January 18, 2025 • 17 mins
Karen examines the use of kava supplements, exploring their potential benefits for anxiety and their serious risks, including liver toxicity. She highlights key studies on kava's effectiveness, explains its traditional use, and warns of its interactions with medications. She also shares a list of alternative supplements that have been shown to help with anxiety and depression without the significant risks associated with kava.
Visit our website itchyandbitchy.com to read blog posts on the many topics we have covered on the show.
Visit our website itchyandbitchy.com to read blog posts on the many topics we have covered on the show.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered a substitute for professional medical advice. Hello everyone,
(00:22):
this is Karen Nickel, family nurse practitioner, and this is
Itchy and Bitchy, a podcast that provides answers to your
many unanswered health questions. I'm going to remind you again
about my course called the Perimenopause Answer. If you are
going through this phase in life called perimenopause, or if
you don't know if you're in pairimenopause, I would love
to have the opportunity to talk to you about the
(00:44):
course to see if it's the right fit for you.
There is a link on our website Itchyanbitchy dot com
on our Facebook page I N t B Podcast where
you can schedule an appointment for a zoom call with me.
This is a zoom call with me. When you make
this appointment, I will be sitting at my desk waiting
for you to join the one on one zoom call.
(01:04):
One of my course members asked me about the use
of kava supplements. That's kava, kava supplements to treat anxiety.
She heard it mentioned as an option to reduce anxiety
on a quote unquote health podcast. I asked her if
the podcast episode described what kava is, how it's dosed,
(01:28):
or the risks and benefits of the supplement, and she
said they didn't go into any of those details. They
just said it was an option to address anxiety. To
be honest, I was a little perturbed to hear that
someone is out there on a podcast recommending a supplement
like kava without giving credible information about it. If you
(01:49):
are listening to any podcasts that makes supplement recommendations without
giving information about risks, benefits, dosing, how it works, or
if it's been studied, you should probably stop listen listening
to that podcast. Okay, I'll step off my soapbox for
now and share with you that in today's episode, I
will give you all that information about Kava that my
(02:11):
course member did not receive when listening to a different
podcast that discussed supplements for anxiety. In addition to talking
specifically about Kava, I will share with you a list
of supplements that have been studied and shown to have
anxiety reducing benefits. Kava is a member of the Pepper
(02:31):
family and it's a tall shrub that grows in the
islands of the Pacific Ocean. This shrub produces long, green,
heart shaped leaves and long, slender flowers. The roots look
like woody, hairy branches gathered in a bundle. The root
is the part of the plant that is used medicinally.
(02:52):
Kava Lactone is the active ingredient in the kava root.
In Fiji, the plant is called yaquona. In Hawaii, it
is known as ava. In Aboriginal tribes, it is referred
to as grog. Pacific Islanders have used kava for thousands
of years as a medicine for physical relaxation and for
(03:15):
ceremonial purposes. The rituals were done to strengthen ties among groups,
to help reaffirm a person's status, and to help people
communicate with spirits. With traditional cultures, the root of the
plant is crushed, ground and then combined with a mixture
of water and or coconut milk to make it drinkable.
(03:39):
There has been a fair amount of research in people
on the use of kava, specifically for anxiety, but few
studies have been done on other conditions in which kava
has been used. A two thousand and three review of
eleven trials with a total of six hundred and forty
five patients evaluated kava supplements ability to treat anxiety. Varying
(04:03):
doses of the cavalactones. Again, this is the active ingredient
in the kava root. The varying doses from sixty milligrams
to two hundred and eighty milligrams were used in these studies.
These doses are significantly higher than what Pacific Islanders traditionally used.
The length of the studies ranged from one to twenty
(04:25):
five weeks. Ten of the eleven studies showed a decrease
in anxiety compared with placebo. These benefits seemed to be
comparable to the effect of tranquilizers such as benzodiazepines that's
medications like Xanax and adavan, benzodiazepines and the anxiety drug
(04:45):
abuse perone that's a prescription med Side effects experienced by
people in the study included nausea, stomach aches, drowsiness, and headaches.
