Kava

This article is about the kava plant. For the class of pharmacological derivatives, see Kavalactone. For other uses, see Kava (disambiguation).

Kava
Young Piper methysticum
Scientific classification
Kingdom:	Plantae
(unranked):	Angiosperms
(unranked):	Magnoliids
Order:	Piperales
Family:	Piperaceae
Genus:	Piper
Species:	P. methysticum
Binomial name
Piper methysticum G.Forst.

Kava or kava-kava (Piper methysticum) (Piper: Latin for 'pepper', methysticum: (Latinized) Greek for 'intoxicating') is a crop of the western Pacific.

The name kava(-kava) is from Tongan and Marquesan;^[1] other names for kava include ʻawa (Hawaiʻi), 'ava (Samoa), yaqona (Fiji), and sakau (Pohnpei).

The roots of the plant are used to produce a drink with sedative and anesthetic properties. Kava is consumed throughout the Pacific Ocean cultures of Polynesia including Hawaii, Vanuatu, Melanesia and some parts of Micronesia. Kava is sedating and is primarily consumed to relax without disrupting mental clarity. Its active ingredients are called kavalactones. A Cochrane Collaboration systematic review of its evidence concluded that it was likely to be more effective than placebo at treating short-term social anxiety.^[2] Safety concerns have been raised over liver toxicity largely due to the use of stems and leaves by supplement makers, as opposed to solely the root of the plant as dictated by traditional uses.^[3][4] However, based on a retrospective study of retained P. methysticum drug materials in Germany, the alkaloid pipermethystine, occurring to about 0.2% in the leaves, is an unlikely cause for the observed hepatotoxicity.^[5] Whether kava hepatotoxicity may be due to contamination with aflatoxins or other mould hepatotoxins, requires further studies.^[6] Heavy use of kava with comorbid alcohol consumption or an existing liver condition appears to lead to malnutrition, weight loss, liver damage (causing elevated serum γ -glutamyl transferase and high-density lipoprotein cholesterol levels), renal dysfunction, rashes, pulmonary hypertension, macrocytosis of red cells, lymphocytopenia, and decreasing platelet volumes.^[7]

Preparation and consumption

Kava root drying in Lovoni village, Ovalau, Fiji

Traditional preparation

Kava is consumed in various ways throughout the Pacific Ocean cultures of Polynesia, Vanuatu, Melanesia and some parts of Micronesia and Australia. Traditionally it is prepared by either chewing, grinding or pounding the roots of the kava plant. Grinding is done by hand against a cone-shaped block of dead coral; the hand forms a mortar and the coral a pestle. The ground root/bark is combined with only a little water, as the fresh root releases moisture during grinding. Pounding is done in a large stone with a small log. The product is then added to cold water and consumed as quickly as possible.

The extract is an emulsion of kavalactone droplets in starch. The taste is slightly pungent, while the distinctive aroma depends on whether it was prepared from dry or fresh plant, and on the variety. The colour is grey to tan to opaque greenish.

Kava prepared as described above is much more potent than processed kava. Chewing produces the strongest effect because it produces the finest particles. Fresh, undried kava produces a stronger beverage than dry kava. The strength also depends on the species and techniques of cultivation. Many find mixing powdered kava with hot water makes the drink stronger. However the active ingredients of kava, such as Kavalactone, are ruined at 140 °F (60 °C).^{[citation needed]} Most tea steeps at 180 °F (82 °C) for at least a couple of minutes which will reduce the potency of the kava.

In Vanuatu, a strong kava drink is normally followed by a hot meal or tea. The meal traditionally follows some time after the drink so that the psychoactives are absorbed into the bloodstream quicker. Traditionally no flavoring is added.

In Papua New Guinea, the locals in Madang province refer to their kava as "waild koniak" ("wild cognac" in English).

