Everything You Need to Know About Kava Before Trying It
Kava is becoming a hot wellness trend thanks to its anti-anxiety properties—but this controversial supplement is banned in several countries. Here's what you need to know.
Perhaps you've seen a kava bar popping up in your neighborhood (they're starting to appear in places like Boulder, CO, Eugene, OR, and Flagstaff, AZ), or you're checking out the "stress relief" teas with kava at Whole Foods or on Amazon. Kava isn't as common as, say, CBD, so you may not be familiar with what it is. Read on to get the full download on all your kava questions—including whether or not it's even safe.
What Is Kava?
Kava (sometimes called kava kava) is an herb derived from the roots of the piper methysticum plant, which is a member of the nightshade family of plants, says Habib Sadeghi, D.O., osteopathic doctor in Agoura Hills, CA.
"It has been postulated to be a substance that can promote relaxation, reduce anxiety, and induce sleep," says Cynthia Thurlow, N.P., a nurse practitioner and functional nutritionist.
Though used in modern homeopathy and supplementation, it has a rich history stemming from the South Pacific islands, where the piper methysticum plant grows. "It's been used for centuries [in that region] as a ceremonial tea," says Steve McCrae, N.M.D., a naturopathic medical doctor at LIVKRAFT Performance Wellness. Now, you can consume kava in mixed drinks at kava bars, teas, tinctures, capsules, and topically (more on that below).
Fast facts about kava:
It has a strong flavor. "It's pungent, a little astringent, and bitter," says Amy Chadwick, N.D., at Four Moons Spa. "It is a warm and dry herb."
Its superpower is kavalactones. "Kavalactones—the active compound in kava—act as a pain reliever, muscle relaxant, and anti-convulsant," says Madhu Jain, M.S., R.D., L.D.N., medical dietitian at Advocate Lutheran General Hospital.
It's banned in parts of Europe and throughout Canada. "Kava is banned in France, Switzerland, Canada, and the UK," says Thurlow. "In the U.S., the FDA has issued an advisory that using kava may lead to liver injury."
What Are the Benefits of Kava?
So why do people take it? Primarily, for anxiety. All medical, pharmacological, and naturopathic sources we spoke to pointed to anxiety relief as kava's chief purpose. There has been some evidence that it can help with other health woes as well.
1. Kava may reduce anxiety.
"Kava helps to decrease levels of anxiety without affecting alertness," says McCrae. Chadwick seconded this: "It can especially help reduce social anxiety while allowing the mind to stay focused; it allows for a euphoric but clear-minded state." (Related: 7 Essential Oils for Anxiety and Stress Relief)
"Kava has been used as an alternative to benzodiazepines," says Jain. Also called "benzos," this class of anti-anxiety medication can be addicting (think Valium, Klonopin, Xanax), therefore, some patients may opt for kava. "Kava has been found effective as soon as after one to two uses and is non-habit-forming, which is a big win," says Jain. "Studies have shown kava significantly reduces stress and anxiety with no side effects related to withdrawal or dependency, which are common with conventional drugs," says Dr. Sadeghi. "A review of 11 additional studies came to the same conclusion."
"It also doesn't have the typical sedating effect that you would experience with other anti-anxiety treatments, and doesn't impair reaction time," says McCrae.
Julia Getzelman, M.D., a pediatric physician in San Francisco, calls kava "an excellent option"—particularly for "averting a panic attack and is good for decreasing test anxiety, stage fright, or fear of flying." (Related: What Happened When I Tried CBD for Anxiety)
2. Kava may treat urinary conditions.
Chadwick cites medical herbalist texts that point to kava's ability to aid with "chronic cystitis—urinary tract infection and inflammation." She said this is especially good for "mucus, pain, or incontinence."
"Kava can be a very useful herb for urinary tract, prostate, and vaginal inflammation, congestion, and discharge," says Chadwick. "The cause of these conditions must be determined prior to using kava as a treatment, but as a part of a skillful herbal combination, kava is an important herb in the treatment of genitourinary conditions."
3. Kava may reduce insomnia.
"Kava's calming effect also plays a role in alleviating insomnia and improving sleep quality," says Dr. Sadeghi. Pharmacist Peace Uche, Pharm.D. corroborates this, saying, "kava may also help improve sleep in patients with anxiety." (Related: Essential Oils for Sleep That'll Have You Dreaming In No Time)
Arielle Levitan M.D., co-founder of Vous Vitamin, has a different take. Though she's an advocate for certain vitamins and supplements, she does not recommend kava for insomnia. "It has been shown to have some minimal effects on insomnia," she says. But due to the risks (which we'll get to) and in her opinion, limited benefits, she advises against it, saying, "there are better options out there."