No liver toxicity was reported. However, no liver tests were
performed in any of these studies. I'll talk about the
liver effects when using kava in a minute. In contrast
(05:09):
to the two thousand and three review of eleven studies.
A twenty nineteen study compared kava with placebo for the
treatment of generalized anxiety disorder in one hundred and seventy
one people. The sixteen week trial of cava did show
a mild benefit compared to placebo, but the findings were
(05:30):
not statistically significant, so the authors of the study concluded
that kava has no long term benefit for generalized anxiety.
In terms of side effects observed in the study, those
who took kava had diminished memory and experienced tremors compared
to those taking a placebo. Also, those who were taking
(05:53):
kava in the study more commonly had liver function test
abnormalities than those taking the placebo. Although some of these
studies have shown positive results for short term relief of symptoms,
we don't have any strong evidence to suggest it is
effective as a long term treatment, and there are concerns
(06:14):
around its overall safety, especially with long term use. In
the US, Kava is not currently recommended as a medicine
or treatment for anxiety disorders. The risks and benefits of
kava and other options to help with anxiety are up
next after this quick break, so please stay tuned. So
(06:54):
what are the benefits of taking kava well. First of all,
kava affects people differently based on their size, weight, and
state of health. Benefits also vary depending on whether the
person is used to taking it, whether other drugs are
taken around the same time, the amount taken, and the
strength of the drug, which can vary from batch to batch.
(07:18):
Keeping those caveats in mind, the effects that may be
experienced by taking kava include feeling happy and relaxed, mild sleepiness,
numb mouth and throat, or reduced or loss of appetite.
The most common use of kava is to address anxiety.
It's also used for stress, for withdrawal from drugs called benzodiazepines,
(07:43):
and to help with sleep. If you are considering the
use of kava for these benefits, please do so under
the direction of a medical professional who knows how to
dose and monitor the use of kava. As I mentioned earlier,
the studies done thus far focused only on anxiety, so
we don't have evidence that kava aids sleep or helps
(08:06):
with tapering off benzodiazepines. Numerous reports of severe liver toxicity
and liver failure have been reported in Europe and the
United States. These findings occurred within a few weeks up
to two years after starting the supplement, with the average
time of liver problems starting at four and a half
(08:28):
months after beginning kava. The US Food and Drug Administration
the FDA advised that kava should be used with caution
in patients with pre existing liver disease or at risk
for liver disease. Kava's impact on the liver ranges from
temporary increases in liver enzymes to acute liver failure. Some
(08:52):
people actually required liver transplants, and even death is seen
from the liver toxicity. Because serious toxicity cases have been reported,
the FDA issued a consumer advisory regarding the potential liver
toxicity related to taking kava. The product has been banned
(09:13):
from many European markets, including Germany, France, Great Britain, and Switzerland.
The Pacific Islanders have used kava for thousands of years,
but they've used doses significantly lower than the doses of
sixty milligrams to two hundred and eighty milligrams that were
used in the studies I discussed earlier. The link of
(09:33):
toxicity to kava is still being debated. Some say that
the kava solution, if it's made in water the way
the Pacific Islanders have used it, is safe, while others
have shown that even this liquid preparation can lead to
liver toxicity. In addition to possible liver injury, other potential
(09:53):
side effects of kava include vision problems, rashes, nauseam, vomiting,
and s seizures. If taken in large doses, possible symptoms
include drowsiness, nausea, loss of muscle control, mild fever, pupil dilation,
and red eyes. Regular use of large amounts of kava
(10:15):
may eventually cause mood swings, apathy, dry scaly skin, malnutrition
and weight loss, and more frequent infections and shortness of breath.
