Can a herbal soup like Bak Kut Teh cause liver damage, as alleged by an Australian study?!
Take a look at what the study showed, and what the facts really are!
Study : Bak Kut Teh Herbal Soup Can Cause Liver Damage!
Australian scientists recently caused a ruckus when their study alleged that the Asian herbal soup called Bak Kut Teh can cause liver damage.
The media excitedly jumped on it, with alarming titles to draw attention (and drive traffic?) :
ABC : Bak kut teh herbal soup may cause liver damage and interact with medication, study finds
Medical Xpress : Popular Malaysian soup can cause liver damage when mixed with medication
Adelaide Now : Adelaide forensic expert issues safety warning over liver failure soup
The Epoch Times : University Professor Warns of Risks Caused by Popular Chinese Soup
Says : Australian Researchers Find Bak Kut Teh Can Cause Liver Damage When Taken With Medicine
Truth : Study Does Not Show Bak Kut Teh Causing Liver Damage!
Despite the alarming titles, there is no need to panic… because the study does NOT show the herbal soup causing any liver damage.
Here is a quick summary for those who just need to know the basics :
- It was a laboratory study, which means the results may not translate into actual effect in a living human being.
- What we eat is digested and broken down, so our body absorbs the nutrients and not the actual food. Hence, the study does not accurately replicate what happens in our body.
- They didn’t test bak kut teh… they only tested four soup bases used to make bak kut teh.
- The soup concentrations were unspecified, so it is unknown if the doses are equivalent to what our livers are subjected to after a meal.
- They did not test drug interactions, so it is amazing how so many media outlets claimed that the study showed that bak kut teh may interact with medication!
In short, this study does not show that bak kut teh causes liver damage. Neither does it show bak kut teh causing drug interactions of any kind.
I understand Professor Byard’s concerns about the “unknown” contents of these soup base preparations. Certain traditional Chinese medicine (TCM) and Chinese herbal medicine (CHM) have been associated with acute liver failure.
However, that isn’t so much a “bak kut teh” problem, but rather a problem with traditional Chinese medicine or Chinese herbal medicine.
For those who are interested in the details, please scroll down to the next section.
Why Study Does Not Show Bak Kut Teh Causing Liver Damage
Let’s start with the basics, and work our way through the Australian study.
Fact #1 : Study Was Conducted By Australian Scientists
First, the study was conducted by University of Adelaide and University of Melbourne scientists – Susan M. Britza, Rachael Farrington, Ian F. Musgrave, Craig Aboltins and Roger W. Byard.
It was published in the journal Forensic Science, Medicine and Pathology, and you can read the study here.
Fact #2 : It Was A Laboratory Study
It is important to note that this was an in-vitro study – a laboratory study, not a clinical study.
In-vitro studies are important, but they cannot be extrapolated to make any conclusion about what actually happens in a human body.
For example, in-vitro studies have shown that hydroxychloroquine and ivermectin have an inhibitory effect on the SARS-CoV-2 virus; but once tested in actual human beings – they were shown to have no clinical benefit.
In other words – what happens in a test tube, may not happen in an actual human being.
Read more : Did Study Show Pfizer Vaccine Altering Liver DNA In 6 Hours?!
Fact #3 : What We Eat Is Not What Our Body Absorbs
There is one big problem with doing in-vitro tests on food – what we eat is not what our body absorbs.
Food gets digested, and broken down into nutrients that are absorbed in our intestines. Even simple sugar gets broken down into glucose, fructose, galactose, maltose, sucrose, etc.
So soaking liver cells in a bak kut teh soup would most definitely not reflect what our liver cells actually experience after a bak kut teh meal.
In short, this study does not replicate what happens in our liver when we eat bak kut teh.
Fact #4 : There Are Many Types Of Bak Kut Teh
Bak Kut Teh is not so much a “herbal soup” as it is a pork soup dish. The name “bak kut teh” literally means “meat bone tea” in the Hokkien dialect, but there is no tea in it.
It is usually just a dish of pork ribs simmered for hours in a broth of common herbs and spices like star anise, cinnamon, cloves, dong quai, fennel seeds and garlic.
But there are many variants of bak kut teh. In Malaysia and Singapore where bak kut teh is most popular, there are at least four main “styles” :
- Teochew style : light in colour, with more pepper and garlic
- Hokkien style : darker and more fragrant, thanks to a variety of herbs and soy sauce
- Cantonese style : includes medicinal herbs for a stronger flavoured soup
- Klang style : a thick and sticky gravy, like a stew
On top of that, there are also chicken and beef versions of bak kut teh. Muslims, for example, love the chicken version, which is colloquially called chi kut teh, chi being short for chicken.
