Food Chemistry Advances 2 (2023) 100288

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Food Chemistry Advances

journal homepage: www.elsevier.com/locate/focha

Kombucha benefits, risks and regulatory frameworks: A review

Patricia Viera de Oliveira a,b,∗, Afonso Henrique da Silva Júnior b, Carlos Rafael Silva de
Oliveira c, Carolina Fagundes Assumpção d, Cláudia Hernandes Ogeda a
a
Specialization program of Innovation and Technology for Food and Beverages, UERGS, State University of Rio Grande do Sul, Caxias do Sul, RS, Brazil
b
Department of Chemical Engineering and Food Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
c
Department of Textile Engineering, Federal University of Santa Catarina, Blumenau, SC, Brazil
d
Institute of Food Science and Technology, UFRGS, Federal University of Rio Grande do Sul, Bento Gonçalves, RS, Brazil

a r t i c l e i n f o a b s t r a c t

Keywords: The growing demand for functional and healthy drinks has attracted consumers’ attention. In this scenario, kom-
Functional beverage bucha stands out as a fermented tea which has several health benefits due to its antioxidant, anticarcinogenic,
Health benefits anti-inflammatory, antidiabetic, and anti-bacterial properties, among others. However, few studies present the
Consumption risks
potential risks associated with the consumption of this beverage. In addition, the need for global regulatory
Regulation
frameworks is an obstacle to the production and standardization of the product. Given this, the present review
Kombucha
focuses addresses kombucha’s benefits, risks, and regulatory frameworks.

1. Introduction
The great global trend in demand for healthy foods and drinks high-
lights that kombucha has attracted the attention of consumers. Kom-
bucha’s global market was valued at $1.9 billion in 2019, with a Com-
pound Annual Growth Rate (CAGR) of 16.8 % from 2020-2025. The
market is forecasted to continue its growth, reaching between USD 3.5
to 5 billion by 2025 (Intelligence, 2020).
Kombucha is the name of the drink obtained by fermenting sweet-
ened tea initially with Camellia sinensis - mainly black tea, but also
other types of tea such as green and blue oolong tea - which serves
as a substrate for fermentation and uses a symbiotic culture of bacte-
ria and yeasts called SCOBY (Symbiotic Colony of Bacteria and Yeasts)
(Coelho et al., 2020; Martínez Leal et al., 2018). The drink is prepared
initially with tea, but variations made with infusions are possible. The
drink tastes slightly acidic and carbonated (Martínez Leal et al., 2018).
Moreover, recent research refers to kombucha, it is believed that
fermented tea was first used in East Asia in 220 BC for its therapeutic
effects. However, it originated in northeastern China (Manchuria) and
was awarded the title of "Divine Che (remedy of immortality)" during
the Tsin Dynasty (Ling Chi) for its detoxifying and energizing proper-
ties (Coelho et al., 2020; Kim & Adhikari, 2020). The drink spread in
Japan in 414 AD. because a doctor named Kombu brought the tea to
Japan and used it to cure the digestive problems of the Inkyo emperor,
hence the name "Kombucha" or "Kombu tea "(Coelho et al., 2020). After
that, the drink spread to Russia and Eastern Europe through trade routes
(Coelho et al., 2020; Kapp & Sumner, 2019). Since then, the drink’s pop-
ularity has increased.
Since then, the fermented beverage has been gaining popu-
larity due to its therapeutic properties with antimicrobial effects
(Khaleil et al., 2020; Tan et al., 2020), antioxidant (Osiripun & Apisit-
tiwong, 2021; Xia et al., 2019), anticarcinogenic (Cardoso et al., 2020;
Kaewkod et al., 2019), anti-inflammatory (Cardoso et al., 2021), an-
tidiabetic (Hardoko et al., 2020), anti-bacterial (Cardoso et al., 2020;
Lopes et al., 2021), among others applications (Morales, 2020).
The beneficial effects of kombucha can be attributed to bioactive
compounds acting synergistically (Martínez Leal et al., 2018). In addi-
tion, the benefits are attributed to the presence of probiotic microor-
ganisms (like some acetic acid bacteria and lactic acid bacteria), amino
acids, tea polyphenols, sugars, organic acids, ethanol, water-soluble vi-
tamins, and various micronutrients from fermentation (Coelho et al.,
2020).
However, despite the beverage’s advantages, little research has ex-
amined the potential hazards and adverse effects (Alejandra Villarreal-
Soto et al., 2018; Brews international, 2020; Martínez Leal et al., 2018;
Villarreal-Soto et al., 2018). Added to this is the lack of regulatory frame-
works that standardize the production of the beverage and guarantee the
safety of consumers (Batista et al., 2022).
This review aims to highlight the possible benefits and
risks/side effects associated with the consumption of kombucha,
as well as some regulations for the production and marketing of
kombucha.

∗
Corresponding author.
E-mail address: p.v.oliveira@posgrad.ufsc.br (P.V. de Oliveira).