Another thing to consider before starting a kava supplement is
the fact that kava has multiple drug interactions. Kava is
(10:36):
metabolized through the liver using some of the same pathways
that many prescription drugs use, which can lead to excess
amounts of the prescription drugs in the blood. If taking
kava and alcohol together, you can feel more drunk and
increase your risk for liver damage. Taking kava along with
(10:57):
meds like benzodiazepines like xanax or addas and opioids like
hydrocodone may lead to higher sedation and feeling clumsy or uncoordinated,
slow breathing, nauseam, vomiting, memory loss, or passing out. Cava
also interacts with blood thinners, some antidepressants, some meds for
(11:18):
high blood pressure, and anti fungal meds. Yet another kava
warning that you need to know about is what happens
if you are taking kava and need surgery. Since cava
affects the central nervous system, it can increase the effects
of anesesia and other meds that are used during and
after surgery. Stop using kava if you're taking it at
(11:43):
least two weeks before a scheduled surgery. If you are
taking kava and need emergency surgery, make sure the antithesiologists
or nurse anesthetist is informed that you are taking kava.
Additional things to consider Kava is possibly not safe while
someone is pregnant or breastfeeding. It might affect the uterus
(12:06):
while pregnant. Also, some of the chemicals in kava can
pass into breast milk to the breastfed baby and be harmful.
To that sweet little baby. Just don't use kava during
pregnancy and while breastfeeding because of possible liver toxicity that
I described earlier. People who have liver problems should not
(12:28):
take kava since it might make liver disease worse. Also,
people who have Parkinson's disease should not take kava since
it could make that condition worse. I won't go into
detail on the following supplements, but I want to give
you a list of supplements that have been studied to
relieve anxiety and depression. Based on studies, a wide variety
(12:53):
of natural supplements have been shown to have benefit in
reducing depression and or anxiety without all all the complications
of kava. These supplements include fish oil, certain probiotics and prebiotics, kercumin, saffron,
five htp, cbd oil, sam e, dha, ashwagandha, and L
(13:18):
methyl fol eight. Just a reminder that five htp that
I just mentioned is five hydroxy tryptofan, which is a
precursor of serotonin, so some of it will convert to serotonin.
So if you are taking prescription meds that raise serotonin
like an ssri for instance, Prozac, Paxel, lexapro or an
(13:41):
s NRI like effectser or pristique. Make sure you talk
to your healthcare provider before starting five HTP. Too much
serotonin can lead to something called serotonin storm, which causes
mannic like episodes, and you might run out with your
credit card and put five thousand dollars on So we
don't want you to do that. Also, nac in acetyl
(14:04):
systein has been shown to significantly reduce the anxiety related
compulsion specifically to pull hair, known as tricotilomania. Nac is
an excellent brain amino acid. Dosing is usually six hundred
milligrams once daily. If you want to know how to
find high quality supplements that have in them what they
(14:28):
say they have in them, consider getting a subscription to
Consumer Lab. It is a company that does third party
testing on supplements to evaluate if the product contains the
amount of ingredient claimed on the label, if the product
is free of specific contaminants, if the product dissolves properly
(14:49):
so that it may be used by the body, and
if the product meets the level of quality claimed on
the label. It's a super helpful website and their website
is consumer lab dot com. It is worth the investment
for you to be able to look up supplements and
find out what they have approved and which ones are
(15:09):
their top picks. After listening to this episode, I hope
you understand why I am not keen on someone recommending
kava for anxiety without going into the details of this
particular supplement. I appreciate your tuning in so you can
get evidence based information on supplement options. And wherever you
(15:31):
listen to this podcast, please leave a review and rate
the podcast. Your reviews and ratings really really do matter.
I encourage you to visit our Facebook page imb Podcasts,
where you can give us a like and leave comments
or questions for me. Our website is itchymbitchi dot com,
where there are blogs with some of our subjects available
(15:51):
for you to read. On the Facebook page and website,
we have the information about how to schedule an appointment
with me so we can chat about how my paramit
aposuit course can help you if you're going through this
phase in life. As always, thank you so much to
Forest windsl our producer and the composer of our theme music,
and the person who does all the behind the scenes
(16:14):
work to make this podcast possible. Thank you so much.
