SupplementModerate evidenceStress

Kava

Cochrane-reviewed anxiolytic with a real hepatotoxicity history; only justified when product traceability is excellent.

Why

Kava (Piper methysticum) is a Pacific Island ceremonial drink with the most-cited Cochrane signal for any herbal anxiolytic: a meta-analysis of 12 RCTs found benefit on Hamilton Anxiety Scale scores versus placebo. A cluster of European hepatotoxicity reports in the early 2000s led to bans in several markets; the consensus since is that the risk is concentrated in alcohol or acetone solvent extracts of aerial parts, not the traditional water extract of the root. Sale is currently restricted in Germany, France, Switzerland, and the UK.

How it works

Kavalactones (kavain, dihydrokavain, methysticin) modulate GABA-A receptors, inhibit voltage-gated sodium and calcium channels, and weakly inhibit monoamine oxidase B, producing anxiolysis without classical benzodiazepine tolerance or cognitive dulling at standard doses.

Expected onset · Acute calming within 1–2 hours; trials show further benefit by 1–4 weeks

How to take

Dosage

Standardised root extract delivering 60–250 mg kavalactones daily, typically divided.

Timing

Morning and evening with food

On the label

Look for 'noble cultivar', water-extracted, root-only kava with stated kavalactone content. Avoid acetone or ethanol extracts and aerial-part preparations.

Ideal for

Adults with mild-to-moderate generalised anxiety where standard pharmacotherapy is declined or not tolerated, and where product traceability is excellent.

Safety

Use only noble-cultivar water extracts of the root. Avoid in any liver disease, pregnancy, breastfeeding, or with alcohol or hepatotoxic medications. Sale is restricted or banned in several European countries; check local regulations. Limit duration to 1–2 months. Possible additive effects with sedatives and anaesthetics, so flag before surgery.

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Evidence

At a glance

Cochrane 2003 SR (12 RCTs, n=700): kava extract was significantly more effective than placebo on Hamilton Anxiety Scale scores over 1–24 weeks. Sarris 2013 J Clin Psychopharmacol Phase 2/3 RCT in GAD (n=75): aqueous root extract delivering 120–240 mg/day kavalactones produced significant HAM-A reductions vs placebo. Hepatotoxicity reports cluster in solvent-extracted and aerial-part preparations; water-extracted noble root is the lower-risk form.

Where to get it

Shop Kava on Amazon

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