THE SOLUTION TO TODAY’S PROBLEMS OF STRESS AND ANXIETY?
Throughout life, we each experience the anxiety of the unknown and the inevitable stress of our responsibilities combined with our limited supply of time. New technology, a strong economy, and increased competitiveness for jobs in the work force seem to usher in increased stress and anxiety. Although many dismiss this as a natural part of life, the health arena asserts the detrimental side effects of continual stress upon one’s body. In fact, "experts attribute almost 60 percent of doctor visits to stress-related ailments, including high blood pressure, arthritis, and cancer (http://www.doctorcass.com/html/kava_book.html)." In the past, the only mainstream options for treating excessively harmful stress and anxiety were prescription drugs, such as Valium, Xanax, Librium, Diazepam, and Elavil (http://www.herbsnow.com/anxiety.htm), which often result in addiction and unwanted sedation. Due to the increasing need for stress relief and the adversely detrimental effects of the prescription drugs available, there is a need for alternatives to psychiatric medications. According to Lehmann, Klieser, Klimke, Krach, and Spatz (1989, p. 258), the success of benzodiazepines (anti-anxiety prescription drugs) is being continually questioned, "especially because of the problem of addiction, and other side effects". Seeing this need, the herbal supplements market, including the Internet market, has overwhelmed consumers with possible better and safer solutions to fill the void left by psychiatric anti-anxiety medications. Among these relatively new alternatives, Kava-Kava has been pronounced as "the next blockbuster herbal remedy (http://www.betterlivingusa.com/kavapaper.htm)" by its advertisers. However, in order to affirm Kava-Kava as both a safe and effective alternative to addictive and sedating prescription medications, careful attention must be paid to the claims, explanations, and support offered by the online market. In addition, substantiated clinical studies and reviews from peer-reviewed journals must be summoned to validate the value of Kava-Kava as a candidate to fill the role of an alternative to anti-anxiety psychiatric treatments.
ARE MADE ABOUT THE USES AND BENEFITS OF KAVA-KAVA?
ANY HARMFUL SIDE EFFECTS FROM KAVA-KAVA?
HOW ARE THE
CLAIMS ABOUT KAVA-KAVA SUPPORTED?
Originating from the South Pacific as a favorite drink of the Pacific Islanders, the plant known as Kava-Kava (Pipper Methysticum Forster) is a member of the pepper family. The brownish root of the plant, known as Waka, is sun-dried, ground into powder, and mixed with water to create the therapeutic drink known by the name of the plant, Kava-Kava (http://www.kavakure.com/WHATISKA.htm). Although only recently advertised in the United States, Kava-Kava, also known as awa and yaquona, has been used for thousands of years by Pacific Islanders as a ceremonial drink, social beverage, and therapeutic elixir for relaxation and anti-anxiety. In these cultures, the drink is often drunk by elite chiefs and elders and commonly used for both official and social events, sacred rituals, and for welcoming special guests (http://lavakava.com/aboutkava.htm). However, white man did not discover the drink until Captain Cook’s voyage in 1768-1771 lead to an encounter with Kava at sacred ceremonies (http://lavakava.com/aboutkava.htm). Many years later, in 1995, Killham of Lincoln, Massachusetts finally convinced an American herbal company, Pure World, Inc. to begin a line of Kava products. With the aide of Killham’s book and media relations as well as the actions of the subsequently formed Kava General Committee, Kava-Kava began its rise to the forefront of anti-anxiety treatments and herbal remedies in the United States (http://www.betterlivingusa.com/kavapaper.htm).
