EGCG Clinical Trial Results
My interest in EGCG ( chemical name “epigallocatechin-3-gallate”), main component of green tea extracts, started in the Fall of 2001 soon after my husband PC was diagnosed with CLL. Like most of you, I came across anecdotal stories of cancer patients who tried green tea extract as well as glowing testimonials extolling its virtues on websites that were hawking capsules of their brand of green tea extracts for a hefty price.
I dug a little deeper. I read most of the earlier laboratory research papers that discussed the possible cellular mechanisms that might explain the biologic impact of green tea extracts. While there were no credible reports that translated the lab work into actual clinical results of green tea extracts used in CLL patients, the science was intriguing and I was hooked.
From the lab bench to the patient bedside
This is where most new concepts and “miracles-of-the-month” fall by the wayside, making the transition from the lab bench to the patient bedside. The million dollar questions were these: does green tea extract help in controlling or rolling back CLL in real life patients? If the answer to this is yes, how high does the dose have to be to do some good? How much of a price tag is there in terms of adverse effects at an effective dose level?
These are important questions and they cannot be answered by anecdotal information. Anecdotal information is simply too unreliable. I am not talking about obvious commercial bias built into internet shops hyping stuff they sell, I am also talking about wishful thinking we all indulge in at some point or the other when facing an incurable cancer. Won’t it be wonderful if all you have to do is drink lots of green tea and your CLL goes away? Problem with wishful thinking is that it rarely pans out and when the unjustified optimism wears thin payback is a real bitch.
Patients in the drivers’ seat
I am a scientist, I have been one pretty much my whole professional life. I am very familiar with the process of the well constructed hypothesis and carefully conducted clinical trial to test the hypothesis. I hoped green tea extracts would be helpful in treating CLL, the early work suggested it might, but there was no solid proof. We needed a formal clinical trial conducted by credible researchers before we could answer questions of efficacy, dosage and safety.
I knew there was not going to be a deep pocket drug company backing this trial (hard to patent green tea or its extracts and therefore hard to make a lot of money off of it). If this project was going to go anywhere, it would have to be driven by CLL patients’ interest and funded by their hard earned cash.
I made a list of every CLL expert center in the USA and wrote letters suggesting this clinical trial concept. We registered CLL Topics as a non-profit and started collecting donations from our members, to pay for the trial we hoped to kick start. We waited breathlessly to hear back from the CLL Consortium experts. One expert, just one, called us back and expressed interest in our proposal. I will always be grateful to Dr. Neil Kay of the Mayo Clinic for his vision and his willingness to work with a newly formed patient group. Our partnership with his team was a first of its kind in many ways. With sincere desire on both sides, it was surprisingly easy to sort out the details and Project Alpha was launched December 2003.
Goals of the EGCG clinical trial
First step in designing the clinical trial protocol was determining exactly what will be used as a well defined green tea extract. Mitsui Norin of Japan had already developed a relationship with the NCI and formulated a well characterized green tea extract that they named “Polyphenon E“. It contained a mix of ‘catechins’, biologically active compounds including the most famous one, EGCG. Having access to a well characterized green tea extract was a huge advantage and it got our trial off to a fast start.
I hoped the Mayo clinical trial would answer the following questions:
- Is Polyphenon E safe for human consumption? This is the first hurdle to cross. Yes, we know Japanese and Chinese cultures have elevated drinking green tea to an art form for centuries with no obvious toxicity. But in this clinical trial we are talking of using much more concentrated form of green tea and much higher doses. That can be a whole new ball game.
- What is the right dose? Every early phase trial hopes to establish a “therapeutic window”, a dose range where the dosage is high enough to be effective but not so high as to cause toxicity or other adverse effects. Researchers need to establish a “maximum tolerated dose” (MTD), beyond which the adverse effects are simply unacceptable.
- Is there risk associated with taking a therapeutically effective dose for many months? Neither Mayo nor I had illusions that taking green tea extract for a couple of days would do the job. Most likely it was going to take months of dosing volunteers with Polyphenon E. Is that safe?
- Once toxicity issues have been addressed to everyone’s satisfaction, we come to the real $70,000 question: does Polyphenon E actually help control or treat CLL?
- Did particular groups of CLL patients benefit more than others? We all know that CLL comes in many flavors and it is important to know if Polyphenon E worked in one set of patients but not others.
We had $70,000 of your hard earned donations on the line, as well as many months of hard work on the part of everyone associated with this project. We had hopes, but we did not know the answers ahead of time. And that is the whole point of doing well designed clinical trials, to get answers that are credible and dependable.
The results are finally here, published in a well regarded professional and peer-reviewed journal, blue ribbon author list of Mayo Clinic researchers (lead researcher Tait Shanafelt). You can be proud that CLL Topics is listed among the sponsors. Below is the abstract of the article. If you are interested, I can help you locate a full text copy of it. My cheat-sheet review of the paper follows the abstract.
J Clin Oncol. 2009 May 26.
Phase I Trial of Daily Oral Polyphenon E in Patients With Asymptomatic Rai Stage 0 to II Chronic Lymphocytic Leukemia.
Shanafelt TD, Call TG, Zent CS, Laplant B, Bowen DA, Roos M, Secreto CR, Ghosh AK, Kabat BF, Lee MJ, Yang CS, Jelinek DF, Erlichman C, Kay NE.
Department of Internal Medicine, Division of Hematology; Division of Biostatistics, and Departments of Immunology and Oncology, Mayo Clinical, Rochester, MN; and the Department of Chemical Biology, and the Ernest Mario School of Pharmacy Rutgers, the State University of New Jersey, Piscataway, NJ.
PURPOSE: To define the optimal dose of Polyphenon E for chronic daily administration and tolerability in patients with chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS: Previously untreated patients with asymptomatic Rai stage 0 to II CLL were eligible for participation. Polyphenon E with a standardized dose of epigallocatechin-3-gallate (EGCG) was administered using the standard phase I design with three to six patients per dose level (range, 400 to 2,000 mg by mouth twice a day). Trough plasma EGCG levels were measured 1 month after initiation of therapy. Response was classified using the National Cancer Institute (NCI) Working Group (WG) Criteria. RESULTS: Thirty-three eligible patients were accrued to dose levels 1 to 8. The maximum-tolerated dose was not reached. The most common adverse effects included transaminitis (33%, all grade 1), abdominal pain (30% grade 1, 0% grade 2, and 3% grade 3), and nausea (39% grade 1 and 9% grade 2). One patient experienced an NCI WG partial remission. Other signs of clinical activity were also observed, with 11 patients (33%) having a sustained >/= 20% reduction in absolute lymphocyte count (ALC) and 11 (92%) of 12 patients with palpable adenopathy experiencing at least a 50% reduction in the sum of the products of all nodal areas during treatment. Trough plasma EGCG levels after 1 month of treatment ranged from 2.9 to 3,974 ng/mL (median, 40.4 ng/mL). CONCLUSION: Daily oral EGCG in the Polyphenon E preparation was well tolerated by CLL patients in this phase I trial. Declines in ALC and/or lymphadenopathy were observed in the majority of patients. A phase II trial to evaluate efficacy using 2,000 mg twice a day began in November 2007.