https://doi.org/10.1016/j.focha.2023.100288
Received 22 January 2023; Received in revised form 14 April 2023; Accepted 25 April 2023
2772-753X/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
P.V. de Oliveira, A.H. da Silva Júnior, C.R.S. de Oliveira et al.
2. Health benefits
The health advantages of kombucha have been demonstrated in the
literature. Most of these studies are in vitro, and some in vivo studies are
on rodents, small animals, and human peripheral blood lymphocytes.
Some in vivo clinical trials are underway to understand kombucha’s
health benefits better (Kim & Adhikari, 2020).
Kombucha traditional is mainly composed of vitamins, organic acids,
minerals, sugars, antioxidant compounds, and other components, as
seen in Fig. 1. Kombucha is a source of bioactive compounds such as
polyphenols and glucuronic acid. The benefits of kombucha can be at-
tributed to the synergistic effect between the compounds, making the
drink potentially beneficial to health (Martínez Leal et al., 2018).
Most researchers have focused on antioxidant activity and phenolic
compounds. However, a wide variety of bioactive compounds can be
found in kombucha beverages, and the diversity of raw materials that
can be fermented should motivate further studies analyzing the biolog-
ical activities of released and produced peptides, lipids, and secondary
metabolites, among others (Morales, 2020).
This way, new functional beverages with high health benefits are
developed using new plant-based sources with valuable bioactive com-
pounds. The studies that evaluated kombucha’s benefits in terms of its
bioactive compounds are described below. The main results have been
summarized.
2.1. Variables in the fermentation process can affect beverage properties
Process variables such as fermentation, temperature, and time,
among other properties, can affect the amount of bioactive compounds,
antioxidant properties, and composition of kombucha can be achieved
by appropriate control of this variable (Ferreira & Salgueiro, 2021).
Table 1 summarizes how some of the main process variables affect
the characteristics of the beverage.
Srihari & Satyanarayana (2012) evaluated the total antioxidant ac-
tivity, total phenolic content and titratable acidity of kombucha. With
2
Food Chemistry Advances 2 (2023) 100288
Fig. 1. Chemical composition of traditional kombucha.
longer fermentation times, kombucha also contains more phenolic com-
pounds, malic acid, tartaric acid, acetic acid, and B-complex vita-
mins. Kombucha also has a high antioxidant properties and free radical
scavenging action. Additionally, using RP-HPLC(reversed-phase high-
performance liquid chromatography), significant chemical compounds,
acids, and water-soluble vitamins present in kombucha were identified
(Srihari & Satyanarayana, 2012) .
In addition, fermentation time is related to antioxidant activity, phe-
nolic composition, and sensory quality of kombucha. The effect of fer-
mentation time of kombucha is fermented from tea (green, black, and
oolong tea) and fruits (grape, dragon, and guava) was observed in the
work of Li et al. (2022) found that the highest antioxidant activities oc-
curred in green tea kombucha fermented at 25-30 °C for 6-7 days and
grape kombucha at 37 °C for 48 hours. Moreover, grape kombucha ex-
hibited better physicochemical properties due to higher polyphenols,
high antioxidants, phenolic compounds, and texture. Furthermore, in
the sensory evaluation, grape-flavored kombucha is more acceptable in
young people (Li et al., 2022).
Aung & Eun (2022) studied the effects of temperature and time dur-
ing fermentation on the properties of Laver Kombucha (Porphyra den-
tata). The higher total flavonoid content was observed at 25 °C om 14
days, and after 15 days, the total flavonoid content declined signifi-
cantly. The total phenolic content of the 25 °C and 30 °C gradually
increased during fermentation, except at 22 d, when the content de-
clined significantly. The average amounts of total phenolic content were
27.08–33.43 mg GAE/100 mL for 25 °C and 27.08–37.00 mg GAE/100
mL for the 30 °C. Also, at the lowest temperature of 25 °C, more bioac-
tive compounds and higher 𝛼-amylase inhibitory activity (92% at 25 °C
and 83% at 30 °C in 14 days). At longer fermentation, higher acidity,
which may affect the product’s taste, lower pH, and lower amount of
bioactive compounds were observed (Aung & Eun, 2022).
Nizioł-Łukaszewska et al. (2020) evaluated the ferments extracted
from green coffee beans after different fermentation times with kom-
bucha. The highest values were found for the samples tested after 28
days of fermentation. After 14 days of fermentation, low cytotoxicity to
P.V. de Oliveira, A.H. da Silva Júnior, C.R.S. de Oliveira et al. Food Chemistry Advances 2 (2023) 100288

Table 1
Variables in fermentation process can affect beverage properties.

Variable process What does it affect? Main results References

Fermentation time Antioxidant activity total Long fermentation time, more phenolic compounds, malic acid, tartaric acid, acetic acid, and (Srihari & Satya-
phenolic content B-complex vitamins and increase of antioxidant activity. narayana, 2012)
Fermentation time Antioxidant activity Highest antioxidant activities occurred in green tea kombucha fermented at 25-30 °C for 6-7 (Li et al., 2022)
days and grape kombucha at 37 °C for 48 hours
Temperature and Bioactive compounds, acidity At the lowest temperature of 25 °C, more bioactive compounds (92%) and higher 𝛼-amylase (Aung & Eun, 2022)
time during and taste inhibitory activity.
fermentation At longer fermentation, higher acidity, which may affect the product’s taste, lower pH, and
lower amount of bioactive compounds
Fermentation times bioactive compounds and The highest values were recorded for the tested samples after 28 days of fermentation. After 14 (Hordyjewicz-
with kombucha antioxidant properties days of the fermentation process, it was observed that the analyzed ferments were Baran, 2020)
characterized by low cytotoxicity to keratinocytes and fibroblasts
Infusion methods of Bioactive compounds Ultrasound-assisted extracts had higher organic acid content, particularly 𝛼-ketoglutaric acid (Aung & Eun, 2021).
the extracts in the (224.97 mg/100 ml) and acetic acid (564.15 mg/100 ml), with higher titratable acidity, lower
kombucha pH, and increased DPPH scavenging capacity
fermentation process
Using bioreactors Better control of kombucha Using these starter cultures in combination with shake cultures allows a better fermentation (Sharifudin et al.,
fermentation strategy to be applied and the safety of the fermentation processes 2021)
Sugar concentrations Inhibition of 𝛼-glucosidase e The optimal treatment for inhibition was at a sugar concentration of 10% and a fermentation (Hardoko et al.,
and fermentation enzyme for antidiabetic time of 14 days with an IC50 of 33.95 ppm. The kombucha from the fruits of R. mucronata had 2020).
times activity, total phenolics, total a pH of 3.11 and a total phenolic content of 19,679.82 mg GAE /100g, 0.52% of total acids,
acids, and organoleptic which the panelists highly appreciated
characteristics

