Acai Power Berry Pure-Body Cleanse by Nature&#39;s Secret

Aging skin. Although there is interest in using oral or topical acai to prevent aging skin, there is insufficient reliable information about the clinical effects of acai for this purpose.
Athletic performance. It is unclear if oral acai is beneficial for improving athletic performance. Details: Preliminary clinical research in amateur cyclists shows that consuming 400 grams of pasteurized acai pulp daily for 15 days prevents oxidative damage and decreases levels of blood lactate during exercise by 28% when compared with placebo. Consuming acai pulp also seems to increase anaerobic threshold intensity, but does not improve maximum workload or measures of exertion, when compared to baseline (102860).
Erectile dysfunction (ED). Although there is interest in using oral acai for ED, there is insufficient reliable information about the clinical effects of acai for this condition.
Hypercholesterolemia. Although there is interest in using oral acai for hypercholesterolemia, there is insufficient reliable information about the clinical effects of acai for this condition.
Metabolic syndrome. Although there is interest in using oral acai for metabolic syndrome, there is insufficient reliable information about the clinical effects of acai for this condition.
Obesity. It is unclear if oral black seed is beneficial for improving metabolic indices in overweight individuals. Details: In overweight individuals, preliminary clinical research shows that consuming 100 mg of acai pulp (Sambazon Acai Smoothie Pack, Sambazon Inc.) twice daily for one month reduces fasting glucose and total cholesterol levels when compared with baseline. However, no effect was seen on levels of low density lipoprotein (LDL) cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, or blood pressure (17731). The validity of these findings is limited by the lack of a comparator group.
Osteoarthritis. Although there is interest in using oral acai for osteoarthritis, there is insufficient reliable information about the clinical effects of acai for this condition.
Tinnitus. It is unclear if oral acai is beneficial for chronic tinnitus. Details: A small clinical study in adults with unilateral or bilateral chronic tinnitus, with either normal hearing or mild hearing loss, shows that taking dried acai pulp extract 100 mg daily for 3 months decreases tinnitus discomfort when compared with baseline (107846). However, the validity of this finding is limited by the lack of statistical comparison to the placebo group, which reported a numerically similar improvement in tinnitus discomfort. More evidence is needed to rate acai for these uses.

BLUEBERRY (Blueberry (Vaccinium angustifolium) powder)

POSSIBLY INEFFECTIVE

Hypertension. Most clinical research suggests that consuming freeze-dried blueberries or blueberry powder does not lower blood pressure in patients with hypertension, prehypertension, or other risk factors for cardiovascular disease. Details: Although conflicting results exist (92386,99139), a meta-analysis of 6 clinical trials including approximately 200 patients with hypertension, prehypertension, or other risk factors for cardiovascular disease shows that consuming freeze dried blueberries or blueberry powder 22-50 grams daily for 6-8 weeks does not significantly lower systolic or diastolic blood pressure when compared with placebo (92390).

Anxiety. It is unclear if oral blueberry can improve symptoms of anxiety. Details: A small clinical study in healthy adults shows that drinking 30 mL of blueberry juice diluted in 100 mL of water twice daily for 20 days reduces measures of state and trait anxiety when compared with placebo (111235).
Age-related cognitive decline. Small clinical studies suggest that oral blueberry products may slightly improve some measures of cognitive function in older adults with age-related cognitive decline. Details: Most clinical evidence shows that blueberry can improve some aspects of cognitive decline, but it has minimal effect on other measures. One small clinical trial in older patients with self-reported cognitive decline shows that taking freeze-dried blueberry powder 12.5 grams twice daily for 6 months modestly improves cognitive performance in daily activities but most measures of cognitive function did not improve (97181). Another small clinical study in patients 60 years of age and older with self-reported memory complaints shows that taking a wild blueberry extract (ThinkBlue, Naturex Inc) 100 mg daily with cysteine and glutathione modestly improves episodic memory at 3 months, but not at 6 months, when compared with placebo. However, taking this same blueberry extract or a wild blueberry powder 450 mg or 900 mg daily with cysteine and glutathione does not improve sequence recall, working memory, or executive function (99139). Other small clinical studies show a benefit in some, but not all measures of executive functioning and memory (96467,111234)
Aging. It is unclear if consuming blueberry can improve functional mobility in adults 60 years of age and older. Details: One small clinical study in adults over 60 years of age shows that consuming 2 cups of frozen blueberries daily for 6 weeks improves some measures of functional mobility, such as foot placement and balance, when compared with drinking carrot juice. However, blueberry does not seem to improve hand grip strength, executive function, or other measurements of gait speed when compared with carrot juice (92387). Another small clinical study in this same age group shows that consuming 12 grams of powdered blueberry mixed with liquid twice daily for 3 months does not improve measures of functional mobility when compared with placebo (96467).
Athletic performance. Small clinical studies suggest that oral freeze-dried blueberry powder may not reduce exertion or improve long-distance running performance in trained runners. Details: Two small clinical studies in adults with running experience show that taking freeze-dried blueberry powder 24 grams three times daily for four days does not improve perceived exertion, the time to run 8 km, or distance run over 30 minutes when compared with placebo. However, blueberry does appear to modestly attenuate increases in blood lactate after running (101963,107282).
Cancer. Although there has been interest in using oral blueberry for preventing cancer, there is insufficient reliable information about the clinical effects of blueberry for this purpose.
Cardiovascular disease (CVD). Small clinical studies suggest that oral blueberry supplementation might modestly improve body weight and triglyceride levels, but not body mass index (BMI), glycemic control, or cholesterol levels, in patients at risk for CVD. Details: A meta-analysis of 11 small and low-quality clinical studies involving a total of 497 adults with various risk factors for CVD shows that taking blueberry for 4-16 weeks modestly reduces weight and triglyceride levels, but does not improve other risk factors for CVD, including BMI, glycemic indices, cholesterol levels, and certain inflammatory mediators, when compared with placebo or other control. In a sub-group analysis, weight reduction was slightly more favorable in studies of longer than 6 weeks' duration (mean reduction of 0.91 kg) and in studies using blueberry powder or freeze-dried blueberry (mean reduction of 0.86 kg) (105702). The validity of these findings is limited by the heterogeneity and small size of the included studies. Additionally, it is unclear if blueberry is beneficial for reducing the risk for CVD or CVD-related complications.
Cataracts. Although there has been interest in using oral blueberry for preventing cataracts, there is insufficient reliable information about the clinical effects of blueberry for this purpose.
Cognitive function. Small clinical studies suggest that oral blueberry products may improve some, but not most, measures of cognitive function in children and adults. Details: Several small clinical studies in children 7-10 years of age show that drinking a blueberry drink containing 30 grams of freeze-dried blueberries or 200 grams of fresh blueberries as a single dose does not improve most measures of cognitive function when compared with placebo. These trials showed small improvements in some measures of cognitive function, including auditory-verbal learning, word recognition, and delayed memory, but these specific findings were not consistent across all studies (92394,96465,101961). Additionally, a small clinical trial in healthy young adults shows that taking a combination of blueberry and grape extracts (Memophenol, Activ'Inside) 600 mg increases the ability to complete serial three subtraction by 2.5-fold when compared with placebo. However, there were no other improvements in working memory or attention during a sustained cognitive effort (101960).
Depression. It is unclear if oral blueberry extract or freeze-dried powder is beneficial in patients with depression. Details: One small clinical study in adults with cerebral venous thrombosis (CVT)-associated depression and depression-associated gastrointestinal infection shows that taking blueberry extract 10 mg daily for 3 months reduces symptoms of depression by 49% and gastrointestinal infection rates by 84% when compared to baseline; when compared with placebo, these changes are significant (96464). Another small clinical study in healthy adults shows that drinking 30 mL of blueberry juice diluted in 100 mL of water twice daily for 20 days reduces symptoms of depression when compared with placebo (111235). A small clinical study in healthy adolescents 11-17 years of age without diagnosed mental health issues at baseline shows that drinking freeze-dried wild blueberry powder 13 grams daily for 4 weeks improves self-reported depressive symptoms, but not anxiety symptoms or transient affect, when compared with placebo. The adolescents enrolled in this study were found to have suboptimal fruit and vegetable intake at baseline (105703).
Diabetes. It is unclear if oral freeze-dried blueberry powder is beneficial in patients with diabetes. Details: A small clinical study in males 45-75 years of age with type 2 diabetes shows that drinking 11 grams of freeze-dried highbush blueberry powder mixed with water twice daily with a meal for 8 weeks reduces glycated hemoglobin (HbA1c) values and triglyceride levels, but not body weight, fasting plasma glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, or blood pressure, when compared with placebo. This study may have been inadequately powered to detect a difference between groups (105701). Blueberry has also been evaluated for the prevention of gestational diabetes. A small clinical study in patients with a history of gestational diabetes shows that consuming 280 grams of blueberries plus 12 grams of soluble fiber daily for 18 weeks, starting at less than 20 weeks' gestation, along with standard care reduces maternal weight gain and blood glucose levels after glucose challenge testing when compared with standard care alone. However, neither gestational diabetes incidence nor infant birth weight was lower with blueberry supplementation when compared with standard care alone (107281).
Hyperlipidemia. It is unclear if oral blueberry is beneficial in patients with hyperlipidemia. Details: One small clinical study in healthy adults shows that drinking blueberry juice 30 mL twice daily for 20 days reduces total cholesterol and low-density lipoprotein (LDL) cholesterol when compared with placebo (111235). Additionally, drinking a combination of blueberry, apple, chokeberry, and cranberry juice 300 mL daily for 6 weeks appears to decrease total cholesterol and increase high-density lipoprotein (HDL) cholesterol when compared to baseline in females with overweight or obesity and at least one risk factor for cardiovascular disease (111233). However, the validity of the study is limited by its small size, short duration, and lack of a comparator group. It is unclear if these effects are due to blueberry, other ingredients, or the combination. In contrast, other small clinical studies suggest that blueberry does not improve lipid levels (105701,111234). A small clinical study in males 45-75 years old shows that blueberry has no effect on total cholesterol, HDL cholesterol, and LDL cholesterol, but may reduce triglycerides, when compared with placebo. However, in a sub-group of patients also taking lipid-lowering medications, blueberry reduced levels of total cholesterol and LDL cholesterol when compared with placebo (105701). Another small clinical study in middle-aged adults with overweight shows that taking oral blueberry powder daily for 12 weeks does not impact total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides when compared with placebo (111234). However, these studies may have been inadequately powered to detect a difference between groups.
Hypertriglyceridemia. It is unclear if oral blueberry leaf extract is beneficial in patients with hypertriglyceridemia. Details: A small clinical trial in patients with mild to moderate hypertriglyceridemia shows that taking a single dose of a blueberry leaf extract 300 mg along with a high-fat meal reduces postprandial triglyceride levels, but not postprandial glucose or insulin levels, when compared with placebo (101959).
Juvenile idiopathic arthritis (JIA). It is unclear if oral blueberry juice is beneficial in children with JIA. Details: A small clinical study in children with JIA shows that adding 50 mL of blueberry juice daily to treatment with etanercept 50 mg twice weekly for 6 months increases the percentage of patients who achieve a 20% improvement in symptoms based on American College of Rheumatology criteria when compared with taking etanercept along with placebo juice. About 75% of patients in the blueberry juice group experienced a 20% improvement in symptoms, compared with 51% of patients in the placebo group, suggesting that for every four patients that drink blueberry juice along with etanercept therapy, one additional patient will experience a 20% or greater improvement in symptoms. Drinking blueberry juice also appears to reduce side effects caused by etanercept, including weight gain, infection, diarrhea, and anorexia (92388).
Metabolic syndrome. Small clinical studies in patients with metabolic syndrome, along with an analysis of studies in patients at risk for metabolic syndrome, suggest that oral freeze-dried blueberries do not improve body weight or glycemic control, but may slightly lower blood pressure and cholesterol levels. Details: A small clinical study in patients with metabolic syndrome shows that taking freeze-dried blueberry powder 26 grams daily for 6 months improves flow-mediated dilation by 45% when compared with placebo, but does not affect low-density lipoprotein (LDL) cholesterol levels, insulin resistance, or blood pressure. In a sub-group of patients not taking statins, blueberry increased levels of high-density lipoprotein (HDL) cholesterol by 3 mg/dL; however, a lower dose of 13 grams daily had no beneficial effects (101958). Another small clinical trial in patients with metabolic syndrome shows that consuming freeze-dried blueberries 25 grams twice daily for 8 weeks reduces systolic blood pressure by around 4% and diastolic blood pressure by around 3% when compared with placebo, but does not affect body weight, lipid levels, or glycemic control (107278). Additionally, a small clinical trial in patients with metabolic syndrome shows that drinking a smoothie containing freeze-dried blueberry powder 22.5 grams twice daily for 6 weeks does not improve blood pressure, body weight, glycemic control, or lipid levels when compared with placebo, although it does improve measures of endothelial function (107279). A meta-analysis evaluating the studies above, along with 9 small clinical trials in patients at risk for metabolic syndrome, shows that blueberry supplementation does not improve body weight, glycemic control, triglyceride levels, or systolic blood pressure. However, it reduces total cholesterol by around 8 mg/dL, low-density lipoprotein (LDL) cholesterol by around 9 mg/dL, and diastolic blood pressure by around 2 mmHg when compared with placebo (107280).
Muscle strength. Oral blueberry has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial in young, healthy males shows that taking blueberry extract 200 mg plus phosphocreatine disodium salts 5 grams daily for 28 days improves peak torque and average power during leg extension exercises when compared to baseline, while individuals taking placebo saw no improvements in these measures (107284). It is unclear if these findings are due to blueberry, phosphocreatine, or the combination.
Night vision. Although there has been interest in using oral blueberry for improving night vision, there is insufficient reliable information about the clinical effects of blueberry for this purpose.
Obesity. Oral blueberry has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in females with overweight or obesity and at least one risk factor for cardiovascular disease shows that drinking a combination of blueberry, apple, chokeberry, and cranberry juice 300 mL daily for 6 weeks does not reduce body weight, body mass index (BMI), or blood pressure but might improve total cholesterol and high-density lipoprotein (HDL) cholesterol when compared to baseline (111233). However, the validity of these findings is limited by the small study size, short duration, and lack of a comparator group. It is unclear if these effects are due to blueberry, other ingredients, or the combination.
Urinary tract infections (UTIs). Although there has been interest in using oral blueberry for preventing UTIs, there is insufficient reliable information about the clinical effects of blueberry for this purpose. More evidence is needed to rate blueberry for these uses.