PMID: 19470922
Clinical trial design
- Previously untreated patients in Rai stage 0 – II CLL who did not yet have any symptoms or need treatment were recruited. Basically, the trial was looking to see if otherwise healthy CLL patients can be helped by EGCG
- The original plan was to let the patients take the capsules on an empty stomach. This was later changed to taking the capsules with food, to address some concerns raised by the FDA. Dose range in the study was 400 to 2,000 mg by mouth twice daily for up to 6 months.
- With the approval of the treating hematologist, patients who had not experienced disease progression and who desired to remain on EGCG were provided capsules at their assigned dose level for up to 12 additional months.
- All patients underwent comprehensive prognostic testing including assessment of CD38 and ZAP-70 expression, FISH detectable cytogenetic defects, and IgVH gene mutation status. This was a big deal. Back then, some of these tests were not readily available and not too many insurance companies covered the cost of getting the testing done. Giving innumerable tubes of blood for all the monitoring and testing was part of the deal. But many of our members thought getting prognostic testing done at Mayo was one of the valuable fringe benefits of participating in this clinical trial.
Patient Profile
It is important to get a clear picture of the kind of patients who volunteered for this trial, how they stack up in terms of their disease staging and prognostic profile. As you can see in the table below, most of the patients were early stage with a sprinkling of folks with the undesirable prognostic indicators (ZAP70 and CD38 positive, unmutated IgVH, 12 Trisomy). All in all, not a tough crowd and this was the intent of the trial, to see if green tea extract can help stabilize or even reverse their disease status.
Toxicity
Patients were enrolled in all 8 dose levels, ranging from 400 mg to 2,000 mg twice daily. There were only two patients who experienced any kind of dose limiting toxicity (DLT). One patient at a dose of 1,200 mg twice daily had trouble swallowing (grade 2 level) and another patient at the highest 2,000 mg twice daily had problems with sweating, gas, nausea and tummy bloating (grade 2). Not much to write home about. Remember, toxicity is graded on a scale of 1-4, grades 1-2 are considered mild and researchers sit up and take notice only when the problem escalates to a higher grade of 3-4. In addition to these two cases of dose limiting toxicity, one patient experienced grade 3 abdominal pain and another patient had grade 3 diarrhea.
Response
Now we come to the real interesting part. Was the green tea extract biologically active or was it like taking capsules filled with lawn clippings? Based on the results of this study, the answer is clear: EGCG is biologically active in this CLL patient cohort. Table below gives the decrease in ALC (absolute lymphocyte count) observed.
Frankly, I am more impressed by the reduction in size of lymph nodes. Out of the 12 patients who entered the trial with any kind of lymphadenopathy, an impressive 11 of them got at least 50% reduction in size. Not bad! Overall, 55% of the patients fulfilled the criteria for biologic response (sustained decline in ALC of more than 20% and/or more than 50% reduction in lymphadenopathy). Just about right for the proverbial half full glass, in my opinion.
As one would expect, achieving a biologic response appeared to be related to dose level; two (17%) of 12 patients treated on dose levels 1 to 3 achieved a biologic response where as 16 (76%) of 21 patients treated on dose levels 4 to 8.
There was no statistically significant difference based on prognostic indicators (IgVH, ZAP70, CD38), but patients with 12 Trisomy seemed less likely to respond.
Editorial: Putting it into perspective
Did this clinical trial achieve its objectives? Yes, it did. In a well characterized and monitored group of CLL patients green tea extract was shown to be well tolerated with few adverse effects and biologically active when orally administered. It did what I hoped it would do, provide credible information on safety, efficacy and dosage. Our $70,000 contribution to fund this trial is money well spent.
Now let us look at the details. Did green tea extract cure anyone’s CLL? The clear and unambiguous answer is that it did not. It is important to know what we can expect from any given drug treatment. Wishful thinking does not do a whole heck of a lot for cancer patients.
So, what is the big deal here? Well, it is always a question of weighing costs and benefits. EGCG clearly does not have the oomph of more conventional therapies such as fludarabine, Rituxan or combinations thereof. But on the other hand, it does not have the toxicity associated with just about any of the conventional therapy options available to CLL patients. Even the modest benefit from green tea extracts becomes significant when seen in the context of very low toxicity.
Watch & Wait is a frustrating concept to most Type A personalities. We want to do something, anything, that can possibly help us, while we wait for the disease to continue its upward march. After the completion of this trial and publication of the results, I feel comfortable telling patients it is perhaps a good idea to cultivate the Asian habit of drinking several cups of green tea each day. If you can make a relaxing ritual of it and thereby reduce some of your stress as well, what is not to like?
But taking green tea extracts as supplements is a whole different thing. For starters, we are still stuck with the problem of what brand to use. Polyphenon E used in this trial is not commercially available to consumers. I do not know how easy it is to get hold of it even if you get your doctor to write a prescription for it. I am not in the business of shilling for any particular company selling green tea extracts and the best advice I can give you is to do your home work, buyer beware is a good mantra. I also want to warn you that taking large amounts of green tea extracts without medical monitoring may not be so good to your liver. Please read the FDA concerns we reported in our earlier article.
The clinical trial pointed out another issue with oral dosing of green tea extracts. The highest dose used in this trial was 2,000 mg twice daily. They reason why they stopped at that level was not because of toxicity or reaching maximum tolerated dose but because it becomes a logistics headache telling patients to take more than 10 capsules of the stuff twice daily.
There is reasonable indication that the response was determined by dose level, more patients got a better response at the higher dose levels. The problem is one that we identified even before the start of the trial: green tea extracts have very poor bioavailability when taken orally. For starters, taking large amounts upsets your stomach, secondly even the small amount that is absorbed in the gut is mostly broken down in the liver before it can get into blood circulation and do any good. This is called “first pass metabolic loss”. A fancy term that means your liver sees the green tea extracts as toxic and promptly breaks them down and gets rid of them. A very large percentage of the green tea that volunteers were swallowing was being excreted by their bodies, literally getting pissed away. This is what we mean by poor bioavailability when taken orally.
This issue was discussed in an article on our website that drew a lot of attention, an article with the whimsical title of “Harvey’s chocolates“. If you have not read it I suggest you do so now.
Oral ingestion of drugs is notorious for poor dose control. How much you absorb depends on many details, such as what you just ate, the level of acidity in your stomach, the health and vigor of your liver (damaged livers cannot get rid of perceived toxins as effectively), how long the capsules stay in your gut before getting excreted etc.
Many drugs share the problem of poor oral bioavailability and we have already invented ways around this problem. How many of you are familiar with the concept of skin delivery of medicine, as in nicotine patches to help quit smoking? Transdermal drug delivery gets rid of the upset tummy and first pass metabolic loss issues, not to mention the extra load on the liver. We know how to do this. It is “just” a case of getting a reputable and interested drug manufacturer to develop, test and market green tea extract skin patches. Easier said than done. It took us roughly 6 years to get the Mayo clinical trial done to this stage.
How about buccal delivery? By that I mean drug transport through the inside of your mouth, the inside of your cheeks and under your tongue. Any of you take sublingual (under the tongue) vitamin B products? People at risk of heart attacks are also familiar with sublingual nitrate pills. Again, we already have a well known and well understood mechanism of doing a better job of drug absorption than swallowing pills or capsules. Harvey’s Chocolates is a layperson approach to the same concept. I understand there are several firms out there now that do sell EGCG candies that you can keep in your mouth and suck on for long periods of time.
