About Herbs, Botanicals & Other Products

Scientific Name
Spirulina sp., Aphanizomenon flos-aquae
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Common Name

Spirulina platensis, Spirulina fusiformis, AFA-algae, Arthrospira platensis, tecuitlatl, BGA, dihe

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Clinical Summary

Blue-green algae are primitive autotrophic prokaryotes (aka Cyanobacteria). Spirulina species are cultured in alkaline fresh water while Aphanizomenon flos aquae (AFA) is naturally grown and harvested from Upper Klamath Lake, Oregon, USA. Blue-green algae products frequently contain one or both of these strains of algae. Patients take blue-green algae supplements to prevent and treat cancer and viral infections, and for weight loss. A cholesterol-lowering effect was found in patients with nephrotic syndrome induced hyperlipidemia. Blue-green algae are used a source of food in parts of the world. Although no human clinical data support its use for any of the proposed claims, studies suggested spirulina has chemoprotective and radioprotective effects in animals. Blue-green algae may be contaminated by strains of algae (e.g. microcystin species) that are toxic. Adverse effects are uncommon except when products are contaminated; contaminant toxins can cause hepatotoxicity, renal failure, and neurotoxicity. To date, there are no known drug interactions. Supplementation with blue-green algae provides protein and small amounts of vitamins and minerals, but no research supports their value.

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Purported Uses
  • Appetite suppression
  • Attention deficit hyperactivity disorder
  • Cancer prevention
  • Cancer treatment
  • Fatigue
  • High cholesterol
  • HIV and AIDS
  • Immunostimulation
  • Oral leukoplakia
  • Viral infections
  • Weight loss
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Constituents
  • Proteins (50-70%): All essential amino acids
  • Carbohydrates: Rhamnose, ribose, mannose, fructose, polysaccharides
  • Vitamins: A, E, cyanocobalamin, niacin, choline, folic acid, thiamine
  • Other: Chlorophyll, copper, magnesium, zinc, potassium
    (1) (2)
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Mechanism of Action

The mechanism of action is unknown. The protein and vitamin content may contribute to any alleviation of fatigue. Calcium spirulan, a polysaccharide extract from Spirulina platensis, demonstrates inhibition of HIV-1 viral replication via possible binding and disruption of CD4-gp120 interaction in vitro, although the clinical significance of this is unknown. In vitro, calcium spirulan also inhibits replication of herpes simplex I, cytomegalovirus, and influenza. Studies performed in healthy humans suggest that AFA-algae increase the level of circulating natural killer cells. In vitro studies also suggest that AFA-algae has antiviral and antimutagenic activity. Other studies suggested spirulina has chemoprotective and radioprotective effects in animals through the stimulation of the hemopoietic system. Although uncommon, several toxins from Microcystis species of algae may contaminate AFA-algae and Spirulina algae blooms. Anatoxin can cause paralysis of respiratory muscles due to irreversible binding and sustained action of the nicotinic acetylcholine receptor. Saxitoxin contamination is thought to block nerve cell neuronal transmission due to binding to voltage-gated sodium channels. Microcystins are cyclic heptapeptides that induce hepatotoxicity.
(1) (2) (3) (4) (5) (6) (7) (8)

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Warnings

Microcystin contamination can cause hepatotoxicity, renal failure, and neurotoxicity. Products should be certified free from contamination.

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Adverse Reactions

Infrequent: Nausea, vomiting, anxiety, insomnia
Rare: Cyanotoxin (e.g. anatoxin, saxitoxin, microcystins) contamination of AFA-algae and possibly Spirulina may cause hepatotoxicity, renal failure, neurotoxicity, seizures, respiratory arrest, acute pancreatitis, and cardiomyopathy.
(2) (6) (9)

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Literature Summary and Critique

Selmi C, et al. The effects of Spirulina on anemia and immune function in senior citizens. Cell Mol Immunol. 2011 Jan 31.
This study enrolled 40 volunteers, aged 50 years or older, who had been diagnosed with anemia within the previous 12 months. Participants took a Spirulina supplement and completed a nutritional questionnaire for 12 weeks. Complete cell count (CCC) and indoleamine 2,3-dioxygenase (IDO) enzyme activity were measured at baseline and weeks 6 and 12. Over the 12-week study period, there was a steady increase in average values of mean corpuscular hemoglobin (MCH) in the subjects of both genders who completed the study (n=30). The increases in MCH, mean corpuscular hemoglobin volume, and mean corpuscular hemoglobin concentration were found to be statistically significant (p<0.05) for male participants. Over 50% of subjects also achieved increased IDO activity and WBC count at 6 and 12 weeks of Soirulina supplementation. No significant changes in dietary intake were found to have occurred during the study period. The investigators concluded that spirulina may improve anemia and immunosenescence in older subjects, however larger, randomized clinical trials are necessary to confirm these benefits.

