Articles

Morinda citrifolia L.

Synonyms

Belicea hoffimannioides Lundell, Morinda angustifolia Roth [Illegitimate], Morinda aspera Wight & Arn., Morinda asperula Standl., Morinda bracteata Roxb. [Illegitimate], Morinda chachuca Buch.-Ham., Morinda elliptica (Hook.f.) Ridl., Morinda ligulata Blanco, Morinda littoralis Blanco, Morinda macrophylla Desf., Morinda mudia Buch.-Ham., Morinda multiflora Roxb., Morinda nodosa Buch.-Ham., Morinda quadrangularis G.Don, Morinda stenophylla Spreng., Morinda tinctoria Noronha [Invalid], Morinda tomentosa B.Heyne ex Roth, Morinda zollingeriana Miq., Platanocephalus orientalis Crantz, Samama citrifolia (L.) Kuntze, Sarcocephalus leichhardtii F.Muell. [12]    

Vernacular Names

Malaysia Mengkudu, Mengkudu Besar, Mengkudu Jantan
English Noni Plant, Hog Apple, Indian Mulberry
China Ba Ji Tian
Indonesia Pace, Bentis, Cangkudu (Java); Kondhuk (Madura); Bangkudu, Bengkudu, Pamarai (Sumatra); Neteu (Mentawai); Mangkudu, Bengkudu (Minang); Mekudu (Lampung); Wungkudu, Tibah (Bali); Ai kombo, Manakudu, Bakudu (Sumba); Wangkudu, Mangkudu, Labanau, Rewonang (Kalimantan)
Thailand Yo Ban
Philippines Tumbong-aso (Tagalog); Bangkuro (Bidaya); Apatot-nga-basit (Ilokano)
Japan Yae-aoki
France Morinde, Murier des Indes
Germany Indische Maulbeere, Noni, Zitronenvlattrige
Spain Mora de la India
South Pacific Lada (Guam, Northern Mariana Islands); Mangal’wag (Yap); Kesengal, Lel, Ngel (Palau); Kikiri (Solomon Islands); Kura (Fiji); Nen, Nin (Marshall Islands, Chuuk); Non (Kirabiti Island); Noni (Hawai’I, Marquesas); Nono (Cook Island, Tahiti); Non, Nonu, Atogi, Gogu Atogi (Niue, Samoa, Tonga, ‘Uvea, Futuna); Weipwul (Pohnpei) [1] [2] [11]

General Information

Description

Morinda citrifolia is a member of the Rubiaceae family. It is a tree that could reach up to 9 m high. The leaves are simple, large, measuring 10-15 cm x 20-30 cm, decussate and stipulated. The blade is broadly elliptic to obovate, shinny, soft and succulent. The flowers are small, sessile, white and 1.5-2 cm across. They appear terminal or in the leaf axilla. The fruit is succulent, oval, measures 5-7 cm across, light grayish green when young and yellowish white when ripened. [9]

Plant Part Used

Fruits, flowers, leaves, barks, roots.

