Kombucha Caution

In the late 1980s in high-income countries, only one drug was available for the treatment of HIV/AIDS: AZT (zidovudine, Retrovir). It had to be taken six times daily and at high doses that caused serious side effects -- and it had limited effectiveness against HIV.

In 2009, HIV positive people living in these countries have a choice of combination therapy that has a record of improved safety and effectiveness compared to AZT monotherapy. Also, in people starting their first regimen, once-daily dosing is often an option.

Despite these enormous and favourable changes in anti-HIV therapy over the past 20 years, myths and misunderstandings about the safety of these therapies continue to circulate among some people who are at risk for or who have HIV infection.

Doctors in Los Angeles, California, recently reported the unfortunate case of a young HIV positive man who experienced life-threatening toxicity from a complementary therapy called Kombucha tea. Before we report their findings, we first present some background information on Kombucha.

About Kombucha

According to the young man's emergency room physicians, this tea "is made by fermenting sugared black tea with a round, flat, grey fungus for a minimum of seven days." Although some people refer to this fungus as a Kombucha mushroom, it is really a mix of bacteria and several yeasts.

Kombucha and mice

To begin to document the effects of Kombucha tea, researchers in the United States performed experiments on mice. They found that the life span of the mice increased by 5%. However, this came at the price of a swollen liver and spleen, which suggests liver and spleen toxicity. Also, mice given Kombucha tea tended to not gain weight compared to mice that did not receive this substance. And Kombucha-treated mice appeared to have somewhat smaller brains. However, extensive blood tests, CAT scans, MRIs and other scans were not done, so the researchers could only provide a limited analysis of the effects of this alternative therapy on the animals.

Kombucha in people -- an absence of evidence

Unfortunately, there have not been any well-designed studies to assess the impact of Kombucha tea on the health of people. Kombucha tea is alleged to have a broad range of beneficial effects on the following health conditions:

• arthritis
• higher-than-normal blood pressure
• cancer
• HIV infection

There have also been claims that Kombucha tea can do the following:

• reduce acne
• eliminate wrinkles
• restore grey hair to its original colour

Astonishingly, all of these claims for Kombucha's effect in people have been made in the absence of clinical trials.

Case details

The emergency room doctors' report concerned a 22-year-old man who had recently been diagnosed with HIV infection. He had a CD4+ count of 414 cells, was not taking any anti-HIV therapy and was otherwise well.

A month after his diagnosis he drank a litre of unpasteurized Kombucha tea. Four hours after this he developed a mild fever. The next day he developed the following symptoms:

• uncontrolled shaking
• shortness of breath
• high fever

As a result of his worsening condition, he sought care at the emergency department of a local hospital. Doctors there found that he had alarmingly high blood pressure. Lab tests of his blood revealed the following:

• Levels of a liver enzyme called AST (aspartate amino transferase) were higher than normal, suggestive of liver damage.
• His blood had become acidic because of excessive levels of lactic acid.
• His kidneys began to malfunction and shut down.
• No recreational drugs were detected.
• His CD4+ count had undergone a massive decrease, down to 70 cells.
• The doctors described his behaviour as "combative and confused" so they sedated him.
• No detectable bacteria, fungi or viruses were found. However, this is not surprising, as some bacteria and fungi can take weeks or months to grow before they can be detected.

Confounded by his symptoms and in the absence of detectable germs, his medical team presumed that he was suffering from meningitis -- an inflammation of the tissues lining the brain and spinal cord. So they prescribed several antibiotics on the assumption that he was attacked by bacteria.

As his condition deteriorated, the man was transferred to the hospital's Intensive Care Unit (ICU). Doctors in the ICU added the antiviral drug acyclovir to his regimen because his symptoms were suggestive of viral meningitis. He was not given any antifungal drugs during his time in the hospital.

An unexpected turn

While in the ICU, much to his doctors' surprise, his symptoms began to resolve. In particular, his fever cleared. Within two days his symptoms disappeared as his blood returned to its normal pH balance and his kidneys improved. He was released from the hospital.

A week later he returned for observation and further laboratory testing. Doctors confirmed his recovery. His CD4+ count had surged to slightly more than 400 cells.

A month after his visit to the ER, cultures of his blood grew two different types of fungi.

The toxicity of Kombucha

In the past decade, scattered reports of toxicity linked to drinking Kombucha have been reported, including the following:

• severely acidic blood
• liver damage
• muscle damage
• problems breathing
• internal bleeding, leading to death

The young man's physicians issued the following caution:

"Kombuch tea may pose serious health risks, particularly to people with [weakened immune systems]." Although the doctors did not specify which groups of people have weakened immune systems, the following conditions or behaviours are associated with weakened immunity:

• alcohol abuse
• autoimmune illnesses (Crohn's disease, lupus, rheumatoid arthritis)
• being very young (for example, babies)
• being 65 years or older
• cancer
• cardiovascular disease (heart attack or stroke)
• diabetes
• HIV infection
• kidney disease
• lung disease
• substance use

As well, Dr. Edzard Ernst, a Europe-based expert on complementary and alternative therapies, has reviewed data on the potential benefits and risks associated with Kombucha tea. He cautions that there is not enough evidence to support its use.

References:

1. Ferguson B. Statistics from a Kombucha questionnaire. Available at: http://www.kombu.de/benefits.htm. Accessed June 16, 2009.
2. Hartmann AM, Burleson LE, Holmes AK, et al. Effects of chronic kombucha ingestion on open-field behaviors, longevity, appetitive behaviors, and organs in c57-bl/6 mice: a pilot study. Nutrition. 2000 Sep;16(9):755-61.
3. Sunghee Kole A, Jones HD, Christensen R, et al. A case of Kombucha tea toxicity. Journal of Intensive Care Medicine. 2009 May-Jun;24(3):205-7.
4. Ernst E. Kombucha: a systematic review of the clinical evidence. Forsch Komplementarmed Klass Naturheilkd. 2003 Apr;10(2):85-7.