On the Internet, many resale sites market Kava-Kava products, making several claims about the therapeutic uses of Kava-Kava root. These claims include the following, ranging form the most prevalent and emphasized assertion involving stress and anxiety relief to improvement of social life and emotional well-being:
· Relieve stress and anxiety
o Without the unwanted side effects of sedation, addiction, and impairment of alertness
· "Keep the mind alert while the body relaxes"
o muscle relaxation
o calmed nerves
· Enhance mental awareness, alertness, acuity, concentration
· Provide a restful night’s sleep to insomniacs
· Relieve headaches (particularly tension headaches)
· Relieve PMS symptoms
· Alleviate muscle cramps and aches
While most sites claim muscle relaxation, calmed nerves, and relief from anxiety and tension, some extend their claims to include an overall greater sense of well-being and alleged life-quality improvement and emotional state alterations:
· Improve its user’s social life by reducing social anxiety
o Increase sociability, friendliness, and affiability
· Provide overall greater sense of well-being
o "Enjoy a Greater Sense of Well-Being, Drink Kava Kure Kava"
· Elevate users’ emotional state due to sensations of peacefulness and contentment
o Kava-Kava "brings on a happy, tranquil state"
While very few sites make claims beyond these, further alleged benefits include fighting obesity (http://www.kavakure.com/what_is_kava_used_for.htm) and control of bladder infections (http://www.kayaresource.com/kavakava.html).
Because most of the Kava-Kava sites encountered on the Internet serve to advertise product, many do not mention any undesirable side effects or problems with the use of Kava-Kava. However, some do mention a period of "temporary weakness and dizziness" that follows the promised initial energy (http://www.kavakure.com/what_is_kava_used_for.htm). Cautions are sometimes included, warning customers not to take Kava-Kava products if they are currently using other anti-anxiety drugs, if they have Parkinson’s Disease, if they are pregnant or nursing, or if they have other possible complicating medical conditions (http://www.betterlivingusa.com/herbalremedies.htm;http://www.kavakure.com/kavaDosages.htm). Other noted negative side effects include, "a skin disorder consisting of a scaly rash and eye irritation,…mild dizziness, insomnia, nausea, and gastrointestinal disturbances (http://www.kavakure.com/kavaDosages.htm)."
Although many websites provide little information on medical research concerning the potentially harmful side effects of Kava-Kava, several recorded case studies, clinical studies and reviews address the above noted side effects and the disadvantages of Kava as a psychiatric alternative. Because many studies involve the efficacy of Kava’s active ingredients, the most prevalent information available concerning the side effects of new alternative treatments comes in the form of case studies. In Germany, two case reports discussed a "drug eruption in sebaceous gland-rich areas" (Jappe, Franke, Reinhold, and Gollnick, 1998, p. 104). In the first case report, a 70 year old woman, who had been receiving Kava extract therapy for two to three weeks complained of itching and "erythematous, infiltrated plaques" that surfaced following sun exposure. According to the subsequent biopsy, a lymphocytic infiltrate "penetrat[ed] and destroy[ed] the sebaceous glands and lower infundibula" (Jappe et al., 1998, p. 104). Similarly, a 52 year old woman reported papules and plaques in the second case report. The biopsy then revealed "a prominent infiltrate in the reticular dermis" (Jappe et al., 1998, p. 104). Following the subsequent review of these two case studies, the doctors concluded that the use of Kava can cause a build-up of kavapyrones in sebaceous areas, resulting in skin reactions and lesions in areas with high densities of sebaceous glands, such as the back, thorax, arms, and face. In a case study by P. Schmidt and W.H. Boehncke in Frankfurt, Germany (2000), a 36 year old woman who had been receiving Kava treatment for 3 weeks similarly demonstrated papules, a generalized rash, and severe itching. Although these case studies along are not sufficient to make generalized claims concerning an adverse side effect of Kava-Kava, several reviews and clinical studies also identified a "characteristic rash" in connection with the consumption of Kava-Kava (Mathews et al., 1988, p. 549). In a review of several clinical studies of Kava, two studies were sited which identified dermatological related side effects of long-term usage (Wong, Smith, Boon, 1998). Both Singh (1997) and Bone (1993/1994) suggested that Kava may cause skin scaling on the extremities of the body due to Kava’s tendency to produce a Vitamin B deficiency. Another review also confirmed scaly dermatitis and ichthyosiform as side affects of Kava usage. Other possible adverse side effects noted by studies include shortness of breath, a puffy face, and quick patellar reflexes (Mathews et al., 1988). Although only arising in 5 or less patients in each trial, a review of seven trials noted complaints of stomach irritation, restlessness, headaches, tremors, and drowsiness (Pittler and Ernst, 2000).
