
Green tea supplements ruined my liver - gadders
https://www.bbc.co.uk/news/stories-45971416
======
sieveoferos
This is not great reporting by the BBC. Most grievously, as others have
mentioned, they don't mention the dosages this guy was taking.

The important point to grasp behind all this concern over "supplements" is
that there's no such thing as a supplement. Everything that's not a food is a
drug. If something is not part of a human diet somewhere - i.e. if it's been
extracted and refined significantly - then it's a drug. (Does that mean you
regulate supplements? No, because then you end up in ridiculous situations
like banning high doses of water-soluble B vitamins. Banning certain brands
and formulations is sometimes appropriate.)

Drugs have a dose-response curve, a median lethal dose, and all the rest.
People taking "supplements" (taking them seriously, beyond taking a common-or-
garden multivitamin you can pick up anywhere) should be aware of this and
understand the risks.

"Natural" doesn't mean safe. Polio is natural.

Not all sets of genetics tolerate all "supplements" at recommended dosages.

In vitro is not in vivo.

Animal studies are not human studies.

I got into nutrition and supplementation through bodybuilding, and within that
community the knowledge that _things you put in your body can hurt you, do
your homework_ is fairly widespread and well passed-on. Unfortunately that
perspective hasn't really permeated broader fitness culture.

I think the attitude of "have this problem, take this pill" (without regard
for risks or better options) is mostly at fault here. I'd argue corporate
pharmaceutical companies have some culpability here - "ask your doctor if X is
right for you" \- or don't, and just bloody do some cardio or something.

This article is only interesting if you still conflate "green tea" with
"natural" and "natural" with "safe".

~~~
istjohn
Strongly disagree.

>This article is only interesting if you still conflate "green tea" with
"natural" and "natural" with "safe".

Green tea _is_ natural. And I conflate "consumed daily by millions of people
for thousands of years without incident" with safe. Green tea is not an
obscure herb like echinachea or ginko biloba. The idea that putting it in
capsules would make it dangerous is not obvious at all. It sounds like magical
thinking. So the fact that it is true, and it is in fact dangerous, is
actually quite curious to my mind.

~~~
vorpalhex
"All things are poison, and nothing is without poison, the dosage alone makes
it so a thing is not a poison." \- Paracelsus

Think about the amount of green tea (the plant) that you actually consume in a
cup of tea. Even if it's loose tea and you've done a sloppy job, perhaps a few
granules.

Now imagine popping a couple of capsules packed with the stuff every day. All
of a sudden your intake of something has spiked a few hundred times. It could
be cinnamon and you'd have health consequences.

~~~
bunderbunder
Also, you're usually just drinking the bits that readily dissolve in water,
not the whole leaf.

Go to a tea shop and order some Dragonwell, and drink it. Then have a bowl of
matcha. You will feel the difference, and it can be a rather alarming one.

Edit: Why that's a big distinction: Your body typically flushes water soluble
chemicals fairly easily. It has a harder time with the ones that aren't water
soluble, so they tend to accumulate over time. So capsule of tea leaves is
probably _not_ the same thing as a cup of tea, from a pharmacological
perspective, and theres good basis to assume that it has a lot more ability to
hurt you. The same goes for pill version of traditional medicinal teas
(echinacea, kava kava, etc.)

------
munchhausen
Thank you for posting this article. It gave me pause for thought.

I have been taking a green tea supplement occasionally. I saw it in a vitamin
store, and bought it because of the supposed benefits of antioxidants. I
figured - I have a stressful job, I live in a polluted city and do drink
alcohol - I probably need the antioxidants. Plus, something that's made out of
green tea sounds safe, not likely do any harm, right?

Well. I am disposing of the supplement, obviously. More to the point, though,
I have to revisit my whole thinking process around supplements. I take a bunch
of them, and it's purely on the basis of "I read a study somewhere or other
that this is supposed to be good for you" \- and _not_ because I have a
specific health concern that I need to address.

This approach suddenly does not seem so sane anymore, and I need to take a
step back and rethink what I am doing here.

It's amazing how easy it is to gradually lose touch with your common sense,
simply because you read the "right" subreddits (in this particular case,
/r/nootropics), and start to subscribe to the hype.

