{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T03:02:37Z","timestamp":1776826957416,"version":"3.51.2"},"reference-count":94,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2011,3,28]],"date-time":"2011-03-28T00:00:00Z","timestamp":1301270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Phytotherapy Research"],"published-print":{"date-parts":[[2011,9]]},"abstract":"<jats:p>Kava hepatotoxicity is a well described disease entity, yet there is uncertainty as to the culprit(s). In particular, there is so far no clear evidence for a causative role of kavalactones and non\u2010kavalactone constituents, such as pipermethystine and flavokavain B, identified from kava. Therefore, novel enzymatic, analytical, toxicological, ethnobotanical and clinical studies are now required. Studies should focus on the identification of further potential hepatotoxic constituents, considering in particular possible adulterants and impurities with special reference to ochratoxin A and aflatoxins (AFs) producing <jats:italic>Aspergillus<\/jats:italic> varieties, which should be urgently assessed and published. At present, <jats:italic>Aspergillus<\/jats:italic> and other fungus species producing hepatotoxic mycotoxins have not yet been examined thoroughly as possible contaminants of some kava raw materials. Its occurence may be facilitated by high humidity, poor methods for drying procedures and insufficient storage facilities during the time after harvest. Various experimental studies are recommended using aqueous, acetonic and ethanolic kava extracts derived from different plant parts, such as peeled rhizomes and peeled roots including their peelings, and considering both noble and non\u2010noble kava cultivars. In addition, ethnobotanical studies associated with local expertise and surveillance are required to achieve a good quality of kava as the raw material. In clinical trials of patients with anxiety disorders seeking herbal anxiolytic treatment with kava extracts, long\u2010term safety and efficacy should be tested using traditional aqueous extracts obtained from peeled rhizomes and peeled roots of a noble kava cultivar, such as Borogu, to evaluate the risk: benefit ratio. Concomitantly, more research should be conducted on the bioavailability of kavalactones and non\u2010kavalactones derived from aqueous kava extracts. To be on the side of caution and to ensure lack of liver injury, kava consuming inhabitants of the kava producing or importing South Pacific islands should undergo assessment of their liver function values and serum aflatoxin levels. The primary aim is to achieve a good quality of kava raw material, without the risk of adulterants and impurities including ochratoxin A and AFs, which represent the sum of aflatoxin B1, B2, G1 and G2. Although it is known that kava may naturally be contaminated with AFs, there is at present no evidence that kava hepatotoxicity might be due to aflatoxicosis. However, appropriate studies have yet to be done and should be extended to other mould hepatotoxins, with the aim of publishing the obtained results. It is hoped that with the proposed qualifying measures, the safety of individuals consuming kava will substantially be improved. Copyright \u00a9 2011 John Wiley &amp; Sons, Ltd.<\/jats:p>","DOI":"10.1002\/ptr.3464","type":"journal-article","created":{"date-parts":[[2011,3,28]],"date-time":"2011-03-28T08:35:32Z","timestamp":1301301332000},"page":"1263-1274","source":"Crossref","is-referenced-by-count":31,"title":["Kava and Kava Hepatotoxicity: Requirements for Novel Experimental, Ethnobotanical and Clinical Studies Based on a Review of the Evidence"],"prefix":"10.1002","volume":"25","author":[{"given":"Rolf","family":"Teschke","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II Division of Gastroenterology and Hepatology, Klinikum Hanau Teaching Hospital of the Goethe University of Frankfurt\/ Main  Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel X.","family":"Qiu","sequence":"additional","affiliation":[{"name":"Key Laboratory of Plant Resources Conservation and Sustainable Utilization South China Botanical Garden Chinese Academy of Sciences  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tran Dang","family":"Xuan","sequence":"additional","affiliation":[{"name":"Department of Subtropical Bioscience and Biotechnology Faculty of Agriculture University of the Ryukyus  Okinawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Lebot","sequence":"additional","affiliation":[{"name":"CIRAD  Port\u2010Vila Vanuatu"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2011,3,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1021\/jf073133d"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-815533"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jep.2004.04.009"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.8384"},{"key":"e_1_2_10_6_1","unstructured":"Codex Alimentarius.Commission E. Discussion Paper on the Development of a Standard for Kava. Joint FAO\/WHO Food Standards Programme September 2010 eleventh session CX\/NASWP 10\/11\/8. Available at:ftp:\/\/ftp.fao.org\/codex\/ccnaswp11\/na11_08e.pdf[Accessed November 7 2010]"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/10755530260127943"},{"key":"e_1_2_10_8_1","unstructured":"DevanesenD FurberM HamptonD.1986.Health Indicators in the Northern Territory.Northern Territory Department of Health:Darwin."