Acerola Malpighia glabra Malpighia punicifolia

Background:

Acerola (Malphighia glabra), also known as Barbados cherry, is the fruit of a small tree known as Malphighia glabra L. in the Antilles and north of South America. In 1945, the School of Medicine at the University of Puerto Rico found that the Barbados cherry was a very rich source of vitamin C.
Folk healers have used acerola to treat liver ailments, diarrhea, dysentery, coughs, colds and sore throat. As one of the richest sources of vitamin C, acerola may be used as an immune stimulator and modulator.
Acerola has been used as a supplement for both adults and infants. The Barbados cherry extract, the fruit of Malpighia emarginata DC, has been reported to prevent age-related diseases. The Barbados cherry has been shown to exhibit cytotoxic effects and may be useful in the treatment of cancer. It has high antibacterial activity and shows multi-drug resistance reversal activity.
Currently, there is a lack of available scientific evidence and additional study is needed to evaluate acerola's safety, effectiveness and dosing.

Related Terms:

Acerola fruits, Antilles cherry, Barbados cherry, cerea-do-para, cereja-das-antillhas, cereso, Malpighia emarginata DC, Malpighia glabra L., Malpighia punicifolia, Malpighia punicifolia L., Puerto Rican cherry, West Indian cherry.

Dosing:

Adults (18 years and older)

Safety, efficacy, and dosing have not been systematically studied in adults.

Children (younger than 18 years)

Safety, efficacy, and dosing have not been systematically studied in children.

Safety:

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

Individuals with a known allergy or hypersensitivity to acerola or species in the Malpighiaceae family should not use acerola.

Side Effects and Warnings

In general, acerola appears to be generally well tolerated in recommended amounts in otherwise healthy individuals. High doses may cause diarrhea, nausea, abdominal cramps, insomnia, fatigue or sleeplessness due to the vitamin C content.
Patients with gout should not take acerola because the vitamin C in acerola might increase uric acid levels.
Patients with a history of kidney stones (nephrolithiasis) should also not take acerola as large doses of vitamin C in acerola may cause the production of urate, cystine or oxalate stones.

Pregnancy and Breastfeeding

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

Interactions:

Interactions with Drugs

The vitamin C in acerola may interact with acidic or basic drugs, acidify urine and affect excretion. Patients taking medications should consult with a qualified healthcare professional, including a pharmacist.
Vitamin C appears to interfere with the "blood thinning" effects of warfarin by lowering prothrombin time. In theory, acerola may reduce the effectiveness of anticoagulant or anti-platelet agents. Examples include heparin (Hepalean®), lepirudin (Refludan®), warfarin (Coumadin®), abciximab (ReoPro®) and clopidogel (Plavix®).
Use of acerola with medications containing estrogen or birth control pills may increase the absorption and therapeutic effects due to the vitamin C content. Caution is advised.
Use of fluphenazine (Prolixin®) with acerola may decrease blood levels due to vitamin C content. Patients taking fluphenazine should consult with a qualified healthcare professional, including a pharmacist.

Interactions with Herbs and Dietary Supplements

Acerola cherry extract may increase the antioxidant effects of alfalfa or soy. Caution is advised.
Vitamin C appears to interfere with the "blood thinning" effects of warfarin (Coumadin®) by lowering prothrombin time. In theory, acerola may reduce the effectiveness of herbs and supplements that are used for their "blood thinning" effects, such as willow bark.
When taken together, the vitamin C in acerola may increase the absorption of iron in the gastrointestinal tract. Caution is advised.
Due to acerola's high vitamin C content, taking vitamin C supplements in addition to acerola may increase the total amount of vitamin C in the body and lead to adverse effects. Caution is advised.

Attribution:

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Abrams, PharmD (University of Rhode Island); Heather Boon, B.Sc.Phm, PhD (University of Toronto); Chi Dam, PharmD (Northeastern University); Nicole Giese, MS (Natural Standard Research Collaboration); Mary Giles, PharmD (University of Rhode Island); Tamara Milkin, PharmD (Northeastern University); Adrianne Rogers, MD (Harvard Medical School), Erica Seamon, PharmD (Nova Southeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration): Lisa Wendt, PharmD (Albany College of Pharmacy); Jennifer Woods, BS (Northeastern University).

References:

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.

Back DJ, Breckenridge AM, MacIver M, et al. Interaction of ethinyloestradiol with ascorbic acid in man. Br Med J (Clin Res Ed) 5-9-1981;282(6275):1516.
Caceres A, Lopez B, Juarez X, et al. Plants used in Guatemala for the treatment of dermatophytic infections. 2. Evaluation of antifungal activity of seven American plants. J Ethnopharmacol. 1993;40(3):207-213.
Clein NW. Acerola juice, the richest known source of vitamin C; a clinical study in infants. J.Pediatr. 1956;48(2):140-145.
de Assis SA, Martins AB, Guaglianoni DG, et al. Partial purification and characterization of pectin methylesterase from acerola (Malpighia glabra L.). J.Agric.Food Chem. 7-3-2002;50(14):4103-4107.
de Medeiros RB. [Proportion of ascorbic, dehydroascorbic and diketogulonic acids in green or ripe acerola(Malpighia punicifolia)]. Rev.Bras.Med. 1969;26(7):398-400.
Hanamura T, Hagiwara T, Kawagishi H. Structural and functional characterization of polyphenols isolated from acerola (Malpighia emarginata DC.) fruit. Biosci.Biotechnol.Biochem. 2005;69(2):280-286.
Hwang J, Hodis HN, Sevanian A. Soy and alfalfa phytoestrogen extracts become potent low-density lipoprotein antioxidants in the presence of acerola cherry extract. J.Agric.Food Chem. 2001;49(1):308-314.
Morris JC, Beeley L, Ballantine N. Interaction of ethinyloestradiol with ascorbic acid in man. Br Med J (Clin Res Ed) 8-15-1981;283(6289):503.
Motohashi N, Wakabayashi H, Kurihara T, et al. Biological activity of barbados cherry (acerola fruits, fruit of Malpighia emarginata DC) extracts and fractions. Phytother.Res. 2004;18(3):212-223.
Nagamine I, Akiyama T, Kainuma M, et al. Effect of acerola cherry extract on cell proliferation and activation of ras signal pathway at the promotion stage of lung tumorigenesis in mice. J.Nutr.Sci.Vitaminol.(Tokyo) 2002;48(1):69-72.
Rosenthal G. Interaction of ascorbic acid and warfarin [letter]. JAMA 1971;215:1671.
Trindade RC, Resende MA, Silva CM, et al. Yeasts associated with fresh and frozen pulps of Brazilian tropical fruits. Syst.Appl.Microbiol. 2002;25(2):294-300.
Visentainer JV, Vieira OA, Matsushita M, et al. [Physico-chemical characterization of acerola (Malpighia glabra L.) produced in Maringa, Parana State, Brazil]. Arch.Latinoam.Nutr. 1997;47(1):70-72.
Visentainer JV, Vieira OA, Matsushita M, et al. Vitamin C in Barbados cherry Malpighia glabra L. pulp submitted to processing and to different forms of storage. Arch Latinoam.Nutr. 1998;48(3):256-259.
Wakabayashi H, Fukushima H, Yamada T, et al. Inhibition of LPS-stimulated NO production in mouse macrophage-like cells by Barbados cherry, a fruit of Malpighia emarginata DC. Anticancer Res. 2003;23(4):3237-3241.

Disclaimer :

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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