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Antioxidant and Associated Capacities of Camu Camu ( Myrciaria dubia ): A Systematic Review

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  • NEMA Research Inc.

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Abstract An aging population in the United States presents important challenges for patients and physicians. The presence of inflammation can contribute to an accelerated aging process, the increasing presence of comorbidities, oxidative stress, and an increased prevalence of chronic pain. As patient-centered care is embracing a multimodal, integrative approach to the management of disease, patients and physicians are increasingly looking to the potential contribution of natural products. Camu camu, a well-researched and innovative natural product, has the potential to contribute, possibly substantially, to this management paradigm. The key issue is to raise camu camu's visibility through increased emphasis on its robust evidentiary base and its various formulations, as well as making consumers, patients, and physicians more aware of its potential. A program to increase the visibility of camu camu can contribute substantially not only to the management of inflammatory conditions and its positive contribution to overall good health but also to its potential role in many disease states.
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Antioxidant and Associated Capacities
of Camu Camu (Myrciaria dubia):
A Systematic Review
Paul C. Langley, PhD,
1
Joseph V. Pergolizzi Jr., MD,
2–4
Robert Taylor Jr., PhD,
5
and Caroline Ridgway, JD
6
Abstract
An aging population in the United States presents important challenges for patients and physicians. The presence
of inflammation can contribute to an accelerated aging process, the increasing presence of comorbidities,
oxidative stress, and an increased prevalence of chronic pain. As patient-centered care is embracing a multi-
modal, integrative approach to the management of disease, patients and physicians are increasingly looking to
the potential contribution of natural products. Camu camu, a well-researched and innovative natural product, has
the potential to contribute, possibly substantially, to this management paradigm. The key issue is to raise camu
camu’s visibility through increased emphasis on its robust evidentiary base and its various formulations, as well
as making consumers, patients, and physicians more aware of its potential. A program to increase the visibility of
camu camu can contribute substantially not only to the management of inflammatory conditions and its positive
contribution to overall good health but also to its potential role in many disease states.
Introduction
An aging population in the United States presents
important challenges for patients and physicians. The pres-
ence of inflammation can contribute to an accelerated aging
process, the increasing presence of comorbidities, oxidative
stress, and an increased prevalence of chronic pain. As patient-
centered care is embracing a multimodal, integrative approach to
the management of disease, patients and physicians are increas-
ingly looking to the potential contribution of natural products.
The contribution of chronic systemic inflammation to the
initiation and mediation of chronic diseases has been recog-
nized for many years (Fig. 1). Chronic inflammation can arise
from viral or microbial infections, antigens in the environ-
ment, autoimmune reactions, or the continual activation of
inflammatory molecules. The inflammatory process involves
cascades of molecular and cellular signals in the transition
from acute to chronic inflammation. Of particular interest is
the role of interleukin-6, which exhibits an anti-inflammatory
profile in acute inflammation yet is proinflammatory in dis-
eases such as collagen-induced arthritis.
1
Inflammation has
been linked to several disease states. Apart from diseases that
are inflammatory in nature, such as Crohn’s disease, celiac
disease, inflammatory bowel disease, and rheumatoid arthri-
tis, other diseases have inflammatory elements, such as obe-
sity, type 2 diabetes, some cancers, and Alzheimer’s disease;
chronic inflammation is also seen as a potential risk factor
for cardiovascular disease. More recently, the presence of
chronic inflammation has been shown to decrease pain
thresholds.
2
Large-scale observational studies have linked
chronic inflammation to unhealthy aging phenotypes,
3
sudden
cardiac death,
4
and the association of depressive symptoms
and pulmonary function.
5
All too often inflammation is considered something to get
rid of and is generally treated with medication to alleviate
pain, swelling, or stiffness. Primary treatment options, such
as nonsteroidal anti-inflammatories, are used to relieve the
discomfort but these are not without adverse effects. Well
known for their gastrointestinal adverse effects, use of non-
steroidal anti-inflammatory drugs must be closely moni-
tored, especially in select populations such as the elderly. In
addition, anti-inflammatory agents also disable the body’s
natural ability to detoxify, repair, and protect itself. Because
of this, some patients and physicians are beginning to move
1
Maimon Research LLC, Tucson, AZ.
