A couple of weeks ago, we alerted our readers to a recent study from the Journal of the American Medical Association underlining the potential problems of unsupervised use of herbal and other dietary supplements. We noted that at least some of these products could potentially interact with prescription and other pharmaceuticals with unforeseen adverse effects on consumers. In addition, the products themselves are not closely regulated in this country, and safe or effective dosages are not necessarily known.
The reality of such concerns was brought home by a warning from Health Canada (www.hc-sc.gc.ca), that country's equivalent of the U.S. Food and Drug Administration (FDA), advising consumers to avoid use of the herbal product kava-kava. The warning was based on recent reports from Europe of liver toxicity a couple of dozen of them related to its use. In fact, the HC warning reported at least one death and some cases where livers were so badly damaged that a transplant was necessary.
The FDA is now asking physicians and other health care providers to be on the alert for possible adverse effects of patients consuming kava (www.fda.gov). According to an AP account, two teenagers were hospitalized after taking kava, one because of an overdose, and the other because it interacted with a dental anesthetic.
Kava, or kava-kava, native to the South Pacific, is valued for its soothing sedative properties. Touted in the U.S. as (what else) natural and therefore safe, kava has enjoyed widespread popularity among consumers seeking to relieve stress, anxiety, insomnia, and PMS. According to the FDA, kava products are marketed to all ages children, adults, and the elderly.
The bottom line on kava: Those with liver problems should avoid it, as should those using substances with which it might interact. That means, at the very least, don't use it if you're drinking alcohol or having a medical or dental procedure that requires use of an anesthetic. If you're not sure what other medicines and procedures you'll be undergoing, tell your doctor, dentist, or other health care providers that you're using kava. That's always good advice.
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| Responses:
June 21, 2002 The news about kava-kava and liver problems is a real blow to me. I'm an anxious person (due in part to personal problems) and often rely on prescription medicines to relieve my constant anxiety. I have found this herbal product, when taken as prescribed for at least three weeks, to be effective quite amazing in fact. For instance, I can't sleep at all without some help, and I hate having to rely on medications. But if I take kava-kava regularly, and with two tablets before bedtime, I am sometimes able to sleep well and deeply without medication a miracle for me! And now this bad news. Unfortunately (also because of stress) I have always enjoyed a glass of wine before dinner at night, and maybe one or two glasses with my food. Now I am worried. What are the statistical chances of developing liver problems? Thanks sincerely for what I hope you can tell me. Zuri June 24, 2002 Kava replies: It's understandable that you are concerned about possible interactions between kava-kava and other medications/alcohol. Unfortunately, there are not sufficient data to determine the statistical risk of liver problems. I would strongly advise that you consult the physician who prescribes your medications and perhaps the pharmacist who provides them. Kava-kava could interact with alcohol, but the doses of either that would be damaging have not, to my knowledge, been reliably determined. See our brochure on supplements for more information about possible supplement-drug interactions. Ruth Kava, Ph.D., R.D. July 22, 2002 This is just another example of Western medicine throwing up a red flag against a natural herbal product in order to scare people into switching to manmade pharmaceuticals that: a) cost a lot more per pill prescription (kava: $8.00/month; Xanax: $80.00/month; generic xanax: $45.00/month) b) must be used in conjunction with anti-depressants because prescription kava substitutes only help with anxiety (additional prescriptions = more $$$ for the doctors, etc.) c) are addictive and change your brain chemistry for life, thus ensuring continual prescription dependency (and more $$$ for the doctors, etc.) d) require a doctor visit to get an initial prescription ($$$) e) require additional monthly evaluation doctor visits to get prescription refills ($$$) f) are accompanied by a recommendation for some kind of regular therapy in conjunction with the prescription drugs (major $$$, depending on how often you have to go) g) have serious (and potentially fatal) interactions with other prescription drugs for blood pressure, cholesterol reduction, etc. h) have known and potentially dangerous side effects, including irrational behavior and violent mood swings (Paxil and Xanax use have been used as murder defenses in court) i) drug you into non-functionality (you don't care if you bathe, brush your teeth, dress, etc., and you make Ozzy Osbourne sound like a Rhodes