Kava may one day replace benzodiazepines in the pharmacological treatment of anxiety.
—MICHAEL T. MURRAY, N.D., NATURAL ALTERNATIVES TO PROZAC
Kava kava, or simply kava, is rapidly becoming an herbal superstar. Its calming effects have generated increasing scientific interest because synthetic tranquilizers are generally not suitable for longer than three weeks. Whereas benzodiazepine tranquilizers can be addictive, impair memory, and worsen a depression, kava improves mental functioning and mood and is not addictive.
Kava pills come in different strengths, usually from 100 to 250 mg, and the percentage of kavalactones (the active chemicals in kava) in the extract can vary from 30 to 70 percent. The dosage used in most clinical studies for anxiety is three daily 100-mg doses of kava extract standardized to 70-percent kavalactone content, which research has shown can be as effective as the benzodiazepine drug Serax (oxazepam), 15 mg daily. A 70-percent kava extract is not yet commercially available in the United States.
Enzymatic Therapy has a 150-mg capsule of a 55-percent kava extract, which would contain 82.5 mg of kavalactones. A 100-mg capsule of 70-percent kava extract would equal 70 mg of kavalactones (.70 x 100). A 250-mg capsule of 30-percent extract would contain 75 mg of kavalactones (.30 x 250). It is best to begin with a total daily dosage of 70 to 85 mg of kavalactones, taken in the evening. Stay on one capsule if it effectively reduces anxiety. If it is not enough, you can add a second pill in the morning. Remain on this twice daily dosage for at least a week. If you still feel tense or fearful after that, you can add a third capsule in the middle of the day. When you consistently feel more relaxed, you can gradually decrease your dosage by one pill every few days.
Consuming kava on a daily basis is not recommended for longer than twenty-five weeks (four to six months). When used in small amounts on an occasional basis, it can be used longer, if necessary. If 70 to 85 mg of kavalactones three times a day is not effective for your anxiety, see your doctor for a reevaluation to see if taking more kava is indicated or if you may require a prescription drug.
Unless you are under medical supervision, do not combine kava with benzodiazepine tranquilizers. In 1996 Dr. Y. N. Singh reported in a letter to the Annals of Internal Medicine that a patient became disoriented and lethargic after combining Xanax (alprazolam) and kava, requiring brief hospitalization. This case suggests that kava can potentiate the sedative effect of benzodiazepines. If you are taking a synthetic tranquilizer, you should be gradually withdrawn from it under medical supervision before beginning kava.
Kava (Piper methysticum) is a member of the pepper tree family, native to Fiji, Samoa, and other South Pacific islands, where it was traditionally consumed by Polynesian chieftains during ceremonial rites. A description of kava’s effects was written in 1777 by George Forster, a naturalist aboard Captain James Cook’s ship. Cook and his crew introduced kava to the Western world following this South Pacific voyage. Today the thick, knotty kava root is cultivated throughout the South Pacific islands for local consumption as a beverage and to export for processing as a natural tranquilizer. The active chemicals, the kavalactones, are concentrated in the root, which is harvested at three to four years of age for optimal potency.
English, German, Swiss, and other European health boards have approved kava for the treatment of anxiety and insomnia. Research studies have demonstrated that kava can relieve a wide range of anxiety symptoms. Although researchers are not yet sure exactly how kava works, some researchers theorize that it has a direct soothing action on an overactive amygdala, the brain’s alarm center, thereby both relieving anxiety and elevating mood. Kava does not appear to lose its benefits over time and does not impair memory.
In a 1996 randomized, placebo-controlled, double-blind study, two groups of 29 patients with anxiety syndromes were treated with 100 mg of kava extract standardized to 70-percent kavalactones three times a day for four weeks. The symptoms of anxiety were significantly reduced in patients taking kava as compared to placebo. No adverse reactions were observed in the kava group.
In a 1997 multicenter, randomized, placebo-controlled study reported by Drs. Volz and Kieser in the journal Pharmacopsychiatry, a total of 101 outpatients were given one capsule of a kava extract containing 70 mg of kavalactones or placebo three times daily. In this twenty-five-week study, all the patients suffered from moderate to severe anxiety, including agoraphobia, generalized anxiety disorder, specific phobia, and social phobia. The results showed that the short-and long-term effectiveness of kava was superior to that of placebo. After twenty-four weeks, over half of the kava group were rated as “very improved”: anxiety, fear, tension, and insomnia decreased steadily with treatment. Kava was well tolerated, and adverse reactions were mild and rare. The researchers concluded that kava was a treatment alternative to both benzodiazepines and synthetic antidepressants for anxiety disorders.
At ten times the recommended dosage, consumed for many months, some heavy drinkers of kava root in the Polynesian islands have developed a scaly eruption or yellowing of the skin associated with muscle spasms, biochemical abnormalities, vision disturbances, and even shortness of breath. Such skin problems associated with kava abuse have not been reported in the United States or Europe. These disturbances go away quickly when kava is discontinued. Large intake of kava is unnecessary and strongly discouraged. At the recommended therapeutic levels, no such side effects have been reported.
Kava should not be taken by people suffering from Parkinson’s disease, because it might worsen muscular weakness and twitching. A few cases of an allergic reaction to kava have been reported. Kava should also not be taken after ingesting alcohol or mixed with pharmaceutical antidepressants, benzodiazepine tranquilizers, or sleeping pills. Care should be taken when driving or operating machinery. People who are elderly or medically ill should take smaller doses of kava and only under a doctor’s supervision. Kava is not recommended during pregnancy or breast-feeding or for severe anxiety disorders and depression.
Kava reduces anxiety without causing the lethargy, diminished concentration, and fuzziness so often associated with synthetic tranquilizers. Though caution is always indicated, people who are taking appropriate doses of kava can generally drive an automobile or focus on work without experiencing any sedation. With the growing availability of high-quality kava products, this natural tranquilizer could soon become a first-line treatment for mild to moderate anxiety.
Kava is also being used in combination with other natural ingredients. For example, REPOSE from Sunsource blends kava with Siberian ginseng (see chapter 15), magnesium, and vitamins B and C to further aid stress relief.