Concentrated green tea extract induces severe acute hepatitis in a 63-year-old woman – A case report with pharmaceutical analysis

Pillukat, Mike H.; Bester, Carolin; Hensel, Andreas; Lechtenberg, Matthias; Petereit, Frank; Beckebaum, Susanne; Müller, Klaus‐Michael; Schmidt, Hartmut

doi:10.1016/j.jep.2014.05.015

Cited by 27 publications

(20 citation statements)

References 42 publications

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“…Nevertheless, only in some cases (Pillukat et al 2014;Gallo et al 2013), a laboratory analysis of the product ingested was carried out to exclude the presence of contaminants, a recurrent problem with herbal products.…”

Section: Discussionmentioning

confidence: 99%

Hepatotoxicity of green tea: an update

2015

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Green tea (GT), obtained from the leaves of Camellia sinensis (L.) Kuntze (Fam. Theaceae), is largely used for its potential health benefits such as reduction in risk of cardiovascular diseases and weight loss. Nevertheless, it is suspected to induce liver damage. Present work reviews the hepatic adverse reactions associated with GT-based herbal supplements, published by the end of 2008 to March 2015. A systematic research was carried out on PubMed, MedlinePlus, Scopus and Google Scholar databases, without any language restriction. Moreover, some accessible databases on pharmacovigilance or phytovigilance were consulted. The causality assessment was performed using the CIOMS/RUCAM score. Nineteen cases of hepatotoxicity related to the consumption of herbal products containing GT were identified. The hepatic reactions involved mostly women (16/19); the kind of liver damage was generally classified as hepatocellular (16/19). The causality assessment between consumption of herbal preparation and hepatic reaction resulted as probable in eight cases and as possible in eleven cases. In seven cases, patients used preparations containing only GT, while twelve reactions involved patients who took multicomponent preparations (MC). The reactions induced by GT had a generally long latency (179.1 ± 58.95 days), and the outcome was always resolution, with recovery time of 64.6 ± 17.78 days. On the contrary, liver injury associated with MC had a shorter latency (44.7 ± 13.85 days) and was more serious in four cases that required liver transplantation and, when resolution occurred, the recovery time was longer (118.9 ± 38.79). MC preparations contained numerous other components, many of which are suspected to induce liver damage, so it is difficult to ascribe the toxicity to one specific component, e.g., GT. Present data confirm a certain safety concern with GT, even if the number of hepatic reactions reported is low considering the great extent of use of this supplement. The mechanism of GT hepatotoxicity remains unclear, but factors related to the patient are becoming predominant. A major safety concern exists when GT is associated with other ingredients that can interact between them and with GT, enhancing the risk of liver damage. Patients should be discouraged from using herbal or dietary supplements containing complex mixtures and should be encouraged to use herbal and dietary supplement possibly under supervision of healthcare professionals.

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Section: Discussionmentioning

confidence: 99%

Hepatotoxicity of green tea: an update

2015

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“…The same anti‐nutritional effect was observed in tannins, despite the beneficial effect of tannins in exhibiting antioxidant, anti‐cancer and anti‐mutagenicity activities . Perhaps the focus should be on a balanced intake as supplementation with concentrated herbal extracts induces liver toxicity and inhibits the absorption of essential nutrients …”

Section: Adverse Effects Of Herbal Infusionsmentioning

confidence: 99%

“…118 Perhaps the focus should be on a balanced intake as supplementation with concentrated herbal extracts induces liver toxicity and inhibits the absorption of essential nutrients. 119,120 Mycotoxins are toxic secondary metabolites from certain fungi. Fungal contamination of raw materials can lead to mycotoxin accumulation during storage and post-harvest processing of herbal raw materials, including tea, resulting in kidney disease, liver disease and oesophageal cancer.…”

Section: Adverse Effects Of Herbal Infusionsmentioning

confidence: 99%

The synergistic potential of various teas, herbs and therapeutic drugs in health improvement: a review

2017

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Tea is one of the most widely consumed non-alcoholic beverages in the world next to water. It is classified as Camellia sinensis and non-Camellia sinensis (herbal teas). The common bioactive compounds found mainly in green teas are flavan-3-ols (catechins) (also called flavanols), proanthocyanidins (tannins) and flavonols. Black tea contains theaflavins and thearubigins and white tea contains l-theanine and gamma-aminobutyric acid (GABA), while herbal teas contain diverse polyphenols. Phytochemicals in tea exhibit antimicrobial, anti-diabetic and anti-cancer activities that are perceived to be helpful in managing chronic diseases linked to lifestyle. Many of these phytochemicals are reported to be biologically active when combined. Knowledge of the synergistic interactions of tea with other teas or herbs in terms of biological activities will be of benefit for therapeutic enhancement. There is evidence that various types of teas act synergistically in exhibiting health benefits to humans, improving consumer acceptance and economic value. Similar observations have been made when teas and herbs or medicinal drugs were combined. The aim of this review is to highlight potential beneficial synergies between combinations of different types of teas, tea and herbs, and tea and medicinal drugs. © 2017 Society of Chemical Industry.

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“…There has been a previously reported case of a patient developing fulminant hepatitis requiring liver transplantation following consumption of dry extract of green tea ( C. sinensis ), which was used as an adjuvant therapy for a weight loss programme 6. A recent case study reported the association between hepatitis and concurrent consumption of concentrated herbal extracts from green tea, with a very high dose level of epigallocatechin gallate and epicatechin 7. Authors of another case have hypothesised green tea infusions ( C. sinensis ) as a potential trigger for autoimmune hepatitis 8…”

Section: Discussionmentioning

confidence: 99%

Chinese green tea and acute hepatitis: a rare yet recurring theme

Lugg¹,

Menezes

Gompertz

2015

BMJ Case Reports

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SUMMARYA previously healthy 16-year-old girl presented with signs of acute hepatitis. On initial enquiry, she had not taken any prescribed or 'over-the-counter' medications, and there was no recent travel history. Further investigations revealed no viral, autoimmune or metabolic cause of hepatitis. Only following specific questioning did she reveal that she had, in the preceding 3 months, regularly consumed internet ordered Chinese green tea, which contained Camellia sinensis. After ceasing green tea consumption, there was a rapid and sustained recovery of her hepatitis. The authors discuss the probable cause of herbal tea in this case of acute hepatitis, and the importance of awareness of this rare yet recurring theme for patients and clinicians alike. BACKGROUND

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Concentrated green tea extract induces severe acute hepatitis in a 63-year-old woman – A case report with pharmaceutical analysis

Cited by 27 publications

References 42 publications

Hepatotoxicity of green tea: an update

Hepatotoxicity of green tea: an update

The synergistic potential of various teas, herbs and therapeutic drugs in health improvement: a review

Chinese green tea and acute hepatitis: a rare yet recurring theme

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