Noni (Morinda citrifolia)

Category

Herbs & Supplements

Synonyms

Al, alizarin, alkaloids, americanin A, amino acids, anthraquinone, anthraquinone glycoside, asperuloside, asperulosidic acid, atchy (Hindi), ß-sitosterol, borreriagenin, cada pilva (Malay), caproic acid, caprylic acid, carotene, citrifolinin B epimer a, citrifolinin B epimer b, citrifolinoside, cytidine, deacetylasperuloside, dehydromethoxygaertneroside, d-glucose, dilo'k (Pijin), d-mannitol, epi-dihydrocornin, flavone glycosides, Indian mulberry, iridoid glycoside, kura (Fijian), kuti, ladda (Chamorro), L-asperuloside, linoleic acid, maddichettoo (Telugu), manja-pavattay, methyl alpha-d-fructofuranoside, methyl beta-d-fructofuranoside, molagha, Morinda citrifolia, morindacin, morindone, murier d'Inde, najalanun, nakura, narcissoside, nen (Chamorro), nicotifloroside, nolom, nono (Cook Islands Maori), nonu (Tongan, Wallisian, Futunian, Niuean, Tokelauan, Tuvaluan), nonu togi (Samoan), noona (Tamil), nordamnacanthal, nowoi (Bislama), octanoic acid, potassium, riro (Tok Pisin), proxeronine, Rubiaceae (family), rubiadin, rutin, scopoletin, te non (Gilbertese), terpenoids, TNJ, ursolic acid, vitamin A, vitamin C, yelotri.

Background

Noni (Morinda citrifolia) is a traditional folk medicinal plant that has been used for over 2,000 years in Polynesia. Traditionally, Polynesians had many medicinal uses for noni including for fevers, headaches, malaria, bone fractures, dislocations, gastrointestinal disorders, urinary ailments, worms, wounds, rheumatism, and hypertension (high blood pressure). All parts of the noni plant were utilized.

Although noni is a popular supplement, few clinical trials have been conducted on its uses. There is preliminary research supporting noni's popular use as an antioxidant, but more research is needed in this area to establish noni's effects.

Based on scientific analysis and review of Tahitian Noni® juice, the European Commission Health and Consumer Protection Directorate-General Scientific Committee on Food found that "although some nutritional benefits are claimed for Morinda citrifolia L. products, the data supplied and the information available to the Committee provided no evidence for special nutritional benefits of Tahitian Noni® juice which go beyond those of other fruit juices."

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Antioxidant: Laboratory studies indicated that Tahitian Noni® juice (TNJ) may have greater antioxidant activity than some commonly used antioxidants. Although human study suggests that TNJ does have antioxidant effects, whether TNJ protects smokers from oxidative damage is yet to be proven. More high quality studies are needed in this area.
Grade: C

Hearing loss: Noni juice has been used for many years for a wide variety of indications in Southeast Asia, and noni juice may improve hearing in people with auditory dysfunction. Although results are promising, additional research is warranted in this area.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Abscesses, addictions, allergies, analgesic (pain reliever), anthelmintic (kills intestinal/parasitic worms), antibacterial, antifungal, anti-inflammatory, antiviral, appetite stimulant, arthritis, asthma, atherosclerosis (hardened arteries), attention deficit and hyperactivity disorder (ADHD), boils, bone fractures, brain injuries, broken bones, bruises, burns, cancer, carbuncles (clusters of boils on the skin), cardiovascular disease, chemical sensitivities, chronic fatigue syndrome, chronic pain, colds, constipation, cuts, depression, diabetes, diarrhea, digestive problems, joint disorders (dislocation), ear infections, endometriosis (growth of endometrial tissue outside the uterus), energy, fever, fibromyalgia, food uses, gastric ulcers, gout (foot inflammation), headache, hemorrhoids, hernia, hypertension (high blood pressure), immune deficiency, infections, inflammation, inflammatory conditions, influenza, insect repellent, itching, intestinal worms, jaundice, jet lag, joint pain, laxative, lice, malaria, menstrual problems, mouth infections, multiple sclerosis, muscle aches, muscle pain, pregnancy (pain), rheumatism, scabies, senility, sinus disorders, sore throat, sores, sprains, sties, stiffness, stimulant (brain), stings (stonefish), stomachache, swelling (abdominal), toothaches, tuberculosis, ulcers, urinary tract disorders, vascular problems, veterinary medicine, viral infections (polio), vitamin A deficiency, weight loss, wounds.