Fijians commonly share a drink called grog made by pounding sun-dried kava root into a fine powder, straining and mixing it with cold water. Traditionally, grog is drunk from the shorn half-shell of a coconut, called a bilo. Grog is very popular in Fiji, especially among young men, and often brings people together for storytelling and socializing. Drinking grog for a few hours brings a numbing and relaxing effect to the drinker, grog also numbs the tongue and it is typical that grog drinking be followed by a "chaser" or sweet or spicy snack to follow a bilo.^[8]

Kava root being prepared for consumption in Asanvari village on Maewo Island, Vanuatu

Modern preparation

In Western countries, Kava beverage is usually made from Kava root powder. The root is dried and then finely ground into powder before being exported. Generally one tablespoon of powder is added per cup of water, but sometimes as much as a half a cup of powder (eight tablespoons) is added per cup of water to increase potency. The powder is then soaked in water for approximately 30 minutes to allow the water to completely soak through the powdered fibers. Lecithin is often added to aid in the process of emulsifying the kavalactones with water. The Kava powder, water, and lecithin are blended in a blender for several minutes then strained into a straining cloth. Nylon, cheesecloth, and silk screen are common materials for straining. The remaining liquid is squeezed from the pulp and the rest is discarded. As an alternative to the blender method, with the powdered pulp enclosed within the straining material, the pulp is massaged for five to thirty minutes in water, then the liquid is wrung out. The more pressure that is applied to the wet powdered pulp while wringing it out, the more kavalactones will be released from it. Finally the pulp resin is discarded and the beverage is enjoyed. Often coconut water, coconut milk, lemongrass, cocoa, sugar, or soy milk is added to improve flavor.

Pills

Pharmaceutical companies and herbal supplement companies extract kavalactones from the kava plant using solvents such as acetone and ethanol and produce pills standardized with between 30% and 90% kavalactones. Some kava herbal supplements have been accused of contributing to very rare but severe hepatotoxic reactions (see section on safety) such may have been due to the use of plant parts other than the root, such as stems or peelings that are known to have been exported to European manufacturers. A kava pill usually has anywhere from 60 mg to 150 mg of kavalactones. By comparison the typical bowl of traditionally prepared kava beverage has around 250 mg of kavalactones.

Herbal medicine

Kava is chewed by some to relieve symptoms of throat pain, as Kava produces a "numbing" effect on the tongue and throat. The Kava is first chewed in the back of the mouth for 5 to 10 minutes while swallowing the saliva and kavalactones released from the process. The Kava produces an effect similar to that of a chloraseptic spray (An over-the-counter medicine to alleviate sore throat by numbing it, via pump-sprayed into the mouth).

Pharmacology

Kava's active principal ingredients are the kavalactones, of which at least 15 have been identified and are all considered psychoactive. Only six of them produce noticeable effects, and their concentrations in kava plants vary. Different ratios can produce different effects.

The general structure of the kavalactones, without the R₁-R₂ -O-CH₂-O- bridge and with all possible C=C double bonds shown.

Pharmacodynamics

Effects of kavalactones include mild sedation, a slight numbing of the gums and mouth, and vivid dreams. Kava has been reported to improve cognitive performance and promote a cheerful mood.^[9] Kava has similar effects to benzodiazepine medications, including muscle relaxant, anaesthetic, anticonvulsive and anxiolytic effects. They are thought to result from direct interactions of kavalactones with voltage-gated ion channels.^[10] Research currently suggests that kavalactones potentiate GABA_A activity but do not alter levels of dopamine and serotonin in the CNS.^[11] Heavy, long-term kava use does not cause any reduction of ability in saccade and cognitive tests but is associated with elevated liver enzymes.^[12]

Desmethoxyyangonin, one of the six major kavalactones, is a reversible MAO-B inhibitor (Ki 280 nM)^[13] and is able to increase dopamine levels in the nucleus accumbens. This finding might correspond to the slightly euphoric action of kava.^[14]

Kavain, in both enantiomeric forms, inhibits the reuptake of noradrenalin at the transporter (NAT), but not of serotonin (SERT).^[15] An elevated extracellular noradrenalin level in the brain may account for the reported enhancement of attention and focus.