keratinocytes and fibroblasts was observed. The short fermentation time
of 7 days also negatively affected the tested yeasts’ properties (Nizioł-
Łukaszewska et al., 2020).
Also, depending on the infusion method of the extracts in the kom-
bucha fermentation process, kombucha may have different levels of
bioactive compounds. Aung & Eun (2021) developed a kombucha with
a fermentation period of 14 days at 25 °C. Laver (Porphyra dentata) kom-
bucha from infusion extracts and ultrasound-assisted extracts was com-
bined with black and green tea kombucha. The kombucha in which the
ultrasound-assisted extracts had higher organic acid content, particu-
larly 𝛼-ketoglutaric acid (224.97 mg/100 ml) and acetic acid (564.15
mg/100 ml), with higher titratable acidity, lower pH, and increased
DPPH scavenging capacity (Aung & Eun, 2021).
Also, further optimization of kombucha fermentation using biore-
actors could provide opportunities for better control of kombucha fer-
mentation, as in the work of Sharifudin et al. (2021), in which they used
isolated, identified and characterized the microorganisms found in kom-
bucha starters and developed papaya-based kombucha beverages using
juice and leaves of papaya such as subtract. The isolated microorgan-
isms showed high similarity (99%) to an acetic acid bacterium, Koma-
gataeibacter rhaeticus and a yeast, Dekkera bruxellensis MFS1. Both strains
remained viable when exposed to pH 3-4 for 3 hours. When tested for
tolerance to bile salts at various concentrations (0.3-1%), D. bruxellensis
MFS1 showed high tolerance with viability up to log7 CFU/ml after 4
hours of exposure at a concentration of 1%. In contrast, the viability of
K. rhaeticus MFS1 in a bile salt environment was maintained for only up
to 2 hours. 1.45-1.62% acetic acid with less than 0.5% ethanol was de-
tected in both kombucha-papaya samples at the end of the 4-day fermen-
tation. D. bruxellensis MFS1 showed better potential probiotic properties
due to its low pH and bile acid tolerance. Using these starter cultures
in combination with shake cultures (for better soluble oxygen content)
allows a better fermentation strategy to be applied and the safety of
the fermentation processes to be controlled to avoid contamination by
microorganisms (Sharifudin et al., 2021).
The antidiabetic potential of kombucha tea from the fruit of Rhi-
zophora mucronata based on in vitro, chemical, and physical analyses
was evaluated by Hardoko et al. (2020) R. mucronata herbal tea, a kom-
bucha beverage with different sugar concentrations (10, 20, 30%) and
fermentation times (7, 14, 21 days). It was found that sugar concentra-
tion and fermentation time significantly affected the properties of the
produced kombucha in terms of inhibition of 𝛼-glucosidase. The opti-
mal treatment for inhibition was at a sugar concentration of 10% and a
fermentation time of 14 days with an IC50 of 33.95 ppm. The kombucha
from the fruits of R. mucronata had a pH of 3.11 and a total phenolic
content of 19,679.82 mg GAE /100g, 0.52% of total acids, which the
panelists highly appreciated (Hardoko et al., 2020).
2.2. Antioxidant properties
This ability to effectively fight free radicals can be explained by the
high content of phenolic compounds, mainly flavonoids, contained in
the substrate used for the beverage preparation (Chakravorty et al.,
2016; Xu et al., 2017). Approximately 127 phenolic compounds (70.2%
flavonoids, 18.3% phenolic acids, 8.4% other polyphenols, 2.3% lig-
nans, and 0.8% stilbenes) were identified in green and black tea bev-
erages fermented by kombucha culture over 10 days. It is added that
factors such as fermentation time may influence antioxidant capac-
ity. The antioxidant capacity of kombucha is mainly attributed to the
polyphenols produced during fermentation and the synergistic effect of
the various compounds present in the tea from the fermentation process
(Chakravorty et al., 2016).
One study examined the effects of black tea and green tea residues on
kombucha, observing antioxidant activity, total phenolic content, and
polyphenol concentration at different stages of fermentation. Fermen-
tation with tea residue can increase 3.25 times the antioxidant activity
and 5.68 times the concentration of polyphenols in the beverage. In
addition, fermentation with tea residue can produce beverages rich in
polyphenols and have higher antioxidant activity than those produced
without tea residue (Zhou et al., 2022).
Fermentation temperature affects diverse characteristics of the bev-
erage, like the antioxidant capacity. Xia et al. (2019) studied soymilk
fermentation at 28 °C and 37 °C and analyzed the factors like bioactiv-
ity and chemical compositions. The total contents of phenolic, ferulic
acid, chlorogenic acid, and ascorbic acid increased significantly after
fermentation at 37 °C. The antioxidant (DPPH/ABTS ± scavenging abil-
ity and FRAP) and inhibitory activities for 𝛼-glucosidase and 𝛼-amylase
of kombucha-fermented soymilk increased significantly and were higher
at 37 °C if compared with 28 °C (Xia et al., 2019).
A recent study investigated the polyphenolic and antioxidant ac-
tivities of fermented kombucha from black tea, green tea, and oolong
tea. Fruit juices such as pineapple, apple and pomegranate juices were
also studied due to their high phenolic content and strong antioxidant
activity. The highest content of total phenolics was found in oolong
kombucha tea fermented with pomegranate juice: 994.42 mg GAE /L.

