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Avocado

Scientific Name(s): Laurus persea L., Persea americana Mill., Persea gratissima Gaertn
Common Name(s): Ahuacate, Alligator pear, Avocado, Avocado soybean unsaponifiable (ASU), Avocato

Clinical Overview

Use

All plant parts of P. americana have been investigated for therapeutic applications. Consumption of avocado fruit is loosely associated with lower risks of cardiovascular disease and metabolic syndrome, but studies are lacking. Antimicrobial, chemoprotective, and dermatological properties have been described. Clinical studies have focused on the combination of avocado/soybean unsaponifiables in osteoarthritis, with equivocal findings.

Dosing

ASU fraction has been studied for osteoarthritis of the knee at 300 to 600 mg daily dosage.

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

Avocado fruit is generally recognized as safe (GRAS) when used as food. Avoid extracts from other plant parts and dosages above those found in food, because safety and efficacy are unproven.

Interactions

None well documented.

Adverse Reactions

An allergen cross-sensitivity to natural rubber latex and some plant-derived foods (eg, avocado, melons, peaches) may exist.

Toxicology

Reports of toxicity are rare, although poisoning in grazing animals that have ingested avocado leaves has been reported.

Botany

The avocado grows as a tree to heights of 15 to 18 m. It bears a large, oval, or spherical fleshy fruit, the skin of which can be thick and woody. Although the plant is native to Mexico and Central America, numerous varieties are now widely distributed throughout the world.1

History

The avocado has been widely used in the past, not only for food, but also for medicinal purposes. The pulp has been used as a pomade to stimulate hair growth and to hasten the healing of wounds. The fruit has been purported to be an aphrodisiac and emmenagogue, and American Indians have used the seeds to treat dysentery and diarrhea. Today, the fruit is eaten widely throughout the world, and the oil is a component of numerous cosmetic formulations.1

Chemistry

The pulp of the avocado fruit contains fiber, sugars, minerals, vitamins, and other phytochemicals and lipids. The fruit is thought to provide large amounts of potassium and magnesium, with a similar nutrient profile to tree nuts, such as walnuts, almonds, and pistachios. Avocado oil is derived from the fruit pulp and is primarily composed of glycerides of oleic acid and approximately 10% unsaponifiable (ie, cannot be hydrolyzed) compounds, such as sterols and volatile acids. Oleic acid is a beneficial monounsaturated fatty acid; its concentration ranges from 61% to 95% in an avocado. The vitamin D content of the oil exceeds that of butter and eggs.

The large seed contains fatty acids, alcohols, and a number of unsaturated compounds with exceedingly bitter tastes; it is the subject of a number of investigational studies. The leaves of the Mexican avocado have been reported to contain approximately 3% of an essential oil primarily composed of estragole and anethole.1, 2, 3, 4, 5

Uses and Pharmacology

Antimicrobial

Animal data

Several of the unsaturated oxygenated aliphatic compounds in the fruit pulp and seed have been shown to possess strong in vitro activity against gram-positive bacteria, including Staphylococcus aureus. Antimycobacterial activity has also been demonstrated in vitro.3, 6, 7, 8, 9

Clinical data

There are no clinical data regarding the use of extracts from P. americana for antimicrobial activity.

Cancer

Animal data

Chemoprotective and anticarcinogenic chemical constituents have been found in avocado fruit, seed, leaf, and bark. Inhibition of cell growth and apoptosis have been described in in vitro studies on human cancer cell lines and animal models.3, 4, 10, 11, 12, 13, 14

Clinical data

There are no clinical data regarding the use of extracts from P. americana for the prevention or treatment of cancer.

Dermatology

Animal data

The carotenoid content of the fruit and the chlorogenic acid content of the seed have been examined for effect on human keratinocysts and fibroblasts.3, 15, 16, 17 Avocado oil increased collagen synthesis and decreased inflammation in a study on wound healing in rats, possibly because of the high oleic acid content.18 A study using ASU found similar effects.19

Clinical data

There are no recent clinical data regarding the use of extracts from P. americana for dermatological applications.