Effects

Medical literature sometimes claims Kava has a "potential for addiction" because "it produces mild euphoria and relaxation"^[16] In a traditional setting, a moderately potent kava drink causes effects within 20–30 minutes that last for about two and a half hours, but can be felt for up to eight hours. Some report longer term effects up to two days after ingestion, including a feeling of mental clarity, patience, and an ease of acceptance. The effects of kava are most often compared to alcohol, or diazepam.^[17]

The sensations, in order of appearance, are slight tongue and lip numbing (the lips and skin surrounding may appear unusually pale); mildly talkative and sociable behavior; clear thinking; calmness; relaxed muscles; and a sense of well-being. As with other drugs that affect the GABA receptors, there can also be paradoxical dysphoria. The numbing of the mouth is caused by the two kavalactones kavain and dihydrokavain which cause the contraction of the blood vessels in these areas acting as a local topical anesthetic. These anesthetics can also make one's stomach feel numb. Sometimes this feeling has been mistaken for nausea. Some report that caffeine, consumed moderately in conjunction with kava can significantly increase mental alertness.^{[citation needed]}

The effects of a kava drink vary widely with the particular selection of kava plant(s) and amount. A potent drink results in a faster onset with a lack of stimulation; the user's eyes become sensitive to light, the person soon becomes somnolent and then has deep, dreamless sleep within 30 minutes. Sleep is often restful and there are pronounced periods of sleepiness correlating to the amount and potency of kava consumed. After wakening the drinker usually does not experience any mental or physical after effects.^{[citation needed]} However, this sleep has been reported as extremely restful and the user often wakes up more stimulated than he or she normally would (though excessive consumption of exceptionally potent brew has been known to cause pronounced sleepiness into the next day). Although heavy doses can cause deep dreamless sleep, it is reported that many people experience lighter sleep and rather vivid dreams after drinking moderate amounts of kava.^[17]

Adverse effects

Australian studies focused on populations with heavy concomitant consumption of alcohol and overall poor health. In one study, heavy kava use in an Aboriginal community in Arnhem Land was associated with overall poor health, a puffy face, scaly rash, and a slight increase in patellar reflexes.^{[18] [19]} There are also several documented adverse interactions with drugs, both prescription and non-prescription – including, but not limited to, Anticonvulsants, Alcohol, Anti-Anxiety Medications, Antipsychotic Medications, and Levodopa.^{[20][unreliable source?]}

Detection in biological fluids

Recent usage of kava has been documented in forensic investigations by quantitation of kavain in blood specimens. The principal urinary metabolite, conjugated 4'-OH-kavain, is generally detectable for up to 48 hours.^[21]

Kava culture

A sign showing a "Kava license area" at Yirrkala, in the Northern Territory of Australia

Main article: Kava culture

Kava is used for medicinal, religious, political, cultural and social purposes throughout the Pacific. These cultures have a great respect for the plant and place a high importance on it. In Fiji, for example, a formal yaqona (kava) ceremony will often accompany important social, political, religious, etc. functions, usually involving a ritual presentation of the bundled roots as a sevusevu (gift), and drinking of the yaqona itself.^[22]

A traditional Fijian yaqona bundle of roots

Correspondingly, the paraphernalia surrounding the traditional kava ceremony are expertly crafted. Traditionally designed Kava bowls are bowls made from a single piece of wood, with multiple legs. More modern examples are also highly decorated, often carved and inlayed with mother of pearl and shell.

Kava is used primarily at social gatherings to increase amiability and to relax after work. It has great religious significance, being used to obtain inspiration. Among some Christian denominations and sects in the Western Pacific, such as the Church of Jesus Christ of Latter-day Saints,^[23] the drink has been seen as a vice to some, and some young members of these religions often reject its traditional and non-traditional uses. However, among many mainline Christian denominations, i.e. the Roman Catholic, Methodist, and Anglican churches, kava drinking is encouraged where it replaces alcohol.

