Moringa
Scientific Name(s): Moringa oleifera
Common Name(s): Ben oil, Benzoil tree, Drumstick tree, Horseradish tree, Moringa, Mulaka, Sajna, Saragva, Shajmah, Shevga, Sujana, Sundan
Medically reviewed by Drugs.com. Last updated on Feb 20, 2024.
Clinical Overview
Use
M. oleifera components have traditionally been used for various conditions and purposes. Clinical studies have examined the blood pressure-lowering, antidiabetic, and antidyslipidemic effects of M. oleifera. However, clinical trial data are lacking to recommend use for any indication.
Dosing
Clinical data are insufficient to determine dosing recommendations for M. oleifera. Daily dosages of leaf preparations used in clinical studies evaluating potential antidiabetic and antidyslipidemic effects have varied widely.
Contraindications
Contraindications have not been identified.
Pregnancy/Lactation
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
None well documented. No clinical studies have evaluated herb-herb interactions or herb-drug interactions with M. oleifera use.
Adverse Reactions
In general, M. oleifera is well tolerated. Case reports exist of toxic reactions following consumption of moringa powder, including one report of Stevens-Johnson syndrome and one of cutaneous toxicity with respiratory distress and tongue edema.
Toxicology
No data.
Scientific Family
- Moringaceae (horseradish tree)
Botany
M. oleifera is an evergreen tree that grows to approximately 8 to 9 m in height. The bark of the tree is soft and white on the inside and cork-like on the outside.(Mishra 2011, Paliwal 2011) The stem is thin and tall, and the twigs are finely hairy and green. The taste of the vesicant roots resembles that of horseradish. The leaves are longitudinally cracked, 30 to 75 cm in length, and glandular at joints.(Mishra 2011, Paliwal 2011) The leaflets are dark green at the top surface and pale underneath. The flowers are white and sweet smelling, with individual stalks approximately 90 cm in length.(Mishra 2011, Paliwal 2011) The distinctive fruits are 90 cm in length and 12 mm broad, gradually tapering at the end; in many regions, these fruits are known as "drumsticks." The fruits split along the length to expose rows of black, oily seeds covered with paper-like rings.(Mishra 2011, Paliwal 2011)
Related/similar drugs
turmeric, Ginkgo Biloba
History
The moringa tree is indigenous to India and grows widely on the foothills of the Himalayas. It is also widely cultivated in Pakistan, Bangladesh, Sri Lanka, Afghanistan, and most of Southeast Asia. M. oleifera is the most well known of the 13 species of the Moringa genus (family Moringaceae).(Paliwal 2011) The fast-growing tree is grown for food, fodder and dyes, and for water clarification purposes.(Anwar 2007, Mishra 2011, Paliwal 2011) The seeds are used to flocculate contaminants and purify drinking water, and are also consumed in broths; oil from the seeds is used for cooking.(Anwar 2007, Mishra 2011, Paliwal 2011) Moringa has traditionally been used for various medicinal purposes. In India and Southeast Asia, M. oleifera is used for the treatment of inflammation and infectious diseases, as well as for cardiovascular, GI, hematological, and hepatorenal disorders.(Anwar 2007, Mishra 2011, Paliwal 2011) In the Philippines, it is known as "mother's best friend" because of its purported ability to increase milk production in breastfeeding mothers.(Anwar 2007) The seeds can be consumed fresh as peas or pounded, roasted, or pressed into sweet, nondesiccating, high-quality oil, commercially known as Ben oil.(Paliwal 2011) The seed cake also serves as a natural coagulant for water treatment. Parts of the plant are used as decoctions for gargling in hoarseness and sore throat; the plant is believed to have antiparalytic, antiviral, anti-inflammatory, and analgesic properties.(Anwar 2007, Mishra 2011, Paliwal 2011) Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates use of the dried root bark in goiter, glycosuria, and lipid disorders.(Ayurvedic 2008, Mishra 2011)
Chemistry
M. oleifera contains many compounds of the rhamnose sugar and the distinctive glucosinolates and isothiocyanates niaziridin and niazirin.(Eilert 1981, Faizi 1994, Villasenor 1989) The stem bark contains 2 alkaloids, moringine and moringinine.(Singh 2012) Vanillin, beta-sitosterol, beta-sitostenone, 4-hydroxymellin, and octacosanoic are found in the stem of M. oleifera.(Singh 2012) The gum exudate from the tree contains L-arabinose, galactose, glucuronic acid, L-rhamnose, mannose, and xylose.(Bhattacharya 1982) Moringa flowers contain some flavonoid pigments, such as kaempherol, rhamnetin, isoquercitrin, and kaempferitrin.(Siddhuraju 2003) Gallic acid, chlorogenic acid, ellagic acid, and ferulic acid are present in the aqueous extracts of leaves, fruits, and seeds of M. oleifera.(Singh 2009) The plant contains a wide range of terpenoids, primary among which are alpha-phellandrene and p-cymene.(Ogunbinu 2009) An in vitro study demonstrated dipeptidyl peptidase IV (DPP-IV) inhibitory activity of 3 chemical compounds isolated from M. oleifera.(Yang 2020)
