Several experimental and animal studies have demonstrated that substances rich in antioxidants can reduce the physicochemical and peroxidative risk factors for calcium oxalate (CaOx) renal stone formation in urine and blood. However, there are very few such investigations in humans. In the present pilot study, two varieties of tea, a green one from Japan (JGT) and a herbal one from South Africa (Rooibos) (RT), both rich in antioxidants, were administered to a group of CaOx stone formers (SF) (n = 8) for 30 days. Both teas were analysed for polyphenols by high-performance liquid chromatography and for minerals by plasma atomic and optical emission spectroscopy. 24 h urines (baseline and day 30) were analysed for lithogenic factors. CaOx metastable limits and crystal nucleation and growth kinetics were also determined in each urine sample. Deposited crystals were inspected by scanning electron microscopy. Blood samples were collected (baseline and day 30). Biomarkers of oxidative stress including plasma and urinary thiobarbituric acid reactive substances (TBARS) and urinary N-acetyl-β-D-glucosaminidase (NAG) were also determined. Urinary physicochemical risk factors were also investigated after ingestion of RT for 30 days in two control groups (CG1 and CG2), the latter one of which consisted of habitual JGT drinkers. Statistical analyses were performed using Wilcoxon signed rank tests and Mann–Whitney tests for paired and independent measurements, respectively. Several flavonoids and catechins were quantified in RT and JGT, respectively, confirming that both teas are rich sources of antioxidants. Mineral content was found to be far below dietary reference intakes. There were no significant changes in any of the urinary physicochemical or peroxidative risk factors in the control groups or in SF, except for the supersaturation (SS) of brushite (Bru) which decreased in the latter group after ingestion of JGT. Crystal morphology showed a tendency to change from mixed CaOx mono- and di-hydrate to monohydrate after ingestion of each tea. Since the latter form has a stronger binding affinity for epithelial cells, this effect is not protective. Analysis of the physicochemical and peroxidative risk factors in CG1 and CG2 did not reveal any evidence of a synergistic effect between the two teas. Paradoxically, baseline risk factors in the habitual JGT control group were significantly raised relative to those in CG1. Our preliminary results suggest that ingestion of RT and JGT does not reduce the risk factors for CaOx stone formation in humans, but these findings need to be tested in further studies involving much larger sample sizes.
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Selvam R (2002) Calcium oxalate stone disease; role of lipid peroxidation and antioxidants. Urol Res 30:35–47
Khan S (2012) Is oxidative stress a link between nephrolithiasis and obesity, hypertension, diabetes, chronic kidney disease, metabolic syndrome? Urol Res 40:95–112
Khan S (2013) Reactive oxygen species as the molecular modulators of calcium oxalate kidney stone formation: evidence from clinical and experimental investigations. J Urol 189:803–811
Thamilselvan S, Byer K, Hackett R, Khan S (2000) Free radical scavengers, catalase and superoxide dismutase provide protection from oxalate-associated injury to LLC-PK1 and MDCK cells. J Urol 164:2240229
Thamilselvan S, Khan S (2003) Oxalate and calcium oxalate mediated free radical toxicity in renal epithelial cells: effect of antioxidants. Urol Res 31:3–9
Itoh Y, Yasui T, Okada A, TozawaK Hayashi Y, Kohri K (2005) Preventative effects of green tea on renal stone formation and the role of oxidative stress in nephrolithiasis. J Urol 173:271–275
Jeong B, Kim B, Kim J, Kim H (2006) Effects of green tea on urinary stone formation: an in vivo and in vitro study. J Endourol 20:356–361
Jyothilakshmi V, Thellamudhu G, Chinta R, Anil K, Debadatta N (2014) Beneficial effect of homeopathic preparation Berberis vulgaris in alleviation oxidative stress in experimental urolithiasis. Forschende Komlementarmedizin 21:7–12
Tugcu V, Kemahli E, Ozbek E, Annci Y, Uhri M et al (2008) Protective effect of a potent antioxidant, pomegranate juice, in the kidney of rats with nephrolithiasis induced by ethylene glycol. J Endourol 22:2723–2731
