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DECEMBER/JANUARY 2002 Kava - Piper Methysticum
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Keeping the Plants Alive is written by Isla Burgess, pictures are by WhaleGrave Photos.
The Old Ways…
An island paradise of warm waters, white sands. The sun sets and people gather around the table. The ceremony begins. Elijah takes his role as the Master of Ceremonies, in this case the maker of the yaqona or Kava drink, seriously,
but with enjoyment.
He places the powder we bought in a cotton cloth bag in a tanoa (kava bowl) and kneads it as one would knead bread; the water becomes cloudy like a clay water slurry and people talk about the day just as one would talk with friends over a glass of wine or dinner. Later there is singing and the atmosphere is one of ease, warmth and friendship.
The coconut bowl is handed to me. Everyone claps (cobo) three times, I drink and there is further clapping. The bowl is handed back, refilled and passed to the next person. Both hands are used in the giving and receiving of the cup.
I feel relaxed, clearheaded as the world becomes a slightly better place!
Captain James Cook in 1768, during his voyage through the Pacific ocean describes a somewhat different experience: the root being chewed before being mixed with water, and the drink being part of more formal meetings between village elders and chiefs.
Kava grows in most islands of the South Pacific, in Polynesia, Melanesia and Micronesia and has also been used medicinally in these countries in many different ways.
A diuretic, for filiarisis, coughs, colds and sore throats, as a contraceptive (leaves), and to topically treat wounds (juice) in Fiji. 1
The pounded leaves to soothe crying infants in Tonga. 1
The root to treat gonorrhoea in Samoa. 1
For genitourinary tract inflammation and infection . 3
A New Zealand physician, Sir Peter Buck in 1930, describes it as "cooling, refreshing and stimulating without being intoxicating…" 2
The New Ways…
Tinctures, fluid extracts, tablets, standardised extracts and guaranteed potency preparations are readily available throughout the western world. As Kava takes its place as one of the most focused upon herbs in the media, there have been concerns regarding its safety and potential abuse. For example, Merck, a German pharmaceutical group has just recalled its products containing any but tiny amounts of kava.
The standardised products can contain 30% to 70% kavalactones considered to be the most important anxiolytic phytochemical in kava.
All of these preparations are of course in a quite different form from the traditional preparation, and safety issues should consider the type of extract (acetone, hexane or alcohol), the amount used, for which person with what condition.
Currently medical herbalists use it for the treatment of anxiety and restlessness and other conditions in which nervous tension is either an underlying or contributary factor. It is mildly sedating and is used as a muscle relaxant. 3
On taste.
A water extract has a numbing effect, is pungent with a bitter/sweet taste. The alcohol extract is more bitter, a little stinging on the tongue, and eventually more drying.
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What Plant?
This Piperidaceae or pepper family, has members whose genera are both Pipers, Peperomia and Macropipers, with the various species having medicinal uses often similar to Kava.
Looking at the shrubby nature of this yellow/greenish cordate (heartshaped) leaved plant is like looking at a larger version of the New Zealand Kawa Kawa (Macropiper excelsium). The leaves are larger, up to 28cm long with veins radiating from the base. Flowers spikes are erect and in the New Zealand species the traditional use was to use these for men with impotence. Perfect Doctrine of Signatures.
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What Part?
The fleshy part of the root and underground parts of the stem are used sometimes green in the Islands but more often dried. It is ground or pounded into pulp.
How and when to use?
Personally I prefer the powder mixed in water and strained followed by the alcohol extract (remove the alcohol if using for the genitourinary tract).
For people with insomnia…
Kava combines well with other traditionally used herbs such as hops and valerian.
It is a medicine for the person who has difficulty getting to sleep or maintaining sleep because they are anxious or restless. It is also invaluable for the person who wakes worrying about the day as is sometimes experienced through menopause. I have friends who use it to calm themselves before an important event especially if they wish to remain clearheaded.
As a muscle relaxant…
and headaches..
For people with headaches due to tension in the neck muscles
and muscle cramps..
In theory it should be used to reduce spasm but in practice Kava does not appear to have this effect. 4
As medicine for the Genitourinary tract…
It is suggested by herbal practitioners as a medicine for people with cystitis, prostatitis, irritations and inflammation of the bladder. The British Herbal Pharmacopeia states that it is a specific for infections of the genitourinary tract.
How to prepare…
The powder can be added to half a cup of cold water, mixed well and left to infuse for 30 mins, stirring occasionally.
A tincture can be made from the powder by adding 100gm of powder to 500mls of menstruum but a higher alcohol percentage of around 60% is required. (Refer Keeping the Plants alive - St Johns Wort).
Today many standarised extracts are available, giving a percentage of kavalactones, in the plant. For example, there is an average of around 7% (the range being between 3 and 15%) of these so check the labels. A product containing say 70% kavalactones cannot be representative of the whole plant.
How much to Use…
For water based extracts - 1 to 2 gms daily.
For alcohol based extracts - 3-6mls of a 1:2 extract daily.
I often give people 5mls at night before bed.
For tablets if the kavalactone levels are around 5%, 2-4 tablets daily.
Your qualified medical herbalist knows how much and if kava would be appropriate for you.
Safety…
Within the therapeutic dose range, kava is not considered to have an adverse effect on health.
Its use and abuse can be likened to the use and abuse of alcohol.
People who ingest large doses of kava over a long period of time can develop a scaly skin rash (kava dermopathy), liver abnormalities, shortness of breath and symptoms of liver disease. (See Research Review).