POSSIBLY INEFFECTIVE

Bowel preparation. Taking cascara sagrada orally with magnesium sulfate or magnesium hydroxide prior to colonoscopy does not appear to improve bowel cleansing when used alone or as an adjunct to polyethylene glycol. Details: Some clinical research shows that taking a specific combination of cascara sagrada plus magnesium sulfate (Pico-Salax) orally along with polyethylene glycol (GoLYTELY) is not more effective than polyethylene glycol alone for bowel preparation prior to colonoscopy (40086). Other clinical research shows that taking cascara sagrada plus magnesium sulfate orally, alone or in combination with polyethylene glycol (GoLYTELY), is actually less effective than polyethylene glycol alone (40087,40088). Additionally, some clinical research shows that taking a combination of cascara sagrada 5 mL plus milk of magnesia 30 mL orally does not improve bowel cleansing or examination quality when compared with no bowel preparation (40090,40093).

Constipation. It is unclear if oral cascara sagrada is beneficial in patients with constipation. Details: Cascara sagrada has a history of use for its laxative effects in patients with constipation (272). In fact, cascara sagrada was formerly approved by the US Food and Drug Administration (FDA) as a safe and effective over-the-counter (OTC) laxative; however, this designation was removed in 2002 due to a lack of supporting evidence (8229). More evidence is needed to rate cascara sagrada for this use.

CRANBERRY (Cranberry (Vaccinium macrocarpon) powder)

POSSIBLY EFFECTIVE

Urinary tract infections (UTIs). Cranberry products may possibly reduce the risk of repeat, symptomatic UTI in females with recurrent UTI, in children, and in people susceptible to UTI following kidney transplant, urogenital surgery, or radiation therapy near the urogenital system. While some positive evidence exists, most research suggests that cranberry products do not seem to reduce the risk of UTI in older adults in institutions, pregnant patients, or adults with neuromuscular dysfunction of the bladder. Cranberry is not recommended for the treatment of UTI in any population. Details: Cranberry appears to reduce the risk of UTI in some populations but not others. In healthy females at an increased risk of UTI or history of recurrent UTI, meta-analyses of clinical trials show that cranberry products decrease the overall risk of recurrent or first-time UTI by 26% to 35% (46473,92578,96739,111407). In 2019, the American Urological Association published guidelines stating that, based on low certainty evidence, clinicians may offer cranberry tablets or juice as prophylaxis for females with recurrent UTIs. Due to a lack of compelling evidence for any specific product, the guidelines recommend choosing formulations based on availability and tolerability (100855). In 2020, the US Food and Drug Administration (FDA) approved qualified health claims stating that consuming cranberry juice in doses of at least 8 ounces daily, or cranberry supplements in doses of at least 500 mg daily, may help reduce the risk of recurrent UTI in healthy females. However, the FDA has concluded that there is limited scientific evidence to support these claims (103302). The benefits of cranberry for prevention of UTI during pregnancy are unclear. Subgroup analysis of meta-analyses suggest that cranberry supplementation does not reduce the risk of UTI in pregnant adults compared with placebo or no treatment (100855,111407). A preliminary clinical study shows that drinking cranberry juice 240 mL three times daily until delivery does not reduce the frequency of asymptomatic bacteriuria or symptomatic UTI during pregnancy, although the study was not adequately powered to detect a difference in these outcomes (16415). In contrast, one preliminary clinical trial shows that UTI frequency was reduced in 70.5% of those ingesting cranberry juice 250 mL four times daily, compared with only 32% of those taking placebo (93670). In children, a meta-analysis shows that taking cranberry products probably reduces the risk of subsequent symptomatic UTIs by up to 54% compared with placebo or no treatment, but does not specify a particular formulation (111407). Clinical trials show that daily consumption of cranberry syrup (Pharmatoka), cranberry juice (Cranberry UR-50, Kikkoman Company) 100 mL, cranberry-lingonberry juice 50 mL, and cranberry extract (Anthocran) 120 mg reduce the risk of UTI recurrence in children (46452,96733,96737,108055). In contrast, another clinical trial shows that drinking cranberry juice (Ocean Spray Cranberries, Inc) 5 mL/kg daily for 6 months does not reduce the incidence of recurrent UTI when compared with placebo, although it does decrease the total number of UTI episodes and length of antimicrobial therapy per child (46470). In older, institutionalized adults, a meta-analysis of 5 studies evaluating the effectiveness of cranberry products shows little or no benefit in preventing symptomatic, culture-verified UTIs (111407). A clinical study in females residing in long-term care (LTC) facilities shows that taking a specific cranberry supplement (Ellura, Pharmatoka) once daily for 1 year does not reduce the incidence of UTI or asymptomatic bacteriuria (92517). However, clinical trials of cranberry products in elderly patients in LTC facilities suggest that cranberry may be more effective in patients at a higher risk for UTIs, such as those with diabetes, long-term catheterization, or recurrent UTIs (90041,108055), and in patients with E. coli-related UTIs (46389,46472). In one small study, providing all patients living in a LTC facility with 4 ounces of cranberry juice or six tablets of a specific concentrated cranberry product (Azo-Cranberry, i-Health, Inc.) daily for 13 months decreased the facility's overall monthly UTI rate from 27.7 to 20.7 (46492). In another clinical trial, taking cranberry juice cocktail (Ocean Spray Cranberries, Inc) 300 mL daily for 6 months decreased the rate of asymptomatic bacteriuria plus pyuria by 13% in older females living in institutional settings (7008). In another clinical trial, taking a cranberry capsule 500 mg, standardized to 1.8% PACs, twice daily for 12 months decreased the risk of UTI by around 26% in patients at high-risk for UTI, including those with catheters, diabetes, or at least one UTI in the previous 12 months (90041). Meta-analyses and clinical research show that cranberry products do not reduce the risk of UTI associated with neurogenic bladder, neuromuscular dysfunction, or insufficient bladder emptying in adults or children (2811,6759,11980,46379,46425,46473,90044,92578,96737,108055,111407). However, one study found benefit in patients with neurogenic bladder due to spinal cord injury taking cranberry capsules (Cran-Max, Proprietary Nutritionals, Inc.) 500 mg daily (46443). Cranberry products have also been evaluated in a variety of other high-risk populations, with mixed results. A meta-analysis of 7 studies shows that cranberry products reduce the risk of UTIs in people with increased susceptibility to UTI due to an intervention (e.g., kidney transplant, radiotherapy to urogenital system, or urogenital surgery) when compared with placebo (111407). Cranberry extracts do not seem to reduce the risk of UTIs in individuals undergoing hysterectomy and/or anterior vaginal repair (46465), pelvic floor surgery (104245), or in patients with multiple sclerosis (46496,111407). Taking cranberry powder capsules (NurtiCran90, Petefa AB) 550 mg three times daily for 5 days does not reduce the UTI rate at days 5 or 14 when compared with placebo in postoperative females with hip fracture receiving a urinary catheter; however, the study was not adequately powered to detect a difference in this outcome (96734). Other preliminary clinical research in elderly males with benign prostatic hyperplasia and a recent UTI shows that taking a standardized cranberry extract (Anthocran) 120 mg daily for 60 days reduces the UTI recurrence rate by about 62% when compared with placebo (96735). Cranberry supplements have been studied in a variety of formulations, but it is unclear whether certain cranberry formulations are better than others (111407). Most positive studies utilized oral cranberry EXTRACTS in tablet, powder, or capsule form (6760,17210,46366,46432,93669,111407). Some products (Cranberry Supreme, GNC; Cranpac, IPCA Laboratories), taken as 200 mg twice daily, were standardized to provide 100-120 mg of proanthocyanidins (PACs) daily (46432). Some of these studies used capsules containing 400 mg cranberry solids twice daily (6760) or Natural Cranberry Extract (Solgar Vitamin and Herb Co.) 800 mg twice daily (17210). However, a clinical study in healthy females with a history of UTIs shows that taking a specific cranberry extract product (Urophenol; Diana Food) does not reduce the risk of symptomatic UTI when taken at a dose of 120 mg twice daily, standardized to 15% PACs, or at a dose of 1 mg twice daily, standardized to 1% PACs. A subgroup analysis suggests that the high dose may have modest benefit in those with less than 5 UTIs a year (108054). Cranberry JUICE or syrup has yielded mixed results for the prevention of UTI in patients with a history of recurrent UTIs, with some showing significant benefit (8253,46366,96736,111407). These studies used cranberry juice 240-250 mL 1-3 times daily (46366,96736), cranberry syrup, or a combination beverage containing cranberry juice plus lingonberry juice (Maija) 50 mL daily (8253). However, other studies found no significant improvement when compared with placebo (17524,46471,90047), although some of these studies may have been inadequately powered to detect a difference (17524,46471). Cranberry products have also been compared with other treatments including antibiotics and probiotics for preventing recurrent UTI, but the results are unclear. A meta-analysis suggests that cranberry products reduce the risk of symptomatic UTIs compared to probiotics. The analysis also showed no difference in the risk of UTI between cranberry products and antibiotics, but the precision of included studies was poor (111407). In one study, taking cranberry extract capsules (Cran-Max; Proprietary Nutritionals, Inc) 500 mg daily for 6 months was as effective as trimethoprim 100 mg daily in elderly females with recurrent UTI (16720). However, taking this same cranberry product twice daily for 12 months was less effective than trimethoprim-sulfamethoxazole 480 mg once daily in younger premenopausal individuals (17176). Additional research in children with vesicoureteral reflux (VUR) shows that daily consumption of cranberry products results in UTI recurrence rates equivalent to those obtained with prophylactic antibiotics. Cranberry juice (Cranberry UR-50, Kikkoman Company) 100 mL daily was equally effective to cefaclor 5-10 mg/kg daily; cranberry syrup (Pharmatoka) 0.2 mL/kg daily was equally effective to trimethoprim 0.2 mL/kg daily (96737).