3
P.V. de Oliveira, A.H. da Silva Júnior, C.R.S. de Oliveira et al.
Oolong kombucha tea fermented with apple juice showed the highest
antioxidant activity (1,273.74±4.15 mg AAE/L). The main components
in this kombucha are acetic acid, lactic acid, glucuronic acid, sucrose,
fructose and ethanol. In addition, sensory evaluation showed that kom-
bucha made from fermented black tea, green tea and oolong tea with
pineapple, apple and pomegranate juice improved sensory properties
and its tremendous polyphenols and antioxidant activities contributed to
the promotion of health and well-being (Osiripun & Apisittiwong, 2021).
Tanticharakunsiri et al. (2021) fermented kitchen mint leaves (Men-
tha cordifolia Opiz Ex Fresen) and oolong tea leaves (Camellia sinensis)
to produce kombucha. On the 14th day of fermentation, phenolic com-
pounds and flavonoids were increased in all kombucha samples. The
number of acetic acid bacteria and yeasts in kombucha gradually in-
creased during the 7-to-14-day fermentation. The DPPH (2,2-Diphenyl-
1-picrylhydrazyl) and ABTS (2,2′-azino-bis (3-ethylbenzothiazoline-6-
sulfonic acid) antioxidant activity of these kombuchas increased during
the fermentation period and showed the highest antioxidant capacity on
the 14th day. In addition, all kombucha samples showed antioxidant ef-
fects by attenuating H2 O2 -induced Reactive Oxygen Species (ROS) pro-
duction, increasing the mRNA expression of catalase, Glutathione Re-
ductase (GRe), and Manganese Superoxide Dismutase (Mn- SOD), and
inducing the enzymatic activity of GRe in HEK-293 cells. Based on this
study, kombucha can be a healthy beverage to mitigate oxidative stress
in many diseases (Tanticharakunsiri et al., 2021).
A recent study showed that prolonged storage conditions of soursop
kombucha have a high potential to improve quality, metabolite content,
and biological activity (Tan et al., 2020). Tan et al (2020) optimize the
production of soursop kombucha and determine the effects of differ-
ent storage conditions on quality. The optimal production parameters
were 300 ml of soursop juice, 700 ml of black tea, 150 g of sugar, and
fermentation at 28 °C for 14 days. Higher antioxidant (90.76%), was
observed in the sample stored in the light at 25 °C for 14 days, while
21 days 25 °C and dark conditions showed lowest antioxidant activity
(85.71%).The highest total phenolic content (TPC) in the sample stored
in the dark at 4 °C for 7 days (Tan et al., 2020).
These results are noteworthy because these compounds may be well
suited for the pathogenesis of diseases characterized by the overproduc-
tion of free radicals (Essawet et al., 2015). Products made with Cof-
feeBerry® components, which are sourced from the entire coffee fruit,
have the potential to be nutrient- and health-beneficial. Samples of fer-
mentation broths fortified with CoffeeBerry® extract and traditional
kombucha were analyzed. Fermentation took place in a bioreactor at
28±1 °C for nine days. The results showed that CoffeeBerry® extract
contributed to a faster fermentation of the culture medium. Some indi-
vidual polyphenolic compounds and catehins in the fermentation broth
samples were identified and quantified by high performance liquid chro-
matography. Among the bioactive compounds in the studied samples ob-
tained during the fermentation of kombucha from sweetened black tea
enriched with CoffeeBerry® extract, chlorogenic acid (188.94-458.56
𝜇g/ml) was predominant. Using electron spin resonance (ESR) spec-
troscopy, the analyzed materials’ antioxidant activity was evaluated in
terms of their capacity to neutralize DPPH and reactive hydroxyl rad-
icals. The ability to scavenge DPPH and hydroxyl radicals increased
with the duration of fermentation. Based on the scavenging ability of
DPPH and hydroxyl radicals, the IC50 values (50% inhibitory concen-
tration) for the kombucha fermentation broth fortified with CoffeBerry®
ranged from 26.33 to 170.13 and 11.33to 102.22 𝜇L/mL, respectively
(Essawet et al., 2015).
There are also articles in the literature on the use of fermented and
non-fermented kombucha extracts, and Ziemlewska et al. (2022) eval-
uated the potential use in the cosmetic area. The authors evaluated the
chemical composition and biological activity of the leaves of Rubus fru-
ticosus L., Vaccinum myrtillus L., Ribes nigrum L., and Fragaria vesca L.,
especially for R. fruticosus and V. myrtillus ferments, through DPPH and
ABTS assays. Cytotoxicity tests on skin cell lines showed a positive effect
on the viability of fibroblasts and keratinocytes, especially for R. fruti-
4
Food Chemistry Advances 2 (2023) 100288
cosus and V. myrtillus ferments after 10 days of fermentation. According
to the results of the DPPH test, the lowest IC50 value indicating the best
antioxidative properties was found for fermented 20 days (IC50 = 91.4
μg/mL ± 0.17) and for fermented 10 days (IC50 = 96.2 μg/mL ± 0.18)
for R. fruticosus L. (in comparison, IC50 for the extract was 324.5 μg/mL
± 0.25 μg/mL). Furthermore, ferments from V. myrtillus L. leaves showed
high antioxidant properties. The value of IC50 was 118.3 μg/mL ± 0.18
μg/mL for fermented 10 days and 105.2 μg/mL ± 0.08 for fermented 20
days (for the extract value of IC50 = 494.7 μg/mL ± 0.31). These values
indicate that kombucha ferments have stronger antioxidant properties
than unfermented plants, but the time differences in values between
fermentation times are insignificant. The ABTS assay showed no differ-
ences significant between the extract and ferments (Ziemlewska et al.,
2022).
Also, the development of applications from kombucha has been de-
scribed in the literature. Kaya & Asir (2022) develop freshly formu-
lated bread products from kombucha tea, fermented from black and
green tea leaves, and compare them with classic recipe bread. As a re-
sult, it was observed that the addition of kombucha tea significantly
increased the total phenolic content of the crumb (31.5–37.3%) and
crust (54.3–60.3%) in the bread. The antioxidant activities evaluated by
the ABTS+ and DPPH methods showed that bread products with signifi-
cantly higher radical scavenging properties were produced in the crumb
and crust of freshly formulated bread (Kaya & Asir, 2022).
The tea used to make kombucha influences its composition and
bioactive properties. Khaleil et al. (2020) developed kombucha based
on three substrates: black tea, green tea, and Psidiumguajava guava juice
extract. Kombucha tea prepared with guava juice extract showed the
highest polyphenol content, and the growth of kombucha copy fortified
with guava extract showed maximum growth in terms of weight (fresh
and dry) and percent moisture content, as well as the highest yield. In
addition, high scavenging activity of DPPH radical was observed in the
control. The increased synthesis of phenols and flavonoids may have
contributed to the fermented guava extract from kombucha’s increased
DPPH radical scavenging action (Khaleil et al., 2020).
2.3. In vivo/in vitro studies
In vivo and in vitro studies are performed to verify kombucha’s pos-
sible benefic effects; this information can be seen in Table 2.
The effect of fermented and unfermented blueberry kombucha bev-
erages was investigated after the induction of gastric ulcers in mice. It
was found that using blueberries as an alternative substrate for the fer-
mentation of kombucha beverages was beneficial due to the increase
in the content of phenolic compounds, tannins, and anthocyanins in
the fermented beverage. However, fermentation resulted in lower an-
tioxidant activity compared to non-fermented beverages. Regarding the
gastroprotective effect of the fermented kombucha drink, the biochem-
ical parameters remained at normal levels, but some animals showed
gastric lesions in an expressive range. The authors suggest evaluating a
reduction in the fermentation time of the beverage, which could favor
antioxidant activity due to a less acidic medium and thus improve the
ulcerogenic effect of the beverage (Barbosa et al., 2022) .
Zubaidah et al. (2021) investigated the immunomodulatory effects
of turmeric and black tea kombucha in vivo in Balb-C mice. The mice
were infected with Salmonella and given kombucha orally in the study.
Both turmeric kombucha and black tea kombucha improved the adap-
tive immune response (indicated by an increase in CD4+, TNF𝛼, IFN-𝛾)
and innate immune response (indicated by a decrease in CD68 IL -6).
Turmeric kombucha showed more pronounced immunomodulatory ac-
tivity compared to black tea kombucha (Zubaidah et al., 2021).
Seagrapes kombucha has good potential and activity as a functional
anti-aging food. Permatasari et al. (2021), investigated the effects of
seagrape-based kombucha tea on blood glucose, cholesterol, and PGC-
1𝛼 levels in Swiss albino mice. The animals were fed a cholesterol-
and fat-enriched diet (CFED). Antiglycation, tyrosinase inhibitory, and
P.V. de Oliveira, A.H. da Silva Júnior, C.R.S. de Oliveira et al. Food Chemistry Advances 2 (2023) 100288

Table 2
In vivo/in vitro studies performed with kombucha.

Types of kombucha studied Objectives In vivo /in vitro model Reference

Fermented and unfermented
blueberry kombucha
Turmeric and black tea kombucha
Seagrapes kombucha
Pollen fermentation with a
kombucha/SCOBY consortium
kombucha of C. sinensis with 1%
green tea, oolong tea, black tea
kombuchas obtained by fermentation
of green or black tea
Kombucha of green and black tea
kombucha and green banana flour
Yerba mate kombucha
Black tea and snake fruit kombucha
Kombucha from fruits (blackberry,
raspberry, and red goji berry).
kombucha with Malvaviscus arboreus
and Camellia sinensis
Kombucha black tea
Investigate the effect of fermented and unfermented blueberry Mice (Barbosa et al., 2022)
kombucha beverages after the induction of gastric ulcers in mice
Investigated the immunomodulatory effects of turmeric and black tea Mice (Zubaidah et al., 2021)
kombucha in Balb-C mice
Investigated the effects of seagrape-based kombucha tea on blood Mice (Permatasari et al., 2021)
glucose, cholesterol, and PGC-1𝛼 levels in Swiss albino mice
Optimize bioavailability of bioactive pollen constituents and test and Caco-2 cells (Uțoiu et al., 2018)
evaluation of antitumor impact in Caco-2 cell.
Investigated the antioxidant and antibacterial properties of kombucha Escherichia coli. O157:H7. Shigella (Kaewkod et al., 2019)
that was obtained from different types of C. sinensis, including green dysenteriae, Salmonella Typhi,
tea, oolong tea, and black tea, and the degree of toxicity it displays Vibrio cholera and Caco-2
against the colorectal cancer cell line colorectal cancer cells
Evaluated kombuchas prepared by fermentation of green or black tea Salmonella sp. (ATCC 14028), (Cardoso et al., 2020)
at 25 °C for 10 days, and their antioxidant, antibacterial, and Escherichia coli (ATCC 11219),
antiproliferative abilities Staphylococcus aureus (ATCC
6538) and Listeria monocytogenes
(ATCC 15313)
Investigated the effects of kombucha consumption of green and black Rats (Cardoso et al., 2021)
tea on adiposity, metabolism, lipids and glucose, hepatic steatosis,
oxidative stress, and inflammation in Wistar rats over 10 weeks
Investigated the effects of supplementation with kombucha and green Rats (Urrutia et al., 2021)
banana flour (GBF) were investigated in Wistar rats fed a cafeteria
diet
Characterized yerba mate kombucha and showed its inhibitory Saccharomyces cerevisiae, (Lopes et al., 2021).
property of oxidative stress using the yeast Saccharomyces cerevisiae Staphylococcus aureus and
as a model to determine its antibacterial activity against Escherichia coli.
Staphylococcus aureus and Escherichia coli.
Examined the chemical alterations that occurred during kombucha Salmonella Typhi and mice (Zubaidah et al., 2020)
fermentation and showed immunomodulatory action in mice exposed
to Salmonella Typhi.
Determined the physical, chemical, microbiological and sensory Staphylococcus aureus and (Akarca & Budel, 2022)
properties, and antibacterial and antifungal effects of Kombucha teas Rhizopus nigricans
produced with Black tea and some small berries
Compare kombucha beverages made from Malvaviscus arboreus and Galleria mellonella larvae and (Silva et al., 2021)
Camellia sinensis in terms of their physico-chemical characteristics, in fungus (Paracoccidioides
vivo toxicities, and antioxidant and antimicrobial potentials. brasiliensis Staphylococcus aureus
and Listeria monocytogenes).
Demonstrated kombucha’s antimicrobial activity in vitro and in fruit Staphylococcus aureus ATCC6538 (Al-Mohammadi et al.,
juices. and Escherichia coli ATCC11229 2021)

