Vegetable Essentials by Wonder Laboratories

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Diabetes. Although there has been interest in using oral alfalfa for diabetes, there is insufficient reliable information about the clinical effects of alfalfa for this purpose.
• Dyspepsia. Although there has been interest in using oral alfalfa for dyspepsia, there is insufficient reliable information about the clinical effects of alfalfa for this purpose.
• Hypercholesterolemia. It is unclear if oral alfalfa seeds are beneficial in patients with hypercholesterolemia. Details: A small, uncontrolled clinical study in patients with hypercholesterolemia shows that taking heat-prepared alfalfa seeds 40 grams three times daily for 8 weeks reduces total cholesterol and low-density lipoprotein (LDL) cholesterol levels when compared to baseline (5816). The validity of these findings is limited by the lack of a control group.
• Menopausal symptoms. Although there has been interest in using oral alfalfa for menopausal symptoms, there is insufficient reliable information about the clinical effects of alfalfa for this purpose. There is insufficient reliable information available about the effectiveness of alfalfa for its other uses.

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POSSIBLY EFFECTIVE

• Athletic performance. Oral beet may improve athletic performance associated with aerobic activities. However, it is not clear who is most likely to benefit, for which type of competition it is most useful, or what dose or duration of use is most appropriate. Details: Several small clinical trials, most of which enrolled elite athletes, recreational athletes, and sedentary males, as well as meta-analyses of some of these and other studies, show that beet improves various measures of athletic performance, including ability, muscular endurance, power output, sprinting, and strength (93844,94464,94468,94469,100143,100150,100152,105761,113422). Clinical research also shows that drinking beetroot juice improves the use of oxygen during exercise testing in recreationally-trained athletes, especially with severe exercise testing (94460,94463,94467,100147,105762). Also, in obese adolescents, taking beetroot juice daily for 6 days increases the time to exhaustion from severe exercise, but does not improve moderate exercise (100145). Not all research shows that beet supplementation benefits athletic performance. Another meta-analysis of several small clinical studies, including some of the studies above, shows that taking beetroot does not improve performance in high-intensity or sprint interval training (111159). Additionally, the majority of research in elite athletes does not support the use of beetroot juice to decrease the time needed to complete a task, aid in some sort of graded exercise test, or improve the use of oxygen during exercise testing (94455,94458,94460,94461,94464,94465,94466,94469,94473,100142,100153,105763). The supposed lack of effect of beetroot juice in elite athletes might be related to the natural production of nitrates and nitrites in the body or the increased ability to use oxygen that comes from extensive training (94458,94463). Alternatively, any changes might be very small (<1%) and not identified with statistical comparisons, although even very small changes might be beneficial in competition (94464). The most commonly used doses in all studies, regardless of effect, have included an acute dose of beetroot juice 70-500 mL up to 3 hours prior to exercise (93844,94463,94464,94466,94467,94473,97726,100142,100143,105761)(105762,111159,113422) or chronic dosing of up to 500 mL daily for 3-6 days (94459,94464,94469,100145,100147,100153,111159,113422). Less commonly, beetroot juice 70-140 mL daily, betalain-rich concentrate 100 mg daily, or a beetroot-based nutritional gel 100 grams daily, have been taken for longer dosing schedules of 7-15 days (97720,100144,100148,100152,105763,113422). Benefits in elite athletes, most often related to time trials, are usually limited to studies using chronic dosing of 7-15 days, which is longer than the duration of 6 days used in the majority of studies (94473,97720,100144,100148). Brands of juice used in clinical trials have included Beet It Sport (James White Drinks Ltd.) (94455,94458,94465,100142,100143,100144,100148,105761,105763), Beet It Stamina Shot (James White Drinks Ltd.) (93844), Beet It (James White Drinks Ltd) (94457,94459,94460,94467,94469,97726,100145,100153,105762,111159), and Love Beets Beetroot Juice (Gs Fresh Ltd.) (94461,94462). Although plasma levels have not been analyzed in all studies, the majority of studies suggest that these doses are adequate to increase levels of nitrates or nitrites, which is thought to be essential for increasing athletic potential (93844,94455,94458,94459,94460,94465,94467,94469,94466,94473,97726). The evidence also suggests benefit in both normoxic and hypoxic environments (94465,100148,105763).
• Exercise-induced muscle soreness. Drinking beetroot juice 7-8 times over 48 hours after strenuous exercise may reduce exercise-induced muscle soreness, but evidence is conflicting. Details: Some clinical research shows drinking beetroot juice (Love Beets Beetroot Juice, Gs Fresh Ltd.) 125 mL or 250 mL seven times over 48 hours after strenuous box jumps improves muscle soreness when compared with placebo and sodium nitrite (96964,97722). Other small clinical studies show that drinking beetroot juice 50-250 mL as eight separate doses over 48 hours after strenuous exerciseimproves muscle soreness and reduces tissue edema when compared with placebo (94461,113424). However, drinking beetroot juice 250 mL as seven separate doses over 48 hours after running a marathon does not appear to reduce muscle soreness when compared with placebo (94462). A meta-analysis of 4 small studies, mostly in healthy or physically active males, shows that drinking beetroot juice improves the pressure pain threshold, which is a measure of muscle soreness, at 48- and 72-hours post-exercise when compared with a fruit-flavored drink. However, beetroot juice does not improve subjective muscle soreness scores (111160). The validity of the findings from this meta-analysis is limited by the heterogeneity of the beetroot juice regimens among the included studies. Further, these results should not be generalized to elite athletes.

POSSIBLY INEFFECTIVE

• Chronic obstructive pulmonary disease (COPD). Drinking beetroot juice for up to 14 days may not improve exercise capacity in patients with COPD. Details: A meta-analysis of eight small clinical trials in patients with COPD shows that taking nitrate-rich beetroot juice does not improve most measures of exercise capacity, including the 6-minute walk test, cycling ergometry endurance time, and maximum rate of oxygen consumption (VO2 max), when compared with placebo. Additionally, beetroot juice did not reduce blood pressure or heart rate. However, the analysis did show a significant improvement in scores on the Borg Rating of Perceived Exhaustion scale with beetroot juice over placebo. Nitrate-rich beetroot juice doses ranged from 70-140 mL daily for up to 14 days (104200).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cognitive function. It is unclear if drinking beetroot juice is beneficial for cognitive function. Details: A small clinical study in adults with overweight or obesity on a calorie-restricted diet shows that drinking 70 mL of concentrated beetroot juice daily for 14 days improves the time to complete part B of the trail making test, which is a test of cognitive function, but not part A, when compared with controls (111158). However, the duration and size of this study limits its validity. Further, it is unclear whether any improvement is clinically significant. The effect of acute beet administration on cognitive function has also been studied. A very small clinical study in healthy adults shows that taking beet extract (RedNite, Enovate Biolife) chewable tablets 3 grams 90 minutes prior to neuropsychological testing improves immediate and delayed memory capacity, frontal lobe function, and lexical flexibility but does not improve working memory, information processing speed, or subjective reports of memory performance when compared with placebo (113427).
• Coronary heart disease (CHD). It is unclear if oral beetroot extract is beneficial in patients with CHD. Details: A small clinical trial in patients with CHD shows that taking red beetroot extract 500 mg, containing around 25 mg betalains, twice daily for 2 weeks reduces total cholesterol and low-density lipoprotein (LDL) cholesterol by 15 mg/dL and reduces triglycerides by 8 mg/dL when compared to baseline. Slight improvements in blood pressure and blood glucose were also reported, but these changes were not clinically significant (103883). The validity of these findings is limited by the lack of a comparator group. Also, it is unclear whether beetroot can reduce the risk of cardiovascular events in patients with CHD.
• Dyslipidemia. It is unclear if oral beetroot is beneficial in patients with dyslipidemia. Details: A meta-analysis of small clinical studies in healthy individuals or patients with dyslipidemia, cardiovascular disease, or overweight or obesity, shows that consuming beetroot juice or leaves does not improve levels of triglycerides or total, low-density lipoprotein, or high-density lipoprotein cholesterol when compared with controls (111163). However, the validity of the findings from this meta-analysis is limited by the heterogeneity of the enrolled patients and beetroot regimens.
• Exercise-induced muscle damage. It is unclear if oral beetroot juice improves recovery from muscle damage after exercise. Details: A meta-analysis of 4 small clinical studies in healthy or physically active individuals, most of which enrolled males only, shows that drinking beetroot juice improves measures of muscle recovery at 72 hours post-exercise when compared with a fruit-flavored drink. However, beetroot juice does not consistently improve recovery at earlier time points post-exercise, nor does it reduce levels of creatine kinase or markers of inflammation (i.e., interleukin-6, interleukin-8, c-reactive protein, or tumor necrosis factor-alpha) (111160). However, the validity of the findings from this meta-analysis is limited by the heterogeneity of the beetroot juice regimens among the included studies, which usually varied from 210-250 mg of nitrate in 7-11 servings over 3-7 days. Further, these results should not be generalized to elite athletes. Another very small clinical study in semi-professional female athletes shows that ingesting beetroot juice 50 mL 8 times over 48 hours after exercise-induced muscle damage enhances the recovery of some functional parameters such as muscle endurance but not others such as flexibility and vertical jump performance when compared with placebo (113424).
• Hypertension. Oral beet may slightly reduce blood pressure in healthy individuals, but it is unclear if it is beneficial in patients with hypertension. Details: Meta-analyses of small studies show the potential for a minor reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in healthy adults taking beetroot juice (94470,97718,97728). The average reduction in SBP and DBP with beetroot juice consumption is about 4 mmHg and 1 mmHg, respectively, which is greater than the effect seen with consuming blackcurrant juice or nitrate-depleted beetroot juice. The most benefit is seen when beetroot juice is taken for at least 2 weeks or at doses of 500 mL daily (97728). The effect of acute beet supplementation on blood pressure is conflicting. A small clinical study in healthy adults shows that drinking beet juice (Beet It, James White Company) 140 mL two hours prior to cardiovascular measurements reduces resting SBP by about 4 mmHg but does not improve resting or post-exercise DBP, central blood pressure, or arterial stiffness nor does it improve post-exercise SBP when compared with placebo. Subgroup analysis suggests that the reductions in resting SBP were only observed in males, not females (113423). Another small clinical study shows that consuming beet 100 grams baked into bread modestly decreases DBP over a 6-hour period when compared with white bread (97725). It is possible that genetics might play a role in the magnitude of effect seen with beetroot consumption. Adults with a specific gene polymorphism, eNOS Glu298Asp, experienced a greater reduction in DBP after consuming beet-containing bread (97724). Despite positive findings in studies of healthy individuals, research on the use of beetroot juice in patients with hypertension is unclear. A small clinical study in adults with hypertension who were taking antihypertensive medications shows that drinking nitrate-rich beetroot juice (Beet it; James White Drinks Ltd.) 70 mL twice daily for one week does not lower blood pressure when compared with nitrate-depleted beetroot juice (94457). Also, in patients with mild to moderate hypertension, clinical research shows that taking a combination of beetroot powder (Sensient) 300 mg, olive leaf extract 1000 mg, and green coffee bean extract 200 mg daily for 6 weeks does not lower blood pressure when compared with placebo (97723). However, some evidence suggests that at least part of the blood pressure lowering effects of beet might be independent of nitrate (97728). Furthermore, some research suggests that identifying effects on blood pressure might be dependent on the method of measurement, including clinic resting measurements, 24-hour monitoring, or morning/evening home resting measurements (97729).
• Hypertriglyceridemia. It is unclear if oral beet is beneficial in patients with hypertriglyceridemia. Details: A small clinical study in overweight or obese individuals with dyslipidemia shows that taking freeze-dried beet leaf 2.8 grams daily for 4 weeks in addition to nutritional guidance does not lower triglyceride levels when compared with nutritional guidance alone (100146). Beet has also been evaluated in combination with other ingredients. A small clinical trial in patients at risk for heart disease shows that a specific combination of beet and hawthorn berry (Neo40-Daily, Neogenis Labs), taken twice daily for 30 days, can modestly reduce blood triglyceride levels when compared to baseline (18222). It is unclear if these findings are due to beet, hawthorn berry, or the combination.
• Liver disease. Although there has been interest in using oral beet for liver disease, there is insufficient reliable information about the clinical effects of beet for this purpose.
• Muscle strength. It is unclear if oral beetroot juice is beneficial for muscle strength. Details: A meta-analysis of 18 clinical studies in healthy males shows that taking beetroot juice or beetroot gel 2-3 hours before exercise improves muscular strength when compared with placebo. Subgroup analysis suggests that beetroot-based supplements improve muscular strength in a fatigued but not resting state (113422). A small clinical study in adults with overweight or obesity on a calorie-restricted diet shows that drinking 70 mL of concentrated beetroot juice daily for 14 days improves handgrip strength by approximately 18% compared with 4% in controls (111158). However, it is unclear whether any improvement is clinically significant.
• Obesity. It is unclear if oral beet leaf or beetroot juice is beneficial for weight loss. Details: A small clinical study in patients with overweight or obesity and dyslipidemia shows that taking freeze-dried beet leaf 2.8 grams daily for 4 weeks in addition to nutritional guidance does not reduce body weight or body mass index (BMI) when compared with nutritional guidance alone (100146). Similarly, a small clinical study in adults with overweight or obesity on a calorie-restricted diet shows that drinking 70 mL of concentrated beetroot juice daily for 14 days does not improve weight loss when compared with controls (111158). However, the size and duration of this study may have been inadequate to detect differences between groups.
• Pregnancy-induced hypertension. It is unclear if oral beetroot juice is beneficial in patients with pregnancy-induced hypertension. Details: A small clinical trial in pregnant patients with hypertension who are at approximately 22-35 weeks gestation shows that taking beetroot juice (James White Drinks Ltd) 70 mL daily for 8 days does not reduce blood pressure when compared with a nitrate-depleted beetroot juice (100151). However, the study was small and designed to investigate the feasibility of using beetroot juice in this population.
• Pulmonary hypertension. It is unclear if oral beetroot juice is beneficial in patients with pulmonary hypertension. Details: A small clinical study shows that taking beetroot juice (Beet-It Sport; James White Drinks Ltd) 70 mL twice daily for 7 days does not improve right ventricular systolic function when compared with nitrate-depleted beetroot juice in patients with pulmonary hypertension (100149). However, this study was small and not adequately powered to detect differences between groups.
• Raynaud syndrome. It is unclear if oral beetroot juice is beneficial in patients with Raynaud syndrome. Details: A small clinical study in patients with Raynaud syndrome undergoing cold sensitivity tests shows that drinking beetroot juice (Beet-It, James White Drinks Ltd) 70 mL daily for 13 days, followed by 140 mL prior to testing, does not reduce pain in the hands or feet, but might improve thermal comfort in the feet, when compared to baseline (103884). The validity of this finding is limited by the lack of a comparator group. More evidence is needed to rate beet for these uses.

