Is Kava Dangerous?

The relaxing herbal medicine, Kava has been used for centuries in Pacific Island cultures as a calming beverage in welcoming ceremonies. These relaxing, anxiolytic (anxiety-relieving) qualities are a herbalist’s best friend when you need an effective herbal medicine for someone who is stressed, struggling in social situations, suffering from a racing mind or can’t close down the tabs in their brain to get a restful night’s sleep.

The traditional way to consume Kava is as a beverage brewed with water and the roots and rhizomes of the plant. This brewed drink has an earthy, chalky consistency, and on consuming, it helps bring about a sense of calm. It can also make the mouth feel a little numb and tingly due to its mild analgesic (pain-relieving) qualities. It has been safely consumed in this water extraction method for hundreds of years.

Kava’s Safety Profile

The extraction method used is of great importance when it comes to the safety of Kava.

In the past decade, Kava’s traditional use has fallen victim to misplaced fear following some safety issues that were flagged concerning liver toxicity reports. It’s important to understand that these safety concerns were extensively investigated and what became evident was that the extraction method used played a critical role in this safety controversy.

You see, when it comes to the extraction and manufacturing of herbal medicines, there are several ways herbal extracts can be produced. To create any extract, a herb must be mixed with a solvent, which is usually selected based on the constituents (therapeutic components) you are trying to yield from the plant substance. Some of the most commonly used are water and ethanol (alcohol), but other less desirable solvents include acetone, dichloromethane, n-hexane, ether and chloroform.[2]

Non-Traditional Extraction Methods Leads to Safety Questions

So, how did a herb that’s been consumed safely and effectively for hundreds of years suddenly start raising safety questions? In short, by pursuing an unnaturally high concentration of the key active constituent, kavalactones. You see, kavalactones are a measure we use as a qualitative marker of the extract. So more must be better, right?

More definitely does not always equal better and certainly not in this case.

In the pursuit of boosting the kavalactone content, some manufacturers deviated from it’s traditional water brewing method and instead, began using acetone (or ethanol) as a solvent, this was particularly more commonplace in Europe. And this is how a herb that had a long history of safe use, suddenly became connected to liver problems. And this is why regulators (including Australia’s Therapeutic Goods Administration) now only permit extracts that are made with water as the solvent – ie. the traditional method used in Island cultures for centuries.

Does this mean Kavalactones are bad?

Kavalactones are not ‘bad’. On the contrary, in fact, kavalactones are an important qualitative assessment used to measure the quality of one extract source to another. Every herbal medicine has key constituent markers that are measured to ensure the extract is of good quality and meets safety and efficacy requirements.

What has been done now, to ensure maximum safety is that regulators have set a limit on the permissible amount of kavalactone content in extracts to ensure levels remain in lower, more natural concentrations. Australia’s TGA allows for an upper limit of up to 125mg of Kavalactones per capsule for a maximum daily dose of 250mg.[4] Most herbal extracts are actually much, much lower in concentration than this.

Why does Kava carry a liver warning?

A confounding factor in the handful of identified safety concerns was that it was considerably more likely for issues with Kava to arise when someone may already have compromised liver function or complex health issues. A number of the reported cases had complex medical histories, and this could not be ruled out as a causative factor. Investigations also revealed that in some cases, consumers had exceeded recommended dosages by up to 400%.

According to the American Botanical Council, who did an extensive review of the evidence around these reports; “A review of the cases reported in Germany and Switzerland, based on the information available so far, is instructive. Of 34 cases reported (including duplicate reports), 18 appear to be associated with the concomitant use of prescription medications, some of which are known or suspected to be hepatotoxic. In some instances, people consumed kava at higher doses than recommended by the Commission E (60–120 mg kavalactones per day)11; one report shows that the subject exceeded this dose by 400 percent. Experts point to other potentially confounding co-factors that raise questions about kava’s culpability. Whether some of these AERs [adverse event reports] were caused by the simultaneous use of conventional drugs, the interaction of kava and the conventional drugs, or simply the kava products used still remains to be determined. However, what has become increasingly clear is that many of the AERs are clouded by numerous confounding variables.”

The warnings required on therapeutic goods labels about liver harm serve an important part of the regulatory reforms. It has been an essential cautionary step in ensuring there is ongoing consumer awareness about the potential for risk of taking too much or with pre-existing conditions, and by including a warning it means customers are asking the right questions to ensure safe use. Anyone taking Kava should be mindful of any prescribed drug interactions and the safety aspects around alcohol consumption or pre-existing liver health issues and act accordingly.

What do I need to know about taking Kava?

When used responsibly, Kava is a wonderful herbal medicine. It’s relaxing, soothing and helps with stress, sleep and anxiousness.

The things to know about Kava are:

✅ Kava has been consumed safely for hundreds of years in traditional Pacific Island herbal medicine

✅ All approved Kava herbal medicines in Australia are ONLY water extracted

✅ The Therapeutic Goods Administration and several other global regulators have permitted Kava for sale since 2003 without incident since the initial safety concerns were reviewed in 2002

✅ Kavalactones are a measure of quality of Kava extracts

✅ The upper limit of Kavalactones in Kava is 250mg per day. NB: This is 250mg of this constituent, not the overall extract.

✅ Always consult with your health professional about the suitability of Kava if you are on multiple medications, have a history of liver health issues, or other chronic illness that may be a risk factor.

Kava in myBrainCo. Sleep Well™

Kava was added to Sleep Well™ as part of a reformulation to remove Lavender but maintain its efficacy as a calming, sleep aid. Kava is an ideal choice as an alternative with Lavender, as many people experience perfumed burps from lavender and can experience nausea and stomach upset from the volatile oils in lavender.

Sleep Well™ contains, in accordance with regulatory requirements, a cold water solvent extraction form of Kava. Each individual capsule of Sleep Well™ contains well below the upper limit (125mg per capsule and/or 250mg per day) of allowable Kavalactones, with -/+ 27.86mg per capsule. Sleep Well™ complies with all the required TGA regulations for extraction method, batch testing and stability, so you can be assured it meets all requirements for safety as laid out by the regulator. Like when adding any new supplement to your regime, it is important to consider your current health status, and discuss your specific health needs with your preferred health professional for support if you have any concerns. If you’re unsure, we invite you to reach out to our clinical support team to guide you.

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REFERENCES

1. Braun L, Cohen M. Herbs and Natural Supplements: an evidence-based guide, 2nd ed. Elsevier, 2007
2. Abubakar AR, et al. Preparation of Medicinal Plants: Basic Extraction and Fractionation Procedures for Experimental Purposes. J Pharm Bioallied Sci. 2020 Jan-Mar;12(1):1-10
3. Blumenthal M. Kava safety questioned due to case reports of liver toxicity. Herbalgram 5:26-32
4. Therapeutic Goods Administration. Final Decisions and Reasons for Decision By Delegates of the Secretart to the Department of Health and Ageing. February 2012. P.115 – 125