Health-Promoting Effects of Black Tea: A Narrative Review of Clinical Trials
Corresponding Author
Yusuf Yilmaz
Department of Gastroenterology , School of Medicine , Recep Tayyip Erdoğan University , Rize , Türkiye , erdogan.edu.tr
Search for more papers by this authorCorresponding Author
Yusuf Yilmaz
Department of Gastroenterology , School of Medicine , Recep Tayyip Erdoğan University , Rize , Türkiye , erdogan.edu.tr
Search for more papers by this authorAbstract
Black tea, a popular beverage, is rich in polyphenols. However, thorough analyses of clinical trial evidence supporting its health benefits are lacking. This narrative review is aimed at addressing this knowledge gap by synthesizing findings across pivotal clinical domains and identifying critical areas for further investigation. A comprehensive search of PubMed/MEDLINE, PubMed Central, Scopus, Web of Science, and Google Scholar was performed for English-language papers from January 1990 to July 2024, focusing on cardiovascular and metabolic health, as well as cognitive function. Findings from clinical trials indicated that consuming black tea regularly enhances endothelial and vascular health, notably by improving flow-mediated vasodilation. These advantages are largely due to the tea’s antioxidant, anti-inflammatory, and gut microbiota–modulating effects, including the promotion of beneficial bacterial species such as Flavonifractor plautii. Effects on metabolic health, such as lipid profiles and glucose metabolism, were inconsistent. However, black tea was linked to improved cognitive function, especially attention and alertness, likely due to caffeine and L-theanine. Despite these promising results, further research is needed to overcome limitations like small sample sizes and short study durations. Future studies should be aimed at standardizing black tea preparations to optimize health benefits.
Conflicts of Interest
The author declares no conflicts of interest.
Open Research
Data Availability Statement
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
References
- 1 Dou Q. P., Tea in health and disease, Nutrients. (2019) 11, no. 4, https://doi.org/10.3390/nu11040929, 2-s2.0-85065294284, 31027187.
- 2 Brody H., Tea, Nature. (2019) 566, no. 7742, https://doi.org/10.1038/d41586-019-00394-5, 2-s2.0-85061124704.
- 3 Chen Q., Zhu Y., Liu Y., Liu Y., Dong C., Lin Z., and Teng J., Black tea aroma formation during the fermentation period, Food Chemistry. (2022) 374, 131640, https://doi.org/10.1016/j.foodchem.2021.131640, 34839968.
- 4 Singh B. N., Rawat A. K., Bhagat R. M., and Singh B. R., Black tea: phytochemicals, cancer chemoprevention, and clinical studies, Critical Reviews in Food Science and Nutrition. (2017) 57, no. 7, 1394–1410, https://doi.org/10.1080/10408398.2014.994700, 2-s2.0-85013376981, 26561007.
- 5 Tanaka T. and Matsuo Y., Production mechanisms of black tea polyphenols, Chemical and Pharmaceutical Bulletin. (2020) 68, no. 12, 1131–1142, https://doi.org/10.1248/cpb.c20-00295.
- 6 Butt M. S., Imran A., Sharif M. K., Ahmad R. S., Xiao H., Imran M., and Rsool H. A., Black tea polyphenols: a mechanistic treatise, Critical Reviews in Food Science and Nutrition. (2014) 54, no. 8, 1002–1011, https://doi.org/10.1080/10408398.2011.623198, 2-s2.0-84893583235, 24499118.
- 7 Naveed M., BiBi J., Kamboh A. A., Suheryani I., Kakar I., Fazlani S. A., FangFang X., Kalhoro S. A., Yunjuan L., Kakar M. U., Abd El-Hack M. E., Noreldin A. E., Zhixiang S., LiXia C., and XiaoHui Z., Pharmacological values and therapeutic properties of black tea (Camellia sinensis): a comprehensive overview, Biomedicine & Pharmacotherapy. (2018) 100, 521–531, https://doi.org/10.1016/j.biopha.2018.02.048, 2-s2.0-85042390288, 29482046.
