Kava, a traditional beverage made by soaking the roots of the piper methysticum plant (Kava plant) in water has been enjoyed for millennia throughout the south pacific islands without known health issues. However, there have been several reports of liver failure associated with Kava use, including a few deaths. So what’s the deal with the kava liver damage myth? Is Kava actually dangerous, or is it safe to drink? In this article, I’ll do my best to provide an answer.
- 1 The Kava Paradox
- 2 Kava Liver Damage: Myth or Reality?
- 3 Risk of Death from Kava
- 4 How to Minimize Health Risks When Enjoying Kava
- 5 Conclusion: Kava Hepatoxicity
The Kava Paradox
Why have pacific islanders been able to drink the Kava beverage for over 1,500 years without any known liver issues, while several cases of liver hepatoxicity manifested themselves as Kava spread throughout the world?
There are several factors that seem to lead to this paradox, and this article will look at some of the reports of problems. We will examine potential causes and will discuss the global economic circumstances that may have led to these issues.
We will also look at ways to minimize risk from Kava while still enabling those who love this entheogen to continue to enjoy it!
Kava Liver Damage: Myth or Reality?
In the late 1990s and early 2000s, when Kava became known around the world, there was a boom in sales, and millions of people across the world began enjoying the pleasant vibes and calming effects of Kava in various forms.
Kava got quite popular, and many buyers purchased Kava products that were unsafe, or perhaps they misused the products. A variety of different circumstances coalesced into a significant problem, with several people suffering hepatoxicity, liver failure, and even some deaths linked to Kava use.
What Happened Back in the 1990s?
There were several reports, mostly in Europe, of deaths and severe injuries from Kava consumption back in that time. According to a World Health Organization Report:
” Of the 93 case reports initially identified by WHO, eight were identified as having a ‘probable’ association with the use of kava (six with kava organic solvent extract and two with kava beverage). Reported dosages ranged from 45 mg to 1200 mg kavalactones per day, taken for one week to twelve months. The WHO report concluded that:
- the relationship (causality) ratings provide a significant concern of a cause-and-effect relationship between kava products and hepatotoxicity; a non-random effect is indicated by a higher rate for the organic extracts than for synthetic products
- chemicals other than kava lactones might be responsible for hepatotoxicity with the organic extracts
- kava products have a strong propensity for kava–drug interactions
- risk factors for hepatic reactions appear to be the use of organic extracts, heavy alcohol intake, pre-existing liver disease, genetic polymorphisms of cytochrome P450 enzymes and excessive dosages. Also, co-medication with other potential hepatotoxic
drugs and interacting drugs, particularly anxiolytics, antipsychotics and antithrombotics, might lead to harm.”
Scientists went back and forth over these claims for over ten years, before the general consensus of health organizations found that Kava, as traditionally prepared, was not a significant health risk.
What Caused these Problems?
The general consensus of the circumstances that led to these deaths are the following:
- Consumption of poor quality Kava extracts
- Consumption of parts of the Kava plant not traditionally used
- Simultaneous heavy alcohol and kava use
- Mixing of Kava with other drugs/substances
- Consumption of Kava contaminated with mycotoxins or mold
- Kava consumption among individuals with pre-existing liver problems
- Potential excessively high dosages of Kavalactones
As a result of the hepatoxic incidents, Kava was made illegal in many parts of the world for several years. After many governments and companies throughout the South Pacific fought the new laws, most have been overturned.
It was eventually shown that, as the WHO states, “on balance, the weight-of-evidence from both a long history of use of kava beverage and from the more recent research findings indicates that it is possible for kava beverage to be consumed with an acceptably low level of health risk.”
Kava has since been re-legalized through most of the world and is once again experiencing a surge in popularity.
Will this time be different, or will we see similar events unfold?
Scientists have learned quite a bit about the Kava plant and its risks, and while no single cause for the liver issues has been discovered, the general consensus is that these deaths occurred through a confluence of several factors. I’ll look at those factors here, and will discuss how to minimize risk.
Kava Demand in the 1990s and Early 2000s
Demand for Kava root spiked during the first wave of Kava’s popularity throughout the world. Suppliers could not keep up with the demand.
Why couldn’t growers handle the demand, and why does it matter?
