Kava: What It Is, Uses, & Side Effects

What Is Kava?

Kava is part of the pepper family and is consumed in one of two ways.  Traditionally, the root of the plant is ground up and mixed with water to make a drink which is used as part of cultural, medicinal, and spiritual practices. Now commercial producers create plant extracts that are manufactured into tablets or syrups.

Kava is often used for anxiety, to promote sleep, to treat pain or to manage cravings for alcohol or drugs. Traditional uses focus on the mild analgesic, antifungal, or antibacterial effects.  The relaxant effect of kava is attributed to compounds in the plant called kavalactones which act on receptors in the brain and central nervous system.  While Kava is often compared to alcohol, it lacks the disinhibiting and intoxicating effects.

The “Kava rhizome contains 80% water; dried rhizome consists of about 43% starch, 20% fibre, 12% water, 3.2% sugars, 3.6% proteins, 3.2% minerals, and 3–20% kavalactones.”¹ Like any substance, the effect psychoactive and potential side effects of Kava vary depending upon the concentration, dose, and frequency of use.  The World Health Organization published a safety report on the use and preparation of Kava in 2016.¹

Forms of Kava

Kava’s use may be described based on traditional versus modern uses. In traditional use, Kava is consumed as a beverage, typically from the varietal known as “noble Kava”.  Consumed for over 2000 years ceremonially and recreationally in the South Pacific, the rhizome or root of the plant is peeled, ground, and mixed with water. In other preparations, other plant material may be added as well.  Other names for Kava: Awa, Grog, Kava-Kava, Kavain, Kawa, Lewena, Malak, Sakau, Wati, and Yaquona.

Beginning in the 1990’s interest in and use of Kava spread as a supplement. Largely used to treat anxiety, “ Kava medicinal products are sold as powdered extracts, capsules, tinctures and fluid extracts. They are made from a concentrated kavalactones mixture prepared by extracting the dried peeled rhizome/root (and possibly other plant parts) with either ethanol or acetone.”¹ These modern preparations of Kava are estimated to be 2-10 times stronger than the traditional preparation methods.

Kava Tea

Kava tea is the most traditional and safest preparation of Kava.  “Traditional kava is typically prepared from the root of the plant (fresh or dry), although some regions use peelings or stems as well. Typically, the dried root is ground into a powder, which is then mixed with ambient temperature water or coconut milk, and filtered through a cloth into a suspension.”² Varying from the traditional social and ceremonial occasions for consuming Kava tea, Kava bars serve the beverage to consumers in Hawaii, the Pacific Islands, and in some Western nations.

Kava Tincture

Kava tincture uses a kava extract and alcohol as a solvent to produce a concentrated liquid form of Kava. Typically, tinctures are administered by drops on the tongue.

Kava Capsules

Kava tinctures can be Kava exclusively or Kava extracted with ethanol and dried before packaging in capsule form. These are typically consumed “one to three capsules with a daily dose of 60–250 mg kavalactones for one or two months”.²

What Are the Benefits of Kava?

Kava’s mood-altering, muscle-relaxing, and pain-relieving effects are the reasons that its use is sought after as an alternative to commercial pharmaceutical medications. The over-the-counter availability and natural sourcing are seen by many as preferable for treating mild to moderate conditions such as anxiety, pain, and sleep concerns.

Some benefits of kava include:

• Better sleep: Kava has demonstrated effects in improving sleep onset and quality. It seems to reduce restlessness in users based on the psychoactive components present in Kava preparations. “We conclude that sleep disturbances associated with non-psychotic anxiety disorders can be effectively and safely treated with kava extract WS 1490.”³
• Reduce anxiety: Reduction of anxiety symptoms is one of the most common and popular uses of the plant. Data on clinical effectiveness for this purpose is unclear, although potential safety concerns appear low. A 2003 Meta-analysis concluded, “The data available from the reviewed studies suggest that kava is relatively safe for short‐term treatment (1 to 24 weeks), although more information is required.”⁴
• Cancer Treatment: It has been suggested that Kava’s compounds may be helpful in preventing the spread of some cancers. However, its’ efficacy has not been clearly demonstrated.  “… the use of kava extracts, or their isolated components, leads to the inhibition of cell proliferation, cell cycle arrest and induction of apoptosis, showing promising results against cancer. “…it is still largely unknown how kava and its constituents interact with cancer cells and the molecular mechanisms involved, being this an emerging research topic.” (5)
• Menstrual Relief: Kava has demonstrated pain-relieving and anti-spasmodic properties which are helpful for menstrual cramps and pain.
• Menopause Relief: Kava’s use for menopausal symptoms relates primarily to its’ anxiolytic and depression-relieving properties. It has not proven useful in relieving hot flashes or other concerns during menopause.
• Anti-Inflmmatory: “Inflammation plays important roles in the pathology of a wide variety of diseases, ranging from cancer to neurological disorders [46]. Studies into kava and inflammation have been partly stimulated by its analgesic effects [47], as anti-inflammatory drugs are widely used for pain relief.” (2) The use of Kava as an anti-inflammatory agent must be balanced against its’ contra-indications and areas lacking clinical evidence.
• Social and Cultural:  It is important to consider the cultural implications as a potential benefit of Kava. When used in traditional and ceremonial contexts, Kava acts as a social lubricant and a way to relax. When used in this context, with the traditional methods of preparation, Kava seems to have a demonstrably low level of risk and can be seen as beneficial.¹