scholar) So, do I think the FDA has a bit of an agenda behind putting out this kind of scare? Hell, yes. These tests are done with a concentrated form of kava (stronger than you'd ever get in nature), injected directly into the bloodstream rather than ingested (again, something that doesn't happen with natural kava), and in doses ten to a hundred times stronger than an average person would take in one day. Under those conditions, anything including water could cause cancer or liver failure. Yes, overdoing anything can be bad for you, but I'd rather take my risks on a natural, herbal product created by God than on a mix of man-made chemicals. Patti.Spigarelli P.S. Sorry for preaching I just hate the way Western medicine uses scare tactics against natural products but sees nothing wrong with spending money on prime-time commercials for prescription drugs. July 31, 2002 As someone who has been dealing with depression and anxiety since the age of thirteen, I strongly disagree with Ms. Spiragelli's response to Dr. Kava's piece on kava kava. I can understand why some people would prefer to seek a more "natural" alternative therapy for their depression and anxiety problems, but at the same time, I don't think Ms. Spiragelli can reasonably conclude that the kava kava scare is a grand conspiracy thought up by Western medicine and the FDA. England, France, Japan, and Singapore have all banned products containing kava kava sixty-eight cases of liver toxicity worldwide, resulting in six liver transplants and three deaths, are nothing to make light of. Also, I don't appreciate her insinuating that those of us who are taking prescribed drugs are addicted, non-functional, and violent. I was on Paxil for a year, and it took care of both my anxiety _and_ my depression. I have taken Xanac too and never once did I have violent mood swings or commit murder. Instead, I was happy, outgoing, and energetic. I would just like to add that the $50 I spend a month on my current antidepressant prescription is worth every penny. The difference in the quality of my life today, compared to what it was six months ago, is astounding. I was non-functional prior to going on my current antidepressant therapy. My brain chemistry was messed up then and is now back on track thanks to my new prescription. Yes, I spend money on doctor's visits, but I wouldn't want to be on a medication without a doctor's consult and close regulation. You shouldn't self-medicate serious depression and anxiety, or even moderate for that matter. So, you can say that I'm addicted, have listened to too many commercials, and have too much faith in "Western medicine," but I know that my depression is something that will probably come and go for the rest of my life. There are times when I'm off medicine and functional and happy, but I've also spent too many of my twenty-four years sad and anxious. It's comforting to know that Western medicine can provide me with a safe and effective remedy. One last thing, if man is an integral part of our natural world, then why aren't his "man-made pharmaceuticals" just as much a part of God's world, too? kldonovan August 21, 2002 Try valerian root. It is equally effective without the side effects. I used to take a combination with valerian and vitamin B complex, but they took out the valerian and substituted St. John's Wort, which is useless and dangerous. I miss that supplement! vicsannabelle August 21, 2002 What about occasional kava usage? I am aware of the liver damage it can cause, and that is why I do not take it regularly. But I do like to experiment, and combining it with cannabis proved effective, although nothing I would desire on a regular basis [Editor's note: the writer of this letter also wrote to suggest filtered gravity bongs and vaporizers as methods of marijuana use less harmful than joint-smoking]. I find what kava does for me in a day's usage (one or two 30% capsules) is enough for about a week. But my question is, do you think that occasional use of kava alone still presents a personal health threat? As far as I know, my family has no history of liver problems. This may not be the best thing to base a decision on, but I can handle a good deal of alcohol, and I'm not a regular drinker. I try to eat as healthily as possible, not eating meat and supplementing the vitamins/nutrients lost. littlesnarf August 21, 2002 Kava replies: The valerian-using reader should check out our brochure on possible interactions of supplements and drugs: There is some evidence that valerian could interact with alcohol and some anesthetics, so it is not necessarily safe under all circumstances. And of course, the fact that these products are not closely regulated in the U.S. (some would say are not regulated at all) means that there are no real guarantees about the content or purity of these supplements. I do not know of any data indicating harm from occasional use of kava kava. That may simply mean that no one has done those studies, not that there is no potential for problems. As with most herbal supplements, the advice is to "use at your own risk." Ruth Kava, Ph.D., R.D. |