2
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
3
Department of Anesthesiology, Georgetown University School of Medicine, Washington, DC.
4
Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA.
5
NEMA Research Inc., Naples, FL.
6
Amazon Origins, LLC, Naples, FL.
ªP.C. Langley et al. 2015; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative
Commons License Attribution-Non-Commercial Share Alike (http://creativecommons.org/licenses/by-nc-sa/4.0/).
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 21, Number 1, 2015, pp. 8–14
DOI: 10.1089/acm.2014.0130
8
toward natural approaches, such as lifestyle and dietary
modifications, to improve overall health, immune function,
and the normal inflammatory response and strip themselves
of pharmaceutical medications.
A perennial question is how systemic chronic disease
markers might be modified by lifestyle and dietary modifi-
cations. A few observations are important in this regard:
The last 20 years has seen an increasing emphasis on
the antioxidant capacity of diet, the effect on antioxi-
dant status, and ultimately the effect of diet on health
outcomes through reducing oxidative damage and its
potential corresponding impact on disease status.
6
As far as lifestyle and dietary studies are concerned the
evidence base, although limited, would suggest that
‘‘Western’’ diets tend to be associated with biomarkers
for inflammation, typically C-reactive protein, while
‘‘Mediterranean’’ diets are inversely associated.
7
More substantive conclusions are limited by the dearth
of long-term cohort studies to evaluate the association
between absolute food intakes, dietary patterns, and
changes in inflammatory markers.
8
Regarding dietary supplements, attention has also been
given to claims that natural products containing par-
ticular minerals, vitamins, and phytochemicals may
have an anti-inflammatory effect in humans.
These claims include those for tropical fruits with
demonstrated claims for substantive antioxidant activ-
ity in vitro and that these have the potential to translate
to in vivo claims; even so, care must be taken to avoid
unsubstantiated medical claims.
Camu camu (Myrciaria dubia H.B.K. [McVaugh]) is a
particularly versatile berry, with its pulp, seeds, and skin all
presenting antioxidant potential in differing degrees once
processed. The plant is present in many environments, which
variously affect its biochemical profile and properties. Camu
camu is a low-growing shrub, populating swampy or flooded
areas. The shrub grows to a height of 1 to 3 m, with globular
fruits with a diameter of 1.0–3.2 cm. It has a thin, shiny skin
with a juicy (and extremely acidic) pink pulp surrounding
one to four seeds. The fruit is not consumed in its natural
state, except by the indigenous peoples who inhabit the
fruit’s natural territories, because of its very high acidity;
rather, it is generally consumed in the form of juices, purees,
and pulp, the last to support beverage production and pow-
der as a food additive.
The purpose of the present review is to report on the ev-
idence base for camu camu and to consider options for
product development. It is not the intention here to support or
otherwise report on potential medical claims. While there ap-
pears, on the basis of the evidence to date, to be a prospective
role for camu camu as a mediator for inflammation and
antioxidant stress, this should be seen in the context of its
unique vitamin C content compared with other tropical fruits,
together with its content of flavonoids and anthocyanins.
FIG. 1. Initiation of
and mediation of chronic
diseases associated with
inflammation.
ANTIOXIDANT CAPACITIES OF CAMU CAMU 9
Methods
PubMed was searched ( January 10, 2014) by using the
following keywords: (camu-camu OR myrciaria dubia)
AND (phenolic compounds OR ascorbic acid OR antioxi-
dant OR rats OR mice OR fruit). A total of 16 references
were found, 4 of which were not related to the fruit’s anti-
oxidant properties. Further literature searches were con-
ducted with Google Advanced Scholar, supplemented by
references cited in papers and references provided by the
manufacturers. All references have appeared, as far as can
be ascertained, in peer-reviewed journals.
Nutritional Composition and Antioxidant Activity
The nutritional content of camu camu fruit has been sum-
marized most recently by Akter et al. (2011).
