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Apricot

Scientific Name(s): Prunus armeniaca L.
Common Name(s): Apricot, Apricot kernel oil, Semen Armeniacae, Vitamin B17

Clinical Overview

Use

Apricots are used as a dietary source of vitamins and minerals, and in confectionery. Apricot kernels have been used for cancer treatment; however, there is no clinical evidence to support this use.

Dosing

No clinical evidence is available to provide guidance on dosing of apricots or apricot-containing products.

Contraindications

Contraindications have not been identified. Consumption of the dried ripe seeds of P. armeniaca is not recommended during pregnancy or breast-feeding, or in children.

Pregnancy/Lactation

Apricot fruit is generally recognized as safe (GRAS). Doses greater than those found in food should be avoided because safety and efficacy are unproven. Consumption of apricot kernels or laetrile is not recommended in pregnant or breast-feeding women.

Interactions

None well documented.

Adverse Reactions

Hypersensitivity and adverse reactions similar to cyanide poisoning have been reported.

Toxicology

Cyanide poisoning and death have resulted from laetrile and apricot kernel ingestion.

Botany

Apricot trees grow up to 9 m in height. The plant leaves are oval and finely serrated, and the 5-petaled white flowers grow in clusters. The downy, orange-red drupe (fruit) ripens in late summer and has a fleshy outer layer and inner hard stone containing the seed (kernel). The apricot is native to China and Japan but is also cultivated in warmer, temperate regions of the world, including Turkey, Iran, southern Europe, South Africa, Australia, and California. The many varieties and species of apricot differ in flavor, color, and size, and are related to other members of the plum genus, including the peach. 1, 2, 3 Synonyms include P. armeniaca L. var. vulgaris Zabel, Armeniaca vulgaris Lam., Amygdalus armeniaca (L.) Dumort., and Armeniaca vulgaris Lam.

History

The apricot has been used medicinally for more than 2,000 years in India and China. The Greeks wrongly assumed that the apricot originated in Armenia, hence its botanical name P. armeniaca. The Romans named the fruit "praecocium," meaning "precocious," which refers to the fruit's early ripening. From this word, the name "apricot" evolved3, 4

In Chinese medicine, the amygdalin present in apricot kernels has been traditionally prescribed in very small amounts for treating asthma, cough, and constipation.3, 4 A decoction of the plant's bark has been used as an astringent to soothe irritated skin. In folk medicine, other uses include the treatment of hemorrhage, infertility, eye inflammation, and spasms. Apricot kernel paste has been used in vaginal infections. The oil has been used in cosmetics and as a vehicle in certain pharmaceutical formulations4, 5

Chemistry

The fresh apricot fruit contains carbohydrates, vitamins C and K, beta-carotene, thiamine, niacin, and iron. Organic acids, phenols, volatile compounds (eg, benzaldehyde), some esters, norisoprenoids, and terpenoids have also been isolated.6, 7, 8 When apricot seed essential oil was evaluated under spectroscopy, benzaldehyde was the predominant compound, with lesser amounts of benzoic acid and the cyanogenic glycoside amygdalin identified.7, 8, 9 Oleic acid, sterols (including campesterol, beta-sitosterol, and others), and squalene have also been identified in the seed oil.10, 11

Amygdalin, a cyanogenic glycoside from the kernels of apricots, can be hydrolyzed to form glucose, benzaldehyde, and hydrocyanic acid. Enzymatic release of cyanide occurs in the presence of beta-glucuronidase, an enzyme found in human intestines.12 "Laetrile" is a term often used interchangeably with "amygdalin," but they are not the same chemical entity. The term "laetrile" refers to a purified form of amygdalin.13 The US patent for laetrile specifies a semisynthetic derivative of amygdalin that is different from the Mexican laetrile/amygdalin made from crushed apricot seeds.13 Amygdalin may also be referred to as vitamin B17 or amygdaloside.14

Uses and Pharmacology

Anti-inflammatory

Animal data

Anti-inflammatory effects of the kernel extract and/or oil were demonstrated in rats with induced ulcerative colitis.15 In rats with induced benign prostatic hyperplasia administered an extract of P. armeniaca bark, histological and biochemical parameters were improved, possibly due to reduced inflammation from phytosterol activity.16

Clinical data

Research reveals no clinical studies evaluating the efficacy of apricot extracts on inflammatory diseases.