Chemical Constituents

(+)-3,4,3',4'-tetrahydroxy-9,7'alpha-epoxylignano-7 alpha,9'-lactone; (+)-3,3'-bisdemethyltanegool; (-)-pinoresinol; (-)-3,3'-bisdemethylpinoresinol; (2E,4E,7Z)-deca-2,4,7-trienoate-2-O-β-D-glucopyranosyl-β-D-glucopyranoside; 1-hydroxy-2-primeverosyloxymethyl-anthraquinone-3-olate; 1-hydroxy-5,6-dimethoxy-2-methyl-7-primeverosyloxyanthraquinone; 1-hydroxy-2-methylanthraquinone; 1-methoxy-2-primeverosyloxymethyl-anthraquinone-3-olate; 1, 2-dihydroxy-anthraquinone; 1, 3-dimethoxy-anthraquinone; 1,3-dihydroxy-2-methylanthraquinone; 1,3,6-trihydroxy-2-methylanthraquinone; 1,5,7-trihydroxy-6-methoxy-2-methoxymethylanthraquinone; 1,5,15-trimethylmorindol; 1,5,15-tri-O-methylmorindol; 1,6-dihydroxy-5-methoxy-2-methoxymethylanthraquinone; 1,8-dihydroxy-6-methoxy-3-methyl-9-anthrone; 1-n-butyl-4-(5'-formyl-2'-furanyl)methyl succinate; 1-n-butyl-4-methyl-2-hydroxysuccinate; 1-n-butyl-4-methyl-3-hydroxysuccinate; 1-O-(3'-methylbut-3'-enyl)-beta-D-glucopyranose; 2-formyl-1-hydroxyanthraquinone; 2-ethoxy-1-hydroxyanthraquinone; 2-hydroxyanthraquinone; 2-methoxyanthraquinone; 2-hydroxy-3-(hydroxymethyl)anthraquinone; 2,4-dimethoxy-9-anthrone;  2,5-dihydroxy-4-methoxybenzaldehyde; 2,6-di-O-(beta-D-glucopyranosyl)-1-O-octanoyl-beta-D-glucopyranose; 2,6-di-O-(beta-D-glucopyranosyl)-1-O-decanoyl-beta-D-glucopyranose; 2,6-di-O-(beta-D-glucopyranosyl)-1-O-hexanoyl-beta-D-glucopyranose; 2-O-(beta-D-glucopyranosyl)-1-O-hexanoyl-beta-D-gluropyranose;  2-O-(beta-D-glucopyranosyl)-1-O-octanoyl-beta-D-gluropyranose; 2-O-(6-O-octanoyl-beta-D-glucopyranosyl)-6-O-(beta-D-glucopyranosyl)-1-O-octanoyl -beta-D- glucopyranose; 2-O-(6-O-octanoyl-beta-D-glucopyranosyl)-6-O-(beta-D-glucopyranosyl)-1-O-hexanoyl -beta-D-glucopyranose; 2-O-(6-O-hexanoyl-beta-D-glucopyranosyl)-6-O-(beta-D-glucopyranosyl)-1-O-octanoyl -beta-D-glucopyranose ; 3,3'-bisdemethylpinoresinol; 3-methylbut-3-enyl 6-O-beta-D-glucopyranosyl-beta-D-glucopyranoside; 4-(3'(R)-hydroxybutyl)-3,5,5, trimethyl-cyclohex-2-en-1-one; 4-epi-borreriagenin; 4-hydroxy-3-methoxybenzaldehyde, 4-hydroxy-3-methoxycinnamaldehyde; 5-benzofuran carboxylic acid-6-formyl methyl ester; 5-hydroxyhexyl 2-hydroxypropanoate; 5,15-O-dimethylmorindol; 6alpha-hydroxyadoxoside; 6beta,7beta-epoxy-8-epi-splendoside; 6-O-(beta-D-glucopyranosyl)-1-O-hexanoyl-beta-D-glucopyranose; 6-O-(beta-D-glucopyranosyl)-1-O-octanoyl-beta-D-glucopyranose; americanin A; americanin D, americanoic acid; americanol; amyl-1-O-β-D-apio-furanosyl-1,6-O-β-D-glucopyranoside; asperulosidic acid; asperuloside; beta-sitosterol; blumenol C; borreriagenin; beta-sitosterol 3-O-beta-d-glucopyranoside; butyl 3-(2,4-dihydroxy-5-methoxyphenyl)propionate; caproic acid; citrifolinoside; citrifolinoside A; cycloartenol; campesta-5,7,22-trien-3beta-ol; citrifolinin B epimer a, citrifolinin B epimer b, cytidine, citrifoside; d-glucose; d-mannitol; damnacanthol-11-O-beta-primeveroside; damnacanthal; deacetylasperuloside; deacetylasperulosidic acid; dehydromethoxygaertneroside; digiferruginol-1-methylether-11-O-beta-gentiobioside; digiferruginol-11-O-beta-primeveroside; epi-dihydrocornin, E-phytol; isoprincepin; isoscopoletin; kaempferol; linoleic acid; luteolin; methyl alpha-d-fructofuranoside; methyl beta-d-fructofuranoside, methyl 3-(2,4-dihydroxy-5-methoxyphenyl)propionate; morindafurone; morinaphthalenone; morindacin; morindadiol; morindicininone; morindicinone; morindicone; morindone-6-methyl-ether; morindiconel; morindin; morindolin; morinthone; morintrifolin A and B; morinaphthalenone; morintrifolins A and B; narcissoside; nicotifloroside; noniosides E – H; nordamnacanthal; octanic acid; oleic acid; orindone; p-cresol; p-hydroxybenzoic acid; p-hydroxybenzaldehyde; quercetin; rutin; scopoletin; stigmasterol; stigmasta-4-en-3-one; stigmasta-4-22-dien-3-one; ubiadin; vanillin. [8][9][16-24][26-44]

Traditional Uses

The South-east Asian Polynesians people make use of the roots, leaves, flowers and fruits of M. citrifolia to treat all kinds of ailments from coughs to skin diseases. [2] All parts of the plant have laxative properties [11].