9
The fruits are
a substantive source of minerals, such as sodium, potassium,
calcium, zinc, magnesium, manganese, and copper. They
contain small amounts of pectin and starch. The major
sugars are glucose and fructose. The fruits also contain a
range of amino acids, organic acids (such as citric acid,
isocitric acid, and malic acid), and fatty acids (predomi-
nantly stearic, linoleic, and oleic acid). There are 21 volatile
compounds. Camu camu fruits are a major source of a range
of bioactive compounds. These include many polyphenols
(flavonoids, phenolic acids, tannins, stilbenes, and lignans).
The compounds depend on state of maturity of the plant and
extraction method used. Total phenolic content is higher
than that in a range of other tropical fruits, with a higher
content in seeds and peel. Evidence for the anthocyanin
content of camu camu is mixed.
Antioxidant capacity
Zanatta et al. (2005) reported for the first time on the
anthocyanin profile of camu camu in fruits from two re-
gions of Sao Paulo, Brazil.
10
The major anthocyanins were
cyaniding-3-glucoside, which was the major pigment, fol-
lowed by delphinidin-3-glucoside. In addition to their light
attenuating role, anthocyanins act as powerful antioxidants.
More recently, the antioxidant capacity of camu camu was
reported to be the highest among the Brazilian fruits evalu-
ated by Goncalves et al. (2010).
11
These results confirmed
those of an earlier study by Rodrigues et al. (2006), which
examined fruit from two different sources.
12
In that study,
both samples exhibited significant and almost identical anti-
oxidant properties through use of the total oxidant scavenging
capacity assay against peroxyl radicals and peroxynitrite,
although the effects of the two samples on hydroxyl radicals
were substantially different.
Genovese et al. (2007) reported on a comprehensive as-
sessment of the bioactive compounds contents and antioxi-
dant activity of five exotic fruits and seven commercial frozen
pulps from Brazil.
13
The assessment considered vitamin C
and total phenolics content, together with antioxidant capacity
(b-carotene/linoleic bleaching method and 1,1-diphenyl-2-
picrylhydrazyl [DPPH] radical scavenging activity), flavo-
noids, chlorogenic acid content, and ellagic acid content.
Among the fruits, camu camu demonstrated the highest vi-
tamin C and total phenolics content and the highest DPPH
scavenging activity. The main flavonoids present were quer-
cetin and kaempferol derivatives. Cyaniding derivatives were
found only in camu camu. Camu camu and araca demon-
strated the highest total ellagic acid contents. In particular,
commercial frozen pulps had lower antioxidant capacity and
bioactive compound content than the respective fruits. In
addition, Chirinos et al. (2010) reported on the antioxidant
compounds and capacity of Peruvian camu camu at differ-
ent ripening or maturity stages.
14
The screening found that
ascorbic acid decreased while anthocyanin, flavonol and fla-
vonol contents, and DPPH antioxidant capacity increased
during ripening. Fractionating camu camu found that an ascor-
bic acid–rich fraction was the major contributor to antioxidant
capacity (67.5%–79.3%) while a phenolics-rich fraction had
only a minor role (20.7%–32.5%).
Stability of vitamin C content
The stability of camu camu pulp vitamin C has been eval-
uated by Justi et al. (2000).
15
When pulp was stored at -18C,
vitamin C concentration decreased considerably, a loss of 23%
(from 1.57 to 1.21 b/100 g) to day 28. This remained approx-
imately the same until the end of the observation period. After
335 days of storage, the content was 1.16 g/100 g of pulp. The
ascorbic acid loss was 26%.
Camu camu juice by-products
Myoda et al. (2010) reported on the total phenolic con-
tents and antioxidant and antimicrobial activities of residual
by-products of camu camu fruit production.
16
They found
that the seeds and fruit contained significantly more phenols
than did other tropical fruits—notably in the seed. Fractio-
nated seed and peel extracts showed potential antioxidant
activity, with antimicrobial activity to Staphylococcus au-
reus, due to lipophilic constituents.