- 8 Inoue-Choi M., Ramirez Y., Cornelis M. C., Berrington de González A., Freedman N. D., and Loftfield E., Tea consumption and all-cause and cause-specific mortality in the UK Biobank: a prospective cohort study, Annals of Internal Medicine. (2022) 175, no. 9, 1201–1211, https://doi.org/10.7326/M22-0041, 36037472.
- 9 Chen Y., Zhang Y., Zhang M., Yang H., and Wang Y., Consumption of coffee and tea with all-cause and cause-specific mortality: a prospective cohort study, BMC Medicine. (2022) 20, no. 1, https://doi.org/10.1186/s12916-022-02636-2, 36397104.
- 10 Wu E., Bao Y. Y., Wei G. F., Wang W., Xu H. Q., Chen J. Y., Xu Y. N., Han D., Tao L., and Ni J. T., Association of tea and coffee consumption with the risk of all-cause and cause-specific mortality among individuals with metabolic syndrome: a prospective cohort study, Diabetology and Metabolic Syndrome. (2023) 15, no. 1, https://doi.org/10.1186/s13098-023-01222-7, 37993869.
- 11 Hariton E. and Locascio J. J., Randomised controlled trials - the gold standard for effectiveness research: study design: randomised controlled trials, BJOG : An International Journal of Obstetrics and Gynaecology. (2018) 125, no. 13, https://doi.org/10.1111/1471-0528.15199, 2-s2.0-85056558920, 29916205.
- 12 Trevisanato S. I. and Kim Y. I., Tea and health, Nutrition Reviews. (2000) 58, no. 1, 1–10, https://doi.org/10.1111/j.1753-4887.2000.tb01818.x.
- 13 Mak J. C., Potential role of green tea catechins in various disease therapies: progress and promise, Clinical and Experimental Pharmacology & Physiology. (2012) 39, no. 3, 265–273, https://doi.org/10.1111/j.1440-1681.2012.05673.x, 2-s2.0-84857376492, 22229384.
- 14 Pervin M., Unno K., Ohishi T., Tanabe H., Miyoshi N., and Nakamura Y., Beneficial effects of green tea catechins on neurodegenerative diseases, Molecules. (2018) 23, no. 6, https://doi.org/10.3390/molecules23061297, 2-s2.0-85047883784, 29843466.
- 15 Keller A. and Wallace T. C., Tea intake and cardiovascular disease: an umbrella review, Annals of Medicine. (2021) 53, no. 1, 929–944, https://doi.org/10.1080/07853890.2021.1933164, 34396859.
- 16 Duffy S. J., KeaneyJ. F.Jr., Holbrook M., Gokce N., Swerdloff P. L., Frei B., and Vita J. A., Short- and long-term black tea consumption reverses endothelial dysfunction in patients with coronary artery disease, Circulation. (2001) 104, no. 2, 151–156, https://doi.org/10.1161/01.cir.104.2.151, 2-s2.0-0035838446, 11447078.
- 17 Hodgson J. M., Puddey I. B., Burke V., Watts G. F., and Beilin L. J., Regular ingestion of black tea improves brachial artery vasodilator function, Clinical Science (London, England). (2002) 102, no. 2, 195–201, https://doi.org/10.1042/cs1020195, 11834139.
- 18 Grassi D., Mulder T. P., Draijer R., Desideri G., Molhuizen H. O., and Ferri C., Black tea consumption dose-dependently improves flow-mediated dilation in healthy males, Journal of Hypertension. (2009) 27, no. 4, 774–781, https://doi.org/10.1097/HJH.0b013e328326066c, 2-s2.0-67649643512, 19516176.
- 19 Hodgson J. M., Croft K. D., Woodman R. J., Puddey I. B., Fuchs D., Draijer R., Lukoshkova E., and Head G. A., Black tea lowers the rate of blood pressure variation: a randomized controlled trial, The American Journal of Clinical Nutrition. (2013) 97, no. 5, 943–950, https://doi.org/10.3945/ajcn.112.051375, 2-s2.0-84876938978, 23553154.