Uses and Pharmacology
Antibacterial effects
In vitro data
Extracts of food and spice plants used in traditional Thai medicine for GI conditions were investigated for their antimicrobial effects on 18 strains of Helicobacter pylori. Of the 20 extracts tested, 9 inhibited the growth of all 18 strains. Moringa was found to have a minimal inhibitory concentration (MIC) of more than 100 mcg/mL and, therefore, was considered to be inactive. Amoxicillin (MIC range, 0.0039 to 0.25 mcg/mL) and metronidazole (MIC range, 64 to 124 mcg/mL) were used as controls.(Bhamarapravati 2003)
Blood pressure-lowering effects
Clinical data
In a small (N=41) open-label study, participants were randomized to consume sautéed M. oleifera leaves (120 g) with a meal (n=23) or placebo (n=18). Blood pressure was measured at baseline (before meal) and at regular intervals over 24 hours. A reduction in postprandial systolic and diastolic blood pressure was reported in the M. oleifera group at 2 hours.(Chan Sun 2020)
Cancer
In vitro data
A study evaluated the anticancer effects of M. oleifera bark, leaf, and seed extracts . The leaf and bark, but not seed, extracts showed increased late apoptosis, decreased cell motility, and decreased cell survival in breast and colorectal cancer cell lines.(Al-Asmari 2015)
Diabetes
Animal and in vitro data
An in vitro study demonstrated DPP-IV inhibitory activity of 3 chemical compounds isolated from M. oleifera.(Yang 2020)
Studies in rodents report reduced postprandial glucose levels with M. oleifera leaf powder administration.(Mbikay 2012, Ndong 2007, Villarruel-Lopez 2018) The hypoglycemic effect was reported to be equivalent to that of the sulfonylurea glipizide.(Jaiswal 2009)
Clinical data
A controlled study of patients with untreated type 2 diabetes mellitus evaluated the effect of M. oleifera added to a standardized meal (after an overnight fast) on 1- and 2-hour postprandial plasma glucose relative to a standard meal alone or to a 75 g oral glucose load. M. oleifera was compared with bitter gourd (Momordica charantia) and curry leaves (Murraya koenigii). Compared with the glucose load, standard meals with or without vegetable supplements induced a lower rise in postprandial plasma glucose (glycemic response) according to AUCs. However, when leaf-supplemented meals were compared with standard meals, only the M. oleifera leaf-supplemented meal elicited a lower response (−21%; P<0.01).(William 1993)
Glycemic and lipidemic effects were examined in a study of patients with type 2 diabetes (N=46) receiving 8 g/day of powdered M. oleifera leaves (in tablet form) for 40 days. Fasting plasma glucose and postprandial plasma glucose were reduced by 28% and 26%, respectively, at 40 days. Total cholesterol, triglycerides, and low-density lipoprotein (LDL) levels were 14%, 14%, and 29% lower, respectively, relative to the control group.(Stohs 2015)
In a double-blind, randomized, placebo-controlled study of participants with prediabetes (N=65), consumption of M. oleifera dry leaf powder 2,400 mg/day for 12 weeks showed statistically significant differences from placebo in some outcomes, such as HbA1c; improvements in HbA1c occurred in 58% of the moringa group at 12 weeks, compared with only 38% of the placebo group. There were no differences between groups in change to normoglycemic status. No significant differences were noted in multiple safety outcomes, including liver function, renal function, and gut microbiome.(Gomez-Martinez 2021)
A review that identified 5 low-quality controlled trials evaluating use of M. oleifera in patients with type 2 diabetes (published between 1950 and 2019) reported overall favorable but equivocal results.(Haber 2020)
Dyslipidemia
Animal data
Two studies evaluated the effects of M. oleifera leaves on induced dyslipidemia in rabbits receiving a high-cholesterol (5%) diet for 12 weeks.(Chumark 2008, Mbikay 2012) When concomitantly fed an M. oleifera aqueous leaf extract at a daily dose of 100 mg/kg of body weight for the duration of the protocol, the following were reduced: total cholesterol and lipoprotein cholesterol by approximately 50%, triglycerides by 75%, and carotid plaque formation by 97%. This protective effect was comparable to that of the statin drug simvastatin given at a daily dose of 5 mg/kg of body weight.(Chumark 2008, Mbikay 2012)