Because most Kava-Kava sites are aimed at an audience of average consumers and perspective buyers rather than researchers and scientists, detailed scientific descriptions of how Kava-Kava works are rare on the Internet. A few Kava-Kava sites briefly explain that the root of the plant contains a high concentration of the active ingredient known as Kavalactones or Kavapyrones (http://kavakure.com/WHATISKA.HTM; http://www.kayaresource.com/kava/ingredients.html) and that this ingredient interacts with the central nervous system to produce the calming effects of Kava-Kava (http://herbsnow.com/anxiety.htm). However, the Alden Botanica site, a distributor of Kava products, refers its customers to Dr. Hyla Cass’s book "Kava: Nature’s Answer to Stress, Anxiety, and Insomnia", which can be accessed online (http://aldbot.com/ch7Cass.htm). In her book, Dr. Cass provides a more in depth scientific explanation for the effects of Kava-Kava upon the body. Dr. Cass explains how Kava curtails the "activity in the spinal part of the nervous system rather than in the higher centers of the brain", allowing it to relax the body without sedation unlike other anti-anxiety drugs. In addition, Kava affects the limbic system, "the emotional control center", to treat insomnia without sedation (http://aldbot.com/ch7Cass.htm).
Within the world of advertisement, especially on the World Wide Web, advertisers often fail to specify supporting research, evidence, and studies to justify the validity of their claims. While almost all sites avow that Kava-Kava has been "proven" and that "studies and research shows" its effectiveness, many sites only cite limited clinical studies while others rely solely on testimonials and media excerpts to support their claims. Two Kava-Kava sites in particular, http://nutrition-and-health.com/kavakava.htm and http://apothecaryon-line.com/lib/apothecary/kavakava.html, assert Kava’ ability to relieve anxiety, kill pain, reduce social phobia, and alleviate insomnia but provide no proof or backing. However, most other Kava sites employ some form of support for their claims, including cited studies, testimonials, and published books. Kava Kure’s advertisement refers to two German studies, Volz (1997) and Singhi (1988), that help explain Kavalactones’ psychoactive and muscle relaxing characteristics (http://www.kavakure.com/WHATISKA.HTM). Although Kava’s anti-anxiety capability, among other claims, remains unsupported by scientific research, the Kava Kure site employs testimonials and excerpts from widely respected media sources to provide validity to their other claims. Statements from ABC News Primetime, Dateline, and 20/20, such as "Kava…is being hailed by top researchers as a modern-day stress-buster", are quoted to convince customers (http://www.kavakure.com/ARTICLES.HTM). However, because no laws hold advertisers responsible for the honesty of such endorsements, customers should still be cautious concerning apparent endorsements from even the most reliable sources. Similarly, the LavaKava site repeatedly champions Kava as a "proven" remedy, yet fails to provide proof of clinical research that proves Kava-Kava to be a remedy and only supply testimonials to back the claims. Although the testimonials by health-field professions are more substantial than the praises of average customers, testimonials still fall short of clinically proving a products’ success (http://lavakava.com/Experiences.htm). In contrast to the limited support provided by most sites, both Herbs Now and Alden Botanica substantiate their claims with clinical studies, as well as thorough explanations of the findings and conclusions. At the Herbs Now site, the advertisement for Kava-Kava includes results of a clinical study in Herbal Gram (No.39), in which either Kava (100mg) or a placebo were administered to 58 subjects. The Kava patients experienced "a significant reduction in anxiety symptoms as compared to the group taking the placebo" after one week and the reduction continued throughout the study "without any side effects" (http://www.herbsnow.com/anxiety.htm). By providing the online resource of Dr. Hyla Cass’s book, Alden Botanica employs the most extensive support for claims concerning the uses of Kava-Kava. Not only does Ch.8 of her book expound upon several German clinical studies and their conclusions, but Dr. Cass also documents an extensive list of references. According to Dr. Cass, researchers have performed six double-blind studies where neither the administrator/evaluator