4. Kava could help with benzodiazepine withdrawal.
If you're coming off benzos, kava may come in handy, says Uche. "Discontinuation of benzos may lead to anxiety, and kava may be used to mediate withdrawal-induced anxiety associated with discontinuing long-term use of benzos."
How Do You Consume Kava?
As mentioned, kava has long been consumed as a ceremonial tea, but that can be hard to dose accurately when you're using kava as a medicinal supplement, says Chadwick. So which way is best? It's up to you. "There is no 'best' delivery for kava," says McCrae. "Teas, tinctures, extracts, and capsules are all possible routes of administration and have pros and cons associated with each. The form and route of administration best suited for the patient needs to be determined by their healthcare provider."
Here are your kava options:
Tea. You've likely seen anti-stress kava teas at natural markets. When consuming kava as tea, be sure that the kavalactone content is listed on the packaging, so you know it actually contains the beneficial compounds, advises Dr. Sadeghi.
Liquid tinctures and concentrates. "Tinctures can be taken straight out of the dropper or mixed with juice to cover the strong taste (that some liken to whisky)," says Dr. Sadeghi. "Liquid forms are concentrated, so a little goes a long way."
Capsules. Perhaps the easiest form of delivery. This is the most convenient way to take kava, says Dr. Sadeghi.
Applied by a doctor/herbalist. "A skilled herbalist may also prepare kava in a topical application or wash for the mouth or vaginal canal, and in muscle rubs or topical applications," says Chadwick.
No matter which way you're using kava, Dr. Getzelman recommends following these kava tips:
Start with a low dose the first time it's used.
Allow 30 minutes for the onset of relief (it doesn't always take effect quickly).
Adjust by increasing the dose until the desired effect is achieved.
How Much Kava Sh0uld You Take?
All the healthcare providers we spoke with emphatically advised starting with a "low dose." But what does "low" mean in this context?
"For every herb or plant medicine, there's a therapeutic dose," says Heather Tynan, N.D. "At this dose, the medicinal effects are seen; above it (how high above is different for each plant) there may be toxic potential, and below it there may not be enough of the medicinal plant components in the system to provide desired benefits."
Kava's therapeutic dose is "100 to 200mgs of standardized kavalactones in about three divided doses per day," according to Tynan. Don't go above 250mgs. She says this is the "safe upper limit" per day. Dr. Sadeghi noted that a 100mg capsule contains around 30 percent kavalactones—meaning, you'd be getting roughly 30mgs of kavalactones from a 100mg kava pill. "Follow instructions for dosing, and always consult your doctor before taking any supplement," he says.
McCrae emphasized that dosing is dependent on the person, and to let a healthcare practitioner determine the right dose for you. "What may be a low dose for one person could be a high dose to someone else."
Potential Side Effects from Kava
If you have any experience with kava, you may know that common sensations include tingly numbness in the mouth and tongue, and sensation of euphoria. If not, the effects can be startling at first.
Numbness in the mouth. As mentioned, numbness is normal (to a degree). "Don't be alarmed if you've added kava powder to a smoothie or brewed kava tea and your mouth feels numb and tingly!" says Tynan. "The numbing effect, a sensation similar to that of cloves or echinacea, is a normal, natural response."
Relaxation and euphoria. "Some people report a feeling of quick-onset stress relief, a 'light' feeling similar to a deep relaxation," says McCrae. "This is what some people would report as euphoria. Kava does not make you high, but can produce a feeling of wellbeing that is extremely enjoyable for some people." Note: If you're too relaxed, you may have had too much. "Higher doses of kava can be sedating and cause drowsiness and impaired focus and attention," says Chadwick. "This usually only occurs after long-term, chronic use," she says.
- Skin problems. Tynan and Chadwick both say to watch your skin while taking kava. "Dry, itchy, hyperpigmented skin that becomes scaly is a characteristic effect of high kava intake," says Tynan. This goes away once you stop using kava. Jain called this "kava dermopathy," and Chadwick says this is the "most common adverse reaction to kava." She advised paying close attention to "the palms of the hands, soles of the feet, forearms, back, and shins," and taking a break from kava if you notice any of these symptoms. (Related: This Is Why Your Skin Feels So Itchy Right Before You Fall Asleep)
Severe (see a doctor immediately):
All of the following are indicators of liver failure: the most feared response to kava. "Liver injury progressing from hepatitis to fulminant liver failure," is the top risk, according to Thurlow. Watch out for the following (and stop taking kava immediately if you experience any of these symptoms):
Yellow skin and eyes
Is It Safe to Take Kava?
The most debated topic is kava's potential toxicity to the liver. As mentioned above, the supplement has been banned in certain countries, including France, Switzerland, the UK, and Canada (it's also strictly regulated in Australia, and was temporarily banned in Germany). Though some medical sources have advised against taking kava, others have said it's perfectly safe.