Abbazhagan M, Hariprasad C, Samudram P, Latha E, Latha M, Selvam R (1999) Effect of supplementation of vitamin E on urinary risk factors in patients with hyperoxaluria. J Clin Biochem Nutr 27:37–47
Sumitra K, Pragasam V, Sakthivel R, Kalaiselvi P, Varalakshmi P (2005) Beneficial effect of vitamin E supplementation on the biochemical and kinetic properties of Tamm-Horsfall glycoprotein in hypertensive and hyperoxaluric patients. Nephrol Dial Transplant 20:1407–1415
Tracy C, Henning J, Newton M, Aviram M, Zimmerman M (2014) Oxidative stress and nephrolitiasis: a comparative pilot study evaluating the effect of pomegranate extract on stone risk factors and elevated oxidative stress levels of recurrent stone formers and controls. Urolithiasis 42:401–408
Balentine D, Wiseman S, Bouwens L (1997) The chemistry of tea flavonoids. Clin Rev Food Sci Nutr 37:693–704
du Toit R, Volsteedt Y, Apostolides Z (2001) Comparison of the antioxidant content of fruits, vegetables and teas measured as vitamin C equivalents. Toxicology 166:63–69
Cabrera C, Artacho R, Gimenez R (2006) Beneficial effects of green tea—a review. J Am Coll Nutr 25:79–99
Kim J, Choi J, Yoon G, Yang E, Kim D (2005) Effect of green tea on calcium oxalate stone formation and excretion in ethylene glycol-treated rats. Korean J Urol 46:299–305
Wilson N (2005) Cape natural tea products and the US market: rooibos rebels ready to raid. Rev Agric Econ 27:139–148
Dos A, Ayhan Z, Sumnu G (2005) Effects of different factors on the sensory attributes, overall acceptance and preferences of rooibos (Aspalathus linearis) tea. J Sens Stud 20:228–242
Huang M, Plessis J, Preez J, Hamman J, Viljoen A (2008) Transport of Aspalathin, a rooibos tea flavonoid, across the skin and intestinal epithelium. Phytother Res 22:699–704
Marnewick JL, Rautenbach F, Venter I, Neethling H, Blackhurst D et al (2011) Effects of rooibos (Aspalathus linearis) on oxidative stress and biochemical parameters in adults at risk for cardiovascular disease. J Ethnopharm 133:46–52
Holmes R, Kennedy M (2000) Estimation of the oxalate content of foods and daily oxalate intake. Kidney Int 57:1662–1667
Halvorsen B, Carlsen M, Phillips K, Bohn S, Holte K et al (2006) Contents of redox-active compounds (i e antioxidants) in foods consumed in the United States. Am J Clin Nutr 84:95–135
Grases F, Costa-Bauza A, Prieto R (2006) Renal lithiasis and nutrition. Nutr J 5:1–7
Wolmarans P, Humphreys J, Sayed N (2001) Foodfinder™ 2. Nutritional Intervention Unit, South African Medical Research Council, Cape Town
Allie-Hamdulay S, Rodgers A (2005) Prophylactic and therapeutic properties of a sodium citrate preparation in the management of calcium oxalate urolthiasis: randomized, placebo-controlled trial. Urol Res 33:116–124
Yasui T, Itoh Y, Okada A, Hamamoto S, Hirose M, Kobayashi T, Tozawa K, Kohri K (2009) Alendronate reduces the excretion of risk factors for calcium phosphate stone formation in postmenopausal women with osteoporosis. Urol Int 83:226–229
Tiselius H (1982) An improved method for the routine biochemical evaluation of patients with recurrent calcium oxalate stone disease. Clin Chim Acta 122:409–418
Werness PG, Brown CM, Smith LH et al (1985) EQUIL2: a basic computer program for the calculation of urinary saturation. J Urol 134:1242–1244
Ryall R, Hibberd C, Marshall V (1985) A method for studying inhibitory acrivity in whole urine. Urol Res 12:285–289
Hess B, Mienhardt U, Zipperle L, Giovanoli R, Jaeger P (1995) Simultaneous measurements of calcium oxalate crystal nucleation and aggregation: impact of various modifiers. Urol Res 23:231–238
Ryall R, Grover P, Stapleton A et al (1995) The urinary F1 activation peptide of human prothrombin is a potent inhibitor of calcium oxalate crystallisation in undiluted human urine in vitro. Clin Sci 89:533–541
Honow R, Gu K, Hesse A, Siener R (2010) Oxalate content of green tea of different origin, quality, preparation and time of harvest. Urol Res 38:377–381
Bramati L, Minoggio M, Gardana C, Simonetti P, Mauri P, Pietta P (2002) Quantitative characterization of flavonoid compounds in rooibos tea (Aspalathus linearis) by LC-UV/DAD. J Agric Food Chem 50:5513–5519
Cabrera C, Gimenez R, Lopez M (2003) determination of tea components with antioxidant activity. J Agric Food Chem 51:4427–4435
Olivier J, Symington EA, Jonker CZ, Rampedi IT, Van Eeden TS (2012) Comparison of the mineral composition of leaves and infusions of traditional and herbal teas. S Afr J Sci 108:1–7