Botany and agronomy

There are several cultivars of kava, with varying concentrations of primary and secondary psychoactive substances. The largest number are grown in the Republic of Vanuatu, and so it is recognised as the "home" of kava. Kava was historically grown only in the Pacific islands of Hawaii, Federated States of Micronesia, Vanuatu, Fiji, the Samoas and Tonga. Some is grown in the Solomon Islands since World War II, but most is imported. Kava is a cash crop in Vanuatu and Fiji.

The kava shrub thrives in loose, well-drained soils where plenty of air reaches the roots. It grows naturally where rainfall is plentiful (over 2,000 mm/yr). Ideal growing conditions are 70–95 °F (21–35 °C) and 70–100% relative humidity. Too much sunlight is harmful, especially in early growth, so kava is an understory crop.

Kava cannot reproduce sexually. Female flowers are especially rare and do not produce fruit even when hand-pollinated. Its cultivation is entirely by propagation from stem cuttings.

Traditionally, plants are harvested around 4 years of age, as older plants have higher concentrations of kavalactones. But in the past two decades farmers have been harvesting younger and younger plants, as young as 18 months. After reaching about 2 m height, plants grow a wider stalk and additional stalks, but not much taller. The roots can reach a depth of 60 cm.

Strains and origins

A painting showing women preparing Kava

One of the most potent strains is called "Isa" in Papua New Guinea, and also called "Tuday" in Hawaii. In Vanuatu it is considered a type of "Tudei" kava, pronounced as "two-day" because it is said to have effects lasting two days due to its chemical profile being high in the kavalactone dihydromethysticin. The plant itself is a strong, very hardy, fast-growing variety with multiple light to dark green stems covered with raised dark spots.

In Vanuatu, there are strict laws over the exportation of Kava. Only strains they deem as "noble" varieties that are not too weak or too potent are allowed to be exported. Only the most desirable strains for every day drinking are selected to be noble varieties in order to maintain quality control. In addition their laws mandate that exported kava must be at least five years old and farmed organically. Their most popular noble strains are "Boroguu" or "Boronggoru" from Pentecost Island. "Melomelo" from Ambae island, (called 'sese' in North Pentecost) and "Palarasul" kava from Espiritu Santo Island. In Vanuatu, Tudei (two-days) kava is reserved for special ceremonial occasions and exporting it is not allowed. "Palisi" is a popular Tudei variety.

In Hawaii, there are many other strains of kava. Some of the most popular strains are the "Mahakea," "Mo'i," "Hiwa" and "Nene" varieties. The Ali'i (kings) of old Hawaii coveted the special kava they called "Mo'i" that had a strong cerebral effect due to a predominant amount of the kavalactone kavain. This sacred variety was so important to them that no one but royalty could ever experience it, "lest they suffer an untimely death." The reverence for Hiwa in old Hawai‘i is evident in this portion of a chant recorded by N.B. Emerson and quoted by Handy and Handy. "This refers to the cup of sacramental‘awa brewed from the strong, black ‘awa root (‘awa hiwa) which was drunk sacramentally by the kumu hula":   The day of revealing shall see what it sees: A seeing of facts, a sifting of rumors, An insight won by the black sacred ‘awa, A vision like that of a sacred god!   Winter describes a hula prayer for inspiration which contains the line, "He ‘ike pū ‘awa hiwa." Pukui and Elbert translated this as "a knowledge from kava offerings." Winter explains that ‘awa, especially of the Hiwa variety, was offered to hula deities in return for knowledge and inspiration. [pg. 34, Hawaiian 'Awa, Views of an Ethnobotanical Treasure, 2006].

Other strains are found in Fiji, Tonga, and Samoa.