Forest Forest is about to start his second of Forest
semesters to earn a master's degree in music composition at
the prestigious Peabody Music Conservatory. He is currently composing a
symphonic piece to be performed this April, so exciting. If
you want to listen to some of his music other
(16:34):
than Itchy and Bitchy theme song, which I personally love,
you can go to his website forestwinsl dot com f
O r r E S t w e N t
z e l dot com. Always remember that your health
is in your hands s
The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered a substitute for professional medical advice. Hello everyone,
(00:22):
this is Karen Nickel, family nurse practitioner, and this is
Itchy and Bitchy, a podcast that provides answers to your
many unanswered health questions. I'm going to remind you again
about my course called the Perimenopause Answer. If you are
going through this phase in life called perimenopause, or if
you don't know if you're in pairimenopause, I would love
to have the opportunity to talk to you about the
(00:44):
course to see if it's the right fit for you.
There is a link on our website Itchyanbitchy dot com
on our Facebook page I N t B Podcast where
you can schedule an appointment for a zoom call with me.
This is a zoom call with me. When you make
this appointment, I will be sitting at my desk waiting
for you to join the one on one zoom call.
(01:04):
One of my course members asked me about the use
of kava supplements. That's kava, kava supplements to treat anxiety.
She heard it mentioned as an option to reduce anxiety
on a quote unquote health podcast. I asked her if
the podcast episode described what kava is, how it's dosed,
(01:28):
or the risks and benefits of the supplement, and she
said they didn't go into any of those details. They
just said it was an option to address anxiety. To
be honest, I was a little perturbed to hear that
someone is out there on a podcast recommending a supplement
like kava without giving credible information about it. If you
(01:49):
are listening to any podcasts that makes supplement recommendations without
giving information about risks, benefits, dosing, how it works, or
if it's been studied, you should probably stop listen listening
to that podcast. Okay, I'll step off my soapbox for
now and share with you that in today's episode, I
will give you all that information about Kava that my
(02:11):
course member did not receive when listening to a different
podcast that discussed supplements for anxiety. In addition to talking
specifically about Kava, I will share with you a list
of supplements that have been studied and shown to have
anxiety reducing benefits. Kava is a member of the Pepper
(02:31):
family and it's a tall shrub that grows in the
islands of the Pacific Ocean. This shrub produces long, green,
heart shaped leaves and long, slender flowers. The roots look
like woody, hairy branches gathered in a bundle. The root
is the part of the plant that is used medicinally.
(02:52):
Kava Lactone is the active ingredient in the kava root.
In Fiji, the plant is called yaquona. In Hawaii, it
is known as ava. In Aboriginal tribes, it is referred
to as grog. Pacific Islanders have used kava for thousands
of years as a medicine for physical relaxation and for
(03:15):
ceremonial purposes. The rituals were done to strengthen ties among groups,
to help reaffirm a person's status, and to help people
communicate with spirits. With traditional cultures, the root of the
plant is crushed, ground and then combined with a mixture
of water and or coconut milk to make it drinkable.
(03:39):
There has been a fair amount of research in people
on the use of kava, specifically for anxiety, but few
studies have been done on other conditions in which kava
has been used. A two thousand and three review of
eleven trials with a total of six hundred and forty
five patients evaluated kava supplements ability to treat anxiety. Varying
(04:03):
doses of the cavalactones. Again, this is the active ingredient
in the kava root. The varying doses from sixty milligrams
to two hundred and eighty milligrams were used in these studies.
These doses are significantly higher than what Pacific Islanders traditionally used.
The length of the studies ranged from one to twenty
(04:25):
five weeks. Ten of the eleven studies showed a decrease
in anxiety compared with placebo. These benefits seemed to be
comparable to the effect of tranquilizers such as benzodiazepines that's
medications like Xanax and adavan, benzodiazepines and the anxiety drug
(04:45):
abuse perone that's a prescription med Side effects experienced by
people in the study included nausea, stomach aches, drowsiness, and headaches.
No liver toxicity was reported. However, no liver tests were
performed in any of these studies. I'll talk about the
liver effects when using kava in a minute. In contrast
(05:09):
to the two thousand and three review of eleven studies.
