I recently spent time in Hawaii on vacation where I discovered my first Kava bar.I was walking along the market streets of Kona on the Big Island and ventured inward a bit, when I happened across a small outdoor café—a pleasant place called Kanaka Kava. Behind the bar was a friendly hip-looking guy in his 20s, looking cool stirring a brownish liquid in a large wooden bowl. Imagine a salad bowl for 20 people—that’s how big this thing was—large enough to hold 6 gallons of fluid. Behind him stood a variety of smaller bowls that turned out to be coconut shells, all handsomely decorated. One had a small red heart lacquered into it; another had carved spider webs all around the sides. These were bowls of regulars who came to drink kava from their own personalized cups.

Courtesy of Jim NicolaiKanaka Kava in Hawaii
Kava Bar

I bought a coconut cup myself for five bucks— I wanted to be a regular.MORE: Relieve Your Stress With Holy BasilI’ve read about Kava, prescribed as a mild reliever of stress and anxiety. I’ve even tried an extract of it in liquid form during my training as an Integrative Medicine fellow. I remember it numbing my lips and tongue, while providing a subtle but satisfying feeling of calm.I’d never had it fresh as a beverage.Kava has been used in traditional Polynesian cultures as a ceremonial drink for over 3,000 years. It is made from the root of a species of pepper plant known as Awa (Piper methysticum—or intoxicating pepper). To make fresh Kava, the root of the plant is harvested, then washed and pulverized. The resulting powdery mash is then strained repeatedly through a cloth while being mixed with fresh water. This mixing intensifies the extraction and the taste.My first drink of Kava was wonderfully interesting. Right off the bat, I noticed a mild tingling of my lips and tongue. It tasted earthy and vegetal. Some people say it tastes like dirt—by no means bad dirt. Unfortunately, I wasn’t taught how to drink it according to tradition—all down in one slurp while holding the shell with two hands, followed by clapping twice to release the sacred kapu, which ends the ceremony. Unbeknownst to me, I found myself sipping it with no clapping.Now I know.QUIZ: How Stressed Are You?I definitely felt a deliciously subtle feeling of calm without any effects of intoxication. It was very nice and gave me an ease that lasted into the night. I slept marvelously.Kava fell out of favor as a supplement a decade ago as reports suggested a link between certain extracts of kava and potential liver damage. Remember, Kava has been used as a water-based beverage for thousands of years in the South Pacific islands without reported liver problems. So what’s the difference? How can one cause liver toxicity and one not? Maybe they are not the same thing.Kavalactones are a group of compounds found in the Kava plant that are identified for its calming effects. Not only do these kavalactones vary in different varieties of the plant, so do other compounds that also may have effects. The natives of the South Pacific are very selective in the use of Kava for consumption, based on what they are looking for. One variety may be used at a particular setting—a specific ceremony, using Kava for medicinal purposes or recreationally—whereas another version is used for other purposes.As the popularity and commercialization of Kava began to grow, a lack of attention to detail and traditional understanding shaped its use as an herbal supplement (not altogether for the better). Rather than using water, chemical solvents like alcohol and acetone began to be used to extract and concentrate these powerful kavalactone compounds, making them more intense and leaving out some important compounds found in water-based extractions. The effects were different from those produced by traditional methods. It was these supplements that were found to produce liver problems in certain individuals—to date, approximately 30 cases of liver toxicity have been reported in Europe using these different extracts. When side effects like this occur from these drug-like extractions, the whole herb is unjustly implicated.MORE: How Acupressure WorksUnfortunately, it’s like saying drinking the juice from grapes is the same as drinking wine.  You can’t call them the same thing; the effects are different based on what is being done with the grape. Same goes for Kava.In present day Vanuata—a tiny island in the South Pacific—there are establishments called Nakamals (Kava bars) that serve thousands of servings of fresh Kava juice daily. Nakamal owners will typically announce which version of Kava is being served, and professional Kava drinkers will gravitate toward which one fits their needs on that day. I think drinking fresh Kava juice is not only a good thing, it may be a much better remedy for muscle tension and anxiety.The saying at Kanaka Kava goes like this: “When it comes to drinking Kava… one is necessary, two is better, and three is a good place to be.”If you don’t have access to fresh Kava juice, there are some options. I do not recommend alcohol or acetone extractions of Kava. I do, however, like freeze-dried juice of the water extract taken from fresh Kava root. This provides the same concentration of kavalactones you might get in a beverage, while also providing quantities of Kava’s other compounds found in water-based extractions. This may not only enhance Kava’s activity but provide the protection that other extractions do not.MORE: The Basics of MeditationI use Kava for the relief of situational anxiety, insomnia and muscle tension. Knowing that the United States Food and Drug Administration has administered warnings to doctors and consumers about the use of Kava, my suggestions are to take the water-based extract (I like one made by Eclectic Institute, called of all things: NAKAMAL), one to four capsules as needed. I do not recommend any more than eight capsules taken in a day. For the preferred “Nakamal” experience, empty the contents of one to four capsules into a small amount of water. Stir and drink.Follow these precautions for the use of Kava from the American Botanical Council:

  • Don’t use Kava if you have liver problems (such as hepatitis), drink alcohol regularly, or consistently take a drug with known adverse effects on the liver, including acetaminophen (Tylenol), statin drugs, and niacin.
  • Don’t use Kava on a daily basis for more than four weeks.
  • Discontinue Kava if you develop jaundice (yellowing of the skin or the whites of the eyes) or symptoms of hepatitis (nausea, abdominal pain, loss of appetite, dark urine, clay-colored stools).
  • Check with your doctor if you have a history of liver problems or suspected liver problems before using or continuing to use Kava.

And when you take Kava, don’t forget to clap twice to release the Kapu.MORE: How to Talk to Your Doctor About Stress