Composition

Fresh kava root contains on average 80% water. Dried root contains approximately 43% starch, 20% fibers, 15% kavalactones,^[24] 12% water, 3.2% sugars, 3.6% proteins, and 3.2% minerals. Kavalactone content is greatest in the roots and decreases higher up the plant. Relative concentrations of 15%, 10% and 5% have been observed in the root, stump, and basal stems, respectively.

The mature roots of the kava plant are harvested after a minimum of 4 years (at least five years ideally) for peak kavalactone content. Most kava plants produce around 50 kg (110 lb) of root when they are harvested. Kava root is classified into two categories: crown root (or chips) and lateral root. Crown roots are the large diameter pieces that look like big (1.5 to 5 inches (38 to 130 mm) diameter) wooden poker chips. Most kava plants consist of approximately 80% crown root upon harvesting. Lateral roots are smaller diameter roots that look more like a typical root. A mature kava plant is approximately 20% lateral roots. Kava lateral roots have the highest content of kavalactones in the kava plant. "Waka" grade kava is kava that is made of lateral roots only.

Basic research on anti-cancer potential

On 15 February 2006, the Fiji Times and Fiji Live reported that researchers at the University of Aberdeen in Scotland and the Laboratoire de Biologie Moleculaire du Cancer in Luxembourg had discovered that kava may treat ovarian cancer and leukemia. Kava compounds inhibited the activation of a nuclear factor that led to the growth of cancer cells. The Aberdeen University researchers published in the journal The South Pacific Journal of Natural Science that kava methanol extracts had been shown to kill leukemia and ovarian cancer cells in test tubes.^[25] The kava compounds were shown to target only cancerous cells; no healthy cells were harmed. This may help explain why kava consumption is correlated with decreased incidence of cancer.^[26]

Fiji Kava Council Chairman Ratu Josateki Nawalowalo welcomed the findings, saying that they would boost the kava industry. For his part, Agriculture Minister Ilaitia Tuisese called on the researchers to help persuade members of European Union to lift their ban on kava imports.

In November 2008, the EU announced its lifting of the kava trade ban, which had been imposed due to accusations made in 2001 and since debunked through scientific review of the facts.^[27]

Side effects and safety

Skin rashes

Chronic and heavy use of kava for a period of three months or more has occasionally been reported to cause a scaly, yellow skin rash and an eye irritation that disappears after discontinuation of the herb. The rash resembles one brought on by a niacin (vitamin B₃) deficiency; however, a double-blind, placebo-controlled study showed no change in the rash after niacin supplementation.^{[citation needed]} The 29 Tonga islanders who presented with the rash after heavy kava consumption—more than 900 g/week—were given either 100 mg of oral niacinamide or placebo. No statistically significant improvement was seen in the supplementing group, suggesting niacin deficiency may not cause the rash, which is more characteristic of an acquired ichthyosis.

Reports of liver damage and regulation

In 2001, concerns were raised about the safety of commercial kava products.^[28] There were allegations of liver toxicity in some people who had used dietary supplements containing kava extract (but not in anyone who had drunk kava the traditional way). The allegations of liver damage consequently prompted action of many regulatory agencies in European countries where the legal precautionary principle so mandated. In the UK, the Medicines for Human Use (Kava-kava) (Prohibition) Order 2002 prohibits the sale, supply or import of most derivative medicinal products. Kava is banned in Switzerland, France, and the Netherlands.^[29] The health agency of Canada issued a stop-sale order for kava in 2002. But legislation in 2004 made the legal status of kava murky to many, especially since not everyone is aware that a stop-sale order does not constitute a ban such as that applies in several European countries. Kava is not illegal in Canada and doesn't fall under any of the Food and Drugs Act & Regulations. Many retailers have been ignoring the no-sale order without further consequence than having Health Canada issue warnings about the product's safety. At least one US manufacturer of kava products who had suspended export to Canada in 2002 has since lifted the restriction and resumed shipping kava to Canada after obtaining confirmation that it wasn't illegal for Canadians to import kava.^[30] The United States CDC has released a report^[31] expressing reservations about the use of kava and its possibly adverse side effects (specifically severe liver toxicity), as has the Food and Drug Administration (FDA).^[32] The aviation medicine branch of the FAA has strongly recommended against any use of Kava by pilots (http://aviationmedicine.com/articles/index.cfm?fuseaction=displayArticle&articleID=48) In Australia, the supply of kava is regulated through the National Code of Kava Management. The sale and supply of kava is prohibited in western Australia and the Northern territory.^[16][33] The Australian Therapeutic Goods Administration has recommended that no more than 250 mg of kavalactones be taken in a 24 hour period.^[34] According to the Medicines Control Agency in the U.K., there is no safe dose of kava, as there is no way to predict which individuals would have adverse reactions, if any.^[35]