Age-related cognitive decline. It is unclear if oral cranberry is beneficial for age-related cognitive decline. Oral cranberry may be beneficial for improving visual episodic memory in healthy, elderly adults, but its effects on other aspects of cognition are unclear. Details: A clinical study in healthy adults aged 50-80 years shows that taking a freeze-dried cranberry powder 4.5 grams twice daily (standardized to provide 281 mg proanthocyanidins daily), provided as a sachet and added to food or beverage for 12 weeks, improves visual episodic memory performance during a memory and recall test (Rey Complex Figure Test), but does not appear to affect other measures such as attention, orientation, fluency, language, processing speed, or short-term memory, when compared with placebo (108564). Cranberry supplementation also does not appear to affect grey matter structure; however, due to the low number of patients who completed a baseline and follow-up MRI, this study may not have been adequately powered to detect a difference between groups.
Benign prostatic hyperplasia (BPH). Preliminary clinical research suggests that oral cranberry is beneficial for reducing BPH symptoms. Details: Preliminary clinical research shows that taking powdered dried cranberry fruit 500 mg three times daily for 6 months improves lower urinary symptoms and reduces prostate specific antigen (PSA) levels when compared with no treatment in patients 45 years of age or older with elevated PSA levels, a negative prostate biopsy, and clinically confirmed non-bacterial prostatitis (17126). Another small study in those 45 years of age and older without elevated PSA levels shows that taking a specific dried cranberry powder (Flowens, Naturex-DBS, LLC) 250-500 mg daily for 6 months reduces lower urinary tract symptoms and improves voiding and storage symptoms when compared with placebo (96738).
Cancer. Although there has been interest in using oral cranberry for cancer, there is insufficient reliable information about the clinical effects of cranberry for this condition.
Cardiovascular disease (CVD). Although some research suggests that oral cranberry may modestly improve some CVD risk factors, it is unclear if it is beneficial for CVD prevention. Details: A meta-analysis of 10 clinical studies shows that cranberry juice or cranberry extract seems to reduce systolic blood pressure by 3.6 mmHg and body mass index by 0.3 kg/m2 when compared with placebo. However, these improvements are unlikely to be clinically significant, and cranberry does not appear to improve diastolic blood pressure, lipid levels, glycemic control, or waist circumference (102849). The generalizability of these results is limited, as the study populations ranged from healthy adults to those with type 2 diabetes, metabolic syndrome, or coronary heart disease. A clinical crossover study in patients who are overweight or obese and have elevated blood pressure shows that drinking cranberry juice 250 mL twice daily for 8 weeks reduces ambulatory diastolic blood pressure by 2 mmHg during daytime hours, but does not improve systolic blood pressure, glycemic control, or lipid levels, when compared with placebo (108059). The validity of these findings is limited due to short duration of treatment and broad heterogeneity of patient baseline characteristics.
Catheter-related infections. Although there has been interest in using oral cranberry for catheter-related infections, there is insufficient reliable information about the clinical effects of cranberry for this condition.
Chronic fatigue syndrome (CFS). Although there has been interest in using oral cranberry for CFS, there is insufficient reliable information about the clinical effects of cranberry for this condition.
Diabetes. It is unclear if oral cranberry is beneficial for diabetes. Details: A small clinical trial shows that taking cranberry supplements orally does not improve fasting serum glucose, glycated hemoglobin (HbA1C), fructosamine, triglycerides, high-density lipoprotein (HDL) cholesterol, or low-density lipoprotein (LDL) cholesterol levels in patients with type 2 diabetes (11328).
Helicobacter pylori. There is conflicting evidence regarding the use of oral cranberry for Helicobacter pylori eradication, either as a standalone treatment or in combination with standard triple therapy. Details: Two small clinical studies show that taking cranberry juice 480-500 mL, containing 88 mg proanthocyanidins (PACs), daily in two divided doses for 2-3 months can modestly increase the H. pylori eradication rate at 8 weeks, but not at 2 weeks, when compared with placebo. However, the eradication rate was only 20% or less, which is much lower than that obtained with conventional triple therapy (46388,104248). Lower doses, as either cranberry juice or cranberry powder, do not seem to improve H. pylori eradication rates. Cranberry juice containing only 23 mg or 44 mg PACs or cranberry powder containing 36 mg or 72 mg PACs did not demonstrate benefit when compared with placebo (104248). Cranberry juice has also been studied in combination with standard triple therapy. Preliminary clinical research shows that taking cranberry juice 250 mL daily for 3 weeks along with omeprazole, amoxicillin, and clarithromycin for one week does not increase the eradication rate when compared with triple therapy plus placebo. However, the combination treatment increased the rate of H. pylori eradication when only females were considered (46439). A meta-analysis of 4 small clinical studies, including three studies already discussed, shows that taking cranberry, either as a juice or a dried powder, does not improve H. pylori eradication rate when compared with placebo, regardless of treatment duration (108060). The validity of these findings is limited by the high heterogeneity of the included studies and incomplete reporting. In asymptomatic children aged 6-16 years old with H. pylori, one clinical study shows that drinking cranberry juice 200 mL, with live or heat-killed Lactobacillus johnsonii 80 mL, daily for 3 weeks eradicates H. pylori in 15% to 22% of patients, compared with 1.5% of those receiving placebo. However, these rates are lower than those typically obtained with conventional triple therapy (46441).
Hyperlipidemia. Oral cranberry has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Drinking a combination of cranberry, blueberry, apple, and chokeberry juice 300 mL daily for 6 weeks appears to decrease total cholesterol and increase high-density lipoprotein (HDL) cholesterol when compared to baseline in females with overweight or obesity and at least one risk factor for cardiovascular disease (111233). However, the validity of the study is limited by its small size, short duration, and lack of a comparator group. It is unclear if these effects are due to cranberry, other ingredients, or the combination.
Kidney stones (nephrolithiasis). It is unclear if oral cranberry is beneficial for reducing the risk of kidney stones. Details: Although some preliminary clinical research shows that drinking cranberry juice 500 mL diluted in 1500 mL water daily for 2 weeks can decrease urinary excretion of oxalate in healthy males, which suggests a decreased risk of kidney stone formation (46371), other preliminary clinical research shows that both cranberry juice and concentrated cranberry extracts can increase urinary oxalate levels, suggesting an increased risk of stone formation (7074,46393).
Memory. It is unclear if oral cranberry is beneficial for memory. Details: Preliminary clinical research in cognitively intact older adults shows that taking cranberry juice 16 ounces twice daily for 6 weeks does not improve memory when compared with placebo (46390).
Metabolic syndrome. It is unclear if oral cranberry is beneficial for metabolic syndrome. Details: Preliminary clinical research shows that drinking cranberry juice 240 mL twice daily for 8 weeks can increase plasma antioxidant capacity when compared with placebo in adults with metabolic syndrome. However, cranberry juice does not appear to affect blood pressure, blood glucose, serum lipids, or markers of inflammation when compared with placebo in these patients (46467).
Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral cranberry is beneficial for NAFLD. Details: Preliminary clinical research in adults with NAFLD shows that adding cranberry extract 288 mg daily to a weight loss diet for 12 weeks does not appear to affect body weight, liver enzymes, lipid levels, or steatosis grade when compared with placebo. Cranberry extract may moderately reduce insulin levels and insulin resistance (104249). However, the clinical impact of these reductions is unclear. Another clinical trial in adults with NAFLD shows that taking dried cranberry powder 144 mg daily after lunch for 6 months improves steatosis grade as measured by ultrasound, insulin sensitivity, and levels of total cholesterol and triglycerides, but does not affect liver enzyme levels, when compared with placebo. All patients also consumed a reduced-calorie diet and an undefined dose of supplemental vitamin E (108058).
Obesity. Oral cranberry has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in females with overweight or obesity and at least one risk factor for cardiovascular disease shows that drinking a combination of cranberry, blueberry, apple, and chokeberry juice 300 mL daily for 6 weeks does not reduce body weight, body mass index (BMI), or blood pressure but might improve total cholesterol and high-density lipoprotein (HDL) cholesterol when compared to baseline (111233). However, the validity of these findings is limited by the small study size, short duration, and lack of a comparator group. It is unclear if these effects are due to cranberry, other ingredients, or the combination.
Overactive bladder. It is unclear if oral cranberry is beneficial for overactive bladder. Details: Preliminary clinical research in otherwise healthy females shows that taking dried cranberry powder 500 mg daily for 24 weeks can reduce daily micturition by 16% and urgency episodes by 57% when compared with placebo. Patients taking cranberry powder also reported an improvement in their own perception of their bladder condition when compared with placebo (104246). Limitations of this study include a short duration, lack of a run-in period, and high drop-out rate, which interfered with the ability to meet power.
Periodontitis. Topical cranberry extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with chronic periodontitis shows that applying a topical combination gel product containing cranberry extract 2.5 grams and garcinia extract after scaling and root planing reduces plaque index, gingival index, probing pocket depth, clinical attachment level, and salivary biomarkers of periodontal disease when compared with scaling and root planing alone and similarly to scaling and root planing with tetracycline fibers (112272). It is unclear if these effects are due to cranberry, garcinia, or the combination.
Peristomal lesions. Although there has been interest in using oral cranberry for peristomal lesions, there is insufficient reliable information about the clinical effects of cranberry for this condition.
Prostate cancer. It is unclear if cranberry is beneficial for preventing prostate cancer recurrence. Details: Clinical research shows that taking cranberry powder (Pacran, Naturex) 1500 mg for a mean of 30 days prior to radical prostatectomy for prostate cancer does not improve prostate tissue markers when compared with taking placebo. However, levels of prostate tissue antigen decreased by approximately 22% when compared with baseline (105127).
Radiation-induced cystitis. Evidence for the use of cranberry juice in the prevention of radiation-induced cystitis is conflicting. Details:One small clinical study in individuals with prostate cancer shows that taking 200 mg of a cranberry extract standardized to 30% proanthocyanidins (Monoselect Macrocarpon; PharmExtracta) once daily during external beam radiotherapy for 6-7 weeks reduces the risk of lower UTI by 64% when compared with placebo (92579). However, other preliminary clinical research shows that taking cranberry capsules, standardized to contain a total of 72 mg proanthocyanidins, daily during radiation treatment for prostate cancer and for two weeks post-treatment, does not improve pain, burning, nocturia, or urinary flow symptoms from radiation-induced cystitis when compared with a beetroot placebo (104247). Additionally, preliminary clinical research in patients receiving radiotherapy for bladder or cervical cancer shows that consuming cranberry juice 250 mL daily for 2 weeks does not seem to reduce the incidence of UTIs (46469).
Rheumatoid arthritis (RA). It is unclear if oral cranberry is beneficial in RA. Details: A clinical study in adults with RA shows that drinking reduced-calorie cranberry juice 250 mL twice daily in addition to taking fish oil 1 gram three times daily for 90 days improves disease activity score (DAS28-CRP) when compared with no supplementation. However, this combination was similarly effective to patients taking fish oil alone, suggesting that any benefits may be due to fish oil, as opposed to cranberry juice (108057). In contrast, another small study in adults with RA shows that drinking reduced-calorie cranberry juice 500 mL daily for 90 days does not improve disease activity score or clinically relevant biologic markers of RA such as rheumatoid factor, anti-cyclic citrullinated peptide antibodies, erythrocyte sedimentation rate, or C-reactive protein when compared with a control group (112273).
Upper respiratory tract infection (URTI). It is unclear if oral cranberry is beneficial for the prevention or treatment of URTIs. Details: Clinical research shows that drinking a cranberry juice beverage 450 mL daily for 70 days does not decrease the incidence of cold or flu, but may reduce cold and flu symptoms, when compared with placebo in healthy adults (90046).
Urinary odor. It is unclear if oral cranberry is beneficial for urinary odor. Details: Preliminary clinical research shows that cranberry juice cocktail might reduce urinary odors when given orally on a regular basis to patients with urinary incontinence (3333,3334,8254). Cranberry juice cocktail up to 237 mL three times daily for up to 4 weeks has been used (3334). More evidence is needed to rate cranberry for these uses.

