Tribulus terrestris has a long history of use for a variety of conditions. It has been suggested that it was used in ancient Greece and India as a physical rejuvenation tonic. In China, it is used as a component of therapy for conditions affecting the liver, kidney, cardiovascular system and immune systems. It has also been used in Eastern European folk medicine for increased muscle strength and sexual potency. Despite its history of use, there is limited human data available in order to evaluate its clinical effectiveness.
Tribulus has been studied as a non-steroidal alternative to treatment of infertility. Although the results of the few studies done with the combination product Tribestan® are promising, more studies are needed in order to further evaluate its clinical effectiveness. Preliminary research with tribulus also suggests that it may be useful in treating coronary heart disease, but additional study is needed.
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.
Coronary artery disease:
Preliminary research suggests that tribulus may be beneficial to patients with coronary heart disease. Additional study is needed to further evaluate its clinical effectiveness.
Grade: C
Exercise performance enhancement:
Preliminary studies indicated that tribulus may enhance body composition or exercise performance in resistance trained males. More information is needed before a firm recommendation can be made.
Grade: C
Infertility (female):
Although the results of one study investigating the effects of Tribulus terrestris are encouraging, larger studies of better design are needed in order to evaluate the effectiveness of Tribestan® in treatment of female infertility.
Grade: C
Infertility (male):
Although Tribestan® seems to increase sperm count and viability and increase libido, its effectiveness in the treatment of male infertility remains inconclusive, due to a lack of well-designed clinical trials.
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. Abortifacient (induces abortion), anemia, angina pectoris (chest pain), anthelmintic (expels worms), aphrodisiac, appetite stimulant, astringent, atopic dermatitis, body tone improvement, breast milk stimulant, Bright's disease, cancer, childbirth, chronic fatigue syndrome, colic, cough, digestion, diuretic, dysuria (painful urination), flatulence (gas), gonorrhea (STD), headache, hepatitis, high cholesterol, hypertension (high blood pressure), immune enhancement, inflammation, kidney stones, leprosy, menopausal symptoms, mood stimulant, neurasthenia (nervous exhaustion), pain relief, premenstrual syndrome (symptoms), psoriasis (chronic skin disease), rheumatism (painful disorder of the joints, muscles or connective tissues), scabies, sore throat, spermatorrhea (excessive ejaculation), stomatitis (mouth sores), tonic, tumors (nasal), vertigo.
Dosing
Adults (18 years and older):
There is no proven safe or effective dose for tribulus; 85-250 milligrams of 40% furostanol saponins extract in three divided doses with meals has been used. For exercise performance enhancement, 3.21 milligrams per kilogram of tribulus for eight weeks has been used.
Children (younger than 18 years):
There is no proven safe or effective dose for tribulus 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 Tribulus terrestris or its constituents.
Side Effects and Warnings
Tribulus terrestris appears to be generally safe with a few adverse events of insomnia and menorrhagia (heavy menstrual bleeding) occurring. Use cautiously in patients with menstrual disorders. One case of pneumothorax (air between the lungs and the lining of the chest cavity) upon digestion of the fruit has been reported. In another case report, the patient developed a polyp in the lobar bronchus of the right interior lobe due to the presence a tribulus fruit spine. In a case report, gynecomastia (excessive development of male breasts) was observed in a weight-trainer taking an herbal supplement containing tribulus.
Most adverse effects reported, such as exceptionally strong libido, general excitation, and insomnia have been from use of the combination product Tribestan®. However, these adverse effects cannot be solely attributed to tribulus, due to the other ingredients in this product.
Although not well studied in humans, a saponin from tribulus may reduce levels of glucose and total cholesterol. Use cautiously in patients with diabetes (high blood sugar) or using hypoglycemic (blood sugar altering) medication, as tribulus may decrease blood sugar levels.
Although not well studied in humans, tribulus may increase prostate weight. Use cautiously in patients with benign prostatic hyperplasia (enlarged prostate) or prostate cancer.
Pregnancy and Breastfeeding
Tribulus is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence. Traditionally, tribulus has been used as an abortifacient (induces abortion).
Tribulus may exacerbate digoxin effects. Caution is advised.
Tribulus may exhibit diuretic effects (increases urine flow). Caution is advised when used with other drugs that have diuretic effects.
