Kava: A Story of Misinformation and Resilience (Part 2/3)

A group of kava farmers in Vanuatu

Published in The Fiji Times on March 19, 2024

This series details kava's rise, economic impacts, and recent positive developments as it continues to gain popularity worldwide, overcoming stigma and misinformation.

Moving Past Misinformation

With claims of liver toxicity scientifically debunked (as described in Part 1), a separate hypothesis suggests the products were adulterated. Later, it emerged that one of the German companies was sourcing raw kava from a source of unclear origins. There are over 200 kava plant varieties, and so-called “non-noble” strains are not suitable for the making of the drink because they are more likely to cause nausea. As the initial kava boom in the West took off in the 1990s, deprivation and greed in the Pacific fuelled low-equality exports. Dr. Lebot is aware of some producers who sold whatever they had – residues, peelings, stems, leaves, tudei (“two-day”) varieties, wild kava – to unscrupulous Western buyers. Vanuatu acted swiftly to pass the Kava Act, which largely prohibits sales of non-noble varieties.

Dr. Mathias Schmidt, the foremost European expert on kava, from consultancy Herbresearch Germany, investigated the reports at the time. He agrees that the most likely scenario relates to the supply chain. “The relatively sudden development of reports of alleged hepatotoxity might point to a problem with raw material quality associated with some of the implicated kava preparations,” he says. “The selection of the ‘two-day’ variety Palisi was made in 1997, the first harvest must have been brought to the extraction company in 1998, and the first cases in Switzerland occurred in 1999, all 10 between 1999 and 2000 with the acetone extract.”

Economic Impact on Kava-Producing Nations

Regardless, the reputational damage to the popular herbal remedy was vast. The consequent economic damage was even greater. In Samoa alone, it was estimated to have been $3 billion (USD). The WHO report acknowledges that the bans “unnecessarily harmed the economies of the Pacific Island kava-producing nations and denied patients an effective treatment for anxiety.” The US held out on a ban, only issuing a health advisory warning. “What we are saying is: ‘OK, consumers, if you are taking kava you should be aware of this pattern,’” Food and Drugs Administration spokesperson Ruth Welch said at the time. “We’re saying there is some reason for concern, but we do not have a biological explanation for this.”

But across much of the rest of the world, kava was banned. Interventions from advocates made little headway. Dr. Lebot and a few notable others continued to petition authorities, while some of the kava companies that had suddenly lost access to their markets lobbied and took legal action.

Germany Repeals De Facto Ban

In 2015, after courts ruled that the data did not support the hepatotoxicity allegations – originally from scientists who observed hospital admission reports – Germany repealed its de facto ban on all kava-containing preparations. The decision came after The Federal Institute for Drugs and Medical Devices (BfarM) was sued by around a dozen kava companies that were negatively affected by the initial ban. The following year, the WHO report deemed the kava beverage as “low risk” after two safety reviews. It said that clinical trials examining the efficacy of kava extracts to treat occasional anxiety, although limited, had not identified adverse health effects. “On balance, the weight of evidence from both a long history of use of kava beverage and from the more recent research findings indicate that it is possible for kava beverage to be consumed with an acceptably low level of health risk.”

Pacific-Rim Research and Response

In New Zealand, which never took action – seemingly cognisant of how any ban would invoke the ire of the Pacific population – kava is classified as a food, reflecting how safe it is considered. A landmark 2013 clinical study published in the Journal of Clinical Psychopharmacology found that kava use significantly reduces symptoms of anxiety disorder. Dr. Jerome Sarris, lead researcher from the Department of Psychiatry at the University of Melbourne, said: “We've been able to show that kava offers a potential natural alternative for the treatment of chronic clinical anxiety. Unlike some other options, it has less risk of dependency and less potential for side effects.”

In 2022, the joint Australia-New Zealand food standards regulator issued an updated risk assessment, which acknowledged that “in rare cases,” there have been reports of liver toxicity following consumption of kava and complementary medicines containing kava. “The etiology of these cases is not well understood but may relate to factors including use of non-historical varieties of kava plants, methods of extraction, drug interactions, or aflatoxin contaminated kava,” it said.

However, it is widely accepted that long-term, copious kava consumption can lead to a dry, scaly rash. A 2004 expert report by Phytopharm Consulting, published in Seminars in Integrative Medicine, said that “during its long-term traditional medical use, kava has not shown any severe side effects, such as hepatotoxicity.” It acknowledged the kava-induced skin reaction, known as “kava dermopathy”, but said the condition was benign and would recede without treatment if the individual stopped consuming the non-addictive beverage.

In hindsight, reactions of individual countries that instituted an outright ban on kava would now seem to have been premature.  With more than twenty years having passed since these issues surfaced, it is time for countries to re-evaluate these decisions and pave a pathway for the re-introduction of kava.