And the Malaysian town of Melaka serves a delicious beef bak kut teh, which is based on a unique black pepper soup with red fermented bean curd.
Fact #5 : They Tested Four Soup Bases
The Australian team were somewhat aware of the wide variety of bak kut teh soup bases. They tested four varieties :
- Formulation 1 : Dried hawthorn
- Formulation 2 : Goji berries, ginseng, bark, and dried mushrooms
- Formulation 3 : Polygonatum odoratum, ligusticum chuanxiong, codonopsis pilosula, cinnamomum cassia, angelica sinensis, illicium verum, piper nigrum, and Eugenia caryophyllata
- Formulation 4 : Spices, pepper and salt
It is important to note that instead of preparing bak kut teh like you and I would – with meat, vegetables, bean curd slices, etc., the researchers tested soups that were created only using the ingredients listed above.
In short, they did not actually test bak kut teh… they tested soups made from the ingredients above.
Fact #6 : Soup Concentration Was Unspecified
To prepare the four soups for testing, researchers added a sachet of each soup mix to boiling water (of unspecified quantity) for 5 minutes.
The concentration of each soup base was unspecified. They only listed the dilution factor. As such, it is quite impossible to draw any sort of conclusion from the results.
As any toxicologist will tell you – the dose makes the poison. This is why the concentration of any substance is critical in any study. Even water and oxygen – essential to human life to be sure – is toxic at high doses.
Fact #7 : Soups Were Prepared In 5 Minutes
It is important to point out that the soups the researchers used were prepared in just 5 minutes. Bak kut teh is usually prepared by simmering the meat in the soup for hours.
It would have been a good idea to prepare the soup bases like real bak kut teh soup, because boiling the soup for several hours could potentially break down toxins present in its ingredients.
In fact, it would have been better for the researchers to just buy real bak kut teh, instead of resorting to their soup bases prepared in just 5 minutes.
Fact #8 : They Tested Using HepG2 Liver Cancer Cells
It is also important to note that the researchers tested the soup bases by adding them to HepG2 cell cultures, not normal liver cells.
HepG2 is a hepatoblastoma (a type of liver cancer) cell line that was obtained from a 15 year-old boy suffering from liver cancer in 1975.
Now, there is nothing wrong with that – HepG2 is commonly used to test cytotoxicity of substances. Still, it must still be pointed out that HepG2 is not the same thing as normal liver cells.
In-vitro studies based on these cells should not be used to draw any conclusion, only used to drive further research.
|Differences||HepG2 Cells||Normal Liver Cells|
|Cell Size||12-19 µm||15 µm|
|Nuclei||Single large nuclei
with 3-7 nucleoli
|Two or more nuclei|
|Smooth Endoplasmic Reticulum||Poorly Developed||High|
|No. of Chromosomes||50-60||46|
|DNA Content||7.5 pg||~6 pg|
Fact #9 : Spices, Pepper + Salt Did Worst In Their Tests
What I found most interesting in their results was the fact that the most “toxic” soup was Formulation 4, which consisted of nothing more than spices, pepper and salt.
Formulation 4 showed the most significant toxicity to the HepG2 cell line with approximately 83% cell death before dilution (p < 0.0001) and persistent toxicity even with dilution 1:10 (15% ± 3.7, p = 0.023) and 1:1000 (14% ± 3.8, p = 0.024)
Well, that’s gonna worry fans of Kentucky Fried Chicken, which boasts 11 herbs and spices, including pepper and salt!
Jokes aside, this result suggest that common spices, pepper and salt are more toxic to HepG2 liver cells than the more fanciful bak kut teh preparations!
Fact #10 : They Did Not Test Drug Interactions
I’m not sure how this study touches on drug interaction, since they didn’t test the soup bases with common hepatotoxic drugs like paracetamol to see if there is a synergistic effect.
No matter how you slice and dice this study’s results, they tell us nothing about any possible interaction with other herbs / drugs.
Yet so many media outlets made the startling claim that the study showed that bak kut teh may interact with medication! Nowhere in the study does it say that!
It seems obvious that most of these journalists did not even bother to read the study, and only paraphrased what other people were writing.
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Dr. Adrian Wong has been writing about tech and science since 1997, even publishing a book with Prentice Hall called Breaking Through The BIOS Barrier (ISBN 978-0131455368) while in medical school.
He continues to devote countless hours every day writing about tech, medicine and science, in his pursuit of facts in a post-truth world.
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