Dosing

Adults (18 years and older):

There is no proven safe or effective dose for noni in adults. However, 1 ounce every 12 hours has been used. As an antioxidant 2 ounces of Tahitian Noni® juice twice daily for 30 days has been used; for hearing loss, 2 ounces of noni juice twice daily (morning and evening) for three months has been used.

Noni is likely safe when taken orally from preparations of fruits and leaves of the noni plant or when ≤10 grams of ripe noni fruit extract is taken daily for up to 28 days. Noni is possibly unsafe when ≥10 grams of ripe noni fruit extract is taken daily for more than 28 days.

Children (younger than 18 years):

There is no proven safe or effective dose for noni in children.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to noni or its constituents.

Side Effects and Warnings

Overall, noni has had very few reported side effects. Although noni roots are known to contain liver-damaging anthraquinones, recent research indicates that noni fruit also contains anthraquinones.

There is one report of acquired coumarin resistance caused by increased vitamin K intake through ingestion of a noni juice product. However, the product appeared to be vitamin K fortified and contained >115 components from several plants. (Note: Noni juice/fruit itself is not a source of vitamin K; it would therefore be unsubstantiated to draw any conclusions concerning a potential warfarin/coumarin interaction with noni from this case report).

Noni juice may cause elevated lactate dehydrogenase and elevated transaminases.

Potassium concentrations of the noni juice samples were found to be similar to potassium levels in orange and tomato juice. Patients with kidney disease may wish to avoid noni products. Effects in individuals with normal kidney function are not known.

Use cautiously in patients with injuries or post-surgery, as noni may have antiangiogenic properties (prevent new vessel growth).

Avoid in patients with gastrointestinal disorders, as noni may decrease gastric transit time.

Pregnancy and Breastfeeding

Noni is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

Noni may decrease gastric transit time and patients taking any medication by mouth should consult with a qualified healthcare professional, including a pharmacist, to check for any interactions.

Based on laboratory studies, noni may prevent new vessel growth. Caution is advised when taking noni with other antiangiogenic agents.

Although not well studied in humans, a vitamin K-fortified juice product containing noni and >115 components from several other plants may have caused acquired coumarin resistance. Noni juice/fruit itself is not a source for vitamin K. It is unlikely that noni would interact with anticoagulants ("blood thinners"), although caution is advised.

Although not well studied in humans, noni roots and various noni root extracts may lower blood pressure. Noni has also shown anti-inflammatory properties, and may interact with other agents with similar effects.

Noni may be hepatotoxic, and caution is advised when combining with other potentially liver damaging agents. Studies have been inconclusive in this area, and clinical significance is currently unknown.

Noni may stimulate the immune system. It may have either no effect or suppressive effects on HIV. When taking with immune enhancing or HIV medications, additive effects may occur, although this is not yet well proven.

Interactions with Herbs and Dietary Supplements

Noni may decrease gastric transit time and patients taking any herb or supplement by mouth should consult with a qualified healthcare professional, including a pharmacist, to check for any interactions.

Based on laboratory studies, noni may prevent new vessel growth. Caution is advised when taking noni with other antiangiogenic agents.

Although not well studied in humans, a vitamin K-fortified juice product containing noni and >115 components from several other plants may have caused acquired coumarin resistance. Noni juice/fruit itself is not a source of vitamin K. It is unlikely that noni would interact with other herbs with blood thinning effects, although caution is advised.

Although not well studied in humans, noni roots and various noni root extracts may lower blood pressure. Noni has also shown anti-inflammatory properties, and may interact with other agents with similar effects.

Noni may be hepatotoxic, and caution is advised when combining with other potentially liver damaging agents. Studies have been inconclusive in this area, and clinical significance is currently unknown.