Tribulus may lower blood glucose levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Tribulus has been found to have blood pressure lowering effects, and may affect patients taking drugs that also alter blood pressure.
Based on preliminary study and studies of combination products containing tribulus, tribulus may increase levels of steroid hormones.
Interactions with Herbs and Dietary Supplements
Tribulus may exacerbate the effects of cardiac glycoside herbs.
Tribulus may exhibit diuretic effects (increase urine flow). Caution is advised when used with other herbs that have diuretic effects.
Tribulus may lower blood glucose levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Tribulus has been found to have blood pressure lowering effects, and may affect patients taking herbs that also alter blood pressure.
Based on preliminary study and studies of combination products containing tribulus, tribulus may increase levels of steroid hormones.
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): Julie Conquer, PhD (RGB Consulting); Anait Gasparyan, PharmD (Northeastern University); Nicole Giese, MS (Natural Standard Research Collaboration); David Sollars, MAc, HMC (Merrimack College); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); 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.
Bedir E, Khan IA, Walker LA. Biologically active steroidal glycosides from Tribulus terrestris. Pharmazie 2002;57(7):491-493.
Brown GA, Vukovich MD, Martini ER, et al. Effects of androstenedione-herbal supplementation on serum sex hormone concentrations in 30- to 59-year-old men. Int J Vitam.Nutr.Res 2001;71(5):293-301.
Conrad J, Dinchev D, Klaiber I, et al. A novel furostanol saponin from Tribulus terrestris of Bulgarian origin. Fitoterapia 2004;75(2):117-122.
De Combarieu E, Fuzzati N, Lovati M, et al. Furostanol saponins from Tribulus terrestris. Fitoterapia 2003;74(6):583-591.
Deepak M, Dipankar G, Prashanth D, et al. Tribulosin and beta-sitosterol-D-glucoside, the anthelmintic principles of Tribulus terrestris. Phytomedicine. 2002;9(8):753-756.
Deng Y, Yang L, An SL. [Effect of Tribulus terrestris L decoction of different concentrations on tyrosinase activity and the proliferation of melanocytes]. Di Yi.Jun.Yi.Da.Xue.Xue.Bao. 2002;22(11):1017-1019.
Gauthaman K, Adaikan PG, Prasad RN. Aphrodisiac properties of Tribulus Terrestris extract (Protodioscin) in normal and castrated rats. Life Sci 8-9-2002;71(12):1385-1396.
Huang JW, Tan CH, Jiang SH, et al. Terrestrinins A and B, two new steroid saponins from Tribulus terrestris. J Asian Nat Prod Res 2003;5(4):285-290.
Jameel JK, Kneeshaw PJ, Rao VS, et al. Gynaecomastia and the plant product "Tribulis terrestris". Breast 2004;13(5):428-430.
Joshi VS, Parekh BB, Joshi MJ, et al. Inhibition of the growth of urinary calcium hydrogen phosphate dihydrate crystals with aqueous extracts of Tribulus terrestris and Bergenia ligulata. Urol.Res 2005;33(2):80-86.
Kohut ML, Thompson JR, Campbell J, et al. Ingestion of a dietary supplement containing dehydroepiandrosterone (DHEA) and androstenedione has minimal effect on immune function in middle-aged men. J Am Coll Nutr. 2003;22(5):363-371.
Li M, Qu W, Wang Y, Wan H, et al. [Hypoglycemic effect of saponin from Tribulus terrestris]. Zhong.Yao Cai. 2002;25(6):420-422.
Neychev VK, Mitev VI. The aphrodisiac herb Tribulus terrestris does not influence the androgen production in young men. J Ethnopharmacol. 2005; Oct 3;101(1-3):319-23
Sun B, Qu WJ, Zhang XL, et al. [Investigation on inhibitory and apoptosis-inducing effects of saponins from Tribulus terrestris on hepatoma cell line BEL-7402]. Zhongguo Zhong.Yao Za Zhi. 2004;29(7):681-684.
Sun B, Qu W, Bai Z. [The inhibitory effect of saponins from Tribulus terrestris on Bcap-37 breast cancer cell line in vitro]. Zhong.Yao Cai. 2003;26(2):104-106.
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