Kava (or kava-kava) has an important place in the cultures of many islands of the South Pacific. Traditionally, it was painstakingly prepared and consumed with great ceremony and considered a sacred drink.
It was also used to greet important visitors and in other ceremonial occasions, but elders in the community also drank it in the course of the day.
The name kava carries the meanings of “sour,” “bitter,” or “sharp,” which may be some indication of the taste of the beverage.
Kava’s pharmacological activity has led to its increasing popularity in the United States, where the Oceanic steps of chewing or pounding are eliminated, and it is taken in capsule form.
In the Pacific, kava is considered to reduce anxiety without dulling the mind. Oliver Sacks has described his experience in The Island of the Colorblind:
The roots were all macerated now, their lactones emulsified; the pulp was placed on the sinewy, glistening hibiscus bark, which was twisted around it to form a long, closely wound roll. The roll was wrung tighter and tighter, and the sakau [Pohnpei for kava] exuded, viscous, reluctant, at its margins. This liquid was collected carefully in a coconut shell, and I was offered the first cup. Its appearance was nauseating-grey, slimy, turbid-but thinking of its spiritual effects, I emptied the cup. It went down easily, like an oyster, numbing my lips slightly as it did so…By the time it [the coconut shell] came back to me, the sakau was thinner. I was not wholly sorry, for a sense of such ease, such relaxation, had come on me that I felt I could not stand, I had to sink into a chair.
The part of the plant used is the rhizome. Human saliva makes the effects stronger, which is why traditional preparation techniques started with chewing.
**Active Ingredients**
A great deal of chemical research has been done on kava, but plants grown in different places appear to vary in composition.
The principal ingredients are alpha-pyrones: methysticin, kawain, dihydromethysticin (DHM), and yangonin, as well as derivatives of these compounds. There are also pigments.
The leaves contain an alkaloid, pipermethystine, which is found in only trace amounts in the roots. Kava alpha-pyrones do not work on the same pathways as narcotics, because the effects can’t be blocked by naloxone.
**Uses**
Although Hawaiian healers used kava for dozens of purposes, there is no question that its use to induce relaxation is not culture-specific.
Tests on animals show that extracts of the drug-but no single identified compound-cause muscle relaxation to the point that animals fall out of revolving cages.
Methysticin and DHM protect animals from muscle convulsions due to strychnine.
Kava was used in Hawaii to reduce anxiety, bring on sleep, counteract fatigue, and treat asthma, arthritis pains, and urinary difficulties.
Kava appears to act as a diuretic, and the root was even used as a weight loss agent.
Medical tests suggest it may be helpful in treating psychosomatic symptoms in menopause.
Kawain acts as a local anesthetic, numbing the lips and mouth. Food eaten after ingesting kava drink cannot be tasted.
**Dose**
60 to 120 mg kava pyrone equivalent.
Clinically tested: 100 mg dry extract standardized to 70 mg kava lactones three times a day.
Kava should not be taken for more than three months except under a doctor’s supervision.
**Special Precautions**
Kava is inappropriate for pregnant women and nursing mothers.
People with depression should avoid the use of kava.
Common sense dictates not driving or operating complex equipment while under the influence of a sedating plant such as kava.
**Adverse Effects**
Effects of kava depend on the dose. The mild euphoria produced by low doses does not interfere with the ability to walk in a straight line, run up stairs, or recall information. At higher doses, people may be unable to move about well.
Kava also affects vision by dilating the pupil and may interfere with visual accommodation. Gastrointestinal upset and allergic reactions, as well as a yellowish tint to the skin, have been reported.
Kava abuse has deleterious consequences. Those who take it daily to the point of intoxication may lose weight, develop a distinctive scaly rash, and have lower counts of albumin, protein, bilirubin, platelets, and lymphocytes in the blood.
In rare cases, shortness of breath, possibly indicating pulmonary hypertension, a serious complication, may develop.
**Possible Interactions**
Kava should never be mixed with alcohol. It can also interact in a dangerous way with other sedative drugs such as barbiturates.
People should not combine it with drugs such as Ativan, Valium, or Xanax. One man who did so actually went into a comalike state.
Combining kava with other sedative herbs, such as valerian, may not be wise.

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