𝛼-glucosidase inhibitory activities were also determined. Studies con-
ducted in vitro reveal that the inhibitory activities of anti-glycation
(62.79 ± 0.78), L-tyrosine (9.05 ± 0.16), L-dopa (27.14 ± 1.62), 𝛼-
glucosidase (90.42 ± 0.77), and 𝛼-amylase (80.44 ± 1.00). The find-
ings demonstrate that seagrape-derived kombucha tea has good poten-
tial and activity as a useful anti-aging diet (Permatasari et al., 2021).
Some recent work has reported an anticancer effect (Cardoso et al.,
2020; Kaewkod et al., 2019; Uțoiu et al., 2018). Utoiu et al. (2018) per-
formed pollen fermentation with a kombucha/SCOBY consortium to
optimize the bioavailability of bioactive pollen constituents. The an-
titumor activity was realized in a human cell line, laryngeal epi-
dermoid carcinoma cells (Hep-2), and human colon adenocarcinoma
cells (Caco-2) and realized MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-
diphenyltetrazolium bromide) and analyze of cell morphology incu-
bated um presence of the pollen suspension.They fermented the sus-
pended pollen with SCOBY in sweetened green tea for kombucha vine-
gar from the beginning and added the pollen to the fermentation of
kombucha after 20 days. The addition of pollen increases the propor-
tion of lactic acid bacteria (LAB) in the total number of SCOBY micro-
bial strains. The fermented pollen has a higher concentration of bioac-
tive substances such as polyphenols, soluble silicon species, and SCFAs
(short-chain fatty acids) and has a moderate antitumor effect on Caco-2
cells (Uțoiu et al., 2018).
Kaewkod et al (2019) prepared kombucha with 1% green tea, oolong
tea, black tea, and 10% sucrose with acetic acid bacteria and yeast. Af-
ter 15 days of fermentation, the pH values of kombucha tea ranged from
2.70 to 2.94, with the lowest pH of 2.70 obtained for kombucha made
from black tea. The total acidity of kombucha from black tea was the
highest at 16.75 g/L and was retained after heat treatment by boiling
and autoclaving. Six organic acids: glucuronic acid, gluconic acid, D-
saccharic acid-1,4-lactone, ascorbic acid, acetic acid, and succinic acid,
were detected in kombucha tea by HPLC. The highest organic acid con-
tent was gluconic acid. Kombucha prepared from green tea had the
highest phenolic content and antioxidant activity against DPPH radicals
with 1,248 and 2,642 mg of gallic acid/ml kombucha, respectively. In
addition, pathogenic enteric bacteria: Escherichia coli. O157:H7. Shigella
dysenteriae, Salmonella Typhi, and Vibrio cholera inhibited kombucha and
heat-denatured kombucha with inhibition zone diameters of 15.0 ± 0.0-
25.0 ± 0.0 mm. In addition, kombucha prepared from green and black
tea showed toxicity on Caco-2 colorectal cancer cells (Kaewkod et al.,
2019).
Cardoso et al. (2020) evaluated kombuchas prepared by fermenta-
tion of green or black tea at 25 °C for 10 days, and their antioxidant, an-
tibacterial, and antiproliferative abilities were determined. 127 phenolic
compounds were identified (70.2% flavonoids, 18.3% phenolic acids,
8.4% other polyphenols, 2.3% lignans, and 0.8% stilbenes), with 103
phenolic compounds detected for the first time in kombuchas. Greater
diversity and abundance of phenolic compounds were detected in kom-
bucha black tea, resulting in greater antioxidant capacity. However,
green tea from kombucha was the only one to exhibit antibacterial ac-
tivity against all bacteria (Salmonella sp. (ATCC 14028), Escherichia coli
(ATCC 11219), Staphylococcus aureus (ATCC 6538) and Listeria mono-
cytogenes (ATCC 15313), greater antiproliferative activity, and antipro-
liferative activity against cancer cell lines (colorectal adenocarcinoma