- 20 Schreuder T. H., Eijsvogels T. M., Greyling A., Draijer R., Hopman M. T., and Thijssen D. H., Effect of black tea consumption on brachial artery flow-mediated dilation and ischaemia-reperfusion in humans, Applied Physiology, Nutrition, and Metabolism. (2014) 39, no. 2, 145–151, https://doi.org/10.1139/apnm-2012-0450, 2-s2.0-84893401445, 24476469.
- 21 Grassi D., Draijer R., Schalkwijk C., Desideri G., D’Angeli A., Francavilla S., Mulder T., and Ferri C., Black tea increases circulating endothelial progenitor cells and improves flow mediated dilatation counteracting deleterious effects from a fat load in hypertensive patients: a randomized controlled study, Nutrients. (2016) 8, no. 11, https://doi.org/10.3390/nu8110727, 2-s2.0-84996537897, 27854314.
- 22 Greyling A., Wolters T. L. C., de Bresser D. M., Roerink S. H. P. P., Riksen N. P., Mulder T. P., Rowson M. J., Hopman M. T., and Thijssen D. H. J., The acute effect of black tea consumption on resistance artery endothelial function in healthy subjects. A randomized controlled trial, Clinical Nutrition ESPEN. (2018) 23, 41–47, https://doi.org/10.1016/j.clnesp.2017.10.011, 2-s2.0-85034436471, 29460812.
- 23 Woodward K. A., Hopkins N. D., Draijer R., de Graaf Y., Low D. A., and Thijssen D. H. J., Acute black tea consumption improves cutaneous vascular function in healthy middle-aged humans, Clinical Nutrition. (2018) 37, no. 1, 242–249, https://doi.org/10.1016/j.clnu.2016.12.013, 2-s2.0-85009188331.
- 24 Ahmad A. F., Rich L., Koch H., Croft K. D., Ferruzzi M. G., Kay C. D., Hodgson J. M., and Ward N. C., Effect of adding milk to black tea on vascular function in healthy men and women: a randomised controlled crossover trial, Food & Function. (2018) 9, no. 12, 6307–6314, https://doi.org/10.1039/c8fo01019f, 2-s2.0-85058597768, 30411751.
- 25 Davies M. J., Judd J. T., Baer D. J., Clevidence B. A., Paul D. R., Edwards A. J., Wiseman S. A., Muesing R. A., and Chen S. C., Black tea consumption reduces total and LDL cholesterol in mildly hypercholesterolemic adults, The Journal of Nutrition. (2003) 133, no. 10, 3298S–3302S, https://doi.org/10.1093/jn/133.10.3298S, 14519829.
- 26 Fujita H. and Yamagami T., Antihypercholesterolemic effect of Chinese black tea extract in human subjects with borderline hypercholesterolemia, Nutrition Research. (2008) 28, no. 7, 450–456, https://doi.org/10.1016/j.nutres.2008.04.005, 2-s2.0-44849131991, 19083445.
- 27 Bahorun T., Luximon-Ramma A., Neergheen-Bhujun V. S., Gunness T. K., Googoolye K., Auger C., Crozier A., and Aruoma O. I., The effect of black tea on risk factors of cardiovascular disease in a normal population, Preventive Medicine. (2012) 54, no. Supplement, S98–102, https://doi.org/10.1016/j.ypmed.2011.12.009, 2-s2.0-84860854440.
- 28 Hodgson J. M., Puddey I. B., Mori T. A., Burke V., Baker R. I., and Beilin L. J., Effects of regular ingestion of black tea on haemostasis and cell adhesion molecules in humans, European Journal of Clinical Nutrition. (2001) 55, no. 10, 881–886, https://doi.org/10.1038/sj.ejcn.1601231, 2-s2.0-0034817339, 11593350.
