Yaeyama Chlorella [Discontinued] by Jarrow Formulas

POSSIBLY EFFECTIVE

• Pregnancy-related iron deficiency. Oral chlorella, which contains iron, can help to prevent iron deficiency and anemia in pregnancy. Details: A small clinical study in Japanese patients in their first trimester of pregnancy shows that taking chlorella (Sun Chlorella A, Sun Chlorella Corp.) 2 grams three times daily, providing 7.2 mg iron daily, starting at the 12-18th week of gestation and continuing until delivery, reduces the incidence of maternal anemia, defined as a hemoglobin level less than 11 g/dL, to about 30%, compared with about 60% in patients receiving no intervention (95013).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Brain tumor. It is unclear if oral chlorella is beneficial in patients with glioma. Details: A small clinical study in patients with glioma shows that taking chlorella tablets plus chlorella liquid extract over 2 years might improve tolerability of chemotherapy and radiotherapy, but does not seem to affect tumor progression or survival, when compared to baseline (6804). The validity of this finding is limited by the lack of a comparator group.
• Depression. It is unclear if oral chlorella is beneficial as an adjunct to conventional antidepressant therapy in patients with major depressive disorder. Details: One open-label clinical trial in patients with major depressive disorder shows that taking chlorella extract tablets (ALGOMED, Bioprodukte Prof. Steinberg Produktions-und Vertreibs GmbH & Co.) 600 mg three times daily in addition to standard antidepressant therapy for 6 weeks improves subjective symptoms of depression and anxiety, measured on the Beck Depression Inventory II and the Hospital Anxiety and Depression Scale, when compared with standard antidepressant therapy alone (92132). The validity of this finding is limited by the large number of patients lost to follow-up and a lack of blinding.
• Dysmenorrhea. It is unclear if oral chlorella improves symptoms of dysmenorrhea. Details: A small clinical study in females 18-35 years of age with primary dysmenorrhea shows that taking chlorella (American Super Golden Med) 1500 mg daily for 8 weeks modestly decreases the severity and duration of painful menstrual cramps when compared with placebo (99882). This study is limited by small sample size and unclear allocation concealment.
• Exercise-induced respiratory infections. It is unclear if oral chlorella can prevent respiratory infections related to exercise. Details: A small clinical trial in physically active adults shows that taking chlorella (Sun Chlorella A, Sun Chlorella Corp.) 3 grams twice daily for 6 weeks increases salivary IgA, a marker of immune response, but doesn't improve the duration or severity of upper respiratory symptoms or reduce the risk for upper respiratory tract infections when compared with placebo (99881). However, this study was likely underpowered to detect differences in these outcomes.
• Fatigue. It is unclear if oral chlorella improves fatigue from exercise. Details: A small clinical trial in healthy males shows that taking chlorella (Chlorella Kogyo Co., Ltd) 2 grams three times daily for 4 weeks does not decrease exercise-induced fatigue or fatigue at rest when compared with placebo (99880).
• Fibromyalgia. It is unclear if oral chlorella improves symptoms of fibromyalgia. Details: A small open-label clinical trial in people with fibromyalgia shows that taking chlorella tablets (Sun Chlorella) 10 grams plus a liquid chlorella extract (Wakasa Gold) 100 mL daily for 2 months improves general symptoms and pain scores when compared with baseline (5890). The validity of this finding is limited by the lack of a comparator group.
• Halitosis. Although there is interest in using oral chlorella for halitosis, there is insufficient reliable information about the clinical effects of chlorella for this purpose.
• Hepatitis C. It is unclear if oral chlorella improves outcomes in patients with chronic hepatitis C infection. Details: A small clinical trial in patients with chronic hepatitis C virus (HCV) genotype 1 infection shows that taking chlorella tablets (Sun Chlorella A, Sun Chlorella Corp) 1500 mg twice daily for one week, then 1500 mg three times daily for 11 weeks, in addition to an extract containing 82 mg/mL of chlorella (Wakasa Gold, Sun Chlorella Corp) 30 mL twice daily for 12 weeks, decreases alanine aminotransferase (ALT) levels, but not aspartate aminotransferase (AST) or HCV RNA levels, when compared to baseline (92130). The validity of this finding is limited by the lack of a comparator group.
• Hyperlipidemia. It is unclear if oral chlorella reduces lipid levels. Details: A small clinical trial in patients with mild hypercholesterolemia, defined as total cholesterol between 200-250 mg/dL, who are not using lipid-lowering medications, suggests that taking chlorella (Daesang Corp.) 1664 mg three times daily for 4 weeks reduces total cholesterol by 1.6% and triglycerides by 10.3%, but does not affect low-density lipoprotein cholesterol or high-density lipoprotein cholesterol, when compared with placebo (92131). This study was limited by its short duration and small size.
• Hypertension. It is unclear if oral chlorella is beneficial in patients with hypertension. Details: Preliminary clinical research in patients with mild to moderate hypertension shows that taking chlorella 10 grams and chlorella extract 100 mL daily for 1-2 months does not reduce blood pressure when compared to baseline (41811).
• Metabolic syndrome. Although there is interest in using oral chlorella for metabolic syndrome, there is insufficient reliable information about the clinical effects of chlorella for this condition.
• Nonalcoholic fatty liver disease (NAFLD). Oral chlorella has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small open-label clinical trial in patients with NAFLD shows that taking chlorella extract 1200 mg with metformin 750 mg and vitamin E 200 mg daily for 3 months decreases alanine aminotransferase (ALT), aspartate aminotransferase (AST), and triglyceride levels when compared to baseline. Treatment with metformin 1250 mg and vitamin E 200 mg daily without chlorella does not appear to improve these outcome measures (99878). This study is limited by the lack of statistical comparison between groups.
• Peptic ulcers. Although there is interest in using oral chlorella for peptic ulcers, there is insufficient reliable information about the clinical effects of chlorella for this purpose.
• Pregnancy-induced hypertension. It is unclear if oral chlorella is beneficial for preventing pregnancy-induced hypertension. Details: A small clinical study in healthy Japanese patients in their first trimester of pregnancy shows that taking chlorella (Sun Chlorella A, Sun Chlorella Corp.) 2 grams three times daily, starting at the 12-18th week of gestation and continuing until delivery, reduces proteinuria and leg edema, but does not affect blood pressure, when compared with no intervention (95013). It is unclear if chlorella is beneficial in patients who are at risk for hypertension during pregnancy.
• Ulcerative colitis. Although there is interest in using oral chlorella for ulcerative colitis, there is insufficient reliable information about the clinical effects of chlorella for this condition. More evidence is needed to rate chlorella for these uses.