(Read more about BEET)

POSSIBLY EFFECTIVE

• Colorectal cancer. Consumption of cruciferous vegetables, including broccoli, seems to reduce the risk of developing colorectal cancer. Details: Epidemiological research suggests that the highest intakes of cruciferous vegetables, including broccoli, are associated with an 18% to 20% reduced risk of developing colorectal neoplasms when compared with the lowest intakes (14148,96187,96189).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bladder cancer. It is unclear if consumption of broccoli reduces the risk of developing bladder cancer. Details: Epidemiological research suggests that eating about 1.75 cups daily of cruciferous vegetables, such as broccoli or cabbage, is associated with a 30% reduced risk of developing bladder cancer (14864).
• Breast cancer. It is unclear if consumption of broccoli reduces the risk of developing breast cancer. Details: Epidemiological research suggests that consumption of broccoli is associated with a modestly reduced risk of developing breast cancer in premenopausal adults. However, broccoli consumption does not seem to be associated with breast cancer risk in postmenopausal adults (14146).
• Fibromyalgia. Broccoli has only been evaluated in combination with ascorbigen; its effect when used alone is unclear. Details: A small clinical study in females with fibromyalgia shows that taking one capsule containing ascorbigen 100 mg and broccoli powder 400 mg once daily for one month improves pain by 18% and reduces physical impairment by 20% when compared to baseline (19605). It is unclear if this effect is due to broccoli, ascorbigen, or the combination. The validity of these findings is limited by the lack of a comparator group.
• Gastric cancer. It is unclear if consumption of broccoli reduces the risk of developing gastric cancer. Details: A small epidemiological study suggests that higher consumption of broccoli is associated with a reduced risk of developing gastric cancer when compared with lower consumption (14148).
• Helicobacter pylori. It is unclear if consumption of broccoli is beneficial for treating Helicobacter pylori infection. Details: A moderate-sized clinical study in adults with Helicobacter pylori infection shows that taking broccoli seed extract 200 mg, containing 16% glucosinolates, daily before bedtime for 2 months does not improve Helicobacter pylori eradication rate when compared with placebo (112445,112446).
• Hypercholesterolemia. Broccoli has only been evaluated in combination with cabbage; its effect when used alone is unclear. Details: A small clinical study in patients with mild to moderate hypercholesterolemia shows that consuming 160 grams of a beverage containing broccoli, cabbage, and fruit twice daily for 12 weeks reduces levels of low-density lipoprotein (LDL) cholesterol by 8.5% when compared to baseline. It is unclear if the improvement from baseline differed when compared with those consuming a similar beverage without broccoli and cabbage (19607). It is unclear if this effect is due to broccoli, other ingredients, or the combination.
• Hypertension. It is unclear if consumption of broccoli can prevent hypertension in healthy adults. Details: A meta-analysis of 3 prospective cohort studies in healthy adults suggests that eating 100 grams of broccoli daily is associated with a 12% reduced risk of hypertension. However, 2 other studies in the meta-analysis suggest that broccoli, consumed as part of a larger group of cruciferous vegetables, is associated with an 11% increased risk of hypertension per 100 grams eaten daily (112087).
• Prostate cancer. It is unclear if consumption of broccoli reduces the risk of developing prostate cancer; the available research is conflicting. In patients with prostate cancer, broccoli has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Some epidemiological research suggests that consumption of Brassica vegetables, such as broccoli, Brussels sprouts, cauliflower, and cabbage, is associated with a reduced risk of developing prostate cancer (14145). However, other epidemiological research has found no association (14147,15172). Clinical research in adults with prostate cancer shows that taking a whole food formulation containing broccoli powder 100 mg, turmeric powder 100 mg, pomegranate whole fruit powder 100 mg, and green tea extract 20 mg three times daily for 6 months prevents an increase in prostate specific antigen (PSA) levels. Mean PSA levels increased by 15% in the whole food formulation group, compared with 79% in the placebo group. Also, 46% of those taking the whole food formulation showed final PSA levels that were the same or lower than initial PSA levels, compared with 14% of those in the placebo group (89730). However, it is not yet known whether the whole food formulation reduces the risk of prostate cancer progression or recurrence. It is unclear if these effects are due to broccoli, other ingredients, or the combination. More evidence is needed to rate broccoli for these uses.

(Read more about BROCCOLI)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Benign prostatic hyperplasia (BPH). Population research has found that higher intake of Brussels sprout is not associated with significantly reduced risk of BPH (26190).
• Bladder cancer. Epidemiologic research has found that eating about 1 cup daily of cruciferous vegetables, such as cabbage, Brussels sprout, cauliflower, broccoli, kale, or collards, is associated with a 30% lower risk of developing bladder cancer in adults (14864). Other population research has found that higher intake of cruciferous vegetables, such as cauliflower, Brussels sprout, cabbage, broccoli, and kale, is associated with a 51% reduction in the risk of developing bladder cancer in males. However, higher intake of Brussels sprout alone does not seem to be associated with a reduced risk of bladder cancer (26184).
• Breast cancer. Some population research has found that higher intake of cruciferous vegetables, including broccoli, Brussels sprout, cabbage, cauliflower, collards, and kale, is associated with a slight increase in the risk of breast cancer in premenopausal adults, while higher intake appears to be associated with a slight but statistically insignificant decrease in the risk in postmenopausal adults (26188). However, other population research has found that higher intake of Brussels sprout alone is not associated with a reduced risk of breast cancer (26189). Cruciferous vegetables might increase urinary levels of 2-hydroxyestrone, and its ratio to 16-alpha-hydroxyestrone, which could reduce the risk of breast cancer. However, research in pre-menopausal adults shows that taking a dried Brussels sprout and kale supplement, 3.3 grams daily for 8 weeks, or increasing dietary intake of Brussels sprout or broccoli by one 40-gram serving daily, does not increase urinary levels of 2-hydroxyestrone, or its ratio to 16-alpha-hydroxyestrone, when compared with placebo (112086).
• Diabetes. Population research has found that higher intake of cruciferous vegetables, including broccoli, cabbage, cauliflower, and Brussels sprout, is not associated with a reduced risk of developing type 2 diabetes (26187). A meta-analysis of 23 studies shows that the highest levels of combined vegetable and fruit intake are associated with a 7% reduction in the risk of developing type 2 diabetes, when compared with the lowest intakes, but higher intake of Brussels sprout alone is associated with a 7% increase in the risk (112088).
• Hypertension. A meta-analysis of 18 studies in healthy adults shows that the highest levels of combined vegetable and fruit intake are associated with a 9% to 11% reduction in the risk of developing hypertension, when compared with the lowest intakes, but higher intake of Brussels sprout alone is associated with a 25% increase in the risk (112087).
• Lung cancer. Population research has found that people who consume Brussels sprout and broccoli at least once weekly have a 22% lower risk of developing lung cancer when compared with those who consume these vegetables less than once monthly (26192).
• Non-Hodgkin lymphoma. Population research has found that females who consume at least half a serving of Brussels sprout or other cruciferous vegetables daily have a lower risk of developing non-Hodgkin lymphoma, particularly the follicular lymphoma subtype, when compared to those who eat these vegetables less often. However, eating Brussels sprout and other cruciferous vegetables does not appear to be associated with a reduced risk of non-Hodgkin lymphoma in males (26186).
• Pancreatic cancer. Population research has found that consuming higher amounts of Brussels sprout is not associated with a reduced risk of pancreatic cancer (26181).
• Prostate cancer. Population research has found that people who consume higher amounts of Brussels sprout and other cruciferous vegetables have a lower risk of developing prostate cancer (25420,25421).
• Stroke. Population research has found that higher intake of Brussels sprout and other cruciferous vegetables is associated with a 32% reduction in the risk of ischemic stroke (7394). More evidence is needed to rate Brussels sprout for these uses.

