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Tuesday, August 7, 2012

Use of Black Tea and its Effect on Health: A Survey Review

Aim: 

To review and organize the most appropriate way of using tea and assess tea users in Pakistan according to it.
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Black Tea
 

Background:

 Every year a large amount of tea is imported by Pakistan. Tea is actually a very healthy beverage and can be very effective in preventing certain diseases only if used in an appropriate manner. However, if, not used properly its consumption can become useless or can even bring health problems. The main purpose of our study was to establish the proper way of tea usage and determine whether tea users in Pakistan follow the way.

Method of Study: 

Already available databases were consulted and the most appropriate way of tea usage consisting of three criteria was found so that it gives maximal benefit and no harm to health. A large scale, cross-sectional study was carried out to assess the Pakistani tea users according to these criteria.

Results: 

Clear evidence showed that tea can be very beneficial for health if used less than 8 cups/day, not used to get uplift before any task and used without milk or with soy milk. It was also found that if tea is used, keeping these criteria in mind, it will not harm health in any way as well. However, survey to assess Pakistani tea users showed that a very small percentage of people i.e. 0.72 % were perfect users of tea.

Conclusion: 

The extensive tea use in Pakistan is actually a misuse and gives us no edge. Tea is very beneficial for health if used in a proper way. The finding indicates the need to make people aware of the proper way of using tea, especially by promoting it through media.

Introduction:

Tea is a beverage usually made by combining hot water with processed cured leaves of Camellia sinensis 1. Six different types of tea have been recognized which include black, white, yellow, oolong, green and pu-erh 2. Our focus is on the use of black tea because it is more common than other forms of tea 3. It is the most oxidized and fermented form of tea 4. It also has the highest content of caffeine as compared to others 5. Caffeine content of tea is 42-72 mg (averaging 57 mg) per cup (8 oz.)6. Tea is effective in preventing lots of diseases including certain heart diseases and even malignancies (cancer)7. However; its misuse can devoid the person of preventive medicinal effects of tea and can even bring health problems. Black tea is quite popular and common in Pakistan. But how tea should be used for maximal benefits and no harm on body? We address this question basically in our study.
Pakistanis are very fond of tea. However, tea is not produced in Pakistan. So to fulfill the demands, every year above 100 thousand tons of tea is imported that costs about 13 billion rupees, making Pakistan the third largest importer of tea in the world leaded by Russia and U.K 8. Above 10 billion rupees each year is a big amount to be spent on tea import by a third world country. Therefore we also assessed the way of use of tea in Pakistan in our study to see whether Pakistanis are using tea properly for maximal benefits or not.

Methods of Study:

Study was carried out from May 2010 to July 2010. Already available databases such as lots of journals, publications, sites & books were consulted to set up the most appropriate way to use tea so that it gives maximal benefit. The most appropriate way was decided to be dependant on following three criteria: 

1. Less than 8 cups/day of tea use
2. Recreational use only and not for an intention to get uplift so that user can start off day/work in absence of tea without any discomfort as well.
3. Use it alone or with soy milk 

A large scale, cross-sectional study was carried out using written questionnaires (for literate sample units) and face to face interviewing (for illiterate sample units) as data collection techniques so that the objective of survey can be achieved. Objective of the study was to assess the use of tea in Pakistani users according to above mentioned criteria. 5000 people from different areas (cities, villages, towns) of Pakistan were used as a sample for the study keeping in account an equal ratio of males to females. Inclusion criteria were: Pakistani national (to focus on tea as drunk in Pakistani style), aged above 15 years (so that tea drinking style of sample unit was not forced upon by elders), study must be restricted to “black” form of tea use only. Differentiation between types of tea was necessary to prevent any ambiguity in the conclusions. The data was then analyzed and results were extracted.

Results:

Various studies suggest that using 8 cups/day (<400mg of caffeine intake/day) doesn’t produce any adverse effects of caffeine on the body 9,10. These effects may include nervousness, irritability, anxiety, tremulousness, muscle twitching (hyper reflexia), insomnia, headaches, respiratory alkalosis, heart palpitations, heart burn, peptic ulcers, erosive esophagitis and gastro-esophageal reflux disease 11,12,13. 2-3cups of tea in a day is healthy; 4-6 cups are healthier 14 .More than 8 cups/day, however, can produce harmful effects on health. Moreover anything that enhances CNS activity like caffeine can have an additional drawback of “dependency”. Overuse of tea, particularly for uplifts before any task (referred to as getting a “kick” 15) can certainly be more harmful because the person may get psychologically dependant on tea 16. Psychological dependence is characterized by continuous administration of tea to produce pleasure, feeling of satisfaction, psychic drive or to avoid any sort of discomfort 17. In such a condition, the person needs tea before starting the day or any task and if he doesn’t get it, he is unable to give his 100% to the task and as a result his physical and mental capabilities are masked 16. Some people also report “headache” if not given tea in the morning which suggests that physical dependence can also be related to tea use 16. Tea is most commonly used with milk but dairy milk used for tea contains casein. A research carried out in Germany in 2006 showed that this casein binds to catechins present in tea that are protective against diseases and therefore form a complex that devoids the tea of its beneficial preventive medicinal effects 18.The antioxidant levels of people who use tea with milk remain equal to those who don’t use tea at all, however, antioxidant levels of tea users who don’t add milk to tea definitely rise up 19. Soy milk lacks casein and can be used as a substitute for dairy milk in tea 20. Therefore, tea use can be maximally beneficial for body as a preventive medicine without having any harmful effects on health if it is used: 

