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Artichoke

Scientific Name(s): Cynara cardunculus L., Cynara scolymus L.
Common Name(s): Alcachofra, Artichaut, Extractum Cynarae aq. Siccum, Garden artichoke, Globe artichoke

Medically reviewed by Drugs.com. Last updated on Jan 1, 2019.

Clinical Overview

Use

Artichoke has demonstrated antioxidant, antimicrobial, and anti-inflammatory activities and has been investigated for use in the treatment of cardiovascular disease risk factors (ie, cholesterol), diabetes, GI disease, and liver diseases. However, clinical data are lacking to support use of artichoke for any indication.

Dosing

In clinical trials, dosages of 600 mg/day and 2,700 mg/day of artichoke leaf extract (in divided doses) for 2 months have been studied in patients with liver diseases.

Contraindications

Allergy to plants in the Asteraceae family (eg, daisy, chrysanthemum, marigold, Echinacea, ragweed); bile duct obstruction; gallstones.

Pregnancy/Lactation

Artichoke heads are generally recognized as safe (GRAS) when used as food. Information regarding safety and efficacy of artichoke leaf extract in pregnancy and lactation is lacking; caution is warranted.

Interactions

Cytochrome P450 (CYP-450) 3A4/2C9/2C19/2E1/2D6/1A2/2B6 substrates: Artichoke may inhibit various CYP-450 isoenzymes, although the mechanism is not fully understood. Therefore, caution is warranted in patients receiving other medications that are substrates for these isoenzymes.

Adverse Reactions

Mild, transient, and infrequent adverse reactions, generally limited to GI complaints such as bloating and flatulence, have been reported. Allergic reactions including anaphylaxis, bronchial asthma, and irritant contact dermatitis, as well as a case of hepatotoxicity, have been reported.

Toxicology

No data.

Scientific Family

  • Asteraceae (daisy)

Botany

The artichoke, a member of the daisy family, is a perennial herb widely cultivated in Mediterranean regions and in adjoining parts of central Europe. Artichoke species include the following: globe artichoke (Cynara cardunculus var. scolymus L.), cardoon (Cynara cardunculus var. altilis DC), and wild cardoon (Cynara cardunculus L. var. sylvestris). The plant grows to a height of approximately 2 m, and has a strong, erect stem with large, thistle-like leaves that are lobed and gray-green. The edible flower bud, which blooms from July to August, is purple-green and enclosed by scales or bracts. The receptacle, also known as the "heart," is edible. The plant should not be confused with the Jerusalem artichoke (Helianthus tuberosus).Ben Salem 2015, Blumenthal 2000, Chevalier 1996, Leung 2003, Sonnante 2007

History

Artichoke was consumed as a food and used medicinally by ancient Egyptians and Greeks; artichoke images have been discovered on ancient Egyptian tablets and altars. Artichoke was first described in the fourth century BC by the Greek writer Theophrastus. In the Roman Empire, artichoke was used as a digestive aid and enjoyed as a delicacy. Artichoke seemed to fall out of use until the 16th century, when it was used medicinally for liver ailments, such as jaundice, and also consumed by the royal and rich and considered a "noble" vegetable. The botanical name is derived in part from the tradition of fertilizing the plant with ashes, and partly from the Greek word "skolymos" (meaning "thistle") to refer to the spines on the bracts that enclose the flower heads forming the edible portion of the plant. The French have used artichoke juice as a liver tonic. Artichoke has been used traditionally to treat a variety of conditions, including hepatic diseases, jaundice, dyspepsia, and chronic albuminuria. Artichoke leaves have been used as a diuretic and as a choleretic to stimulate bile flow from the liver and gallbladder.Ben Salem 2015, Blumenthal 2000, Chevalier 1996, Leung 2003, Sonnante 2007

Chemistry

Nutritionally, the artichoke head contains fat, carbohydrates, and protein. It also contains fiber (inulin), calcium, phosphorus, potassium, folic acid, vitamin C, niacin, thiamine, trace minerals, and carotenoids. Artichoke is a source of essential polyunsaturated fatty acids and contains stearic, palmitic, oleic, and linoleic (50%) acids. Artichoke seed oil composition has been described. Color and anthocyanin pigments in artichoke have also been evaluated, and the identity of numerous enzymes, including oxidases, peroxidases, cynarase, and ascorbinase, have been reported.

