Opinion » Antidote

High Anxiety

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Almost every one of my classes this semester has a final presentation and I get freaking nervous talking in front of people. It gets so bad that my armpits start dripping, my hands get freezing cold, I start shivering and forget to breathe. An old boyfriend used to use kava-kava pills before his job interviews and I was considering trying them, except he said they always made him high. That could come in handy for certain lectures, but can kava-kava relax me enough to get through my speeches?

I think I can identify. I get the exact same symptoms every time I'm invited to a co-ed baby shower. It's not that I'm afraid I'll lose the one-handed Cabbage Patch Kid diapering contest or the bobbing-for-pacifiers game. In fact, I once made a fair showing in a baby bottle beer-drinking race. But graphic descriptions of delivery room gore and pandemonium, more suitable to an episode of ER than a North End living room, make me shudder. And don't get me started about passing around the hand-me-down breast pump.

Happily changing the subject, kava (often singular) was originally—and continues to be—drunk as a ceremonial and social beverage by the South Pacific islanders of Fiji, Samoa and New Hebrides. Kava tea, usually described as muddy-tasting, is less familiar in the United States than the more palatable capsule. Both the tea and the herbal supplement are made from the root of a perennial shrub called Piper methysticum, which means "intoxicating pepper."

It's popularity for both medication and recreation stems from a distinct mellowing effect that could all but change a shrill Dr. Laura into an amiable Dr. Phil. Kava is best known for use in anxiety conditions, but now also for pre-menstrual syndrome and insomnia. The fact that the herb is considered non-addictive has given rise to a new type of establishment, the Kava Bar. Various strengths of these mouth-numbing teas are served which also, thankfully, deaden the taste buds. I'm told the only bar fights these patrons get into are over who gets to lie across the seat of the booth.

The medical literature is full of studies of kava, both for safety and effect. First, the good news: Kava research is clear that the active compounds, kavalactones, curtail anxiety without excessive sedation. In fact, one journal's review of the entire body of literature on kava's use in anxiety described the supplement as valuable "beyond a reasonable doubt."

Baby showers aren't the only parties I poop; here comes the bad news. A few years ago, cases of liver toxicity associated with kava began appearing in the literature. In Germany, authorities immediately banned the supplement. Most of the remainder of the European Union soon followed, as did Canada. In 2002, our own FDA released a consumer advisory that warns the public of the potential risk of liver injury in kava users and promises continued research.

Happily, the new research papers have contradicted the link between kava and liver damage, citing a lack of clear evidence and introducing a credible explanation. Like Who Wants to Be a Millionaire, kava may have been a victim of its own popularity: Traditional preparation methods call for only the plant's root, but as its reputation spread, dangerous shortcuts were taken. The usually discarded leaves and stems were virtually free, could be easily dried and sold truthfully as 100 percent kava. But, even though there are enough active compounds in these green parts to bliss you out, there are also other alkaloids that are toxic to liver cells.

With some care, the actual risk of using kava is quite minimal compared to the benefits. First, kava should never be used when taking sedatives, antidepressants, alcohol, Tylenol (some student's typical brunch menu), or if you have any liver disorder. Further, use only as needed rather than long-term. Most importantly, consider buying actual fresh or freeze-dried kava root, or purchase certified root-only capsules. A couple of arrests for DUI have occurred after excessive use (probably following brunch), so common sense is warranted.

A little kava before your classroom presentations is fine, but simply practicing the speeches might be a better idea. I'd bet you could get that old boyfriend of yours to sit and listen if you enticed him with some fresh kava tea. If your subject is tedious, you might offer to mix it with strong coffee and make KavaJava. Failing that, merely threaten to invite him to your baby shower. Speaking for men everywhere, we'll do anything you ask.

Dr. Ed Rabin is a chiropractor practicing at Life Chiropractic Center in Boise. Don't send invitations, but do send health-related questions to theantidote@edrabin.com (on the Web at www.edrabin.com).