Health Care Professional Information

Scientific Name
Morinda citrifolia
Common Name

Lada, Indian mulberry, nono, och plant, cheese fruit, hog apple, mora de la India, wild pine. Morinda citrifolia should not be confused with Morinda officinalis, also known as Ba Ji Tian, commonly used in Chinese medicine.

Brand Name

Morinda®

Clinical Summary

Noni is an evergreen plant found throughout Polynesia. The plant bears fleshy yellowish-white fruit and is used in traditional medicine for wound healing, infections, diarrhea, skin conditions, and as tonic. It is cultivated in Hawaii and other Polynesian islands and is marketed worldwide as Noni. Fresh or fermented juices are available as drinks while capsules, pills and powders are sold as dietary supplements. Over the last two decades, products containing Noni have been heavily promoted for immunostimulation, chronic fatigue syndrome, hypertension, and cancer treatment via network marketing schemes. The FDA issued a warning letter to an Internet distributor of noni juice for presenting misleading claims of health benefits (1).

In vitro and animal studies suggest that the plant extracts have antifungal (14), antitumor and immunomodulatory (3) (7) (8) (17) (18) properties. Noni also inhibits low-density-lipoprotein oxidation and may be useful in preventing arteriosclerosis (15). Glycosides and other constituents isolated from the fruits and leaves have demonstrated antioxidant effects (12) (13). In addition, high concentration (>5%) of noni juice was shown to have anti-angiogenic properties in an ex vivo assay (16).

In human studies, a noni extract was shown to be effective in reducing the incidence of early postoperative nausea (29). Consumption of noni juice alleviated cigarette smoke-induced dyslipidemia (30). A Phase I study of noni in cancer patients has also been completed at the University of Hawaii's Cancer Research Center. The findings are yet to be published (11).

Purported Uses
  • Cancer treatment
  • Chronic fatigue syndrome
  • Diabetes
  • Health maintenance
  • Hypertension
  • Immunostimulation
  • Menstrual cramps
  • Pain
Constituents
  • Acids: Caproic, caprylic
  • Anthraquinone: Damnacanthal
  • Polysaccharides: Noni-ppt, galactose, arabinose, rhamnose, glucuronic acid
  • Glycosides: Rutin, 6-O-(beta-D-glucopyranosyl)-1-O-octanoyl-beta-D-glucopyranose, asperulosidic acid (2)
  • Terpenes
  • Alkaloids
Mechanism of Action

The aqueous extract of noni roots produced a central analgesic effect that was antagonized by naloxone in Swiss mice (6). When combined with sub-optimal doses of certain chemo agents, polysaccharides from noni improved survival time and curative effects in animal model (4). Glycosides isolated from noni juice inhibited AP-1 transactivation and cell transformation in the mouse epidermal JB6 cell line (2).
In addition, noni juice exhibited antioxidant effects by reducing aromatic DNA adducts (5)(19).
The apoptotic effects of noni are thought to be medicated via up-regulation of p53 and pro-apoptotic Bax proteins, as well as down- regulation of the anti-apoptotic Bcl-2, Bcl-XL proteins and survivin. Increase in caspase 9 and 3 was also reported, which suggests involvement of the intrinsic mitochondrial pathway (31).