(Read more about BRUSSELS SPROUT)

POSSIBLY EFFECTIVE

• Vitamin A deficiency. Some preliminary clinical research shows that consuming one spoonful of carrot jam daily for 10 weeks improves growth velocity when compared with control in children with vitamin A deficiency (25819). Other preliminary research shows that consuming 100 grams of grated carrot daily for 60 days improves vitamin A status when compared with placebo in lactating women at risk for vitamin A deficiency (67861).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Breast cancer. A meta-analysis of observational research has found that consuming a diet highest in carrots is associated with a 21% decreased odds of developing breast cancer when compared with consuming a diet lowest in carrots (101715).
• Colorectal cancer. A large observational study in older Danish adults shows that self-reported high consumption of raw carrot (2-4 carrots weekly or greater than 32 grams daily) is associated with a 17% lower likelihood of colorectal cancer diagnosis, whereas lower carrot consumption is not associated with a decreased risk. The validity of these findings may be limited by selection bias, recall bias, and other confounding factors (106559).
• Fibromyalgia. Preliminary clinical research shows that consuming a mostly raw, pure vegetarian diet that includes two to four 240 mL servings of carrot juice daily for 7 months might improve fibromyalgia symptoms in some people (98057). The effect of carrot alone on fibromyalgia is unknown.
• Prostate cancer. Population research has found that higher intake of carrot is associated with an 18% decrease in the odds of developing prostate cancer. Increasing carrot consumption by 10 grams daily or 1 serving per week is associated with a 4% to 5% decrease in the odds of developing prostate cancer (96307). More evidence is needed to rate carrot for these uses.

(Read more about CARROT)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bladder cancer. Epidemiologic research has found that eating about 1 cup per week of cruciferous vegetables, such as cabbage, Brussels sprouts, cauliflower, broccoli, kale, or collards, is associated with a 30% decreased risk of developing bladder cancer in men and women (14864). Other population research has also found that higher intake of cruciferous vegetables, such as cauliflower, Brussels sprouts, cabbage, broccoli, and kale, is associated with a 51% reduction in the risk of developing bladder cancer in men. However, higher intake of cauliflower alone does not seem to be associated with a reduced risk of bladder cancer (26184).
• Breast cancer. Population research has found that higher intake of cruciferous vegetables, including broccoli, Brussels sprouts, cabbage, cauliflower, collards, and kale, is associated with a slight increase in the risk of breast cancer in premenopausal women, while higher intake of these vegetables is associated with a slight, but statistically insignificant, decrease in the risk of breast cancer in postmenopausal women (26188).
• Diabetes. Population research suggests that higher intake of cruciferous vegetables, including broccoli, cabbage, cauliflower, and Brussels sprouts, is not associated with a reduced risk of developing type 2 diabetes in women (26187).
• Lung cancer. Population research has found that increased dietary intake of cauliflower is associated with a 61% reduction in the risk of lung cancer in women; however, it does not seem to be associated with a reduced risk of lung cancer in men (26185).
• Non-Hodgkin lymphoma. Population research has found that, for women, consuming at least half a serving of cauliflower or other green vegetables daily is associated with a lower risk of developing non-Hodgkin lymphoma, particularly the follicular lymphoma subtype, compared with eating these vegetables less often. However, eating cauliflower and other green vegetables does not appear to be associated with a reduced risk of non-Hodgkin lymphoma in men (26186).
• Prostate cancer. Population research has found that people who consume higher amounts of cauliflower and other cruciferous vegetables have a lower risk of developing prostate cancer (25420).
• Stroke. Population research has found that higher intake of cauliflower and other cruciferous vegetables is associated with a 32% reduced risk of ischemic stroke (7394). More evidence is needed to rate cauliflower for these uses.

(Read more about CAULIFLOWER)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Anxiety. It is unclear if oral celery seed extract is beneficial in patients with anxiety. Details: A small clinical study in Iranian adults with hypertension on standard antihypertensive therapy shows that taking celery seed extract 1.34 grams daily for 4 weeks reduces symptoms of anxiety and depression when compared with placebo (112409). However, it is unclear if these benefits can be extrapolated to patients in geographic locations other than Iran.
• Depression. It is unclear if oral celery seed extract is beneficial in patients with depression. Details: A small clinical study in Iranian adults with hypertension on standard antihypertensive therapy shows that taking celery seed extract 1.34 grams daily for 4 weeks reduces symptoms of anxiety and depression when compared with placebo (112409). However, it is unclear if these benefits can be extrapolated to patients in geographic locations other than Iran.
• Diabetes. It is unclear if oral celery seed extract is beneficial in patients with diabetes. Details: A small clinical study in adults with type 2 diabetes shows that taking celery seed powder 250 mg three times daily for 12 weeks does not improve fasting blood glucose, fasting insulin, insulin resistance, total cholesterol, low-density lipoprotein or high-density lipoprotein cholesterol, triglycerides, or blood pressure when compared with placebo (112411). However, the study may have been inadequately powered to detect a difference between groups.
• Dysmenorrhea. Oral celery seed has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One clinical trial in female college students shows that taking a specific combination product containing celery seed, saffron, and anise extracts (SCA, Gol Daro Herbal Medicine Laboratory) 500 mg three times daily for 3 days, starting at the beginning of bleeding or pain, reduces severity and duration of pain symptoms associated with menstruation when compared with placebo (17214). It is not clear if these effects are due to celery, other ingredients, or the combination.
• Dyspepsia. Oral celery seed has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A moderate-sized clinical trial in adults with functional dyspepsia conducted in Iran shows that taking celery seed powder 500 mg daily with bishop's weed 500 mg daily spread over three doses after meals for 4 weeks reduces patient-reported dyspepsia symptom severity when compared with domperidone. Taking celery and bishop's weed also reduces patient-reported symptom frequency when compared to baseline (112410). However, it is unclear if these effects are due to celery, bishop's weed, or the combination, or if results can be extrapolated to patients in geographic locations other than Iran. The interpretation of these results is also limited by the lack of a placebo group.
• Gout. Oral celery has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small, open-label clinical study in patients with gout shows that taking a specific combination product (GoutFigher, Max Biocare) containing celery seed extract 600 mg, devil's claw root extract 300 mg, sour cherry extract 200 mg, and other ingredients twice daily for 45 days reduces pain, joint inflammation, and uric acid levels when compared to baseline (106488). The validity of these findings is limited by the lack of a control group. Additionally, it is unclear if these findings are due to celery, other ingredients, or the combination.
• Headache. Although there has been interest in using oral celery for headache, there is insufficient reliable information about the clinical effects of celery for this purpose.
• Hypertension. It is unclear if oral celery seed extract is beneficial in patients with hypertension. Details: A small clinical study in Iranian adults with hypertension on standard antihypertensive therapy shows that taking celery seed extract 1.34 grams daily for 4 weeks reduces daytime systolic blood pressure by about 12 mmHg compared to less than 1 mmHg with placebo. Celery seed extract also reduces night-time blood pressure, diastolic blood pressure, and mean arterial pressure, but does not impact the heart rate (110755). However, it is unclear if these benefits can be extrapolated to patients in geographic locations other than Iran.
• Impaired glucose tolerance (prediabetes). It is unclear if oral celery leaf extract is beneficial in patients with prediabetes. Details: A small clinical study in elderly patients with prediabetes shows that taking celery leaf extract 250 mg three times daily for 12 days reduces postprandial plasma glucose levels, but not insulin levels, when compared to baseline (99572). Although a control group was included in the study, statistical comparisons between treatment and control groups were not reported.
• Mosquito repellent. It is unclear if topical celery seed extract is beneficial for use as a mosquito repellant. Details: One small clinical study shows that applying gel formulations containing celery seed extract 5% to 25% can repel mosquitos in a dose-dependent manner for up to 4.5 hours. These formulations show similar repellant action when compared with DEET-containing formulations and appear to be superior to commercial repellants without DEET (40988). Celery extract has also been evaluated in combination with other ingredients. Two clinical studies show that application of a specific formulation (G10, E.A.R. Samunpri) containing celery seed extract 5%, along with vanillin, eucalyptus oil, orange oil, and citronella oil, seems to repel mosquitos for up to 4.5 hours comparably to other commercial products, including DEET 25% and Insect Block 28 (41049,41052). It is unclear if these findings are due to celery, other ingredients, or the combination.
• Osteoarthritis. Oral celery seed has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small, open-label clinical study in patients with mild knee osteoarthritis shows that taking a specific combination product (Tregocel, Max Biocare) providing celery seed 1000 mg, Boswellia serrata resin extract 1000 mg, devil's claw 1000 mg, ginger rhizome 330 mg, and curcumin 180 mg daily for 36 weeks reduces pain, improves functional capacity, and increases walking distance when compared to baseline (106078). The validity of these findings is limited by the lack of a control group. Additionally, it is unclear if these findings are due to celery, other ingredients, or the combination.
• Rheumatoid arthritis (RA). Although there has been interest in using oral celery juice for RA, there is insufficient reliable information about the clinical effects of celery for this purpose.
• Sexual dysfunction. It is unclear if oral celery seed powder is beneficial in females with sexual dysfunction. Details: One small clinical study in females with sexual dysfunction shows that taking celery seed powder 500 mg three times daily for 6 weeks improves sexual dysfunction symptom scores, primarily due to patient-rated improvements in sexual desire, arousal, lubrication, and pain, when compared with placebo (106486).
• Urinary tract infections (UTIs). Although there has been interest in using oral celery juice for UTIs, there is insufficient reliable information about the clinical effects of celery for this purpose. More evidence is needed to rate celery for these uses.