Clinical data
The potential antidyslipidemic effect of M. oleifera was examined in 35 hyperlipidemic patients (26 men and 9 women; total cholesterol levels greater than 180 mg/dL or triglycerides greater than 140 mg/dL). The control and experimental groups consisted of 18 subjects and 17 subjects, respectively. The experimental group received 4.6 g of dehydrated M. oleifera leaves daily (as four 550 mg tablets twice daily) for 50 days. Compared with the control group, the experimental group experienced a 1.6% decrease in plasma total cholesterol (P<0.05) and a 6.3% increase in high-density lipoprotein cholesterol, with nonsignificant trends toward lower LDL cholesterol, very low-density lipoprotein cholesterol, and triglycerides.(Nambiar 2010) In patients with type 2 diabetes (N=46) given 8 g/day of powdered M. oleifera leaves (in a tablet form) for 40 days, total cholesterol, triglyceride, LDL, and VLDL levels were 14%, 14%, 29%, and 15% lower, respectively, relative to the control group at the end of the study.(Stohs 2015)
Nutritional deficiency
Clinical data
A single-blind, randomized, controlled clinical study evaluated the nutritional impact of supplemental M. oleifera leaf extract over 6 months in HIV-positive patients (N=60). An increase in body mass index was reported for the M. oleifera group compared with the control group.(Tshingani 2017)
Dosing
Clinical data are insufficient to determine dosing recommendations for M. oleifera. The fruits and leaves are consumed as food and are part of a regular diet in India and other parts of South Asia.(Anwar 2007, Mishra 2011, Paliwal 2011) Various M. oleifera plant parts are also incorporated into formulations marketed for a variety of human health disorders.(Paliwal 2011)
Daily dosages of M. oleifera leaf preparations used in clinical studies evaluating potential antidiabetic and antidyslipidemic effects have varied widely (range, 2.4 to 8 g/day; treatment duration, up to 12 weeks).(Gomez-Martinez 2021, Nambiar 2010, Stohs 2015)
Pregnancy / Lactation
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.
Abortifacient effects have been reported with orally administered leaf extract in rats.(Bernstein 2021)
A study in Indonesia evaluated M. oleifera leaf extract as an alternative to iron supplementation during pregnancy. While study results suggest similar effects between M. oleifera and iron folate in terms of low-birth-weight incidence, information regarding the study sample size, dosing, and treatment duration were not provided. Further study is necessary to determine the effects of M. oleifera on other pregnancy outcomes, including maternal and child mortality.(Nadimin 2020)
Interactions
No clinical studies have evaluated potential herb-herb interactions or herb-drug interactions with M. oleifera use. One in vitro study revealed that components of M. oleifera extracts may inhibit both CYP3A4 and P-gp; concomitant use of drugs that are CYP3A4 substrates or P-gp dependent is discouraged.(Aworte 2016) However, another study of M. oleifera phytochemicals found no inhibition of the CYP2D6 enzyme. The majority of chemical constituents also showed only weak protein binding capacity.(Yang 2020)
Animal studies suggest that M. oleifera inhibits conversion of thyroxine to triiodothyronine, suggesting a potential interaction with levothyroxine.(Haber 2020)
Amodiaquine: Moringa may decrease the serum concentration of amodiaquine. No action needed.(Olawoye 2018)
Nevirapine: Moringa may increase the serum concentration of nevirapine. No action needed.(Fantoukh 2019, Monera-Penduka 2017)
Adverse Reactions
In general, M. oleifera is well tolerated. Limited clinical studies have been published, with few (eg, diarrhea) or no adverse effects reported.(Haber 2020, Stohs 2015)
Case reports exist of toxic reactions following consumption of moringa powder, including one report of Stevens-Johnson syndrome and one of cutaneous toxicity with respiratory distress and tongue edema.(Sagrera 2021)
Toxicology
Information regarding toxicity in humans is lacking.
Equivocal findings have been reported in rodent toxicity studies of M. oleifera leaf methanol extract; hepatic and kidney damage have been reported in a number of studies.(Oyagbemi 2013, Saleem 2020, Singh 2014, Villarruel-Lopez 2018) Differences in dose, methods of extraction and purification, and source of the plant may account for differences in observations.(Villarruel-Lopez 2018)
Abortifacient effects have been reported with orally administered leaf extract in rats.(Bernstein 2021)
Methanol extract of M. oleifera root has been reported to cause hematological, renal, and hepatic insult.(Mazumder 1999, Stohs 2015)
References
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