As you can see, much remains to be done. Whether things gets done and how long it will take to get a move on some of these concepts is anyone’s guess.
I would like to close this long editorial with one last comment. My sincere and heartfelt thanks to each and every one of you that participated in this clinical trial, as well as the generous donors that made it possible for us to fund this trial to the tune we did. I regret that this intense level of patient involvement that made pateint recruitment a breeze and kick started the trial in the first place did not merit a special “thank you” from the Mayo authors when they published their paper. This is a pet peeve of mine, that researchers do not seem to understand clinical trials will not happen unless patients risk their bodies and their lives by volunteering. This is not hubris, I am not talking about me or CLL Topics. I am talking about thanking the actual volunteers that made the trial possible. Talk of partnership is wonderful, but I would like to see it acknowledged and acted upon more openly.
75 comments on "Green Tea"
Hmmm. So what you are thinking is green tea as an alternative to watch and wait?
Is there any way a more conventional food processing company could aquire rights to Mitsui Norin’s recipe and market it as a general health food product with established and frequently monitored levels of polyphenon E?
I have been a big believer in green tea but even more so now with this evidence esp. with the reduction of node size. Are you aware of any studies done with burdock root?
Patrick:
I do not know the answer to that question. It would depend on the two interested parties striking a business deal that satisfies both of them.
A while back there was a product called “Teavigo”, a very high purity pharmaceutical grade EGCG product (and not the mix of many catechins, including EGCG, in the Polyphenon E product used in the Mayo clinical trial) marketed by Roche Pharmaceuticals. I do not know if it is still available and who sells it.
Back when I made EGCG laden caramels for my husband I used a similarly high grade EGCG that I obtained directly from a supplier in China. We went through many hurdles in getting hold of the product and then getting it analyzed both in the USA and Japan to make sure the Chinese manufacturer’s assay was accurate. FYI, mixtures of catechins are very bitter and it is hard to hide the bitterness even in a candy. Pure EGCG on the other hand is a pure white material with very little bitterness and therefore easy to use in my chocolate caramel recipe. They tasted pretty good!
I want to thank you and PC for all of the creativity, intellect and guts to make this trial and CLL Topics work. When I was first diagnosed 2 years ago (nasty Zap 70 and all) this was one of the first places I was encouraged to look. I gained much from this site. One of the things that I gained was knowledge of ECGC. I have no idea if it helps or not, but I have pretty stable blood levels. I thank you for all you do. I want to thank the volunteers as well as Dr. Kay.
Teavigo EGCG is by a company called Pure Encapsulation.
from: http://www.needs.com/prod_detail_list/s
Pure Encapsulations Teavigo 150 mg
ITEM NUMBER: PUE-5293-120
SIZE: 120 Vegetable Capsules
Your Price: $69.80
It used to be about 58.00, but as study was going on it jumped.
Chaya – Thank you once again for a great article and thank you for continually pushing and fighting for us. As a participant in this trial I am benefiting directly from this research. I have seen my counts drop by >30% in the first four months. In my case the biggest issue with this treatment as you point out is the oral ingestion. Taking 20 “large” pills a day and dealing with the digestive issues that result will be a deterrent to getting this to the masses. I don’t know how much green tea one would need to consume to get the same 4000mg of EGCG but I would guess that it would be excessive and as you point out OTC green tea supplements can vary widely and do not match the quality of the Polyphenon E that is given as part of the trial. Please let us know if you hear of a company needing encouragement to work on an alternative delivery method.
Thanks again for all of your hard work.
This is very interesting…I have been taking 3 lozenges for CanTeaMax per day for 3 months now…when I return to Mayo in 3 more months, it will be ifascinating to see if I get some of these good results I have just read about. A Big Thank You Chaya, P.C., Dr. Neil Kay and all the CLL participants who made this study possible.—Aaron
Really the Teavigo is just too expensive and all those pills. I really like the Transdermal drug delivery Chaya mentions. I also take the B12s sublingual and this is a good method of delivery also.
CLLtopics, PC and Chaya made this study come together, and as she mentions, if not for the patients, it would not have happened. I tried very hard to be part of this study but was overlooked and cried a river over that, but am grateful to those who were chosen and did participate.
Big thank you to you all.
Questions, now that the study is completed, do you no longer have this available to you? For those with reduced nodes and lower WBC, does it change if not on the high study doses?
Now how do we get the transdermal or sublingual? In re-reading about Harvey’s chocolates, where does one buy the egcg powder (and $?) for the recipe, and is it necessary to eat enough to get the 2000 – 4000 a day, ugh, or just make the candies with a higher concentration?
Thank you.
There is a product called Teavigo distributed by Healthy Origins, Pittsburg, Pa, Ph 1-888228-6650. The label says ‘supplies 90% EGCG’ Serving size, one capsule. Amount per serving : ECGC from Green tea extract is 150mg. (Camelia Sinensis) (90% EGCG = 135mg. The bottle info: Teavigo is a trademark of DSM Nutritional Products. Does anyone know if this is the same product made by Roche and more importantly of pharmaceutical grade and contents are as stated?
I purchased the product on line from iHerb.com. The company is located in Irwindale Ca. 91706 Ph 866-328-1171
The advertised price for 60 capsules is $14.80 plus shipping. I have been taking 2 capsules in the AM and 1 capsule in the PM. According to the study, this dose alone without taking steeped green tea. Wondering if the capsule is opened and the powder is placed under the tongue, would it produce significantly more benefits than swallowing the capsule with liquid.
Chaya, your work is of inestimable value. Cannot tell you the sadness I experienced when your dear husband left your world. Can you or anyone else comment on this product and related questions. Thanking you in advance.
Good Indormation about green tea and its usage importance informatipn to cancer patients.
PREMA SWARUP, INDIA
For my mother, we have used what looks like a much cheaper version of Teavigo : http://www.healthspan.co.uk/Herbal-savings/green-tea-tablets-340mg-extr/ProductDetail-p315-c3193447.aspx (she takes 1 per day).
She is also on CanTeaMAX (purchased directly from the friendly people at Origin Biomed).
My instinct tells me that Green Tea is still going to be best for somebody who takes a lot of pills already, as it will be eassier to stick to, and hopefully cause less stomach upset. Mum tries to drink it several times a day, and does a bit of a gargle with it (and to help prevent the recurrent oral infections she is prone to) to help buccal absorption.
For me, the problem with Green Tea is that I’m never sure how much of a dose you’re getting with the various teas, and how much of the good stuff remains in the tea leaves themselves? One approach we’ve started trying is Organic Matcha (finely ground green tea), as used in the
Japanese Tea Ceremony.
This is the one we’ve used: http://www.hibiki-an.com/product_info.php/cPath/29/products_id/378
The service is pretty prompt and the product looks good. The only concern may be the relatively high caffeine levels due to the high concentration of tea solids. We don’t bother with the tea-making paraphernalia, although it may well help as part of a relaxation routine :-)
Good Health and Happy Tea Drinking!
The “best” caffeine-free green tea extract I had previously come across is from Source Naturals. Tablets are 500mg of extract, containing 175mg EGCG and other polyphenols. It’s also vegan, for those of a veggie persuasion. But I didn’t know about Teavigo EGCG, which claims to be 94% EGCG, and is also caffeine-free. TEAVIGO is a trademark of DSM Nutrition Products, and their product is used in a number of formulations by other companies, including Pure Encapsulations (mentioned above).