~~~
Tor3
The general rule is: You don't need supplements. Period.

That's because supplements provide (or are supposed to provide) trace elements
that you need, but you only need a little bit of it. Like minerals and certain
vitamins etc. The thing is - you basically need the same (trace) amount of it,
whatever your lifestyle is. And you get it through eating a normal varied diet
(e.g. a little meat, vegetables, some fish and seafood when you can, some
(unprocessed) grains). So when do you not get enough of it? When you don't eat
much food, or not enough of certain kinds of foods. Say, if you are a vegan
with a sedentary life style. You're simply not getting enough of the trace
elements through the restricted type of food you eat. If you're an athlete and
you're also a vegetarian then you don't actually need food supplements at all
- you're eating a lot of food due to the energy requirements and you'll get
enough of it. Think Roman gladiator - they were vegetarians. No supplements
needed.

For some reason a lot of people think that you need supplements if you
excercise a lot, while it's in reality the other way around.

~~~
Broken_Hippo
" So when do you not get enough of it? When you don't eat much food, or not
enough of certain kinds of foods."

The exception to this is Vitamin D... if you live in certain areas of the
world. In general, the closer you live to the equator, the less you'll need
this supplement during the winter. I wound up with a low level last winter -
enough to go to the doctor for testing. My other nutrients were just fine: I'm
mostly vegetarian and eat fish about once a week.

I have to take the supplements from September through May. The other months I
have the choice to take them. If I do not take them, I'm supposed to be
outside for at least 15 minutes daily with exposed skin. Minimally short
sleeves. I still take the supplements because I wear long sleeves for a good
amount of summer.

This is the only supplement I see generally recommended here (Norway) simply
because the way the sunlight is in winter.

~~~
baccheion
Vitamin D goes with magnesium, and at higher amounts, vitamin K(2 MK-4).

~~~
Broken_Hippo
Both are pretty easy to get, though. I personally eat a lot of broccoli and
tend to eat red, fatty fish once a week. Unless the doctor says something,
most folks won't need to take those supplements. It is a lot more difficult to
meet your vitamin D needs through food, however.

~~~
baccheion
Magnesium deficiency/insufficiency is almost as common as vitamin D's. If
status hasn't been verified by something like an RBC or WBC magnesium test,
then it isn't really known.

------
fastball
Did anyone else see a dosage that he was actually taking for these green tea
supplements? It seems to be missing from the article but is arguably the most
important point.

Anything is poisonous to the body in high enough doses.

Does the producer of these capsules (apparently Vitacost) specify a maximum
dosage? If so, was Jim exceeding this recommendation? Or well under it?

Come on BBC.

~~~
fredley
There is no 'dosage', because—as mentioned in the article—these capsules are
classified as food, not medicine:

> What is it about green tea supplements that might cause harm at certain
> doses to some people? Scientists do not know for certain. Because green tea
> has been drunk for thousands of years, supplements consisting of its
> concentrated form are regulated in the US and Europe as foods, not
> medicines. That means that specific safety testing has not been required, so
> the scientific picture of how green tea supplements might affect our health
> is incomplete.

~~~
beagle3
Same with water, table salt (NaCl), coffee, pomegranate juice and many other
things.

Dose makes the poison, some people are capable of handling more, and some
less.

Tea, among other things, has caffeine in it, and enough caffeine will kill
you, but other than in pill form, you’ll likely not manage to get to the
threshold because you’ll start vomiting way earlier.

It’s possible that there are other compounds harmful at high concentration.
And of course, it’s not unthinkable that some of his pills were contaminated
with something more dangerous.