Kava can only grow in a few locations throughout the world. Obviously, this plant is pretty successful throughout the South Pacific islands, and is grown on many different islands like Vanuatu and Fiji. However, these islands have a somewhat unique climate and environment, one that is not easily replicated elsewhere. Virtually all of the Kava that is sold is manufactured throughout the South Pacific, though some countries like China are attempting to grow it in other environments.
Kava plants typically take about five years to grow from seedlings to harvest-ready plants. That’s a long time! For this reason, it can be quite difficult to manage kava production. Any spikes in demand may not be able to be met for at least five years. And of course, over a five-year time horizon, much can happen in terms of blight, disease, drought, and the like.
In the 1990s during the first Kava boom, suppliers found themselves severely short of Kava plant, and had a great deal of demand. They responded by lowering quality.
Parts of the Kava Plant
Traditionally, only the roots of the kava plant are consumed in tea. The leaves, stems, and other parts of the plant positioned above ground are not consumed and are discarded. Additionally, Traditionally, Kava was only consumed in tea form, and was not usually extracted or otherwise manipulated with alcohol or solvents.
When demand spiked in the 1990s, suppliers unscrupulously began selling parts of the plant that typically were not consumed. These leaves, stems, and other plant parts were usually turned into extracts, pills, or other kava forms, rather than sold as actual root powder.
Kava Extracts vs. Traditional Powders
As mentioned above, dried Kava powder mixed with water or perhaps coconut milk is the traditional way to consume Kava beverages (barring those who have access to fresh kava, which is pretty rare). It’s relatively easy to judge the quality of a kava powder by its looks and smell, relative to extracts and pills.
Extracts and pills have become popular ways of consuming kava. There’s no kava preparation involved with extracts and pills, and users can bypass the acquired taste (ahem) by popping a pill or drinking a dropper of something. However, on the whole, there is much less transparency and quality control among extract vendors and kava tablet makers, and it is almost always best for users to avoid these concoctions.
Extracts are often made with alcohol and other solvents. These solvents will extract additional compounds that water will not pull out. This phenomenon makes Kava extracts potentially much riskier than traditional water-based kavas.
Any mold or mycotoxins present in the kava being extracted will be pulled out in much higher percentages with a solvent than they would with a traditional tea preparation.
There’s no way to know what’s in most supplements, tablets, and tinctures containing Kava. The types of information supplied by a reputable Kava vendor is quite different than that supplied by a questionable supplier like Toniiq Kava Capsules. If the Kava is advertised as organic, non-GMO, and the like, or is blended with other substances and marketed as some sort of herbal drug, the vendor is probably not sourcing great kava.
If they’re not giving test information, stay away.
Instead, Kava users should want to know the Kava Chemotype and the testing facility where the kava was tested. If the Kava vendor can show that the Kava is of Noble variety, and has been tested to be free of mold and other chemicals, it’s almost certainly safe and enjoyable to consume.
Noble vs. Tudei Kavas
There are two primary classifications of Kava: noble varieties, and Tudei (“two-day”) varieties. These are identified by their Chemotypes, and the classification has to do with the number of different kavalactones present in a specific strain of Kava.
Most Kava sold by responsible vendors is of Noble variety, and Vanuatu will only permit the export of Noble Kava. Tudei Kava is usually considered to be lower quality kava, and the effects of Tudei kava are a bit different than Noble strains. Often there is more nausea present in Tudei strains, and the effects can last for a couple of days. Additionally, you’re more likely to get a hangover with a Tudei variety.
The FDA in the United States makes no distinction between Noble and Tudei varieties, and if kava is not advertised as Noble (and proven with test results or Chemotype data), there’s a reasonable chance the kava is not entirely Noble. It’s cheaper for product developers to buy Tudei as it is lower quality, and many manufacturers know that their buyers won’t have the knowledge to even ask.
Supplements and other nootropic-style Kava blends don’t often identify the strain of kava, the location of cultivation, or any information like that, which suggests the Kava in these products may contain Tudei root.
There’s no clear connection between liver issues and Tudei kava. But unless you know what you’re doing, it’s almost certainly best to stick to Noble strains that have been properly vetted, tested, and classified by an independent agency like the University of the South Pacific’s Testing Lab.
Kava and Mold/Mycotoxins
It’s pretty humid throughout the Pacific islands, and dry storage can be a challenge in these areas. Mold is always a risk, and that risk is amplified when users are imbibing alcohol or solvent-extracted kava, as mentioned above.