Bitter sesquiterpene principles, such as grosheimin, cynaratriol, and cynaropicrin, have been reported, as well as dehydrocynaropicrin, grosulfeimin and related guaianolides, and cynarolide. Flavonoids (0.1% to 1%), including flavone glycosides and rutin, are present in artichoke. The flavonoid glycosides apigenin, luteolin, cynaroside, scolimoside, cosmoside, quercetin, isorhamnetin, maritimein, and others have also been reported. Volatile oils of artichoke include beta-selinene and caryophyllene as major sesquiterpenes, eugenol, phenylacetaldehyde, and decanal.

Much of the pharmacologic activity of the leaves has been attributed to the presence of polyphenolic compounds such as caffeoylquinic acid derivatives; mono- and di-caffeoylquinic acids, including chlorogenic, neochlorogenic, and cryptochlorogenic acids; luteolin; and cynarin.

Analysis by high-performance liquid chromatography and other methods has been described. The relative proportion of the various compounds varies with the strain, age, and generation of the plant. For example, germinating seeds of the artichoke have higher cynarin content than the leaves, and cynaropicrin content is highest in young leaves, while the root and mature fruits and flowers are devoid of cynaropicrin.Abu-Reidah 2013, Azzini 2007, Ben Salem 2015, Farag 2013, Hassanein 2011, Leung 2003, Nassar 2013, Negro 2012, Pandino 2011, Schauenberg 1977, Wittemer 2005

Uses and Pharmacology

Alcohol hangover

Clinical data

A randomized trial (N=15) evaluating effects of artichoke on alcoholic hangover symptoms found no difference compared with placebo.Pittler 2005

Anti-inflammatory effects

Animal data

In a murine model of inflammation, an alcohol extract of C. scolymus leaves inhibited inflammation compared with the reference group (indomethacin).Ben Salem 2017

Antimicrobial activity

In vitro data

Probiotic-enriched artichoke heads antagonized Escherichia coli and Clostridium spp. in an experiment.Valerio 2011 An extract from the fruit of artichoke inhibited Campylobacter spp. in vitro, while the leaf extracts showed antifungal activity.Zhu 2005 Pills containing 500 mg of artichoke inhibited the growth of methicillin-resistant Staphylococcus aureus, with a minimum inhibitory concentration (MIC) of 1.9 mg/mL.Pereira 2016

Antioxidant activity

Animal and in vitro data

Antioxidant activity of artichoke leaf extract has been demonstrated in animal studies using oxidative stress biomarkers.Ben Salem 2017, Jacociunas 2013, Magielse 2014 Protective effects have also been demonstrated against carbon tetrachloride–, lead-, paracetamol-, and cadmium-induced toxicity.Colak 2016, El-Boshy 2017, El Morsy 2015, Heidarian 2013

Clinical data

A small clinical study conducted in athletes found that pretreatment with artichoke leaf extract over 5 weeks increased total antioxidant capacity compared with untreated participants following intensive exercise. Effects on performance were not reported.Skarpanska-Stejnborn 2008

Cancer

The components rutin, gallic acid, and quercetin from artichoke have been suggested to induce apoptosis and to decrease cancer cell proliferation.Ben Salem 2015

Animal and in vitro data

Artichoke leaf extract protected hamster ovary cells against induced DNA lesions.Jacociunas 2013 Flavonoids, polyphenol fractions, and C. cardunculus var. altilis lipophilic extracts have demonstrated chemopreventive effects in mouse skin cancers as well as human breast cancer and hepatoma cell lines.Miccadei 2008, Mileo 2012, Ramos 2016, Yasukawa 2010 In an in vitro study, an aqueous extract of C. scolymus leaves induced genotoxic effects in human hepatocellular carcinoma cells.da Silva 2017 Total and lipophilic extracts of C. cardunculus inhibited cell viability of chronic myeloid leukemia cells (ie, K562 and K562 imatinib resistant). Specifically, cynaropicrin and deacyl cynaropicrin, components of the lipophilic fraction of C. cardunculus, inhibited cell viability of these cell lines.Russo 2017 In another study, artichoke extracts (ie, Cynara syriaca and C. cardunculus) exerted inhibitory effects on the proliferation of human colorectal cancer DLD1 cells and induced the apoptosis pathway in these cells.Simsek 2013 Both in vitro and animal data suggest that a freeze-dried extract of artichoke leaf extract exerts antitumor effects on mesothelioma cell lines. Specifically, the extract caused apoptosis, decreased cell proliferation, reduced colony formation, and restrained migration and invasion of mesothelioma cells.Pulito 2015