But the dosage alone in some cases may explain enough of the damage.

~~~
arkades
Average caffeine pill is 100mg (roughly on par with a cup of tea or coffee).
Caff can be fatal for adults at about 10g of consumption (Heckman 2010) -
about 100 caffeine pills.

Caffeine toxicity can happen much earlier, but it's mostly concerning in
combination with other substances. Caff on its own ... it's really, really
hard to get to a dangerous dose inadvertently.

If the substance is pure, and the dosage is correctly labeled. Neither of
which is especially common for nutritional supplements.

The key to this article is the line, "catechin doses at or above 800mg may
pose health concerns." Pop over to amazon and look at one of the top results
for green tea extract: [https://www.amazon.com/NOW-Green-Tea-Extract-
Capsules/dp/B00...](https://www.amazon.com/NOW-Green-Tea-Extract-
Capsules/dp/B0013OQL0U?th=1) A single pill is 160mg.

------
bshep
I work in a transplant hospital ( for liver and other organs ) and we see A
LOT of people with liver damage from suplements ( green tea, valerian root,
etc ) I would recommend against any supplements unless you clear them with
your doctor, some are ok like VitD ( in the correct dosage ) others are
downright dangerous.

~~~
nate_meurer
Interesting. How do you distinguish damage due to supplements from other
causes, like viral hepatitis or alcohol?

~~~
bshep
Liver Biopsy - appearance is different depending on etiology

------
CaptainZapp
Good grief!

Why not drink green tea if you're interested in the positive effects of green
tea?

Apart from its positive effects it's a fantastic drink.

~~~
ianai
I wish we knew the equivalent amount of green tea he was taking.

~~~
tluyben2
Must be an awful lot... Why do people when they read ‘x is good for you’ or ‘x
might cure y’ go completely overboard. We had these ‘fasting might help
prevent Alzheimer’ and the articles contain something about 24 hours low
calory etc; then I read HN and Reddit and see people, responding to the
article, doing 2 weeks water fast saying it is da bomb. There was an article
about coffee preventing (...) liver cancer; people responding eating packs of
raw coffee beans, drinking liters of coffee etc. All vitamin news is the same;
people taking handsful of then dangerous amounts of vitamins. Moderately seems
key to all.

~~~
CaptainZapp
There's only one word that wants to make me yell at my flat screen more than
_super food_

And that would be _influencer_

------
ohnope
This really makes me wonder if matcha powder poses a similar danger.
Apparently it has 137 times the amount of EGCG compared to regular green tea

~~~
kup0
Interesting thought. Matcha is powdered whole tea leaves, so one would be
consuming far more of the internal ingredients of the leaf than they would by
having other green teas, where the leaves are just being steeped in water.

I guess the only questions there would be how concentrated Matcha is compared
to the supplement forms and how much the body would absorb from it in this
form. If the resulting dose is still a fraction of the supplement form, then
it's likely safe if one doesn't drink a ton of it.

Thanks for mentioning this though, as a tea drinker I've been considering
getting some matcha, and now I need to research more before I do

~~~
adrianN
You are probably safe if you drink about as much Matcha as people who
regularly drink Matcha. That is a cup or two a day. Drinking Matcha is
supposed to be a ritualistic action, its preparation takes a bit of time and
it should be drunk in a mindful manner. It's not a drink where you prepare a
large amount and drink it throughout the day.

------
baccheion
Green tea extract (EGCg) can cause liver damage in those with particular
genetic mutations.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324012/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324012/)

------
IloveHN84
I'm in a holding pattern to since more than 6 weeks now because of increased
values of the liver. No alcohol, no smoke, always trying to be fit with 3x
week sport.

Became suddenly yellow, done the liver-biopsy, nothing came out and still with
high liver values (GPT, GOT). None of doctors have a fucking idea of what I
have. Done all tests against all the kind of Hepatitis, but all of them were
negative.

~~~
rATRIJS
I become yellow from time to time ( although hasn't happened in a few years )
and was diagnosed with Gilbert's syndrome (
[https://en.wikipedia.org/wiki/Gilbert%27s_syndrome](https://en.wikipedia.org/wiki/Gilbert%27s_syndrome)
).

First time it happened when I was ~15 and had to stay in hospital for a week
or so until they figured out what was happening.

For me physical over-exhaustion, too much spicy food or too much alcohol can /
could trigger this.

~~~
arkades
> increased values of the liver.

Gilbert syndrome doesn't affect any liver function tests aside from
unconjugated bilirubin - a value that reflects a backup of bilirubin
processing, and not a liver-damaging process.