The polyphenol and vitamin C content, together with the
antioxidant capacity of camu camu pulp powder and the
dried flour from the skin and seeds residue from pulp prep-
aration of camu camu, was reported in a recent paper by
Fracassetti et al. (2013).
17
The phenolic content of camu
camu flour was higher than that of pulp powder. In both
products, flavonol myricetin and conjugates, ellagic acid and
conjugates, and ellagitannins were detected. Cyanidin 3-
glucoside and quercetin (and its glucosoids) were found only
in the pulp powder, while proanthocyanidins were found
only in the flour. The vitamin C content was lower in the
pulp powder with a higher radical-scavenging capacity.
Animal Studies
Overall, six animal studies of camu camu juice have been
reported. These have assessed the antioxidant, genotoxic,
and antigenotoxic potential of camu camu juice in mice,
18
the effect of camu camu pulp on obesity in rats,
19
the he-
patoprotective effect of camu camu juice in rats, the anti-
inflammatory effects of camu camu,
20
the mutagenic effect
of camu camu juice on mouse bone marrow,
21
and sper-
matogenic effect in rats.
11
Anti-inflammatory effects of camu camu
Two studies have reported on the anti-inflammatory effect
of camu camu juice and seed extract on inflammatory ac-
tivity. The study by Yazawa et al. (2011) considered camu
camu seeds, while that by da Silva et al. (2012) addressed
10 LANGLEY ET AL.
the contribution of camu camu juice.
18,20
Both are high-
quality studies.
The potential role of camu camu seeds in anti-inflamma-
tory activity was reported by Yazawa et al. (2011).
20
Noting
that the seeds of many fruits contain ingredients with bio-
logical activity, the authors screened the methanolic extract
from camu camu seeds for anti-inflammatory activity fol-
lowing carrageenan-induced paw edema in mice that was
induced by injection. The mouse paws became edematous
after the injection, with edema reaching its peak at 4 hours in
the control group. While the increase in paw edema was
suppressed to less than 0.1% by oral treatment of dexa-
methasone (1.0 mg/kg), pretreatment of the mice with extract
of camu camu seeds (2000 mg/kg) significantly reduced
edema formation with respect to both size and volume at 2
and 4 hours after carrageenan treatment. The inhibitory ef-
fects of camu camu seeds were shown independently in four
experiments. The average inhibitory ratio was calculated as
35.7% 6.7% at 2000 mg/kg, 63.8% 7.3% at 1000 mg/kg,
and 85.1% 10.3% at 500 mg/kg at control paw thickness
at 2 hours. Results assessed both in vivo and in vitro sug-
gested that the extract suppresses the formation of paw
edema by inhibiting localized nitric oxide production from
macrophage-derived RAW 264.7 cells in vitro. The active
compound in the extract was identified as a potent anti-
inflammatory triterpenoid known as betulinic acid.
The antioxidant, genotoxic, and antigenotoxic potential of
camu camu juice on the blood cells of mice were reported
by da Silva et al. (2012).
18
The blood cells of mice after
acute, subacute, and chronic treatments were evaluated for
flavonoids and vitamin C, with in vitro antioxidant activity
evaluated by DPPH assay. Blood samples were collected for
analysis after treatment, and the alkaline comet assay was
used to analyze the genotoxic and antigenotoxic activity.
The amount of vitamin C per 100 mL of camu camu was
52.5 mg. DPPH assay showed an antioxidant potential of the
fruit. No camu camu concentration tested exerted any gen-
otoxic effect on mice blood cells. In the ex vivo test, the
juice demonstrated antigenotoxic effect, and acute treatment
produced the most significant results. After the treatments,
there was no evidence of toxicity or death.
Camu camu and rat obesity
Nascimento et al. (2013) reported on the antiobesity ac-
tion of camu camu pulp in a rat model of diet-induced
obesity.