I do wonder at the therapeutic efficacy of the other polyphenols in green tea. Nature is often more synergistic than to have just one so-called “active ingredient”. On the other hand, to make up a dose of 2000mg of EGCG from a general green tea extract would mean a huge intake of the other polyphenols as well. Total effect, no doubt unresearched.
I wonder what the comparative efficacy would be of a CLL-tailored mix of curcumin, green tea extract & vit. D3? BTW, according to at least one study I’ve seen, the absorption of curcumin is greatly enhanced by piperine in black pepper, which seems act as a carrier across the gut wall. Don’t know what it does with EGCG. WWW searches for any of the above keywords bring up oodles of hits, of varying merit.
Chaya, as I approached my two year anniversary my wbc was approaching the mark where it would double to 32. My last test had climbed to 30 and moving up. I upped my dosage of EGCG to 900mg a day, two 150mg capsules three times a day. My count went down to 24.7 and the last one was 25.2, these were three months apart I believe. I don’t know if the tea is doing it, but I’m not gonna stop taking it.
I get “Teavigo” from Vitacost for 29 dollars for 120 caps of 150mg.
Thank you so much for your hard work, I for one appreciate it as do
so many others. Mike
I don’t shill for or have any financial interest with this outfit but I have been taking (for a couple of years) Mega Green Tea Extract from the Life Extension Foundation (Lef.org). 725mg. std. to 98% polyphenols (710.5 mg), 45% EGCG (326.25mg) at one per day. I take at least two per day. I do take curcummin and a bunch of other supps too. All I know is my lymph % is down to 24% with absolutes at about 6.
Thanks for the reporting Chaya.
Jim L.
Chaya,
Thanks for this article and all you and PC did to get this trial started. Shortly after being dx. in the fall of 2005, I started taking 1000mg twice daily of green tea caps. with my hematologist/onc.s blessing. My liver enzymes are monitored and have always been OK.
At the start I was stage 0, trisomy 12 and 13q deleted. MY WBC was stable at around 17,000.00. It has stayed there since starting. My oncologist tells me that under the microscope my cells appear very aggressive looking and he is amazed that I have not progressed. Is it the green tea- with the trial report, maybe. I am optimistic. Perhaps I am doing something helpful and at least it is not very toxic.
Will there be results from the Phase 2 arm of the trial soon or was that what was reported in the article? Will there be a phase 3? Is there more that could be studied in this trial?
Chris R.
This is great news. I know that swollen lymph nodes can remind one every single time that they look in the mirror that they have cancer. When faced with W&W, it seems that this treatment would be wonderful to help with taking away the emotional trauma of seeing swollen lymph nodes. Just fantastic!
I know that the trial at MDACC of watercress hit some problems with the pill form because of how heavy the concentration had to be. At this time, they are using it in an oil base concentration that the patient would use similar to dipping a piece of bread in Oil at an Italian Restaurant. They think that it is easier to take and ingest since it will not be in capsule form. This is not in trial stage for patient’s yet. In fact, Dr’s at MDAderson are testing it on themselves to see if this would be a good way to take treatment.
Perhaps putting green tea in an oil base could be an alternative.
jlou
Great job, Chaya. PS I’m with you 100% on the partnership in research concept. It is not understood yet among researchers. The Myeloma research group being, by many accounts, a notable exception.
Best regards,
Karl
First and foremost, Chaya, you and your late husband as well as all of those who donated their money and, most importantly, those who donated themselves as subjects for this study are all to be thanked and congratulated for conceiving and participating in a worthwhile effort.
Having said that, I must point out the obvious…no one yet knows whether the reductions of ALC and lymphadenopathy in this group of early stage CLL patients with mainly good prognostic markers makes any difference at all in their ultimate outcome.
I hope that the initial cohort will be followed and at least compared to historical controls. It is understandable that people would wish to use EGCG on their own as indicated by the comments already made, but we must remember that “magical thinking” doesn’t make the things that we wish for happen in the real world.
Mr. Davidson speculated on the benefits of combining green tea extracts with other agents such as curcumin. Even he pointed out that no one can guess what interactions may occur and what results may ensue.
I certainly hope that further work is done along this pathway to investigate whether there are long term benefits to be derived as well as improved drug delivery systems available. In the meantime, I would caution everyone to go slowly when entering unexplored territory as ‘magical thinking’ is just that…magical.
Good luck to all,
Rick
One consideration from the chemo-naive perspective: How much does self-medication with EGCG undercut the potential benefits of high-powered combination therapies when needed? Mark
As Rick and John Davidson mention, combining different “natural” substances is a good question. The Journal of Clinical Oncology (JCO) has an interesting article….not CLL specific but it does mention EGCG, curcumin, resveratrol, and some other natural substances in relation to CLL. Interestingly, some substance seem to have a synergystic effect, similar to FC or FCR being better than F, C, and R alone. This is very preliminary work, but it looks promising.
http://jco.ascopubs.org/cgi/content/abstract/27/16/2712
I found the best way to search out prices for items like this is through Amazon.com. Teavigo is offered there by several different stores, and is around $20-$30 for 60 150 mg capsules. Shipping is from nothing up to as much as $10 a bottle! So be careful.
But, I just did a little research on Teavigo, and think I will stay with Life Extension’s Mega Green Tea extract, as Jim L. mentioned above.
I have been taking 2 Life Extension capsules daily for two years now, and decided on that specific brand for several reasons. Most reasons were mentioned above. But, to sum up…
First, and most important in my mind, it had the highest concentration of EGCG of any of the brands I found. Almost twice as much per capsule as one capsule of Teavigo. (326 mg in a 725 mg capsule of Life Extension’s…yeah, they’re pretty big capsules!…vs 135mg in a 150 mg Teavigo capsule). So fewer capsules per day, and lower cost per gram of EGCG!
Next…the cost per bottle is about the same as Teavigo, but there are 100 caps per bottle, and as I mentioned, more EGCG per large capsule. So, the cost per gram of EGCG is far less.
These large capsules also contain everything else that is in green tea in concentrated form as well…not just the EGCG. Just in case the effect is symbiotic.
Finally, the independent testing lab, Consumer Labs, has found that Life Extension’s product is one of the very few of the green tea products they tested (23 brands, I believe…I know of four that were approved) that actually had an accurate label claim, and no other unwanted toxic materials, like lead. As far as I know they haven’t tested Teavigo…
Has it done anything for me? I think so. I started taking two capsules a day at the finish of my PCR treatment when my doctor said that my nodes looked like they were going to be around for a long time and may never completely disappear. She also decided that I would need Campath for awhile to finish the job that the PCR started, but told me not to expect a dramatic reduction in the node size as Campath is not noted for having a large effect on them.
Well…today, 16 months later, I have no visible node enlargement…it took almost all this time for them to disappear completely. And mu ALC is still low.
Dr. L is also a bit surprised…although she has mentioned that other patients have shown a reduction in node size after Campath, but not many or taking this long to get there. I have to think it’s the EGCG working steadily and slowly in the dose I’ve been taking (~650mg a day). However, she is not quite ready to attribute the node reduction to the EGCG.
There you go! A true anecdotal recommendation! The EGCG may not be the reason for my “recovery”, and it may not last forever, but I am certainly going to keep it up for now…as long as I can tell myself that it works for me…
And, I have no monetary interest in Life Extension’s Mega Green Tea Extract…I just like to pass on info that I think is worth a try.