nor the treatment recipient knew who was receiving a placebo and who was receiving the treatment. When compared to the placebo, Volz’s study in 1997 and a similar study in 1996 demonstrated Kava’s reduction of anxiety and depression. In addition, emotional and muscular relaxation were documented in a 1989 Kava study. When compared to benzodiazepines (prescription anti-anxiety drugs), a 1993 study "seems to confirm the claim that kava, as opposed to benzodiazepines, does not sedate" and, rather than "impairing mental sharpness, it actually improves it". In another double-blind study in 1993, "kava matched both drug groups in improving anxiety scores as measured by the Hamilton Anxiety Scale" (http://aldbot.com/ch8cass.htm). Through Dr. Cass’ book, the Alden Botonica site extensively discusses the results of the major Kava-Kava studies performed to date, all of which are German clinical studies. While the other sites fail to fully substantiate their claims, Dr. Cass employs all available studies to support the claims about Kava-Kava’s effectiveness.
In order to truly determine the validity for Kava-Kava’s benefits, direct research of the medically documented clinical studies and peer-edited reviews is necessary. By going outside the advertisement market to the direct source of medically valid documentation, the possibility for biased reporting and exaggeration greatly diminishes and, therefore, the conclusions truly indicate the usefulness of Kava-kava as a n alternative to prescription psychiatric medications. Although the majority of the studies investigating Kava are German, some clinical studies have been translated and are published in American medical journals. In addition, experts have reviewed groups of studies and published several review papers explaining and summarizing the recent discoveries and determinations concerning Kava’s effectiveness. One such German study performed at the University of Dusseldorf (Lehmann, Klieser, Klimke, and Spatz, 1989) sought to evaluate the efficacy of Cavain, another term for the active ingredient in Kava extract in treating anxiety. In a randomized double-blind trial, 56 patients with DSM-III diagnoses of panic syndrome, generalized anxiety syndrome, disturbance of adaptability, or phobic disturbances were evaluated using the Hamilton Anxiety Scale (HAMA) and the global therapeutic efficacy rating over a period of 28 days. To compare the treatment group to a control group, patients were randomly divided into two groups, with 29 of the patients receiving Cavain and 27 receiving a placebo. In the final comparison of the two groups, the two variables, HAMA score reduction and physician’s global impression of therapeutic effect, "prove equally that Cavain, as opposed to placebo, had a significant anxiolytic effect" (Lehmann et al., 1989). Besides confirming Kava’s ability to relieve anxiety, the study also validated other claims, such as sound sleep and physical relaxation without any indication of addiction. With much greater medical validity and unbiased reporting, the Lehmann (1989) study confirmed several of the key claims asserted by Kava-Kava advertisers. Similarly, a review and meta-analysis of three double-blind trials showed "a significant difference in the reduction of the HAM-A total score from baseline in favor of Kava extract compared with placebo" (Lehmann et al., 1989, p. 85). With increased accuracy due to the collaboration of statistics from several studies, this meta-analysis and review add further support for Kava-Kava as a "relatively safe" (Lehmann et al., 1989, p. 88) and effective anxiety reducer. Finally, another review of several studies again confirmed the usefulness of Kava as asomatic and psychic anxiety treatment. With particular reference to two randomized, double-blind, placebo-controlled studies, Lehmann, Kinzler, and Friedemann (1996) and Volz and Kiesser (1997), both of which were mentioned by Dr. Cass at the Alden Botanica site, the review substantiates Kava’s ability to reduce HAM-A results and curtail anxiety. Besides confirming Kava as an effective anxiolytic, studies and reviews also reveal the superiority of Kava compared to benzodiazepines (prescription anxiolytic drugs) by demonstrating Kava’s maintenance of mental activity and cognition. In a German double-blind, placebo-controlled, crossover-designed study (Munte, Heinze, Matzke, and Steitz, 1993), 12 male subjects were randomly assigned to three groups, one which received Kava extract, another which received a