The Commission E Monographs do not recommend use during pregnancy and lactation although this is not supported by other writers. 7
If you are using benzodiazepines or tricyclic antidepressants then kava should be used on recomendation from your health practitioner. There is no evidence to suggest adverse effects but caution is advised.
Recent Research Review...
The German extract using acetone and standardised to 70% kavalactones, has been used in most of the clinical trials.
Studies prior to 2000 focused on the anti-anxiety and sleep promoting effects of Kava, as well as its muscle relaxing effects.2
Kava and Interactions…
Kava's action probably involves the central GABA (gamma amino butyric acid) neurotransmission. Dopamine and histamine receptors may also be affected.8
Kava and Insomnia
Phytother Res 2001 Sep;15(6):549-51
Kava and Valerian in the treatment of stress-induced insomnia.
Wheatley D.
24 patients suffering from stress-induced insomnia were treated for 6 weeks with kava 120 mg daily. This was followed by 2 weeks off treatment and then, 5 having dropped out, 19 received valerian 600 mg daily for another 6 weeks.
Total stress severity was significantly relieved by both compounds (p < 0.01) with no significant differences between them.
Kava and Anxiety
Maturitas 2001 Aug 25;39(2):185-8
Evaluation of combining kava extract with hormone replacement
therapy in the treatment of postmenopausal anxiety.
De Leo V, la Marca A, Morgante G, Lanzetta D, Florio P, Petraglia F.
DISCUSSION: The combined use of hormone replacement therapy and kava extract seems to be effective against menopausal anxiety. Kava extract accelerates resolution of psychological symptoms while hormone therapy safeguards against osteoporosis and cardiovascular
disease.
Comment.
Recent studies have contradicted prior claims that Hormone Replacement Therapy is beneficial for cardiovascular health.
Clin Psychopharmacol 2000 Feb;20(1):84-9
Efficacy of kava extract for treating anxiety: systematic review and meta-analysis.
Pittler MH, Ernst E.
Superiority of kava extract over placebo was suggested by all seven reviewed trials. The meta-analysis of three trials suggests a significant difference in the reduction of the total score on the Hamilton Rating Scale for Anxiety in favour of kava extract.
Kava and Cancer
Hawaii Med J 2000 Nov;59(11):420-2
The correlation between cancer incidence and kava consumption.
Steiner GG.
RESULTS/CONCLUSIONS: The data indicates that the more kava consumed by a population the lower the cancer incidence for that population. The data suggests there is a close inverse relationship between cancer incidence and kava consumption.
Kava and Hepatitis
BMJ 2001;322:139 (20 January)
Hepatitis associated with Kava, a herbal remedy for anxiety
Monica Eschera, Jules Desmeulesa, Emile Giostrab, and Gilles Menthac
Introduction
Heavy consumption of kava has been associated with increased concentrations of _-glutamyltransferase, suggesting potential hepatotoxicity.1 A case of recurring necrotising hepatitis has been reported.2 In our patient a relation between ingestion of kava and fulminant hepatic failure is supported by the chronology, histological findings, and exclusion of other causes of hepatitis. Assessment of causality according to the definitions of the World Health Organization is probable.
References
1. Mathews, JD., Riley, MD., Fejo, L., Munoz, E., Milns, N., & Gardner, ID. Effects
of the heavy usage of kava on physical health: summary of a pilot survey in an
Aboriginal community. Med J Aust 1988; 148: 548 555.
2. Strahl, S., Ehret, V., Dahm, HH., & Maier, KP. Necrotizing hepatitis after taking
herbal medication. Dtsch Med Wschr 1998; 123: 1410 1414. (In German.)
3. Sheikh, NM., Philen, RM., & Love, LA. Chaparral-associated hepatotoxicity. Arch
Intern Med 1997; 157: 913 919.
Comment
A closer study of the Mathews et al paper would suggest that there were confounding factors which may affect the statistics;
-the economic status of the community studied
-other health issues such as the incidence of Hepatitis B
-nutritional status generally
For the Strahl et al paper two women were admitted with "aetiologically uncertain acute hepatitis" although one of these was taking lesser celandine.
Recent Statistics
For the 52 weeks ending Jan.7 2001 retail sales in the US were $14,683,264. 9
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References
1. Cambie, R.C. and Ash, J., Fijian Medicinal Plants, Csiro, Australia, 1994.
2. Rasmussen P., Phytonews. Kava (Piper Methysticum) - A Review. 1999;5
3. Mills S, Bone K. Principles and Practice Of Phytotherapy. Modern Herbal Medicine. Churchill Livingstone, 2000.
4. Asesela Ravuvu, Vaka I Taukei, The Fijian way of life.
5. Brooker, S.G., Cambie, R.C., Cooper, R.C., New Zealand Medicinal Plants, Heineman, New Zealand, 1987
6. Fisher, C., Painter, G., Materia Medica for the Southern Hemishere. 1996
7. Blumenthal, M., Golberg, A., Brinckman J., Herbal Medicine. Expanded Commission E Monographs. American otanical Council;2000. CD Rom.
8. Rasmussen P., Phytonews. 2001;10
9. American Botanical Council, HerbalGram, 2001;51
Reflections
Some thoughts on the recent proposed banning of Kava in Germany.
1. The type of kava product should be considered, along with the extraction process and percentage of kavalactones in the product used.
2. The detailed case study including past illnesses and drug and alcohol use should be considered as factors influencing the ability of the liver to metabolise the plants constituents.
3. It is highly unlikely that 1-2gm daily of the water based preparation adverse effects on any consumer.
4. Can a 70% standardised extract be considered Herbal Medicine?
Send your comments to Isla@HerbCollege.com
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