Article date: February 2012
By: Rolf Teschke, Jerome Sarris, Isaac Schweitzer, in Volume 73, Issue 2, pages 170-174
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
• The rhizome of the Pacific kava plant (Piper methysticum) contains as its active constituents numerous kavalactones known for their relaxing properties. Kavalactones are found in aqueous, acetonic and ethanolic extracts of the kava rhizomes. These kava extracts are consumed worldwide and used for recreational purposes as well as to treat general anxiety. Kava use is associated with rare hepatotoxicity.
WHAT THIS PAPER ADDS
• Kava is a Pacific herb consumed worldwide and used for recreational purposes and to treat general anxiety. Kava use is associated with rare hepatotoxicity. The previously proposed Pacific kava paradox was based on kava hepatotoxicity, not observed following use of traditional aqueous extracts in the Pacific region but restricted to use of Western acetonic and ethanolic extracts. However, cases assessed by the WHO report and additional published case reports revealed that traditional aqueous extracts used in New Caledonia, Australia, the USA and Germany may also be hepatotoxic; hence, there is no longer a basis to sustain the previously proposed Pacific kava paradox. It appears that the primary cause of toxicity may be attributed to poor quality of the raw material caused by mould hepatotoxins.
Kava, a Pacific herb consumed worldwide for medicinal, recreational and cultural purposes, has been associated with rare hepatotoxicity, and there is currently a critical need to determine this causation. The previously proposed Pacific kava paradox was based on the theory that kava hepatotoxicity was not observed following use of traditional aqueous extracts in the Pacific region, but was restricted to use of Western acetonic and ethanolic extracts. Subsequent cases analyzed by the World Health Organization and published case reports revealed that traditional aqueous extracts used in New Caledonia, Australia, the USA and Germany may also be hepatotoxic; thus, there is no longer a basis to sustain the previously proposed Pacific kava paradox. It appears that the primary cause of toxicity may reside in the time before the preparation of the various kava extracts, possibly attributed to poor quality of the raw material caused by mould hepatotoxins. Rigorous testing of kava raw material is urgently advised, in addition to Pan‐Pacific kava manufacturing quality standards.
DOI: 10.1111/j.1365-2125.2011.04070.x
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