In a 2009 study by the University of Queensland, Australia, researchers found that the study's participants did not show any signs of potential liver damage, contrary to concerns that prompted European, British and Canadian authorities to ban kava sales in 2002. Kava products sold in those countries were based on ethanol or acetone extracts of the kava plant, not the water-soluble extracts used traditionally by Pacific islanders and approved for sale in Australia.^[36]

It has been suggested that Flavokawain B is the hepatotoxic chemical in Kava. It is not known if this chemical survives traditional preparation of the herb.^[37]

Toxicology of pill from kava extracts with stems and leaves

Piperidine alkaloids from the kava plant

The legal intervention of several countries stimulated research, and hepatotoxic substances were found in the stems and leaves of the plant. Researchers from the University of Hawaii at Manoa found that an alkaloid called pipermethystine (formula 1), contained in stem peelings and leaves but not in the roots, had toxic effects on liver cells in vitro^[38] and in vivo.^[3] In rats fed with 10 mg/kg pipermethystine for two weeks, indications of hepatic toxicity were found. Comparable signs of toxicity were not detected with kava rhizome extracts (100 mg/kg, 2 weeks),^[3] (73 mg/kg, 3 months).^[4]

Flavokavain B, found in the plant's rhizome (large horizontal underground stem), may also contribute to toxic effects.^[39] It is also known that some of the kavapyrones block several subtypes of the enzyme cytochrome P450,^[40] which can result in adverse interactions with other drugs used concomitantly.

Hawaiian researchers learned from a trader in Fijian kava that European pharmaceutical companies eagerly bought up the stem and leaves peelings when demand for kava extract soared in Europe in 2000 and 2001. Before 2002, substantial amounts of aerial parts of the kava plant were being exported to North America and Europe and obviously used for the production of commercial pill extracts. For traditional use in the South Pacific, stem peelings and leaves are discarded, and only the rhizomes are used and extracted with water. This may explain why native populations that make heavy use of kava experience side effects that are mild, temporary, and confined to the skin, whereas industrialized countries that have newly adopted kava occasionally show severe, acute responses.

Toxicity of traditional kava beverage preparations

In April 2003, University of Hawaii scientists reported to have discovered that traditionally discarded stem peelings and leaves of kava contain a toxic alkaloid—not present in the plant's roots. European pharmaceutical companies are known to have purchased such peelings when demand for kava extract soared in 2000-2001.^[41]

Two studies still allege changes in liver function, with the first describing the effects as temporary and reversible when discontinuing kava use.^[42] There is evidence of health concerns among heavy alcohol drinkers, including poor nutrition and a rise in liver enzymes typically associated with liver damage.^[43][44]

Another study published in the journal Pytochemistry in 2003 indicates that traditional aqueous preparations of Kava also extract glutathione, which alcoholic extracts lack when they are made with high concentrations of alcohol. The authors discover that the glutathione in traditional preparations interacts with the kava-lactones and prevents cell death. They claim that in all standardized extracts that contributed to liver damage, there were only the kava-lactones without any glutathione. ^[45]

Allergy

Literature suggests that <0.5% of people that take kava have an allergic reaction to it.^{[citation needed]} Allergic reactions are usually mild and include itchy skin or itchy throat, and hives on the skin usually prevalent on the user's belly region.