Kalafati M, et a;. Ergogenic and antioxidant effects of spirulina supplementation in humans. Med Sci Sports Exerc. 2010 Jan;42(1):142-51.
This double-blind, placebo-controlled, counterbalanced crossover study enrolled moderately conditioned male subjects (n=9) to investigate the effect of spirulina on exercise performance, substrate metabolism, and blood redox status at rest and after exercise. After taking a spirulina supplement daily for 4 weeks, each subject ran on a treadmill at an intensity corresponding to 70-75% of their V02 max for 2 hours, and then at 95% VO2 max until exhaustion. Blood samples were drawn at baseline, immediately after, and at 1, 24, and 48 hours post-exercise. Time to fatigue following the 2 hour run was found to be significantly longer after spirulina supplementation compared to placebo (2.05 + 0.68 vs 2.70 + 0.79 min; p=0.048). During the 2 hour run, spirulina supplementation also decreased carbohydrate oxidation rate by 10.3% (p=0.008) and increased fat oxidation rate by 10.9% (p=0.003), as compared to placebo (p<0.05). Reduced glutathione levels were also significantly higher after spirulina supplementation than after placebo, at rest and 24 hours after exercise (p=0.049). The authors concluded that spirulina supplementation significantly increased exercise performance, fat oxidation, and GSH concentration and reduced exercise-induced lipid peroxidation.

Lee EH. et al. A randomized study to establish the effects of spirulina in type 2 diabetes mellitus patients. Nutr Res Pract. 2008 Winter;2(4):295-300.
This randomized, placebo-controlled study enrolled 37 Korean patients with Type 2 diabetes. Patients received spirulina or placebo for 12 weeks. Spirulina supplementatiion for 12 weeks was found to significantly lower plasma triglyceride (TG) (p<0.05) and malondialdehyde levels (p<0.05), and also showed a tendency to increase plasma adiponectin levels (p<0.1). The lipid lowering effect of spirulina supplementation differed according to the subject serum levels prior to intervention. Subjects with higher initial TG levels had a greater reduction in plasma TG levels and blood pressure. Subjects with higher initial total cholesterol and LDL-cholesterol levels had a greater reduction in these values, as well as in IL-6 and blood pressure. The authors concluded that these results provide evidence that spirulina has a beneficial effect on blood lipid profiles, inflammatory variables, and antioxidant capacity in patients with type 2 diabetes.

Cingi C, et al. The effects of spirulina on allergic rhinitis. Eur Arch Otorhinolaryngol. 2008 Oct;265(10):1219-23.
This randomized, double-blind, placebo controlled-study, evaluated the effectiveness and tolerability of spirulina in the treatment of patients with a history of allergic rhinitis (n=150). Of the patients who completed the study (n=129), patients received either spirulina tablets (n=85) or placebo (n=44). Symptoms (nasal discharge, sneezing, nasal congestion, and itching) were assessed and scored on a four point scale at baseline and at study end. Patients also used a four point scale to grade the severity of their own symptoms. Satisfaction and symptom relief were also graded on a ten point scale by the patients. Spirulina supplementation was found to significantly improve allergic rhinitis symptoms compared to placebo (p<0.001). Patient diaries also revealed a statistically significant difference in effectiveness (p<0.001) and satisfaction (p<0.001) for spirulina compared to placebo. The investigators concluded that spirulina is clinically effective for the treatment of allergic rhinitis, but further studies should be performed to confirm the mechanism of this effect.

