Hyla Cass, M.D., speaks on Kava

[Guest guest]

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IS KAVA SAFE?

 

Health Sciences Institute e-Alert

 

January 14, 2002

 

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Please note: Information in the HSI e-Alerts should not be

substituted

for personal medical advice from a physician.

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Dear Reader,

 

Many of you have written to us recently about kava. The news has been

full of reports connecting this popular herb with liver toxicity.

Understandably, people are confused and concerned.

 

Fortunately, we have a kava expert on the HSI panel. Hyla Cass, M.D.,

is an orthomolecular physician and a psychiatrist, as well as the

author of several books, including " Kava: Nature's Answer to Stress,

Anxiety, and Insomnia. " So we asked Dr. Cass to write to you today

to address the concerns we've heard about kava. I think you'll find

her insight very interesting - it certainly puts a new perspective

on the coverage we've been seeing in the mainstream media. Here's

what she had to say...

 

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HSI panelist tells the REAL story about kava

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The South Pacific herb, kava kava, is one of the most popular herbs

on the market, based on its proven ability to relieve stress,

anxiety, and tension. But recently, kava has come under the scrutiny

of the Food and Drug Administration (FDA), which is acting on

reports from Europe that kava may damage the liver. German and Swiss

health authorities have identified approximately 30 cases of

sometimes-serious liver toxicity, including four cases requiring

transplantation and one death, which are believed to be

associated with kava consumption. Based on these reports, the U.K.

banned sales of kava products, and German authorities notified

manufacturers of kava products that their licenses to market the

herb could be withdrawn. In the U.S., the FDA sent a letter to

doctors requesting that any adverse events associated with the use

of kava products be promptly communicated to FDA's " Medwatch

Program. "

 

There are scant details available from the 30 European cases, but a

closer examination reveals that the vast majority (21 cases)

involved the simultaneous use of hepatotoxic drugs (drugs that

poison the liver) and/or alcohol. This is certainly not significant

evidence of kava causing hepatotoxicity.

 

And the information that has been reported through the FDA MedWatch

program is not entirely reliable. For example, the Medwatch site

contains reports of numerous " kava toxicity " cases stemming from a

product sold at a 1996 New Year's Eve rave (dance) event. Initial

reports alleged that the product contained kava, but in fact, it

contained a highly toxic industrial chemical, called 1,4-butane-

diol -- and absolutely NO kava. The Los Angeles police department

toxicologists published a report to this effect within

weeks. Nonetheless, these spurious claims against kava have remained

on the FDA website ever since.

 

As with the European cases reported above, when the most recent FDA

reports on kava are examined more closely, it is clear that most

cases of liver toxicity involved the use of multiple drugs, and in

some cases, alcohol abuse. There is no evidence that kava was the

primary cause of these problems.

 

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Valium or Tylenol more likely to damage your liver than kava

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The fact is, you are far likelier to suffer from liver damage by

taking the prescription anti-anxiety drug, Valium, then you are by

taking kava, yet Valium is taken by millions daily with little

question-and with no major adverse publicity. The over-the counter

pain medication, acetaminophen, which is the main ingredient in

Tylenol, also has a high incidence of liver toxicity, especially

when combined with alcohol.

 

Kava has a long tradition of use in the South Pacific at often

considerably higher doses than those used in Europe, with few

reported liver toxic effects, and its safety/toxicity has been

studied extensively in recent years. The longest running study

conducted to date, with 101 people taking 70 mg three times a day

for six months, showed negligible side effects, and in fact, more of

the placebo subjects reported side effects than those taking kava.

The researcher concluded that, " in contrast to both benzodiazapines

(the class of sedative drugs that includes Valium) and

antidepressants, kava possesses an excellent side-effect profile. "

 

The safe and effective anxiety-relieving benefits of kava were also

supported in a meta-analysis, a systematic statistical review of

seven human clinical trials published in 2000 in the Journal of

Clinical Psychopharmacology, and again in a similar critical review

in 2001. The reviews did not find significant adverse effects

related to liver toxicity.

 

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Should you change the way you use kava?

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There has been a strong response from the herbal industry to ensure

kava's safety. A coalition of trade associations of the dietary

supplement industry is actively engaged in evaluating the

information that has been made available by the German regulatory

authorities.

 

In the meantime, Mark Blumenthal of the American Botanical Council

recommends that kava users consider the following:

a.. Kava should not be used by anyone who has any liver problems, or

by anyone who is taking any drug product with known adverse effects

on the liver, or anyone who consumes alcohol regularly.

b.. Since the reports so far are associated with chronic use,

Blumenthal suggests considering that kava not be taken on a daily

basis for more that four weeks. (Note: I consider that to be overly

conservative, preferring the German Commission E's recommendation of

three months.)

c.. In addition, Blumenthal noted that consumers should discontinue

use if symptoms of jaundice (e.g., dark urine, yellowing of the

eyes) occur.

d.. Consumers should consult their primary healthcare provider if

they have a history of liver problems or suspect possible liver

problems before using kava or continuing its use. We must be aware

that herbs are potent medicines, which must be treated with the

appropriate respect regarding potential interactions and

toxicity. On the other hand, kava's margin of safety far surpasses

that of its pharmaceutical equivalent. Nothing would be gained by

having previously satisfied kava consumers switch to a more toxic

prescription medication, such as a benzodiazepine, in the mistaken

belief that they were making a safer choice.

 

For updates on kava and other herbal news, visit Dr. Cass's website

at http://www.cassmd.com