- Custard apple
- Brazilian paw paw
For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
How It Works
Graviola showed anticancer effects in lab studies, but human data are lacking.
In lab experiments, graviola extracts appear to be effective against some types of viruses, bacteria, parasites, and cancer cells. Chemicals called acetogenins are thought to be the major active compound. However in lab and animal experiments, substances derived from graviola damaged nerve cells and caused neurological side effects similar to Parkinson’s disease. Other animal studies suggest long-term use may increase the risk of neurological diseases. Whether this translates to similar effects in humans is unclear, so more studies are needed to determine safety and efficacy.
Of note, animal studies suggest graviola may affect nuclear imaging because it has been shown to decrease the uptake of radiopharmaceuticals used in such procedures. Therefore, patients should discuss the use of this product with their healthcare practitioners.
Do Not Take If
You are undergoing medical imaging: Animal studies suggest graviola may affect nuclear imaging because it may decrease the uptake of radiopharmaceuticals used in such procedures.
You are taking blood pressure medications: Animal studies suggest graviola has blood pressure-lowering effects, so it may have additive effects when taken with these drugs. Clinical relevance has yet to be determined.
You are taking diabetic medications: Animal studies suggest graviola has blood sugar-lowering effects, so it may have additive effects when taken with these drugs. Clinical relevance has yet to be determined.
For Healthcare Professionals
Graviola is a tree prevalent in the rain forests of Africa, South America, and Southeast Asia. The fruits, also known as soursop, are consumed as food. The leaves and stems are used in traditional medicine for symptoms associated with inflammation and infection. Graviola is also available as a dietary supplement and widely promoted as an alternative treatment for cancer, although clinical evidence is lacking. In some Caribbean countries, it is one of the common herbal remedies used among prostate, breast, and colorectal cancer patients (33).
Perceived health benefits of graviola are attributed to its antioxidant properties (1) (2) (3) (4). In animal models, graviola extracts showed anti-inflammatory (5), analgesic (6), antidiabetic (7), antiulcer (8), and antiviral (9) effects. The leaf extracts also have antimicrobial activities (10) (11).
Lab studies have also evaluated extracts from the graviola leaf, fruit, and seed for their anticancer effects. Some of these studies suggest activity against breast (16), lung (12), colon (13), prostate (14), pancreatic (15), liver (17), and skin cancer (18) cell lines, but human studies are lacking. In addition, it is unclear whether the neurotoxicity identified in preclinical studies may translate to humans, as one systematic review suggests a favorable profile with graviola leaf extract (36), so more studies are needed to determine safety and efficacy.
Mechanism of Action
Annonaceous acetogenins isolated from the leaves, bark, and twigs are among the active constituents (35). Graviola-induced cell death inhibited by glucose supplementation suggests energy depletion (20). Graviola has also been shown to stimulate serotonin receptors (24). Cell-stimulating behaviors may occur either by increased mitochondrial turnover or by preparation to leave the G1 phase, possibly through a promitotic stimulus present within the extract which acts like a growth factor (28).
In animal models, antidiabetic effects are due to antioxidant, hypolipidemic, and protective effects in pancreatic beta-cells, which improves glucose metabolism (7). Antiulcer effects may occur via increased nitric oxide and prostaglandin E2 activities (8). Anti-inflammatory and analgesic actions with a fruit extract occurred via COX-1/2 inhibition and the blocking of opioid receptors (5).
Graviola extracts were effective against adriamycin-resistant human mammary adenocarcinoma by blocking ATP access and inhibiting plasma membrane glycoprotein (29). Inhibition of HIF-1α, NF-κB, glucose transporters, and glycolytic enzymes also decreased glucose uptake and ATP production in pancreatic cancer cells (15). In breast cancer cells, EGFR expression was downregulated (16) and free-radical scavenging occurred (30). In colon and in lung cancer cell lines, G1 cell-cycle arrest occurred by upregulating Bax and downregulating Bcl-2 proteins (12) (13).
In vitro, graviola alkaloids caused movement disorders and myeloneuropathy with symptoms mimicking Parkinson’s disease (20) (21). Animal studies suggest that long-term ingestion of graviola juice promotes generation of reactive nitrogen species that may accelerate development of neurodegenerative diseases involving the microtubule-associated protein tau (34).
Antidiabetics: In a murine model, graviola showed hypoglycemic effects (31), and may have additive effects with antidiabetic drugs. Clinical relevance is not known.
Antihypertensives: In a murine model, graviola showed hypotensive effects (32), and may have additive effects with antihypertensive medications. Clinical relevance has yet to be determined.
Herb Lab Interactions
Nuclear imaging (radiopharmaceutical biodistribution): In animal models, graviola decreased uptake of radioactivity per gram of tissue in bladder, kidney, and blood (22).
Blood glucose test: In a murine model, graviola reduced blood glucose levels (31).
Blood pressure readings: In a murine model, graviola reduced blood pressure readings (32).