- 29 Hodgson J. M., Puddey I. B., Burke V., Beilin L. J., Mori T. A., and Chan S. Y., Acute effects of ingestion of black tea on postprandial platelet aggregation in human subjects, The British Journal of Nutrition. (2002) 87, no. 2, 141–145, https://doi.org/10.1079/BJN2001499, 2-s2.0-0036264906, 11895166.
- 30 Steptoe A., Gibson E. L., Vuononvirta R., Hamer M., Wardle J., Rycroft J. A., Martin J. F., and Erusalimsky J. D., The effects of chronic tea intake on platelet activation and inflammation: a double-blind placebo controlled trial, Atherosclerosis. (2007) 193, no. 2, 277–282, https://doi.org/10.1016/j.atherosclerosis.2006.08.054, 2-s2.0-34447265697, 17010979.
- 31 Xu S., Ilyas I., Little P. J., Li H., Kamato D., Zheng X., Luo S., Li Z., Liu P., Han J., Harding I. C., Ebong E. E., Cameron S. J., Stewart A. G., and Weng J., Endothelial dysfunction in atherosclerotic cardiovascular diseases and beyond: from mechanism to pharmacotherapies, Pharmacological Reviews. (2021) 73, no. 3, 924–967, https://doi.org/10.1124/pharmrev.120.000096, 34088867.
- 32 de la Sierra A., Blood pressure variability as a risk factor for cardiovascular disease: which antihypertensive agents are more effective?, Journal of Clinical Medicine. (2023) 12, no. 19, https://doi.org/10.3390/jcm12196167, 37834811.
- 33 Hodgson J. M., Woodman R. J., Puddey I. B., Mulder T., Fuchs D., and Croft K. D., Short-term effects of polyphenol-rich black tea on blood pressure in men and women, Food & Function. (2013) 4, no. 1, 111–115, https://doi.org/10.1039/c2fo30186e, 2-s2.0-84871772634, 23038021.
- 34 Kengne A. P., Brière J. B., Gudiña I. A., Jiang X., Kodjamanova P., Bennetts L., and Khan Z. M., The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review, Expert Review of Pharmacoeconomics & Outcomes Research. (2024) 24, no. 7, 807–816, https://doi.org/10.1080/14737167.2024.2319598, 38366854.
- 35 Minoretti P., Biagi M., and Emanuele E., An open-label study on the short-term effects of a novel EFSA-compliant nutraceutical combination in mild-to-moderate hypercholesterolemia, Avicenna Journal of Phytomedicine. (2022) 12, no. 6, 559–565, https://doi.org/10.22038/AJP.2022.20662.
- 36 Mukamal K. J., MacDermott K., Vinson J. A., Oyama N., Manning W. J., and Mittleman M. A., A 6-month randomized pilot study of black tea and cardiovascular risk factors, American Heart Journal. (2007) 154, no. 4, 724.e1–724.e6, https://doi.org/10.1016/j.ahj.2007.07.008, 2-s2.0-34548760342, 17892999.
- 37 Trautwein E. A., Du Y., Meynen E., Yan X., Wen Y., Wang H., and Molhuizen H. O., Purified black tea theaflavins and theaflavins/catechin supplements did not affect serum lipids in healthy individuals with mildly to moderately elevated cholesterol concentrations, European Journal of Nutrition. (2010) 49, no. 1, 27–35, https://doi.org/10.1007/s00394-009-0045-7, 2-s2.0-74149089850.
- 38 Troup R., Hayes J. H., Raatz S. K., Thyagarajan B., Khaliq W., JacobsD. R.Jr., Key N. S., Morawski B. M., Kaiser D., Bank AJ, and Gross M., Effect of black tea intake on blood cholesterol concentrations in individuals with mild hypercholesterolemia: a diet-controlled randomized trial, Journal of the Academy of Nutrition and Dietetics. (2015) 115, no. 2, 264–271.e2, https://doi.org/10.1016/j.jand.2014.07.021, 2-s2.0-84921825235, 25266246.
- 39 Olie R. H., van der Meijden P. E. J., and Ten Cate H., The coagulation system in atherothrombosis: implications for new therapeutic strategies, Research and Practice in Thrombosis and Haemostasis. (2018) 2, no. 2, 188–198, https://doi.org/10.1002/rth2.12080, 30046721.
