Sutherlandia frutescens

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Sutherlandia frutescens

Common Names

  • Sutherlandia
  • Cancer bush
  • Kankerbos
  • Balloon-pea

For Patients & Caregivers

How It Works

Although lab studies suggest that Sutherlandia has anticancer properties, it has not been shown to treat or prevent cancer in humans.

Sutherlandia frutescens is a shrub native to Southern Africa and along the coast of West Africa. It is used in traditional medicine to treat diabetes, chicken pox, and external wounds, and also as a cancer treatment. Laboratory studies show that Sutherlandia can fight off viruses, bacteria, and fungi, and also appears to have anticancer properties. A few case reports show that it can decrease fatigue in cancer patients.

Because Sutherlandia may be able to fight HIV virus, it is being proposed as an AIDS treatment in Africa. However in a trial of adults with HIV, patients taking Sutherlandia did not experience benefits, but did have longer infection times. Additional studies are needed.

Purported Uses
  • Prevent infections
    Laboratory studies show that Sutherlandia has antibacterial, antiviral, and antifungal effects. However in a study of HIV patients, two cases of tuberculosis occurred in the Sutherlandia group, even though they were on preventive therapy for tuberculosis.
  • Stomach and blood ailments
    There is no scientific evidence to support this claim.
  • Cancer
    Sutherlandia showed anticancer effects in lab studies, but it has not been studied in cancer patients.
  • AIDS
    Laboratory studies suggest that Sutherlandia has antiviral properties. However in a study of HIV patients, those who took Sutherlandia did not experience benefits over placebo, but infection times were longer in a few patients. Additional studies are needed.
Do Not Take If
  • You are taking isoniazid: In a safety trial of adults with HIV, a possible interaction between S. frutescens and isoniazid occurred, as two participants developed tuberculosis despite taking isoniazid.
  • You are taking antiretrovirals (eg, atazanavir): Studies in human subjects suggest Sutherlandia may reduce the bioavailability of atazanavir. Also, many antiretrovirals are metabolized by CYP 3A4.
  • You are taking Cytochrome P450 3A4 substrate drugs: Lab and animal studies suggest Sutherlandia may interact with these drugs and increase the risk of side effects. Clinical relevance has yet to be determined.
  • You are taking P-glycoprotein substrate drugs:  Lab studies suggest Sutherlandia may increase the risk of side effects of these drugs. Clinical relevance has yet to be determined.
Side Effects

Common: Diarrhea, dry mouth, dizziness.
Rare: Drinking or swallowing high doses of Sutherlandia may cause sweating and vomiting.

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For Healthcare Professionals

Scientific Name
Sutherlandia frutescens, Lessertia frutescens
Clinical Summary

Sutherlandia frutescens is a shrub native to South Africa and the coast of West Africa. This plant and its related species have been used in traditional medicine to treat diabetes, chicken pox, and external wounds. Although Sutherlandia is not generally consumed as a dietary supplement in the West, some use the raw herb as an adaptogen. Constituents in Sutherlandia have antiviral, antibacterial, antifungal and anticancer properties (2). Sutherlandia is also known as cancer bush for its purported use as a cancer treatment. There are case reports of Sutherlandia’s ability to reduce fatigue in cancer patients (3).

In recent years, there has been a growing effort in Africa to promote the use of local herbs to treat AIDS due to the lack of availability of pharmaceuticals. Based on reports that Sutherlandia is effective against HIV virus (4), it has been proposed as a treatment for AIDS (5). However in a double-blind safety trial in adults with HIV, patients randomized to S. frutescens did not have changes in viral load or CD4 T-lymphocyte count, but did have longer duration of secondary infection (1).

Adverse effects are rare but Sutherlandia may interact with cytochrome P450 3A4 and P-glycoprotein substrate drugs, and particularly drugs used to treat AIDS or prevent tuberculosis (1) (7) (16) (17).

Food Sources
  • Sutherlandia frutescens is generally consumed as a tea.
Purported Uses
  • Prevent infection
  • Stomach and blood ailments
  • Cancer
  • AIDS
Mechanism of Action

Sutherlandia was shown to have antioxidant and anti-inflammatory effects in vitro (9). Pinitol, a constituent of Sutherlandia, demonstrated antidiabetic effects by increasing the availability of glucose for cell metabolism (2). Sutherlandia was also shown to upregulate VAMP3, a gene which plays a role in vesicle transport, and also regulate 26 other genes that code for vesicle transporters, receptors, signalling molecules, transcription factors, and metabolic enzymes (14).

GABA found in the dry leaves of this herb can slow down nerve cell activity (2). In other studies, the ethanolic extract of Sutherlandia inhibited growth of MCF-7 breast adenocarcinoma cell line by inducing apoptosis (10) (11). Sutherlandia also downregulated metalloproteinases (MMP), which control cell migration, proliferation, apoptosis, and regulate tumor expansion, angiogenesis, and dissemination (10).

Contraindications
  • Patients taking isoniazid to prevent tuberculosis should avoid taking Sutherlandia, as it may interfere with the effectiveness of that drug (1).
Adverse Reactions

Common: Diarrhea, dry mouth, dizziness (2).
Rare: Drinking or swallowing high doses of Sutherlandia may cause sweating and vomiting (2).