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References
  1. Selmi C, Leung PS, Fischer L, et al. The effects of Spirulina on anemia and immune function in senior citizens. Cell Mol Immunol. 2011 Jan 31.
  2. Kalafati M, Jamurtas AZ, Nikolaidis MG, et al. Ergogenic and antioxidant effects of spirulina supplementation in humans. Med Sci Sports Exerc. 2010 Jan;42(1):142-51.
  3. Lee EH, Park JE, Choi YJ, Huh KB, Kim WY. A randomized study to establish the effects of spirulina in type 2 diabetes mellitus patients. Nutr Res Pract. 2008 Winter;2(4):295-300.
  4. Samuels R, Mani UV, Iyer UM, Nayak US. Hypocholesterolemic effect of spirulina in patients with hyperlipidemic nephrotic syndrome. J Med.Food 2002;5:91-6.
  5. Cingi C, Conk-Dalay M, Cakli H, Bal C. The effects of spirulina on allergic rhinitis. Eur Arch Otorhinolaryngol. 2008 Oct;265(10):1219-23.
  6. Zhang H, et al. Chemo- and radio-protective effects of polysaccharide of Spirulina platensis on hemopoietic system of mice and dogs. Acta Pharmacol Sin. 2001;22:1121-4.
  7. Premkumar K. et al. Effect of Spirulina fusiformis on cyclophosphamide and mitomycin-C induced genotoxicity and oxidative stress in mice. Fitoterapia 2001;72:906-11.
  8. Mathew B, et al. Evaluation of chemoprevention of oral cancer with Spirulina fusiformis. Nutr Cancer 1995;24:197-202.
  9. Draisci R, et al. Identification of anatoxins in blue-green algae food supplements using liquid chromatography-tandem mass spectrometry. Food Addit Contam 2001;18:525-31.
  10. Patocka J. The toxins of Cyanobacteria. Acta Medica 2001;44:69-75.
  11. Iwasa M, Yamamoto M, Tanaka Y, Kaito M, Adachi Y. Spirulina-associated hepatotoxicity. Am.J Gastroenterol. 2002;97:3212-3.
  12. Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies 4th ed. New York: Haworth Herbal Press; 1999.
  13. Ziegler R. Aphanizomenon flow-Aquae (AFA-Algae). A food supplement with dubious health claims. Meeting of the Swiss Study Group for Complementary and Alternative Methods in Cancer. Weiskirchen (Switzerland): November 9, 2001.
  14. Ayehunie S, et al. Inhibition of HIV-1 replication by an aqueous extract of Spirulina platensis (Arthrospira platensis). J Acquir Immune Defic Syndr Hum Retrovirol 1998;18:7-12.
  15. Hayashi T, et al. Calcium spirulan, an inhibitor of enveloped virus replication, from a blue-green algae Spirulina platensis. J Nat Prod 1996;59:83-7.
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How It Works

Bottom Line: Blue-green algae may contain nutrients and vitamins, but it is NOT an effective treatment for cancer, HIV, attention deficit hyperactivity disorder (ADHD), or other serious medical conditions.

Scientists do not know how blue-green algae supplements might work, since limited research has been performed. Blue-green algae are a natural source of protein and vitamins, which might contribute to alleviation of fatigue. Blue-green algae products usually contain either AFA-algae (Aphanizomenon flos aquae) or Spirulina species, or both. Both may have biological activities. In laboratory experiments, calcium spirulan, an extract from Spirulina, inhibits the replication of HIV virus, herpes simplex virus, cytomegalovirus, and influenza virus in the test tube, but it is not known whether any of these anti-viral effects would occur in the human body. Other studies showed that spirulina protected lab animals from genetic mutations caused by chemicals and radiation, but again, it is unclear whether these effects happen in humans. In healthy humans, AFA-algae appear to increase blood levels of natural killer cells (a type of immune cell). AFA-algae also show anti-viral and anti-mutation activity in the laboratory.

Spirulina algae also contain high levels of gamma-linolenic acid (GLA), an essential fatty acid that is often able to prevent the accumulation of cholesterol in the body.

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Purported Uses
  • As an appetite suppressant
    No scientific evidence supports this use.
  • To treat ADHD (attention deficit hyperactivity disorder)
    No scientific evidence supports this use.
  • To prevent and treat cancer
    Laboratory studies show that blue-green algae may help protect against DNA mutations, but it is unknown whether this effect occurs in humans. One clinical trial supported the use of blue-green algae for prevention of oral cancer in tobacco chewers. There is no evidence that blue-green algae can treat cancer.
  • To prevent and treat fatigue
    No scientific evidence supports this use.
  • To treat HIV and AIDS
    Blue-green algae show anti-viral activity in the laboratory, but it is unknown whether this effect occurs in humans. There is no proof from clinical trials that blue-green algae can treat HIV and AIDS.
  • To stimulate the immune system
    One study in healthy humans showed that AFA-algae increased blood levels of natural killer cells (immune cells). There is no evidence that such effects help the body fight infections or maintain health.
  • To treat oral leukoplakia (a pre-cancerous condition characterized by thick white patches on the oral mucosa and tongue)
    One clinical trial supported the use of blue-green algae for prevention of oral cancer in tobacco chewers.
  • To treat viral infections
    Blue-green algae show anti-viral activity in the laboratory, but there is no proof from clinical trials that it can treat infections in humans.
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Research Evidence

