How It Works
Bottom Line: Because there is no evidence that noni has beneficial effects in humans, it should not be used alone to treat cancer, diabetes, or any other serious disease.
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. It is still unclear whether this effect occurs in humans
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
University of Hawaii is conducting an NIH funded phase I study of noni in cancer patients.
Warnings
This product is regulated by the FDA 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.
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)
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 (associated with paracetamol)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.
Special Point
Ask your doctor if you are currently undergoing radiation therapy or chemotherapy; it is still unknown whether noni juice contains high enough levels of antioxidants to interfere with these therapies.
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
M. citrifolia 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 M. citrifolia juice for presenting misleading claims of health benefits
(1).
Although many of the beneficial effects of M. citrifolia are unsubstantiated, in vitro and animal studies suggest that M. citrifolia plant extracts have antifungal
(14), antitumor and immunomodulatory
(3) (7) (8) (17) (18) properties. M. citrifolia also inhibits low-density-lipoprotein oxidation and has been suggested for use 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 M. citrifolia juice was shown to have anti angiogenic properties in an ex vivo assay
(16). An NIH funded Phase I study of M. citrifolia in cancer patients is underway at the University of Hawaii's Cancer Research Center
(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 exact mechanism of action is unknown. The aqueous extract of M. citrifolia root produced a central analgesic effect in Swiss mice that was antagonized by naloxone
(6). When combined with sub-optimal doses of certain chemo agents, polysaccharides from M. citrifolia improved survival time and curative effects in animal model
(4). Glycosides isolated from M. citrifolia juice inhibited AP-1 transactivation and cell transformation in the mouse epidermal JB6 cell line
(2). In addition, oral administration of M. citrifolia juice reduced 7, 12-dimethylbenz(a)anthrancine (DMBA)-DNA adduct formation in C57 BL-6 mice
(5).
Warnings
This product is regulated by the FDA 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.
Contraindications
Patients with renal insufficiency should consume noni juice with caution
Patients with diabetes should be careful when consuming noni products
Adverse Reactions
M. citrifolia juice can cause hepatotoxicity possibly due to its anthraquinone contents (9) (10).
Many M. citrifolia 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.
Patients using potassium-sparing diuretics, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers should avoid consuming large amounts of M. citrifolia juice.
Some noni juice products have high sugar content therefore diabetics should use them with caution.
In addition, the antioxidant effects of M. citrifolia products may interfere with the actions of chemo drugs and radiation therapy.
Literature Summary and Critique
References
- FDA Letter. http://www.fda.gov/cder/warn/cyber/2002/CFSANhawaiian.htm (accessed on June 22, 2005).
- 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.
- Hirazumi A, et al. Immunomodulation contributes to the anticancer activity of Morinda citrifolia (noni) fruit juice. Proc West Pharmacol Soc 1996;39:7-9.
- 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.
- Wang MY, Su C. Cancer preventative effect of Morinda citrifolia (noni). Ann N Y Acad Sci 2001;952:161-8.
- Younos C, et al. Analgesic and behavioural effects of Morinda citrifolia. Planta Med 1990;56:430-4.
- Mueller BA, et al. Noni juice (Morinda citrifolia): hidden potential for hyperkalemia? Am J Kidney Dis 2000;35:310-2.
- 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.
- Stadlbauer V, et al. Hepatotoxicity of NONI juice: Report of two cases. World J Gastroenterol. 2005;11(30):4758-60.
- 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.
- Ernst C. Wonder drug or latest fad? http://www.hawaii.edu/malamalama/2006/05/f5_noni.html (accessed June 14, 2006)
- 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.
- 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.
- 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.
- 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.
- 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.
- Arpornsuwan T, Punjanon T. Tumor cell-selective antiproliferative effect of the extract from Morinda citrifolia fruits. Phytother Res 2006; 20(6):515-7.
- 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.