Contraindications
  • Patients with renal insufficiency should consume noni juice with caution.
  • Patients with diabetes should be careful when consuming noni products.
Adverse Reactions
  • Several cases of hepatotoxicity, some acute, have been reported following consumption of noni juice products (9) (10) (22) (23) (24) (26).
  • Many noni juice products are high in potassium content. Consuming large amounts of these juices may cause hyperkalemia (7) and potentially harmful in patients with compromised renal function.
  • A 41-year-old woman developed resistance to Coumadin following concurrent intake of noni juice. Her symptoms improved after treatment and discontinuing noni juice (25).
  • Some noni juice products have high sugar content therefore diabetics should use them with caution.
  • In addition, the antioxidant effects of noni products may interfere with the actions of chemo drugs and radiation therapy.
  • However, a company-sponsored study showed that dose-related adverse effects are minimal in a noni product (20).
Herb-Drug Interactions
  • Chemotherapy: Noni juice may decrease the activity of some chemotherapeutic agents (21).
  • Coumadin: Noni juice was reported to antagonize the effects of Coumadin (25).
  • Cytochrome P450 substrates: An in vitro study finds noni juice induces CYP 3A4, 2C8, 2C9, and 2D6. It may decrease the therapeutic effects of substrate drugs (21). Another study shows that noni juice inhibits CYP 3A4 enzyme (27). The duration of exposure may account for this difference.
  • UGT (Uridine 5'-diphospho-glucuronosyltransferase) substrates: Noni modulates UGT enzymes in vitro and can increase the side effects of drugs metabolized by them (28).
Dosage (Inside MSKCC Only)
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References
  1. FDA warning letter. http://www.fda.gov/NewsEvents/Testimony/ucm114985.htm. Accessed June 6,2013.
  2. Liu G, et al. Two novel glycosides from the fruits of Morinda citrifolia (noni) inhibit AP-1 transactivation and cell transformation in the mouse epidermal JB6 cell line. Cancer Res 2001;61:5749-56.
  3. Hirazumi A, et al. Immunomodulation contributes to the anticancer activity of Morinda citrifolia (noni) fruit juice. Proc West Pharmacol Soc 1996;39:7-9.
  4. Hirazumi A, Furusawa E. An immunomodulatory polysaccharide-rich substance from the fruit juice of Morinda citrifolia (noni) with antitumour activity. Phytother Res 1999;13:380-7.
  5. Wang MY, Su C. Cancer preventative effect of Morinda citrifolia (noni). Ann N Y Acad Sci 2001;952:161-8.
  6. Younos C, et al. Analgesic and behavioural effects of Morinda citrifolia. Planta Med 1990;56:430-4.
  7. Mueller BA, et al. Noni juice (Morinda citrifolia): hidden potential for hyperkalemia? Am J Kidney Dis 2000;35:310-2.
  8. Hirazumi A, et al. Anticancer activity of morinda citrifolia (noni) on intraperitoneally implanted Lewis lung carcinoma in syngeneic mice. Proc West Pharmacol Soc 1994;37:145-6.
  9. Stadlbauer V, et al. Hepatotoxicity of NONI juice: Report of two cases. World J Gastroenterol. 2005;11(30):4758-60.
  10. Millionig G, Stadlmann S, Vogel W. Herbal hepatotoxicity: acute hepatitis caused by a Noni preparation (Morinda citrifolia). Eur J Gastroenterol Hepatol. 2005; 17(4):445-7.
  11. Study of Noni in Cancer Patients. http://www.clinicaltrials.gov/ct2/show/NCT00033878?term=noni&rank=1. Accessed June 6, 2013.
  12. Su BN, et al. Chemical constituents of the fruits of Morinda citrifolia (Noni) and their antioxidant activity. J Nat Prod 2005 68(4):592-5.
  13. Sang S, et al. Flavonol glycosides and novel iridoid glycoside from the leaves of Morinda citrifolia. J Agric Food Chem 2001 49(9):4478-81.
  14. Banerjee S, et al. An Extract of Morinda citrifolia Interferes with the Serum-Induced Formation of Filamentous Structures in Candida albicans and Inhibits Germination of Aspergillus nidulans. Am J Chin Med 2006; 34(3):503-9.
  15. Kamiya K, et al. Chemical constituents of Morinda citrifolia fruits inhibit copper-induced low-density lipoprotein oxidation. J Agric Food Chem 2004; 52(19): 5843-8.
  16. Hornick CA, et al. Inhibition of angiogenic initiation and disruption of newly established human vascular networks by juice from Morinda citrifolia (noni). Angiogenesis 2003; 6(2):143-9.
  17. Arpornsuwan T, Punjanon T. Tumor cell-selective antiproliferative effect of the extract from Morinda citrifolia fruits. Phytother Res 2006; 20(6):515-7.
  18. Furusawa E, et al. Antitumour potential of a polysaccharide-rich substance from the fruit juice of Morinda citrifolia (Noni) on sarcoma 180 ascites tumour in mice. Phytother Res 2003; 17(10):1158-64.
  19. Wang MY, Peng L, Lutfiyya MN, et al. Morinda citrifolia (noni) reduces cancer risk in current smokers by decreasing aromatic DNA adducts. Nutr Cancer. 2009;61(5):634-9.
  20. West BJ, White LD, Jensen CJ, Palu AK. A double-blind clinical safety study of noni fruit juice. Pac Health Dialog. 2009 Nov;15(2):21-32.
  21. Santiago K, Gaikwad A, Coffer L, et al. Evaluation of the Hepatic Metabolism and Antitumor Activity of Noni Juice ( Morinda citrifolia L.) in Combination with Chemotherapy. Journal of the Society for Integrative Oncology. Vol 8, No 3 (Summer), 2010: p. 89.
  22. Millonig G, Stadlmann S, Vogel W. Herbal hepatotoxicity: acute hepatitis caused by a Noni preparation (Morinda citrifolia). Eur J Gastroenterol Hepatol. 2005 Apr;17(4):445-7.
  23. Yuce B, Gulberg V, Diebold J, Gerbes AL. Hepatitis induced by Noni juice from Morinda citrifolia: a rare cause of hepatotoxicity or the tip of the iceberg? Digestion. 2006;73(2-3):167-70.
  24. Stadlbauer V, Weiss S, Payer F, Stauber RE. Herbal does not at all mean innocuous: the sixth case of hepatotoxicity associated with morinda citrifolia (noni). Am J Gastroenterol. 2008 Sep;103(9):2406-7.
  25. Carr ME, Klotz J, Bergeron M. Coumadin resistance and the vitamin supplement “Noni”. Am J Hematol. 2004 Sep;77(1):103.
  26. Yu EL, Sivagnanam M, Ellis L, Huang JS. Acute hepatotoxicity after ingestion of Morinda citrifolia (Noni Berry) juice in a 14-year-old boy. J Pediatr Gastroenterol Nutr. 2011 Feb;52(2):222-4.
  27. Engdal S, Nilsen OG. In vitro inhibition of CYP3A4 by herbal remedies frequently used by cancer patients. Phytother Res. 2009 Jul;23(7):906-12.
  28. Mohamed ME, Frye RF. Effects of herbal supplements on drug glucuronidation. Review of clinical, animal, and in vitro studies. Planta Med. 2011 Mar;77(4):311-21.
  29. Prapaitrakool S, Itharat A. Morinda citrifolia Linn. for prevention of postoperative nausea and vomiting. J Med Assoc Thai. 2010 Dec;93 Suppl 7:S204-9.
  30. Wang MY, Peng L, Weidenbacher-Hoper V, et al. Noni juice improves serum lipid profiles and other risk markers in cigarette smokers. ScientificWorldJournal. 2012;2012:594657.
  31. Gupta RK, Banerjee A, Pathak S, Sharma C, Singh N. Induction of mitochondrial-mediated apoptosis by Morinda citrifolia (Noni) in human cervical cancer cells. Asian Pac J Cancer Prev. 2013;14(1):237-42.