By sticking to reputable vendors who test their kava, and provide data on it, buyers can be pretty comfortable that mold should not be a danger.
If you ever purchase kava that has been packaged wet or has visible mold on it, do not consume it. It can be hard to identify mold from the smell, as different types of kava and different drying techniques can impart different scents onto the kava powder.
Kava and Alcohol
While it is not uncommon for the Pacifika peoples to drink kava and then enjoy an alcoholic beverage, the almost universal consensus is that this should be avoided. Both kava and alcohol stress the liver (as do pills like Tylenol), and these substances should not be combined.
Just as most alcohol drinkers know that it is unwise to consume Tylenol and alcohol at the same time, Kava should be treated similarly.
Kava is a fantastic substitute for alcohol and can provide similar feelings of pleasure and calm, without producing hangovers, aggressive behavior, and the like.
Risk of Death from Kava
All this said, the risk of death or injury from drinking Kava is far lower than the risk of injury from consuming Tylenol or Alcohol. For this reason, it’s wise to remember the actual risk of damage from Kava may not be zero, but most people don’t freak out over taking a couple of Tylenol; Kava is very much the same.
You’ve probably never even thought to google Tylenol’s risks to the liver.
Germany had banned Kava for 12 years, and finally reversed its ban after a study showed that, compared to over the counter medicines like Paracetamol (Tylenol) “researchers reported that kava is dramatically safer than these commonly prescribed over-the-counter pain medications”.
The overall risk of death from Kava is really quite low and compared to commonly used substances like Alcohol or Tylenol, the risk is minimal. The bottom line risk assessment is that there may be some risk to taking Kava, but there’s risk to walking outside your house (or even staying inside!), and we need to compare those risks to other factors.
For those who choose to substitute Alcohol with Kava, their risk of liver harm is likely much lower than it would be if they were drinking alcohol.
How to Minimize Health Risks When Enjoying Kava
There are a few easy steps to take when consuming kava to ensure that your health risks are minimized.
1. Only purchase Kava from Reputable Vendors who Test their Kava
Don’t purchase crappy supplement pills, extracts, shady supplement Kavas, and the like. Stick to a reputable vendor and you’ll be fine. The Kava Subreddit has an excellent list of responsible vendors. Many great vendors like Gourmet Hawaiian Kava only sell through their website, but you can find plenty of high-quality Kava on Amazon. A few examples can be found here:
2. Stay away from Extracts and Pills
Among the examples above, you’ll notice that all but one item is a root powder, either micronized or traditional grind. This is unquestionably the best way to drink your Kava.
There are a few reputable vendors who sell other forms of Kava like the Kava Candies mentioned above, and Bula Kava House’s CO2 extract. But these are fairly rare, and are not alcohol extracts. They’re also produced by reputable vendors.
3. Avoid Mixing Kava and Alcohol or other Substances
This one is pretty easy. Don’t mix Kava with alcohol or other substances that put stress on the liver. Enjoy one or the other, and wait ideally around 24 hours between sessions for either. Kava can be a great substitute for alcohol and does not usually lead to any kava hangover, which is always a plus.
4. Don’t Drink Kava if Your Liver is Compromised
If you know that you already have liver issues due to alcoholism, various autoimmune diseases, pregnancy, or any other medical condition, speak to your doctor before you consume any kava. This should be obvious, but it still bears mention.
5. Don’t Take Heroic Quantities of Kava on a Regular Basis
Stick to regular amounts of kavalactones, in the +/- 200 mg range. It’s pretty hard to take thousands of mg of kavalactones with the traditional method: the taste is pretty bad, and eventually, you’d get sick of drinking all the water.
Taking massive amounts of pills or extracts is much easier, and again, it’s best to stay away from these.
Conclusion: Kava Hepatoxicity
Kava presents no significant risk if used responsibly. Avoid sketchy extracts and stick to reputable vendors. Don’t mix kava with alcohol, and don’t take absurd quantities. Don’t take kava if your liver is in rough shape.
It is unfortunate that many of the extracts, pills, and other forms of kava are still sold with little regulations, and it would not be a complete shock to see a repeat of some of the events of the 1990s for some users. The good news is that more and more responsible vendors are springing up, and getting high-quality kava from a safe source is quite easy.
Stay safe, and enjoy your kava. Bula!