Age-related macular degeneration (AMD). It is unclear if oral goji berry reduces the risk of developing AMD. Details: A small, unblinded clinical study in healthy adults aged 45 to 65 years shows that consuming goji berries 28 grams five times a week for 90 days improves macular pigment optical density, which is a marker for AMD, when compared to baseline (110767). The validity of this finding is limited by the lack of statistical comparison to the other study group that received a supplement containing lutein and zeaxanthin.
Cancer. Although there is interest in using oral goji for cancer, there is insufficient reliable information about the clinical effects of goji for this condition.
Cardiovascular disease (CVD). It is unclear if oral goji improves risk factors for CVD. Details: A meta-analysis of 6 mostly small clinical studies of adults in China shows that consuming goji as polysaccharide extract or juice for 1-3 months modestly improves triglycerides, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and fasting blood glucose but does not impact total cholesterol when compared with no treatment or placebo (110765). Another meta-analysis of 4 small clinical studies in adults also shows that consuming goji polysaccharide extract or goji berries for 1-4 months modestly improves triglycerides and HDL but does not impact total or LDL cholesterol when compared with placebo or healthy eating. Goji also had no impact on systolic or diastolic blood pressure, or markers of oxidative stress (110768). However, the interpretation of the findings from these meta-analyses is limited by the use of variable goji forms and doses, as well as inclusion of studies in heterogeneous patients, including healthy people, patients with diabetes, and patients with metabolic syndrome. Furthermore, most studies were conducted in China; it is unclear if these benefits can be extrapolated to other geographic locations.
Cognitive function. It is unclear if oral goji berry improves cognition in healthy young individuals. Details: A small clinical crossover study in healthy participants 14-24 years of age shows that taking goji berry fruit water extract (BIOMIX Company) 3600 mg in 3 divided doses daily for 4 weeks might improve certain cognitive measures such as verbal learning, short-term memory, and attention when compared with baseline (105488). The validity of these findings are limited due to incomplete outcome reporting and a lack of statistical comparisons between the treatment and placebo groups.
Cough. Although there is interest in using oral goji for cough, there is insufficient reliable information about the clinical effects of goji for this purpose.
Depression. It is unclear if oral goji berry polysaccharide is beneficial for adolescents with subthreshold depression. Details: A small clinical study in adolescents aged approximately 15 years with subthreshold depression in China shows that taking goji berry polysaccharide extract 300 mg daily for 6 weeks modestly improves clinician-assessed depression scores (i.e. Hamilton Depression Scale, HAMD-24) but does not improve self-reported depression scores (i.e. Beck Depression Inventory) or scores assessing sleep quality, psychological distress, or anxiety when compared with placebo (110769). However, these results are from an interim analysis, which limits the interpretation of these findings. Furthermore, it is unclear if results can be extrapolated to patients in other geographic locations.
Diabetes. It is unclear if oral goji berry polysaccharides improve glycemic control in patients with diabetes. Details: One small clinical study in patients with type 2 diabetes shows that taking goji fruit polysaccharide powder 150 mg twice daily for 3 months results in a slightly lower postprandial glucose area under the curve (AUC), but does not seem to affect insulin levels or insulin resistance, when compared with placebo. A subgroup of patients who were not taking antidiabetes medications had a greater reduction in postprandial blood glucose (92117).
Dry eye. Although there is interest in using oral goji for dry eye, there is insufficient reliable information about the clinical effects of goji for this purpose.
Erectile dysfunction (ED). Although there is interest in using oral goji for ED, there is insufficient reliable information about the clinical effects of goji for this condition.
Hypertension. Although there is interest in using oral goji root bark for hypertension, there is insufficient reliable information about the clinical effects of goji for this condition.
Obesity. It is unclear if oral goji berry juice improves weight loss. Details: Preliminary clinical research in healthy, overweight adults shows that drinking a specific goji fruit juice (GoChi, FreeLife International LLC) 120 mL daily for 14 days while following a weight loss diet and participating in an exercise program decreases waist circumference by about 4.7 cm more than exercise and diet alone. However, drinking goji berry juice along with diet and exercise does not improve body weight, body mass index, or body fat when compared with diet and exercise alone (52536).
Quality of life. Small clinical studies suggest that oral goji berry juice may modestly improve quality of life in healthy adults. Details: Small clinical studies in healthy adults suggest that taking a specific standardized goji fruit juice (GoChi, FreeLife International LLC) 120 mL daily for 14-30 days improves subjective measures of energy levels, athletic performance, sleep quality, mental acuity, calmness, feelings of well-being, and gastrointestinal regularity when compared with placebo (17082,52532,52542). These studies were funded by the juice manufacturer.
Sunburn. It is unclear if oral goji extract can prevent sunburn. Details: A small clinical study in healthy Japanese adults shows that taking goji extract 900 mg daily for 8 weeks reduces and accelerates resolution of erythema after exposure to a standard dose of UVB irradiation when compared with placebo (110770). All study participants were highly UV-sensitive; it is unclear whether these results can be extrapolated to individuals less sensitive to UV irradiation.
Tinnitus. Although there is interest in using oral goji for tinnitus, there is insufficient reliable information about the clinical effects of goji for this purpose. More evidence is needed to rate goji for these uses.

POSSIBLY EFFECTIVE

Periodontitis. Oral and topical mangosteen may modestly improve gum health. Details: A small clinical study in adults with chronic periodontitis shows that applying a gel containing mangosteen pericarp 4% to the periodontal pocket following scaling and root planing procedures improves pocket depth, clinical attachment, and bleeding by 56% to 63%, compared with a 33% to 42% improvement with placebo (97875). Another small clinical study in similar patients shows that applying mangosteen 4% gel to the periodontal pocket following scaling and root planning improves pocket depth and clinical attachment when compared with placebo. However, plaque and bleeding indices were not compared between groups (110126). A clinical study in patients with generalized or localized gingivitis or stage I periodontitis shows that taking 194 mg of a product containing mangosteen and propolis orally improves the modified gingival index by 31% or 40% at weeks 4 or 8, respectively, compared with 16% or 25% in those receiving placebo. No changes in probing depth, clinical attachment, plaque index, bleeding, or gingival recession were observed (106789). It is unclear if these effects are due to mangosteen, propolis, or the combination.

Alzheimer disease. It is unclear if oral mangosteen is beneficial for patients with Alzheimer disease. Details: A small clinical study in adults with Alzheimer disease in Thailand shows that treatment with oral mangosteen pericarp extract, provided either as 220-280 mg daily for 24 weeks, or as 220-280 mg daily for 12 weeks followed by 440-560 mg daily for 12 weeks, does not consistently improve cognitive function scores to a clinically significant extent when compared with placebo. This study assessed cognitive function on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and Thai Mental State Examination (110127). However, the validity of this study is limited by poor methodology, including inadequate power and blinding.
Androgenic alopecia. Mangosteen has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large clinical trial in males and females with androgenic and diffuse alopecia shows that applying a hair lotion containing fermented mangosteen 2%, fermented papaya 2%, and caffeine 0.5% to the scalp daily plus use of a shampoo containing fermented mangosteen 0.5% and fermented papaya 0.5% 3 times weekly for 14 weeks improves hair shaft and root quality, hair diameter, and the density and percentage of thick hairs compared to baseline (111719). It is unclear if these effects are due to fermented mangosteen, other ingredients, or the combination.
Atopic dermatitis (eczema). Although there has been interest in using topical mangosteen for eczema, there is insufficient reliable information about the clinical effects of mangosteen for this purpose.
Muscle fatigue. It is unclear if oral mangosteen is beneficial in preventing muscle fatigue during physical activity. Details: A very small clinical study in healthy, physically active adults shows that drinking 250 mL of a specific mangosteen juice product (Lord Duke Biotechnology Corporation) containing mangosteen, pomegranate, acerola, white grape, strawberry, passion fruit, and tamarind, 1 hour prior to physical activity, does not improve time to exhaustion when compared to the juice product without mangosteen (92805).
Muscle strength. Oral mangosteen has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study in young, resistance-trained males shows that taking a combination product (CinDura, Laila Nutraceuticals) containing mangosteen fruit rind extract and Indian cassia leaf extract 400 mg twice daily for 42 days increases muscle strength and endurance when compared with placebo. Single bench and leg presses improved by approximately 23.5 kg and 29.3 kg, respectively, compared with 3.4 kg and 5.2 kg, respectively, in those taking placebo. Also, the number of leg extension repetitions increased by 6.5, compared to an increase of 2 with placebo (101079). It is not clear if these benefits are due to mangosteen, Indian cassia, or the combination.
Obesity. Oral mangosteen has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy adults who were overweight shows that taking a specific combination product containing a mixture of mangosteen and Sphaeranthus indicus (Meratrim, Laila Nutraceuticals) 400 mg twice daily for 16 weeks results in weight loss of 6.7%, compared with weight loss of 1.4% with placebo (97876). In adults with obesity, taking the same dose of this product for 8 weeks results in an additional reduction in body weight of 4.6% when compared with placebo (97878,97879). This product also seems to improve body mass index (BMI), waist and hip measurements, and blood lipids in some patients (97876,97878,97879). It is not clear if these benefits are due to mangosteen, Sphaeranthus indicus, or the combination.
Osteoarthritis. Topical mangosteen has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large, single-blind clinical study in adults with knee osteoarthritis causing moderate pain shows that applying a specific cream (TMP-4) containing extracts of mangosteen peel, sesame seed, soybean, and gotu kola leaf four times daily for 4 weeks provides similar improvement in pain scores when compared with diclofenac 1% gel. Topical TMP-4 cream also seems to improve knee stiffness, stair climbing, and mobility similarly to diclofenac gel. However, patient impression of overall improvement was higher with diclofenac (110128). The validity of this study is limited by inadequate blinding.
Schizophrenia. It is unclear if oral mangosteen is beneficial in schizophrenia. Details: A clinical study in adults with schizophrenia or schizoaffective disorder shows that taking mangosteen pericarp 1000 mg daily for 24 weeks does not improve total symptom severity when compared with placebo (106787). A secondary analysis of cognitive outcomes also did not demonstrate any differences (106790). More evidence is needed to rate mangosteen for these uses.

POSSIBLY EFFECTIVE

Hypertension. Oral pomegranate juice seems to modestly reduce blood pressure. Details: Most clinical research evaluating pomegranate juice for reducing systolic blood pressure (SBP) and diastolic blood pressure (DBP) shows modest benefits (8310,13023,13691,69372,69373,69374). A meta-analysis of results from eight clinical studies including 574 patients shows that pomegranate juice reduces SBP by about 5 mmHg, but does not affect DBP, when compared with placebo. Doses of pomegranate juice ranged from 43-330 mL daily for 2 weeks to 18 months. Changes in SBP and DBP were not related to the dose or duration of pomegranate juice consumption (96247).

POSSIBLY INEFFECTIVE

Diabetes. Most oral pomegranate products do not seem to be beneficial for diabetes. It is unclear if pomegranate seed powder is beneficial. Details: A meta-analysis of clinical research shows that taking pomegranate has no effect on glycated hemoglobin (HbA1c) or plasma levels of insulin, lipids, or fasting glucose when compared with placebo in patients with type 2 diabetes. Various formulations, including juice, fruit extract, peel extract, and seed oil, were used in these studies (105265). However, a more recent clinical trial shows that drinking a beverage twice daily for 8 weeks, made by soaking a 'tea bag' containing pomegranate seed powder 5 grams in hot water for 10 minutes, modestly reduces levels of fasting blood glucose, HbA1c, total cholesterol, and triglycerides when compared with placebo. Fasting blood glucose levels were reduced by approximately 4%, compared with a 6% increase in the placebo group (105270).
Hyperlipidemia. Oral pomegranate does not seem to be beneficial for hyperlipidemia. Details: Most clinical research shows that taking pomegranate does not increase high-density lipoprotein (HDL) cholesterol levels or reduce total cholesterol, low-density lipoprotein (LDL) cholesterol, or triglyceride levels when compared with placebo (13022,13023,13690,69142,69168,69276). A meta-analysis of results from 12 clinical studies including 545 patients with or without hyperlipidemia shows that taking pomegranate daily for at least 10 days and up to 1 year does not improve blood lipid levels when compared with placebo. Pomegranate formulations evaluated in these studies include juice, seed oil, whole fruit, extract, and vinegar beverage; no specific form or dose of pomegranate was associated with improvements in cholesterol or triglyceride levels (96248). One preliminary clinical study has evaluated pomegranate juice in combination with other fruits. Results from the study show that taking a specific pomegranate-containing combination product (Radical Fruits, Garden of Life) 900 mg orally three times daily before meals reduces total and LDL cholesterol and increases HDL cholesterol in males with hypercholesterolemia (69170). However, it is unclear if these benefits are due to pomegranate, other ingredients, or the combination.