A twenty nineteen study compared kava with placebo for the
treatment of generalized anxiety disorder in one hundred and seventy
one people. The sixteen week trial of cava did show
a mild benefit compared to placebo, but the findings were
(05:30):
not statistically significant, so the authors of the study concluded
that kava has no long term benefit for generalized anxiety.
In terms of side effects observed in the study, those
who took kava had diminished memory and experienced tremors compared
to those taking a placebo. Also, those who were taking
(05:53):
kava in the study more commonly had liver function test
abnormalities than those taking the placebo. Although some of these
studies have shown positive results for short term relief of symptoms,
we don't have any strong evidence to suggest it is
effective as a long term treatment, and there are concerns
(06:14):
around its overall safety, especially with long term use. In
the US, Kava is not currently recommended as a medicine
or treatment for anxiety disorders. The risks and benefits of
kava and other options to help with anxiety are up
next after this quick break, so please stay tuned. So
(06:54):
what are the benefits of taking kava well. First of all,
kava affects people differently based on their size, weight, and
state of health. Benefits also vary depending on whether the
person is used to taking it, whether other drugs are
taken around the same time, the amount taken, and the
strength of the drug, which can vary from batch to batch.
(07:18):
Keeping those caveats in mind, the effects that may be
experienced by taking kava include feeling happy and relaxed, mild sleepiness,
numb mouth and throat, or reduced or loss of appetite.
The most common use of kava is to address anxiety.
It's also used for stress, for withdrawal from drugs called benzodiazepines,
(07:43):
and to help with sleep. If you are considering the
use of kava for these benefits, please do so under
the direction of a medical professional who knows how to
dose and monitor the use of kava. As I mentioned earlier,
the studies done thus far focused only on anxiety, so
we don't have evidence that kava aids sleep or helps
(08:06):
with tapering off benzodiazepines. Numerous reports of severe liver toxicity
and liver failure have been reported in Europe and the
United States. These findings occurred within a few weeks up
to two years after starting the supplement, with the average
time of liver problems starting at four and a half
(08:28):
months after beginning kava. The US Food and Drug Administration
the FDA advised that kava should be used with caution
in patients with pre existing liver disease or at risk
for liver disease. Kava's impact on the liver ranges from
temporary increases in liver enzymes to acute liver failure. Some
(08:52):
people actually required liver transplants, and even death is seen
from the liver toxicity. Because serious toxicity cases have been reported,
the FDA issued a consumer advisory regarding the potential liver
toxicity related to taking kava. The product has been banned
(09:13):
from many European markets, including Germany, France, Great Britain, and Switzerland.
The Pacific Islanders have used kava for thousands of years,
but they've used doses significantly lower than the doses of
sixty milligrams to two hundred and eighty milligrams that were
used in the studies I discussed earlier. The link of
(09:33):
toxicity to kava is still being debated. Some say that
the kava solution, if it's made in water the way
the Pacific Islanders have used it, is safe, while others
have shown that even this liquid preparation can lead to
liver toxicity. In addition to possible liver injury, other potential
(09:53):
side effects of kava include vision problems, rashes, nauseam, vomiting,
and s seizures. If taken in large doses, possible symptoms
include drowsiness, nausea, loss of muscle control, mild fever, pupil dilation,
and red eyes. Regular use of large amounts of kava
(10:15):
may eventually cause mood swings, apathy, dry scaly skin, malnutrition
and weight loss, and more frequent infections and shortness of breath.
Another thing to consider before starting a kava supplement is
the fact that kava has multiple drug interactions. Kava is
(10:36):
metabolized through the liver using some of the same pathways
that many prescription drugs use, which can lead to excess
amounts of the prescription drugs in the blood. If taking
kava and alcohol together, you can feel more drunk and
increase your risk for liver damage. Taking kava along with
(10:57):
meds like benzodiazepines like xanax or addas and opioids like
hydrocodone may lead to higher sedation and feeling clumsy or uncoordinated,
slow breathing, nauseam, vomiting, memory loss, or passing out. Cava
also interacts with blood thinners, some antidepressants, some meds for
(11:18):
high blood pressure, and anti fungal meds. Yet another kava
warning that you need to know about is what happens
if you are taking kava and need surgery. Since cava
affects the central nervous system, it can increase the effects
of anesesia and other meds that are used during and
after surgery. Stop using kava if you're taking it at
(11:43):
least two weeks before a scheduled surgery. If you are
taking kava and need emergency surgery, make sure the antithesiologists
or nurse anesthetist is informed that you are taking kava.