"There has been some concern with liver toxicity partly due to kava's ability to prevent the liver from fully breaking down certain drugs a person may be taking," explained Dr. Sadeghi. This is not ideal, because "The buildup of these unassimilated drugs over time is what has the potential to harm the liver," he says. (Keep reading for specifics drugs that have negative interactions with kava.) Additionally, he warned that shady supplement "brands" are cutting kava with potentially harmful ingredients. "Cheap versions of kava where manufacturers use stems and leaves (which are toxic) in addition to the root to save money have also been known to harm the liver." (Related: How Dietary Supplements Can Interact with Your Prescription Drugs)
"Concerns for safety are heightened also by contaminants with mold, heavy metals, or solvents used in processing," says Thurlow. She specifically advises against the consumption of kava due to these risks and the risks of liver injury. (Those things might be hiding in your protein powder, too.)
Tynan says it's safe if you're taking the proper dose. "All precautionary warnings considered, no toxic effects have been noted in controlled studies observing the effects of kava when taken at the therapeutic dose," she says. "Liver enzymes have not been shown to elevate until doses greater than nine grams a day are ingested, which is much higher than the therapeutic dose and even what's considered the safe upper limit. Bottom line: Stay within the therapeutic dose range."
McCrae acknowledged the studies on liver toxicity and noted that it's "very rare" to experience this. "Researchers haven't been able to reliably replicate its [liver toxicity]. This means that some research data has shown a correlation between the intake of kava and liver toxicity, it does not, however, demonstrate that the intake of kava causes liver toxicity."
Why might some people have experienced this negative effect? As Tynan mentioned, taking such a high dose. Additionally, some subjects may have been taking another medication at the same time, says Dr. Sadeghi. "Other studies have found no liver damage in people taking kava over the short-term (one to 24 weeks), especially if they're not taking medications at the same time," he says.
In McCrae's opinion, kava "generally poses minimal risk," when "taken at low doses, occasionally, and for a short term."
Is Kava Contraindicated with Anything?
Yes. It's essential to discuss adding kava to your regimen with a doctor and your pharmacist.
Anesthesia: "Avoid kava two weeks prior to surgery to avoid potential anesthesia interactions," says Tynan.
Alcohol: Jain, McCrae, and Chadwick all advise against combining alcohol and kava as it can strain the liver, and tax the central nervous system as both kava and alcohol are depressants.
Tylenol (acetaminophen): Taking this with kava increases the demand and stress on the liver, says Chadwick.
Barbiturates: These are a class of drugs sometimes used to induce sleep, which are central nervous system depressants.
Antipsychotics: This class of medications is primarily used to manage psychosis, principally schizophrenia and bipolar disorder.
Benzodiazepines: These "can have a large number of side effects which can include sedation and memory problems, and should not be combined with any other medications or supplements without first checking with a healthcare provider," says McCrae.
Levodopa: This drug is often prescribed for Parkinson's disease.
Warfarin: This is an prescription anticoagulant (aka blood thinner).
Who Should *Not* Take Kava?
According to Thurlow, anyone who falls into the following categories should avoid kava:
Pregnant or breastfeeding
Anyone with preexisting liver complications
Anyone with preexisting renal complications
Also, "Caucasians are more susceptible to side effects than Polynesians," who are from the same local area as the plant itself, according to Thurlow, who suggests "CBD, magnesium, or valerian root" as an alternative.
You should avoid kava if you have severe anxiety or depression, Parkinson's, and if you're about to operate machinery (like a car, for instance—don't kava and drive), recommends Tynan. And kava should be avoided by "people with epilepsy, any seizure disorder, schizophrenia, or bipolar depression," says McCrae.
How Long Can You Take It?
You shouldn't take kava as a daily supplement—even advocates of kava agree about that. "If you're depending on these relatively higher doses of kava regularly, it's time to get down to the bigger question anyway: what stressors in your life, and/or your reaction to them, are so great that you need daily self-medication—even if it's with a medicinal plant?" says Tynan. "Just like other herbs and pharmaceuticals, the drug or supplement is not the fix; it does not actually address or correct the underlying issue."
"When I work with patients with anxiety, it's important to look at the individual, how anxiety is presenting for them, their particular symptoms, and to understand why these symptoms are arising," says Chadwick. "If indicated for the individual person and presentation, I may prescribe kava short-term or in combination with other herbs to reduce symptoms temporarily while the underlying causes are addressed."
If you're taking it for anxiety, may need to take it for five weeks, says Uche. "Dosing and duration of treatment for anxiety is unclear, but studies hint at a minimum of five week treatment for symptom improvement," she says. At most, cap it at roughly six months, advises Tynan. "Studies have shown 50-100mgs of kavalactones three times a day for up to 25 weeks to be safe," she says. "However, studies on long term consumption are more difficult to obtain and are lacking."