Harley
I have no idea as to purity, but I’ve been buying 290 mg capsules thru Amazon for $17.49 for 100 pills, much cheaper than the product mentioned above. It’s called Green Tea Mega EGCG and claims to have 290 mg of EGCG….I’ve only been taking one a day, so obviously I should try more, but I do notice a slight bit of stomach upset if taken without food. It sounds like I might want to try as many as 10 or more a day….has anyone else tried this product?
Am I correct in understanding that drinking several cups of green tea per day is essentially a complete waste of time?
Paul Garland
What I’m trying is the Green Tea Extract sold by Sam’s. It has 150 mg EGCG per capsule. Cost is about $13 for 300. I just started taking 10 capsules in the morning and 10 after dinner. Anyway, for the cost, it seems pretty cheap. Comments?
I was one of the Mayo study participants. While node size may have decreased slightly, my lymphocyte count continued to increase slightly. My dosage level was continuously decreased over the six-months due to elevated liver enzymes (transaminitis, as noted above being observed in 33% of the participants). ECGC is not something to mess around with unless you are regularly checking the ALT/AST levels in your blood. Also, the over-the-counter products are not “drugs”–so no FDA oversight; some may have any number of other products in them (rtowlen’s comment above about “purity” is a serious one).
The greatest benefit of being in the study is that I now have a great doctor at Mayo (Clive Zent), who is a true CLL expert, and who I will continue to use as my regular oncologist. Another benefit: once the six months of the trial ended, we are able to continue getting ECGC tablets from Mayo at no charge for a year (unfortunately, due to the liver irritation, I was told to discontinue use). Study participants are also monitored for several years after completion of the study.
To respond to hpgarland, you couldn’t drink enough cups of green tea to get even close to the study dosages. But it can’t hurt to drink it.
Thank you, Chaya, for all you have done to promote this study and for getting the word out about green tea.
My impression is that drinking several cups of green tea every day is not a waste of time. While the dosage of EGCG per cup is not nearly as high as in a capsule, I think you might get better absorption from a tea rather than a capsule. And let’s not forget that the whole hypothesis of using green tea extract to heal CLL (and other cancers) began from the anecdotal evidence of green tea drinkers.
Jenny
Did the material used in this trial still contain caffeine and if so what dose of it would people have been getting along with their maximum dose of extract?
Chaya,
you are a AMAZING being!
I am so gratefull for your generous nature.
ondrea
Isrba:
There is no caffeine in the Polyphenon E product. I think that is also true for many of the extracts marketed by other companies, the process of extracting the catechins (such as EGCG) from the raw tea also removes the caffeine. But it is important to chack and be sure about that since you surely do not want to be injesting all that caffeine.
Jim said:
>>Also, the over-the-counter products are not “drugs”–so no FDA oversight; some may have any number of other products in them (rtowlen’s comment above about “purity” is a serious one).<>ECGC is not something to mess around with unless you are regularly checking the ALT/AST levels in your blood.<<
I checked with Dr Shanafelt before I started doing this myself…and his advice was the same…be sure to keep track of your liver enzymes while taking EGCG in heavy doses.
I have…
Harley
Great input, Jim. As much as I would like to jump in and up my dose to the 4000mg/day level, your comments about monitoring ALT/AST levels, and my own ongoing questions about the purity for each product, have convinced me that I need to proceed cautiously. Hopefully we’ll eventually have some products which we KNOW are pure; meanwhile I’ll check with my excellent oncologist in Vermont to see how much EGCG I might want to take, and how often I should have my blood monitored.
I want to reiterate that warning as well. Taking large quantities of Polyphenon E while under able medical supervision is one thing. Taking dozens of capsules of over-the-counter products without being sure what exactly they contain is a very different thing indeed. Liver health is very important and as we discussed this is the organ that gets the brunt of it as it tries to “detoxify” all that EGCG you consume.
I have allowed links to commercial brands to get through our spam filter for this article since there are so many brands out there and I thought it might be helpful for you guys to share information. But please be selective in the links you do publish, OK?
First, thanks to Chaya, P.C. and CLL topics for all their energy and determination in making this study happen. Then, my questions. What about platelet counts? I have read in other places that large doses of EGCG may reduce platelets. Does the Phase II include more patients with ALC > 100k? I’m interested in any feedback from those with higher counts.
Could the EGCG be administered by a pellet inserted into the skin? I’m taking a hormone supplement by this method that releases slowly over a 3 month period.
Hi Chaya —
1) One supplemental note that should be added to your excellent discussion is that there are a couple of very persuasive in vitro and animal studies published in Blood in the past half year showing that egcg (as well as many flavinoids) are very much contraindicated if the patient is using Bortezomib(Velcade). I’m coming at this from a lyphoma perspective, so I have no idea whether Velcade or other competetive proteasome inhibitor is used in CLL, but if it is the data pretty clearly indicates to stay off the grean tea.
2) Purecaps seems to be the place that one can be assured that they are purchasing the highest quality grade of Green Tea Extract, but note that the company has been sold and is no longer controlled by Roche. Still, they seem to do a good job at providing by the lot assays of their products. Their retail markup is however, 100%, so one can save quite a bit of money by find a health care provider willing to cooperate in purchasing at a much lower price.
3) Any advance info on how the phase 2 study is going?
As always, Chaya, thank you for everything you do. You’re amazing.
How long after taking EGCG do most people see any decrease in lymphocytes? I have my blood tested every 6 months, when I visit my oncologist. I started taking 3000 mg per day about a month ago, but I sure would like to decrease the dosage if and when I find out if it’s doing any good at all. My next blood test will be in December.
I decided in early June to see a naturpathic doctor who specialized in Oncology for their help in deciding dosages and brands of supplements to take. After her extensive blood work and extensive history and physical exams I was put on 550 mg. twice a day of green tea extract from ‘Vital Nutrients’. I was also put on 5oo mg. of Curcumin twice a day from ‘Vital Nutrients’, along with Resveteral and other nutrients. This particular brand of supplements is only available through a Naturpathic doctor but it was very worth the cost of seeing her to me! My counts in four weeks had dropped from 21.1 to 19.1. I feel comfortable having her monitor me including my liver functioning and knowing that there is another head besides mine helping me make these important decisions.
As a follow up to observations by JohnDavidson and 11qRick, there is an article authored by some of the doctors from the Mayo Clinic whose names have appeared in responses above.
“Curcumin Inhibits Prosurvival Pathways in Chronic Lymphocytic Leukemia B Cells and May Overcome Their Stromal Protection in Combination with EGCG”
Asish K. Gosh, Neil E. Kay, Charla R Secreto, and Tait D. Shanafelt
[Clin Cancer Res 2009;15(4) February 15, 2009, pp. 1250-1258]
My take away from the article is that alternating EGCG and Curcumin (always start with EGCG first) is synergistic and can cause apoptosis of CLL-B cells. Starting with Curcumin is not as good, and taking both together often causes interference.
I’ve tried a month or two of alternating EGCG and Curcumin. Both hopefully enhanced a little with piperine taken with grapefruit juice fifteen minutes before the capsules.
I also add EGCG and piperine to caromel and dissolve it under my tongue. Chaya, you are certainly right about the taste of the mixed catechins at 100mg/candy. The last bits are pretty strong.