Additional things to consider Kava is possibly not safe while
someone is pregnant or breastfeeding. It might affect the uterus
(12:06):
while pregnant. Also, some of the chemicals in kava can
pass into breast milk to the breastfed baby and be harmful.
To that sweet little baby. Just don't use kava during
pregnancy and while breastfeeding because of possible liver toxicity that
I described earlier. People who have liver problems should not
(12:28):
take kava since it might make liver disease worse. Also,
people who have Parkinson's disease should not take kava since
it could make that condition worse. I won't go into
detail on the following supplements, but I want to give
you a list of supplements that have been studied to
relieve anxiety and depression. Based on studies, a wide variety
(12:53):
of natural supplements have been shown to have benefit in
reducing depression and or anxiety without all all the complications
of kava. These supplements include fish oil, certain probiotics and prebiotics, kercumin, saffron,
five htp, cbd oil, sam e, dha, ashwagandha, and L
(13:18):
methyl fol eight. Just a reminder that five htp that
I just mentioned is five hydroxy tryptofan, which is a
precursor of serotonin, so some of it will convert to serotonin.
So if you are taking prescription meds that raise serotonin
like an ssri for instance, Prozac, Paxel, lexapro or an
(13:41):
s NRI like effectser or pristique. Make sure you talk
to your healthcare provider before starting five HTP. Too much
serotonin can lead to something called serotonin storm, which causes
mannic like episodes, and you might run out with your
credit card and put five thousand dollars on So we
don't want you to do that. Also, nac in acetyl
(14:04):
systein has been shown to significantly reduce the anxiety related
compulsion specifically to pull hair, known as tricotilomania. Nac is
an excellent brain amino acid. Dosing is usually six hundred
milligrams once daily. If you want to know how to
find high quality supplements that have in them what they
(14:28):
say they have in them, consider getting a subscription to
Consumer Lab. It is a company that does third party
testing on supplements to evaluate if the product contains the
amount of ingredient claimed on the label, if the product
is free of specific contaminants, if the product dissolves properly
(14:49):
so that it may be used by the body, and
if the product meets the level of quality claimed on
the label. It's a super helpful website and their website
is consumer lab dot com. It is worth the investment
for you to be able to look up supplements and
find out what they have approved and which ones are
(15:09):
their top picks. After listening to this episode, I hope
you understand why I am not keen on someone recommending
kava for anxiety without going into the details of this
particular supplement. I appreciate your tuning in so you can
get evidence based information on supplement options. And wherever you
(15:31):
listen to this podcast, please leave a review and rate
the podcast. Your reviews and ratings really really do matter.
I encourage you to visit our Facebook page imb Podcasts,
where you can give us a like and leave comments
or questions for me. Our website is itchymbitchi dot com,
where there are blogs with some of our subjects available
(15:51):
for you to read. On the Facebook page and website,
we have the information about how to schedule an appointment
with me so we can chat about how my paramit
aposuit course can help you if you're going through this
phase in life. As always, thank you so much to
Forest windsl our producer and the composer of our theme music,
and the person who does all the behind the scenes
(16:14):
work to make this podcast possible. Thank you so much.
Forest Forest is about to start his second of Forest
semesters to earn a master's degree in music composition at
the prestigious Peabody Music Conservatory. He is currently composing a
symphonic piece to be performed this April, so exciting. If
you want to listen to some of his music other
(16:34):
than Itchy and Bitchy theme song, which I personally love,
you can go to his website forestwinsl dot com f
O r r E S t w e N t
z e l dot com. Always remember that your health
is in your hands s
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