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.

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.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. 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 health care professional.

• Aging, antibacterial, antioxidant, atherosclerosis (hardening of the arteries), blood clot prevention, cancer, colds, coughs, depression, diabetes, diarrhea, dysentery (severe diarrhea), exercise performance, fungal infections, gum disease, hay fever, heart disease, hemorrhage (retinal), hypercholesterolemia (high cholesterol), immunostimulation, liver disorders, pressure ulcers, scurvy, skin conditions, sore throat, tooth disease, vitamin C deficiency.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

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

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

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

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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.

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2. 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. View Abstract

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4. 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. View Abstract

5. 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. View Abstract

6. 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. View Abstract

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8. 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. View Abstract

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11. Rosenthal G. Interaction of ascorbic acid and warfarin [letter]. JAMA 1971;215:1671.

12. 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. View Abstract

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14. 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. View Abstract

15. 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. View Abstract