title: Kava hepatotoxicity in traditional and modern use: the presumed Pacific kava paradox hypothesis revisited.
abstract: Kava, a Pacific herb consumed worldwide for medicinal, recreational and cultural purposes, has been associated with rare hepatotoxicity, and there is currently a critical need to determine this causation. The previously proposed Pacific kava paradox was based on the theory that kava hepatotoxicity was not observed following use of traditional aqueous extracts in the Pacific region, but was restricted to use of Western acetonic and ethanolic extracts. Subsequent cases analyzed by the World Health Organization and published case reports revealed that traditional aqueous extracts used in New Caledonia, Australia, the USA and Germany may also be hepatotoxic; thus, there is no longer a basis to sustain the previously proposed Pacific kava paradox. It appears that the primary cause of toxicity may reside in the time before the preparation of the various kava extracts, possibly attributed to poor quality of the raw material caused by mould hepatotoxins. Rigorous testing of kava raw material is urgently advised, in addition to Pan-Pacific kava manufacturing quality standards.
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Goethe University of Frankfurt/Main, Hanau, Germany. rolf.teschke@gmx.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Teschke
authors.forename: Jerome
authors.initials: J
authors.lastname: Sarris
authors.forename: Isaac
authors.initials: I
authors.lastname: Schweitzer
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D006801:Humans; D020901:Kava / Q000633:toxicity*; D008099:Liver / Q000187:drug effects*; D010139:Pacific Islands; D010936:Plant Extracts / Q000592:standards / Q000633:toxicity*; D011786:Quality Control; D027343:Rhizome / Q000633:toxicity*; D012307:Risk Factors
chemical_list: D010936:Plant Extracts