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Hi'iaka's Healing Herb Garden : Column Index : 2002 : June02
Coming Soon...
Demystifying Some Herb Safety Issues
Recent news stories about herb safety may have left you confused and perhaps fearful about the possible harmful side effects of herbs such as kava kava (Piper methysticum; known as `awa in Hawai`i). There have been reports that kava can be toxic to your liver and that it can interact with prescription medications. In this column, I hope to clear up some of that confusion about herb safety, especially about kava.
We'll first describe what this herb is, what it's used for, and how you can take it. Then we'll review some of the news stories that have appeared recently. Lastly, I'll explain the safety issues, dosages, and drug interactions that can possibly occur when you mix kava and certain other herbs with some prescription medications.
Kava kava is familiar to many people in Hawai`i and throughout the Pacific islands. It has important ritual and cultural significance for all Polynesian peoples and is well-known as a relaxing, pain-reducing beverage. In fact, it is the best-researched herb for promoting relaxation and reducing feelings of anxiety. The active ingredients are a group of chemical compounds called kavalactones. These lactones have a depressant effect, so kava is very useful for conditions such as insomnia, fatigue and nervousness. It also relaxes tense muscles and is helpful for relieving chronic pain such as arthritis because of its diuretic and analgesic effects. As a result of the many laboratory studies that have been conducted on kava, it has been known for many years that the resins in this plant can be hard on the liver and kidneys if taken in large, frequent doses. Yet there is disagreement over whether it is safe to take on a prolonged, daily basis. Traditional kava drinkers claim that it's all right to do so, yet recent news stories seem to indicate otherwise. We'll talk about this later in more detail.
The traditional Polynesian way of taking kava is to dry the root, grind it, and mix it with room temperature water. Traditional kava drinkers believe that this method is safe and can document no cases of people developing liver disease as a result of long-term use. They also believe that kava should not be mixed with hot water or any sweeteners or fruit. However, traditional herbalists often make tinctures and elixirs with many different herbs and fruit, and I believe that these methods of preparation are also safe and that they taste much better than the traditional kava drink. In researching and writing to several experts, including Mark Blumenthal of the American Botanical Council (www.herbalgram.org), I have not been able to find any evidence that mixing kava with fruit sugars is harmful. One of the cautions I have read about kava is that you should not mix it with alcoholic beverages: therefore, tinctures and elixirs made with brandy or vodka should be taken only as directed (in small doses). Kava is also available in capsule form -- you can buy it at drug stores and natural food stores. Again, follow the label directions for safety and don't take more than the recommended dosage.
The press has reported that 28 people in Europe have suffered liver damage after consuming kava. According to an article written by Mark Blumenthal (available on the Internet at www.herbalgram.org), "in three of the cases other potentially hepatotoxic (toxic to the liver) drugs had been taken and concurrent viral infections and alcohol use could not be ruled out... the causality between kava intake and liver reaction is not clear... In many cases, detailed information on the patients' history, co-medication, consumption of alcohol and further particulars are missing, thus not permitting a sound evaluation of these cases." Blumenthal concludes that "the jury is still out on kava safety."
As with many other pleasurable parts of life, we should take kava and other herbs in moderation. Always follow label instructions if you're taking any herb from a pill bottle or in tincture form. If you enjoy a cup or two of kava juice at the farmer's market, continue to do so. But think twice before you drink many cups of the stuff every day. I believe that's where you might get into trouble. Even if you drink too much carrot juice, it can turn your skin a lovely orange color!
Herb-drug interactions can occur, so if you're taking any prescription tranquilizers (brand names such as alprazolam and diazepam or valium), other sedatives such as sleeping pills, anesthetics or analgesics, you should not take kava. Combining drugs of this type with kava might interfere with your mental or motor functions because the herb can magnify the drugs' effects. There have been only a few documented cases of adverse interactions between kava and the prescription drugs listed, according to studies reported in the Herbalgram and Herbs for Health magazines.
Other herbs can interact with prescription drugs as well: St. John's wort, ginkgo, valerian, ephedra, garlic (yes! garlic should not be taken with aspirin or warfarin as it can cause increased bleeding), licorice, ginseng, senna, cascara sagrada, and buckthorn bark are commonly associated with problems of this type. If you would like details, the January/February 2001 issue of Herbs for Health magazine (www.herbsforhealth.com) has an excellent chart with lots of helpful information on potential herb/drug interactions. Other herb magazines are in publication and there are tons of web sites devoted to herbs, so get in the habit of reading about herbs in order to inform yourself about their safety and better yet, their miraculous healing effects and uses.