Metabolic syndrome

Animal data

Experiments in rats have demonstrated improvements in the lipid prolife and enhanced insulin sensitivity with consumption of avocado fruit, seed, and leaf extracts.3, 20, 21, 22, 23

Clinical data

Data from the National Health and Nutrition Examination Survey from 2001 to 2008 found a lower body mass index, body weight, and waist circumference, as well as a higher high-density lipoprotein cholesterol and a decreased risk of metabolic syndrome, in avocado consumers than in nonconsumers, adding significance to findings from older clinical studies.4, 24 A Cochrane review of clinical trials up to 2011 reported limited evidence for increased fruit and vegetable consumption, as a single intervention, on reducing cardiovascular disease risk factors.25 Small clinical studies suggest that the addition of avocado to meals improves satiety and postprandial glycemic indices.26, 27 However, ASU did not modify insulin sensitivity in a further small clinical study.28

As a component of medical nutrition therapy for patients with type 2 diabetes, the American Diabetes Association Standards of Care (2014) recommends higher quality dietary fat intake, as an alternative to decreased fat intake, by replacing saturated and/or trans fats with mono- and poly-unsaturated fatty acids in the diet. This Mediterranean-style approach to eating may improve glycemic control and cardiovascular disease risk factors (moderate quality evidence).49

Osteoarthritis

Animal data

ASU has been evaluated in vitro and in horses and sheep with osteoarthritis. Activity on chondrocytes as inflammatory mediators has been demonstrated.29, 30, 31

Clinical data

Systematic reviews, meta-analyses, and recommendations have been published with regard to a place in osteoarthritis therapy for ASU.32, 33, 34 Pooled data from 4 clinical trials (N = 664), all using the same French ASU product, found an effect size of 0.39 (95% confidence interval [CI], 0.01 to 0.76; P = 0.04) favoring the preparation over placebo for pain in hip and knee osteoarthritis. The pooled effect size for the Lequesne Index was also significant for ASU over placebo (0.45 [95% CI, 0.21 to 0.70; P = 0.0003]). One of the 4 trials observed patients for a longer time period (2 years vs 3 to 6 months) and did not find a difference between the 2 study groups for any outcome measures.33, 34 A 3-year, industry-sponsored clinical trial using ASU 300 mg per day (N = 399) suggested that a protective effect on the joint occurs as a result of ASU therapy, as measured by change in joint space width over the length of the trial. A lower rate of progression (deterioration) was found in the experimental group (40% vs 50%; P = 0.04), but no difference in mean joint space width loss was determined. No differences were found for secondary outcomes of Lequesne Index, Western Ontario and McMaster Universities Arthritis Index pain scores, or analgesic/nonsteroidal anti-inflammatory use.35

Other uses

A neuroprotective effect of ASU in reperfusion injury has been shown in rats.36 An open-label study evaluated the effect of ASU in symptoms of menopause.37

In rats, avocado has been shown to have gastric-mucosal protective effects and experimental suppression of hepatic injury.38, 39

Avocado peel was added to porcine patties by a group of researchers to limit the extent of cholesterol oxidation during cooking.40

Avocado seed extract has been studied as a natural orange food colorant.41

Dosing

The US Nutrition Labeling and Education Act defines a serving size of avocado as 30 g (1 ounce) or one-fifth of a fruit.4

ASU fraction has been studied for osteoarthritis of the knee at 300 to 600 mg daily dosage.31, 34

Pregnancy / Lactation

Avocado fruit is GRAS when used as food. Avoid extracts from other plant parts and dosages above those found in food, because safety and efficacy are unproven.

Interactions

Few cases documenting a possible interaction with warfarin exist in literature from the 1990s.42 Causality was not demonstrated in these cases, and no mechanism of action has been proposed.

Adverse Reactions

Hypersensitivity to avocado has been described and includes rare instances of anaphylaxis. Manifestations of allergy to avocado may be limited to the mouth or throat (eg, oral allergy syndrome with itchy mouth, throat, and swollen tongue) or oral symptoms with generalized symptoms (eg, wheezing, chest tightness, abdominal cramping, diarrhea). An allergen cross-sensitivity has been shown with avocado, melons (eg, cantaloupe), peaches, bananas, chestnuts, tomatoes, potatoes, and kiwi fruits and natural rubber latex ("latex-fruit syndrome"). An immunoglobulin E–mediated inflammatory mechanism has been shown to similarly produce an allergic reaction to latex, bananas, and avocados.43, 44

