Interview with Jack Bukowski M.D., Assistant Professor of Medicine, Harvard Medical School
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Topic: Tea and Hearing: Update 2004
AO/Beck: Hi Dr. Bukowski, it's a pleasure to meet with you again. Would you please give me a thumbnail sketch of your education and your professional activities?
Bukowski: Sure Dr. Beck. I attended Johns Hopkins for my bachelor's and I earned my PhD in 1984 in Immunology. I went to medical school at the University of Massachusetts Medical Center and earned my MD in 1989. I did my internship and residency at the New England Deaconess Hospital which is now the Beth Israel Deaconess Hospital in Boston, Massachusetts. In 1992, I started a three year rheumatology fellowship at Brigham and Women's Hospital. In the year 2000, I was promoted to Assistant Professor of Medicine in the Rheumatology Division at Brigham and Women's Hospital in Harvard Medical School.
AO/Beck: I read some of your very clever and innovative research relating to drinking common teas -- and the potential impact of tea on health. I wonder if you can briefly review that for me?
Bukowski: Certainly. In general terms, the healthy aspect of tea has been appreciated for centuries. Most of the information about tea has been anecdotal, but within the last 10 years there have been significant advances in research related to the molecular aspects of tea and health. One of the first significant findings was the discovery of flavinoids and antioxidants in tea -- those are thought to do at least two main things. One, is to inhibit the formation of cancer cells, so it's an anti-mutagenic, and two, it's thought that tea might have significant protective effects on the cardiovascular system by decreasing the number of free radicals which can lead to atherosclerosis. Dr Beck, as you know, flavinoids are molecules that mediate antioxidant effects, and antioxidants are felt to decrease damage to DNA and therefore, decrease the formation of cancer cells.
AO/Beck: Since we last spoke a year ago, have there been any new findings?
Bukowski: Yes, since we last talked, the WHI study was released. Part ofthat study confirmed the utility of tea drinking in slowing down osteoporosis, most likely by inhibiting overactive osteoclasts. And with respect to hearing, since otosclerosis is associated with overactive osteoclasts, tea drinking mighthelp this. We know that administration of medicines originally designedfor osteoporosis called bisphosphonates, are now being used forotosclerosis and Meniere's disease.
AO/Beck: As hearing healthcare professionals, we deal with patients with endolymphatic hydrops, Meniere's disease, Meniere's syndrome and similar manifestations. Many people believe these diseases and syndromes are autoimmune responses. What are your thoughts on that?
Bukowski: I think it could indeed be an autoimmune response. I don't know too much about the particulars of those diseases and syndromes but I looked into an ear disease called "cochlear otosclerosis" and some people believe cochlear otosclerosis and Meniere's are possibly autoimmune diseases.
AO/Beck: Just to clarify, there are two types of otosclerosis. Classic otosclerosis is a middle ear disorder in which the stapes is immobilized by a spongiotic growth along the footplate. Classic otosclerosis has traditionally been addressed through surgical management. The other type of otoscleroisis is cochlear otosclerosis, and that is the one you were just speaking about. Cochlear oto is not a middle ear problem, it's a sensorineural hearing problem, and middle ear surgery is not useful for cochlear oto.
Bukowski: Yes, that's correct. I believe there are cases of cochlear otosclerosis in which there is excess osteoclast activity. Osteoclasts have the effect of reabsorbing bone, not only in the middle ear bones but also in the otic capsule and they secrete cytokines which may damage inner ear hair cells. Interestingly, tea may have anti-osteoclast activity, so if you were to drink tea, perhaps it would slow the progression of cochlear otosclerosis. I cannot say that for sure as we didn't study it, but it's possible.
AO/Beck: When you say tea I know there are a million different types, what teas are you speaking of in particular?
Bukowski: Tea, or true tea is made from the leaf of a tea tree, and there's only one species of tea tree. There are several ways to manufacture tea from the tea tree. The common teas we think of such as black tea, green tea, pekoe tea are teas that come from the leaf of a tea tree and they are processed in different ways. Those manufacturing processes have some effect on the antioxidant activities of tea, but as far as the immune system reactivity, the manufacturing processes have no effect on the immune process.
AO/Beck: I'm glad you mentioned that because I remember reading that if you were to microwave certain baby foods, you would break down the proteins and then those proteins became meaningless. So you're saying that the processing of tea leaves does not impact the health benefits?
Bukowski: No, it doesn't.
AO/Beck: What about teas that are caffeine free?
Bukowski: Great question. The decaffeination process is one that I am not intimately familiar with, regarding which molecules they remove. Theoretically, the decaffeination process should be fine, but I haven't tested that directly and I don't have the expertise to say for sure. HH/Beck: What about sleepy time and herbal teas?Bukowski: Teas such as sleepy time tea and some so-called herbal teas are made from leaves of herbs that mostly grow in the ground. They are not from tea trees, and thus don't have the same health benefits of traditional tea.