------
dreamcompiler
There are at least two big problems with supplements in the US: Their benefits
and potential harm have not been evaluated by a rigorous scientific process,
and it wouldn't matter if they had been because the potency, quality, and
purity of their ingredients is almost entirely unregulated.

------
TheSpiceIsLife
If I recall correctly, the tea plant is great at taking up certain heavy
metals from the soil.

Quick search turned up something
[https://www.scribd.com/doc/24451227/Analysis-of-Heavy-
Metals...](https://www.scribd.com/doc/24451227/Analysis-of-Heavy-Metals-in-
Tea)

Lead, Mercury, arsenic, aluminium, copper.

Could be a concern?

~~~
nabla9
Monitoring of essential and heavy metals in green tea from different
geographical origins
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762913/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762913/)

Same for many edible seeds. For example pumpkin seed and sunflower seed have
high hyperaccumulation capacity.

------
raincom
I remember about Hydroxycut, another weight loss pill from old days. That was
recalled due to liver damage.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952288/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952288/)

~~~
gadders
If you want a weight loss tablet that can kill:
[https://en.wikipedia.org/wiki/2,4-Dinitrophenol](https://en.wikipedia.org/wiki/2,4-Dinitrophenol)

Seems to kill a couple of people a month in the UK.

~~~
SmellyGeekBoy
Why can't people just eat a bit less and do some exercise? It's not rocket
science.

~~~
Broken_Hippo
Sure it isn't rocket science, but it isn't nearly as simple as "just eat a bit
less and do some exercise". I've lost a lot of weight and kept it off for
years. Good advice is hard to come by, and half of the advice is complete crap
or so restrictive that it is difficult to follow. Even "simply eating less"
isn't that simple.

1\. Few tell you ways to deal with actual hunger. Frank talks about this would
help: I explain that it is, to a point, something you get used to and to a
point, something you learn to control after a while. It isn't that hard to
wait an hour for a snack, but it is hard to simply not have a snack.

2\. Most folks still need to be satisfied with food. I personally opt for
eating less during the day and eating more in the evening because that is when
I am the most hungry.

3\. Simply being sure to eat enough fruits and vegetables might cause you to
lose weight without eating less bulk. You don't need to focus on eating less,
just healthier. Same goes for whole grains. You wind up eating less calories.

4\. A slew of people need to learn to cook differently and have options
available at times when they cannot cook.

5\. American society (at least) puts a lot of emphasis on food.

6\. Exercise doesn't actually help you lose much weight. In fact, you might
find yourself more hungry for doing it. It does, however, help with health -
but it doesn't have to be tons of stuff. It would really help if more places
had safe biking and walking paths along roads.

~~~
hedvig
Per 4, I think our imposed "market" focused ideology is mostly responsible.
And I am not of the belief that there are market based solutions that will get
us out of the obesity problem.

------
vackosar
> Concern has focused on a potentially toxic ingredient called
> Epigallocatechin-3-gallate or EGCG, the most abundant of the naturally
> occurring compounds with antioxidant properties in green tea, called
> catechins. There are likely to be a number of factors that might make an
> individual susceptible to harm from EGCG including genetics, and the way
> supplements are used.

~~~
Gibbon1
Here is another where about 5-10% of people have genetic susceptibility to
aristolochic acid, causing kidney damage and cancer.

[https://en.wikipedia.org/wiki/Aristolochia#Herbalism,_toxici...](https://en.wikipedia.org/wiki/Aristolochia#Herbalism,_toxicity_and_carcinogenicity)

------
clumsysmurf
While we're talking about things we assume are healthy (but may not be)
refined Inulin may cause liver cancer — a concern if more foods use it as an
additive

[https://medicalxpress.com/news/2018-10-adding-refined-
fiber-...](https://medicalxpress.com/news/2018-10-adding-refined-fiber-food-
negative.html)

------
arethuza
In _This is Going to Hurt: Secret Diaries of a Junior Doctor_ (strongly
recommended) there is a part where a consultant has a rant about "natural not
meaning safe" and mentions a plant in his garden that would kill you if you
sat under it for ten minutes...

~~~
tomhoward
I think everyone understands that plenty of things in nature are poisonous or
dangerous in other ways.

But it's also reasonable to trust our intuition that food is generally better
- i.e., more easily digested and more nutritionally complete - the closer it
is to its natural form.

In the linked article, the supplement in question was was far from natural; it
was highly refined and concentrated.

So the cause of the damage in this case was not from consuming a natural
product, but from taking a highly _unnatural_ product.

If he'd just had ordinary green tea (i.e., dried tea leaves steeped in water)
once or twice a day, as millions of people have done for many generations,
this would not have happened.