Nelson G, Morris V, Schmidt P, Levander O (1993) The urinary excretion of thiobarbituric acid reactive substances and malondialdehyde by normal adult males after consuming a diet containing salmon. Lipids 28:757–761
Srikrishna K, Kanagasabapathy A, John L (1994) N-acetyl-β-D-glucosaminidase, alanine aminopeptidase and protein: creatinine ratio as early indicators of diabetic microanlopathy. Indian J Clin Biochem 9:5–8
Boonla C, Wunsuwan R, Tungsanga R, Tosukhowong P (2007) Urinary 8-hydroxyguanosine is elevated in patients with nephrolithiasis. Urol Res 35:185–191
Huang H-S, Ma M-C, Chen C-F, Chen J (2003) Lipid peroxidation and its correlations with urinary levels of oxalate, citric acid and osteopontin in patients with renal calcium oxalate stones. Urology 62:1123–1128
Sakuma N, Iwata S, Hibino T, Tamai N, Sasai K et al (1997) Effects of vitamin C and vitamin E on plasma levelsof lipid hydroperoxides and thiobarbituric acid reactive substances in humans. Curr Therapeutic Res 58:317–322
Mol M, de Rijke Y, Demacker P, Stalenhoef A (1997) Plasma levels of lipid and cholesterol oxidation products and cytokines in diabetes mellitus and cigarette smoking: effects of vitamin E treatment. Atherosclerosis 129:169–176
Ide T, Tsutsui H, Ohashi N, Hayashidani S, Suematsu N et al (2002) Greater oxidative stress in healthy young men compared with premenopausal women. Arterioscler Thromb Vasc Biol 22:438–442
Goraca A, Skibska B (2005) Plasma antioxidantstatus in healthy smoking and non-smoking men. Bratisl Lek Listy 106:301–306
Moselhy H, Reid R, Yousef S, Boyle S (2013) A specific, accurate and sensitive measure of total plasma malondialdehyde by HPLC. J Lipid Res 54:852–858
Tang R, Nancollas GH, Giocondi JL, Hoyer JR, Orme CA (2006) Dual roles of brushite crystals in calcium oxalate crystallization provide physicochemical mechanisms underlying renal stone formation. Kidney Int 70:71–78
Kuriyama S, Shimazu T, Ohmori K, Kikuchi N, Nakaya N et al (2006) Green tea consumption and mortality due to cardiovascular disease, cancer and all causes in Japan. JAMA 296:1255–1265
Charrier M, Savage G, Vanhanen L (2002) Oxalate content and calcium binding capacity of tea and herbal teas. Asia Pacific J Clin Nutr 11:298–301
Curhan G, Willett W, Rimm E, Spiegelman D, Stampfer M (1996) Prospective study of beverage use and the risk of kidney stones. J Epidemiol 143:240–247
Siener R, Honow R, Seidler A, Voss S, Hesse A (2006) Oxalate contents of species of the Polygonaceae, Amaranthaceae and Chenopodiaceae families. Food Chem 98:220–224
Wesson J, Worcester E, Weissner J, Mandel N, Kleinman J (1998) Control of calcium oxalate crystal structure and cell adherence by urinary macromolecules. Kidney Int 33:952–957
Joubert E (1996) HPLC quantification of the dihydrochalcones, aspalathin and nothofagin in rooibos tea (Aspalathus linearis). Food Chem 55:403–411
Shulz H, Joubert E, Schutze W (2003) Quantification of quality parameters for reliable evaluation of green rooibos (Aspalathus linearis). Eur Food Res Technol 216:539–543
Ferreira D, Marais C, Steenkamp J (1995). Rooibos as a likely health food supplement. In: Fundamental Foods for Health, University of the Orange Free State, p 73–88
The authors wish to thank the South African National Research Foundation (NRF) and the Japan Society for the Promotion of Science (JSPS) for the award of a joint research grant. One of us (AR) also extends thanks to the University of Cape Town for the award of research funding. The Nagoya authors would like to thank Ms N Kasuga and Ms M Noda for their experimental assistance and the NCU Stone Research Team for their participation in the study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Conflict of interest
This study was funded by the South African National Research Foundation (NRF) and the Japanese Society for the Promotion of Science (JSPS), (Grant number UID 85106). The authors declare that that they have no conflicts of interest.
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Rodgers, A., Mokoena, M., Durbach, I. et al. Do teas rich in antioxidants reduce the physicochemical and peroxidative risk factors for calcium oxalate nephrolithiasis in humans? Pilot studies with Rooibos herbal tea and Japanese green tea. Urolithiasis 44, 299–310 (2016). https://doi.org/10.1007/s00240-015-0855-4
- Calcium oxalate
- Crystallization risk factors
- Rooibos tea
- Green tea
- Peroxidative risk factors