Atherosclerosis. It is unclear if oral pomegranate juice is beneficial for preventing atherosclerosis. Details: Preliminary clinical research shows that drinking pomegranate juice 50 mL daily reduces intima-media thickness of the carotid artery by up to 35% after one year when compared to baseline in patients with atherosclerosis and carotid artery stenosis (13023).
Athletic performance. It is unclear if oral pomegranate extract is beneficial for athletic performance. Details: Preliminary clinical research in trained male cyclists shows that taking pomegranate extract (POM Wonderful LLC) 15 mg/kg daily for 8 days moderately reduces the amount of oxygen needed to perform submaximal exercise when compared with placebo. However, pomegranate extract does not improve performance in a timed trial (99100). Other preliminary clinical research in regionally competitive male cyclists shows that taking pomegranate extract (Pomanox P30, Euromed S.A.) 750 mg daily for 15 days increases the time to exhaustion by 94 seconds after a prolonged submaximal effort, as well as the time to reach the anaerobic threshold by about 55 seconds, when compared with placebo. There was no effect on the restoration of force or on oxygen consumption (101881).
Chronic obstructive pulmonary disease (COPD). It is unclear if oral pomegranate juice is beneficial for COPD. Details: A small clinical trial shows that drinking pomegranate juice 400 mL daily for 5 weeks does not improve symptoms or respiratory function in patients with COPD when compared with placebo (13692).
Coronary heart disease (CHD). It is unclear if oral pomegranate juice is beneficial for patients with CHD. Details: Some preliminary clinical research shows that drinking pomegranate juice (POM Wonderful Pomegranate Juice, POM Wonderful LLC) 240 mL daily for 3 months decreases stress-induced myocardial ischemia in patients with CHD. The average improvement in myocardial perfusion was about 17% with pomegranate juice, compared with an 18% worsening of myocardial perfusion in patients taking placebo (13691). However, other preliminary clinical research in patients with moderate CHD risk shows that drinking the same pomegranate juice product 240 mL daily for 18 months does not improve carotid intima-media thickness when compared to control (17329). It is not known if drinking pomegranate juice can prevent or reduce the risk of a myocardial infarction or other cardiovascular outcomes.
Dental plaque. It is unclear if rinsing the mouth with pomegranate extract is beneficial for reducing dental plaque. Details: Preliminary clinical research shows that rinsing with pomegranate extract mouthwash for one minute once or twice daily reduces dental plaque in patients with or without fixed orthodontic appliances. The antiplaque activity of pomegranate extract is similar to that of chlorhexidine (69171,69316).
Erectile dysfunction (ED). It is unclear if oral pomegranate juice is beneficial for ED. Details: In patients with mild-to-moderate ED, preliminary clinical research shows that drinking pomegranate juice daily for 4 weeks does not improve symptoms of ED when compared with placebo (69175).
Exercise-induced muscle soreness. It is unclear if oral pomegranate juice is beneficial for reducing exercise-induced muscle soreness. Details: Preliminary clinical research shows that drinking pomegranate juice (POM Wonderful Pomegranate Juice, POM Wonderful LLC) 250 mL twice daily for 15 days reduces post-exercise muscle soreness in elbow flexor, but not knee extensor, muscles in resistance-rained males when compared with placebo (69355). However, in non-resistance trained males, drinking the same pomegranate juice 250 mL twice daily for 9 days does not reduce exercise-induced muscle damage or delayed onset soreness of elbow flexor muscles when compared with placebo (101880).
HIV/AIDS. Although there has been interest in using oral pomegranate for HIV/AIDS, there is insufficient reliable information about the clinical effects of pomegranate for this condition.
Influenza. Although there has been interest in using oral pomegranate for influenza prevention, there is insufficient reliable information about the clinical effects of pomegranate for this purpose.
Intrauterine growth restriction (IUGR). It is unclear if oral pomegranate juice is beneficial for preventing brain injury in IUGR neonates. Details: In patients with an IUGR pregnancy, clinical research shows that drinking pomegranate juice 8 ounces daily from 24-34 weeks' gestation until delivery reduces the risk of an MRI-diagnosed gray matter brain injury in the infant by approximately 28%. There was no effect on brain volume or white matter injury (105267).
Kidney failure. It is unclear if oral pomegranate juice is beneficial for patients on hemodialysis; the available research is conflicting. Details: Some preliminary clinical research shows that taking pomegranate juice (Nutrafood) 100 mL during the first dialysis treatment hour three times weekly for one year reduces antihypertensive medication requirements and the rate of second hospitalization due to infection when compared with placebo. Consuming pomegranate juice also increases high-density lipoprotein (HDL) cholesterol in patients with baseline levels of 40 mg/dL or less and reduces triglycerides in patients with baseline levels of at least 200 mg/dL (91698,91699). Preliminary clinical research also shows that taking pomegranate juice 100 mL immediately after dialysis three times weekly for 8 weeks reduces triglycerides by approximately 20%, as well as systolic and diastolic blood pressure by 5% and 7%, respectively, when compared with baseline. HDL cholesterol was also increased by approximately 23%. These changes were significant when compared with placebo (101882). However, pomegranate juice did not affect total cholesterol, low-density lipoprotein (LDL) cholesterol, liver enzymes, or incidence of cardiovascular events when compared with placebo (91698,91699,101882). Other preliminary clinical research shows that drinking pomegranate juice (POM Wonderful Pomegranate Juice, POM Wonderful LLC) 100 mL or taking pomegranate juice extract tablets (POM Wonderful LLC) 1050 mg daily prior to each dialysis session for 4 weeks does not improve blood pressure, lipids, or markers of inflammation and oxidative stress when compared to baseline in patients receiving maintenance hemodialysis (91697). Although the reason for these conflicting findings is not clear, it may have to do with the timing of consumption. The evidence suggests that offering pomegranate during dialysis or after completion of dialysis might be more effective than prior to dialysis.
Menopausal symptoms. It is unclear if oral pomegranate seed oil or pomegranate extract is beneficial for menopausal symptoms. Details: Preliminary clinical research shows that taking a specific pomegranate seed oil (Delima, Pekana Naturheilmittel GmbH) 30 mg orally twice daily for 12 weeks does not reduce the frequency of hot flashes when compared with placebo in postmenopausal adults experiencing at least 5 hot flashes per day. However, pomegranate seed oil might improve sleep in some patients with sleep disturbances attributed to menopause (91685). A clinical study in healthy, perimenopausal and menopausal adults with untreated menopausal symptoms shows that taking pomegranate extract 3 mL three times daily for 4 weeks reduces symptoms, including hot flashes and vertigo, and improves physical and mental quality of life when compared with placebo. Additionally, these improvements were sustained 3 weeks after discontinuing treatment (108484). The validity of this study is limited by the short duration of treatment.
Metabolic syndrome. It is unclear if oral pomegranate juice is beneficial for metabolic syndrome. Details: Preliminary clinical research shows that drinking pomegranate juice 240 mL daily for one month improves endothelial dysfunction in adolescents with metabolic syndrome when compared with drinking grape juice 240 mL daily (53174,69362).
Muscle strength. It is unclear if oral pomegranate juice is beneficial for increasing muscle strength. Details: Preliminary clinical research shows that taking a specific pomegranate extract (POMx, POM Wonderful LLC) 480 mL twice daily modestly improves recovery of strength 2-3 days after eccentric exercise but does not reduce muscle soreness after exercise when compared with placebo (69261).
Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral pomegranate seed oil or pomegranate extract improves anthropometric measures in adults with NAFLD. Details: A small clinical study in overweight and obese adults with NAFLD shows that taking a dried pomegranate extract, standardized to contain 90 mg of ellagic acid, twice daily for 12 weeks reduces body mass index and body weight when compared with placebo. A 5 kg weight reduction occurred in the pomegranate group, compared to a small increase in weight in the placebo group. Pomegranate also improved diastolic blood pressure, as well as lipid and glycemic parameters; however, the patients included in this study had normal baseline parameters, limiting the validity of this finding (108481). Pomegranate has also been evaluated in combination with other ingredients. One small clinical crossover study in obese females with NAFLD shows that taking a specific combination product (Xanthigen, Polinat) containing pomegranate seed oil 300 mg and brown marine algae 300 mg (standardized to fucoxanthin 2.4 mg) modestly reduces body weight and liver fat content when compared with placebo (69257).
Obesity. It is unclear if oral pomegranate is beneficial for obesity. Most evidence suggests that it is not beneficial, although some studies have yielded conflicting findings. Details: A meta-analysis of 513 participants shows that taking pomegranate extract, juice, or concentrate for 2-26 weeks does not reduce body weight, body mass index, waist circumference, or body fat percentage when compared with placebo or other control (101883). However, most of these studies were not designed to investigate weight as the primary outcome, and some preliminary clinical research in overweight or obese individuals suggests that some pomegranate products might have some benefit. Drinking pomegranate juice 120 mL daily for one month helps these individuals maintain weight when compared with placebo, although it does not appear to improve glucose, insulin secretion, or insulin sensitivity (91693).
Oropharyngeal candidiasis. It is unclear if topical pomegranate peel extract is beneficial for oropharyngeal candidiasis. Details: Preliminary clinical research in patients with candidiasis associated with denture stomatitis shows that applying a gel containing the extract of pomegranate fruit peel to the gums three times daily for 15 days seems to be as effective as miconazole gel for improving symptoms of candidiasis (13689).
Polycystic ovary syndrome (PCOS). It is unclear if oral pomegranate juice is beneficial for PCOS. Details: In patients with PCOS, preliminary clinical research shows that taking pomegranate juice 45 mL daily for 8 weeks reduces systolic and diastolic blood pressures by 10 and 4 mmHg, respectively, when compared with a control group not taking pomegranate juice. Triglyceride and high-density lipoprotein (HDL) cholesterol levels were also modestly improved. However, there was no effect on glycemic measures, and low-density lipoprotein (LDL) cholesterol levels increased by 6 mg/dL (105266). Another clinical trial in patients with PCOS shows that taking synbiotic pomegranate juice containing inulin and lactobacillus as 2 liters weekly for 8 weeks improves insulin sensitivity, body mass index, waist circumference, and testosterone levels when compared with baseline or a control juice. However, patients consuming a drink containing only the synbiotic ingredients experienced the same improvements, whereas patients consuming only regular pomegranate juice experienced no benefits, suggesting that pomegranate was not responsible for these changes (101884).
Prostate cancer. It is unclear if oral pomegranate extract or juice is beneficial for prostate cancer. Details: Preliminary clinical research shows that pomegranate might slow prostate cancer progression in some patients after surgery or radiation for prostate cancer. The length of time to doubling of prostate specific antigen (PSA) was longer in those who took a specific pomegranate extract (POMx, POM Wonderful LLC) 1-3 grams daily, as well as those who drank 8 ounces of pomegranate juice daily, for up to 24 months (14137,14388,91695). However, the results from a large well-designed study do not support these findings. This study shows that taking 8 ounces of a pomegranate liquid extract does not increase the length of time to doubling of PSA (105271). In patients with favorable-risk localized prostate cancer, a small clinical trial also shows that taking pomegranate fruit extract (POMx, POM Wonderful) 1000 mg daily for 12 months does not affect the length of time to doubling of PSA, although there were some changes in tumor markers of DNA damage (105269). Pomegranate has also been evaluated in combination with other ingredients. Preliminary clinical research in patients with localized prostate cancer shows that taking a combination supplement containing pomegranate powder 100 mg, broccoli powder 100 mg, turmeric powder 100 mg, and green tea extract 20 mg daily for 6 months slows the increase in PSA levels when compared with placebo (89730). It is not clear if this effect is due to pomegranate, the other ingredients, or the combination.
Rheumatoid arthritis (RA). It is unclear if oral pomegranate extract is beneficial for RA. Details: Preliminary clinical research shows that taking a specific pomegranate extract (POMx, POM Wonderful LLC) 5 mL twice daily for 12 weeks decreases disease activity and reduces tender joint count by 62% when compared to baseline in patients with RA (91686). The validity of these findings is limited by the lack of a control group.
Rhinosinusitis. It is unclear if intranasal pomegranate extract is beneficial for chronic rhinosinusitis. Details: A clinical study in adults with chronic rhinosinusitis or rhinitis persisting longer than 12 weeks, with or without the presence of nasal polyps, shows that using a nasal spray containing pomegranate extract in an unknown dose twice daily for 30 days does not improve objective or subjective nasal or sinus symptoms when compared with placebo nasal spray. In a subgroup of patients with chronic rhinitis, including allergic and nonallergic rhinitis, improvement in thick nasal discharge is also observed in those receiving the pomegranate nasal spray; however, the study does not report outcomes for each subtype of rhinitis (108480).
Stroke. Although there has been interest in using oral pomegranate for stroke recovery, there is insufficient reliable information about the clinical effects of pomegranate for this purpose.
Sunburn. It is unclear if oral pomegranate extract is beneficial for sunburn prevention. Details: A small clinical study shows that taking pomegranate extract standardized to contain ellagic acid 100-200 mg daily for 4 weeks does not reduce skin pigmentation caused by UV light exposure when compared with placebo (69172). However, this study was not adequately powered to detect a difference between treatments.
Trichomoniasis. It is unclear if oral pomegranate extract is beneficial for trichomoniasis. Details: A very small clinical study in patients with vaginal Trichomoniasis suggests that taking pomegranate extract might help to eradicate Trichomonas vaginalis infection (69286). The validity of this finding is limited by the small study size, unclear reporting, and lack of a control group. More evidence is needed to rate pomegranate for these uses.

