Acerola 450 mg 25% Extract by TerraVita Premium Collection

POSSIBLY EFFECTIVE

• Vitamin C deficiency. Orally, consuming acerola might help to prevent or treat vitamin C deficiency since acerola contains a significant amount of vitamin C. Details: Acerola is a rich source of vitamin C (30260). Therefore, taking acerola orally might prevent vitamin C deficiency and scurvy. An infant with scurvy was successfully treated with acerola juice by the Puerto Rican researchers who first identified acerola as a good source of vitamin C (93207).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Atherosclerosis. Although there is interest in using oral acerola for atherosclerosis, there is insufficient reliable information about the clinical effects of acerola for this condition.
• Common cold. Although there is interest in using oral acerola for the common cold, there is insufficient reliable information about the clinical effects of acerola for this condition.
• Diarrhea. Although there is interest in using oral acerola for diarrhea, there is insufficient reliable information about the clinical effects of acerola for this condition. More evidence is needed to rate acerola for these uses.

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POSSIBLY SAFE ...when acerola fruit is used orally and appropriately. Acerola fruit contains an average of 2000 mg vitamin C per 100 grams of fruit, although this content varies widely. Acerola fruit should be consumed in amounts that do not provide more vitamin C than the tolerable upper intake level (UL) of 2000 mg per day for adults (4844).

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

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ALKYLATING AGENTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, the antioxidant effects of acerola might reduce the effectiveness of alkylating agents.  Details Acerola contains vitamin C, an antioxidant. There is concern that antioxidants might reduce the activity of chemotherapy drugs that generate free radicals, such as alkylating agents (391). In contrast, other researchers theorize that antioxidants might make alkylating chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells (14012,14013). More evidence is needed to determine what effect, if any, antioxidants such as vitamin C have on chemotherapy.

ALUMINUM Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of acerola with aluminum salts might increase the amount of aluminum absorbed.  Details Acerola contains vitamin C. It is thought that vitamin C chelates aluminum, keeping it in solution and available for absorption (10549,10550,10551). In people with normal renal function, urinary excretion of aluminum likely increases, making aluminum retention and toxicity unlikely (10549). However, patients with renal failure who take aluminum-containing compounds, such as phosphate binders, should avoid acerola in doses that provide more vitamin C than the recommended dietary allowances.

ANTITUMOR ANTIBIOTICS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, the antioxidant effects of acerola might reduce the effectiveness of antitumor antibiotics.  Details Acerola contains vitamin C, an antioxidant. There is concern that antioxidants might reduce the activity of chemotherapy drugs that generate free radicals, such as antitumor antibiotics (391). In contrast, other researchers theorize that antioxidants might make antitumor antibiotic chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells (14012,14013). More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on antitumor antibiotic chemotherapy.

ASPIRIN Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Unlikely •  Level of Evidence = B Theoretically, acerola might reduce the clearance of aspirin; however, its vitamin C content is likely too low to produce clinically significant effects.  Details Acerola contains vitamin C. It has been suggested that acidification of the urine by vitamin C can decrease the urinary excretion of salicylates, increasing plasma salicylate levels (3046). However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion (10588,10589). The vitamin C content of acerola is typically about 2000 mg per 100 grams. Thus, a clinically significant interaction between acerola and aspirin is unlikely.

ESTROGENS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of acerola with estrogens might increase estrogenic effects.  Details Acerola contains vitamin C. Increases in plasma estrogen levels of up to 55% have occurred under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products (129,130,11161). It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall (129,11161). When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. However, increases in plasma estrogen levels may occur when women who are deficient in vitamin C take supplements (11161).

WARFARIN (Coumadin) Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, acerola might reduce the effectiveness of warfarin; however, its vitamin C content is likely too low to produce clinically significant effects.  Details Acerola contains vitamin C. High doses of vitamin C may reduce the response to warfarin, possibly by causing diarrhea and reducing warfarin absorption (11566). This occurred in two people who took up to 16 grams daily of vitamin C, and resulted in decreased prothrombin time (9804,9806). Lower doses of 5-10 grams daily of vitamin C can also reduce warfarin absorption, but this does not seem to be clinically significant (9805,9806,11566,11567). The vitamin C content of acerola is typically about 2000 mg per 100 grams. Thus, a clinically significant interaction between acerola and warfarin is unlikely.

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General ...Orally, acerola seems to be well tolerated. However, a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Acerola has been linked with one case of anaphylaxis and one case of rectal obstruction.

Gastrointestinal ...Osmotic diarrhea and gastrointestinal upset have been reported with doses of vitamin C greater than the tolerable upper intake level (UL) of 2000 mg daily (4844). Theoretically this could occur with large doses of oral acerola. A case report describes rectal obstruction with mass consisting of partially digested acerola fruits in a 5-year-old child who had ingested an unknown quantity of fruits daily for 7 days. The child presented with vomiting, abdominal pain and distension, tenesmus, constipation, and dehydration, and required surgical disimpaction (93205).

Immunologic ...There is a case report of a 37 year old man who developed a pruritic rash, dyspnea, and tachycardia 5 minutes after drinking a mixture of apple and acerola juices. He had a history of hay fever, oral allergy symptoms with avocado, celery, walnut, and curry, and contact urticaria with latex, but tolerated apples and apple juice. IgE antibodies to acerola were identified in the patient's serum. Ultimately, cross-reactivity between a latex protein and acerola was determined (93206).

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