Kava Kava in the Crossfire

Millions of kava kava users got a surprise in March this year when the US Food and Drug Administration (FDA) warned that the herb may be linked to rare cases of severe liver injury. The FDA reported that four people in the US had required liver transplants and that consumers should be informed of the potential risk of this herb.

So what should consumers think? This issue deserves a closer examination.

The FDA said that it issued the warning because kava (Piper methysticum) has been associated with 24 liver-related injuries in European countries including Germany, Switzerland, France and the United Kingdom. Canada's Health Products and Food Branch (formerly the Health Protection Branch) has also urged consumers not to take kava until the safety question is settled even though the FDA didn't actually rule that kava caused liver damage. As a result, and despite the fact that kava remains a non-restricted herbal supplement sold freely worldwide, some health food stores have become too cautious by pulling kava products off their shelves.

I am inclined to adopt the more positive, objective view of kava that dominates Europe. Two renowned phyto-pharmacologists, Adolf Nahstedt and Matthias Schmidt of the University in M?er, have criticized the actions of both German government regulators (who also issued an advisory) and the FDA, calling them a questionable means of oppression of the natural remedy market. They point out that kava is by no means an unresearched herbal product and that the results of more than 100 clinical studies have been published in Europe confirming the herb's efficacy and safety.

In Europe, the 24 reports of adverse incidents involving kava-containing products have also been associated with liver-related conditions such as hepatitis, cirrhosis and liver failure caused by diet and lifestyle. The injured liver cases reported from Switzerland were all well-documented viral infections. Kava was shown as a secondary contributor. However, orthodox medicine treats herbal products with the greatest suspicion, and since kava had been identified as a possible culprit, or at least a contributor to liver damage, most media reports involving kava have been very sloppy and hastily done, laying the blame on kava rather than where it belongs on drug interaction, alcohol misuse or viral infection.

The only known fatality linked to kava, a death widely popularized by the German media, involved a female 81-year-old patient who had been taking a kava supplement for three months. She died during the course of hepatitis and liver malfunction; kava was blamed. Besides kava, the patient also took hydrochlorothiacid, a drug that can lead to jaundice, a liver dysfunction. And the real cause of death, however, was neither kava nor the drug, but severe liver cirrhosis from the long-term overconsumption and misuse of alcohol. A biopsy of the liver tissue confirmed that alcohol had destroyed the liver, which started long before the patient took kava kava. Unfortunately, the press did not report these details.

The fact is, kava is a safe herb valued for its soothing, sedative properties. It is indigenous to the islands in the South Pacific, where it is prepared daily as a traditional beverage. Supplements containing kava are promoted for relaxation, to relieve stress, anxiety and tension and to alleviate sleeplessness, menopausal symptoms and more.

In the last 10 years, approximately 275 million daily doses of kava have been prescribed in Europe. The risk of liver damage using kava supplements at the proper dose is minimal, says Schmidt. He calculated that the risk is about one per 350,000 patients per year a splendid record compared to pharmaceutical drugs with their history of side-effects, injuries and fatalities. In 1998 alone, there were 106,000 known adverse drug reaction deaths in the US.

The FDA hasn't concluded if kava, or its use together with some other supplement or medication, is to blame for the four reported cases of liver injury in the US. What all of this means is that the safety record for herbal medicine and kava kava as an efficacious natural remedy remains untarnished.