Cardiovascular effects

Animal and in vitro data

Artichoke has demonstrated cholesterol-lowering effects in rodent studies. Leaf extracts inhibited cholesterol biosynthesis. An increased excretion of fecal bile acids was also reported. The constituents cynaroside and aglycone luteolin were suggested to be mainly responsible for this effect, while chlorogenic and caffeic dicaffeoylquinic acids and cynarin demonstrated little or no inhibitory effects.Ben Salem 2015, Küçükgergin 2010, Küskü-Kiraz 2010, Qiang 2012 Additionally, in vitro and animal data suggest potential vasodilatory activity as well as cardioprotective effects via regulation of the endothelial nitric oxide synthase gene.Ben Salem 2015 In a study of cholesterol-fed rats, C. scolymus dosed at 150, 300, or 600 mg/kg/day for 30 days reduced total cholesterol and low-density lipoprotein (LDL) cholesterol compared to a control group. The effects were similar to those noted with rats treated with simvastatin 4 mg/kg/day. Additionally, in a study evaluating the hypolipidemic and antiatherogenic effects of C. scolymus in cholesterol-fed rats, C. scolymus was associated with an improvement in biomarkers of inflammation of atherosclerosis.Mocelin 2016 In another study, an ethanolic extract of C. scolymus leaves (200 to 400 mg/kg/day) administered for 28 days reduced total cholesterol, LDL cholesterol, and triglyceride levels in alloxan-induced diabetic rats.Ben Salem 2017

In one study of rats fed an atherogenic diet, artichoke leaf extract demonstrated beneficial effects to the arterial wall by decreasing oxidative stress and triglyceride levels.Bogavac-Stanojevic 2018

In a human coronary artery smooth muscle cell line, artichoke leaf extract inhibited inducible nitric oxide synthase (iNOS) in a concentration- and time-dependent manner. The extract also decreased iNOS promotor activation and protein expression. Specifically, 4 compounds tested (ie, cynarin, cyanidin, luteolin, cynaroside) reduced iNOS mRNA expression, with cynarin being the most potent.Xia 2014

An in vitro study found C. scolymus exhibits moderate angiotensin-converting enzyme inhibitory activity.Villiger 2015

Clinical data

Two published studies have reported reductions in total cholesterol, with one demonstrating improved measures of endothelial function and the other reporting increased high-density lipoprotein (HDL) and decreased LDL. Participant numbers in these studies were small: 18 in one and 92 in the other.Lupattelli 2004, Rondanelli 2013 In a small clinical study conducted in athletes and designed to measure antioxidant effects of C. scolymus, pretreatment with artichoke leaf extract over 5 weeks decreased total cholesterol but had no effect on HDL, LDL, or triglycerides.Skarpanska-Stejnborn 2008 Similarly, in a clinical study evaluating the hypotensive effects of artichoke leaf juice in patients with mild hypertension, no effects on lipid profile, despite reductions in systolic and diastolic pressure, were observed.Roghani-Dehkordi 2009

In a systematic review of the literature, 5 studies evaluating the effects of artichoke on HDL cholesterol were evaluated. The investigators concluded that artichoke leaf extract might be a viable option for raising HDL cholesterol in patients who do not have high basal total cholesterol or HDL cholesterol levels.Rondanelli 2016

In a clinical study of 50 women with metabolic syndrome, supplementation with artichoke leaf extract 1,800 mg/day for 12 weeks reduced triglyceride levels in carriers of A allele of FTO-rs9939609 polymorphism, which is a risk factor for obesity, type 2 diabetes, and metabolic syndrome.Rezazadeh 2018