See also

• Kava culture
• Samoa 'ava ceremony
• List of herbs with known adverse effects
• Alcohol and Drugs History Society
• Samoan plant names

References

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2. ^ Pittler MH, Ernst E (2003). Pittler, Max H. ed. "Kava extract for treating anxiety". Cochrane database of systematic reviews (Online) (1): CD003383. doi:10.1002/14651858.CD003383. PMID 12535473. 
3. ^ ^{a b c} Lim ST, Dragull K, Tang CS, Bittenbender HC, Efird JT, Nerurkar PV (May 2007). "Effects of kava alkaloid, pipermethystine, and kavalactones on oxidative stress and cytochrome P450 in F-344 rats". Toxicol. Sci. 97 (1): 214–21. doi:10.1093/toxsci/kfm035. PMID 17329236. 
4. ^ ^{a b} Sorrentino L, Capasso A, Schmidt M (September 2006). "Safety of ethanolic kava extract: Results of a study of chronic toxicity in rats". Phytomedicine 13 (8): 542–9. doi:10.1016/j.phymed.2006.01.006. PMID 16904878. 
5. ^ Lechtenberg M, Quandt B, Schmidt M, Nahrstedt A (2008). “Is the alkaloid pipermethystine connected with the claimed liver toxicity of Kava products?” Pharmazie 63 (1) : 71–74. doi: 10.1691/ph.2008.7638
6. ^ Teschke R., Qiu S.X., Lebot V. "Herbal hepatotoxicity by kava: Update on pipermethystine, flavokavain B, and mould hepatotoxins as primarily assumed culprits" [Article in Press] Digestive and Liver Disease 2011
7. ^ Fu PP, Xia Q, Guo L, Yu H, Chan PC (2008). "Toxicity of kava kava". J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 26 (1): 89–112. doi:10.1080/10590500801907407. PMID 18322868. http://pdfserve.informaworld.com/46977__791234079.pdf. 
8. ^ Kevin Cassell (2005). "Fiji: A Visitor's Guide". http://kevincassell.com/FIJIARTC/KEVIN.HTM. Retrieved 2007-04-25. 
9. ^ Thompson, R et al. (2004). "Enhanced cognitive performance and cheerful mood by standardized extracts of Piper methysticum (Kava-kava)". Hum Psychopharmacol. 19 (4): 243–250. doi:10.1002/hup.581. PMID 15181652. 
10. ^ Cairney, S et al. (2002). "The neurobehavioural effects of kava". Aust N Z J Psychiatry 36 (5): 657–652. doi:10.1046/j.1440-1614.2002.01027.x. PMID 12225450. 
11. ^ Hunter, A (2006). "Kava (Piper methysticum) back in circulation". Australian Centre for Complementary Medicine 25 (7): 529. 
12. ^ Cairney, S et al. (2003). "Saccade and cognitive function in chronic kava users". Neuropsychopharmacology 28 (2): 389–396. doi:10.1038/sj.npp.1300052. PMID 12589393. 
13. ^ Uebelhack R, Franke L, Schewe HJ (September 1998). "Inhibition of platelet MAO-B by kava pyrone-enriched extract from Piper methysticum Forster (kava-kava)". Pharmacopsychiatry 31 (5): 187–92. doi:10.1055/s-2007-979325. PMID 9832350. 
14. ^ Baum SS, Hill R, Rommelspacher H (October 1998). "Effect of kava extract and individual kavapyrones on neurotransmitter levels in the nucleus accumbens of rats". Prog. Neuropsychopharmacol. Biol. Psychiatry 22 (7): 1105–20. doi:10.1016/S0278-5846(98)00062-1. PMID 9829291. http://linkinghub.elsevier.com/retrieve/pii/S0278-5846(98)00062-1. 
15. ^ Seitz U, Schüle A, Gleitz J (December 1997). "[3H]-monoamine uptake inhibition properties of kava pyrones". Planta Med. 63 (6): 548–9. doi:10.1055/s-2006-957761. PMID 9434608. 