(Read more about CELERY)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bladder cancer. It is unclear if consuming kale in the diet can reduce the risk of bladder cancer. Details: Population research suggests that patients with bladder cancer consumed approximately 0.18 fewer cups of cruciferous vegetables, such as cabbage, Brussels sprout, cauliflower, broccoli, kale, or collards, on a weekly basis in the year prior to diagnosis when compared with people without bladder cancer. The effects of kale, specifically, are unclear (14864). Other population research suggests that eating at least five servings per week of cruciferous vegetables, such as cauliflower, Brussels sprout, cabbage, broccoli, and kale, is associated with a 51% reduction in the risk of developing bladder cancer in males when compared with eating up to one serving per week. However, higher intake of kale alone does not seem to be associated with a reduced risk of bladder cancer (26184).
• Breast cancer. It is unclear if consuming kale in the diet can reduce the risk of breast cancer. Details: Population research suggests that the highest dietary intake of cruciferous vegetables, including broccoli, Brussels sprout, cabbage, cauliflower, collards, and kale, is associated with a slight increase in the risk of breast cancer in premenopausal adults when compared with the lowest intake (26188). Cruciferous vegetables might increase urinary levels of 2-hydroxyestrone, and its ratio to 16-alpha-hydroxyestrone, which could reduce the risk of breast cancer. However, research in pre-menopausal adults shows that taking a dried kale and Brussels sprout supplement, 3.3 grams daily for 8 weeks, or increasing dietary intake of Brussels sprout or broccoli by one 40-gram serving daily, does not increase urinary levels of 2-hydroxyestrone, or its ratio to 16-alpha-hydroxyestrone, when compared with placebo (112086). In postmenopausal adults, the highest intake of cruciferous vegetables appears to be associated with a statistically insignificant reduced risk of breast cancer (26188).
• Inflammatory bowel disease (IBD). Although there is interest in oral kale for IBD, there is insufficient reliable information available about the use of kale for this purpose.
• Menopausal symptoms. Although there is interest in oral kale for reducing menopausal symptoms, there is insufficient reliable information available about the use of kale for this purpose. More evidence is needed to rate kale for these uses.

(Read more about KALE)

POSSIBLY EFFECTIVE

• Scarring. Clinical research in adults and children shows that topical application of onion extract, often as part of combination products, for 10 weeks to 6 months is beneficial for preventing scarring; however, the most effective combination of ingredients, dosage form, and dose are unclear. Details: Many small clinical trials show that using topical onion extract improves the appearance, as well as pain and itching, associated with postburn hypertrophic scars, keloidal scars, scars following tattoo removal, scars following Cesarean delivery, or scars following surgical removal of tissue when compared with control (66895,66918,66939,66951,66987,67089,67104,95151,95156,95159,104773). Products evaluated in clinical research have included gels containing a combination of onion extract, heparin, and allantoin (Contractubex, Merz Pharmaceuticals) (66895,66987,67089,67104,104773); a combination of onion extract and a silicone derivative (Cybele scagel, Bangkok Botanica) (95156,95159); a combination of onion extract, allantoin, pentaglycan, and a solution of glycosaminoglycans (Kaloidon gel, Laboratori Farmacologici Milanesi) (95151); and a transdermal patch containing a combination of onion extract and allantoin (104771). However, not all research agrees. A meta-analysis of randomized controlled trials using onion extract gel for scar management demonstrated mixed results when compared with control. However, the validity of the study is limited by high heterogeneity (109511). In addition, a specific product containing onion extract and allantoin (Mederma, Merz Pharmaceuticals) for 4-11 weeks does not appear to improve the appearance of new surgical scars (66742,66883). Similarly, observational research has found that a topical patch containing onion extract and allantoin is not associated with improved provider- or patient-assessed appearance of scars following cesarean-delivery after 4 weeks when compared with those using no scar treatment (104771). It is possible that the duration of treatment in these studies was inadequate to identify improvement.

POSSIBLY INEFFECTIVE

• Obesity. Clinical research does not support the use of dietary onion or onion supplements for weight loss. Details: Clinical research in overweight patients shows that taking capsules containing steamed onion (Oniro, Kunpoong Bio Co., Ltd) 300 mg orally three times daily for 12 weeks does not reduce body mass index (BMI), fat distribution, or fat mass when compared with placebo (101747). In addition, one clinical study in overweight and obese patients with polycystic ovary syndrome (PCOS) shows that eating raw red onion 80-120 grams daily can actually increase BMI by 0.36 kg/m2 when compared with eating 20-30 grams of raw red onion (95155). Clinical studies have also used onion products standardized by quercetin content. Preliminary clinical research in overweight and obese patients shows that taking onion peel extract providing quercetin 100 mg orally daily for 12 weeks reduces body weight by up to 1.1 kg and BMI by up to 0.4 kg/m2 when compared to baseline, but not when compared with placebo (95152,101748). Another small clinical study in healthy, overweight Japanese adults shows that taking an onion powder containing quercetin 60 mg orally daily for 12 weeks does not reduce body weight, BMI, abdominal circumference, or abdominal fat when compared with the same quantity of quercetin-free onion powder (104772).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alopecia areata. It is unclear if topical onion is beneficial in patients with alopecia areata. Details: Preliminary clinical research in children and adults with alopecia areata shows that topical application of raw onion juice twice daily for 8 weeks improves hair growth when compared with placebo. Hair regrowth was demonstrated in 74% of subjects using onion juice, compared with 13% using placebo (66797).
• Angina. Although there has been interest in using oral onion for angina, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Asthma. Although there has been interest in using oral onion for asthma, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Atherosclerosis. Although there has been interest in using oral onion for atherosclerosis, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Bruises. Although there has been interest in using topical onion for bruises, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Diabetes. It is unclear if oral onion is beneficial in patients with diabetes. Details: Preliminary clinical research in adults with type 2 diabetes shows that taking fresh onion 20 grams orally three times daily, in addition to consuming a controlled diet, for 8 weeks decreases blood glucose levels by 5% when compared with a controlled diet alone (67072).
• Dyspepsia. Although there has been interest in using oral onion for dyspepsia, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Gastric cancer. It is unclear if oral onion is beneficial for preventing gastric cancer. Details: Population research has found that the highest dietary intake of onion is associated with a 48% reduced odds of gastric cancer when compared with the lowest intake (51460).
• Hypertension. It is unclear if oral onion is beneficial in patients with hypertension. Details: Preliminary clinical research in overweight or obese adults with prehypertension or hypertension shows that taking onion skin extract 132 mg orally three times daily for 6 weeks reduces 24-hour systolic blood pressure by 4 mmHg, but does not affect diastolic blood pressure, when compared with placebo (95149). Other preliminary clinical research in patients with hypertension shows that taking a specific product (Campo di mele formula, Phyt-Immun) containing onion 2.5 grams, olive oil 5 mL, grape skin extract 50 mg, L-carnitine 30 mg, vitamin E 3 mg, vitamin C 2 mg, lycopene 1 mg, and folic acid 44 mcg, once daily for one week, decreases systolic and diastolic blood pressure by 5 mmHg and 2 mmHg, respectively, when compared with placebo (66766). It is unclear if this effect is due to onion, other ingredients, or the combination.
• Hypothyroidism. It is unclear if oral onion is beneficial for preventing hypothyroidism. Details: Population research in females has found that high dietary intake of onion is associated with a lower risk of subclinical hypothyroidism when compared with low dietary intake, However, this association was not identified in males. The association of dietary onion intake with symptomatic hypothyroidism was not evaluated (109512).
• Insect bite. Although there has been interest in using topical onion for insect bites, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Insomnia. It is unclear if oral onion is beneficial in patients with poor sleep quality. Details: Preliminary clinical research in healthy adults that were unsatisfied with their current sleep quality shows that taking onion extract 500 mg orally three times daily for 5 days may slightly improve sleep latency and waking after sleep onset, but does not change self-rated sleep quality, when compared with placebo (104774).
• Polycystic ovary syndrome (PCOS). It is unclear if oral onion is beneficial in patients with PCOS. Details: Clinical research in overweight or obese adults with PCOS shows that eating 80-120 grams of raw red onion daily does not improve levels of fasting blood glucose, cholesterol, triglycerides, or lipoprotein (a), and can increase body mass index (BMI) by 0.36 kg/m2, when compared with eating 20-30 grams of raw red onion daily (95155).
• Prostate cancer. It is unclear if oral onion is beneficial for preventing prostate cancer. Details: Population research has found that high dietary intake of onion is not associated with a lower odds of developing prostate cancer when compared with low dietary intake of onion (88410).
• Respiratory tract infections. Although there has been interest in using oral onion for respiratory tract infections, including the common cold, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Stretch marks (striae distensae). Topical onion has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adult females shows that applying a specific cream (Mederma For Stretch Marks, Merz Pharmaceuticals) containing onion extract, gotu kola, and hyaluronic acid to striae rubra twice daily for 12 weeks improves stretch mark scores, including color, softness, and texture, when compared with no treatment (95154).
• Warts. Although there has been interest in using topical onion for warts, there is insufficient reliable information about the clinical effects of onion for this purpose. More evidence is needed to rate onion for these uses.

(Read more about ONION)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Biliary disorders. Although there has been interest in using oral radish for biliary disorders, there is insufficient reliable information about the clinical effects of radish for this purpose.
• Diabetes. Although there has been interest in using oral radish for diabetes, there is insufficient reliable information about the clinical effects of radish for this purpose. More evidence is needed to rate radish for these uses.