- 40 Bryans J. A., Judd P. A., and Ellis P. R., The effect of consuming instant black tea on postprandial plasma glucose and insulin concentrations in healthy humans, Journal of the American College of Nutrition. (2007) 26, no. 5, 471–477, https://doi.org/10.1080/07315724.2007.10719638, 2-s2.0-34948910121, 17914136.
- 41 Butacnum A., Chongsuwat R., and Bumrungpert A., Black tea consumption improves postprandial glycemic control in normal and pre-diabetic subjects: a randomized, double-blind, placebo-controlled crossover study, Asia Pacific Journal of Clinical Nutrition. (2017) 26, no. 1, 59–64, https://doi.org/10.6133/apjcn.112015.08, 2-s2.0-85010747963, 28049262.
- 42 Mackenzie T., Leary L., and Brooks W. B., The effect of an extract of green and black tea on glucose control in adults with type 2 diabetes mellitus: double-blind randomized study, Metabolism. (2007) 56, no. 10, 1340–1344, https://doi.org/10.1016/j.metabol.2007.05.018, 2-s2.0-34548601696, 17884442.
- 43 Bøhn S. K., Croft K. D., Burrows S., Puddey I. B., Mulder T. P., Fuchs D., Woodman R. J., and Hodgson J. M., Effects of black tea on body composition and metabolic outcomes related to cardiovascular disease risk: a randomized controlled trial, Food & Function. (2014) 5, no. 7, 1613–1620, https://doi.org/10.1039/c4fo00209a, 2-s2.0-84903288916, 24889137.
- 44 Popov V. B., Aytaman A., and Alemán J. O., Obesity: the forgotten pandemic, The American Journal of Gastroenterology. (2022) 117, 7–10, https://doi.org/10.14309/ajg.0000000000001553, 34738552.
- 45 Hindmarch I., Quinlan P. T., Moore K. L., and Parkin C., The effects of black tea and other beverages on aspects of cognition and psychomotor performance, Psychopharmacology. (1998) 139, no. 3, 230–238, https://doi.org/10.1007/s002130050709, 2-s2.0-0031679657, 9784078.
- 46 De Bruin E. A., Rowson M. J., Van Buren L., Rycroft J. A., and Owen G. N., Black tea improves attention and self-reported alertness, Appetite. (2011) 56, no. 2, 235–240, https://doi.org/10.1016/j.appet.2010.12.011, 2-s2.0-79551584080, 21172396.
- 47 Okello E. J., Abadi A. M., and Abadi S. A., Effects of green and black tea consumption on brain wave activities in healthy volunteers as measured by a simplified electroencephalogram (EEG): a feasibility study, Nutritional Neuroscience. (2016) 19, no. 5, 196–205, https://doi.org/10.1179/1476830515Y.0000000008, 2-s2.0-84978513705, 25714035.
- 48 Yoto A., Fukui N., Kaneda C., Torita S., Goto K., Nanjo F., and Yokogoshi H., Black tea aroma inhibited increase of salivary chromogranin-A after arithmetic tasks, Journal of Physiological Anthropology. (2018) 37, no. 1, https://doi.org/10.1186/s40101-018-0163-0, 2-s2.0-85042463396, 29361988.
- 49 Langley-Evans S. C., Consumption of black tea elicits an increase in plasma antioxidant potential in humans, International Journal of Food Sciences and Nutrition. (2000) 51, no. 5, 309–315, https://doi.org/10.1080/096374800426902, 2-s2.0-0033772557, 11103296.
- 50 Neyestani T. R., Shariatzade N., Kalayi A., Gharavi A., Khalaji N., Dadkhah M., Zowghi T., Haidari H., and Shab-bidar S., Regular daily intake of black tea improves oxidative stress biomarkers and decreases serum C-reactive protein levels in type 2 diabetic patients, Annals of Nutrition and Metabolism. (2010) 57, no. 1, 40–49.