19
Obesity in the rats was induced by subcutaneous
injection of monosodium glutamate receiving diet ad libi-
tum. The rats were divided into two groups: an experimental
group that ingested 25 ml of camu camu pulp per day and a
nontreated control group. After 12 weeks, blood, liver, heart,
and white adipose tissue were collected and weighed together
with inflammatory and biochemical profiles. The camu camu
group reduced their weights of the fat in white adipose
tissues, glucose, total cholesterol, triglycerides, low-density
lipoprotein cholesterol, and insulin blood levels. High-density
lipoprotein cholesterol levels increased. Inflammatory mark-
ers and liver enzymes did not change.
Camu camu and liver protection in rats
The potential hepatoprotective effect of camu camu was
reported by Akachi et al. (2010).
22
Previous studies had dem-
onstrated the suppressive effects of fruits on D-galactosamine
(GalN)–induced liver injury in rats.
23
IntheAkachietal.
(2010) study, 12 kinds of lyophilized fruit juices were fed to
rats for 7 days, with liver injury induced by GalN injection.
22
The study found that certain fruit juices possessed or tended
to possess suppressive effects on GalN-induced increases in
plasma alanine aminotransferase and aspartate aminotransfer-
ase activities. These decreased to near-normal levels. The most
potent suppressive effect on GalN-induced liver injury was
associated with 1-methylmalate isolated from camu camu juice.
This was potentially attributed to the inhibition of the synthesis
of RNA and proteins through a decrease in the hepatic uridine
triphosphate concentration. This produced a necrosis of liver
cells, but the actual mechanism was unclear.
Mutagenetic effects on bone marrow
In a safety study, Castro et al. (2011) reported on the
potential mutagenic effect of a range of camu camu juice
concentrations on bone marrow cells of male and female
mice.
21
Through use of the micronucleus test, the authors
found the juice could not induce chromosomal mutations.
Spermatogenic cycle in male rats
The effect of camu camu in association with an extract of
black maca (Lepidium meyenii) on spermatogenesis was
reported by Gonzales et al. (2013).
11
The combination of
these two fruits—one with the highest content of ascorbic
acid and the other an extract of black maca—was evaluated
for their effect on the seminiferous tubule stages scored by
transillumination on intact tubules in adult male rats. Over 7
days the rats were assessed for daily sperm production, stage
of spermatogenic cycle, antioxidant activity, and flavonoid
and polyphenol levels. Camu camu increased the stages of
mitosis and meiosis, and a mixture of both increased sper-
miation as well. All treatments increased daily sperm pro-
duction and epididymal sperm count.
Human Trials
Inoue et al. (2008) reported on the first in vivo study in
humans of the antioxidative and anti-inflammatory properties
of camu camu.
24
The study population consisted of 20 ha-
bitual male smokers who were considered to have an accel-
erated oxidative stress state. These volunteers were randomly
assigned to take daily 1050mg of vitamin C tablets or 70 mL
of 100% camu camu juice containing 1050mg of vitamin C
as a dietary supplement for 7 days. Baseline characteristics,
including cigarette consumption, tar and nicotine intake, and
blood pressure, were similar in the two groups. In the camu
camu group, at 7 days, oxidative stress markers urinary 8-
OHdG levels and serum total reactive oxygen species levels
significantly decreased, as did the levels of the inflammatory
markers high-sensitivity C-reactive protein, interleukin-6, and
interleukin-8. No corresponding changes were observed in the
vitamin C group. These markers were restored in the washout
stage of 1 month after cessationofcamucamuuse.The
authors concluded that camu camu has more powerful an-
tioxidative and anti-inflammatory activities than daily intake
of 1500 mg of vitamin C, although the contents of vitamin C
are equivalent. They also concluded, given the equivalent
vitamin C contents, that camu camu possibly contains other
ANTIOXIDANT CAPACITIES OF CAMU CAMU 11
antioxidative substances, including and in addition to the
known presence of carotenoids and anthocyanins. A further
possibility was that camu camu had substances, such as
potassium, that increase the in vivo availability of vitamin C
by absorption or excretion.
A more recent study by Ellinger et al. (2012) reported on
the effects of a bolus consumption of a blended juice of ac¸ai,
Andean blackberries, and camu camu on the concentrations
of plasma antioxidants, plasma antioxidant capacity, and
markers for oxidative stress.