(Read more about RADISH)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cognitive function. It is unclear if consuming spinach is beneficial for cognitive function. Details: Preliminary clinical research in healthy adults shows that consuming spinach 200 grams with lunch does not improve attention or memory after 150 minutes when compared with a rice milk control (96852).
• Muscle strength. It is unclear if oral spinach is beneficial for muscle strength. Details: A small, preliminary clinical study in healthy adults over 50 years of age shows that taking an aqueous spinach extract, 1 gram orally twice daily, in conjunction with a moderate-intensity exercise program, 3 sessions per week of 1 hour each for 12 weeks, improves several measures of muscle strength and quality in both sexes, and increases lower leg muscle mass in males, when compared with placebo (109546).
• Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral spinach can reduce the risk of developing NAFLD. Details: A large observational study has found that raw, but not boiled, spinach consumption is inversely associated with the risk of developing NAFLD (106566).
• Obesity. It is unclear if consuming spinach is beneficial for weight loss. Details: Preliminary clinical research in overweight or obese middle-aged and older females shows that taking a specific spinach product (Appethyl, Greenleaf Medical AB) 5 grams daily before breakfast for 12 weeks increases weight loss by an additional 1.5 kg when compared with placebo. However, fat loss, waist circumference, and blood lipids are not improved when compared with placebo (96856,96857).
• Polycystic ovary syndrome (PCOS). It is unclear if oral spinach-derived thylakoids are beneficial for PCOS. Details: A small clinical study in premenopausal adults with PCOS and obesity shows that adding 5 grams orally daily of spinach-derived thylakoids to a low-calorie diet for 12 weeks reduces weight and body mass index (BMI) by 8%, compared with 4% with placebo and the low-calorie diet. Insulin resistance is also improved among those receiving spinach extract. These changes are unlikely to be clinically significant (106568). More evidence is needed to rate spinach for these uses.

(Read more about SPINACH)

POSSIBLY INEFFECTIVE

• Bladder cancer. Consuming tomatoes and tomato-based products does not appear to reduce the risk of bladder cancer. Details: Observational studies have found no association between tomato and tomato-based product intake and the risk of bladder cancer (2407).
• Breast cancer. Consuming tomatoes and tomato-based products does not appear to reduce the risk of breast cancer. Details: Observational studies have found no association between tomato or tomato-based product intake and risk of breast cancer (15747).
• Diabetes. Consuming tomatoes and tomato-based products does not appear to prevent the development of type 2 diabetes or improve glycemic control in patients with type 2 diabetes. Details: Observational studies have found that increasing intake of tomato or tomato-based products does not significantly decrease the risk of developing type 2 diabetes (14004,14361). Additionally, a small clinical study in non-smoking male patients with type 2 diabetes shows that consuming raw tomato 200 grams daily for 8 weeks does not improve plasma glucose levels when compared to baseline (102477). The validity of this finding is limited by the lack of comparator group.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if tomato improves skin appearance. Details: A small study of females aged 35-55 shows that taking a certain tomato pulp product (Lumenato, Lycored) 1 capsule daily for 12 weeks improves patient reported skin appearance scores when compared to baseline (110523). The interpretation of this result is limited by the lack of a placebo group.
• Benign prostatic hyperplasia (BPH). Oral tomato powder has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial in patients with BPH shows that taking 5 grams of a whole tomato food supplement consisting of tomato powder and polyphenols extracted from olives daily for 2 months improves quality of life and reduces lower urinary tract symptoms including urinary frequency, urinary urgency, and nocturia when compared to baseline. No improvements in these symptoms were reported with placebo (106656). It is unclear if these findings are due to tomato, olive polyphenols, or the combination.
• Cardiovascular disease (CVD). It is unclear if consuming tomato-based foods reduces the risk of cardiovascular events. Details: Observational research has found that increased consumption of tomato-based foods is associated with an insignificant trend towards a reduced risk of myocardial infarction, stroke, and other cardiovascular events (10418,102178).
• Cataracts. It is unclear if consuming tomatoes reduces the risk of cataracts. Details: Observational research has found that eating more than 3 servings of tomatoes each week may decrease the risk of developing cataracts (9439).
• Cervical cancer. It is unclear if consuming tomatoes reduces the risk of cervical cancer. Details: Observational research has found that increased tomato intake is associated with a decreased risk of cervical cancer (2407).
• Colorectal cancer. Research on the benefits of consuming tomatoes or tomato-based products for the prevention of colorectal cancer is conflicting and limited to observational studies only. Details: Some observational research has found that increasing tomato or tomato-based product intake is associated with a reduced risk of colorectal cancer (2404,2407). However, higher quality observational research has found that tomato-based product intake is not associated with risk of colorectal cancer (15747).
• Exercise-induced asthma. It is unclear if oral tomato extract is beneficial in patients with exercise-induced asthma. Details: A small clinical study in patients with exercise-induced asthma shows that taking a specific tomato extract (Lyc-O-Mato, LycoRed Ltd) 30 mg daily for 1 week seems to reduce exercise-induced asthma when compared with placebo. The tomato extract seems to prevent decreases in forced expiratory volume (FEV1) in response to exercise (7898).
• Gastric cancer. Research on the benefits of consuming tomatoes or tomato-based products for the prevention of gastric cancer is conflicting and limited to observational studies only. Details: Some observational studies have found that increasing tomato or tomato-based product intake is associated with a reduced risk of gastric cancer in some subgroups of patients (2407,15747,102480). However, other observational research has found that tomato-based product intake is not associated with risk of gastric cancer (15747). In 2005, the US Food and Drug Administration (FDA) approved a qualified health claim regarding tomatoes and gastric cancer risk. However, the FDA concludes that it is highly unlikely that tomatoes reduce the risk of gastric cancer (102375).
• Hyperlipidemia. Small clinical studies suggest that consuming tomato sauce or semi-dried tomatoes may modestly reduce low-density lipoprotein (LDL) cholesterol levels in patients with hyperlipidemia. Details: One small, open-label clinical trial in patients with hyperlipidemia shows that consuming a specific vine-ripened tomato sauce (OsteoCol, C.G. Food, SRL) 150 mL daily for 6 weeks reduces total cholesterol and LDL cholesterol levels when compared to baseline. Patients adherent to the tomato sauce regimen showed an 11 mg/dL and 12 mg/dL reduction in total and LDL cholesterol, respectively, while those consuming a sterol-enriched yogurt saw total and LDL cholesterol levels decrease by 18 mg/dL and 16 mg/dL, respectively. Patients with a baseline LDL cholesterol level of greater than 152 mg/dL saw the greatest benefit from this tomato sauce (106653). Another small clinical study in Japanese patients with borderline high cholesterol shows that taking 50 grams of a semi-dried tomato containing lycopene 22-27.8 mg daily for 12 weeks modestly reduces LDL cholesterol levels but does not affect high-density lipoprotein (HDL) cholesterol levels when compared with taking 50 grams of a tomato without lycopene (102180). This suggests that any benefit of tomato on blood lipid levels is likely due to its lycopene content.
• Hypertension. Small clinical studies and observational research suggest that oral tomato extract or dietary tomato consumption may modestly reduce blood pressure in patients with hypertension. Details: Several small clinical trials in patients with hypertension show that taking a specific tomato extract product (Lyc-O-Mato, LycoRed, Ltd.), providing lycopene 15-30 mg daily, for 6-8 weeks, reduces systolic blood pressure by around 7-13 mmHg and diastolic blood pressure by around 4-6 mmHg when compared to baseline (14287,60415,102182). The validity of these findings is limited by the lack of a comparator group. Additionally, a large observational study, conducted over 3 years, suggests that moderate consumption of tomato-based products (i.e., 44-82 grams daily) is associated with marginally lower blood pressure when compared with higher and lower consumption in older adults with grade 1 hypertension. However, this association is not seen in patients with grade 2 or 3 hypertension (113145). Interpretation of these results is limited by self-reported data and lack of generalizability outside of confounders relating to a Mediterranean lifestyle. Evidence on the use of tomato in patients with pre-hypertension is mixed. One small clinical study in patients with pre-hypertension shows that taking a specific tomato extract (Fruitflow, Provexis Plc, UK.) 150 mg as a single dose seems to modestly reduce blood pressure over a 24-hour period when compared with placebo (102478). This study is limited by its small size and short duration. Another small clinical study in pre-hypertensive patients shows that taking a specific tomato extract (Lyc-o-Mato, LycoRed Ltd) containing lycopene 15 mg daily for 8 weeks does not reduce blood pressure when compared with placebo (42079). The impact of dietary tomato consumption on preventing hypertension has also been evaluated. A large prospective observational study in Chinese adults without a history of smoking or myocardial infarction suggests moderate dietary intake of tomatoes (i.e. up to 33.3 grams daily) is associated with a 49-58% reduction in the risk of developing new onset hypertension when compared with no consumption after about 6 years' follow up. However, the associated risk reduction was less with higher consumption (110525). These results may not apply to patients in countries where dietary trends are different, and the validity of these findings is limited by the potential for confounding. Another large observational study, conducted over 3 years in older adults at high cardiovascular risk, suggests that higher consumption (i.e., at least 1 large-sized tomato daily) is associated with reduced risk of hypertension by 36% when compared with moderate and lower consumption (113145). However, interpretation of these results is limited by self-reported data, and lack of generalizability outside of confounders relating to a Mediterranean lifestyle.
• Lung cancer. It is unclear if consuming tomatoes reduces the risk of lung cancer; the available research is conflicting. Details: Some observational studies have found an association between increased tomato and tomato-based product consumption and a reduced risk of lung cancer; however, many of these studies were not stratified based on the patient's smoking status. Higher quality, large-scale observational studies have not found any association between tomato product intake and lung cancer risk (15747).
• Muscle strength. It is unclear if consuming tomatoes improves muscle strength or attenuates declines in muscle strength. Details: A small observational study in Japanese adults 22-68 years of age found that more frequent tomato consumption (2 or more times weekly) is associated with an attenuated rate of handgrip strength decline over 3 years when compared with less frequent tomato consumption (102473).
• Ovarian cancer. Research on the benefits of consuming tomatoes or tomato-based products for the prevention of ovarian cancer is conflicting and limited to observational studies only. Details: Some observational research has found that increased tomato or tomato juice intake is not associated with risk of ovarian cancer; however, consuming tomato sauce two or more times weekly is associated with a decreased risk (2407). Other observational research has found that increased dietary intake of lycopene, particularly from tomato sauce, is associated with a reduced risk of ovarian cancer in premenopausal patients (10133). In 2005, the US Food and Drug Administration (FDA) approved a qualified health claim regarding tomato sauce and ovarian cancer risk. However, the FDA concludes that it is highly uncertain that tomato sauce reduces the risk of ovarian cancer (102375).
• Pancreatic cancer. Research on the benefits of consuming tomatoes or tomato-based products for the prevention of pancreatic cancer is conflicting and limited to observational studies only. Details: A large-scale observational study have found that that tomato or tomato-based product intake is not associated with a decreased risk of pancreatic cancer (15747). However, other observational studies have found that raw tomato intake, and high tomato intake in general, is associated with a reduced risk of pancreatic cancer (2407,15747,15750). In 2005, the US Food and Drug Administration (FDA) approved a qualified health claim regarding tomatoes and pancreatic cancer risk. However, the FDA concludes that it is highly unlikely that tomatoes reduce the risk of pancreatic cancer (102375).
• Prostate cancer. Consuming tomatoes or tomato-based products may slightly lower the risk of prostate cancer; however, observational research is mixed and high-quality clinical trials addressing tomato intake and prostate cancer risk are lacking. Details: Some observational studies have found that consuming tomato products, including tomatoes, tomato sauce, pizza, or tomato juice, one time or more per week, is associated with a modest reduction in the risk of prostate cancer (2406,7772,7895,12878,15747,102476). However, other observational research has found that tomato consumption is not associated with a reduced risk of prostate cancer (14125,15172,15747,92171). One small clinical study in patients with high-grade prostatic intraepithelial neoplasia shows that taking tomato extract capsules containing lycopene 30 mg daily for 6 months does not impact benign tissue endpoints when compared with placebo (102471). In 2005, the US Food and Drug Administration (FDA) approved a qualified health claim stating that one-half to one cup of tomatoes or tomato sauce weekly may reduce the risk of prostate cancer. However, the FDA concludes that there is little scientific evidence to support this claim (102375).
• Radiation dermatitis. It is unclear if drinking tomato juice is beneficial in patients with radiation dermatitis. Details: One small, uncontrolled clinical trial in patients undergoing radiotherapy for breast cancer shows that drinking tomato juice 160 mg daily for 6 months after radiotherapy improves the severity of dermatitis within 1 month of treatment when compared to baseline (106654). The lack of a comparator group limits the validity of these findings; it is unclear how tomato juice consumption compared with the natural resolution of radiation dermatitis. More evidence is needed to rate tomato for these uses.