16. ^ ^{a b} http://www.health.gov.au/internet/drugstrategy/publishing.nsf/Content/545C92F95DF8C76ACA257162000DA780/$File/indigenous-background.pdf
17. ^ ^{a b} [1].
18. ^ Mathews JD, Riley MD, Fejo L, et al. (June 1988). "Effects of the heavy usage of kava on physical health: summary of a pilot survey in an aboriginal community". Med. J. Aust. 148 (11): 548–55. PMID 3374423. 
19. ^ Kava R (March 2001). "The adverse effects of kava". Pac Health Dialog 8 (1): 115–8. PMID 12017812. 
20. ^ Purple Lotus Kava (2010). "Drug Interactions With Kava". http://www.purplelotuskavabar.com/drug_interactions_with_kava/. Retrieved 2010-05-10. 
21. ^ R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 803–804.
22. ^ There are many variations to this ceremony; one of which is described in: Biturogoiwasa, Solomoni and Anthony R. Walker (2001). My Village, My World: Everyday Life in Nadoria, Fiji. Suva, Fiji: Institute of Pacific Studies, University of the South Pacific, pp. 17-20. There are numerous anthropological studies, one example being: Tomlinson, Matt (2007). Everything and Its Opposite: Kava Drinking in Fiji. Anthropological Quarterly 80(4): 1065–1081.
23. ^ http://services.byuh.edu/honorcode/
24. ^ Naumov, P., Dragull, K., Yoshioka, M., Tang, C.-S., Ng, S. W. Structural Characterization of Genuine (—)-Pipermethystine, (—)-Epoxypipermethystine, (+)-Dihydromethysticin and Yangonin from the Kava Plant (Piper methysticum), Natural Product Communications(2008), 3(8) 1333—1336.
25. ^ Tabudravu J N, Jaspars M (2005). "Anticancer activities of constituents of kava (Piper methysticum)" (PDF). http://www.publish.csiro.au/?act=view_file&file_id=SP05005.pdf. Retrieved 2008-01-05. 
26. ^ Steiner GG (November 2000). "The correlation between cancer incidence and kava consumption". Hawaii Med J 59 (11): 420–2. PMID 11149250. 
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28. ^ Blumenthal, Mark (2002). "Kava safety questioned due to case reports of liver toxicity". American Botanical Council (Austin, TX) (55): 26–32. http://content.herbalgram.org/new-chapter/herbalgram/articleview.asp?a=2147&p=Y. Retrieved 2008-03-23. 
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53. Hawaiian 'Awa Views of an Ethnobotanical Treasure (2006)

Literature

• Lindstrom, Lamont; Lebot, Vincent; Merlin, Mark David (1992). Kava: The Pacific Elixir – The Definitive Guide to it's Ethnobotany, History and Chemistry. New Haven, Conn: Yale University Press. ISBN 0-300-05213-8. OCLC 25708300 231506209 25708300. 

• The Mars Trilogy by Kim Stanley Robinson, Spectra, 1993. ISBN 0-553-09204-9. Contains many references to Kava, and "Kavajava" – kava mixed with coffee. The book uses kava as the social drink of choice for the "Martians" (human colonizers of Mars).

• The Sex Lives of Cannibals: Adrift in the Equatorial Pacific by J. Maarten Troost, Broadway Books, New York, 2004. ISBN 0-7679-1530-5.

• Getting Stoned with Savages: A Trip Through the Islands of Fiji and Vanuatu by J. Maarten Troost, Broadway Books, New York, 2006. ISBN 978-0-7679-2199-2. ISBN 0-7679-2199-2.

External links

• Kava ban documents
• Piper methysticum information from the Hawaiian Ecosystems at Risk project (HEAR)
•  "Kava". Encyclopaedia Britannica. 14 (9th ed.). 1882.