Give us back our sanity

Kava-kava, a plant-based treatment for anxiety, has been linked to liver damage - and banned. But users, including Joanna Blythman, believe the risks are worth taking

When I learnt that the herbal remedy kava-kava was to be banned, my first reaction was to stockpile as much as I could. Ill-advised? Reckless, even? The UK Medicines Control Agency had decided, two years ago, to prohibit kava on the grounds that it might be toxic to the liver. But I trusted kava, because I had used it on and off for a couple of years, identifying no side effects whatsoever - just very tangible benefits.

When I learnt that the herbal remedy kava-kava was to be banned, my first reaction was to stockpile as much as I could. Ill-advised? Reckless, even? The UK Medicines Control Agency had decided, two years ago, to prohibit kava on the grounds that it might be toxic to the liver. But I trusted kava, because I had used it on and off for a couple of years, identifying no side effects whatsoever - just very tangible benefits.

When I first heard of kava as a remedy for treating mild to moderate anxiety, I was keen to try it. It soon became part of my armoury for managing work. Most people experience certain situations that make them extremely nervous, usually those that involve an element of assessment by others: work meetings, job interviews, exam or stage fright, and so on.

The thing I dreaded as a journalist, author and broadcaster was public speaking. I had begun to turn down such events because the personal cost in terms of nerves, panic and self-doubt was just too high. But then I found that taking a small amount of kava an hour or so before calmed me down, and also concentrated my mind.

I began to find more uses for kava. It is not strictly a remedy for sleeplessness, but it works for me on those nights when I might lie awake, staring at the ceiling and worrying about that "performance" thing the next day - and worrying about how my lack of sleep would compound my inability to perform. To hell with all that angst - I'd take a kava tablet and I'd drift off to sleep, waking refreshed, without the drugged hangover associated with herbal and conventional sleeping pills.

I found, too, that kava could help me to write. Every now and then I'd end up with a difficult article, usually with a tight deadline, which turned into a nightmare. I'd get writer's block, and a paralysing panic would mount. I now realise that this is a kava situation. When I'm on the point of throwing the computer out the window and phoning to say I've had a nervous breakdown, the kava quells the anxiety and refocuses my mind.

Though some people take kava regularly, the great thing for me is that I use it only as and when I need it, and it seems to work more or less instantly. As someone who's more at home in a health-food store than a doctor's surgery, I avoid pharmaceutical drugs. It would take the most ghastly personal crisis to make me even contemplate taking conventional sleeping pills, anti-depressants or anti-anxiety drugs.

I love the fact that kava isn't heavy-duty medicine, but it does the trick. I've been evangelical about it. A few friends have found it helpful for situations they find nerve-racking, such as social occasions that involve making small talk, but where there is an implicit work agenda. A colleague took kava when he was dreading having to sack an employee. Others swear by its muscle-relaxant properties for tension-related knots in neck and shoulder.

Should I be concerned for my liver? Kava, a root, has long been grown in the South Pacific islands, where it is drunk ceremonially to promote contentment and mental sharpness, and healers use it to treat pain. But in 2001 it was linked to 24 cases of liver damage and one death in Germany.

Any direct causal link between these cases and kava is disputed by the proponents of herbal remedies, because most people affected were already taking pharmaceutical drugs known to be toxic to the liver, and several were elderly heavy drinkers. Since then, retrospective trawls of reports of adverse events prompted by the German alert has produced a total of 82 cases worldwide where kava might - just might - be implicated in liver damage (four resulting in death and seven requiring transplants), though the link is extremely tenuous.

Some experts suggest that there may have been a problem with acetone-extracted kava. This is a newer, more pharmaceutical technique designed to extract just the active ingredients - kavalactones. Purists are happier with kava extracted using ethanol.

Other researchers think any problem may lie with the use of bad cultivars of kava. After the US-fuelled kava boom in the late 1990s, stocks became scarce and some companies started buying what is known in the Pacific islands in pidgin English as "today" kava, a cultivar not used by local people because of its adverse effects. Vanuatu banned the export of this type of kava in 2002, and kava producers are pursuing a protected geographical status for good kava, so that manufacturers can have confidence in their source.

Edzard Ernst, professor of complementary medicine at the Peninsula Medicine School at the Universities of Exeter and Plymouth, co-wrote the 2002 Cochrane Collaboration review of research on the root - regarded as the gold standard for medical analyses. "That kava is indeed effective is not in doubt," he says. "As for its safety, the German cases looked rather dodgy and may in fact be politically motivated. [Germany has a powerful pharmaceuticals industry, which views natural remedies as competition.]

"Compared to the health risks associated with conventional benzodiazapines, kava seems safer and, on balance, better. In my view, there is no doubt that kava is preferable. If taken correctly, there is very little risk." An estimated two million women in the UK are addicted to benzodiazapines; kava is not addictive.

The case against kava is not proven, but rather than just requiring a caution statement on labels, the UK Medicines Commission banned kava in 2003 on the grounds that it posed "a rare but serious risk to public health". Some other countries, such as France, Germany and Canada, take a similar approach.

In January, however, the UK Medicines and Healthcare Products Regulatory Agency will begin a review and public consultation to assess whether the controls on kava "remain justified and proportionate" - a pertinent question, given that the root is still legal - and very popular - in the US. After issuing an initial voluntary recall of kava after the German scare, the Australian authorities took no further action: indeed, there are registered kava drinking houses in some states. In New Zealand, any ban would anger its large Pacific population.

Strangely, kava is not banned in Wales because of a technicality, so some health stores there still stock it. The Welsh Assembly decided not to take any further action until the outcome of the appeal against the ban, which is being led by the National Association of Health Food Stores and the actor Jenny Seagrove.

I don't see why I should have to go to Wales to buy kava, or get my mother to bring it home from US holidays. I could buy any amount on the internet from some unknown virtual company. But I'd much rather it was on the shelves of my local health-food store, where I could rely on finding high quality, well-sourced kava from companies I believe are both ethical and responsible, such as Viridian or Bioforce.

I could go to any supermarket and buy enough paracetamol to kill myself. If I burst into tears in front of my GP, he'd write me out a prescription for benzodiazapines. But - even though my liver is healthy and I take no conventional medication - the powers-that-be want to protect me from the infinitesimal, possibly non-existent risk of kava. To which I say: "Find something more important to worry about and let me get on with my life."

Joanna Blythman is the author of 'Shopped: The Shocking Power of British Supermarkets' (Fourth Estate, £12.99)