benzodiazepine known as oxazepam, and a third which received a placebo. After analysis of the Word Recognition Task results and the ERP readings, which identify neural activity that corresponds to cognition and other brain activities, oxazepam adversely and significantly affected reaction time as well as response correctness. On the other hand, kava actually produced memory enhancement and a larger ERP difference, although to lesser degree of significance compared to oxazepam’s impairment. Verifying and confirming these results, a review sting several studies including this one (Singh 1997; Russel 1987; Heinz 1994) also noted that "kava appears not to adversely affect cognitive function, mental acuity, or coordination" (Wong et al., 1998, p. 1036). In addition, a study performed on an Aboriginal community in Australia found similar cognition test results (Mathews et al., 1998). In this study, Kava users and non-users were classified, randomly sampled, and asked to participate in an extensive study of the effects of long-term Kava usage. Thirty-nine Kava users and 34 non-users were blindly assessed and compared by means of urine-samples, health questionnaires, clinical examinations, and memory-cognition testing. According to the memory and cognition tests, no memory or cognition deterioration could be identified in relation to Kava usage, affirming the claim that Kava can relax the body without impairing memory or cognition. Differing form the previously discussed results, the Mathews study also identified a significant decrease in skinfold thickness and body mass index, apparently supporting the obscure claim of weight loss. However, upon further inspection, the weight loss is "attributable directly to the malnutrition that is associated with the use of kava" (Mathews et al., 1988, p. 554) in this particular Aboriginal community, which possible results form the cost, time, and loss of appetite that accompany Kava usage. Besides this disadvantage, the study suggested a correlation, either direct or indirect, between kava usage and liver and renal dysfunction, rashes, eye irritation, pulmonary hypertension, red blood cell abnormalities, and shortness of breath.
Overall, Kava-Kava is harolded throughout the World Wide Web as a herbal remedy for anxiety and stress and a natural alternative to sedating prescriptions. However, consumers must scrutinize the claims made concerning Kava-Kava, considering the central purpose of the majority of the sites. Although a few sites are merely for informative purposes (http://kayaresource.com/kavakava.html;http://www.healthyideas.com/healing/oncall/980303.doc2.html;http://www.herbs.org/current/kava.html), the other Kava sites mentioned above sell products through the online market. Profit possibly motivates exaggerated and unjustified claims concerning the benefits of Kava-Kava among many advertisers. Therefore, when considering the validity of Kava-Kava claims and the efficacy of Kava as the much-needed alternative to prescription psychiatric medications, the focus must be upon the medically documented reviews and clinical studies. However, in the case of Kava, studies, reviews, and meta-analysis confirm the most prevalently asserted benefits of kava extract treatment. By means of statistically sound methods including double-blinding and placebo-controlling, the studies unbiased demonstrate the effectiveness of Kava as an anti-anxiety treatment free from the adverse side effects of addiction and cognition impairment associated with other anxiolytic drugs. However, consumers must still scrutinize advertisements. Many of the more dramatic claims concerning emotional well-being and quality of life are most likely exaggerations and merely advertising enticements. Unlike anxiety which lends itself to testing due to well-developed and widely-accepted tools such as the Hamilton Scale, variables such as peacefulness and quality of life are difficult to accurately test in a scientific and medical setting and are therefore unsubstantiated claims. In addition, as with almost all medications, there are minor adverse side effects to Kava usage, such as skin irritations, rashes, and stomach irritation. Nonetheless, Kava-Kava appears to be a reliable herbal remedy that could be useful in the reduction of stress and anxiety. By providing a safer and beneficial alternative to prescription psychiatric medications, Kava-Kava could be the solution to today’s problems of stress and anxiety.
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