~~~
arethuza
I would recommend reading the book to find out the plant in question and why
you would be killed.... :-)

~~~
tmoravec
Care to share a spoiler? :-)

~~~
arethuza
The author, a junior doctor at the time, later acts the consultant what plant
he was referring to and the consultant says "a water lily".

I think the consultant in question had a bit of a thing about people consuming
large quantities of "natural" products and being surprised that this could
make them quite ill and indulged in a bit of a rant.

~~~
camtarn
Ha!

There actually is a tree which will kill you if you hang around it for long
enough (the manchineel tree), but to be fair I wouldn't expect to find it in
somebody's garden.

[https://www.atlasobscura.com/articles/whatever-you-do-do-
not...](https://www.atlasobscura.com/articles/whatever-you-do-do-not-eat-
touch-or-even-inhale-the-air-around-the-manchineel-tree)

~~~
arethuza
Slightly surprised that tree isn't native to Australia - I guess though that
pretty much any tree of a decent size will potentially kill you if you stand
under it long enough!

------
drcode
I can't find the section in the article where his doctors provide any
convincing rationale that his liver damage was caused by some green tea
extract he briefly took a long time ago.

------
tappaseater
Apropos, Consumer reporters has a guide to alternative (about 1/2 way down):
[https://www.consumerreports.org/alternative-
medicine/guide-t...](https://www.consumerreports.org/alternative-
medicine/guide-to-natural-cures-alternative-medicine/)

------
fchpr
I started using this kind of supplement -among others- and never used to eat
any pill itself: instead I dissolve its content and try not to drink the
particles that do not dissolve in it (like coffee sediments). Anyway liver and
kidneys health are to be taken with caution when using any supplement.

------
magic_beans
Why don't people just drink a cup of green tea!?

------
rv-de
I'd assume pesticides play a big role in that case. It is a known problem and
most countries exporting green tea leaves aren't know for effective regulation
of food safety.

------
sarabande
To save everyone from the clickbait title: green tea capsules are the food
supplement.

~~~
fermigier
This is more that a "clikbait" title. The big picture is that the food
supplement is unregulated in the USA, due, in most part, to intense lobbying
of the food supplement industry.

[https://www.theatlantic.com/health/archive/2016/06/supplemen...](https://www.theatlantic.com/health/archive/2016/06/supplements-
make-tobacco-look-easy/488798/)

In Europe, the situation seems a bit less bleak:

[https://ec.europa.eu/food/safety/labelling_nutrition/supplem...](https://ec.europa.eu/food/safety/labelling_nutrition/supplements_en)

~~~
zone411
They should be mainly regulated to ensure purity standards, prevent
mislabeling, and to allow quick action when a health danger is discovered (and
not a just a 1-in-1,000,000 case). The supplement industry should be forced to
provide independent lab testing results for each batch they sell and to list
all possible known interactions and dangers on the product pages and together
with the physical products, and to provide the government with total sales
numbers. I'm strongly against banning supplements by default.

General problems are the lack of research, especially on humans, low-powered
and short-term studies only, and not publishing null results. It would be nice
if all supplements had safety studies on humans but with a median cost of a
phase 3 trial at $19 million, it would be equivalent to a total ban, unless
the government pays. Maybe some kind of an alternative system could be created
where users report by themselves and all companies have to encourage users to
use this system...

------
throwaway487548
The emphasis is on supplements, not green tea itself.

Lots of chinese are habitually drinking very strong green tea all day long
from one these fancy termos-like transparent cups (an ages old cultural
phenomena, I suppose) and there is no side-effects despite ordinary caffeine
overdose.

Same is true with coffee. Societies with a coffee-culture, like Turkey or
Italy have huge numbers of addicts but uncorrelated number of liver injuries.