Chemotherapy-induced toxicity

Animal data

In a study of rats exposed to doxorubicin, C. scolymus and coenzyme Q10 attenuated the increases in liver and renal function parameters caused by the chemotherapeutic agent.Mustafa 2015

Dermatological effects

Animal data

Cynaropicrin extracted from artichoke leaves suppressed nuclear factor kappa B and prevented skin photoaging processes in a mouse model.Tanaka 2013

Diabetes/Glucose-lowering effects

Animal data

Limited studies in rats show a moderate hypoglycemic effect of artichoke flowering head extract.Fantini 2011, Loi 2013, Zaru 2013 An ethanolic extract of C. scolymus leaves (200 to 400 mg/kg/day) administered for 28 days reduced glucose levels in rats with alloxan-induced diabetes.Ben Salem 2017

Clinical data

In limited clinical trials in overweight subjects, reductions in glycosylated hemoglobin and glycemia have been observed with artichoke extracts alone and in combination with Phaseolus vulgaris (common bean).Rondanelli 2011, Rondanelli 2014 In a small clinical study conducted in athletes and designed to measure antioxidant effects of C. scolymus, pretreatment with artichoke leaf extract over 5 weeks had no effect on serum glucose.Skarpanska-Stejnborn 2008

Differences in clinical trial results may be influenced by genetic differences; effects of artichoke extract on insulin resistance may differ based on genetic polymorphisms.Ebrahimi-Mameghani 2018

As a component of medical nutrition therapy for patients with type 2 diabetes, the American Diabetes Association Standards of Medical Care in Diabetes (2014) guidelines recommend higher-quality dietary fat intake, as an alternative to decreased fat intake, by replacing saturated and/or trans fats with mono- and polyunsaturated fatty acids in the diet. This Mediterranean-style approach to eating may improve glycemic control and cardiovascular disease risk factors (moderate-quality evidence).ADA 2014

GI effects

Animal and in vitro data

Experiments in rodents with induced gastric ulcers have shown dose-dependent increases in mucus production and reductions in gastric ulceration with both artichoke leaf and flower bud/head extract.Costabile 2010, Ishida 2010 Guinea pig and rat ileum have demonstrated both contractile and relaxing effects from hydrophilic and lipophilic leaf extracts.Emendörfer 2005, Verspohl 2008

Clinical data

Very–long-chain inulin derived from artichoke root given to healthy adults (N=32) increased fecal bacterial count, acting as a probiotic.Riezzo 2012 Probiotic-enriched artichokes have also been used as a fiber-rich vegetable to treat constipation and deliver probiotics.Marteau 2012, Valerio 2006, Valerio 2010 Post hoc analysis of an open-label study suggests that artichoke leaf extract provides symptomatic relief in irritable bowel syndrome.Bundy 2004 A combination of ginger and artichoke leaf extract taken for 4 months was associated with improvements in measures of functional dyspepsia.Giacosa 2015 The combination was also found to promote gastric emptying in a pilot study of healthy volunteers.Lazzini 2016

Gout

Animal and in vitro data

In vitro, an artichoke leaf extract exhibited xanthine oxidase inhibitory activity; however, uric acid–lowering effects were not demonstrated following oral administration in rats.Sarawek 2008

Liver disease

Animal and in vitro data

C. scolymus leaf extract improved liver function tests in rats with liver injury from tetrachloride exposure. It also reduced lipid peroxidation by decreasing malondialdehyde levels. Additionally, superoxide dismutase and catalase activity was increased in the rats receiving C. scolymus.Colak 2016

In an in vitro study, 2 compounds (cynaropicrin and a sesquiterpene lactone termed "grosheimol") isolated from water extracts of the leaves of wild Egyptian artichoke (C. cardunculus L. var. sylvestris) inhibited all genotypes of hepatitis C virus (HCV): 1a, 1b, 3a, 4a, 5a, 6a, and 7a. Specifically, these compounds blocked HCV entry into target cells and were active against cell-free infection and cell-to-cell transmission.Elsebai 2015 In human liver samples, water extracts from the wild Egyptian artichoke inhibited CYP2B6 and 2C19 with high affinity and demonstrated moderate inhibitory activity against CYP1A2, 2D6, 2E1, and 3A4.Elsebai 2016