Cancer

Animal data

Amygdalin demonstrated activity against renal cell carcinoma in vitro17 and inhibited the growth of implanted tumors in rats.18 When fed to rats with induced hepatic carcinogenesis, the fruit demonstrated protective qualities by increasing the resistance of healthy cells.19

One experiment reported a potential effect of apricot extract on intestinal P-glycoprotein substrates, suggesting a possible role in multidrug-resistant cancer.20

Clinical data

Despite promising in vitro experiments, the efficacy of amygdalin to treat cancer has not been validated by any rigorous clinical trials. The National Cancer Institute sponsored phase 1 and 2 clinical trials in the 1980s but found no evidence to support the use of laetrile in cancer treatment.21

Although interest in the efficacy of laetrile/amygdalin in cancer treatment continues, a Cochrane meta-analysis found no controlled clinical trials to form an opinion.13 Laetrile is banned from use in cancer therapy by the US Food and Drug Administration and the European Union, and it remains an unapproved drug product in the United States.13, 14, 22

Hepatic disease

Animal data

Studies evaluating the effect of ground apricot kernel on induced hepatic fibrosis in rats suggest positive effects due to the fatty acid content23; a protective effect of beta-carotene from the apricot fruit was also demonstrated on the liver of ethanol-fed rats.24

Clinical data

Clinical data to support traditional use of apricot seed extract in liver disease are limited; however, a small clinical trial reported improvement, as observed with ultrasound evaluation, in participants with fatty liver disease.25

Other uses

Apricots are consumed as a dietary source of vitamins A and C.7, 26 The total antioxidant activity of apricots is lower than that of grapes, raisins, plums, and cherries.7 Protective antioxidant effects of apricot kernel oil were demonstrated in a reperfusion injury study in rats.27

The carotenoid fraction, especially lutein from apricot fruits, exerted antiamyloidogenic properties in vitro, suggesting a potential application as a food source for the prevention of amyloid-associated diseases such as Alzheimer disease.28

Equivocal findings regarding antimicrobial activity of the essential oil have been reported.9, 29

Apricot seed oil inhibited keratinocyte proliferation and induced apoptosis in vitro in a study evaluating potential application in psoriasis.30 Apricot seed oil possibly had a positive influence on the immune system in a rat model of cyclophosphamide-induced immunosuppression.31

Dosing

No clinical evidence is available to provide guidance on dosing of apricots or apricot-containing products.

A short-term reference dose for cyanide (via consumption of bitter apricot kernels) of 0.005 to 0.075 mg/kg of body weight has been suggested based on studies in healthy adults; adverse effects may occur at these doses.32

Pregnancy / Lactation

The apricot fruit is GRAS. Doses greater than those found in food should be avoided because safety and efficacy are unproven.

Consumption of apricot kernels or laetrile is not recommended in pregnant or breast-feeding women because of insufficient data and a potential risk of birth defects.3

Cyanide has not been reported to directly cause human birth defects; however, birth defects occurred in rats that ate cassava root diets, harmful effects on the reproductive system occurred in rats and mice given water containing sodium cyanide, and skeletal abnormalities occurred in the offspring of pregnant hamsters administered oral laetrile.33 Infants born to mothers exposed to cyanide and thiocyanate during pregnancy have exhibited thyroid disease.34

Interactions

None well documented.

Adverse Reactions

Contact dermatitis from apricot kernels has been reported, and allergy to apricots is common. Cross-reactivity to peaches has been demonstrated in clinical and in vitro experiments.35, 36

Adverse effects of amygdalin consumption (eg, nausea, vomiting, headache, dizziness) are similar to those of neurotoxic cyanide.3

Toxicology

Cyanide poisoning due to laetrile and apricot kernel ingestion continues to be reported, but not all cases result in death.37, 38, 39, 40, 41, 42 A minimum lethal dose of cyanide is estimated at 50 mg (ranging from 0.5 to 1.5 mg/kg of body weight in the literature).38, 39, 42 Oral amygdalin/laetrile is considered 40 times more toxic than the intravenous form because of its conversion to hydrogen cyanide by enzymes in the human intestine.12, 23

Symptoms of cyanide poisoning (eg, coma, cyanosis, dizziness, headache, hypotension, nausea, neuropathies, ptosis, vomiting) may be potentiated by eating foods containing beta-glucosidase (eg, bean sprouts, carrots, celery, peaches) or high doses of vitamin C.3, 23

There are no toxicology data regarding the flesh or skin of apricot fruits.

