ONCOLOGY.
No. 11
INTEGRATIVE ONCOLOGY
Noni (Morinda citrifolia)
Complementary Therapies, Herbs, and other OTC Agents
By Guest Editor Barrie Cassileth, PhD1 |
October 25, 2010
1 Laurance S. Rockefeller Chair and Chief, Integrative Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
Noni is an evergreen plant prevalent in Southeast Asia, 
Australia, and the Polynesian islands. It is used in traditional medicine for wound healing, infections, skin conditions, diarrhea, and as a tonic. Noni products have gained worldwide popularity over the past 2 decades and are aggressively marketed for immunostimulation and for treatment of chronic fatigue syndrome and cancer.
Preliminary data from in vitro and animal studies suggest immunomodulatory, antioxidant, and antitumor properties. However, hepatotoxicity and hyperkalemia have also been reported with noni use.
—Barrie Cassileth, PhD
ALSO KNOWN AS: Lada, Indian mulberry, nono, och plant, cheese fruit, hog apple, mora de la India, wild pine.
SUMMARY: Noni, an evergreen plant, is native to Southeast Asia, Australia, Hawaii and other Polynesian islands. The plant bears fleshy yellowish-white fruit which is used in traditional medicine for wound healing; for the treatment of infections, diarrhea, and skin conditions; and as a tonic. Morinda citrifolia should not be confused with Morinda officinalis, also known as ba ji tian, which is commonly used in Chinese medicine.
Fresh or fermented noni juice is a popular drink; capsules, pills, and powders are sold as dietary supplements. Over the past 2 decades, noni products have been heavily promoted for immunostimulation and for treatment of chronic fatigue syndrome, hypertension, and cancer.
Although claims about the beneficial effects of noni abound, many are unsubstantiated.
Some in vitro and animal studies indicate that the plant 
extracts have antifungal,[1] antitumor, and immunomodulatory[2,3] properties. Noni also inhibits low-density-lipoprotein oxidation and may help prevent arteriosclerosis.[4] Glycosides and other constituents isolated from the fruits and leaves demonstrated antioxidant properties.[5] In addition, highly concentrated (greater than 5%) noni juice was shown to have anti-angiogenic properties.[6]
Consumption of noni juice may reduce the risk of cancer in smokers.[7] A National Institutes of Health (NIH)-funded phase I study of noni in cancer patients was recently completed at the University of Hawaii Cancer Research Center, but the data have yet to be published.[8]
ADVERSE REACTIONS, CONTRAINDICATIONS: A company-sponsored study showed that dose-related adverse effects of a noni products were minimal,[9] but other reports have indicated differently. In three cases, consumption of noni juice resulted in hepatotoxicity, possibly as a result of its anthraquinone contents.[10,11] Consuming large amounts of noni-containing juices has caused hyperkalemia[12] and may be harmful in patients with compromised renal function. Also, noni juice can decrease the activity of some chemotherapeutic agents.[13]
REFERENCES
1. Banerjee S, Johnson AD, Csiszar K, et al. An extract of Morinda citrifolia interferes with the serum-induced formation of filamentous structures in Candida albicans and inhibits germination of Aspergillus nidulans. Am J Chin Med. 2006;34:503-9.
2. Arpornsuwan T, Punjanon T. Tumor cell-selective antiproliferative effect of the extract from Morinda citrifolia fruits. Phytother Res. 2006;20:515-7.
3. Furusawa E, Hirazumi A, Story S, Jensen J. Antitumour potential of a polysaccharide-rich substance from the fruit juice of Morinda citrifolia (Noni) on sarcoma 180 ascites tumour in mice. Phytother Res. 2003;17:1158-64.
4. Kamiya K, Tanaka Y, Erdang H, et al. Chemical constituents of Morinda citrifolia fruits inhibit copper-induced low-density lipoprotein oxidation. J Agric Food Chem. 2004;52:5843-8.
5. 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;68:592-5.
6. Hornick CA, Myers A, Sadowska-Krowick H, et al. Inhibition of angiogenic initiation and disruption of newly established human vascular networks by juice from Morinda citrifolia (noni). Angiogenesis. 2003;6:143-9.
7. Wang MY, Peng L, Lutfiyya MN, et al. Morinda citrifolia (noni) reduces cancer risk in current smokers by decreasing aromatic DNA adducts. Nutr Cancer. 2009;61:634-9.
8. Study of noni in cancer patients. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00033878?term=noni&rank=1. Accessed August 16, 2010.
9. West BJ, White LD, Jensen CJ, Palu AK. A double-blind clinical safety study of noni fruit juice. Pac Health Dialog. 2009;Nov;15:21-32.
10. Stadlbauer V, Fickert P, Lackner C, et al. Hepatotoxicity of noni juice: Report of two cases. World J Gastroenterol. 2005;11:4758-60.
11. Millionig G, Stadlmann S, Vogel W. Herbal hepatotoxicity: acute hepatitis caused by Noni preparation (Morinda citrifolia). Eur J Gastroenterol Hepatol. 2005;17:445-7.
12. Mueller BA, Scott MK, Sowinski KM, Prag KA. Noni juice (Morinda citrifolia): hidden potential for hyperkalemia? Am J Kidney Dis. 2000;35:310-2.
13. Santiago K, Gaikwad A, Coffer L, et al. Evaluation of the safety and activity of noni juice (Morinda citrifolia L.) in combination with chemotherapy in the oncology setting. Abstract presented at the 5th Annual Society of Integrative Oncology Conference, Atlanta, Nov 20-21, 2008.