In a murine model of alcohol-induced liver injury, an ethanolic extract of artichoke (dose range, 0.4 to 1.6 g/kg) prevented elevations in liver function tests and cholesterol. It was also associated with reductions in degeneration, inflammatory infiltration, and hepatocyte necrosis.Tang 2017

Clinical data

In a randomized, double-blind, placebo-controlled, parallel-group study, 100 patients with nonalcoholic fatty liver disease were randomized to receive artichoke leaf extract 600 mg daily (in divided doses) or placebo for 2 months. Artichoke demonstrated beneficial effects on various ultrasound liver parameters (ie, portal vein diameter, hepatic vein flow, liver size), liver function tests, and cholesterol levels.Panahi 2018 In a similar study, C. scolymus 2,700 mg/day (in divided doses) for 2 months was found to improve liver enzymes and cholesterol levels in patients with nonalcoholic steatohepatitis.Rangboo 2016

In an open-label study of 15 patients with HCV who received a water extract of wild Egyptian artichoke (C. cardunculus L. var. sylvestris) as a tea infusion 3 times daily for 3 months, the water extract decreased HCV viral load below the detectable level and normalized liver function tests in 12 of the patients.Elsebai 2016

Renal protection

Animal data

In a murine study of gentamicin-induced nephrotoxicity, simultaneous administration of an artichoke leaf extract during gentamicin therapy exerted nephroprotective effects, as evidenced by normalization of kidney parameters (ie, serum creatinine, urea nitrogen, uric acid).Khattab 2016

Dosing

In clinical trials dosages of 600 mg/day and 2,700 mg/day of artichoke leaf extract (in divided doses) for 2 months have been studied in patients with liver diseases.Panahi 2018, Rangboo 2016

Pregnancy / Lactation

Artichoke heads are GRAS when used as food. Dosages above those found in food should be avoided because safety and efficacy are unproven. Information regarding safety and efficacy of artichoke leaf extracts in pregnancy and lactation is lacking; caution is warranted.Zan 2013

Interactions

CYP 3A4/2C9/2C19/2E1/2D6/1A2/2B6 substrates: Artichoke may inhibit various CYP-450 isoenzymes, although the mechanism is not fully understood. Therefore, caution is warranted in patients receiving other medications that are substrates for these isoenzymes.Campos 2018, Elsebai 2016

Adverse Reactions

Most clinical studies with artichoke leaf extract report mild, transient, and infrequent adverse reactions generally limited to GI complaints, including bloating and flatulence.Ben Salem 2015, Costabile 2010

Contact with artichoke and other plants of the Asteraceae family (daisy, chrysanthemum, marigold, Echinacea, and ragweed) has caused allergic reactions in sensitive individuals; cynaropicrin and other sesquiterpene lactones may be the responsible chemical constituents. Case reports of pruritus, lip swelling, rhinitis, and bronchial asthma have been documented with raw artichoke.Davila Fernández 2010, Miralles 2003 Anaphylaxis due to artichoke's inulin content has been reported,Franck 2005 as well as nonallergic irritant contact dermatitis.Pipili 2009

A case report of hepatotoxicity associated with consumption of a French commercial artichoke product has been published, and the manufacturers of the product also acknowledge 2 other cases.Riezzo 2012 The Expanded Commission E Monographs warn against the use of artichoke preparations in any bile duct pathology because of artichoke's choleretic properties.Blumenthal 2000

Toxicology

Specific toxicological studies are limited. No toxicity was observed in in vitro studies evaluating artichoke leaf extract in hamster ovary cells.Jacociunas 2012, Jacociunas 2013 In rats, median lethal doses of 265 mg/kg (intraperitoneal) and 2,000 mg/kg (oral) have been estimated based on caffeoylquinic acid content.Leung 2003 In vitro, some genotoxicity was demonstrated on bone marrow cells at the highest dose tested (2,000 mg/kg orally), possibly due to the flavonoid content of the leaf extract.Zan 2013 Similarly, in vitro and animal data suggest that high doses of artichoke leaf extract are associated with genotoxic effects, while low doses are associated with antigenotoxic effects.Jacociunas 2013

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