Noni may stimulate the immune system. It may have either no effect or suppressive effects on HIV. When taking with immune enhancing or HIV medications, additive effects may occur, although this is not yet well proven.

Noni contains 56mEq/L of potassium. In theory, noni juice may interact with other agents with high potassium content, such as orange and tomato juice.

Attribution

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Rae Abrams, PharmD (University of Rhode Island); Thomas Brendler (PlantaPhile); Ashley Brigham, PharmD (Northeastern University); J. Kathryn Bryan, BA (Natural Standard Research Collaboration); Wendy Diem-Che, PharmD (Massachusetts College of Pharmacy); James Ceurvels, PharmD (Northeastern University); Nicole Giese, MS (Natural Standard Research Collaboration); Joerg Gruenwald, PhD (Phytopharm Research); Faisal Khanzada, PharmD (Massachusetts College of Pharmacy); David S. Lee, PharmD (Massachusetts College of Pharmacy); John S. Markowitz, PharmD (Medical University of South Carolina in Charleston); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Wendy Weissner, BA (Natural Standard Research Collaboration).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Arpornsuwan T, Punjanon T. Tumor cell-selective antiproliferative effect of the extract from Morinda citrifolia fruits. Phytother Res 2006;20(6):515-517.

Burrowes JD, Van Houten G. Use of alternative medicine by patients with stage 5 chronic kidney disease. Adv Chronic Kidney Dis 2005;12(3):312-325.

Carr ME, Klotz J, Bergeron M. Coumadin resistance and the vitamin supplement "Noni". Am J Hematol 2004;77(1):103.

Hornick CA, Myers A, Sadowska-Krowicka H, et al. Inhibition of angiogenic initiation and disruption of newly established human vascular networks by juice from Morinda citrifolia (noni). Angiogenesis 2003;6(2):143-149.

Jensen CJ, Westendorf J, Wang MY, et al Noni juice protects the liver. Eur J Gastroenterol Hepatol 2006;18(5):575-577.

Kamiya K, Tanaka Y, Endang H, et al. Chemical constituents of Morinda citrifolia fruits inhibit copper-induced low-density lipoprotein oxidation. J Agric Food Chem 9-22-2004;52(19):5843-5848.

Kamiya K, Tanaka Y, Endang H, et al. New anthraquinone and iridoid from the fruits of Morinda citrifolia. Chem Pharm Bull (Tokyo) 2005;53(12):1597-1599.

Langford J, Doughty A, Wang M, et al. Effects of Morinda citrifolia on quality of life and auditory function in postmenopausal women. J Altern.Complement Med 2004;10(5):737-739.

Li RW, Myers SP, Leach DN, et al. A cross-cultural study: anti-inflammatory activity of Australian and Chinese plants. J Ethnopharmacol 2003;85(1):25-32.

Millonig G, Stadlmann S, Vogel W. Herbal hepatotoxicity: acute hepatitis caused by a Noni preparation (Morinda citrifolia). Eur J Gastroenterol Hepatol 2005;17(4):445-447.

Pawlus AD, Su BN, Keller WJ, et al. An anthraquinone with potent quinone reductase-inducing activity and other constituents of the fruits of Morinda citrifolia (noni). J Nat Prod 2005;68(12):1720-1722.

Pu HF, Huang WJ, Tseng WM, et al. Effects of juice from Morinda citrifolia (Noni) on gastric emptying in male rats. Chin J Physiol 12-31-2004;47(4):169-174.

Shotipruk A, Kiatsongserm J, Pavasant P, et al. Pressurized hot water extraction of anthraquinones from the roots of Morinda citrifolia. BiotechnolProg 2004;20(6):1872-1875.

Stadlbauer V, Fickert P, Lackner C, et al. Hepatotoxicity of NONI juice: Report of two cases. World J Gastroenterol 8-14-2005;11(30):4758-4760.

Su BN, Pawlus AD, Jung HA, et al. Chemical constituents of the fruits of Morinda citrifolia (Noni) and their antioxidant activity. J Nat Prod 2005;68(4):592-595.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.