Cancer. Oral slippery elm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Retrospective population research has found that taking a specific product containing burdock root, Indian rhubarb, sheep sorrel, and slippery elm bark (Essiac, Resperin Canada Limited) does not improve quality of life in breast cancer patients and may have a negative effect on physical well-being (37419).
Constipation. Although there has been interest in using oral slippery elm for constipation, there is insufficient reliable information about the clinical effects of slippery elm for this purpose.
Cough. Although there has been interest in using lozenges containing slippery elm for cough, there is insufficient reliable information about the clinical effects of slippery elm for this purpose.
Diarrhea. Although there has been interest in using oral slippery elm for diarrhea, there is insufficient reliable information about the clinical effects of slippery elm for this purpose.
Inflammatory bowel disease (IBD). Although there has been interest in using oral slippery elm for IBD, including Crohn disease and ulcerative colitis, there is insufficient reliable information about the clinical effects of slippery elm for this purpose.
Irritable bowel syndrome (IBS). Oral slippery elm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a specific formulation containing slippery elm inner bark, lactulose, oat bran, and licorice root can improve stool frequency by 20% and reduce abdominal pain and bloating in people with constipation-predominant IBS when compared to baseline. Also, taking a different formulation containing slippery elm inner bark, bilberry fruit, cinnamon quilts, and agrimony aerial parts can reduce abdominal pain, bloating, and flatulence in people with diarrhea-predominant IBS when compared to baseline, although stool frequency is increased in these individuals as well (35462). It is unclear if these findings are due to slippery elm, other ingredients, or the combination.
Peptic ulcers. Although there has been interest in using oral slippery elm for peptic ulcers, there is insufficient reliable information about the clinical effects of slippery elm for this purpose.
Pharyngitis. It is unclear if lozenges containing slippery elm are beneficial in patients with sore throat. Details: Slippery elm has demulcent properties and, when added to lozenges, may soothe sore throats (272,512,1740). However, clinical research is lacking. More evidence is needed to rate slippery elm for these uses.

Safety view details

Below is general information about the safety of the known ingredients contained in the product Acai Power Berry Pure-Body Cleanse. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ACAI (Acai (Assai Palm) (Euterpe oleracea) extract)

POSSIBLY SAFE ...when used orally and appropriately, short-term. Acai pulp, in a dose of up to 162.5 grams daily, has been used with apparent safety for up to 3 months in clinical research (17731,99400). There is insufficient reliable information available about the safety of acai when used topically.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

BLUEBERRY (Blueberry (Vaccinium angustifolium) powder)

LIKELY SAFE ...when used orally and appropriately. Blueberry, as the whole fruit, juice, or in a powder formulation, is safe when consumed in amounts commonly found in foods (13533,92387,92388,92394,96467,97181,99139). There is insufficient reliable information available about the safety of blueberry when used topically or when the leaves are used orally.

CHILDREN: LIKELY SAFE
when used orally and appropriately in amounts commonly found in foods (13533,96465).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods (13533,107281). There is insufficient reliable information available about the safety of blueberry for medicinal use; avoid using.

POSSIBLY SAFE ...when used orally and appropriately, short-term. Cascara sagrada seems to be safe when used for less than one week (272,25023,40087). Cascara sagrada was formerly approved by the US Food and Drug Administration (FDA) as a safe and effective over-the-counter (OTC) laxative, but this designation was removed in 2002 due to a lack of supporting evidence (8229).

POSSIBLY UNSAFE ...when used orally, long-term. Using cascara sagrada for more than 1-2 weeks can lead to dependence, electrolyte loss, and hypokalemia (272).

CHILDREN: POSSIBLY UNSAFE
when used orally in children. Cascara sagrada should be used cautiously in children due to the risk of electrolyte loss and hypokalemia (272).

PREGNANCY:
Insufficient reliable information available; avoid using.

LACTATION: POSSIBLY UNSAFE
when used orally. Cascara sagrada is excreted into breast milk and might cause diarrhea (272).

CRANBERRY (Cranberry (Vaccinium macrocarpon) powder)

LIKELY SAFE . .when used orally and appropriately. Cranberry juice up to 300 mL daily and cranberry extracts in doses up to 800 mg twice daily have been safely used in clinical trials (3333,3334,6758,6760,7008,8252,8253,8254,8995,11328) (16415,16720,17100,17126,17176,17210,17524,46379,46388,46389)(46390,46425,46439,46443,46465,46456,46466,46467,46469,46471)(46496,46499,90044,102847,111407).

CHILDREN: LIKELY SAFE
when cranberry juice is consumed in amounts commonly found in the diet (2811,6759,46441,46452,46470,111407). There is insufficient reliable information available about the safety of cranberry when used in medicinal amounts in children.

PREGNANCY AND LACTATION: LIKELY SAFE
when consumed in amounts commonly found in the diet. There is insufficient reliable information available about the safety of cranberry when used therapeutically during pregnancy or lactation; avoid using.

POSSIBLY SAFE ...when goji fruit preparations are used orally and appropriately, short-term. Goji berry whole fruit, boiled or steamed, has been used with apparent safety at a dose of 15 grams daily for 16 weeks (105489). Other goji berry products have also been used with apparent safety in clinical research, including a specific goji fruit juice (GoChi, FreeLife International) 120 mL daily for 30 days (52532), a goji fruit polysaccharide 300 mg daily for 3 months (92117), and a specific milk-based formulation of goji berry (Lacto-Wolfberry, Nestlé Research Center) for 3 months (52539). There has been some concern about the atropine content of goji; however, most analyses show that levels of atropine in goji berries from China and Thailand are far below potentially toxic levels (52524,94667). There is insufficient reliable information available about the safety of oral use of other parts of the goji plant.

PREGNANCY AND LACTATION:
Insufficient reliable information available. Some animal research shows that goji fruit may stimulate the uterus (12). However, this has not been reported in humans. Until more is known, avoid using during pregnancy or lactation.

POSSIBLY SAFE ...when used orally. Mangosteen has been used with apparent safety at a dose of up to 560 mg daily for 12 weeks (110127). It has also been used with apparent safety in combination with Sphaeranthus indicus (Meratrim, Laila Nutraceuticals) or Indian cassia (Cindura, Laila Nutraceuticals), for a total dose of 800 mg daily for up to 16 weeks (97876,97878,97879,101079). ...when used topically as a single dose. Mangosteen pericarp 4% gel has been applied once along the gum line with apparent safety (97875).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

LIKELY SAFE ...when pomegranate fruit or fruit juice is used orally and appropriately. Pomegranate juice has been safely used in studies lasting up to 3 years (4912,8310,13022,13023,13690,14137,14388,17329,91693).

POSSIBLY SAFE ...when pomegranate extract is taken orally and appropriately. A specific pomegranate ellagitannin-enriched polyphenol extract (POMx, POM Wonderful) 1-3 grams daily has been safely used for up to 18 months (17729,69261,91686,91695,91697,99100,105269). ...when pomegranate seed oil is used orally and appropriately. Pomegranate seed oil 60 mg daily has been used with apparent safety for up to 12 weeks (91685). ...when a hot water extract of pomegranate seed powder is used orally and appropriately. Pomegranate seed powder 5 grams daily has been used with apparent safety for up to 8 weeks (105270). ...when pomegranate extract is used topically on oral mucosa (13689).

POSSIBLY UNSAFE ...when the pomegranate root, stem, and peel are used orally in large amounts. Bark of the pomegranate root and stem contains the piperidine alkaloids pelletierine, pseudopelletierine, isopelletierine, and methyl isopelletierine. These alkaloids have muscle relaxant properties that have been associated with paralysis and death in animals (13687,13694,13695). Dried pomegranate peel may contain aflatoxin, which is a potent hepatocarcinogen and toxin (92018).

PREGNANCY AND LACTATION: POSSIBLY SAFE
when the fruit or fruit juice is consumed orally and appropriately (13686,105267). There is insufficient reliable information available regarding the safety of using other forms of pomegranate or other parts of the plant during pregnancy or lactation; avoid using.

POSSIBLY SAFE ...when used orally and appropriately (4,12,272,512,1740).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using. Slippery elm bark has historically been inserted into the cervix to induce abortion. As a result, slippery elm has been reported in some sources to have abortifacient activity. However, there is no reliable information available about whether slippery elm has abortifacient activity when taken orally.

Interactions with Drugs view details

Below is general information about the interactions of the known ingredients contained in the product Acai Power Berry Pure-Body Cleanse. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ACAI (Acai (Assai Palm) (Euterpe oleracea) extract)

ANTIDIABETES DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, taking acai with antidiabetes drugs might interfere with glycemic control.

Details

Preliminary clinical research in healthy adults has shown that taking acai may increase or decrease levels of fasting blood glucose (17731,105321).

BLUEBERRY (Blueberry (Vaccinium angustifolium) powder)

ANTIDIABETES DRUGS

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = D

Theoretically, blueberries or blueberry leaf extracts might increase the risk of hypoglycemia when taken with antidiabetes drugs.

Details

Animal and in vitro research suggests that blueberry and/or blueberry leaf extracts can lower blood glucose levels (909,36743,36759).

BUSPIRONE (BuSpar)

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Unlikely • Level of Evidence = B

Theoretically, blueberry juice might increase blood levels of buspirone.

Details

In vitro research shows that blueberry juice can inhibit the metabolism of buspirone, possibly by inhibiting cytochrome P450 3A (CYP3A) enzymes. However, pharmacokinetic research in humans shows that drinking 300 mL of blueberry juice 30 minutes before taking buspirone hydrochloride 10 mg does not significantly affect the concentration or clearance of buspirone (92385).