25
In this randomized controlled
crossover study, 12 healthy participants consumed 400 mL of
blended juice or a control sugar solution. The primary end-
point of the study was the total antioxidative capacity in blood;
multiple assays with different radicals and mechanisms (hy-
drogen or electron transfer) were used: Trolox Equivalent
Antioxidant Capacity (TEAC) and Folin-Ciocalteau (FCR).
The results indicated that TWEAC and FCR as parameters of
plasma antioxidative capacity were not affected by beverage,
time, or interactions between beverage and time, despite an
obvious increase in ascorbic acid and other substances with
reducing capacity in plasma. Bolus ingestion of the blended
juice only increased the concentration of plasma ascorbic acid
and several unknown substances with reducing properties. It
did not reduce markers of oxidative stress.
Safety in humans
The only published report of adverse events in humans
probably associated with ingestion of a preparation con-
taining camu camu was reported by Bertoli et al. (2013).
26
A
45-year-old man was admitted with a 2-week history of
pruritus, scleral icterus, and dark urine and with fever and
vomiting. Tests for hepatitis A, B, C and E viruses; Epstein-
Barr virus; and cytomegalovirus ruled out viral hepatitis
and metabolic or autoimmune cases of liver injury. Mag-
netic resonance cholangiography showed no abnormalities.
A liver biopsy demonstrated centrilobular hepatocellular
damage. There was no evidence of cholestasis. No necrotic
hepatocytes, eosinophilia, or epithelioid granulomas were
present. There was no identifiable fibrosis. Histologic find-
ings were compatible with drug toxicity of not very recent
origin. Application of the Naranjo et al. (1981) adverse-
reaction probability scale suggested camu camu as the most
likely cause of the acute hepatitis.
27
Signs of liver injury
gradually improved, and the patient was discharged.
Discussion
With an aging U.S. population and a widespread recog-
nition of the part inflammation can play in the aging process,
the negative contribution of comorbidities and the high
prevalence of chronic pain in older populations, there is in-
creasing recognition and acceptance that in patient-centered
medicine integrative, multimodal approaches to disease man-
agement are central to achieving wellness and quality-of-life
targets. Driven in part by the recognition that, particularly
among older populations, multiple comorbidities are present,
physicians are becoming more focused on disease manage-
ment that not only crosses traditional specialist boundaries
but embraces nontraditional players, to include the pro-
spective positive role of natural products in treatment. At
the same time, the potential for polypharmacy-associated
adverse events has also raised awareness that if natural
products and possible dietary supplements are to be em-
braced as part of management protocols, there needs to be a
robust evidence base to address issues of dosing and drug
interactions. Once that evidence base is in place, medical
claims can be made. As an important intermediary step, it is
important that consumers, including patients and physicians,
are made more aware of the potential contribution of natural
products to overall health care.
Camu camu could potentially play a role in multimodal,
integrative approaches to health management. At this stage,
however, specific medical claims are not justified, despite
long-standing claims for vitamin C products. This does not
mean that communications to broaden disease awareness are
unimportant. Recommendations for screening and counsel-
ing to a physician audience as well as to patients to increase
their disease awareness, particularly if there are public
health implications, have a role to play.
At the same time, recognition of the contribution of
chronic systemic inflammation in the initiation and media-
tion of chronic disease has opened the way for a more
considered view of the role of diet and dietary supplements
in the management of disease. Communications to physi-
cians and patients of the need to reduce systemic inflam-
mation, to help restore normal inflammatory function, and to
help restore normal immune function not only meet a public
health need but also raise the issue of the prospective role of
such products as camu camu. Although patients seem in-
creasingly interested in dietary supplements as alternative
self-medication in disease states, all too often, unfortu-
nately, claims for anti-inflammatory status and the role of
the product in specific disease states do not rest on a sub-
stantive evidentiary base. The number of studies is limited,
but the evidence base for camu camu is more substantive
than that for competing products.