My next trip to the VA for a blood draw is July 23rd, so it won’t be long before I can see if anything has happened to my WBC and liver enzymes.
Good article, Chaya. Some of these remedies that have been around for a long time do some good.
Jim
Chaya,
Did any of the 4 Trisomy 12 patients get a responce?
Raymond Parker
Raymond:
No, none of the 4 patients recruited with Trisomy 12 got a biologic response. But please be aware this is small sample size, just 4 patients. A larger group with 12 Trisomy may show a different picture.
Chaya,
I want to thank you up front for your courage in getting this study up and running. As a patient in the clinical trial and a patient of Dr. Clive Zent I was extremely fortunate to be a part of the study.
In my experience there are some things I wish to point out to shed some light on how the course of the trial went.
First, I am mutated, zap 70 neg, CD 38 pos. I was stage 0 at outset. I took 800 mg twice per day pills from Mitsui Norin. I took them for three months straight returning every month for blood work up with Dr. Zent. I tolerated the pills very well and never did take them with any food. My liver enzymes stayed normal. After 3 months Mayo was forced by NCI to discontinue the trial until some further studies could be conducted regarding liver problems experienced by dogs getting huge amounts. After that first 3 months my WBC went down approximately 40%. While off of the green tea for about 6 months, but still on the trial, I again began taking 800 mg twice daily for 3 more months and again saw a 40% decline in my WBC. I was then off of the trial and given an opportunity to continue taking Green tea pills for another year.
At this point you can imagine my amazement. At no time had my WBC ever gone down other than when I took the Mitsui norin pills. When I left the study I was given some other pill that was not the same as the Mitsui Norin pill and I had many gastric problems with the new pills and I had to discontinue the use.
I have been in contact with Mitsui Norin and they state that they are only making this product for sale now in Japan.
I am not at all thinking that the pills could have cured my CLL but I was encouraged at what the short term results turned up. I would sure like to find the same pill that I took during that study but nothing I have tried since has come close to working.
Other pills I have tried have irritated my stomach and I would surely have my liver enzymes checked monthly if I ever continue use after my FCR treatment in November.
Mark
I have read many comments in addition to the ones above about how satisfied certain patients are with their oncologists, some calling them experts, great, etc. I wonder what provokes some to comment on the exceptional quality they find in their doctors. Are they talking about medical credentials, personalities, rapport, published articles, mortality rates? I’m happy for those who feel the utmost confidence in their physicians. They are indeed fortunate to possess that peace of mind. Chuck
Dear Chaya,
It is with pleasure that I read the results of the study and I remain amazed at you, CLL Topics, the patient volunteers and Dr. Kay for taking a patient initiated issue to this level of scientific study. It is so rare for anyone to listen to the patients! To achieve a 50% reduction in adenopathy with minimal adverse side effects is a wonderful result, especially if you are that patient with the bulky nodes! Thanking you with much pride in CLL Topics for this patient oriented effort.
Ann
Chaya,
My husband, Dan, was one of the patients in the clinical trial..I was eternally grateful for the proactive approach, as the caretaker and the researcher in the family I was more frustrated by the watch and wait than he was. He took 1400 mg of EGCG 2 times per day. He had no side effects and his wbc has remained stable for 2 years. We were 8 hours (one way) away from Mayo drive time and it became too difficult to go there for a 20 minute appt. He did continue for 2 years and completed the study.
But I would agree with a previous blogger, we have found a great doctor in Dr. Neil Kay and his phys. asst. Deb Bowen and if/when my husband’s condition worsens we will have an established relationship with the Mayo Clinic.
I too feel your frustration in the researchers’ lack of acknowledgement of patients’ time, emotional cost, financial cost (we figured $400 each trip)and efforts of the donations that made this study possible.
Thoughts of you and your family and thanks again for continuing CLL Topics…it has been my life line.
Lisa Jahnke
A friend just pointed out to me that according to his very smart daughter who is also a research hematologist, you can get significant uptake of green tea catechins very easily by using the following procedure.
Make a strong decoction of your favorite green tea. Water should be just below boiling temperature, and let the tea leaves steep for several minutes. Decant the liquid and throw away the tea leaves. You will have to experiment with the right ratio of tea leaves to water and how long you let it steep to suit your own taste.
Take a good swig of the decoction and swish it around your mouth. You can pretend you are in a Listerine commercial. The longer you can swish it around in your mouth the better. When you are done, you can either swallow it (if you happen to like the taste of tea) or you can spit it out.
My friend says he makes the tea decoction once in the morning and keeps it in the refrigerator, using it to rinse out his mouth everytime he eats something. He says the only downside is that his teeth are not pearly white anymore. One of these days his daughter the research hematologist promises to test his blood for the level of EGCG in it. In the meantime, he is convinced he is getting a hefty dose of the green tea catechins with very little fuss, little or no toxicity and a fraction of the cost of buying “Teavigo”.
Sounds like a good plan to me, I really cannot see much downside to it. By the way, many Japanese do use green tea to rinse out their mouths between each course of an elegant meal. It is thought to cleanse your palate and make the next course taste better. Tea is also a mild anti-bacterial, it will help kill some of the germs in your mouth and improve your general oral health – a good reason to use it as a mouth rinse after you eat anything.
I take Royal Matcha. I buy the The rich taste of powdered green tea for smoothies, lattes, pastries and savory recipes. Gotcha Matcha contains 100% green tea from Japan. No sugar, additives or preservatives. Buy this bulk option with a canister/sifter set and use only what you need while storing the rest in the freezer. Perfect for heavy tea drinkers. I find this stuff shrinks my nodes but not my WBC. I get lotsa energy, drive and weight loss. It’s not cheap but I am happy. People at work are funny and think I am drinking a toxic matter because when its mixed it looks like I am drinking green milk but its yummy and gives me benefit. http://www.matchasource.com/matcha-s/1.htm
I also take one Teavigo pill each morning.
My WBC recently began it’s journey upward. Based on past blood changes leading up to previous chemo sessions, my estimate is this late fall/early winter to start a new series. My last series was early 2005. If my next series begins early 2010 I will have realized a 5 year recovery. My question in the context of this topic string is whether or not the volunteers were trying the green tea therapy during a WBC run up? and if yes, was any slow down of the run up seen/experienced?
I want to also thank you for continuing your work with this group.
duaneoftheozarks –
For me – I saw a reduction in counts after 3 months of taking 4000mg per day. From what I was told this was typical of the rest of the participants in the study.
As many have stated, please all, be careful self medicating. I have had to stop treatments 2 times now due to elevated liver enzymes. As part of the study they take numerous blood samples from us monthly and monitor us very closely. A failed liver could be much worse then the CLL you are trying to slow down.
Thank you, Chaya for getting Dr. Kay interested in this study! I have tried many brands of green tea, including Teavigo and Life Ext. Mega Green Tea, without much change in ALC. I have now seen a reduction of 15% in my ALC while taking 1500 mg. daily of astandardized green tea extract made by Vitabase. It is made by a European pharmaceutical company without the use of solvents – and it does not cause the upset stomach I experienced with other products, when taking large doses on an empty stomach.