(Read more about TOMATO)

POSSIBLY SAFE ...when the leaves are used orally and appropriately, short-term (4,6,12).

LIKELY UNSAFE ...when large amounts are used long-term. Chronic ingestion of alfalfa has been associated with drug-induced lupus effects (381,14828,30602).

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally in medicinal amounts. Alfalfa contains constituents with possible estrogenic activity (4,11,30592).

(Read more about ALFALFA)

LIKELY SAFE ...when used in amounts commonly found in foods.

POSSIBLY SAFE ...when used orally and appropriately for medicinal purposes, short term. Beetroot juice has been safely used in clinical trials in doses of up to 500 mL daily for up to 7 days and a beetroot-based nutritional gel has been used safely in doses of up to 100 grams daily for 8 days (94461,94462,94464,100149,100152,100153).

PREGNANCY AND LACTATION:
There is insufficient reliable information available about the safety of beets used medicinally during pregnancy and breast-feeding.

(Read more about BEET)

LIKELY SAFE ...when used orally in food amounts (14145). There is insufficient reliable information available about the safety of broccoli when used in medicinal amounts.

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in food amounts (14145). There is insufficient reliable information available about the safety of broccoli when used in medicinal amounts during pregnancy and lactation; avoid using.

(Read more about BROCCOLI)

LIKELY SAFE ...when used in amounts commonly found in foods. There is insufficient reliable information available about the safety of Brussels sprout when used in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid amounts in excess of those found in foods.

(Read more about BRUSSELS SPROUT)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Carrot essential oil, extracts, and food additives have Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used orally in medicinal amounts, short-term. Carrot has been used safely in doses of approximately 100 grams three times daily for up to 4 weeks (96308). There is insufficient reliable information available about the safety of carrot when used topically.

CHILDREN: LIKELY SAFE
when used orally in amounts commonly found in foods (4912). Carrot essential oil, extracts, and food additives have Generally Recognized as Safe (GRAS) status in the US (4912).

CHILDREN: POSSIBLY UNSAFE
when carrot juices are used excessively in nursing bottles for small children. Excessive use of carrot juice may cause carotenemia and dental caries (25817).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in food (4912). Carrot essential oil, extracts, and food additives have Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of carrot when used in medicinal amounts during pregnancy and lactation.

(Read more about CARROT)

LIKELY SAFE ...when used orally in amounts commonly found in foods. There is insufficient reliable information available about the safety of cauliflower when used in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using in greater amounts than found in foods.

(Read more about CAULIFLOWER)

LIKELY SAFE ...when celery stems are consumed as food. ...when celery oil or seeds are consumed in amounts commonly found in foods. Celery seed has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when celery seed is used orally and appropriately in medicinal amounts, short-term (12). Celery seed powder has been safely used at doses up to 1500 mg daily for up to 6 weeks and 750 mg daily for up to 12 weeks. Celery seed extract has been safely used at doses up to 1340 mg daily for up to 4 weeks (106486,110755,112409,112411). ...when celery seed extract is used topically and appropriately, short-term (40988,41049,41052).

PREGNANCY: LIKELY UNSAFE
when celery oil or seeds are used orally in larger amounts; celery might have uterine stimulant or abortifacient effects (4,19,19104).

LACTATION:
There is insufficient reliable information available about the safety of medicinal amounts of celery during lactation; avoid using.

(Read more about CELERY)

LIKELY SAFE ...when used in amounts commonly found in foods. There is insufficient reliable information available about the safety of kale when used orally in medicinal amounts.

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods. There is insufficient reliable information available about the safety of kale when used orally in medicinal amounts; avoid use.

(Read more about KALE)

LIKELY SAFE ...when consumed in amounts commonly found in foods. Onion has Generally Recognized as Safe (GRAS) status in the US (4912). ...when onion extract is used topically (66742,66883,66895,66903,67089,95151,95154,95156).

POSSIBLY SAFE ...when onion extract is used orally and appropriately (2). Onion extract has been used safely in doses of 300 mg three times daily for up to 12 weeks (95149,101747).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using in amounts greater than used in foods.

(Read more about ONION)

LIKELY SAFE ...when used orally in moderate amounts (18). Large amounts may lead to gastrointestinal irritation (18).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid very large doses.

(Read more about RADISH)

LIKELY SAFE ...when used in amounts commonly found in foods.

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts. Spinach has been used with apparent safety at a dose of 5 grams daily for up to 12 weeks (96856).

CHILDREN: LIKELY SAFE
when consumed in the amounts commonly found in foods by children older than 4 months of age (18).

CHILDREN: LIKELY UNSAFE
when used orally in infants under 4 months old; the high nitrate content of spinach can cause methemoglobinemia (18). There is insufficient reliable information available about the safety of spinach in children when used in medicinal amounts.

PREGNANCY AND LACTATION: LIKELY SAFE
when used in amounts commonly found in foods; avoid medicinal amounts.

(Read more about SPINACH)

LIKELY SAFE ...when the ripe or unripe tomato fruit or its products are consumed in amounts found in foods (2406,9439,10418,106653,106654). ...when tomato leaf is consumed in regular food amounts (18).

POSSIBLY SAFE ...when a tomato extract is used orally for medicinal purposes. A specific tomato extract (Lyc-O-Mato, LycoRed Ltd) has been used with apparent safety in clinical studies lasting up to 8 weeks (7898,14287,102182).

POSSIBLY UNSAFE ...when the tomato leaf or unripe green tomato fruit is used orally in excessive amounts. Tomato leaf and unripe green tomatoes contain tomatine, which has been associated with toxicity when consumed in large quantities (18,102957). There is insufficient reliable information available about the safety of the tomato vine.

PREGNANCY AND LACTATION: LIKELY SAFE
when the tomato fruit or its products are consumed in typical food amounts. There is insufficient reliable information available about the safety of tomato extracts when used during pregnancy or lactation; avoid using.

(Read more about TOMATO)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, alfalfa might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research suggests that alfalfa decreases blood sugar in diabetic mice (30605). Also, in one case report, a diabetic patient experienced hypoglycemia after consuming alfalfa extract (30608). Monitor blood glucose levels closely. Dose adjustments might be necessary.

CONTRACEPTIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, alfalfa might interfere with the activity of contraceptive drugs.  Details Alfalfa contains coumestrol, a phytoestrogen, and isoflavonoids, which have estrogenic effects (4,30592).

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, alfalfa might interfere with hormone therapy.  Details Alfalfa contains coumestrol, a phytoestrogen, and isoflavonoids, which have estrogenic effects (4,30592).

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, alfalfa might decrease the efficacy of immunosuppressive therapy.  Details In vitro research and human case reports suggest that alfalfa may have immunostimulant effects (12174,14828,14829).

PHOTOSENSITIZING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of alfalfa with photosensitizing drugs might have additive effects.  Details Animal research suggests that excessive doses of alfalfa may increase photosensitivity, possibly due to its chlorophyll content (106043). It is unclear if this effect would be clinically relevant in humans.

WARFARIN (Coumadin) Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, alfalfa might reduce the anticoagulant activity of warfarin.  Details Alfalfa contains a large amount of vitamin K (4,6). This could theoretically interfere with the activity of warfarin.

(Read more about ALFALFA)

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, beet might decrease the levels and clinical effects of CYP1A2 substrates.  Details In vitro research suggests that beet induces CYP1A2 enzymes (111404).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, beet might increase the levels of CYP3A4 substrates.  Details In vitro research suggests that betanin, the major pigment in beet, competitively inhibits CYP3A4 in a dose-dependent manner similarly to strong CYP3A4 inhibitor ketoconazole (113425).

(Read more about BEET)

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, broccoli might reduce the levels and effects of drugs metabolized by CYP1A2.  Details Pharmacokinetic research in humans shows that eating 500 grams of fresh broccoli daily for 6-12 days can increase CYP1A2 activity by 10% to 200% (19608,95722). Induction of CYP1A2 activity by broccoli is attributed to its glucosinolate constituents (19608).

CYTOCHROME P450 2A6 (CYP2A6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, broccoli might reduce the levels and effects of drugs metabolized by CYP2A6.  Details Pharmacokinetic research in humans shows that eating 500 grams of broccoli daily for 6 days increases CYP2A6 activity by 135% to 550%. Induction of CYP2A6 activity is attributed to its glucosinolate constituents (19608).

(Read more about BROCCOLI)

(Read more about BRUSSELS SPROUT)

(Read more about CARROT)

(Read more about CAULIFLOWER)

ACETAMINOPHEN (Tylenol, others) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery juice might increase the effects and side effects of acetaminophen.  Details Animal research suggests that concomitant use of celery juice plus acetaminophen prolongs the effects of acetaminophen. This effect has been attributed to a decrease in hepatic cytochrome P450 activity (25362). However, other animal research shows that pretreatment with celery root extract protects against acetaminophen-induced acute liver failure (106487). These effects have not been reported in humans.

