Traditionally, whenever the people of the South Pacific islands wanted to welcome a visitor or provide a social lubricant for communal rituals, they drank a potent potion made from the roots of an intoxicating pepper plant, kava kava.
The jaw-breaking job of turning the tough root of the piper methysticum into homemade brew fell to young virgins — male or female, depending on the island — who spent hours chewing the root, then spitting out the masticated mush into a communal pot, where it was left to mature for several hours before being quaffed.
The effects, says herbal “medicine hunter” and kava promoter Chris Kilham of Lincoln, were nearly instantaneous: a feeling of profound well-being and relaxation.
What more could one ask? Okay, maybe a little scientific validation. And access.
Westerners are beginning to get both. In fact, although there are other herbs that are said to allay anxiety, it’s kava that seems poised to take off like St. John’s Wort, the herbal antidepressant that was virtually unheard of a couple of years ago in this country and now commands $200 million a year in sales.
“The kava market has come out of nowhere. It’s gone from next to nothing to $40 to $50 million in sales in one year,” says Thomas Aarts, executive editor of the Nutrition Business Journal in San Diego. At that, it’s still a small chunk of the booming business in dietary supplements, which has grown 14 percent a year for the last three years to $11.5 billion now, driven in part by the popularity of herbals.
“Kava is a hot herb,” agrees Matthew Patsky, a stock analyst who specializes in the natural food and nutrition industry for Adams, Harkness & Hill, a Boston investment bank. “It works great for me.”
Others say kava induces a state of relaxation without fogging the mind as some prescription tranquilizers can. Kava produces “a delightful feeling,” enthuses Kilham, who consults for herbal products companies that import or market kava.
Since many things that sound too good to be true are, some caveats: The scientific evidence on the benefits and possible risks of kava is still limited. There have been 38 double-blind, placebo-controlled studies on St. John’s Wort, also known as hypericum, says Dr. Harold Bloomfield, a California psychiatrist who has written a book on it.
By comparison, there are only a half dozen decent studies on kava, he says. “We need many, many more — this is preliminary research at best.”
Dr. Steven E. Hyman, director of the National Institute of Mental Health, agrees, calling the kava data “quite weak.” But NIMH is intrigued enough that it may fund research on it.
If the research is not yet there, the need is: An estimated 23 million Americans wrestle with crippling, life-wrecking, chronic anxiety, and millions more suffer milder forms.
Granted, there are mainstream treatments available, including anti-anxiety drugs like Valium, Xanax and Klonopin, which are often effective but can cause cause physical dependence. Non-habit forming drugs like Prozac, an anti-depresssant, also work against anxiety, as does cognitive-behavior therapy and other “talking” psychotherapy.
Despite all this, there’s still enough angst out there that the potential demand for herbal tranquilizers is huge.
You should, of course, consult your doctor before self-medicating for severe anxiety — or any other serious medical problem. But if you decide to try kava, here’s what you need to know.
The active ingredients in kava go by two interchangeable names: kavalactones or kavapyrones. Check the label — it should say each capsule is “standardized” to roughly 75 milligrams of kavalactones or kavapyrones, meaning the concentration is consistent from batch to batch. (Note: Kava pills come in varying strengths — from 100 to 250 mg — and the percentage of kavalactones also varies. A 250-mg capsule of 30 percent extract would contain 75 mg of kavalactones.)
The German Commission E, a government-appointed panel that reviews herbal remedies, has approved kava to combat anxiety, stress and restlessness and recommends a dose of 60 to 120 milligrams a day of kavapyrones.
Gail Mahady, a pharmacist and plant medicine specialist at the University of Illinois, adds that side effects are apparently rare. A monograph she’s writing for the World Health Organization will endorse the use of kava for anxiety symptoms.
Some people are allergic to it, however, especially those with known allergies to pepper, and kava can cause a temporary yellowing of the skin if used too long. The German commission recommends using it for not more than three months and says pregnant or nursing women and people with serious depression should not take it at all.
For many people, though, kava appears to be both safe and effective at the recommended doses, says Varro Tyler, a plant medicine specialist emeritus at Purdue University.
In fact, six carefully-done studies of kava extracts, all done in Germany since 1989, show kava is “quite satisfactory” when compared to a placebo or a prescription anti-anxiety drug such as oxazepam (Serax), Tyler adds.
Kava is not only a potent muscle relaxant, it also acts, just as alcohol and prescription anti-anxiety drugs do, on so-called GABA receptors in the brain, which regulate anxiety. Kava may also quiet a brain region, the amygdala, which also governs anxiety.
So far, there’s “no evidence of physical or psychological dependence,” adds Dr. David Mischoulon, a psychiatrist and psychopharmacologist at Massachusetts General Hospital.
But even those sympathetic to herbal remedies urge caution, among them Dr. Laura Kramer, a psychiatrist at the American WholeHealth Arlington-Cambridge Center.