Thank you Chaya for getting this funded and for everyone that contributed. I contacted Mayo and they have sent me a number of articles including the latest. I may try to enroll in the phase 2 study since their IRB just approved a few more participants. I only use supplements with the advice and consultation with a naturopthic oncologist and my regular oncologist. One thing for anyone who is considering this is that Green tea increases coagulation so if you are on warfarin for any coagulation issues you will find that it takes more warfarin to keep your INR in a therapeutic range. I decided since the doctors were not on top of that issue to discontinue green tea until I could find someone who understood both mechanisms so perhaps it will be Mayo.
But thanks so much for doing this.
J
Chaya – thank you so much for all you do. And thank you for the latest on the Mayo Clinic green tea trials with dose info. which has encouraged me to up my dose radically. I was diagnosed with CLL in 1996. My WBC count is 200,000, platelets are 98,000, have an enlarged spleen and tremendous fatigue. No node enlargement, night sweats, etc. My oncologist wants me to start chemo based on the scheme he follows at NCCN.org (patient treatment info at NCCN.com) although his practice seems to have its own recs at their own very good website GulfcoastOncology.org (patient treatment info)so I am trying to figure out what to do and will get at least one or two other opinions before chemo.
I had been making Harveys’ choc. using the green tea capsules from iherb.com (caffeine-free Teavigo for $14.80 per 60 capsule bottle, 150mg/capsule, 90% pure EGCG resulting in 135mg EGCG /capsule). I was on a lower dose than now, ran out of Teavigo and they were out of stock during which time my WBC count went from 120,000 to 200,000. I am now using 3 bottles per batch of fudge which I cut 8×8 to get 64 pieces which I take 3X daily (after meals) for a total daily dose of 11140mg sucked slowly over 10-15 mins in the mouth, mainly against the cheeks. This is about as bitter as I find tolerable or I might have tried an even higher dose.
All my fatigue went away in just a few days, I no longer feel ill, have great energy and no longer a fuzzy, dizzy head! No more bloodwork scheduled for 3 weeks but what do I do now? If I continue to feel good is it OK to put off chemo longer? Any ideas? Thanks,
Heather
Some four years ago not long after getting the news of my CLL/SLL and after reading one of Chaya’s early articles on the benfits of green tea I found a product with a high grade of polyphenon E and started taking 15 capsules per day (in lots of 5 3x per day).
I was not sure what to expect but did get stomach upsets if not taken with food.
Some 6 months after starting the self administered treatment I commenced chemotherapy and found no evidence in blood counts of any benefit to me.
I have not since taken any capsules as the research I did showed that the number of capsules necessary to get sufficient into my blood stream was too great a risk.
I am not saying there no benefits but for me a healthy diet and a range of suppliments, including green tea, taken as a tea, gives me the comfort I need to be doing as much as I can to help my challenged immune system.
I am enjoying a two year remission after FCR and every day is a blessing.
Derek Halifax
As always Chaya thanks for your lucid explanations.
I take two capsules a day of Standardized Green Tea Extaract 500mg from Puritans Pride. The price is very competitive but I have no idea as whether it is what they claim.
My counts are very high and I’m going to be treated for the 2nd time in Sept. with PRC.
Heather, I went to NCCN.org and, for CLL treatment, could only find this info in the NHL section,
“We will soon be publishing treatment summaries that outline the treatment strategies used and recommended by lymphoma experts at NCCN Member Institutions. These treatment summaries will include those on:
* Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)
* Follicular lymphoma
* Mantle cell lymphoma
* Diffuse large B cell lymphoma
Please bookmark this page and check back again soon. To learn more about NHL, continue reading below.”
Can you please give me some navigation directions for this site if I’m missing something.
thanks
Lynn
Chaya,
Thanks to you and to other readers for all the valuable information. It certainly helps one’s state of mind and spirit to feel the solidarity in dealing with CLL. After reading a short blurb in Harper’s Magazine about the Mayo experiments, I started taking herbal green tea liquid marketed by HerbalSway Laboratories – a dropperful a day. What, in your opinion, is the efficacy of green tea extract?
Thanks for all you do to advocate for us.
Irving
Here’s some more anecdotal (and somewhat confusing) evidence about green tea.
Based on reading about green tea on CLLTopics, my husband has been taking two Teavigo capsules each evening for over two years. After a few months, he stopped taking them for a few weeks and suddenly started getting night sweats, so began taking them again and the night sweats went away! Just recently, he tried taking three capsules, but strangely enough, the night sweats returned three nights in a row, so he cut back to two capsules and they disappeared.
I had heard that night sweats could be caused by a drop in metabolism during sleep. Since green tea was being marketed as a weight loss aid, I guessed that it might increase metabolic activity to help burn up calories. Perhaps that might be responsible for preventing night sweats . . . But why would they return when he increased the dose? Puzzling!
This site has been a great source of information, both formal and personal.
I made my way through one bottle of EGCG at 1000 mg/day but the stomach distress was so great that I didn’t get another one. However, with the new research and various ideas on ways to tolerate the capsules, I will try again.
There is no doubt though that you will wear your liver out trying to clean up the EGCG on first pass. We really need the sublingual and transdermal preps….it’s good to know that if someone figures this out we will be the first to know.
Has anybody noticed the articles on the combining of green tea and/or green tea extract with citrus juice, (specifically lemon and orange were the main ones mentioned.)? According to the various articles I have read, the addition of citrus increases the absorption and efficacy of the EGCG in the body from 5 to 13 times, since normally EGCG is very fragile. I have been doing that for the last 3 months but still have another month go before my next test. Anybody any experience with that?
EAC
one caution – there was a study (I think posted by Chaya) that curcumin is not good for CLL.
just a follow-up – I now am confused about the curcumin effect. I stopped eating curries, which I love, but really don’t know if it’s a hazard, with EGCG in one’s system. And I’m not clear on whether it’s curcumin – no; curcumin before or after green tea/EGCG….
I am looking for information about sequential doses of green tea and curcumin. I see only one article, which is only available for sale. Does anyone know more about this. The article apparently documents a study by Dr. Ghosh showing positive effects of taking EGCG and curcumin sequentially.
I am trying to find out just what “sequentially” means, in this case — whether the two are taken a few hours apart, or days apart. Chaya — if there is any way for you to read and summarize this article, I am sure that many of us would be enormously grateful. I am trying to decode the language of medical science, in a brief abstract.
Even if I can pay for the article, they are saying I can access it for only one day. As a non-expert, that would be very difficult, as I could not print and read it slowly and more than once.
I hope some of you with science expertise can help.
I had apparently misunderstood some of this a couple of years ago, and thought that curcumin was universally bad for CLL.
Any clarification you can give would be most appreciated.
The paper that reported on the synergy between green tea and curcumin is very early stage work. I do not think there is enough detail here for us to be 100% sure of either the synergy or the business of whihc one should be taken first etc. Certainly it has not been reproduced or reported by any other research group. Interesting findings, but a long way to go before it becomes something I would hang my hat on.
But I want to take this opportunity to say it again: while both green tea and curcumin (from turmeric) are natural compounds and part of everyday diet for millions of people, ingesting them in very large quantities is tough on your liver. You should make sure your doctor knows and agrees with the dosages you take, and furthermore that your liver function is monitored to make sure you are not overloading it.
Thank you for this thoughtful and helpful response. I hope that some follow-up studies will be organized. Thanks, too, for the reminder about watching liver function.