The grated bark of M. citrifolia had been used in the treatment of various respiratory ailments including cough and cold [2]. A decoction of bark is used for stomach ailments [2] and specifically a decoction of the stem bark is reported to be used for jaundice [11].

Leaves are traditionally used in Pacific Islands to treat several diseases including urinary tract ailments, stings from stonefish, fractures, loss of appetite, and diabetes. The poultice of the crushed leaves is used for babies with severe chest cold accompanied with fever while the vapour from crushed leaves is used as a remedy for sty [11]. The poultice of the leaves is also used for the treatment of abscesses and boils. The macerated leaves or heat leaf fomentation could be applied to reduce swellings over arthritic joints. For sore throat, the leaves are chewed and the juice is swallowed to attain relief. The juice extracted from the leaves is used to treat gingivitis in adults [2]Malaria and other forms of fever could be treated with tea made of the leaves [11]. In the meantime Malay used dry leaves as hot compressor over stomach to treat stomachache [1]

The fruit is considered an emmenagogue, antileucorrhoeic, antidysenteric, and anticatarrhal. It is used to treat people with throat infections, asthma, [15] tooth aches and body or intestinal worms [11]. Women consume the raw fruit with salt as a blood purifier [1][2]. A poultice of the fruit is recommended to provide immediate relief of boils and carbuncles. As food, the fruit is cooked and mixed with coconut to be consumed as a stimulant on long sea voyages. A mashed ripe fruit is gargled for sore throat [11]. A mouthwash made of the crushed ripe fruit juice is also used as remedy for gingivitis in children and a charred unripe fruit mixed with salt is applied on diseased gums [2].

The flower extracts are used as eye washes in the treatment of sties [2].

The root is considered anticongestive and hypotensive. A decoction of root is given to help regulate menstruation [15]. Tuberculosis is treated by giving pounded roots in combination with kava and sugar cane [2].

Both roots and leaves are considered cathartic, febrifuge and anti-inflammatory [15]. The fruit juice in combination with a decoction of the bark is used to stimulate the flow of menstruation [3]. Meanwhile, the juice of leaves, roots and fruits pounded together is given to treat diarrhoea [2]. For hypertension, the extracts of the leaves, fruits or bark is prescribed [11].  

Preclinical Data

Pharmacology


Hepatoprotective activity

Noni juice with its polyphenol contents (gentisic acid, p-hydroxybenoic acid and chlorogenic acid) were found to prevent fatty liver in hamsters fed with a high-fat diet. This is via regulations of antioxidative and anti-inflammatory responses.[45]

Pre-treatment with 20% noni juice in drinking water was able to protect Sprague-Dawley rats from toxic effects of CCl4 suggesting that noni juice can protect the liver from extrinsic toxin exposure. [46] [47]

Antitubercular activity

Four compounds isolated from the hexane fraction of crude ethanol extract of M. citrifolia have antitubercular activity. They have been identified as E-phytol, stigma-4-en-3-0ne, stigmasta-4-22-dien-3-one and campesta-5,7,22-3beta-ol. [21]

Antioxidant activity

The neolignan, americanin A showed potent antioxidant activity. [23] Several anthraquinone isolated from the roots and fruits of M. citrifolia proved to be a potent antioxidant. [24] [25] [26]

Antidyslipidaemic activity

The leaves, roots, seeds and fruit juice of M. citrifolia was subjected to a series of test to look into the presence of any antidyslipidaemic activity. The aqueous ethanol extracts of the leaves, roots and fruit exhibited significant antidyslipidaemic activity and this was thought to be mediated through the inhibition of the biosynthesis, absorption and secretion of lipids. The seed oil also showed significant anti-dyslipidaemic activity especially in the presence of hyperlipidaemia. [48] [49] [50] [51]