1. LESS THAN 8 CUPS/DAY (to prevent adverse effects of caffeine)
2. FOR RECREATION AND NOT FOR GETTING A “KICK” (so that user doesn’t get psychologically/physically dependent on tea)
3. WITHOUT MILK OR WITH SOY MILK (so that preventive medicinal power of tea is not lost) 

Black tea is quite popular and in common use in Pakistan. Annual consumption of tea in Pakistan is estimated to be 1kg/capita 21. This is a huge amount. Second question to be addressed in my study was whether Pakistanis are using tea properly for maximal benefits and without any harm on health? A total of 5000 tea users were included in the study from different areas (cities, villages, towns) of Pakistan. There were 2500 males and 2500 females. They were consumers of black tea exclusively. Out of 5000 sample units, only 36 units came out as proper tea users. Whereas, 4964 sample units were recognized as misusers of tea. Out of the total sample units, 2625 (52.5%) fulfilled the first criterion and 2635 (52.7%) fulfilled second criterion, that is, they could start off their work/day without taking tea in the morning and didn’t experience any discomfort. Whereas, only 55 (1.1%) fulfilled third criterion. The study also revealed that 98.4% of the users were unaware of any significant benefit or harm of tea on health. While those who were aware, were all ignorant of the ways to extract maximum health benefits from the tea. As it was just a pilot study no statistical evaluation could be done.

Discussion & Recommendations:

Everything that we eat or drink affects our health one way or the other. Tea is certainly the most popular and common beverage not only in Pakistan, but in the world. Tea is actually a very healthy beverage. It is an excellent preventive medicine and gives us a boost by increasing our attentiveness and concentration. It is helpful in preventing certain fatal diseases even like CHDs and malignancies. However, proper and limited use is necessary to extract all these benefits, otherwise not only the person is devoid of these benefits of tea, he can also experience some adverse effects on his body and soul. Therefore, tea must be used daily for better health but care should be taken as it may bring lots of harms to the body if misused. To get maximum benefit without any harm from it the user should follow all the criteria set up for the most appropriate way of using tea. Tea is so commonly used in Pakistan that it can be regarded as a national drink. Ideally the nation should know how to use tea properly but as the study indicates, the scenario is totally opposite. Only 0.72% users use it in the proper way. Two major reasons for this include traditional basis and ignorance. Tea is being used in Pakistan for years and years. Mostly people misuse tea because they have seen their elders doing it and also because it is implanted very deep in our culture and society. Moreover, mostly people are unaware that tea has certain substances that can be very beneficial for body if used properly but misuse can either result in no benefits or even harmful effects on health depending upon the degree of misuse. Now, only if people are taught the proper way of using tea it can help us becoming a healthier nation. For this we need to make the people aware of these facts so that they can change the traditional way of using tea and shift to more scientific and healthier ways. Also the proper use is not that different from what people are already following.
As indicated in the study, only 1.1% of people use tea without milk or with soy milk. So this is the criterion that needs to be addressed the most. One additional reason for this criterion (apart from traditional basis and ignorance) to be overlooked is that soy milk is not that common in Pakistan. If so much tea is being marketed in Pakistan, then why not we market soy milk with it too and make it a common entity. However, soy milk can be prepared at home very easily and economically 22. Soy milk also has additional health benefits 23,24. Media can play an important role to make people aware of these facts.

Conclusion:

Tea is a very healthy beverage but proper usage is necessary to stay away from any harm and extract maximal benefit. In Pakistan tea is just being misused. However, If people are made aware of the proper usage of tea, then the traditional way of making tea can be changed into a way that will give us an edge and so much money spent on import of tea each year can be rendered more meaningful and constructive in the future.


Authors:

1. Muhammad Amer Saleem, M.B.B.S. (Final year), Rawalpindi Medical College, Rawalpindi.
2. Muhammad Abair-ul-Haq, MBBS, House officer, Medicine Unit-I, Holy Family Hospital, Rawalpindi.
3. Faizan Pervaiz, M.B.B.S. (Final year), Rawalpindi Medical College, Rawalpindi.