Anemia
This study enrolled 40 volunteers, aged 50 years or older, who had been anemia within the previous 12 months. Participants took a Spirulina supplement and completed a nutritional questionnaire for 12 weeks. Complete cell count (CCC) and indoleamine 2,3-dioxygenase (IDO) enzyme activity were measured at baseline and weeks 6 and 12. Over the 12-week study period, there was a steady increase in average values of mean corpuscular hemoglobin (MCH) in the subjects. The increases in MCH, mean corpuscular hemoglobin volume, and mean corpuscular hemoglobin concentration were found to be statistically significant for male participants. No significant changes in dietary intake were found to have occurred during the study period. The investigators concluded that spirulina may improve anemia and immunosenescence in older subjects.

Exercise performance
This double-blind, placebo-controlled, counterbalanced crossover study enrolled moderately conditioned 9 male subjects to investigate the effect of spirulina on exercise performance, substrate metabolism, and blood redox status at rest and after exercise. After taking a spirulina supplement daily for 4 weeks, each subject ran on a treadmill at an intensity corresponding to 70-75% of their V02 max for 2 hours, and then at 95% VO2 max until exhaustion. Blood samples were drawn at baseline, immediately after, and at 1, 24, and 48 hours post-exercise. Time to fatigue following the 2 hour run was found to be significantly longer after spirulina supplementation compared to placebo. During the 2 hour run, spirulina supplementation also decreased carbohydrate oxidation and increased fat oxidation rate compared to placebo. Reduced glutathione levels were also significantly higher after spirulina supplementation than after placebo, at rest and 24 hours after exercise. The authors concluded that spirulina supplementation significantly increased exercise performance, fat oxidation, and GSH concentration and reduced exercise-induced lipid peroxidation.

Diabetes mellitus
This randomized, placebo-controlled study enrolled 37 Korean patients with Type 2 diabetes. Patients received spirulina or placebo for 12 weeks. Spirulina supplementatiion for 12 weeks was found to significantly lower plasma triglyceride (TG) and malondialdehyde levels, and also showed a tendency to increase plasma adiponectin levels. The lipid lowering effect of spirulina supplementation differed according to the subject serum levels prior to intervention. Subjects with higher initial TG levels had a greater reduction in plasma TG levels and blood pressure. Subjects with higher initial total cholesterol and LDL-cholesterol levels had a greater reduction in these values, as well as in IL-6 and blood pressure. The authors concluded that spirulina has a beneficial effect on blood lipid profiles, inflammatory variables, and antioxidant capacity in patients with type 2 diabetes.

Allergic rhinitis
This randomized, double-blind, placebo controlled-study, evaluated the effectiveness and tolerability of spirulina in the treatment of 150 patients with a history of allergic rhinitis. Patients received either spirulina tablets or placebo. Symptoms (nasal discharge, sneezing, nasal congestion, and itching) were assessed and scored on a four point scale at baseline and at study end. Patients also used a four point scale to grade the severity of their own symptoms. Satisfaction and symptom relief were also graded on a ten point scale by the patients. Spirulina supplementation was found to significantly improve allergic rhinitis symptoms compared to placebo. Patient diaries also revealed a statistically significant difference in effectiveness and satisfaction for spirulina compared to placebo. The investigators concluded that spirulina is clinically effective for the treatment of allergic rhinitis.

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Patient Warnings
  • Although it is uncommon, the algae used in this product may be contaminated with several toxins from the Microcystis species of algae. For example, anatoxin and saxitoxin are toxic to the nervous system, causing serious side effects like paralysis of the respiratory system. Microcystins are algal proteins that can cause liver and kidney damage. Any product you buy should be certified free of these Microcystis toxins.
  • This product is regulated by the F.D.A. as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. This product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.
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Side Effects
  • Nausea and vomiting
  • Anxiety
  • Insomnia
  • In rare cases, cyanotoxin (e.g. anatoxin, saxitoxin, microcystins) contamination of this product may cause liver damage, kidney failure, neurological damage, seizures, respiratory arrest, acute pancreatitis, and damage to the muscles of the heart.
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Special Point

Blue-green algae are used a source of food in parts of the world. Consumption of this product appears to be relatively safe, as long as it is not contaminated with Microcystin species.

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Dosage (Inside MSKCC Only)
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Aliases
Aphanizomenon Flos Aquae
Spirulina
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E-mail your questions and comments to aboutherbs@mskcc.org.
Last updated: December 19, 2011