Green extracts

First of all note that I did not name this topic with a negative title even though this report may suggest negatives. I will leave it up to you guys to decide whether the following letter is a warning against green tea extract supplementation. I have some some negative reports with green tea supplementation recently.

Anyway, here is the letter/report

Hepatotoxicity due to extracts of Chinese green tea (Camellia sinensis): A growing concern.

    Javaid A, Bonkovsky HL.

    University of Connecticut Health Center, Farmington, CT 06030, USA.

    Publication Types:

        * LETTER


    PMID: 16793166 [PubMed - as supplied by publisher]



We read with interest the recent review article in your Journal on “herbal hepatotoxicity” [1] and agree that herbal remedies are in increasing use in contemporary life worldwide. Such remedies are also a cause of drug-induced liver injury (DILI) that is of growing frequency and importance. Conspicuous by its absence in the review were extracts of Chinese green tea (Camellia sinensis) as a cause of herbal hepatotoxicity. Because we think it important to alert your readership to this cause, we are writing to you now. Although Chinese green tea has been used for centuries, several recent reports [[2], [3], [4], [5], [6] and [7], reviewed in Ref. 8, which also added a new case with rechallenge leading to severe, accelerated (DILI)] emphasize the risk of serious liver injury due to ingestion of concentrated extracts of green tea. Indeed, a recent letter to this journal described development of severe hepatotoxicity following ingestion of infusions of green tea itself, not in concentrated, extract form [9].

With but one exception [Case 2 of Ref. 3], the patients recently reported, as well as an additional unreported patient whom we recently cared for [a 46-year-old woman who developed jaundice (peak serum total bilirubin = 211 μmol/L (ref. range 3.4–20.4), serum AST = 1188 U/L (ref. range 14–36), ALT = 1100 U/L (ref. range 9–52), and alkaline phosphatase = 194 U/L (ref. range 38–126) seven months after starting extracts of Chinese green teas], developed severe hepatocellular (or hepatitic-like) injury, with peak serum ALT 1100–3962 U/L, and serum total bilirubin = 91–505 μmol/L. Reported patients did not present with features suggestive of immuno-allergic, but rather idiosyncratic, DILI. They did not have known underlying liver disease. To the best of our knowledge, the pathogenesis of such injury remains unknown. Given the relative rarity of the reaction, it seems likely that host genetic factors are important in modulating susceptibility. As with most DILI, the majority of patients with C. sinensis-DILI have been women [2], [3], [4], [5], [6], [7], [8] and [9].

Although C. sinensis contains several polyphenols, which have potent antioxidant properties, based upon this and other recent experience [2], [3], [4], [5], [6], [7] and [8], there no longer can be a reasonable doubt that ingestion of concentrated extracts of Chinese green tea (C. sinensis), and rarely of infusions of green tea itself [9], poses a real and growing risk to liver health, of which your readers need to be aware.

Acknowledgements

This work was supported by Contracts NO1 DK 29236 and UO1 DK 065193 and Grants RO1 DK 38825 and MO1 RR 06192 from the U.S. National Institutes of Health. We thank Laura Glynn, CRA, for help with evaluation of our patient and Jean Clark for help in preparing this manuscript.

References

[1] F. Stickel, E. Patsenker and D. Schuppan, Herbal hepatotoxicity, J Hepatol 43 (2005), pp. 901–910. SummaryPlus | Full Text + Links | PDF (203 K)

[2] T. Vial, G. Bernard, B. Lewden, J. Dumortier and J. Descotes, Acute hepatitis due to Exolise, a Camellia sinensis-derived drug, Gastroenterol Clin Biol 27 (2003), pp. 1166–1167. Abstract-MEDLINE 

[3] T. Stevens, A. Qadri and N.N. Zein, Two patients with acute liver injury associated with use of the herbal weight-loss supplement Hydroxycut, Ann Intern Med 142 (2005), pp. 477–478. Abstract-MEDLINE | Abstract-EMBASE 

[4] C. Pedros, G. Cereza, N. Garcia and J.R. Laporte, [Liver toxicity of Camellia sinensis dried ethanolic extract] [Letter], Med Clin (Barc) 121 (2003), pp. 598–599. Abstract-MEDLINE  | Full Text via CrossRef

[5] S. Garcia-Moran, F. Saez-Royuela, E. Gento, A. Lopez Morante and L. Arias, [Acute hepatitis associated with Camellia tea and Orthosiphon stamineus ingestion] [Letter], Gastroenterol Hepatol 27 (2004), pp. 559–560. Abstract-MEDLINE  | Full Text via CrossRef

[6] Porcel JM, Beilsa S, Madronero AB. Hepatotoxicity associated with green tea extracts [electronic letter]. Accessed at: .

