Acerola (Malpighia glabra, Malpighia punicifolia)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
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.
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.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
No available studies qualify for inclusion in the evidence table.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
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.
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.
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.
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.
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.
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).
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. View Abstract
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
Clein NW. Acerola juice, the richest known source of vitamin C; a clinical study in infants. J.Pediatr. 1956;48(2):140-145. View Abstract
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
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
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
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. View Abstract
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
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. View Abstract
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. View Abstract
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. View Abstract
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. View Abstract
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
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
Copyright © 2013 Natural Standard (www.naturalstandard.com)
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.
March 22, 2017