The appeal of these therapies, in my own case, is that I have a long history of allergies and sensitivities to numerous chemicals and drugs. I have never been allergic to either green tea or turmeric, which makes these (and any other) potentially less invasive possibilities especially appealing. I know there are others in the same situation – I recall at least one posting on this site about an allergy to chemo (Rituxan, I think it was).
I wonder if the Mayo team has considered following up on the EGCG-curcumin work. I’m sure that many of us would be happy to contribute to such a study (both financially and as subjects).
I was diagnosed with early stage CLL Oct. 2009. This excellent website is one of the best resources I’ve found and has provided me with so much helpful info. Chaya, there is a special place in heaven for a dear and special soul such as you!
Based on the Mayo study (and my type A personality) I have began using Life Extension brand Mega Green Tea capsules. This comes in a decaffinated version. Each cap is 725 mg, std. to 98% polyphenols(710.5), 45% EGCG (326.25). The high dosage per cap means you don’t have to take so may caps. I take about 1 cap three times per day with meals. So far I have not had any side effects.
I have no financial interest in Life Extension but have found them to be an good resource for high grade vitamins and or minerals. If interested you can check out their web site “lef.org”
Some months back I saw various articles that indicated that biovailabioity of EGCG is increased 5-13 times by the simultanious intact of citrus juice; preferably lemon but also orange or other citrus to a somwhat lesser degree…..and preferably although not essentially on an empty stomach….anybody know anything about this?
My experincia after being taking 9 months EGCG is that at first the lymphocytes lowered and at the moment are stable but there are lost 10 kilograms
ecardaxo:
True. There have been several reports of people losing weight after initiating green tea extract regimen. I wish it were the case for ALL people! I can really appreciate being 10 kg lighter. Unfortunately in my case there was no such weight loss.
I am absolutely amazed and blown away that this organization was part of the Mayo Clinic Study. THANK YOU> Even though I was newly diagnosed, (this week) I found those Mayo clinic studies and right before going to an oncologist, I started myself on the best brand I could find with no caffeine. I haven’t told my naturopathic ND about it yet because I follow a full protocol from him, but did this on my own. It’s an emotional thing actually. I was waiting to get all the prognostic tests in before contacting him. And for me having to go back to an oncoligst after running away from them 14 years ago was like hitting rock bottom for me, and I thought I had nothing to lose starting the green tea. I’m just being honest. I realize I need an oncologist, but my breast cancer journey is a long story. Bottom line is I already had immune system depression then, and thought the oncologist was being cavalier about what those hard core chemo drugs would do to me. Obviosly time has proved me right. Even this new oncologist admitted to me I made all the right decisions 14 years ago. I was shocked he would admit that.
ihial2
It is a couple of months that I have been taking green tea daily. I still have to wait and see if there is an change. In the meantime I have not seen anything in your articles about alternative medicine
(herbal chinese capsules or powder). Is there any information about
it and do you have any opinion about this kind of treatment. I have
been about 3 years in wait and watch stage. I would appreciate your
answer. Thank you in advance.
Ihial2:
Sorry, I don’t do herbal Chinese medicines or alternative medicines that have not been through formal clinical trials etc and published in peer reviewed journals. Not my gig. If that is your interest, I am sure there are plenty of other sites out there where you may get more help on that front. When you get a chance, please read the “About us” section – it should give you a better idea of what I do and what I don’t do. Best wishes.
Surprisingly, no mention here of the update on the phase II trial at Mayo, which has been ongoing for more than a year at this writing. I would’ve thought to see that here. No matter: here are the relevant links:
Phase II trial of daily oral green tea extract in patients with asymptomatic, Rai stage 0-II CLL – presentation at June 2010 ASCO annual meeting
http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=47574
Mayo Clinic news/press release:
Green Tea Extract Appears to Keep Cancer in Check in Majority of CLL Patients
http://www.mayoclinic.org/news2010-rst/5833.html
@singer99 — the green tea and citrus juice study that you refer to was conducted at Purdue University by Mario Feruzzi and colleagues. In fact, they had two sets of findings, one for green tea/EGCG and citrus juice, and one (more recent) for green tea, citrus juice and sugar. It’s the vitamin C in the citrus juice that makes the difference, but apparently that spoonful of sugar helps, too. Here are the links:
Purdue U. press release, November 13, 2007:
Citrus juice, vitamin C give staying power to green tea antioxidants
http://news.uns.purdue.edu/x/2007b/071113FerruzziTea.html
published September 10, 2009:
Green tea catechins, EGCG absorption boosted by vitamin C plus sugar
http://ihealthbulletin.com/blog/2009/09/10/green-tea-catechins-egcg-vitamin-c/
Funny, I’ve been drinking tea all my life with lemon and sugar — mostly black tea while growing up, black and green in early adulthood, and more green than black over the last 15 years. Also been eating oatmeal most of my life and using monosaturated oils instead of butter or margarine for 25+ years, taking 1,000 mg fish oil capsules w/ omega-3 for 20 years, and taking grape seed extract and green tea extract for about 15 years. Seems I was doing myself some good without knowing it: at 50-something, I’m stable and asymptomatic at stage 0 CLL for at least 2 years, more likely for about 6 years if you look at all my CBCs for that period, but I was only provisionally diagnosed with CLL a few weeks ago while the docs were treating me for something else (since then, another CBC has made the hematologist surer of his diagnosis). There’s been flow cytometry so far, but no ZAP-70 test or FISH test/array-based karyotyping yet. And no family history of cancers, only vascular problems on both sides (we tend to die of other things, not cancer — the women mostly of old age in their mid-80s to mid-90s). All my relatives like their cup of tea, as do I. I’m certainly not going to stop drinking it now! Nor will I stop taking any of my vitamins or supplements, for which my docs have a full list.
I should add that if you’re going to drink green tea for the EGCG (or make a concentrate to gargle with), you should use water that is no hotter than 160 degrees F., perhaps no more than 150 degrees F. The reason is summarized nicely by Wikipedia: “… In a high temperature environment, an epimerization change [in EGCG] is likely to occur, because heating results in the conversion from EGCG to GCG. Thus, it is considered inappropriate to infuse green tea or its extracts with overheated water.” And of course, you want to brew it for at least 4-5 minutes because the longer you let it brew, the more tea polyphenols (of which EGCG is the most abundant) you will extract that way. Then add lemon and sugar, and enjoy. Beats the tea chocolate caramels hands down for absorption, and it’s probably better for your teeth, too.
I wonder if the Mayo study folks have thought about washing down the Polyphenon E caps with lemonade – ? That should increase absorption.
Re:Aluminum poisoning with Healthy Origins Teavigo.
I’ve been taking 300mg Healthy Origins TeaVigo morning and evening (600mg total) daily for over 3 years. Recently I noticed in Dr Blaylock’s nutritional letter on the dangers of Aluminum that green tea, while a lot less than black tea but more than white tea, can have unacceptable levels of Aluminum. Aluminum is a known neurotoxin. My internist said that in his research, it depends on where TeaVigo gets its green tea, that levels of Al in developing countries exceed greatly that of Japan, a safer green tea source, but probably more expensive on the spot market.
After blood tests showed my Aluminum levels in the 600 ug/L !!, I stopped taking for a month, retested, and had a new level of 3ug/L!
Nodal volume also unfortunately increased. How do I find a supplement that is purer and doesn’t keep the caffeine in like the Costco brand?
Can someone recommend what direction to turn? Has a sublingual or dermal patch come along to prevent potential liver problems?
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