Unless your doctor advises otherwise, she says, you should not drive or operate machinery while taking kava because it may make you drowsy. Nor should you take it with other drugs that act on the central nervous system, including alcohol or prescription anti-anxiety drugs like benzodiazepines. At high doses, kava may cause intoxication.
“You have to treat kava as a medication — you have to respect it,” she says.
And start with low doses, about 70 to 85 mg of kavalactones, taken at night, says California psychiatrist Bloomfield. If that’s not enough, he says, take a second pill in the morning.
If, after a week, that is still not enough, you can add a third pill at midday. But once you’re feeling consistently more relaxed, taper down by one pill every few days.
And if, despite three pills a day, you’re still very anxious, don’t waste any more time. Call your doctor.
SIDEBAR 1:
For general information on anxiety, call:
- 1-888-8-ANXIETY, National Institute of Mental Health information line, which will mail you a pamphlet. (You don’t have to dial the `y’ to get through.)
- The Center for Anxiety and Related Disorders at Boston University: 617-353-9610.
- Or you can contact the following organizations:
- National Alliance for the Mentally Ill, 200 N. Glebe Road, Suite 1015, Arlington, Va. 22203-3754. Tel: 800-950-NAMI (950-6264).
- Anxiety Disorders Association of America, Dept. A, 6000 Executive Boulevard, Suite 513, Rockville, MD 20852. Tel: 301-231-9350.
- Freedom from Fear, 308 Seaview Ave., Staten Island, N.Y., 10305. Tel: 718-351-1717.
- American Psychiatric Association, 1400 K Street NW, Washington, DC 20005. Tel: 202-682-6000.
- American Psychological Association, 750 1st Street NE, Washington, DC 20002-4242. Tel: 202-336-5500 or 800-374-2721.
- Association for Advancement of Behavior Therapy, 305 7th Avenue, New York, NY 10001. Tel: 212-647-1890.
- National Mental Health Association, 1201 Prince Street, Alexandria, Va., 22314-2971. Tel: 800-969-6642.
- National Mental Health Consumers’ Self-Help Clearinghouse, 1211 Chestnut Street, Philadelphia, Penn. 19107. Tel: 800-553-4539.
SIDEBAR 2:
Topical reading, for more information on herbal remedies for anxiety, you might read:
- “Healing Anxiety with Herbs,” by Dr. Harold Bloomfield, HarperCollins.
- “Rational Phytotherapy — A Physician’s Guide to Herbal Medicines,” by Volker Schulz, Varro E. Tyler, and Rudolf Hansel, Springer-Verlag N.Y.
- “Kava — Medicine Hunting in Paradise,” by Chris Kilham, Park Street Press.
SIDEBAR 3:
Other herbs may ease anxiety.
Kava is currently the hottest herbal treatment for anxiety, but other plant medicines may also help. Before you experiment, though, talk to your doctor. Many herbs can cause allergic reactions. And don’t take multiple psychoactive drugs of any type — including alcohol and herbals — at the same time, unless a doctor says otherwise.
Among the herbs often used for anxiety are these:
- Valerian. This herb has been used for more than 1,000 years as a minor tranquilizer and sleep inducer. Both the German Commission E and the World Health Organization have reviewed it and deemed it safe and effective. For insomnia, the suggested dose is 450 to 600 milligrams of valerian extract at bedtime. It may take two to four weeks before you see any effect.
Eight placebo-controlled, double-blind studies show valerian reduces the time it takes to fall asleep. Data also suggest that valerian improves mood and scores on a commonly-used anxiety rating scale. But the stuff smells awful, and doses vary. So read the labels and stick to the recommended doses.
- St. John’s Wort. This herbal anti-depressant may also help with anxiety, says the German Commision E, though the data are skimpy. Unlike kava, which works right away, St. John’s Wort — taken as a 300 mg pill three times a day — takes two to four weeks to kick in. Dr. Harold Bloomfield, a California psychiatrist, often starts patients on kava for its immediate effects and adds St. John’s Wort, then tapers off kava as St. John’s Wort kicks in. St. John’s Wort can cause sun sensitivity.
- Chamomile. The German Commission E and WHO approve this for nervous upset and mild insomnia — especially as a tea or extract. Though a 1994 study shows it contains apigenin, an anti-anxiety agent, it’s weaker than valerian and kava. People who are allergic to ragweed, chrysanthemums, and other plants in the daisy family should avoid it.
- Passion Flower. Hops. Lavender. Lemon balm. All these herbs are approved by the German Commission E, but there’s little scientific data to support their use for anxiety.
- Catnip. Pure folklore. There are few, if any, studies of its safety and efficacy. (Like valerian, catnip jazzes up cats but sedates people — for utterly mysterious reasons.)