5
P.V. de Oliveira, A.H. da Silva Júnior, C.R.S. de Oliveira et al.
epithelial, Caco-2). These properties were attributed to the presence of
catechins among the most abundant phenolic compounds and verbasco-
side as the only compound (Cardoso et al., 2020).
Cardoso et al. (2021) investigated the effects of kombucha consump-
tion of green and black tea on adiposity, metabolism, lipids and glucose,
hepatic steatosis, oxidative stress, and inflammation in Wistar rats over
10 weeks. It was observed that kombucha improved glucose metabolism,
total plasma antioxidant capacity, superoxide dismutase activity, and
nitric oxide concentration. In addition, systemic inflammation was re-
duced and the reduction in terms of neutrophils/lymphocytes, reduc-
tion in adipose tissue and triglycerides in blood, and reversal of hepatic
steatosis (from grade 2 to 1), in addition to modulation of genes related
to adipogenesis and 𝛽-oxidation (Cardoso et al., 2021).
Urrutia, et al. (2021) in the in vivo study, investigated the effects of
supplementation with kombucha and green banana flour (GBF) in Wis-
tar rats fed a cafeteria diet (like condensed milk, potato chips, bacon,
stuffed cookie, milk chocolate and commercial feed). It was found that
consumption of the cafeteria diet altered the lipid and liver profiles of
the animals, and consumption of kombucha and GBF did not prevent
these changes. The high content of kombucha polyphenols had no hep-
atoprotective effect as an antioxidant. However, this supplementation
caused the animals to feel more satiated, resulting in less weight gain at
the end of the experiment (Urrutia et al., 2021).
Yerba mate kombucha showed antibacterial activity and effectively
prevented oxidative stress in S. cerevisiae. Lopes, et al. (2021) charac-
terized yerba mate kombucha and showed its inhibitory property of
oxidative stress using the yeast Saccharomyces cerevisiae as a model to
determine its antibacterial activity against Staphylococcus aureus and Es-
cherichia coli. The yerba mate beverage fermented for 12 days had a pH
between 1.8 and 2.3, an acidity ranging from 4.8% to 6.0% acetic acid,
a total reducing sugars between 15.9 and 23.1 g/L, and a total phenolic
compound content between 444.2 and 844.8 mg/L equivalent of gal-
lic acid. The antioxidant activity measured by the ABTS+ method was
16.1% to 31.3% higher than that of the non-fermented extracts. In ad-
dition, Yerba-mate kombucha inhibited the growth of S. aureus and E.
coli, oxidative stress in vivo in S. cerevisiae, thus, increasing the survival
rate of yeasts against H2 O2 as a stress agent (Lopes et al., 2021).
Zubaidah et al. (2020) fermented at room temperature for 14 days
snake juice and black tea extract into kombucha in a SCOBY culture.
They next examined the chemical alterations that occurred during kom-
bucha fermentation and showed immunomodulatory action in mice that
had been exposed to Salmonella Typhi. The fermentation characteristics
(total acidity, pH, and total sugars), bioactive components, and antiox-
idant activity of kombucha made from snake fruit saw significant alter-
ations. Infected experimental animals showed a decline in CD8+TNF+
and CD4+IFN+ populations due to Salmonella Typhi. Black tea and snake
fruit kombucha both have the potential to be employed as immunomod-
ulators to avoid the immune system instability brought on by Salmonella
Typhi (Zubaidah et al., 2020).
Akarca & Budel (2022) prepared Kombucha from small fruits (black-
berry, raspberry, and red goji berry). In addition, catechin and gallic
acid were detected in all samples. Samples prepared with blackberries
were the best in all criteria. The greatest antibacterial and antifungal
effects were detected in the samples with blackberries on Staphylococ-
cus aureus and Rhizopus nigricans (zone diameters of 24.36 and 20.53
mm, respectively). The antibacterial activity, MIC (minimum inhibitory
concentration) and MBC (minimum bactericidal concentration) values
(0.023 and 0.016 mg/L) for Staphylococcus aureus. As for the antifungal
activity, the MIC and MFC (minimum fungicidal concentration) values
were determined to be 0.035 mg/L and 0.023 mg/L in the tea prepared
with blackberries on Rhizopus nigricans (Akarca & Budel, 2022).
The type of substrate used in the production of kombucha inter-
feres with its bioactive properties. This study aimed to produce non-
fermented and kombucha drinks with Malvaviscus arboreus and Camellia
sinensis as substrates. The drinks were prepared from infusions (0.5%,
w/v), with sucrose (5.0%, w/v). v), kombucha culture (2.5%, w/v) and
6
Food Chemistry Advances 2 (2023) 100288
1.0% (v/v) of the previously fermented beverage and incubated at 24
± 2 °C for 14 days. The results showed that both kombuchas produced
are within the physicochemical and microbiological parameters recom-
mended by the Food and Drug Administration (FDA). None of the sam-
ples tested showed toxicity from the in vivo model of Galleria mellonella
larvae. Compared to its infusion, a significant increase of 145% w/v
was observed in the total phenolic content of Malvaviscus arboreus kom-
bucha. Green tea and kombucha green tea showed antifungal activity
against the pathogenic fungus Paracoccidioides brasiliensis. Green tea was
also the only beverage to show antimicrobial activity against all fungal
cultures evaluated and against Staphylococcus aureus and Listeria mono-
cytogenes (Silva et al., 2021).
Al-Mohammadi et al. (2021) have demonstrated the potential of
kombucha as a prophylactic agent and a possible application as an al-
ternative biopreservative providing protection against pathogenic bac-
teria and fungi. The authors studied fermented kombucha, performed a
characterization, and found that the fermented metabolic components
acted synergistically to produce an antimicrobial effect. Fermented kom-
bucha had stronger antimicrobial activity than neutralized and heat-
treated kombucha. Staphylococcus aureus ATCC6538 and Escherichia
coli ATCC11229 were the organisms most susceptible to the antimi-
crobial activity of the kombucha preparation. The kombucha prepara-
tion showed inhibitory activity against Staphylococcus aureus ATCC6538
and Escherichia coli ATCC11229 in a brain heart infusion broth and
some Egyptian fruit juices (apple, guava, strawberry, and tomato) (Al-
Mohammadi et al., 2021).
2.4. Bioavailability
Bioavailability analyzes of bioactive compounds should be per-
formed to obtain realistic approaches to their potential effects after hu-
man consumption (Morales, 2020). The Table 3 below summarizes the
main results found in some research on the bioavailability of kombucha.
Değirmencioğlu et al. (2021) investigated the bioaccessibility of
kombucha teas (white, green, oolong, black, and pu-erh teas) during
fermentation by the simulated in vitro digestion method. They evaluated
the antioxidant capacity and total phenolic content. It was found that
fermentation of kombucha with tea extracts increased antioxidant ca-
pacity, total phenolic content, and bioaccessibility. Kombucha fermen-
tation resulted in a 30-58% increase in bioaccessibility depending on
the tea varieties used. Green tea from kombucha exhibited the highest
antioxidant capacity (4153.23 𝜇mole TEAC/ml (Trolox-equivalent an-
tioxidant capacity, TEAC) and bioaccessibility (50.18%). In vivo/in vitro
studies are needed to evaluate the properties of kombucha with high
antioxidant capacity (Değirmencioğlu et al., 2021).
Yildiz et al. (2020) evaluated kombucha samples containing black
carrot juice (which is widely produced in the Konya and Hatay regions
of Turkey) at two concentrations (10% and 20%) and compared them
with kombucha containing green tea leaves, and then evaluated the
physicochemical properties and antioxidant capacity. The bioaccessibil-
ity are realized mimic the digestion procedure with a porcine pancre-
atic enzyme and porcine bile mixture. It was found that the black car-
rot samples from Hatay region had higher anthocyanin content (660.26
mg C3G/100 g-dw), higher antioxidant capacity (TEACABTS and TEAC-
CUPRAC; 15.33 ± 0.39 and 21.91 ± 0.28 𝜇mole Trolox/g, respectively),
higher content of total phenolic content (67.22 ± 0.24 mg/g GAE), and
bioaccessibility (36.48 ± 0.78 mg/g GAE) than the Hatay black car-
rot variety. The highest anthocyanin content (71.05 mg C3G/100 ml)
and antioxidant capacity (TEACABTS and TEACCUPRAC; 3.67 ± 0.15
and 12.33 ± 0.11 𝜇mole Trolox/g, respectively) were obtained in kom-
bucha tea with black carrot (20%). Black carrot is a supplement in the
preparation of kombucha, a substrate rich in anthocyanins and phenolic
compounds. It can be used in various food formulations due to its rich
nutritional content (Yildiz et al., 2020).
Silva Júnior et al. (2021) evaluated the addition of pitanga (Eu-
genia uniflora L.) and umbu-cajá (Spondia tuberosa) fruits and also
P.V. de Oliveira, A.H. da Silva Júnior, C.R.S. de Oliveira et al. Food Chemistry Advances 2 (2023) 100288

Table 3
Bioavailability of kombucha.