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2007.01.015"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0031-9422(03)00111-0"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9673(01)89682-5"},{"key":"e_1_2_10_12_1","unstructured":"FDA.2002.(U.S. Food and Drug Administration): Consumer advisory: Kava\u2010containing dietary supplements may be associated with severe liver injury. Issued March 25 2002. Available at:http:\/\/www.fda.gov\/Food\/ResourcesForYou\/Consumers\/ucm085482.htm[Accessed November 7 2010]"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00216-010-3526-x"},{"key":"e_1_2_10_14_1","unstructured":"Food Standards Australia New Zealand.2005.Kava. A human health risk assessment. Technical report Series No.30. 2005. Available at:http:\/\/www.foodstandards.gov.au[Accessed November 7 2010]"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-010-9304-7"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2009.11.050"},{"key":"e_1_2_10_17_1","first-page":"369","article-title":"Characterization and physiological activity of some kava constituents","volume":"22","author":"H\u00e4nsel R","year":"1968","journal-title":"Pacific Sci"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aca.2010.01.002"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1021\/jf051853j"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1021\/tx020113r"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(75)91829-2"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1021\/jf800439g"},{"key":"e_1_2_10_23_1","first-page":"55","article-title":"An overview of kava production in the Pacific Islands: what we do know and what we don't know","volume":"4","author":"Lebot V","year":"1997","journal-title":"J South Pacific Agric Univ South Pacific"},{"key":"e_1_2_10_24_1","first-page":"34","article-title":"The quality of kava consumed in the South Pacific","volume":"71","author":"Lebot V","year":"2006","journal-title":"HerbalGram"},{"key":"e_1_2_10_25_1","first-page":"169","article-title":"Geographical survey of genetic variation in kava (Piper methysticum)","volume":"45","author":"Lebot V","year":"1991","journal-title":"Pacific Sci"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02866720"},{"key":"e_1_2_10_27_1","first-page":"223","article-title":"The origin and distribution of kava (Piper methysticum Forst. F. Piperaceae): A phytochemical approach","volume":"5","author":"Lebot V","year":"1989","journal-title":"Allertonia"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/0031-9422(96)00209-9"},{"key":"e_1_2_10_29_1","volume-title":"Kava, the Pacific Elixir","author":"Lebot V","year":"1997"},{"key":"e_1_2_10_30_1","first-page":"71","article-title":"Is the alkaloid pipermethystine connected with the claimed liver toxicity of kava products?","volume":"63","author":"Lechtenberg M","year":"2008","journal-title":"Pharmazie"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.3046"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.1997.77.2.517"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/toxsci\/kfm035"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1078\/094471103322331638"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/jssc.200900663"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phymed.2007.11.003"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/jaoac\/93.2.587"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm0603-634"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1988.tb93809.x"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(82)92411-4"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chroma.2009.10.031"},{"key":"e_1_2_10_42_1","unstructured":"Official Journal of the European Union.2004.Directive 2004\/24\/EC of the European Parliament and of the Council of 31 March 2004 amending as regards traditional herbal medicinal products Directive 2001\/83\/EC on the Community code relating to medicinal products for human use. 2004 L 136\/85."},{"key":"e_1_2_10_43_1","unstructured":"PittlerMH ErnstE.2003.Kava extract for treating anxiety (Cochrane Review). In Cochrane Library Issue I Oxford: Update Software."},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.07-9574LSF"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-200309000-00015"},{"key":"e_1_2_10_46_1","first-page":"12","article-title":"An explorative qualitative analysis of participants' experience of using kava versus placebo in an RCT","volume":"22","author":"Sarris J","year":"2010","journal-title":"Aust J Med Herbalism"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2009.01.003"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2009.0066"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-009-1549-9"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.3109\/00048674.2010.522554"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100030\u20101250290"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1089\/10755530360623284"},{"key":"e_1_2_10_53_1","first-page":"45","article-title":"Quality criteria for kava","volume":"73","author":"Schmidt M","year":"2007","journal-title":"HerbalGram"},{"key":"e_1_2_10_54_1","first-page":"155","volume-title":"The