Comprehensive information about diving and undersea medicine for the non-medical diver, the non-diving physician and the specialist.
*Material provided is intended for information only and should be used only in conjunction with the advice of a physician.*
24th, 2002 the
and Drug Administration warned American consumers that kava
may cause liver damage. The
Food and Drug Administration said it was issuing the warning because
has associated with liver-related injuries in the U.S., and several
countries including Germany, Switzerland, France, Canada and the United
Kingdom. The Food and Drug Administration said 4 people required liver
transplants following their liver injuries.
An Experience With Kava on a Dive Trip
We made the trip over to Quamea in two open boats in water that at times seemed too rough for the over-loaded vessels. One of us made it even more difficult by insisting he stand the whole three mile trip. Our dive group of doctors and wives had been at the Fiji Forbes Island of Laucala for about a week and we were to be shown around the neighboring island, feted and given the Kava ceremony by the local chieftain (or King). Kava kava was not unknown to some of us by this time, as we had been inducted into it's usage through several ceremonies on Fiji Forbes.
Arriving at an inlet where several small boats were tied up, we found friendly welcoming faces of a fairly large group of children and some young adults. Getting ashore required wading, this was accomplished with quite a bit of groaning and squeals from some of the women, having to take off their shoes and walk in the muck. The word "bula" was heard frequently, roughly translated as hello or good luck. We were then all introduced to the elders of the village and to the King (proudly repeating our names to show his good memory), who then directed several young women to show us around the village.
What we saw was a strange mixture of the 18th, 19th and 20th centuries. Thatched huts were next to cinder block buildings, some with electricity and plumbing, some not. The King's grandson had died the previous month from pneumonia and his gravesite next to the King's house was proudly shown with it's arbor of wooden sticks draped with bright streamers of colored cloth. The new "clinic" was an unfinished building of corrugated metal--the old clinic a thatched one room shack with turn of the century medical supplies.
Duly noting all of the amenities (and the lack thereof), we finally gathered in the meeting house, a building of wood poles and thatch, and sat around on grass rugs, the King and his council of two other old men sitting to our left, the natives to their left facing us and an area left open between. After presenting the king with gifts (we brought T shirts), we were regaled with singing and dancing by the young women of the island. Some were embarrassed, as if they felt demeaned--most were honestly enjoying themselves immensely.
During this time, we noted that a large open wooden bowl was brought in and set in front of the King. A tall, thin native elder who looked as if he might be in the last stages of some dread debilitating disease was the designated kava kava person. He took some dried brown powder and roots, wrapped it in an old handkerchief and the ceremony started. At a signal, the handkerchief and the kava root was dipped into the water and squeezed out. It was the passed behind his back and then back into the water until the water appeared a muddy brown. A bowl made from half a coconut shell was passed around to each individual, each person clapping his hands before he received the shell and then drinking the entire shell in one drink.
Our tour director was then made to come forward, and she was asked to drink from a cup which was passed around the elders and others who had joined the circle. By this time, there was not much of the liquid left, and to the surprise of the tour director, she was asked to drink the rest -- which she did somewhat reluctantly. It was at this point that the king muttered something in Fijian and we were told that the tour director had been named "Radini" which means Queen. Well, by this time the "Radini" was somewhat mellow and giddy and, usually at no loss for words, appeared nonplused, explaining that it was "because of the numb lips and tongue".
Kava kava has gained some recent popularity in the United States-mainly due to it's legality and availability. It is said to be a relaxant and mild sleep aid causing a feeling of peace and contentment along with a heightening of the senses. In the Pacific, it's use evolved into a mystical ritual, inducing a state of relaxation and goodwill and was used in meetings between groups, resolving conflicts. Although kava was important for ceremonial occasions, the history of the South Pacific Islands of Polynesia, Melanesia and Micronesia shows it to also have been important in maintaining the social structure. In some societies the order in which the participants in a ceremony drank the kava reflected the hierarchy of the culture. Kava was also taken in preparation for an ocean voyage, ratification of agreements, celebration of marriages and births as well as deaths. It is believed to be a libation to the gods and was believed to cure illnesses and remove curses.
Following his voyage to the South Seas in 1768, Captain James Cook first described to the Western world the ceremonial use of the intoxicating drink made from the kava plant. Kava's name is Piper methysticum, meaning intoxicating pepper. It is a perennial shrub belonging to the pepper family, Piperaceae. Indigenous to the South Sea Islands west of Fiji, it grows well in elevated swampy land, growing both cultivated and wild. Kava has been called awa, kava kava, waka, lawena or yaqona by the Pacific Islanders who have used it for thousands of years.
Ideally suited for the climate and economy of the South Pacific, kava continues to be the major cash crop in the islands. Planted much like sugar cane, it grows from a planted stalks cut from an old bush. It is harvested when it is about 6 feet tall, but it can grow to as much as 20 feet in height.
The kava clones are pharmacologically effective and differences in their actions are qualitative as well as quantitative. Increased cognitive function has been observed with Kava Kava use, according to a 1993 article in Neuropsychobiology. Unlike sedatives, Kava Kava improves mental function instead of "dulling the brain. And unlike alcohol or sedatives, it would be extremely difficult to build up a tolerance to Kava Kava (Clinical and Experimental Pharmacology, 1992, 18:571). Kava root is primarily used as a natural sedative and sleep inducer. It is also effective in reducing menstrual cramps. Small amounts produce euphoria; larger amounts produce extreme relaxation, lethargy or lower limbs and eventually sleep. It does not impair mental alertness. Often there are visual and auditory hallucinations, lasting 2-3 hours with no hangover. Kava is similar to marijuana as effects are not noticed when used for the first several times. As a narcotic, Kava later produces numbing of the mouth, similar to cocaine.
Driving or operating dangerous equipment is also not recommended due to the drowsiness, and disturbances of coordination that may occur. In addition, one should not use alcohol, barbiturates or other psychopharmaceuticals as the effects of these agents will be increased. Pharmaceutical grades of natural Kava root are available from reputable companies in the United States. Synthetic Kava can be produced, but does not possess the same soothing qualities of naturally extracted kavalactones from the Kava plant. Correctly extracted Kava Kava will contain all six kavalactones in high concentrations (25-30%).
As the use of natural alternatives to addictive tranquilizers increases in the Western world, it may turn out that in two or three hundred years we will all be sitting around a bowl, clapping our hands (or some other ritual) and drinking a sacrament of dirty-brown liquid, smiling and cheerfully smacking our lips. Strange that the mainstream western religions haven't jumped on this bandwagon-it would be much better than grape juice or cheap red wine.
Ernest Campbell, MD
Ono Island, AL