Case: 38 years old female is admitted to the ICU with jaundice, fever, hypotension, and elevated liver enzymes. Patient has no past medical history, but a mildly higher BMI of 26. Approximately 6 months ago, the patient began intermittent fasting to lose weight and consuming green tea 8-10 times per day.
Discussion: The extracts of green tea are technically called Camellia sinensis L. and contain catechin polyphenols. It is usually harmless and may be beneficial when consumed in moderation. In higher doses, i.e., more than a gram per day, can be toxic, particularly to the liver. The risk of toxicity is higher in chronic users. Unfortunately, extracts are used and sold over the counter in many other weight-loss products without the buyer's awareness. Overconsumption causes catechin exposure and hepatic injury.
Three major factors affecting are genetic predisposition, female gender, and fasting. Hepatic injury is usually hepatocellular, but can be mixed with cholestatic presentations.
Fortunately, liver injury is reversible with discontinuation of the product.
#toxicity
References:
1. Gurley BJ, McGill MR, Koturbash I. Hepatotoxicity due to herbal dietary supplements: Past, present and the future. Food Chem Toxicol 2022; 169:113445.
Molinari M, Watt KD, Kruszyna T, et al. Acute liver failure induced by green tea extracts: case report and review of the literature. Liver Transpl 2006; 12:1892.
Oketch-Rabah HA, Roe AL, Rider CV, et al. United States Pharmacopeia (USP) comprehensive review of the hepatotoxicity of green tea extracts. Toxicol Rep 2020; 7:386.
Galati G, Lin A, Sultan AM, O'Brien PJ. Cellular and in vivo hepatotoxicity caused by green tea phenolic acids and catechins. Free Radic Biol Med 2006; 40:570.
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