- 51 Widlansky M. E., Duffy S. J., Hamburg N. M., Gokce N., Warden B. A., Wiseman S., KeaneyJ. F.Jr., Frei B., and Vita J. A., Effects of black tea consumption on plasma catechins and markers of oxidative stress and inflammation in patients with coronary artery disease, Free Radical Biology & Medicine. (2005) 38, no. 4, 499–506, https://doi.org/10.1016/j.freeradbiomed.2004.11.013, 2-s2.0-13844299245, 15649652.
- 52 Bahorun T., Luximon-Ramma A., Gunness T. K., Sookar D., Bhoyroo S., Jugessur R., Reebye D., Googoolye K., Crozier A., and Aruoma O. I., Black tea reduces uric acid and C-reactive protein levels in humans susceptible to cardiovascular diseases, Toxicology. (2010) 278, no. 1, 68–74, https://doi.org/10.1016/j.tox.2009.11.024, 2-s2.0-78149406720, 19963031.
- 53 de Maat M. P., Pijl H., Kluft C., and Princen H. M., Consumption of black and green tea has no effect on inflammation, haemostasis and endothelial markers in smoking healthy individuals, European Journal of Clinical Nutrition. (2000) 54, no. 10, 757–763, https://doi.org/10.1038/sj.ejcn.1601084, 2-s2.0-0033754768, 11083483.
- 54 van Duynhoven J., van der Hooft J. J., van Dorsten F. A., Peters S., Foltz M., Gomez-Roldan V., Vervoort J., de Vos R. C., and Jacobs D. M., Rapid and sustained systemic circulation of conjugated gut microbial catabolites after single-dose black tea extract consumption, Journal of Proteome Research. (2014) 13, no. 5, 2668–2678, https://doi.org/10.1021/pr5001253, 2-s2.0-84899886026, 24673575.
- 55 Tomioka R., Tanaka Y., Suzuki M., and Ebihara S., The effects of black tea consumption on intestinal microflora-a randomized single-blind parallel-group, placebo-controlled study, Journal of Nutritional Science and Vitaminology (Tokyo). (2023) 69, no. 5, 326–339, https://doi.org/10.3177/jnsv.69.326, 37940573.
- 56 O’Reilly J. D., Mallet A. I., McAnlis G. T., Young I. S., Halliwell B., Sanders T. A., and Wiseman H., Consumption of flavonoids in onions and black tea: lack of effect on F2-isoprostanes and autoantibodies to oxidized LDL in healthy humans, The American Journal of Clinical Nutrition. (2001) 73, no. 6, 1040–1044, https://doi.org/10.1093/ajcn/73.6.1040, 11382657.
- 57 Mahmoud F., Haines D., Al-Ozairi E., and Dashti A., Effect of black tea consumption on intracellular cytokines, regulatory T cells and metabolic biomarkers in type 2 diabetes patients, Phytotherapy Research. (2016) 30, no. 3, 454–462, https://doi.org/10.1002/ptr.5548, 2-s2.0-84959576383, 26692322.
- 58 Luo S., Zhao Y., Zhu S., Liu L., Cheng K., Ye B., Han Y., Fan J., and Xia M., Flavonifractor plautii protects against elevated arterial stiffness, Circulation Research. (2023) 132, no. 2, 167–181, https://doi.org/10.1161/CIRCRESAHA.122.321975, 36575982.
- 59 Boros K., Jedlinszki N., and Csupor D., Theanine and caffeine content of infusions prepared from commercial tea samples, Pharmacognosy Magazine. (2016) 12, no. 45, 75–79, https://doi.org/10.4103/0973-1296.176061, 2-s2.0-84959020215, 27019564.
- 60 Greenhalgh T., Thorne S., and Malterud K., Time to challenge the spurious hierarchy of systematic over narrative reviews?, European Journal of Clinical Investigation. (2018) 48, no. 6, e12931, https://doi.org/10.1111/eci.12931, 2-s2.0-85045283646, 29578574.