Neurological activities

Anxiolytic and sedative activity 

The methanol extract of M. citrifolia fruit and its butanol and aqueous partitions exhibited significant affinity to the gamma-aminobutyric acid A (GABAa) inhibitory neurotransmitter receptors and showed 75% binding inhibition of the agonist radioligand [3H] muscimol at a concentration of 100 µg/ml. In the fruit is present competitive ligand(s) which may bind to the GABAa receptor as an agonist inducing its anxiolytic and sedative effects. [52]

Improvement of cognitive function

The fruit of M. citrifolia proved to have capabilities of improving cognitive functions in beta-amyloid induced cognitive dysfunction in mice. The ethyl acetate extract showed the following positive activities:

  1. improved both short-term and long-term memory
  2. decreased in escape latency
  3. increased in behavioural alteration
  4. reduced acetylcholinesterase activity
  5. decreased Monoamine oxidase-A levels
  6. increased in serotonin and dopamine level

In stressed induced model in mice, M. citrifolia fruit juice seems to protect the brain from impairment of cognitive function via improvement in stress-induced decrease in blood vessel density in the hippocampal dentate gyrus. In scopolamine-induced cognitive impairment in mice, the ethanol extract and its chloroform and ethyl acetate fractions significantly improved memory and cerebral blood flow. There were also attenuation of the increased oxidative stress and AChE activity induced by scopolamine. [53] [54] [55]

Protection from neuronal damage

 The free intake of 10% M. citrifolia fruit juice was found to protect effects on neuronal damage after ischaemia. This effect was believed to be mediated by the suppression of ischaemic stress-induced glucose intolerance. It was also found that neurological deficit scores were decreased after reperfusion and that there were reduced infarct volume in mice pretreated with the juice. [56] [57] [58]

Antipsychotic activity

 Methanol extract of M. citrifolia fruit was able to significantly reduce cage climbing behavior in apomorphine and methamphetamine induced stereotypy behavior in mice in a dose dependent manner. This indicate that M. citrifolia has antidopaminergic effects thus possessing anti-psychotic-like activity. [59]

Ergogenic function

 Aged mice pretreated with increasing dose of M. citrifolia fruit juice out performed young and aged control mice in forced swim test and rotarod test. This shows that the juice has ability to combat fatigue, improve endurance and increase overall physical performance. [60]

Antiosteoporotic activity

In a study on the effects of anthraquinones derived from extracts of roots of M. citrifolia, the investigators found that 1, 3, 8-trihydroxy-2-methoxy-anthraquinone (1), 2-hydroxy-1-methoxy-anthraquinone (2) and rubiadin (3) are potential inhibitors of bone resorption. The aqueous leaf extract could increase alkaline phosphates activity, and excite the formation of matrix containing mineralized nodules in human periodontal ligament cells. In other words the aqueous leaf extract promote osteogenic differentiation and matrix mineralization useful in bone and periodontal tissue regeneration. [61] [62]

Antidiabetic activity

The fermented fruit juice of M. citrifolia was able to reduce significantly the blood glucose levels of diabetic induced mice. In another study, the fruit juice in combination with fixed dose of insulin given to diabetic model Spraque Dawley rats was able to provide better glycaemic control as compared to controls. It was found that the fermented noni juice improves glucose metabolism via the forkhead box O (Foxo1) regulation in high fat diet mice. Two anthroquinones, damnacanthol-3-O-beta-D-primeveroside (3), lucidin 3-O-beta-D-primeveroside, isolated from the roots exhibit hypoglycaemic effects. [64-67]

Antiangiogenic activity

The fruits and the leaves of M. citrifolia exhibit antiangiogenic activity more potent that suramin but less potent to nutmeg oil. It has been suggested that Scopoletin as the compound responsible for this activity. This effect was seen when tests in a three dimensional fibrin clot matrix model using human placental vein and human breast cancer explants. [68] [69] [70]

Antimelanogenesis activity

The fruit, the leaves and the seeds of M. citrifolia exhibited antimelanogenesis activity with the seed extracts being the most potent. From the seeds two lignans were isolated and proved to be the compounds responsible for this activity. 3,3’-bisdemethylpinoresinol and americanin A were found to inhibit melanogenesis by down regulation of the levels of phosphorylation of p38 mitogen-activated protein kinase, resulting in suppression of tyrosinase expression. In the leaves, 13 compounds were found to be responsible for this activity. From the fruits most of the saccharide fatty acid esters, hemiteroene glycosides and iridoid glycosides were responsible for the inhibitory effects. All these compounds does not exhibit toxicity to the cells. [71] [72] [73]