[7] C. Thiolet, D. Mennecier, C. Bredin, O. Moulin, H. Rimlinger and C. Nizou et al., [Acute cytolysis induced by Chinese tea] [Letter], Gastroenterol Clin Biol 26 (2002), pp. 939–940. Abstract-EMBASE | Abstract-MEDLINE 

[8] H.L. Bonkovsky, Chinese green tea (Camellia sinensis)-containing supplements and hepatotoxicity: case report and brief review, Ann Int Med 144 (2006), pp. 68–71. Abstract-MEDLINE 

[9] M. Jimenez-Saenz and Md C. Martinez-Sanchez, Acute hepatitis associated with ingestion of green tea infusions, J Hepatology 44 (2006), pp. 616–617. SummaryPlus | Full Text + Links | PDF (59 K)

What amounts per day did they use? That is the important bit of information that never seems to come out in these negative reports. Was it 1 cap a day of extract or was it 20 caps or 50? Isolated rare cases are not very impressive. People die every day from reactions to common household items like aspirin and bee stings. If they did a study that followed 1000 people who started on a normal dose of extract and several percent came down with liver disease, I would be concerned. The way the info is presented we have no way of knowing if it's relevent or not.

I'm not criticizing you, zoo. It's the report itself.

Click HERE to rent this advertising spot for SUPPLEMENTS (in thread) to support LongeCity (this will replace the google ad above).

After reading this article I'm left with two rather grave concerns. First and foremost, that finding myself devoid of meaningful scientific database access, for the full text of studies , is becoming more and more annoying by the day. Secondly, that I need to know more languages. Seriously, it seems like the only language not represented among the citations is Esperanto.

But back to the actual letter. I'd definitely say it's interesting, and my ears will probably be a bit more perked to this topic in the future. That said, I don't really think it can be seen as much more than a hazy form on the horizon, which can be taken as pretty much anything due to the ambiguity of the data presented.

First and foremost, the gist of it seemed to be speculation that some people had a genetic factor which led to a negative reaction that isn't present in the majority of the population. Were this the case, it might mean that the negative effects are simply more acute in those people and that long term use by others would create a slower buildup to something similar. It could also just as easily mean that green tea extracts are the pill poppers analogue to peanuts. Delicious and biologically useful to the vast majority of people, but a lurking demon for those poor souls damned to a peanut allergy. Again, from what I could see, there's no way to really judge it one way or another from the data.

My other gripe comes from the citations. Looking through it, one points to use of a topical gel as the delivery mechanism, another to a weight loss pill which contains other ingredients. Those citations I was able to track down were in languages I'm not competent enough in to use those weak skills toward experimental review. The rest seem to fall under letters to the editor. Which doesn't necessarily disqualify them from significance, but it does lower their value by a pretty huge margin.

While it piqued my curiosity, it also had the feel of a paper hurriedly put together at the last hour of an all-nighter. I had a definite impression of mining Bonkovsky's letter for citations given only the most cursory glance by the author.

That said, I'm curious enough to place those remaining texts on my to-do list for the weekend. Bonkovsky's in particular I'd be really curious to see. Not $30 worth of curious, but still. I even resorted to the normal google search in hopes of finding an overview of it, but few had more than a citation with little to no information and almost all were sources that I wouldn't feel comfortable placing that much trust in as far as unbiased and accurate summarizing goes.

For all the nitpicking I'm doing, I have to say I'm glad to see this. The most accurate pictures come from examining the arguments on both sides of an issue. Science without the willingness to ask questions that people don't want to see proven is a lame, toothless, thing.

Edited by emerson, 29 June 2006 - 11:42 AM.