Consumer Information

How It Works

Bottom Line: Noni showed anticancer effects in laboratory studies. It is being studied in cancer patients.

The juice of the noni fruit has been traditionally used in Polynesian cultures as an anti-cancer agent. Scientists have isolated a fraction from noni juice that is rich in complex sugars. This fraction, alone and in conjunction with chemotherapy drugs, is able to increase the survival of laboratory mice that have been implanted with lung cancer. Scientists are unsure exactly how noni exerts this effect, but guess that it has an immune-stimulating effect, since it has enhanced certain aspects of the immune system in laboratory studies. Furthermore, noni juice acts as an antioxidant and slows the transformation of normal cells to cancer cells in certain animal laboratory studies.

Purported Uses
  • To treat cancer
    Laboratory studies in animals show that noni extracts can increase the survival of mice implanted with lung cancer, both when used alone and in conjunction with chemotherapy drugs. There is no proof from clinical trials that the same effect occurs in humans, but a preliminary study is underway.
  • To treat chronic fatigue syndrome
    No scientific evidence supports this use.
  • To treat diabetes
    No scientific evidence supports this use. Noni is a fruit that is rich in complex sugars and therefore may worsen high blood sugar levels.
  • To lower high blood pressure
    No scientific evidence supports this use.
  • As an immune stimulant
    Laboratory studies show that noni juice enhances certain aspects of the immune system, but these results are not always transferable to the human body. There is no proof from clinical trials that these effects occur in humans.
  • To manage menstrual cramps
    No scientific evidence supports this use.
  • As an analgesic
    One study in laboratory mice supports this use, but there is no proof from clinical trials that the same effect occurs in humans.
Research Evidence

A noni extract was shown to be useful in reducing the incidence of nausea following surgery.
A phase I study of noni in cancer patients has been completed at the University of Hawaii. The results are yet to be published.

Do Not Take If
  • You have renal insufficiency (noni is high in potassium content).
  • You have diabetes (noni juice has high sugar content).
  • You are on potassium-sparing diuretics, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers.
  • You are taking chemo or radiation therapy (noni has antioxidant effects and can interfere with the treatments).
  • You are taking blood thinning medications such as Coumadin (noni juice can reduce their effectiveness).
  • You are taking drugs that are substrates of Cytochrome P450 3A4 (noni may reduce the effect or increase the risk of side effects of these drugs).
  • You are taking drugs that are substrates of UGT (Uridine 5'-diphospho-glucuronosyltransferase) enzymes (noni may increase the risk of side effects of these drugs).
Side Effects
  • Constipation
  • In a patient with kidney failure, hyperkalemia (dangerously high potassium levels in the blood) resulted from noni juice use.
  • Reported (Oral): According to a recent case study, a 29-year-old male with previous toxic hepatitis developed sub-acute hepatic failure following ingestion of 1.5 L Noni juice over a period of three weeks. He recovered completely after liver transplantation.
  • Reported (Oral): A 62-year-old woman developed acute hepatitis after consuming 2 L Noni juice for over three months. She recovered following cessation of Noni juice intake.
  • Reported (Oral): A 41-year-old woman developed resistance to Coumadin following concurrent intake of noni juice. Her symptoms improved after treatment and discontinuing noni juice.


However, a company-sponsored study showed that dose-related adverse effects are minimal in a noni product.

E-mail your questions and comments to aboutherbs@mskcc.org.