Kava Side Effects & Risks

Kava use is not without side effects and risks. Much of the potential risk depends upon the varietal used and the method of preparation, as well as how long Kava lasts in the body. It has been suggested that the “noble” variety of Kava is the safest.  Because Kava is a plant and the preparation can vary, it can be difficult to regulate the concentration of kavalactones in the preparation being used. “There is also potential for other contaminants, such as molds, to grow on stored kava material, some of which can produce mycotoxins such as aflatoxins.”¹

Like any chemical introduced into the body, potential negative side effects will increase as the dose and frequency increase. Heavy Kava use is more likely to have associated risks than occasional Kava use.

Possible negative effects on the body from kava include:

• Headaches: Kava can cause headaches in users, which seem related to accompanying dehydration rather than the Kava itself. Heavy users are more likely to suffer from this side effect.
• Nausea: Nausea is another side effect that appears related to the dose and frequency as well as whether the person is sufficiently hydrated.
• Skin Rash: Kava may cause a rough, dry, scaly rash that often begins on the head, face, and neck, and gradually becomes more generalized.
• Eye Irritation: High and continuous Kava use is associated with eye irritation and redness which is reversible upon discontinuation of use.
• Liver Toxicity: Data on long-term liver damage caused by Kava is mixed with demonstrated links to permanent or lethal liver damage being relatively rare. This is a consideration, especially for people taking other medications that impact the liver or have known liver damage previous to taking Kava products.
• Motor Impairment: The mild sedative effects of Kava have been suggested as a potential risk factor when operating heavy machinery or automobiles. This issue is most notable with heavy use or more concentrated preparations.
• Cognitive Impairment:  Data on Kava use does not substantiate long-term nor progressive cognitive impairment. “Despite collecting data from among the heaviest reported kava drinkers in the world, no saccadic or cognitive deficits associated with kava use were identified.”⁶
• Loss of Sex Drive: Some Kava users report a reduction or loss of sex drive while others experience a reduction in anxiety that is associated with increased libido. This appears to be a dose-dependent effect of Kava.

Does Kava Affect Other Medications?

Care should be taken when consuming Kava alongside other medications.  For example, Kava should not be taken alongside other depressants. For example, alcohol and Kava are both depressants which can raise the overall risk for mood changes, cognitive impairment, and risk of liver toxicity.  Similarly, Benzodiazepines and barbituates are depressants that are taken to manage anxiety which used alongside Kava, may interfere with liver function or add to the depressant effects on the central nervous system.

Kava is not recommended for individuals who take medications for Parkinson’s disease. Kava inhibits dopamine reuptake which in turn affects the efficacy of common medications for Parkingson’s. Other supplements may also be contraindicated with Kava use.  Always disclose these to your physician.

Who Should Avoid Kava?

While Kava has been judged as low risk when used infrequently and according to traditional preparations, some people have co-occurring conditions that place them at a higher risk of negative side effects.

People who should avoid kava include:

• Depression: Data related to the mood-boosting effects of Kava are unclear, while there are many evidence-based treatment options for depression available. Taking Kava for depression may delay or interfere with effective treatment.
• Alcoholics: Due to the known liver toxicity of alcohol and the potential issues with Kava use and liver toxicity, heavy alcohol users should avoid Kava.
• Blood Disorders: Kava impedes blood clotting and should be avoided by people with blood disorders.
• Kidney Disease: Kava may be implicated in causing muscle weakness or muscle toxicity that breaks down muscle tissue which then damages the kidneys.
• Liver Disease:  Kava has been linked to potential cases of liver damage, in some cases even causing the need for liver transplant or death.
• Parkinson’s Disease:  Kava may interfere with medications prescribed for Parkinson’s disease and is not recommended.

When to Seek Professional Support for Anxiety

If you have elected to treat anxiety with Kava or are considering it and are finding that you are not getting enough relief or are increasing Kava amounts above recommendations, you may benefit from seeing a therapist. Indicators of needing more help with anxiety are if your anxiety symptoms are limiting your life in negative ways or if it is coupled with low mood or depressive symptoms. A therapist may assess your symptoms and recommend seeing a psychiatrist as well. You may find your therapist through an online therapist directory or online therapy platform or through your insurance company’s preferred provider list.  You may often filter for a therapist specializing in anxiety in online directories.

In My Experience

In my experience, the data on the uses and health properties of Kava offer potential in the future for defined uses in health protocols. However, the lack of clarity in the literature and regulation of the product itself would suggest that it may not be a first-line option for treatment. Like many natural remedies, Kava as a supplement or product may have a “health halo,” which suggests safety and efficacy that are not well defined. Persons suffering from conditions that may be treatable with Kava, such as anxiety, pain,  insomnia, or cancer, are best served by partnering with their primary care physician and a mental health practitioner to determine effective treatment in a particular case. However, the World Health Organization’s position suggests that on an occasional or culturally defined basis, the use of Kava has minimal and acceptable risks.