Demystifying Some Herb Safety Issues
Recent news stories about herb safety may have left you confused and perhaps fearful about the possible harmful side effects of herbs such as kava kava (Piper methysticum; known as `awa in Hawai`i). There have been reports that kava can be toxic to your liver and that it can interact with prescription medications. In this column, I hope to clear up some of that confusion about herb safety, especially about kava.
We'll first describe what this herb is, what it's used for, and how you can take it. Then we'll review some of the news stories that have appeared recently. Lastly, I'll explain the safety issues, dosages, and drug interactions that can possibly occur when you mix kava and certain other herbs with some prescription medications.
Kava kava is familiar to many people in Hawai`i and throughout the Pacific islands. It has important ritual and cultural significance for all Polynesian peoples and is well-known as a relaxing, pain-reducing beverage. In fact, it is the best-researched herb for promoting relaxation and reducing feelings of anxiety. The active ingredients are a group of chemical compounds called kavalactones. These lactones have a depressant effect, so kava is very useful for conditions such as insomnia, fatigue and nervousness. It also relaxes tense muscles and is helpful for relieving chronic pain such as arthritis because of its diuretic and analgesic effects. As a result of the many laboratory studies that have been conducted on kava, it has been known for many years that the resins in this plant can be hard on the liver and kidneys if taken in large, frequent doses. Yet there is disagreement over whether it is safe to take on a prolonged, daily basis. Traditional kava drinkers claim that it's all right to do so, yet recent news stories seem to indicate otherwise. We'll talk about this later in more detail.
The traditional Polynesian way of taking kava is to dry the root, grind it, and mix it with room temperature water. Traditional kava drinkers believe that this method is safe and can document no cases of people developing liver disease as a result of long-term use. They also believe that kava should not be mixed with hot water or any sweeteners or fruit. However, traditional herbalists often make tinctures and elixirs with many different herbs and fruit, and I believe that these methods of preparation are also safe and that they taste much better than the traditional kava drink. In researching and writing to several experts, including Mark Blumenthal of the American Botanical Council (www.herbalgram.org), I have not been able to find any evidence that mixing kava with fruit sugars is harmful. One of the cautions I have read about kava is that you should not mix it with alcoholic beverages: therefore, tinctures and elixirs made with brandy or vodka should be taken only as directed (in small doses). Kava is also available in capsule form -- you can buy it at drug stores and natural food stores. Again, follow the label directions for safety and don't take more than the recommended dosage.
The press has reported that 28 people in Europe have suffered liver damage after consuming kava. According to an article written by Mark Blumenthal (available on the Internet at www.herbalgram.org), "in three of the cases other potentially hepatotoxic (toxic to the liver) drugs had been taken and concurrent viral infections and alcohol use could not be ruled out... the causality between kava intake and liver reaction is not clear... In many cases, detailed information on the patients' history, co-medication, consumption of alcohol and further particulars are missing, thus not permitting a sound evaluation of these cases." Blumenthal concludes that "the jury is still out on kava safety."
As with many other pleasurable parts of life, we should take kava and other herbs in moderation. Always follow label instructions if you're taking any herb from a pill bottle or in tincture form. If you enjoy a cup or two of kava juice at the farmer's market, continue to do so. But think twice before you drink many cups of the stuff every day. I believe that's where you might get into trouble. Even if you drink too much carrot juice, it can turn your skin a lovely orange color!
Herb-drug interactions can occur, so if you're taking any prescription tranquilizers (brand names such as alprazolam and diazepam or valium), other sedatives such as sleeping pills, anesthetics or analgesics, you should not take kava. Combining drugs of this type with kava might interfere with your mental or motor functions because the herb can magnify the drugs' effects. There have been only a few documented cases of adverse interactions between kava and the prescription drugs listed, according to studies reported in the Herbalgram and Herbs for Health magazines.
Other herbs can interact with prescription drugs as well: St. John's wort, ginkgo, valerian, ephedra, garlic (yes! garlic should not be taken with aspirin or warfarin as it can cause increased bleeding), licorice, ginseng, senna, cascara sagrada, and buckthorn bark are commonly associated with problems of this type. If you would like details, the January/February 2001 issue of Herbs for Health magazine (www.herbsforhealth.com) has an excellent chart with lots of helpful information on potential herb/drug interactions. Other herb magazines are in publication and there are tons of web sites devoted to herbs, so get in the habit of reading about herbs in order to inform yourself about their safety and better yet, their miraculous healing effects and uses.
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