AO/Beck: So the consumer should make sure there's actually tea in the tea they're buying! Of course, some products which are labeled tea are in essence water flavorings, which is not a bad thing, but may not have the same beneficial properties of real teas.
Bukowski: Some products labeled "tea" have antioxidants, but not all the immune system benefits. For those that are tea buffs out there, the biological name of the tea tree is Camellia sinensis.
AO/Beck: When you speak about drinking tea and getting the beneficial effects of flavinoids and antioxidants, how much tea do you have to drink and how long do you have to drink it?
Bukowski: I'm not really sure how much and how long. In general, it seems to be more is better. The studies I've seen indicate that less than one cup a day isn't too helpful, 1-3 cups a day is more helpful, and 3-5 cups daily seem to be the most helpful.
AO/Beck: Can you describe your research protocol please?
Bukowski: When I started out, I wasn't looking for benefits of tea. I'm an immunologist and what I was looking for was how certain components of the immune system, called T-Lymphocytes, and a specific subset called Gamma Delta T-Lymphocytes, recognize foreign antigens such as foreign bacteria. We tried to define it on a molecular level. We did a lot of test tube experiments and came up with L-theanine as a precursor to keep the immune system primed and ready for when the bacteria does come along. So what we envision is, if you drink tea, the immune system gets a little dose of what bacteria look like, and when the dangerous bacteria come along, the Gamma Delta T-cells are more ready and able to react to them.
AO/Beck: That seems like classic immunology, and makes sense on an intuitive level, but were you able to test it?
Bukowski: The phenomenon I just described is called immunologic memory. It occurs when the immune system is exposed to something initially, and the next time it comes around again, the immune system is more ready and able to handle it. So what we did was to draw blood from people who didn't drink tea before and after they started to drink tea. And then we took their blood and exposed it to bacteria. We saw that after drinking tea, those blood samples had a five-fold increase in the amount of interferon they were secreting as compared to blood samples taken before drinking tea.
AO/Beck: That's very impressive.
Bukowski: We did the same experiment with non-tea, non-coffee drinkers. We had them start drinking coffee - nothing happened. There was no change before and after drinking coffee regarding the amount of interferon secreted.
AO/Beck: For readers not familiar with interferon, about 20 years ago, many scientists were proposing that interferon could potentially block or reverse some cancerous growths. I think interferon is also produced by cells exposed to a virus, a bacterium or whatever?
Bukowski: Yes, that's right, it occurs naturally in cells and is still being used for cancer. It's not the be-all-and-end-all but it's extremely important in fighting cancer and it's important in fighting infections. It's a critical first line of defense.
AO/Beck: Can you please tell me a little about your work with tea and how it relates to osteoporosis and otosclerosis?
Bukowski: Sure. This is an area ripe for further research, but in my research, I became interested in osteoporosis, which is a disease of brittle bones. In osteoporosis, the most common form is after women reach menopause, called post-menopausal osteoporosis. What happens is that the osteoclast or the cells that are normally suppose to gobble up bone with the idea of remodeling it and not destroying it go out of control and they gobble up bone faster than the bone making cells can replace it and as a result the bones become very brittle.
Likewise, in certain types of hearing loss, such as otosclerosis, osteoclasts can become overactive and secrete harmful chemicals, or cytokines, which can adversely effect the inner ear. That's the theory at least!
AO/Beck: Yes, it sounds familiar. However, some 4 or 5 decades ago it was proposed that sodium fluoride might block or inhibit overactive osteoclasts?
Bukowski: Right. So the thought was that fluoride is a substance that inhibits osteoclast activity, and was indeed used as a treatment for otosclerosis for quite some time.
AO/Beck: And where does tea come into this discussion?
Bukowski: Three observational studies have shown that tea enhances bone mineral density. These were studies on groups of people who drink tea versus those who don't. Those who drink 3-5 cups a day have a higher bone mineral density, so they have less brittle bones than those who don't drink tea.
AO/Beck: So that would make them less susceptible to various bony changes within the inner ear as well as less susceptible to osteoporosis?
Bukowski: Right, that's how all this connects! The osteoclast is the bad actor in all of these diseases, and tea helps keep the osteoclasts in check. That's the common thread.
AO/Beck: That's fantastic. I can envision an amazing study for a graduate student looking for a dissertation topic, comparing tea drinkers to non-tea drinkers and correlating that to hearing loss and dizziness.
Bukowski: Absolutely. Sounds like a wonderful study!