References

1. Prunus armeniaca. USDA, NRCS. 2016. The PLANTS Database. (http://plants.usda.gov, 5 July 2016). National Plant Data Team, Greensboro, NC 27401-4901 USA.
2. Khan I, Abourashed E. Leung’s Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. 3rd ed. Hoboken, NJ: Wiley; 2009.
3. Prunus armeniaca. In: WHO Monographs on Selected Medicinal Plants. Vol 3. Geneva, Switzerland: World Health Organization; 2007. http://apps.who.int/medicinedocs/en/m/abstract/Js14213e/.
4. Chevallier A. The Encyclopedia of Medicinal Plants. New York, NY: DK Publishing; 2001
5. Duke JA, Bogenschutz-Godwin M, duCellier J, Duke P. Handbook of Medicinal Herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002.
6. Riu-Aumatell M, López-Tamames E, Buxadera S. Assessment of the volatile composition of juices of apricot, peach, and pear according to two pectolytic treatments. J Agric Food Chem. 2005;53(20):7837-7843.16190639
7. Karakaya S, El SN, Taş AA. Antioxidant activity of some foods containing phenolic compounds. Int J Food Sci Nutr. 2001;52(6):501-508.11570016
8. Duke JA. Handbook of Biologically Active Phytochemicals and Their Activities. Boca Raton, FL: CRC Press; 1992. http://www.ars-grin.gov/duke/. Accessed July 05, 2016.
9. Lee HH, Ahn JH, Kwon AR, Lee ES, Kwak JH, Min YH. Chemical composition and antimicrobial activity of the essential oil of apricot seed. Phytother Res. 2014;28(12):1867-1872.25219371
10. Matthäus B, Musazcan Özcan M. Oil content, fatty acid composition and distributions of vitamin-E-active compounds of some fruit seed oils. Antioxidants (Basel). 2015;4(1):124-133.26785341
11. Rudzińska M, Górnaś P, Raczyk M, Soliven A. Sterols and squalene in apricot (Prunus armeniaca L.) kernel oils: the variety as a key factor [published online ahead of print January 8, 2016]. Nat Prod Res.26745662
12. Shragg TA, Albertson TE, Fischer CJ Jr. Cyanide poisoning after bitter almond ingestion. West J Med. 1982;136(1):65-69.7072244
13. Milazzo S, Ernst E, Lejeune S, Schmidt K. Laetrile treatment for cancer. Cochrane Database Syst Rev. 2006;(2):CD005476.
14. Import alert 62-01: Laetrile (Amygdalin, other Names). Food and Drug Administration website. http://www.accessdata.fda.gov/cms_ia/importalert_167.html. Published 2011. Accessed August 29, 2016.
15. Minaiyan M, Ghannadi A, Asadi M, Etemad M, Mahzouni P. Anti-inflammatory effect of Prunus armeniaca L. (Apricot) extracts ameliorates TNBS-induced ulcerative colitis in rats. Res Pharm Sci. 2014;9(4):225-231.25657793
16. Jena AK, Vasisht K, Sharma N, Kaur R, Dhingra MS, Karan M. Ameolioration of testosterone induced benign prostatic hyperplasia by Prunus species. J Ethnopharmacol. 2016;190:33-45.27235020
17. Juengel E, Afschar M, Makarević J, et al. Amygdalin blocks the in vitro adhesion and invasion of renal cell carcinoma cells by an integrin-dependent mechanism. Int J Mol Med. 2016;37(3):843-850.26781971
18. Yamshanov VA, Kovan'ko EG, Pustovalov YI. Effects of amygdaline from apricot kernel on transplanted tumors in mice. Bull Exp Biol Med. 2016;160(5):712-714.27021084
19. Karabulut AB, Karadag N, Gurocak S, Kiran T, Tuzcu M, Sahin K. Apricot attenuates oxidative stress and modulates of Bax, Bcl-2, caspases, NFĸ-B, AP-1, CREB expression of rats bearing DMBA-induced liver damage and treated with a combination of radiotherapy. Food Chem Toxicol. 2014;70:128-133.24819963
20. Deferme S, Mols R, Van Driessche W, Augustijns P. Apricot extract inhibits the P-gp-mediated efflux of talinolol. J Pharm Sci. 2002;91(12):2539-2548.12434397
21. National Cancer Institute. Latrile/Amygdalin (PDQ)–Health Professional Version. National Institutes of Health website. http://www.cancer.gov/cancertopics/pdq/cam/laetrile/HealthProfessional. Updated April12, 2016. Accessed July 4, 2016.
