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SUVA, Fiji (Fiji Times, April 25) - A study at the Colonial War Memorial Hospital in Fiji has estimated that kava drinkers consume an average of 100,000 bowls in their lifetime.

The results have prompted calls for a larger study into the effects of such use.

A report in the Fiji Medical Association Journal said that Fiji School of Medicine senior lecturer Doctor Joji Malani warned that care should be taken so the promotion of kava overseas did not promote excessive use locally.

Malani said negative health effects here would negate any short and long-term benefits from kava export.

"Although there is no evidence to link kava with liver and heart disease, there are many lesser serious adverse effects of kava that need to be taken into account," he said.

Malani said although kava fulfilled a central role in traditional and social gatherings, its increased abuse needed serious investigation.

"Most studies so far have shown mild abnormality in liver function and blood tests but they have not linked kava to liver disease when taken in the traditional format."

He said doctors and health workers were concerned about increasing adverse effects, which were supported by evidence.

"We need a larger study to fully appreciate the full impacts of heavy kava use in regards to other aspects of disease presentation, manpower productivity, financial commitment and its demand on family units," he said.

Malani said a boom in the production of kava occurred in the mid-1990s accommodated the use of kava capsules in Europe.

He said for the first time in history, a health concern was brought forward linking reports of liver injury and kava use.

Malani said the reports were not only issued in newsletters and health warnings, they were published and reported in medical journals.

He said three of the 96 cases where it was alleged kava capsules were linked with liver toxicity were probably correct.

"The major task of the kava council is not to deny a possible association but prove that a cost-benefit ratio is acceptable compared to other drugs such as Valium, Paracetamol," said Malani.

He said the use of kava had changed dramatically in the past 50 years in Fiji and Pacific islands.

"Many drink kava now because of changes in the social use of kava and it has become a source of income for farmers."

He said medical reports linked kava to "kanikani" - scales and roughness of the skin - watery eyes, increased salivation, weight loss and restlessness that affect regular consumers.

He said these were observational reports and not many scientific studies were performed.

Malani said there was indication of adverse effects of kava in association with heavy kava use and not in the mild or occasional users.

"Because of increasing health concerns and the heavy use of kava, there has been increasing numbers of good studies to evaluate the extent and effect of kava," he said.

He said a study conducted in 2002 showed that occasional kava users in Fiji experienced little side effects compared to very heavy users.

He said clinical effects of kava were attributed to a group of psychoactive compound called kavalactone.

Malani said some of these kavalactones provide short, intense but pleasant effects while others provide prolonged, unpleasant and nauseous effects that made people feel ill.

"In Fiji, kava is sold as ‘waka’(roots) and lewena (stem) but there is no knowledge as to the type of plant and quality of effect that one is buying into," he said.

April 26, 2005

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