AMINOPYRINE Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery juice might increase the effects and side effects of aminopyrine.  Details Animal research suggests that concomitant use of celery juice plus aminopyrine prolongs the effects of aminopyrine. This effect has been attributed to a decrease in hepatic cytochrome P450 activity (25362). This effect has not been reported in humans.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery root might increase the risk of bleeding when taken with anticoagulant/antiplatelet drugs.  Details Celery root contains the constituents falcarinol and falcarindiol. Laboratory research suggests that these constituents can inhibit platelet aggregation (6048,40991). This effect has not been reported in humans.

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Theoretically, celery seed extract might have additive effects with antihypertensive drugs.  Details Clinical research suggests that taking celery seed extract may reduce daytime systolic blood pressure by about 12 mmHg compared to less than 1 mmHg with placebo (110755).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery might increase levels of drugs metabolized by CYP1A2.  Details In vitro and animal research suggests that constituents of celery can inhibit CYP1A2 (68176). This effect has not been reported in humans.

LEVOTHYROXINE (Synthroid, others) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery seed might decrease the effects of levothyroxine.  Details Several cases of hypothyroidism with low T4 levels have been reported in people who were previously stabilized on levothyroxine and then started taking celery seed tablets. They presented with symptoms such as lethargy, bloating, and dry skin, and recovered when celery seed was stopped (10646). However, celery stem and leaf has been associated with case reports of hyperthyroidism in patients with no pre-existing thyroid disorders (102912,102914).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, celery might reduce excretion and increase levels of lithium due to potential diuretic effects.  Details Celery is thought to have diuretic properties (4,6). However, this effect has not been confirmed in humans.

PHOTOSENSITIZING DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery might increase the risk of photosensitivity reactions when taken with photosensitizing drugs.  Details Laboratory research shows that celery contains photosensitizing agents such as phenols and psoralens (6178,40894,40917,41073,41121).

VENLAFAXINE (Effexor) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery root extract might increase blood levels of venlafaxine.  Details There is one case report of a patient who experienced medication-induced bipolar disorder after beginning to take celery root extract 1000 mg daily along with venlafaxine 75 mg and St. John's wort 600 mg daily. Symptoms included confusion, speech abnormalities, manic affect, and visual hallucinations. The plasma level of venlafaxine was 476.8 ng/mL (normal range 195-400 ng/mL). It is theorized that celery root increased venlafaxine levels by inhibiting cytochrome P450 2D6 (92854).

(Read more about CELERY)

(Read more about KALE)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of anticoagulant or antiplatelet drugs with onion might increase the risk of bleeding.  Details In vitro research shows that onion inhibits platelet aggregation (19,66898).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Concomitant use of antidiabetes drugs with onion may increase the risk of hypoglycemia.  Details Animal research and clinical research shows that taking onion can lower blood glucose levels (19,66800,66812,66859,66982,67033,67043,67053,67072,95148,95160). Monitor blood glucose levels closely.

ASPIRIN Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Concomitant use of aspirin with onion may worsen onion allergy.  Details In one case report, a patient with a mild onion allergy reported worsening allergy, including swelling and severe urticaria, after taking aspirin (5054).

CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, taking onion might increase the levels and clinical effects of drugs metabolized by CYP2E1.  Details Animal research shows that taking onion powder inhibits CYP2E1 (19653). However, this interaction has not been reported in humans.

(Read more about ONION)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, radish might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research shows that radish extract, juice, and sprouts can reduce glucose levels (96960). Animal research also shows that radish root juice 300 mg/kg reduces fasting and postprandial blood glucose in a rat model of diabetes, with effects similar to glibenclamide (98051).

(Read more about RADISH)

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Spinach contains vitamin K, which can interfere with the activity of warfarin.  Details In human research, although eating spinach with one meal does not result in coagulation test results outside the therapeutic range, daily consumption for one week necessitates dose adjustment of warfarin (19600). Individuals using anticoagulants should consume a consistent daily amount of spinach to maintain the effect of anticoagulant therapy (19).

(Read more about SPINACH)

(Read more about TOMATO)

General ...Orally, alfalfa leaf seems to be well tolerated. However, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Abdominal discomfort, diarrhea, and flatulence.
Serious Adverse Effects (Rare):
Orally: Lupus-like syndrome after chronic ingestion of alfalfa.

Dermatologic ...Dermatitis associated with alfalfa use has been reported. In a 1954 publication, dermatitis was noted in a 61-year-old female consuming 4-6 cups of tea made with two tablespoonfuls of alfalfa seeds for approximately two months prior to onset. Examination revealed diffuse, confluent edema and erythema on the face, eyelids, ears, hands, forearms, and distal humeral regions. The dermatitis improved with treatment; re-exposure to alfalfa resulted in a similar reaction (30609).

Endocrine ...Alfalfa contains constituents, including coumestrol, with reported estrogenic activity (30586,30592,4753). Effects in humans are not known.
One case report documents hypokalemia in a female who had been drinking a "cleansing tea" containing alfalfa, licorice, and stinging nettle. The potassium level returned to normal after discontinuing the tea and initiating potassium supplementation. The specific cause of the hypokalemia is not clear. Notably, both stinging nettle and licorice have been associated with hypokalemia and may have been responsible for this effect (30562).

Gastrointestinal ...Orally, flatulence and bulkier feces were reported during the first week of a case series of three subjects ingesting alfalfa (30598). In a case series of 15 patients ingesting alfalfa, increased fecal volume and increased stool frequency was reported. Additional adverse effects included abdominal discomfort in two patients, diarrhea in two patients, loose stools in six patients, and intestinal gas in 13 patients (5816).

Hematologic ...Pancytopenia and splenomegaly were reported in a 59-year-old male who had been taking 80-160 grams of ground alfalfa seeds for up to six weeks at a time, for a five month period. Hematologic values and spleen size returned to normal when alfalfa was discontinued (381).

Other ...Alfalfa products, including sprouts, seeds, and tablets, have been found to be contaminated with Escherichia coli, Salmonella, and Listeria monocytogenes, which have caused documented infections (5600,30566,30568,30572,30569,30564,30604,30610,30563,30607) (30566,30564,30604,30610,30563,30607,30576).
Orally, alfalfa has been associated with the development of a lupus-like syndrome in animals and humans (30594,14828,14830,30602), as well as with possible exacerbations of lupus in patients with known systemic lupus erythematosus (SLE). These reactions may be associated with the amino acid L-canavanine (30594), which appears to be present in alfalfa seeds and sprouts, but not leaves, and therefore should not be present in alfalfa tablets manufactured from the leaves (30601). However, case reports have included individuals ingesting tablets. A lupus-like syndrome was described in four patients taking 12-24 alfalfa tablets per day. Symptoms included arthralgias, myalgias, and rash; positive antinuclear antibodies (ANA) arose anywhere from three weeks to seven months after initiating alfalfa therapy. Upon discontinuation of alfalfa tablets, all four patients became asymptomatic. In two patients, ANA levels normalized (14828). Two additional reports have documented possible exacerbation or induction of SLE associated with alfalfa use. One case involved a female with a 26-year history of SLE, who had been taking 15 tablets of alfalfa daily for nine months prior to an exacerbation. Because of the delay in onset of the exacerbation from the initiation of alfalfa therapy, causation cannot be clearly established (30575). In a different report, SLE and arthritis were found in multiple family members who had been taking a combination of vitamin E and alfalfa tablets for seven years (30602). It is not known what other environmental or genetic factors may have affected these individuals, and the association with alfalfa is unclear.

(Read more about ALFALFA)

General ...Orally, beet seems to be well tolerated when used for medicinal purposes, short term.
Most Common Adverse Effects:
Orally: Red stools and red urine.
Serious Adverse Effects (Rare):
Orally: Hypocalcemia and kidney damage when ingested in large amounts.

Endocrine ...Theoretically, ingestion of large quantities of beets could lead to hypocalcemia because of the oxaluric acid content (18).

Gastrointestinal ...Orally, beet juice may cause red stools (94470,97726,100142,100145,105762). This red coloring of the stools is not harmful. Additionally, beet supplementation has been reported to cause black stools. In one case, a 79-year-old male on apixaban and clopidogrel presented with black stools, nausea, and vomiting after taking beet pills 2-3 days prior. The likelihood of upper gastrointestinal bleed was determined to be low based on factors such as normal vital signs and lack of severe anemia. The patient was diagnosed with beet-induced pseudo-hematochezia which was successfully treated with fluids and discontinuation of the beet supplement (113426).
Other less common gastrointestinal side effects include loose stools, constipation, and nausea (100149).

Genitourinary ...Orally, beet is known to produce red or pink urine (beeturia) in some people (32569,34134,94464,94470,97725,97726,100142,100145,100152,105762,113422). However, this red coloring of the urine is not harmful and dissipates after about 12 hours (113422).

Neurologic/CNS ...Orally, vivid dreams and worsening headaches have each occurred in one person in a clinical trial, although it is not clear if this is due to beet (97723).

Renal ...Theoretically, ingestion of large quantities of beets could lead to kidney damage due to its oxaluric acid content (18).

(Read more about BEET)

General ...Broccoli is well tolerated when consumed as food. A thorough evaluation of safety outcomes when broccoli is taken as medicine has not been conducted.

Dermatologic ...Topically, allergic reactions to broccoli have caused contact dermatitis (14158).

Gastrointestinal ...Orally, loose stools, diarrhea, abdominal pain, and abdominal cramping have been reported following intake of broccoli seed and sprout extracts, particularly at high doses (114753).

Hepatic ...In one case report, a 56-year-old adult developed elevated transaminases, with alanine aminotransferase (ALT) 5. 8 times above normal, aspartate aminotransferase (AST) 2.4 times above normal, and gamma-glutamyl transpeptidase (GGT) 5.1 times above normal. This was thought to be related to the consumption of 800 mL of broccoli juice daily over a 4-week period. Values returned to normal 15 days after cessation of juice consumption (96191).

Immunologic ...Topically, allergic reactions to broccoli have caused contact dermatitis (14158).

(Read more about BROCCOLI)

General ...Orally, Brussels sprout is generally well-tolerated when consumed in dietary amounts. Eating Brussels sprout or other types of fermentable carbohydrates can cause flatulence (26470).

Gastrointestinal ...Orally, eating Brussels sprout or other types of fermentable carbohydrates can cause flatulence (26470).