FLURBIPROFEN (Ansaid, others)

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Unlikely • Level of Evidence = B

Theoretically, blueberry juice might increase blood levels of flurbiprofen.

Details

In vitro research shows that blueberry juice can inhibit the metabolism of flurbiprofen, possibly by inhibiting cytochrome P450 2C9 (CYP2C9) enzymes. However, pharmacokinetic research in humans shows that drinking 300 mL of blueberry juice 30 minutes before taking flurbiprofen 100 mg does not significantly affect the concentration or clearance of flurbiprofen (92385).

CORTICOSTEROIDS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, cascara sagrada might increase the risk of hypokalemia when taken with corticosteroids.

Details

Cascara sagrada has stimulant laxative effects, and long-term use has been associated with hypokalemia (2,4).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Insignificant • Occurrence = Possible • Level of Evidence = D

Theoretically, cascara sagrada might decrease the effects of CYP3A4 substrates.

Details

In vitro research suggests that cascara sagrada can induce CYP3A4 enzymes, albeit to a much lower degree than rifampin, a known CYP3A4 inducer (110704).

DIGOXIN (Lanoxin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, cascara sagrada might cause hypokalemia, potentially increasing the risk of digoxin toxicity.

Details

Cascara sagrada has stimulant laxative effects, and long-term use has been associated with hypokalemia (4,19).

DIURETIC DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, cascara sagrada might increase the risk of hypokalemia when taken with diuretic drugs.

Details

Cascara sagrada has stimulant laxative effects, and long-term use has been associated with hypokalemia (4,19).

STIMULANT LAXATIVES

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, cascara sagrada might have additive adverse effects when taken with stimulant laxatives.

Details

Cascara sagrada has stimulant laxative effects and might compound fluid and electrolyte losses when taken with stimulant laxatives (19).

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, cascara sagrada might increase the risk of bleeding when taken with warfarin.

Details

Cascara sagrada has stimulant laxative effects (19). In some people, cascara sagrada can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding.

CRANBERRY (Cranberry (Vaccinium macrocarpon) powder)

ATORVASTATIN (Lipitor)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, cranberry might increase levels and adverse effects of atorvastatin.

Details

In one case report, a patient taking atorvastatin experienced upper back pain, rhabdomyolysis, and abnormal liver function after drinking cranberry juice 16 ounces daily for 2 weeks. Theoretically, this may have been caused by inhibition of cytochrome P450 3A4 (CYP3A4) enzymes by cranberry juice, as atorvastatin is a CYP3A4 substrate. Creatinine kinase and liver enzymes normalized within 2 weeks of stopping cranberry juice (90042). Patients taking atorvastatin should avoid large quantities of cranberry juice.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B

Theoretically, cranberry might increase the levels and adverse effects of CYP2C9 substrates. However, research is conflicting.

Details

There is contradictory evidence about the effect of cranberry on CYP2C9 enzymes. In vitro evidence suggests that flavonoids in cranberry inhibit CYP2C9 enzymes (10452,11115,90048). However, clinical research shows that cranberry juice does not significantly affect the levels, metabolism, or elimination of the CYP2C9 substrates flurbiprofen or diclofenac (11094,90048). Also, in patients stabilized on warfarin, drinking cranberry juice 250 mL daily for 7 days does not significantly increase the anticoagulant activity of warfarin, a CYP2C9 substrate (15374). Additional pharmacokinetic research shows that cranberry juice does not increase peak plasma concentrations or area under the concentration-time curve of warfarin (15393).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, cranberry might increase the levels and adverse effects of CYP3A4 substrates.

Details

A case of upper back pain, rhabdomyolysis, and abnormal liver function has been reported for a patient taking atorvastatin, a CYP3A4 substrate, in combination with cranberry juice 16 ounces daily for 2 weeks. Creatinine kinase and liver enzymes normalized within 2 weeks of stopping cranberry juice (90042). Also, animal research suggests that cranberry juice, administered intraduodenally 30 minutes prior to nifedipine, a CYP3A4 substrate, inhibits nifedipine metabolism and increases the area under the concentration-time curve by 1.6-fold compared to control (46420).

DICLOFENAC (Voltaren, others)

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B

Theoretically, cranberry might modestly increase the levels and adverse effects of diclofenac.

Details

In vitro evidence suggests that cranberry juice inhibits diclofenac metabolism by human liver microsomes (90048). However, drinking cranberry juice does not seem to affect diclofenac metabolism in humans (90048).

NIFEDIPINE (Procardia)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, cranberry might increase the levels and adverse effects of nifedipine.

Details

Animal research suggests that cranberry juice, administered intraduodenally 30 minutes prior to nifedipine treatment, inhibits nifedipine metabolism and increases the area under the concentration-time curve by 1.6-fold compared to control (46420). This interaction has not been reported in humans.

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = B

Theoretically, cranberry might increase the levels and adverse effects of warfarin. However, research is conflicting.

Details

There is contradictory evidence about the effect of cranberry juice on warfarin. Case reports have linked cranberry juice consumption to increases in the international normalized ratio (INR) in patients taking warfarin, resulting in severe spontaneous bleeding and excessive postoperative bleeding (10452,12189,12668,21187,21188,21189,46378,46396,46411)(46415,90043). Daily consumption of cranberry sauce for one week has also been linked to an increase in INR in one case report (16816). In a small study in healthy young males, taking a high dose of 3 grams of cranberry juice concentrate capsules, equivalent to 57 grams of fruit daily, for 2 weeks produced a 30% increase in the area under the INR-time curve after a single 25-mg dose of warfarin (16416). However, 3 very small clinical studies in patients stabilized on warfarin reported that cranberry juice 250 mL once or twice daily for 7 days (27% cranberry juice or pure cranberry juice) or 240 mL once daily for 14 days does not significantly increase INR or affect plasma warfarin levels (15374,17124,90045). The reasons for these discrepant findings are unclear. It is possible that the form and dose of cranberry may play a role, as cranberry extracts and juices contain different constituents. Additionally, an in vitro study evaluating 5 different cranberry juices found varying effects, with only a cranberry concentrate, and not diluted cranberry juices, inhibiting CYP2C9. However, this concentrate did not inhibit CYP2C9 activity in humans (108062).

ANTIDIABETES DRUGS

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Possible • Level of Evidence = B

Theoretically, concomitant use of goji fruit polysaccharides or goji root bark with antidiabetes drugs might have additive effects.

Details

Animal and in vitro research show that goji root bark and fruit polysaccharides might have hypoglycemic effects (7126,92118,94667). However, clinical research has only shown that taking goji fruit polysaccharides with or without antidiabetes drugs modestly reduces postprandial glucose when compared with control, with no reports of hypoglycemia (92117).

ANTIHYPERTENSIVE DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of goji root bark, but not goji fruit, with antihypertensive drugs might have additive effects.

Details

Animal and in vitro research suggest that goji root bark has hypotensive effects (7126,94667). However, goji fruit juice does not appear to reduce systolic or diastolic blood pressure in humans (17082).

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, goji berry might inhibit CYP2C19 and reduce metabolism of CYP2C19 substrates.

Details

In vitro research shows that goji berry tincture and juice inhibit CYP2C19 enzymes (105486). Concomitant use with goji may decrease metabolism and increase levels of CYP2C19 substrates. However, this has not been reported in humans.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, goji berry might inhibit CYP2C9 and reduce metabolism of CYP2C9 substrates.

Details

In vitro research shows that goji berry tincture and juice inhibit CYP2C9 enzymes (105486). Additionally, multiple case reports suggest that goji berry concentrated tea and juice inhibit the metabolism of warfarin, a CYP2C9 substrate (7158,105462). Concomitant use with goji may decrease metabolism and increase levels of CYP2C9 substrates.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, goji berry might inhibit CYP2D6 and reduce metabolism of CYP2D6 substrates.

Details

In vitro research shows that goji berry juice inhibits CYP2D6 enzymes (105486). Concomitant use with goji may decrease metabolism and increase levels of CYP2D6 substrates. However, this has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, goji berry might inhibit CYP3A4 and reduce metabolism of CYP3A4 substrates.

Details

In vitro research shows that goji berry juice inhibits CYP3A4 enzymes (105486). Concomitant use with goji may decrease metabolism and increase levels of CYP3A4 substrates. However, this has not been reported in humans.

FLECAINIDE (Tambocor)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, goji berry might increase the levels and clinical effects of flecainide.

Details

In one case report, a 75-year-old patient stable on flecainide and warfarin presented to the emergency room with fainting and pleomorphic arrhythmia caused by flecainide toxicity. Flecainide toxicity was attributed to drinking 1-2 glasses of concentrated goji tea daily for 2 weeks. Theoretically, goji may have inhibited the cytochrome P450 2D6 (CYP2D6) metabolism of flecainide (105462).

WARFARIN (Coumadin)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = D

Goji can increase the effects of warfarin and possibly increase the risk of bleeding.

Details

There are at least 5 case reports of increased international normalized ratio (INR) in patients stabilized on warfarin who began drinking goji juice, concentrated goji tea, or goji wine (7158,16529,23896,105462,105487). Goji may inhibit the metabolism of warfarin by cytochrome P450 2C9 (CYP2C9) (7158).

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of mangosteen with anticoagulant or antiplatelet drugs may increase the risk of bleeding.

Details

In vitro and animal research shows that gamma-mangostin, a constituent of mangosteen, is a potent and competitive antagonist of the serotonin 2A (5-HT2A) receptor. Antagonism of the 5-HT2A receptor is believed to reduce platelet aggregation (12017,61685,61686).

DONEPEZIL (Aricept)

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of mangosteen with donepezil might increase the effects of donepezil.

Details

Animal research shows that concomitant use of an aqueous extract of mangosteen pericarp with donepezil increases brain concentrations of donepezil at 4 hours by 64% without associated effects on systemic exposure (106791).

ACE INHIBITORS (ACEIs)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, taking pomegranate with ACEIs might increase the risk of adverse effects.

Details

Pomegranate juice is thought to have ACE inhibitor-like effects (8310).

ANTIHYPERTENSIVE DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, taking pomegranate with antihypertensive drugs might increase the risk of hypotension.

Details

Consuming pomegranate juice can modestly lower blood pressure (8310,13023,69373,69374).

CARBAMAZEPINE (Tegretol)

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = D

Theoretically, taking pomegranate with carbamazepine might increase the risk of adverse effects, although research suggests this interaction is unlikely to be clinically significant.

Details

Animal research shows that pomegranate juice may inhibit cytochrome P450 3A4 (CYP3A4) metabolism of carbamazepine and increase levels of carbamazepine by 1.5 times without prolonging the elimination half-life. This suggests that pomegranate juice inhibits intestinal CYP3A4, but might not inhibit hepatic CYP3A4 (13188). However, some human research suggests that pomegranate does not significantly inhibit CYP3A4 drug metabolism in humans (16711,16712,17326).

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B

Theoretically, pomegranate might increase levels of drugs metabolized by CYP2C9.

Details

Some animal and in vitro research shows that pomegranate juice inhibits intestinal, but not hepatic, CYP2C9 isoenzyme activity (17327). However, clinical research shows that neither pomegranate juice nor pomegranate extract have a significant effect on CYP2C9 activity in humans (91694).

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, pomegranate might increase levels of drugs metabolized by CYP2D6.

Details

In vitro, pomegranate juice inhibits CYP2D6 (13703). However, the clinical significance of this potential interaction in humans is not known.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B

Theoretically, pomegranate might increase levels of drugs metabolized by CYP3A4, but most research suggests this interaction is unlikely to be clinically significant.

Details

Pomegranate contains several polyphenols that have individually been shown to inhibit CYP3A4. However, there is contradictory evidence about the effect of whole pomegranate juice on CYP3A4 activity. In vitro, pomegranate juice significantly inhibits the CYP3A4 enzyme, with comparable inhibition to grapefruit juice (13188,16711,17326). In an animal model, pomegranate juice inhibits CYP3A4 metabolism of carbamazepine and increases levels of carbamazepine by 1.5 times (13188); however, in human volunteers, drinking a single glass of pomegranate juice 240 mL or taking 200 mL daily for 2 weeks does not significantly affect levels of the CYP3A4 substrate midazolam after oral or intravenous administration (16711,17730). Another study in healthy volunteers shows that consuming pomegranate juice 300 mL three times daily for three days also does not significantly affect levels of simvastatin, a CYP3A4 substrate (16712,91696) This suggests that pomegranate is unlikely to significantly affect levels of CYP3A4 substrates in humans (17326).

