Hepatotoxicity of NONI juice: Report of two cases

Department of Internal Medicine, Medical University Graz, Austria.
World Journal of Gastroenterology (Impact Factor: 2.37). 09/2005; 11(30):4758-60.
Source: PubMed


NONI juice (Morinda citrifolia) is an increasingly popular wellness drink claimed to be beneficial for many illnesses. No overt toxicity has been reported to date. We present two cases of novel hepatotoxicity of NONI juice. Causality of liver injury by NONI juice was asses-sed. Routine laboratory tests and transjugular or percutaneous liver biopsy were performed. The first patient underwent successful liver transplantation while the second patient recovered spontaneously after cessation of NONI juice. 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 wk necessitating urgent liver transplantation. A 62-year-old woman without evidence of previous liver disease developed an episode of self-limited acute hepatitis following consumption of 2 L NONI juice for over 3 mo. The most likely hepatotoxic components of Morinda citrifolia were anthraquinones. Physicians should be aware of potential hepatotoxicity of NONI juice.

Download full-text


Available from: Vanessa Stadlbauer,
  • Source
    • "CAM treatments are not without risks, for example, CAM can interact with conventional medication [26]. CAM treatments such as noni juice (Morinda citrifolia) [27,28] or other herbal medicinal products can be toxic to the liver [29], which is important to know, given some IBDs may be associated with disorders in the liver and biliary tract [30-32]. Thus, knowledge of patients’ use of CAM, will allow healthcare professionals to better monitor patients and their responses to treatments. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Complementary and alternative medicine (CAM) use in patients with IBD is on the increase. Patients report they use CAM when their condition is unresponsive to conventional medication or when they suffer from side-effects, negative stress and disease-related concerns. CAM use may improve patients' well-being but it can also lead to side-effects and interactions with conventional medications. Research on attitudes to and experiences of CAM among healthcare professionals working with IBD patients is not well studied. Studies in this area could lead to enhanced awareness of and improved communication about CAM between care staff and IBD patients. The aim of this study was to explore IBD professionals' attitudes to and experience of CAM. Sixteen physicians and nurses, 26-70 years old, who had worked with IBD patients for 1-42 years, were recruited. Semi-structured qualitative interviews were conducted. Qualitative content analysis was performed. Participants stated patients used CAM to improve their well-being generally and there conditions specifically. Participants had a positive attitude towards CAM and respected their patients' decision to use it, but reported a lack of CAM knowledge. They required education about CAM to be able to meet patients' needs and provide adequate information. The result of this study indicates that there is a need for CAM education to be implemented in nursing and medical school. All participants had experience of IBD patients who had used CAM in an attempt to achieve improvement and well-being. Attitudes to CAM were mainly positive, although a problematic aspect was lack of knowledge and evidence in relation to CAM. Implementing CAM education in nursing and medical school will allow healthcare professionals to gain an understanding of therapies widely used by patients with IBD. In clinical practice, using a standard questionnaire regarding CAM use allow healthcare professionals to better understand their patients' wishes and current CAM use.
    BMC Complementary and Alternative Medicine 12/2013; 13(1):349. DOI:10.1186/1472-6882-13-349 · 2.02 Impact Factor
  • Source
    • "During the last decade, noni, mostly marketed as a fermented juice, has become a widely traded food supplement worldwide, based on health claims related to some of its compounds, in particular flavonoids [5– 7]. Starting in 2005, some reports on the hepatotoxicity of noni preparations raised health concerns [8] [9] and led the European Food Safety Authority to conduct further research. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Noni has been used in traditional medicine and as food for thousands of years. While the fruits serve as food and internal medicine, leaves were traditionally used only topically. In recent years, concern regarding the possible content of anthraquinones in noni has led to scrutiny by the European Food Safety Authority. Little research existed on the content of anthraquinones in different noni preparations, with no information about the potential effect of harvest and preparation methods. Our research focused on lucidin, alizarin, and rubiadin, the most important anthraquinones from a health perspective. We found that the production process (fermentation/juice production versus drying/lyophilization) has no effect on the anthraquinone content. The source product, however, does have implications: noni fruit puree from which seeds had been removed as well as consumer products produced from such puree had no detectable amounts of any anthraquinones. Products that did contain seed or leaf material in all cases did contain partly significant amounts of anthraquinones. To alleviate safety concerns, we suggest that noni products, whether fermented or unfermented juice or powder, should be derived only from fully ripe noni fruits, and that any seed material needs to be removed during the production process.
    Evidence-based Complementary and Alternative Medicine 08/2013; 2013:208378. DOI:10.1155/2013/208378 · 1.88 Impact Factor
  • Source
    • "The claimed hepatoprotective properties on noni juice however still remain speculative [6, 7]. Recently, seven cases of Morinda citrifolia-associated liver injury emerged in the literature, emphasizing its possible hepatotoxic effect [8 9 10 11 12 13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Noni juice is a popular herbal dietary supplement globally used for preventive or therapeutic purposes in a variety of ailments, claiming to exhibit hepatoprotective properties as well. Herein we present the case of a 38-year-old woman who developed acute liver injury associated with noni juice consumption on a long-term (9 months) anticonvulsant therapy. Clinical presentation and liver biopsy were consistent with severe, predominantly hepatocellular type of injury. Both agents were stopped and corticosteroids were initiated. Five months later the patient had fully recovered. Although in the literature the hepatotoxicity of noni juice remains speculative, sporadic but emerging cases of noni juice-associated liver injury address the need to clarify and investigate potential harmful effects associated with this supplement.
    Case Reports in Gastroenterology 01/2013; 7(1):19-24. DOI:10.1159/000343651
Show more