Kombucha varieties Main results References

Kombucha teas (white, green, oolong, black, and pu-erh
teas)
kombucha samples containing black carrot juice
Addition of pitanga (Eugenia uniflora L.) and umbu-cajá
(Spondia tuberosa) fruits and also traditional kombucha
Red goji berry (Lycium barbarum L.) and black goji berry
(Lycium ruthenicum Murr.) as substrates for the production
of kombucha
Sweetened black and green tea as substrate for kombucha
fermentation.
Kombucha fermentation resulted in a 30-58% increase in bioacessibility (Değirmencioğlu et al., 2021)
depending on the tea varieties used.
Bioaccessibility evaluated kombucha samples containing black carrot juice is 10% (Yildiz et al., 2020)
Bioacessibility of caphtharic acids (22.38%-29.98%), catechin (17.61%-23.48%), (Silva Júnior et al., 2021)
and hesperidin (22.43%-28.47%)
Total phenolic content and antioxidant capacity in the pre-digestion and (Abuduaibifu & Tamer, 2019)
post-digestion in vitro of the observed samples: black tea kombucha > black goji
berry kombucha > red goji berry kombucha
On days 0 and 9 of storage, the bioaccessibility of total phenols and AC (FRAP and (Tamer et al., 2021)
CUPRAC) showed a significant increase after gastric and intestinal digestion
compared to pre-gastric digestion in all samples

traditional kombucha. Over 7 days, a reduction in pH and content of
soluble solids and sugars and an increase in acidity; characterize the
fermentation process. In all kombuchas analyzed, acetic, butyric, citric,
succinic, and malic acid were observed. Malic acid just was not found
in cherry-flavored kombucha. The main volatile compounds found were
terpenes, and the traditional kombucha showed acetic acid as the main
compound. High antioxidant activity was observed for fruit-flavored
kombuchas; phenolic compounds are identified, predominantly epigal-
locatechin gallate (above 63%). The phenolic compound most bioac-
cessible in the beverage was caphtharic acids (22.38%-29.98%), cat-
echin (17.61%-23.48%), and hesperidin (22.43%-28.47%). However,
after simulated gastrointestinal digestion, the phenolic contents in all
kombuchas were reduced, influencing the significant drop in antioxi-
dant capacity (Silva Júnior et al., 2021).
Abuduaibifu & Tamer (2019) studied red goji berry (Lycium bar-
barum L.) and black goji berry (Lycium ruthenicum Murr.) as substrates
for the production of kombucha drinks. The total phenolic content of all
kombucha samples fluctuated during fermentation and storage. All kom-
bucha samples showed higher antioxidant activity than their infusions.
The total phenolic content of the kombucha samples was as follows:
black tea kombucha > black goji berry kombucha > red goji berry kom-
bucha. All kombucha samples showed higher antioxidant activity than
their infusions in all antioxidant activity assays. During fermentation
and storage, the antioxidant activities of all kombucha samples were in-
creased. However, no significant difference was observed in the antiox-
idant activity determined by the DPPH assay. According to the CUPRAC
and FRAP trials, the kombucha black tea beverage showed relatively
higher antioxidant activity. Total phenolic content and antioxidant ca-
pacity in the pre-digestion and post-digestion in vitro of the observed
samples: black tea kombucha > black goji berry kombucha > red goji
berry kombucha (Abuduaibifu & Tamer, 2019).
Tamer et al. (2021) used sweetened black and green tea as sub-
strate for kombucha fermentation. Infusions of linden, lemon balm, sage,
echinacea, mint, and cinnamon were added to kombucha to develop a
new beverage with improved functional and organoleptic properties.
After fermentation, the antioxidant capacity of kombucha increased by
13.96% DPPH, 48.90% ferric reducing antioxidant power of iron (FRAP)
and 55.54% cupric reducing power of copper (AC (CUPRAC). On days
0 and 9 of storage, the bioaccessibility of total phenols and AC (FRAP
and CUPRAC) showed a significant increase after gastric and intestinal
digestion compared to pre-gastric digestion in all samples (p < 0.05).
The CA (DPPH) after in vitro digestion at the beginning and end of stor-
age in all beverages also increased after gastric digestion compared to
pre-stomach digestion (p < 0.05); however, it decreased after intestinal
digestion (p < 0.05) (Tamer et al., 2021).
2.5. Clinical studies
Several human health benefits are attributed to the beverage kom-
bucha. However, these benefits have only been studied in vitro/in vivo,
without scientific evidence in human models (Coelho et al., 2020).
To identify ongoing human research, we searched (clinicaltrials.gov)
for “kombucha” using the highest search. Five clinical and non-clinician
studies are currently reported. Two are completed, and three are recruit-
ing, but none of the works reported so far have published the results
(Search of: Kombucha - List Results - ClinicalTrials.Gov, 2022 n.d.).
One of these works is entitled "The Effect of the Fermented Tea Bev-
erage Kombucha on the Oral and Gut Microflora." The project aims to
investigate whether consumption of the fermented tea drink kombucha
affects the intestinal and/or oral microbiota and whether it depends on
the content of live bacteria or is inherent even in sterilized kombucha.
Participants will consume one bottle (330 ml) of their designated bev-
erage daily for 21 days. Stool and saliva samples were collected directly
and ten days after the intervention. These will then be examined to see
if there is a change in microflora due to kombucha. The results have not
yet been published.
The other work, "Evaluating the Effects of Kombucha as a Hy-
perglycemic Therapeutic Agent Within Diabetic Human Subjects." The
study aims to determine Kombucha’s ability to impact blood sugar levels
in patients with type II diabetes mellitus. The secondary objective is to
determine Kombucha’s ability to impact blood pressure and quality of
life measures, as measured by a uniform questionnaire that includes gut
health, colds, infections, headaches, sleep, anxiety (GAD2), depression
(PHQ2) and skin health. No results were posted until then.
Moreover, these three works titled "The Effect of Kombucha on Blood
Sugar Levels in Humans how kombucha influences glucose metabolism
in humans”, “Safety and Efficacy of Non-alcoholic Beverage Based on
Kombucha in Patients with Constipations (Kombucha)" and “Effects
of kombucha Intervention on Emotional Distress and Sleep Quality in
Breast Cancer Survivors” are in recruiting status.
3. Potential risks
In a case study published in 2009, a 22-year-old man newly diag-
nosed with HIV became short of breath and febrile (39.4 °C) within 12
hours of drinking kombucha tea. After 15 hours after consuming the
beverage, the patient exhibited symptoms of hyperthermia, lactic aci-
dosis and acute renal failure. Although kombucha tea is regarded as a
healthful beverage, the scant research that is now available raises major
questions about potential health hazards (Sunghee Kole et al., 2009).
Four patients reported side effects likely related to Kombucha tea
consumption. Two had symptoms of an allergic reaction, the third with
jaundice, and the fourth with nausea, vomiting, headaches, and neck
pain. In all four, the use of Kombucha tea near the onset of symptoms
and resolution of symptoms on cessation of tea consumption suggest a
possible etiological association (Srinivasan et al., 1997).
Vijayaraghavan et al. (2000) studied oral toxicity over 90 days in
rats and found no toxic signs. The study involved five groups of rats,
which were kept as follows: (a) control group given tap water orally,
(b) kombucha tea given 2 ml/kg orally, (c) regular tea given 2 ml/kg
orally, (d) kombucha tea given in drinking water 1% (v/v), and (e) plain
tea given in drinking water 1% (v/v). Rats received this treatment daily