Essential Guide to Herbal Safety","author":"Schmidt M","year":"2005"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1078\/1433-187X-00300"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1139\/G06-002"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0305-1978(01)00093-X"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/0031-9422(83)85065-1"},{"key":"e_1_2_10_59_1","unstructured":"SPC Report.2001.Pacific Kava: A Producer's Guide.Secretariat of the Pacific Community:Suva Fiji Islands. ISBN982\u2010203\u2010810\u20100"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1024196"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1080\/026520399283902"},{"key":"e_1_2_10_62_1","first-page":"372","article-title":"Epidemic of toxic hepatitis in India of possible mycotoxic origin","volume":"102","author":"Tandon HD","year":"1978","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.3283"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1665-2681(19)31634-5"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2010.02308.x"},{"key":"e_1_2_10_66_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2710.2009.01131.x"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1078\/0944-7113-00314"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.1986.tb05176.x"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jep.2009.03.038"},{"key":"e_1_2_10_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/0006-291X(72)90594-3"},{"key":"e_1_2_10_71_1","doi-asserted-by":"crossref","first-page":"7397","DOI":"10.1016\/S0021-9258(19)40958-7","article-title":"Hepatic microsomal alcohol\u2010oxidizing system: Affinity for methanol, ethanol, propanol and butanol","volume":"250","author":"Teschke R","year":"1975","journal-title":"J Biol Chem"},{"key":"e_1_2_10_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2011.01.018"},{"key":"e_1_2_10_73_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2010.03775.x"},{"key":"e_1_2_10_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phymed.2010.10.002"},{"key":"e_1_2_10_75_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1689"},{"key":"e_1_2_10_76_1","first-page":"1283","article-title":"Kava hepatotoxicity: a European view","volume":"121","author":"Teschke R","year":"2008","journal-title":"N Zeal Med J"},{"key":"e_1_2_10_77_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e3283036768"},{"key":"e_1_2_10_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2008.03264.x"},{"key":"e_1_2_10_79_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2009.04.003"},{"key":"e_1_2_10_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yrtph.2010.09.006"},{"key":"e_1_2_10_81_1","unstructured":"TGA.2010.Australian Government Department of Health and Aging Therapeutic Goods Administration Kava fact sheet April 2005. Web page last updated September 20 2010. Available at:http:\/\/www.tga.gov.au\/cm\/kavafs0507.htm[Accessed October 16 2010]"},{"key":"e_1_2_10_82_1","first-page":"1083","article-title":"High performance liquid chromatographic determination of aflatoxicol in milk, blood, and liver","volume":"64","author":"Trucksess MW","year":"1981","journal-title":"J Assoc Off Anal Chem"},{"key":"e_1_2_10_83_1","doi-asserted-by":"publisher","DOI":"10.1021\/jf901826a"},{"key":"e_1_2_10_84_1","unstructured":"Vanuatu Legislation: Kava Act2002. Available at:http:\/\/www.paclii.org\/vu\/legis\/num_act\/toc\u2010K.html[Accessed October 16 2010]"},{"key":"e_1_2_10_85_1","doi-asserted-by":"publisher","DOI":"10.1093\/jaoac\/93.1.184"},{"key":"e_1_2_10_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0031-9422(03)00381-9"},{"key":"e_1_2_10_87_1","unstructured":"WHO (World Health Organization).2007.Assessments of the Risk of Hepatotoxicity with Kava Products.WHO Document Production Services:Geneva Switzerland."},{"key":"e_1_2_10_88_1","doi-asserted-by":"publisher","DOI":"10.1093\/carcin\/bgp264"},{"key":"e_1_2_10_89_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11418-007-0203-2"},{"key":"e_1_2_10_90_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2008.09.052"},{"key":"e_1_2_10_91_1","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.104.001594"},{"key":"e_1_2_10_92_1","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.3301"},{"key":"e_1_2_10_93_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.10.163311"},{"key":"e_1_2_10_94_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0024-3205(02)01913-6"},{"key":"e_1_2_10_95_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-818937"}],"container-title":["Phytotherapy Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fptr.3464","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ptr.3464","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T19:26:57Z","timestamp":1698780417000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ptr.3464"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,3,28]]},"references-count":94,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2011,9]]}},"alternative-id":["10.1002\/ptr.3464"],"URL":"https:\/\/doi.org\/10.1002\/ptr.3464","archive":["Portico"],"relation":{},"ISSN":["0951-418X","1099-1573"],"issn-type":[{"value":"0951-418X","type":"print"},{"value":"1099-1573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,3,28]]}}}