(Read more about BRUSSELS SPROUT)

General ...Orally, carrot is well tolerated when consumed as a food. It also seems to be generally well-tolerated when consumed as a medicine. Some people are allergic to carrot; allergic symptoms include anaphylactic, cutaneous, respiratory, and gastrointestinal reactions such as hives, swelling of the larynx, asthma, or diarrhea (25820,93606,106560). In infants, excessive consumption of carrot products in nursing bottles has been reported to cause extensive caries in the primary teeth (25817).
Topically, carrot has been associated with a case of phytophotodermatitis (101716).

Dental ...Orally, feeding carrot juice to infants, with or without sugar- or acid-containing beverages, has been reported to damage teeth and cause dental caries (25817).

Dermatologic ...Orally, excessive consumption of carrots or carrot-containing products can cause yellowing of the skin, which results from increased beta-carotene levels in the blood (25817). Carrots may cause allergic reactions in some patients. Allergic responses to carrot-containing foods include skin reactions such as hives, erythema, swelling, and/or papules (25820,96306).

Gastrointestinal ...Orally, carrots may cause allergic reactions in some patients. Allergic responses to carrot-containing foods can include gastrointestinal symptoms, such as diarrhea (25820).

Immunologic ...Orally, carrots may cause allergic reactions in some patients (25820,96306,106560). Allergic responses to carrot-containing foods can include skin reactions such as hives, erythema, swelling, and/or papules (25820,96306). For one patient, treatment of skin lesions resolved after a month of oral antihistamines and topical steroids, and avoiding further contact with carrot (96306). Allergic responses to carrot-containing foods can also include gastrointestinal symptoms, such as diarrhea, and respiratory symptoms, such as swelling of the larynx or asthma (25820). In one case, a patient with a history of allergic rhinitis and asthma who had been successfully treated with subcutaneous immunotherapy and was tolerant of consumption of raw and cooked carrots developed rhinoconjunctivitis when handling carrots. Inhalation of dust particles and aerosols produced by food processing activities and containing allergens from the peel and pulp of carrots is thought to have sensitized the airway, producing a distinct form of respiratory food allergy in which there are typically no symptoms with ingestion (106560).
Topically, a female runner developed phytophotodermatitis, which was considered possibly associated with the inclusion of carrot in a sunscreen (Yes To Carrots Daily Facial Moisturizer with SPF 15; Yes to, Inc.) (101716).

Psychiatric ...Compulsive carrot eating is a rare condition in which the patient craves carrots. According to one case report, withdrawal symptoms include nervousness, cravings, insomnia, water brash, and irritability (25821).

(Read more about CARROT)

General ...Orally, no adverse effects have been reported when cauliflower is used medicinal amounts; however, a thorough evaluation of safety outcomes has not been conducted.

(Read more about CAULIFLOWER)

General ...Orally, celery seems to be well tolerated.
Most Common Adverse Effects:
Orally: Photosensitivity. Oral allergy syndrome in sensitive individuals.
Topically: Photosensitivity. Contact dermatitis in sensitive individuals.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis in sensitive individuals.

Dermatologic ...Due to its psoralen content, contact with or ingestion of celery and exposure to ultraviolet radiation may cause photodermatitis (4,34347,40968,40969,40986,41085,41087,41143,41146,41151). Acute symptoms include skin eruption with edema and erythema; the main chronic symptom is hyperpigmentation at the eruption site (41093).
Celery can also cause contact or atopic dermatitis (19,41118,41124) and urticaria pigmentosa (40908).

Endocrine ...Celery has been associated with hyperthyroidism in otherwise healthy adults. In one case report a 36-year-old female presented with weight loss, blurred vision, nausea, palpitations, sweating, exophthalmos, elevated serum T4 levels, and low thyroid stimulating hormone (TSH) levels after taking 8 grams of a powdered celery extract for 78 days (102912). In another case report, a 48-year-old male presented with weight loss, exophthalmos, sweating, elevated serum T4 levels, and low TSH levels after taking 4 grams of dried celery leaves for 45 days (102914). In both of these cases, symptoms resolved and thyroid function tests normalized after discontinuing celery and completing a course of methimazole.
In contrast, several cases of hypothyroidism with low T4 levels have been reported in people who were previously stabilized on levothyroxine and then started taking celery seed tablets. They presented with symptoms such as lethargy, bloating, and dry skin, and recovered when celery seed was stopped (10646).

Gastrointestinal ...Symptoms of celery allergy have included oral allergy syndrome, characterized by itching and burning in the mouth and throat (41159,40977,115301), and laryngeal edema (40953).

Immunologic ...Raw celery, cooked celery, and celery juice can all cause allergic reactions (40908,40926,41118,41131,92852,92855,115301). Symptoms of celery allergy include laryngeal edema, skin reactions, nasal congestion and discharge, an urticaria-edema-anaphylactic shock syndrome, celery-dependent exercise-induced anaphylaxis, and anaphylactic shock (40953,41100,41102,41107,41115,41124,41129,41135,41137,92852)(92855,115301). Additionally, in clinical research, itchy throat has been reported in individuals taking celery seed powder (112410).
There is a case report of anaphylactic shock involving hypotension, tachycardia, and tachypnea in a patient who had ingested raw celery 15 minutes prior to symptom onset. The patient was treated with epinephrine, dexamethasone, and antazoline (92855). Another case report describes a patient with positive skin prick tests to celery, pollens including birch, chrysanthemum, mugwort, and ragweed, and to dust mites. When celery was consumed 30 minutes prior to exercise, the patient had an anaphylactic reaction that required treatment with intravenous pheniramine and corticosteroid, as well as nebulized albuterol (92852). Additionally, a patient with a history of shortness of breath and cough after consuming a spice mixture containing dried celery had a positive food challenge with 15 grams of cooked celery mixed with different ingredients to mask the taste. The patient's reaction included wheezing, tachycardia, and itching, and treatment required intravenous dexamethasone and clemastinum and intramuscular epinephrine. Notably, prior to the food challenge, the patient had a negative skin prick test to food allergens including celery, but an inhibition assay confirmed cross-sensitivity to mugwort(115301). Another patient with a history of anaphylactic reactions to undeclared celery in restaurant meals was able to undergo desensitization with gradually increasing oral doses of celery juice over several months, and then chronic daily ingestion of the juice to maintain hyposensitization (40908).

(Read more about CELERY)

General ...Orally, kale is generally well tolerated when consumed in amounts commonly found in foods. No adverse effects have been reported with medicinal use. However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about KALE)

General ...Orally, onion is well tolerated. Topically, onion is generally well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, heartburn.
Topically: Eczema, irritation.
Serious Adverse Effects (Rare):
All ROAs: Anaphylaxis in sensitive individuals.

Dermatologic ...Topically, frequent contact with onions can result in hand eczema, pemphigus, sensitization, and irritation (18,5004,51303,67066,67093).

Gastrointestinal ...The consumption of large quantities of onions or onion powder can cause stomach distress or heartburn (18,95155,104772). Stomach distress from onion powder appears to be transient (104772). In one case report, consumption of raw onions led to esophageal spasm (66841).

Immunologic ...Allergy to onion is rare, although there are reports of symptoms to both oral and topical exposure (41752,101743). In one case, oral exposure or the aroma of onions caused the sensation of throat closing in an allergic woman (88404). In a 35-year-old man, cooked onion ingestion triggered anaphylaxis (101742). In another case, the smell of onion was identified as a trigger for migraines in a 32-year-old female. Because the patient had a positive allergy skin test for onion, allergenic or immunogenic mechanisms were considered to be the origin of the migraines (88404).

Ocular/Otic ...Exposure to onion aroma can cause excessive tearing (67049).

(Read more about ONION)

General ...Orally, radish seems to be well tolerated when used in moderate amounts.

Gastrointestinal ...Large amounts of radish may cause irritation of the gastrointestinal mucus membrane (18). Mild indigestion has also been associated with use of a specific product containing radish, camu camu, acerola, honey, and tapioca in clinical research. However, it is unclear if this adverse event is due to radish, other ingredients in the product, or the combination (94290).

Immunologic ...A case of allergy to oral intake of radish has been reported. Symptoms included throat tightness and generalized urticaria (94289).

(Read more about RADISH)

General ...Orally, spinach is well tolerated when consumed as a food.
Serious Adverse Effects (Rare):
Orally: In infants under 4 months of age, methemoglobinemia has been reported.
All routes of administration: Allergies in sensitive individuals.

Dermatologic ...Topically, contact dermatitis has been reported from spinach in a 54-year-old female farmer (41757).

Gastrointestinal ...Bagged spinach has been linked to Escherichia coli outbreaks, sometimes causing severe gastrointestinal symptoms and even death (75846,75847,75849,75851,96858).

Hematologic ...Orally, spinach ingestion by infants under 4 months of age can cause methemoglobinemia, due to its high nitrate content (75802,75858,75860,75861,75862).

Immunologic ...Orally, topically, and via inhalation, spinach has been reported to cause allergic reactions in sensitive individuals (75870,96859).

Pulmonary/Respiratory ...Lung inflammation associated with allergic alveolitis has been reported after inhalation of spinach powder (75871). The powder has also been reported to induce occupational asthma in a spinach factory worker (75833).

(Read more about SPINACH)

General ...Orally, tomato leaves and ripe or unripe tomato fruit are well tolerated in typical food amounts. Tomato extracts also seem to be well tolerated. Tomatine, a glycoalkaloid found in tomato leaves and unripe green tomatoes, can cause serious side effects when consumed in excessive amounts.
Serious Adverse Effects (Rare):
Orally: Bradycardia, diarrhea, respiratory disturbances, spasms, vomiting, and death with excessive consumption of tomatine, a glycoalkaloid found in tomato leaves and unripe green tomatoes.

Cardiovascular ...Orally, the glycoalkaloid tomatine in tomato leaf or green tomatoes can cause bradycardia when consumed in excessive amounts (18,102957).

Gastrointestinal ...Orally, the glycoalkaloid tomatine in tomato leaf or green tomatoes can cause severe mucous membrane irritation, vomiting, diarrhea, and colic when consumed in excessive amounts (18,102957).

Immunologic ...In a case report, a 31-year-old female working in the supermarket developed an airborne allergy to tomato stem proteins with symptoms of severe rhinoconjunctivitis. This woman did not have a food allergy to tomato fruit (102467).

Neurologic/CNS ...Orally, the glycoalkaloid tomatine in tomato leaf or green tomatoes can cause dizziness, stupor, headache, and mild spasms when consumed in excessive amounts (18,102957).

Pulmonary/Respiratory ...Orally, the glycoalkaloid tomatine in tomato leaf or green tomatoes can cause respiratory disturbances when consumed in excessive amounts. In severe cases, death by respiratory failure might occur (18,102957).

(Read more about TOMATO)