22. Meijer E, Liikan E. Sale over the internet of substances for human consumption which are regarded as harmful in America. OJEC. 2001;44:58-59.
23. Abdel-Rahman MK. Can apricot kernels fatty acids delay the atrophied hepatocytes from progression to fibrosis in dimethylnitrosamine (DMN)-induced liver injury in rats? Lipids Health Dis. 2011;10:114.21736706
24. Shivashankara AR, Azmidah A, Haniadka R, Rai MP, Arora R, Baliga MS. Dietary agents in the prevention of alcohol-induced hepatotoxicty: preclinical observations. Food Funct. 2012;3(2):101-109.22119904
25. Liu ZL, Xie LZ, Zhu J, Li GQ, Grant SJ, Liu JP. Herbal medicines for fatty liver diseases. Cochrane Database Syst Rev. 2013;(8):CD009059.23975682
26. Ruiz D, Egea J, Tomás-Barberán FA, Gil MI. Carotenoids from new apricot (Prunus armeniaca L.) varieties and their relationship with flesh and skin color. J Agric Food Chem. 2005;53(16):6368-6374.16076120
27. Zhang J, Gu HD, Zhang L, et al. Protective effects of apricot kernel oil on myocardium against ischemia-reperfusion injury in rats. Food Chem Toxicol. 2011;49(12):3136-3141.21896302
28. Katayama S, Ogawa H, Nakamura S. Apricot carotenoids possess potent anti-amyloidogenic activity in vitro. J Agric Food Chem. 2011;59(23):12691-12696.22043804
29. Hammer KA, Carson CF, Riley TV. Antimicrobial activity of essential oils and other plant extracts. J Appl Microbiol. 1999;86(6):985-990.10438227
30. Li K, Yang W, Li Z, et al. Bitter apricot essential oil induces apoptosis of human HaCaT keratinocytes. Int Immunopharmacol. 2016;34:189-198.26971222
31. Tian H, Yan H, Tan S, et al. Apricot kernel oil ameliorates cyclophosphamide-associated immunosuppression in rats. Lipids. 2016;51(8):931-939.27262314
32. Abraham K, Buhrke T, Lampen A. Bioavailability of cyanide after consumption of a single meal of foods containing high levels of cyanogenic glycosides: a crossover study in humans. Arch Toxicol. 2016;90(3):559-574.25708890
33. Willhite CC. Congenital malformations induced by laetrile. Science. 1982;215(4539):1513-1515.
34. Agency for Toxic Substances and Disease Registry (ATSDR). ToxFAQs for cyanide. Atlanta, GA: US Department of Health and Human Services, Public Health Service. http://www.atsdr.cdc.gov/toxfaqs/tf.asp?id=71&tid=19. Published July 2006. Updated October 24, 2011. Accessed August 29, 2016.
35. Pastorello EA, D'Ambrosio FP, Pravettoni V, et al. Evidence for a lipid transfer protein as the major allergen of apricot. J Allergy Clin Immunol. 2000;105(2, pt 1):371-377.10669861
36. Rodriguez J, Crespo JF, Lopez-Rubio A, et al. Clinical cross-reactivity among foods of the Rosaceae family. J Allergy Clin Immunol. 2000;106(1, pt 1):183-189.10887323
37. Akil M, Kaya A, Ustyol L, Aktar F, Akbayram S. Acute cyanide intoxication due to apricot seed ingestion. J Emerg Med. 2013;44(2):e285-e286.23158573
38. Cigolini D, Ricci G, Zannoni M, et al. Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels. Emerg Med J. 2011;28(9):804-805.2269488610.1136/bcr.03.2011.3932
39. Sauer H, Wollny C, Oster I, et al. Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child. Wien Med Wochenschr. 2015;165(9-10):185-188.25605411
40. Seghers L, Walenbergh-van Veen M, Salome J, Hamberg P. Cyanide intoxication by apricot kernel ingestion as complimentary cancer therapy. Neth J Med. 2013;71(9):496-498.24218429
41. Vlad IA, Armstrong J, Bertilone C, Matisons M. Apricot kernels: a rare case of cyanide toxicity. Emerg Med Australas. 2015;27(5):491-492.26289124
42. Suchard JR, Wallace KL, Gerkin RD. Acute cyanide toxicity caused by apricot kernel ingestion. Ann Emerg Med. 1998;32(6):742-744.9832674

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