Gastrokinetic activity

The aqueous extract of the fruit of M. citrifolia and its component active principle, Scopoletin, has the ability to induce contraction of rat gastric fundus mediated through 5-HT(4) receptor. They also significantly inhibited gastric acid secretion and pepsin activity in pylorus ligated rats. At the same time they strongly increased gastrointestinal transit of charcoal meal better than cisapride. Thus, scopoletin could be utilized in treating gastro-oesophageal inflammatory diseases because of its anti-secretory and prokinetic activity including an inhibitory activity on serotonin, free radicals and cytokine-mediated inflammation. [74] [75]

Immunomodulatory activity

M. citrifolia  fruit had been found to have the ability to stimulate the immune response. This activity is centered upon the humoral immune system. It was noted that the polysaccharide-rich-substance in the fruit juice could be responsible for the activity via its ability to stimulate the release of several mediators from effector cells including TNF-alfa, IL-1beta, IL-10, IL-12 p70, IFN-gamma and NO. There is also evidence that the fruit juice modulates immune system via activation of the CB2 receptors but inhibits the CB1 receptors thus increasing the IRN-gamma and decreasing the IL-4 production. Furthermore, by increasing the percentage of granulocytes and NK cells in peripheral blood, peritoneum and spleen it is able to exercise antitumour activity. By treating dendritic cells with fermented noni juice it wasfound that there is increase in the production of splenocytes especially B cells and lg class switching cluster. [76] [77] [78[79] [80]

Antioxidant activity

Screening for antioxidant activity in medicinal plants had shown that M. citrifolia do possesses antioxidant activity. The 50% ethanol extracts contain 3,3’-Bisdemethylpinoresinol, amaericanin A and quercetin, and these active constituents exhibited both tyrosine inhibitory and radical scavenging activities. However, the Noni-ppt did not show any antioxidant activity when it failed to protect rats from oxygen toxicity. In a human study on the antioxidant activity in smokers demonstrated after 30 days, the target group showed a reduction in the mean superoxide anion radical and lipid hydroperoxide. [81] [82] [83] [84] [85]

Anti-inflammatory activity

There is enough evidence to show that M. citrifolia as a whole possesses anti-inflammatory activity. The fruit executed the anti-inflammatory effects due to the presence of several polyphenol belonging to the coumarin, flavonoid and phenolic acid groups. The anti-inflammatory activity is mediated through the antioxidant activity of some of these compounds and its direct inhibition of cyclo-oxydase COX-1 and COX-2 activities. Damnacanthal, the anthraquinone isolated from the roots appears to possess these same activities too. [86] [87] [88] [89] [90] [91]

Wound healing activity

The fruit and leaves of M. citrifolia exhibited accelerated wound healing process in mice. This activity is probably due to its ligand binding to the PDGF and A(2A) receptors. [92] [93] [94]

Antigout activity

M. citrifolia fruit juice was found to inhibit xanthine oxidase concentration and this is the probable mechanism by which it ameliorates gout and gout-like diseases. [95]

Analgesic activity

The lypholised aqueous extract of the roots of M. citrifolia exhibited a significant, dose-related, central analgesic activity with sedative activity at a higher dose in mice. This extract did not show any toxic effects to the mice. [96]

Antihypertensive activity

The aqueous-ethanolic extract of the roots of M. citrifolia exhibited spasmolytic and vasodilator effect which were mediated through blockade of voltage dependent calcium channels and release of intracellular calcium. [97]

Antimicrobial activity

M. citrifolia does exhibit antimicrobial activities in particular antifungal. Studies had shown that the fruit extract was active against Candida albicans and Aspergilus nidulans. The fruit extract did not show antibacterial activity per se but indirectly through its immunomodulatory activity was found to enhance the blood phagocytic activity against E. coli in vitro. The aqueous and ethanol extract of the fruit was active against Ascaridia galli[99] [100] [101] [102]

Anticancer activity

The roots M. citrifolia contain damnacanthal, an anthraquinone compound exhibiting selective tumour antiproliferative activity. The apoptotic activity involved sustained activation of the p38 MAPK pathway leading to the transcription of the death receptor family genes encoding DR5/TRAIL and TNF-R1/TNF-alpha genes as well as the p53-regulated Bax gene. Such activity was seen in colorectal cancer cells. [103] [104] [105]