Acknowledgements:

There was no funding or support for this study. We are grateful to Mushaib M. Khan, Muhammad Arsalan Butt, Jamshed Latif, Jawad Naeem and Muhammad Saqlain Bhatti for their excellent technical assistance.

References:

1. Britannica Online Encyclopedia. Tea (beverage). [Online]. Available from: http://www.britannica.com/EBchecked/topic/585115/tea [Accessed 7th June 2010].
2. StarChefs.com. THE RAINBOW OF TEA. [Online]. Available from: http://www.starchefs.com/features/tea/html/types.shtml [Accessed 7th June 2010].
3. Alan Trusso. Foodways, Pakistan. In: Peter J. Claus, Sarah Diamond, Margaret Ann Mills (eds.) South Asian folklore: An Encyclopedia: Afghanistan, Bangladesh, India, Nepal, Pakistan, Srilanka. New York: Routledge; 2003. p.229-230.
4. Tea Time For Your Health. Ebony. 2006 July; 61(9): 118.
5. The New York Times Company. About.com: Coffee/Tea: Caffeine Content. [Online]. Available from: http://coffeetea.about.com/library/blcaffeine.htm [Accessed 30th May 2010].
6. Jane Higdon. An evidence-based approach to dietary phytochemicals. New York: Thieme Medical Publishers; 2007. Chapter 7, Tea; p.38-46.
7. EJ Gardner, CHS Ruxton, AR Leeds. Black tea – helpful or harmful? A review of the evidence. European Journal of Clinical Nutrition. 2007; 61; 3–18.
8. Food and Agriculture Organization of the United Nations. FAOSTAT: trade. [Online]. Available from: http://faostat.fao.org/site/342/default.aspx [Accessed 25 May 2010].
9. Leon Chaitow, Judith DeLany. Clinical Application of Neuromuscular Techniques: The Upper Body. 2nd edition. Pennsylvania: Elsevier; 2008. Chapter 7, The Internal Environment; p.125-160.
10. Health Canada. IT’S YOUR HEALTH: Caffeine. [Online]. Available from http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/food-aliment/caffeine-eng.php [Accessed 7th June 2010].
11. Mackay DC, Rollins JW. Caffeine and Caffeinism. Journal of the Royal Naval Medical Service 1989; 75(2): 65–67.
12. James JE, Stirling KP. CAFFEINE: A summary of some of the known and suspected deleterious effects of habitual use. British Journal of Addiction 1983; 78(3): 251–258.
13. Leson CL, McGuigan MA, Bryson SM. Caffeine Overdose in an Adolescent Male. J Toxicol Clin Toxicol. 1988; 26(5-6): 407–15.
14. Felicia D. Kliment. Eat Right for Your Metabolism. New York: McGraw-Hill books; 2006.
15. CK Prikh. Parikh’s Text Book of Medical Jurisprudence, Forensic Medicine and Toxicology for Classrooms and Courtrooms.6th Edition. New Delhi: CBS Publishers & Distributors; 2006. Chapter 49, Drug Dependence; p.10.7-10.13.
16. Hamid Ghodse. Ghodse's Drugs and Addictive Behaviour: A Guide to Treatment. 4th Edition. New York: Cambridge University Press; 2010. Chapter 1, Drugs, addiction and behaviour; p.5-18.
17. Glen R. Hanson, Peter J. Venturelli, Annette E. Fleckenstein. Drugs and Society. 9th Edition. Massachusetts: Jones & Bartlett Learning; 2005. Chapter 5, How and Why Drugs Work; p.138-161.
18. Mario Lorenz, Nicoline Jochmann, Ame´lie von Krosigk, Peter Martus, Gert Baumann,Karl Stangl, and Verena Stangl, et al. Addition of milk prevents vascular protective effects of tea. Eur Heart J. 2007; 28(2): 219-223.
19. Grzegorz Bartosz. Total Antioxidant Capacity. In: Herbert E. Spiegel (ed.) Advances in Clinical Chemistry. Volume 37. California: Academic Press; 2003. p.255.
20. Mitzi Waltz. Pervasive Developmental Disorders: Diagnosis, Options, and Answers. Texas: Future Horizons; 1999. Chapter 7, Other Interventions; p.134-157.
21. F.S.Hamid. Tea in Pakistan. International Journal of Tea Science. 2007; 6(3): 21-24.
22. Top Cultures. Soya: Information about Soy and Soya Products. [Online]. Available from http://www.soya.be/how-to-make-soy-milk.php [Accessed 12 June 2010].
23. William Roberts, William Clifford Roberts. Facts and Ideas from Anywhere. New York: Futura Publishing Company; 2000. Chapter 23, October 1999; p.145-154.
24. Vickie Vaclavik, Vickie A. Vaclavik, Elizabeth W. Christian. Essentials of food science. 3rd Edition. New York: Springer; 2008. Chapter 11, Milk and Milk Products; p.237-270.

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