Kava beverages are typically prepared from the root of Piper methysticum. They have been consumed among Pacific Islanders for centuries. Kava extract preparations were once used as herbal drugs to treat anxiety in Europe. Kava is also marketed as a dietary supplement in the U.S. and is gaining popularity as a recreational drink in Western countries. Recent studies suggest that kava and its key phytochemicals have anti-inflammatory and anticancer effects, in addition to the well-documented neurological benefits. While its beneficial effects are widely recognized, rare hepatotoxicity had been associated with use of certain kava preparations, but there are no validations nor consistent mechanisms. Major challenges lie in the diversity of kava products and the lack of standardization, which has produced an unmet need for quality initiatives. This review aims to provide the scientific community and consumers, as well as regulatory agencies, with a broad overview on kava use and its related research. We first provide a historical background for its different uses and then discuss the current state of the research, including its chemical composition, possible mechanisms of action, and its therapeutic potential in treating inflammatory and neurological conditions, as well as cancer. We then discuss the challenges associated with kava use and research, focusing on the need for the detailed characterization of kava components and associated risks such as its reported hepatotoxicity. Lastly, given its growing popularity in clinical and recreational use, we emphasize the urgent need for quality control and quality assurance of kava products, pharmacokinetics, absorption, distribution, metabolism, excretion, and foundational pharmacology. These are essential in order to inform research into the molecular targets, cellular mechanisms, and creative use of early stage human clinical trials for designer kava modalities to inform and guide the design and execution of future randomized placebo controlled trials to maximize kava’s clinical efficacy and to minimize its risks.

Indigenous crops, tremendously valuable both for food security and cultural survival, are experiencing a resurgence in Hawaiʻi. These crops have been historically valued by agricultural researchers as genetic resources for breeding, while cultural knowledge, names, stories and practices persisted outside of formal educational and governmental institutions. In recent years, and following conflicts ignited over university research on and patenting of kalo (Hāloa, Colocasia esculenta), a wave of restoration activities around indigenous crop diversity, cultivation, and use has occurred through largely grassroots efforts. We situate four crops in Hawaiian cosmologies, review and compare the loss and recovery of names and cultivars, and describe present efforts to restore traditional crop biodiversity focusing on kalo, ʻuala (Ipomoea batatas), kō (Saccharum officinarum), and ʻawa (Piper methysticum). The cases together and particularly the challenges of kalo and ‘awa suggest that explicitly recognizing the sacred role such plants hold in indigenous worldviews, centering the crops’ biocultural significance, provides a foundation for better collaboration across multiple communities and institutions who work with these species. Furthermore, a research agenda that pursues a decolonizing approach and draws from more participatory methods can provide a path forward towards mutually beneficial exchange among research, indigenous, and farmer communities. We outline individual and institutional responsibilities relevant to work with indigenous crops and communities and offer this as a step towards reconciliation, understanding, and reciprocity that can ultimately work to create abundance through the restoration of ancestral crop cultivar diversity.