First, the antioxidant potential of camu camu has been
well established through several biochemical studies. These
studies have established the nutritional composition of camu
camu and the potential role of phytochemicals in disease
prevention and health promotion. As a case in point, the
presence of anthocyanins has been investigated in a number
of animal models and randomized clinical trials in their
association with blood pressure, endothelial function, and
cardioactive protection.
28
Second, a feature that stands out is the versatility of the
camu camu fruit. It is not just the fruit pulp but the skin and
seed products that show anti-inflammatory potential. Anti-
oxidant capacity is higher from flour produced from the skin
and seed residue than from the pulp or pulp powder.
Third, animal studies involving camu camu juice, while
in their early stages, are providing information on antioxi-
dant and antigenotoxic effects as well as protective effects
in many common conditions and disease states. Although
only suggestive, apart from the evidence for anti-inflam-
matory action, several avenues for further research in hu-
mans may merit attention to support evidence-based claims
for camu camu. These include the following:
1. Potential antiobesity action suggested by the Wistar
rat model for camu camu supplementation. A study
demonstrated a decrease in fat-storing tissue associated
with improvements in fat secretion, insulin levels, a
reduction in VLDL (very-low-density lipoprotein), and
12 LANGLEY ET AL.
an increase in high-density lipoprotein.
19
Because the
authors attributed these results to the high level of di-
etary fiber and the phenolic compounds found in camu
camu, there is the potential for antiobesity with camu
camu as a dietary supplement in human trials. Even so,
it should be noted that although obesity has been linked
to chronic systemic inflammation, no change was re-
ported for inflammatory markers.
29
2. Potential protective effect in liver injury suggested by
the rat model of GalN-induced injury
22
and the role
of 1-methylmalate presence in camu camu on other
types of liver injury and the potential for liver pro-
tection associated with, for example, alcohol abuse
and hepatitis.
3. Potential for the prevention of immune-related disease
in a study that suggested the seed extract is a source of
betulinic acid.
20
Finally, the two human studies of camu camu are highly
suggestive. While these studies differ in their design and
implementation, together they point to the potential contri-
bution of camu camu as a dietary supplement. The trial by
Inoue et al. (2008) evaluated the effect of camu camu in
persons who were smokers and were considered to have an
accelerated oxidative stress state;
24
Ellinger and colleagues’
study (2012), which combined camu camu in a fruit juice
cocktail, considered healthy nonsmokers.
25
While the juice
blend in the latter study did not reduce markers of oxida-
tive stress, the findings do not preclude beneficial effects
in situations with increased oxidative challenge, such as
smoking, physical activity, and after consumption of food.
To this extent, the Ellinger et al. (2012) results are not in-
consistent with those reported by Inoue et al. (2008).
The evidence to date suggests that camu camu could be a
viable option for maintaining a balanced immune response
and viable antioxidant mediating anti-inflammatory pro-
cesses. Although limited, the evidence indicates that the role
of camu camu in disease management may be driven by its
unique formulation as a natural way of increasing vitamin C.
At the same time, when patients are faced with the some-
times daunting requirements of disease management, camu
camu could be readily accommodated as a supplement in
daily treatment regimens as well as an alternative non-
pharmaceutical option.
Even so, it is important to establish clearly camu camu’s
place, not only as a supplement but as having a possibly
more central role in disease interventions. Further studies
should be considered. The objectives here should be to
support labeling and dosing for camu camu as an antioxidant
and as a dietary supplement to mediate inflammation and to
restore normal inflammatory and immune function. It is
important to recognize the role regulatory agencies, such as
the U.S. Food and Drug Administration, play and to ensure
that claims made are consistent with the evidence base for
the product. In this regard camu camu is well placed to build
on its evidence base with its recognized biochemical prop-
erties and vitamin C profile. More studies are definitely
needed to reinforce the existing evidence base, notably in
target small-scale human studies, and to give more confi-
dence to patients and physicians who are looking to alter-
native medicines. A possibility here is to undertake well-
designed, small-scale human studies directed to specific
disease states and stages of disease where there is a prior
expectation of an important role for camu camu in reducing
inflammation and oxidative stress.