ROSUVASTATIN (Crestor)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, taking pomegranate with rosuvastatin might increase the risk of adverse effects.

Details

In one case, a patient taking rosuvastatin 5 mg every other day in combination with ezetimibe 10 mg daily developed rhabdomyolysis after drinking pomegranate juice 200 mL twice weekly for 3 weeks. This patient had a history of elevated creatine kinase levels while not receiving any statin treatment. This suggests a possible underlying myopathy and predisposition to rhabdomyolysis (14465).

TOLBUTAMIDE (Orinase)

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = D

Theoretically, pomegranate might increase levels of tolbutamide, although research suggests this interaction is unlikely to be clinically significant.

Details

Animal research shows that pomegranate juice inhibits the cytochrome P450 2C9 (CYP2C9) metabolism of tolbutamide. Pomegranate juice increased tolbutamide levels by 1.2 times without prolonging the elimination half-life. This suggests that pomegranate juice inhibits intestinal CYP2C9, but might not inhibit hepatic CYP2C9 (17327). Despite this evidence, clinical research shows that neither pomegranate juice nor pomegranate extract have a significant effect on CYP2C9 activity in humans (91694). This interaction does not appear to be clinically significant in humans.

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, pomegranate might increase warfarin levels and increase the risk of bleeding. Also, discontinuing regular consumption of pomegranate juice might decrease warfarin levels.

Details

In one case report, a patient had a stable, therapeutic bleeding time, as measured by international normalized ratio (INR), while taking warfarin in combination with pomegranate juice 2-3 times per week. The patient became subtherapeutic within about 10 days after discontinuing pomegranate juice, which required a warfarin dose increase (17328). In another case report, a patient with a stable INR for over one year presented with an INR of 14. The patient noted no changes to medications or diet but did report consuming around 3 liters of pomegranate juice over the previous week. The patient's INR stabilized upon moderation of pomegranate juice consumption (24273). The mechanism of this potential interaction is unclear.

ORAL DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.

Details

Slippery elm inner bark contains mucilage, which may interfere with the absorption of orally administered drugs (19).

Report an Adverse Reaction to Acai Power Berry Pure-Body Cleanse

Adverse Effects view details

Below is general information about the adverse effects of the known ingredients contained in the product Acai Power Berry Pure-Body Cleanse. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ACAI (Acai (Assai Palm) (Euterpe oleracea) extract)

General ...Orally, acai seems to be well tolerated.

Other ...Raw acai fruit and juice can be contaminated with a parasitic protozoan called Trypanosoma cruzi, which causes American trypanosomiasis or Chagas Disease. A Brazilian outbreak of this disease in 2006 was linked to consumption of acai juice (17194,30245).

BLUEBERRY (Blueberry (Vaccinium angustifolium) powder)

General ...Orally, blueberry is generally well tolerated.
Most Common Adverse Effects:
Orally: Constipation, diarrhea, nausea, and vomiting with freeze-dried blueberries.

Gastrointestinal ...Orally, freeze-dried blueberries may cause constipation, diarrhea, nausea, and vomiting. In one clinical trial, 26% of patients taking freeze-dried blueberries 50 grams daily dropped out in the first week of the study due to gastrointestinal complaints (107278).

General ...Orally, cascara sagrada seem to be well tolerated when used appropriately, short-term.
Most Common Adverse Effects:
Orally: Mild abdominal discomfort and cramps.
Serious Adverse Effects (Rare):
Orally: Hepatotoxicity. Fresh or improperly aged cascara sagrada bark can cause severe vomiting.

Endocrine ...Orally, long-term use of cascara sagrada can lead to potassium depletion (4).

Gastrointestinal ...Orally, cascara sagrada can commonly cause mild abdominal discomfort, colic, and cramps (4). In some cases, chronic use can cause pseudomelanosis coli. Pseudomelanosis coli (pigment spots in intestinal mucosa) is believed to be harmless, usually reverses with discontinuation, and is not directly associated with an increased risk of developing colorectal adenoma or carcinoma (6138).
Fresh or improperly aged cascara sagrada bark can cause severe vomiting due to the presence of free anthrone constituents (2,92307).

Genitourinary ...Orally, long-term use of cascara sagrada can lead to albuminuria and hematuria (4).

Hepatic ...There is some concern about potential liver problems with cascara sagrada. In some cases, cascara sagrada bark 750-1275 mg (containing approximately 21 mg cascaroside) daily in divided doses for three days resulted in cholestatic hepatitis, ascites, and portal hypertension. Symptoms resolved following discontinuation of cascara sagrada (6895,92306).

Musculoskeletal ...Orally, long-term use of cascara sagrada can lead to muscle weakness and finger clubbing (4).

Other ...Orally, long-term use of cascara sagrada can lead to cachexia (4).

CRANBERRY (Cranberry (Vaccinium macrocarpon) powder)

General ...Orally, cranberry seems to be well tolerated.
Most Common Adverse Effects:
Orally: Diarrhea and gastrointestinal discomfort.

Dermatologic ...Orally, skin redness and itching has been reported in one patient (46389).

Gastrointestinal ...In very large doses, for example 3-4 L per day of juice, cranberry can cause gastrointestinal upset and diarrhea, particularly in young children (46364). There are reports of abdominal and gastrointestinal discomfort after taking cranberry tablets, extracts, and juice in clinical trials (16720,46379,111407). Nausea, vomiting, and diarrhea have also been reported with consumption of lower doses of cranberry juice cocktail, 16 ounces per day, equivalent to about 4 ounces cranberry juice, for several weeks (16415).

Genitourinary ...Vulvovaginal candidiasis has been associated with ingestion of cranberry juice (46374). Clinical research suggests that ingestion of cranberry juice may be associated with vaginal itching and vaginal dryness (46471). One patient in clinical research stopped taking dried cranberry juice due to excessive urination (46437), and an isolated case of nocturia following ingestion of cranberry tablets has been reported (16720).

Hematologic ...Thrombocytopenia has been reported as an adverse event to cranberry juice (46459).

Other ...An isolated case of sensitive swollen nipples after taking cranberry tablets has been reported (16720).

General ...Orally, goji fruit seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Allergic reactions including anaphylaxis.

Dermatologic ...A case of photosensitivity secondary to consumption of goji berries has been reported. The patient presented with a pruriginous eruption that had lasted for 2 weeks. The patient had been taking goji berries for 5 months and cat's claw for 3 months. Upon testing, it was revealed that the patient tested positive to goji berries in a photoprovocation test, but not to cat's claw (40263).

Hepatic ...Orally, consumption of goji berries has been associated with a single case report of autoimmune hepatitis (52541). A case of acute hepatitis has also been reported in a female who consumed 2 ounces of a specific combination product (Euforia, Nuverus International) containing goji berry, pomegranate, curcumin, green tea, noni, acai berry, aloe vera, blueberry, resveratrol, mangosteen, and black seed, daily for one month. It is unclear whether the liver injury was caused by goji berry, other ingredients, or the combination (90125).

Immunologic ...Several cases of allergic reactions secondary to consumption of goji berries have been reported. Symptoms included facial angioedema with dyspnea, pharyngeal itching, itching in the mouth, ears, and axilla, labial angioedema, and perioral skin rash (92116). Anaphylaxis has also been reported (52538).

General ...Orally, mangosteen is generally well tolerated. Topically, no adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Lactic acidosis.

Dermatologic ...Orally, mangosteen extract up to 560 mg daily has been reported to cause skin rash. It is not known if this side effect was related to mangosteen (97877).

Gastrointestinal ...Orally, mangosteen extract up to 560 mg daily has been reported to cause constipation, abnormal stool, abdominal discomfort, abdominal bloating, salivation, nausea and vomiting, and diarrhea. It is not known if these side effects were related to mangosteen (97877).

Neurologic/CNS ...Orally, mangosteen extract up to 560 mg daily has been reported to cause mild tiredness, headache, dizziness, and malaise. It is not known if these side effects were related to mangosteen (97877).

Pulmonary/Respiratory ...Orally, mangosteen extract up to 560 mg daily has been reported to cause dry throat, flu-like symptoms, cough, and nasal congestion. It is not known if these side effects were related to mangosteen (97877).

Renal ...Orally, mangosteen extract up to 560 mg daily has been reported to cause abnormal urination. It is not known if this side effect was related to mangosteen (97877). In one case report, a patient with chronic kidney disease and metabolic syndrome consumed mangosteen juice daily for 12 months and later presented with severe lactic acidosis. The juice was reported to contain 250 mg of mangosteen with 25 mg alpha-mangostin per ounce. Alpha-mangostin appears to inhibit mitochondrial function, disrupting the electron transport chain and adenosine triphosphate (ATP) production, causing accumulation of reactive oxygen species and inducing apoptosis. Researchers speculate that these effects might have led to lactic acidosis in this patient (16399).

Other ...Orally, mangosteen extract up to 560 mg daily has been reported to cause weight loss. It is not known if this side effect was related to mangosteen (97877).

General ...Orally, pomegranate fruit juice is generally well tolerated. Pomegranate fruit extract and seed oil seem to be well tolerated. Pomegranate root, stem, and peel should not be used orally in large amounts. Topically, pomegranate fruit extract seems to be well tolerated.
Most Common Adverse Effects:
Oral: Diarrhea, flatulence.

Cardiovascular ...In one clinical trial, 2% of patients experienced hyperlipidemia and hypertension after consumption of pomegranate juice (69175). However, most clinical research shows that pomegranate does not increase cholesterol or blood pressure and may actually improve these parameters in some patients (8310,13022,13023,69168,69373,69374).

Dermatologic ...Topically, pomegranate may cause urticaria (hives) in some patients (8445).

Gastrointestinal ...Orally, pomegranate may cause mild gastrointestinal adverse effects. In one clinical study, drinking pomegranate juice 8 ounces daily caused diarrhea and flatulence in 2% of patients (69175). In another clinical study, taking pomegranate extract (POMx, POM Wonderful LLC) 3000 mg daily caused diarrhea in 10% of patients. This dose of pomegranate extract also caused nausea, abdominal pain, constipation, gastrointestinal upset, and vomiting in a small number of patients (91695).

Immunologic ...Orally, pomegranate fruit or seeds may cause allergic reactions. These allergic reactions occur more commonly in people who are allergic to other plants (7674). In rare cases, pomegranate fruit can cause angioedema. Angioedema seems to occur without warning and in people who have eaten pomegranate for many years. Patients should be told to stop eating pomegranate if swelling of the tongue or face develops (7673). In one report, a patient experienced pomegranate-dependent, exercise-induced anaphylaxis. The patient developed widespread urticaria (hives) and lip edema after eating pomegranate seeds and then exercising (17331). In another report, an atopic patient experienced an allergic reaction to pomegranate fruit. Symptoms included urticaria (hives), facial angioedema, and hypotension (91692).
Topically, pomegranate may cause contact hypersensitivity characterized by urticaria (hives), angioedema, rhinorrhea, red itchy eyes, and dyspnea arising within a few minutes of exposure (8445).

Pulmonary/Respiratory ...Orally, pomegranate juice may cause nasal congestion, but this event is rare. In one clinical study, pomegranate juice was associated with nasal congestion in 2% of patients (69175). There is also one case report of a 7-year-old asthmatic child who developed bronchospasm moments after ingesting several pomegranate seeds (69149).

General ...Orally, slippery elm seems to be well tolerated. A thorough evaluation of safety outcomes with topical use of slippery elm has not been conducted.

Dermatologic ...Topically, slippery elm extracts can cause contact dermatitis. The pollen is an allergen (6). Contact dermatitis and urticaria have been reported after exposure to slippery elm or an oleoresin contained in the slippery elm bark (75131).

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