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LIKELY SAFE ...when used orally and appropriately, short-term. Tablets and liquids containing chlorella 3-10 grams or 60-100 mL daily have been safely used in clinical studies lasting 2-3 months (5890,92130,92131). Also, chlorella extract 200-1800 mg daily has been safely used in clinical research for 4-6 weeks (10388,92132). There is insufficient reliable information available about the safety of chlorella when used topically.

PREGNANCY: POSSIBLY SAFE
when used orally and appropriately in medicinal amounts for up to approximately 28 weeks. A commercially available chlorella supplement (Sun Chlorella A, Sun Chlorella Corp.) has been safely used in doses of 6 grams daily, starting during the 12-18th week of gestation and continuing until delivery (95013).

LACTATION:
Insufficient reliable information available; avoid using.

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PHOTOSENSITIZING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, chlorella might have additive effects with photosensitizing drugs.  Details Chlorella has been reported to cause photosensitization (3900,5852). In five case reports, patients who had ingested chlorella exhibited swelling followed by erythematopurpuric lesions on sun-exposed areas of the body (5852). Theoretically, concomitant use with photosensitizing drugs may exacerbate effects.

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, chlorella might reduce the clinical effects of warfarin.  Details Chlorella contains significant amounts of vitamin K. There is at least one case report of warfarin therapy becoming sub-therapeutic after initiation of chlorella supplements (3900,41830).

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General ...Orally, chlorella is generally well-tolerated.
Most Common Adverse Effects:
Orally: Allergic reactions, abdominal cramping, constipation, diarrhea, fatigue, flatus, nausea, photosensitivity, and stool discoloration.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis.

Dermatologic ...Orally, photosensitivity reactions have occurred following ingestion of chlorella (3900,5852). According to case reports, five patients who had ingested chlorella exhibited swelling followed by erythematopurpuric lesions on sun-exposed areas of the body (5852). The photosensitizing agent in the chlorella tablets was identified as pheophorbide-a and its ester.

Gastrointestinal ...Orally, chlorella can cause diarrhea, abdominal cramping, flatus, and nausea, especially during the first two weeks of treatment (5890,6804,92130,92132). In one clinical trial, one out of 42 patients reported nausea and one reported diarrhea (92132). In another trial, taking chlorella tablets (Sun Chlorella A, Sun Chlorella Corp) and a chlorella extract (Wakasa Gold, Sun Chlorella Corp) resulted in transient worsening of constipation in 4 of 13 patients and transient mild diarrhea in 2 of 13 patients (92130).
Green discoloration of the feces has also been reported, due to the chlorophyll content of chlorella (6804,95013).

Hematologic ...Orally, chlorella has been linked to one case of thrombocytopenia; however, causality has not been determined. A 49-year-old female living in Turkey presented with thrombocytopenia (a platelet count of 27,000/mm³) after taking chlorella 1080 mg daily for 20 days. Platelet counts had been normal one month earlier, and returned to normal two weeks after discontinuing the chlorella supplement (99879).

Immunologic ...Allergic reactions, including asthma and anaphylaxis, have been reported in people taking chlorella and in those preparing chlorella tablets (3900,5847,41827,105645).

Neurologic/CNS ...Orally, manganese (Mn)-induced parkinsonism has been reported after long-term consumption of chlorella extract. In this case, a patient on maintenance hemodialysis reported gait disturbance, dysarthria, elevated serum and cerebrospinal fluid manganese levels, and abnormal magnetic resonance imaging (MRI) findings of the brain. The authors identified the condition as a rare case of Mn-induced parkinsonism, which may have been due to long-term ingestion of a chlorella extract containing 1.7 mg of Mn in the usual daily dose. The patient underwent edetic acid infusion therapy, which improved the MRI abnormalities and the other symptoms improved four months later (41817).
In one study, fatigue was reported in 18 of 41 patients receiving chlorella 200 mg (10388).

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