AO/Beck: Dr. Bukowski, thank you so much for your time. I really enjoyed speaking with you.
Bukowski: Thank you too Dr. Beck. I enjoyed the discussion.
Bukowski: Sure Dr. Beck. I attended Johns Hopkins for my bachelor's and I earned my PhD in 1984 in Immunology. I went to medical school at the University of Massachusetts Medical Center and earned my MD in 1989. I did my internship and residency at the New England Deaconess Hospital which is now the Beth Israel Deaconess Hospital in Boston, Massachusetts. In 1992, I started a three year rheumatology fellowship at Brigham and Women's Hospital. In the year 2000, I was promoted to Assistant Professor of Medicine in the Rheumatology Division at Brigham and Women's Hospital in Harvard Medical School.
AO/Beck: I read some of your very clever and innovative research relating to drinking common teas -- and the potential impact of tea on health. I wonder if you can briefly review that for me?
Bukowski: Certainly. In general terms, the healthy aspect of tea has been appreciated for centuries. Most of the information about tea has been anecdotal, but within the last 10 years there have been significant advances in research related to the molecular aspects of tea and health. One of the first significant findings was the discovery of flavinoids and antioxidants in tea -- those are thought to do at least two main things. One, is to inhibit the formation of cancer cells, so it's an anti-mutagenic, and two, it's thought that tea might have significant protective effects on the cardiovascular system by decreasing the number of free radicals which can lead to atherosclerosis. Dr Beck, as you know, flavinoids are molecules that mediate antioxidant effects, and antioxidants are felt to decrease damage to DNA and therefore, decrease the formation of cancer cells.
AO/Beck: Since we last spoke a year ago, have there been any new findings?
Bukowski: Yes, since we last talked, the WHI study was released. Part ofthat study confirmed the utility of tea drinking in slowing down osteoporosis, most likely by inhibiting overactive osteoclasts. And with respect to hearing, since otosclerosis is associated with overactive osteoclasts, tea drinking mighthelp this. We know that administration of medicines originally designedfor osteoporosis called bisphosphonates, are now being used forotosclerosis and Meniere's disease.
AO/Beck: As hearing healthcare professionals, we deal with patients with endolymphatic hydrops, Meniere's disease, Meniere's syndrome and similar manifestations. Many people believe these diseases and syndromes are autoimmune responses. What are your thoughts on that?
Bukowski: I think it could indeed be an autoimmune response. I don't know too much about the particulars of those diseases and syndromes but I looked into an ear disease called "cochlear otosclerosis" and some people believe cochlear otosclerosis and Meniere's are possibly autoimmune diseases.
AO/Beck: Just to clarify, there are two types of otosclerosis. Classic otosclerosis is a middle ear disorder in which the stapes is immobilized by a spongiotic growth along the footplate. Classic otosclerosis has traditionally been addressed through surgical management. The other type of otoscleroisis is cochlear otosclerosis, and that is the one you were just speaking about. Cochlear oto is not a middle ear problem, it's a sensorineural hearing problem, and middle ear surgery is not useful for cochlear oto.
Bukowski: Yes, that's correct. I believe there are cases of cochlear otosclerosis in which there is excess osteoclast activity. Osteoclasts have the effect of reabsorbing bone, not only in the middle ear bones but also in the otic capsule and they secrete cytokines which may damage inner ear hair cells. Interestingly, tea may have anti-osteoclast activity, so if you were to drink tea, perhaps it would slow the progression of cochlear otosclerosis. I cannot say that for sure as we didn't study it, but it's possible.
AO/Beck: When you say tea I know there are a million different types, what teas are you speaking of in particular?
Bukowski: Tea, or true tea is made from the leaf of a tea tree, and there's only one species of tea tree. There are several ways to manufacture tea from the tea tree. The common teas we think of such as black tea, green tea, pekoe tea are teas that come from the leaf of a tea tree and they are processed in different ways. Those manufacturing processes have some effect on the antioxidant activities of tea, but as far as the immune system reactivity, the manufacturing processes have no effect on the immune process.
AO/Beck: I'm glad you mentioned that because I remember reading that if you were to microwave certain baby foods, you would break down the proteins and then those proteins became meaningless. So you're saying that the processing of tea leaves does not impact the health benefits?
Bukowski: No, it doesn't.
AO/Beck: What about teas that are caffeine free?
Bukowski: Great question. The decaffeination process is one that I am not intimately familiar with, regarding which molecules they remove. Theoretically, the decaffeination process should be fine, but I haven't tested that directly and I don't have the expertise to say for sure. HH/Beck: What about sleepy time and herbal teas?Bukowski: Teas such as sleepy time tea and some so-called herbal teas are made from leaves of herbs that mostly grow in the ground. They are not from tea trees, and thus don't have the same health benefits of traditional tea.
