Q: A while ago I read about a warning label to be placed on green tea extract because of the risk of liver damage. This doesn't seem to have happened. What's going on?
A: In June 2007, the U.S. Pharmacopeia (USP) proposed requiring a cautionary statement (not a warning label) on black cohosh (an herb that may relieve hot flashes and other symptoms of menopause) and on all dietary supplements containing green tea extracts.
The USP is the official public-standards-setting authority for all drugs (both prescription and over-the-counter), dietary supplements, and other health-care products manufactured and sold in the United States. USP standards are recognized and used in more than 130 countries.
My colleague Dr. Tieraona Low Dog, director of the fellowship at the Arizona Center for Integrative Medicine, is on the USP committee that proposed the cautionary statements. She told me at the time that the action was taken after a thorough review of all the reports to the FDA of adverse events for black cohosh and green tea extracts, including liver damage. If there is a relationship between green tea extracts and liver damage, Dr. Low Dog said that the incidence appears to be exceedingly low. Still, the committee decided that consumers should be aware of a growing number of reports suggesting that concentrated green tea extracts (predominantly those prepared with alcohol), with and without other ingredients, may cause elevation of liver enzymes and liver damage.
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However, in June 2008, the USP committee decided to defer its decision on the cautionary label for green tea extract and published its Powdered Decaffeinated Green Tea monograph without the cautionary labeling. The USP said that the reason for the deferral was to give its Dietary Supplements Information Expert Committee time to review its safety classification policy. Until the committee completes this review, the green tea extract cautionary statement will be on hold. If the committee finds that safety issues warrant a cautionary statement, it will act.
The cautionary statement on black cohosh was not deferred. It notes that the supplement can affect the liver and advises consumers to discontinue use if they develop symptoms indicating liver dysfunction, such as nausea and vomiting, abdominal pain or dark urine. Anyone who already has liver disease should be cautious about using black cohosh.
For the record, I have always recommended drinking green tea itself as the best way to get the health benefits it has to offer. I do not recommend using concentrated extracts of tea. Drinking tea poses no risk. I'll continue to follow developments on green tea extract and the question of whether or not it actually presents a risk of liver damage.
Q: My son, 14, lost his spleen due to an accident. What can I do to keep him healthy? He has had the vaccines recommended and took penicillin for two years. He is now on a multivitamin. He plays golf but complains of being tired.
A: The spleen, located in the upper left of the abdomen under the rib cage, is part of the immune system. Its functions include storing old, damaged blood particles and helping identify and destroy bacteria.
Your son can live perfectly well without a spleen, although he will be at higher than normal risk of contracting serious or even life-threatening infections. When the spleen is removed, patients need to be vaccinated against pneumococcal pneumonia, a bacterial infection of the lungs and other organs. Some doctors recommend vaccinations against other types of bacteria as well, and, in the case of children, may suggest long-term treatment with antibiotics to prevent bacterial infections of the bloodstream (sepsis). Long-term antibiotic use is usually not necessary in adults.
The most important strategy you can use to safeguard your son's health is to make sure that he gets medical attention for even minor illnesses such as a sore throat or sinus infections. Sometimes, antibiotics may be needed here as well.
The removal of his spleen is unlikely to be a factor in the fatigue your son is experiencing. Many teenagers complain constantly about being tired. Bear in mind that fatigue due to disease usually worsens as the day goes on, while fatigue due to stress is often worse in the morning. If no underlying medical reason for his fatigue has been found, make sure that he is getting enough sleep (teens need about nine hours a night). Consider, too, whether your son might be depressed, also a leading cause of fatigue in adolescents and teens. If you suspect that he might be, ask his physician to recommend a psychologist or counselor.
You also could try giving him Eleutherococcus (Siberian ginseng), which, taken regularly, can help people who are run down, weak, lack energy and resistance, or suffer from chronic illness. Look for Eleuthero products in herb and health-food stores, or combination products that include cordyceps and ashwaganda, two other herbs I recommend to address fatigue. They vary in concentration and potency, so follow the dosage recommendations of the manufacturer.