Herb-Drug Interactions
  • Isoniazid: In a double-blind safety trial of adults with HIV, a possible interaction between S. frutescens and isoniazid preventive therapy occurred, as two participants taking Sutherlandia developed tuberculosis despite taking isoniazid (1).
  • Atazanavir: In human subjects, Sutherlandia significantly reduced the bioavailability of atazanavir, an antiretroviral protease inhibitor (17).
  • Cytochrome P450 substrates: In vitro, Sutherlandia inhibits CYP3A4 and can affect the intracellular concentration of drugs including antiretroviral treatments metabolized by these enzymes (7). But in an animal study, it was shown to induce rat CYP3A2/human equivalent CYP3A4, resulting in decreased intracellular concentrations of nevirapine, a non-nucleoside reverse transcriptase inhibitor (16). Clinical relevance has yet to be determined.
  • P-glycoprotein substrates: In vitro, Sutherlandia inhibited P-Gp activity and may interfere with the metabolism of drugs including antiretroviral treatments (7). Clinical relevance has yet to be determined.
Dosage (OneMSK Only)
References
  1. Wilson D, Goggin K, Williams K, et al. Consumption of Sutherlandia frutescens by HIV-Seropositive South African Adults: An Adaptive Double-Blind Randomized Placebo Controlled Trial. PLoS One. 2015;10(7):e0128522.
  2. van Wyk BE, Albrecht C. A review of the taxonomy, ethnobotany, chemistry and pharmacology of Sutherlandia frutescens (Fabaceae). J Ethnopharmacol. Oct 28 2008;119(3):620-629.
  3. Grandi M RL, Vernay M. Lessertia (Sutherlandia frutescens) and fatigue during cancer treatment. Phytotherapie. 2005;3:110.
  4. Harnett SM, Oosthuizen V, van de Venter M. Anti-HIV activities of organic and aqueous extracts of Sutherlandia frutescens and Lobostemon trigonus. J Ethnopharmacol. Jan 4 2005;96(1-2):113-119.
  5. Morris K. Treating HIV in South Africa—a tale of two systems. Lancet. Apr 14 2001;357(9263):1190.
  6. A Controlled Study of the Safety and Efficacy of Lessertia Frutescens in HIV-infected South African Adults.
    http://www.clinicaltrials.gov/ct2/show/NCT00549523?term=sutherlandia&ra…. Accessed February 19, 2020.
  7. Mills E, Foster BC, van Heeswijk R, et al. Impact of African herbal medicines on antiretroviral metabolism. AIDS. Jan 3 2005;19(1):95-97.
  8. Brown L, Heyneke O, Brown D, van Wyk JP, Hamman JH. Impact of traditional medicinal plant extracts on antiretroviral drug absorption. J Ethnopharmacol. Oct 28 2008;119(3):588-592.
  9. Fernandes AC, Cromarty AD, Albrecht C, van Rensburg CE. The antioxidant potential of Sutherlandia frutescens. J Ethnopharmacol. Nov 2004;95(1):1-5.
  10. Stander BA, Marais S, Steynberg TJ, et al. Influence of Sutherlandia frutescens extracts on cell numbers, morphology and gene expression in MCF-7 cells. J Ethnopharmacol. Jun 13 2007;112(2):312-318.
  11. Stander A, Marais S, Stivaktas V, et al. In vitro effects of Sutherlandia frutescens water extracts on cell numbers, morphology, cell cycle progression and cell death in a tumorigenic and a non-tumorigenic epithelial breast cell line. J Ethnopharmacol. Jul 6 2009;124(1):45-60.
  12. Chinkwo KA. Sutherlandia frutescens extracts can induce apoptosis in cultured carcinoma cells. J Ethnopharmacol. Apr 8 2005;98(1-2):163-170.
  13. Johnson Q, Syce J, Nell H, Rudeen K, Folk WR. A randomized, double-blind, placebo-controlled trial of Lessertia frutescens in healthy adults. PLoS Clin Trials. 2007;2(4):e16.
  14. Williams S, Roux S, Koekemoer T, van de Venter M, Dealtry G. Sutherlandia frutescens prevents changes in diabetes-related gene expression in a fructose-induced insulin resistant cell model. J Ethnopharmacol. 2013 Mar 27;146(2):482-9.
  15. Minocha M, Mandava NK, Kwatra D, Pal D, Folk WR, Earla R, Mitra AK. Effect of short term and chronic administration of Sutherlandia frutescens on pharmacokinetics of nevirapine in rats. Int J Pharm. 2011 Jul 15;413(1-2):44-50.
  16. Müller AC, Skinner MF, Kanfer I.Effect of the African Traditional Medicine, Sutherlandia frutescens, on the Bioavailability of the Antiretroviral Protease Inhibitor, Atazanavir. Evid Based Complement Alternat Med.2013;2013:324618.
  17. Muller AC, Ducharme MP, Kanfer I. Identification of Mechanism and Pathway of the Interaction between the African Traditional Medicine, Sutherlandia Frutescens, and the Antiretroviral Protease Inhibitor, Atazanavir, in Human Subjects Using Population Pharmacokinetic (PK) Analysis. J Pharm Pharm Sci. 2018;21(1s):215s-221s.
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