AO/Beck: So the consumer should make sure there's actually tea in the tea they're buying! Of course, some products which are labeled tea are in essence water flavorings, which is not a bad thing, but may not have the same beneficial properties of real teas.
Bukowski: Some products labeled "tea" have antioxidants, but not all the immune system benefits. For those that are tea buffs out there, the biological name of the tea tree is Camellia sinensis.
AO/Beck: When you speak about drinking tea and getting the beneficial effects of flavinoids and antioxidants, how much tea do you have to drink and how long do you have to drink it?
Bukowski: I'm not really sure how much and how long. In general, it seems to be more is better. The studies I've seen indicate that less than one cup a day isn't too helpful, 1-3 cups a day is more helpful, and 3-5 cups daily seem to be the most helpful.
AO/Beck: Can you describe your research protocol please?
Bukowski: When I started out, I wasn't looking for benefits of tea. I'm an immunologist and what I was looking for was how certain components of the immune system, called T-Lymphocytes, and a specific subset called Gamma Delta T-Lymphocytes, recognize foreign antigens such as foreign bacteria. We tried to define it on a molecular level. We did a lot of test tube experiments and came up with L-theanine as a precursor to keep the immune system primed and ready for when the bacteria does come along. So what we envision is, if you drink tea, the immune system gets a little dose of what bacteria look like, and when the dangerous bacteria come along, the Gamma Delta T-cells are more ready and able to react to them.
AO/Beck: That seems like classic immunology, and makes sense on an intuitive level, but were you able to test it?
Bukowski: The phenomenon I just described is called immunologic memory. It occurs when the immune system is exposed to something initially, and the next time it comes around again, the immune system is more ready and able to handle it. So what we did was to draw blood from people who didn't drink tea before and after they started to drink tea. And then we took their blood and exposed it to bacteria. We saw that after drinking tea, those blood samples had a five-fold increase in the amount of interferon they were secreting as compared to blood samples taken before drinking tea.
AO/Beck: That's very impressive.
Bukowski: We did the same experiment with non-tea, non-coffee drinkers. We had them start drinking coffee - nothing happened. There was no change before and after drinking coffee regarding the amount of interferon secreted.
AO/Beck: For readers not familiar with interferon, about 20 years ago, many scientists were proposing that interferon could potentially block or reverse some cancerous growths. I think interferon is also produced by cells exposed to a virus, a bacterium or whatever?
Bukowski: Yes, that's right, it occurs naturally in cells and is still being used for cancer. It's not the be-all-and-end-all but it's extremely important in fighting cancer and it's important in fighting infections. It's a critical first line of defense.
AO/Beck: Can you please tell me a little about your work with tea and how it relates to osteoporosis and otosclerosis?
Bukowski: Sure. This is an area ripe for further research, but in my research, I became interested in osteoporosis, which is a disease of brittle bones. In osteoporosis, the most common form is after women reach menopause, called post-menopausal osteoporosis. What happens is that the osteoclast or the cells that are normally suppose to gobble up bone with the idea of remodeling it and not destroying it go out of control and they gobble up bone faster than the bone making cells can replace it and as a result the bones become very brittle.
Likewise, in certain types of hearing loss, such as otosclerosis, osteoclasts can become overactive and secrete harmful chemicals, or cytokines, which can adversely effect the inner ear. That's the theory at least!
AO/Beck: Yes, it sounds familiar. However, some 4 or 5 decades ago it was proposed that sodium fluoride might block or inhibit overactive osteoclasts?
Bukowski: Right. So the thought was that fluoride is a substance that inhibits osteoclast activity, and was indeed used as a treatment for otosclerosis for quite some time.
AO/Beck: And where does tea come into this discussion?
Bukowski: Three observational studies have shown that tea enhances bone mineral density. These were studies on groups of people who drink tea versus those who don't. Those who drink 3-5 cups a day have a higher bone mineral density, so they have less brittle bones than those who don't drink tea.
AO/Beck: So that would make them less susceptible to various bony changes within the inner ear as well as less susceptible to osteoporosis?
Bukowski: Right, that's how all this connects! The osteoclast is the bad actor in all of these diseases, and tea helps keep the osteoclasts in check. That's the common thread.
AO/Beck: That's fantastic. I can envision an amazing study for a graduate student looking for a dissertation topic, comparing tea drinkers to non-tea drinkers and correlating that to hearing loss and dizziness.
Bukowski: Absolutely. Sounds like a wonderful study!
AO/Beck: Dr. Bukowski, thank you so much for your time. I really enjoyed speaking with you.
Bukowski: Thank you too Dr. Beck. I enjoyed the discussion.