Conclusion
The evidence base for camu camu rests on well-conducted
animal and human studies. The results of these studies point to
a potentially substantial role for camu camu in multimodal,
integrative disease and wellness management, notably with
regard to inflammatory conditions. As a supplement, the fruit
itself offers many avenues for processing and presentation. As
with all alternative medicine products, including dietary sup-
plements, the more substantive the evidence base, the greater
the confidence in the product. At the same time, if specific
medicinal claims can be supported, to include dosing and the
potential for adverse events, the more confidence consumers
will have in the product. In the case of camu camu, clearly
many options could be explored, notably in human trials, to
further evaluate its demonstrated anti-inflammatory and oxi-
dative capability, mechanism of action and its prospective
positive contribution to several disease states. At the same
time there is a pressing need to increase the visibility of nat-
ural products such as camu camu to point to their potential
benefits in populations that are not only aging but also ex-
periencing the negative effect of inflammatory and oxidative
conditions.
Acknowledgment
NEMA Research received funding for the preparation of
this manuscript by Amazon Origins.
Author Disclosure Statement
Dr. Langley is a consultant for NEMA Research. Dr.
Pergolizzi is chief operating officer of NEMA Research. Dr.
Taylor is an employee of NEMA Research. Caroline
Ridgway is a consultant for Amazon Origins.
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Address correspondence to:
Caroline Ridgway, JD
Amazon Origins, LLC
P.O. Box 1766
Naples, FL 34106
E-mail: cridgway@hfigroup.net
14 LANGLEY ET AL.
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... In addition to the evidence of antioxidant anti-inflammatory actions of the fruit and its residues, trials and many other supplementary studies have been applied including the use of obese individuals and their comorbidities (Kaneshima et al., 2013;Langley et al., 2015;Arellano-Acuña et al., 2016;Fidelis et al., 2019;Kerimi et al., 2019). This should deserve attention, since many of these diseases reveal a high oxidizing and inflammatory process. ...
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Chapter
The cultivation of a very limited number of crops does not fulfil the nutritional requirements of the growing population. For this, underutilized crops can play a vital role to meet food and nutrition security globally. They are of significant importance in localized areas, as they are highly adapted to marginal lands, do not require high inputs and is resilient to climate variability. The underutilized crops include food crops, such as cereals, vegetables, legumes, oil seeds, root, and tubers, mainly produced as a source of income for livehood of poor farmers in developing countries. Limited germplasm resource availability, lack of information on production, nutritional quality of many of the underutilized plant products, and the lack of improved quality material are the main constraints impacting the availability and productivity of these crops. Plant germplasm resources are the materials required for initiating any crop improvement programme with the help of advances in genomic techniques and various programmes for the improvement of major underutilized crops. At national and international level, genebanks are concerned with the collection, maintenance, ex situ conservation, regional and global germplasm exchange. The chapter highlights the potential of underutilized crops in context to nutrition, food security, and germplasm resources of major underutilized crops for further crop improvement studies.
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Atherosclerosis is one of the most important contributors to the global burden of cardiovascular diseases. With the recognition of atherosclerosis as an inflammatory disease, nutrition research interest has expanded towards the role of dietary patterns in the prevention of atherosclerosis primarily focused on associations with early inflammatory markers. This review summarizes the latest evidence from January 2010 until January 2013 of eight observational studies on the associations between empirically-derived dietary patterns and diet quality scores with markers of inflammation and endothelial function. Overall, results of recently published cohort studies support those of previously published cross-sectional studies suggesting that consuming a healthy type of diet characteristically abundant in fruits and vegetables is associated with lower concentrations of C-reactive protein and other inflammatory markers. Unfavourable associations were found between eating a Western dietary pattern high in meat and inflammatory markers. Different statistical approaches of deriving dietary patterns were applied in these studies and most of them lacked in reporting absolute intakes of foods and/or food groups. Future prospective cohort studies are needed to evaluate long-term associations between dietary patterns and changes in inflammatory markers by comparing various approaches of dietary pattern derivation within a population. Reporting absolute intakes of foods and/or food groups may also facilitate the identification of a typical dietary pattern that may beneficially influence inflammation.
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