol-lowering drugs, and others. There have been hundreds of deaths, with slow action by the press. Cannabis is subject to this same kind of hypocrisy, and has to answer to a much greater standard than synthetic pharmaceuticals.
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