7
P.V. de Oliveira, A.H. da Silva Júnior, C.R.S. de Oliveira et al.
for 90 days. Weight, food, water, and general behavior were recorded
weekly. The study revealed no significant difference in the growth of
the animals as evidenced by the progressive change in body weight. The
organ/body weight ratio and histological evaluation showed no signs of
toxicity. Hematological and biochemical variables were within clinical
limits and thus showed no toxic effects. Additionally, the Food and Drug
Administration (FDA) carried out testing and concluded that kombucha
tea is safe for consumption by people (Vijayaraghavan et al., 2000).
Excessive consumption of kombucha can cause health risks, so ac-
cording to the Centers for Disease Control and Prevention (CDC),
daily consumption of 100 grams of the drink poses no health risks
(Martínez Leal et al., 2018). It is added that from a public health per-
spective, there is a need to address the potential dangers of kombucha
consumption, especially for potentially at-risk populations (i.e., individ-
uals with mold allergies, immunosuppressed individuals, those who are
susceptible to acidosis, and those sensitive to alcohol, such as pregnant
women) (Murphy et al., 2018).
Also, kombucha fermentation is commonly homemade, so it is es-
sential to be careful in processing, as pathogenic microorganisms can
contaminate the tea throughout the preparation, incorrect fermentation
(e.g., long fermentation leads to a very acidic beverage fermentation);
incorporation of non-beneficial bacteria; or inaccurate SCOBY selection
(Laavanya et al., 2021; Sharma et al., 2021). Some individuals have
reported some health disorders with suspected dizziness and nausea,
severe illness, allergic reactions, and headache (Alejandra Villarreal-
Soto et al., 2018; Brews international, 2020; Martínez Leal et al., 2018;
Villarreal-Soto et al., 2018).
However, for the reasons mentioned above and the microbiological
complexity of this drink, it is always essential to produce it following
regulations/standards in each country (Villarreal-Soto et al., 2018).
4. Regulamentation
The marketing of kombucha needs to be regulated to avoid problems
that compromise consumer safety. Factors such as the artisanal produc-
tion of the product make unsafe practices compromise the quality of the
drink (Kim & Adhikari, 2020).
In order to help regulate the production of the drink, in 2014, an
organization called Kombucha Brewers International (KBI) was created
(Kim & Adhikari, 2020). KBI creates an open line of communication be-
tween brewers, consumers, and regulators as industry advances through
advocacy, education, research, and modern legislation (Brews interna-
tional, 2020).
In the United States, there is no specific legislation for kombucha,
as fermented beverages and canned acidified foods are exempt from
FDA regulation. However, kombucha is defined as a fermented bever-
age produced by a "special process" and to obtain it, the manufacturer
must submit to a HACCP (risk analysis and critical control points) plan
(Coelho et al., 2020; de Miranda et al., 2022). In order to control the
process and ensure food safety for beverage consumers, the Pennsylva-
nia Department of Agriculture (USA) has published a document with
guidelines for the production and packaging of kombucha. According
to these guidelines, the pH of kombucha must be monitored throughout
the fermentation process and must be no higher than 4.2 and no lower
than 2.5 to avoid microbiological contamination and acidosis. The doc-
ument also states that health claims are prohibited. Consumers should
be warned about contraindications for immunocompromised individu-
als, consumption limits (which should not exceed 120 ml/day) and the
possible presence of alcohol, even in low concentrations (Coelho et al.,
2020).
One document with recommendations for a food safety plan for mak-
ing and production kombucha is available in Canada from The Center
of Diseases Control of British Columbia (BCCDC) (Centre for Disease
Control, 2020). With a focus on pH and ethanol content monitoring and
establishing critical limits for these parameters, the publication includes
in-depth information on the main biological and chemical risks and
8
Food Chemistry Advances 2 (2023) 100288
potential hazards related to kombucha production. The BCCDC plan
states that pH levels shouldn’t be lower than 2.5 and alcohol levels
shouldn’t be more than 1% or continue to rise over the product’s shelf
life (de Miranda et al., 2022).
The only country that has specific legislation for kombucha is Brazil.
The guidelines defined the identity of kombucha and quality stan-
dards throughout the national territory through Norm Instruction n°
41, of September 17, 2019, instituted by the Ministry of Agriculture,
Livestock and Supply. This legislation includes definition, classifica-
tion, labeling, analytical parameters, composition (mandatory and op-
tional ingredients), and prohibitions related to production and market-
ing (Coelho et al., 2020).
The scarcity of information about the safety and quality of the drink
and specific legislation can be one of the factors that condition the pur-
chase and consumption of kombucha (Batista et al., 2022; Moodi et al.,
2021). The definition of norms guarantees the standards of quality, effi-
cacy, and safety of the product (Batista et al., 2022). In addition, stricter
regulations are needed to standardize the industrial production of bev-
erages globally (de Oliveira et al., 2022).
5. Conclusion
Although there are already studies that report the benefits of kom-
bucha, studies that evaluate the composition of bioactive compounds
related to human health are needed, as well as more in vivo trials that
assess bioavailability and bioaccessibility. Clinical trials are essential to
improve understanding of drinking the beverage’s benefits and risks.
Studies assessing the risks and toxicity of the beverage are also neces-
sary to clarify and guarantee the safety of consumers. Since this market
is expanding, there is also the need for national and international reg-
ulatory frameworks to standardize the beverage and ensure consumer
safety.
Funding
This research received no external funding.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
CRediT authorship contribution statement
Patricia Viera de Oliveira: Conceptualization, Writing – original
draft. Afonso Henrique da Silva Júnior: Conceptualization, Writing –
review & editing. Carlos Rafael Silva de Oliveira: Conceptualization,
Writing – review & editing. Carolina Fagundes Assumpção: Conceptu-
alization, Writing – review & editing. Cláudia Hernandes Ogeda: Con-
ceptualization, Writing – review & editing.
Data availability
No data was used for the research described in the article.
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