The fruit has been reported to have cancer preventive properties. This was mediated through carcinogen-DNA adduct formation and the antioxidant activity of the fruit juice. The polysaccharide-rich substance (Noni-ppt) may be one of the components responsible for this activity. Noni-ppt had produced a cure rate of between 25-45 % in allogeneic mice and this activity was completely abolished by the concomitant administration of specific inhibitors of macrophages (2-chloroadenosine), T-cells (cyclosporine) or natural killer (NK) cells (anti-asialo GM1 antibody). The methanol extract exhibited tumour cell-selective antiproliferative effects against human laryngeal carcinoma, breast cancer (MCF7) and neuroblastoma (LAN5). This anti-growth effect resulted from the induction of apoptosis confirmed by the positive results from the Terminal deoxynucleotidyl transferased dUTO Nick End Labeling (TUNEL) analysis, active caspase-3 cells in tissues, and caspase-cleaved cytokeratin 18 elevation in serum in Ehrlich ascites tumour in female Balb-c mice treated with noni. [106] [107] [108] [109]

Another study showed a dichloromethane extract of the dried leaves of M. citrifolia was cytotoxic against human epidermoid carcinoma. Rutin, scopoletin and other extracts of the leaves showed reduced antiproliferative effects on human epidermoid carcinoma, human cervical carcinoma, human breast carcinoma and human hepatocellular carcinoma. [110]

Toxicities

There has been conflicting reports on toxic effects of the plant in many publications. It is wise for people to be extra cautious when considering taking products derived from M. citrifolia less they may lend themselves into trouble with both liver and kidney complications. There is also the controversy raised on the alkaloid xeronine which is supposed to provide the beneficial effects of noni juice. It is not recommended to take noni supplements with coffee, alcohol or nicotine and it should be taken on an empty stomach for maximum effectiveness. [5] [6] [7] [9] [10] [13] [14]

Teratogenic effects

No documentation

Clinical Data

Clinical Trials

Safety study

A double-blind randomized study on the safety of noni juice was conducted with 96 healthy individuals being given graduated concentration of noni juice 4 times a day for 28 days. Hematology, biochemistry, urinalysis, vital signs and adverse events measurements were taken at 0, 2 and 4 weeks as well as during a two-week follow up (week 6). Electrocardiogram was done at 0 and 6 weeks. A reduction in adverse event report was observed in the noni group as compared to the placebo group. [117]

Anti-inflammatory activity

In a randomized double-blind placebo controlled trial to study the anti-inflammatory activity of noni capsules in women with primary dysmenorrhea, there was no significant difference in mean bleeding score or pain score between the noni group and the control group. [118]

Antiemetic activity

A randomized double blind, placebo-controlled trial to evaluate the efficacy of M. citrifolia in prevention of postoperative nausea and vomiting in patients considered as high risk of developing PONV after various types of surgery was done. The results indicated that M. citrifolia has antiemetic activity and prophylactic used of the extract at 600 mg did effectively reduced the incidence of early postoperative nausea. [119]

Adverse Effects in Human:

Sedation, nausea, vomiting, anorexia, hypersensitivity, hyperkalaemia. [9]

Used in Certain Conditions

Pregnancy / Breastfeeding

Should not be used during pregnancy and lactation [9]. A study of the effects of M. citrifolia juice on pregnancy was done using pregnant Wistar rats. While the result did not show any adverse effects on pregnancy per se, there were evidences that it induced delay in ossification in foetuses. More studies need to be done to further authenticate this. Until such studies are completed it would be wise for pregnant ladies to avoid taking this especially during the active organogenesis period. In another study however, there were evidence that the aqueous extract could reduce the parturition index by 50% and increase post-implantation losses by 74% in rats. [63] [98]


Age Limitations

Neonates / Adolescents

No documentation

Geriatrics

No documentation

Chronic Disease Conditions

No documentation

Interactions

Interactions with drugs

M. citrifolia juice can reduce the efficacy of warfarin. [5] [6]. Additive toxicity has been reported when noni juice was combined with conventional chemotherapy such as vincristine, 5-fluorouracil and doxorubicin. [10]. The ability of noni juice to enhance the effects of insulin in animal models could be used advantageously or otherwise. Patients on antidiabetic drugs should closely monitor their blood glucose level if they choose to consume noni juice. [64] [65] [66]

Interactions with Other Herbs / Herbal Constituents

No documentation

Contraindications

Contraindications

Contraindicated in people with renal disease especially those with hyperkalaemia. People with hypersensitivity to M. citrifolia should avoid using it. [9]

Case Reports

Cases were reported on the adverse effects of M. citrifolia juice.

Electrolyte imbalance

A man with chronic renal insufficiency on dietary restriction of potassium developed hyperkalamaemia (5.8 mmol/l). Investigation showed that he had been taking noni juice. Analysis of the juice showed a potassium level of 56 mmol/l.[4] [6] [7] [116]

Hepatotoxicity

1. Liver damage: A 45 year old man developed very high liver transaminase activities and raised lactate dehydrogenase activity without any evidence of viral hepatitis, Epstein-Barr virus or cytomegalovirus infection, autoimmune hepatitis, Budd-Chiari syndrome, haemochromatosis or Wilson’s disease. Liver biopsy confirmed acute hepatitis and there was an inflammatory infiltrate with numerous eosinophils in the portal tract. The patient admitted to taking M. citrifolia fruit juice for three weeks. Upon cessation of the juice his transaminase activity normalized quickly and were within the reference ranges 1 month later.[7] [111]

2. 38 woman developed acute liver injury associated with noni juice consumption on a long-term (9 months) anticonvulsant therapy. Liver biopsy was consistent with severe, predominantly hepatocellular type of injury. Upon cessation of both medication and provided with corticosteroid therapy, the patient recovered fully in 5 months. [112]

3. A 14 year old  previously health boy developed acute hepatotoxicity after consuming noni juice. [113]

4. Two cases of hepatotocxicity as a result of consumption of noni juice was reported:

  1. A 29 year old man with previous toxic hepatitis associated with small doses of paracetamol developed sub-acute hepatic failure following consumption of 1.5 L noni juice over 3 weeks. He had to undergo liver transplantation.
  2. A 62 year old woman without evidence of previous liver disease developed an episode of self-limiting acute hepatitis following consumption of  2 L noni juice for over 3 months.  [114]

5. A 24 year old female patient developed fulminant hepatitis and impending liver failure with no evidence of apparent usual causes of hepatotoxicity. A fine needle liver biopsy ruled out an autoimmune hepatitis but showed signs indicating drug-induced toxicity. She admitted to taking noni juice for 4 weeks prior to the development of the condition. After cessation of the noni juice her liver enzymes returned to normal within a month. [115]

It is believed that the anthraquinones were the culprit in such cases eventhough one group of investigators denied this. However, it is wise to be cautious when taking noni juice to avoid this from happening. Both promoters of noni based products and consumers should be made aware of the possibility of hepatotoxicity developing with the intake of noni for whatever purposes. Definitely it should not be consumed indiscriminately and on a daily basis over a long period of time. 

References

  1. Mohd. MA., Traditional Malay Medicinal Plants, Institute Terjemahan Nasional Malaysia, Kuala Lumpur 2010 pg. 99
  2. Elkins R., Hawaiian Noni: (Morinda Citrifolia): Price Herb of Hawaii and the South Pacific, Woodland Publishing, Pleasant Grove 1989 pg. 15 – 16
  3. Nelson SC., Elevitch C., Noni: The Complete Guide for Consumers and Growers Permanent Agriculture Resources, Holualoa 2006 pg. 35 – 37
  4. Mueller BA, Scott MK, Sowinski KM., Noni juice (Morinda citrifolia): a hidden potential for hyperkalaemia? Am. J. Kidney 2000; 35:330-332
  5. Carr ME., Klotz J., Bergeron M. Coumadin resistance and the vitamin supplement “noni” Am J Hematol 2004;77:103
  6. Fragakis AS., The Health Professional’s guide to popular dietary supplements American Dietetic Association 2007 pg. 388 – 390
  7. Aronson JK., Meyler’s Side Effects of Herbal Medicine Elsevier BV., Amsterdam 2009 pg. 203 – 204
  8. Kuhn MA., Winston D., Winston and Kuhn’s Herbal Therapy and Supplements, Wolters Kluwer Health Philadelphia 2001 pg. 326
  9. Koh HL., A Guide to Medicinal Plants: An Illustrated Scientific and Medicinal Approach, World Scientific Publications, Singapore 2009 pg. 103 – 104
  10. Cassileth BR., Yeung KS., Gubili., Herb-drug Interactions in Oncology PMPH-USA Shelton 2010 pg. 488
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