Toxicology

Poisoning in grazing animals that have ingested avocado has been reported, and this toxicity also has been observed in other species, including fish and birds.1, 45 Cardiotoxicity to isolated cadiomyocytes by acetogenins in the seed extract have been shown in vitro.46 However, avocado seed extract has not been shown to possess genotoxic properties, or mutagenicity in mice erythrocytes.47 Genotoxicity has been demonstrated within human lymphocytes in vitro by methanol extracts of the avocado fruit and leaf.48

References

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2. Duke JA. Handbook of Medicinal Herbs, Second Edition. Boca Raton, FL: CRC Press; 2003.
3. Dabas D, Shegog RM, Ziegler GR, Lambert JD. Avocado (Persea americana) seed as a source of bioactive phytochemicals. Curr Pharm Des. 2013;19(34):6133-6140.23448442
4. Dreher ML, Davenport AJ. Hass avocado composition and potential health effects. Crit Rev Food Sci Nutr. 2013;53(7):738-750.23638933
5. US Department of Agriculture, Agricultural Research Service. 2013. USDA National Nutrient Database for Standard Reference. Release 26.http://ndb.nal.usda.gov/ndb/foods/show/2205.
6. Guzmán-Rodríguez JJ, López-Gómez R, Suárez-Rodríguez LM, et al. Antibacterial activity of defensin PaDef from avocado fruit (Persea americana var. drymifolia) expressed in endothelial cells against Escherichia coli and Staphylococcus aureus. Biomed Res Int. 2013;2013:986273.24319695
7. Jiménez-Arellanes A, Luna-Herrera J, Ruiz-Nicolás R, Cornejo-Garrido J, Tapia A, Yépez-Mulia L. Antiprotozoal and antimycobacterial activities of Persea americana seeds. BMC Complement Altern Med. 2013;13(1):109.23680126
8. Lu YC, Chang HS, Peng CF, Lin CH, Chen IS. Secondary metabolites from the unripe pulp of Persea americana and their antimycobacterial activities. Food Chem. 2012;135(4):2904-2909.22980888
9. Soliman MF. Evaluation of avocado/soybean unsaponifiable alone or concurrently with praziquantel in murine schistosomiasis. Acta Trop. 2012;122(3):261-266.22342904
10. Bonilla-Porras AR, Salazar-Ospina A, Jimenez-Del-Rio M, Pereanez-Jimenez A, Velez-Pardo C. Pro-apoptotic effect of Persea americana var. Hass (avocado) on Jurkat lymphoblastic leukemia cells [published online November 3, 2013]. Pharm Biol.24188375
11. D'Ambrosio SM, Han C, Pan L, Kinghorn AD, Ding H. Aliphatic acetogenin constituents of avocado fruits inhibit human oral cancer cell proliferation by targeting the EGFR/RAS/RAF/MEK/ERK1/2 pathway. Biochem Biophys Res Commun. 2011;409(3):465-469.21596018
12. Paul R, Kulkarni P, Ganesh N. Avocado fruit (Persea americana Mill) exhibits chemo-protective potentiality against cyclophosphamide induced genotoxicity in human lymphocyte culture. J Exp Ther Oncol. 2011;9(3):221-230.22070054
13. Falodun A, Engel N, Kragl U, Nebe B, Langer P. Novel anticancer alkene lactone from Persea americana. Pharm Biol. 2013;51(6):700-706.23570517
14. Brooke DG, Shelley EJ, Roberts CG, Denny WA, Sutherland RL, Butt AJ. Synthesis and in vitro evaluation of analogues of avocado-produced toxin (+)-(R)-persin in human breast cancer cells. Bioorg Med Chem. 2011;19(23):7033-7043.22044656
15. Rosenblat G, Meretski S, Segal J, et al. Polyhydroxylated fatty alcohols derived from avocado suppress inflammatory response and provide non-sunscreen protection against UV-induced damage in skin cells. Arch Dermatol Res. 2011;303(4):239-246.20978772
16. Ramos-Jerz M del R, Villanueva S, Jerz G, Winterhalter P, Deters AM. Persea americana Mill. Seed: Fractionation, Characterization, and Effects on Human Keratinocytes and Fibroblasts. Evid Based Complement Alternat Med. 2013;2013:391247.24371457
17. Donnarumma G, Paoletti I, Buommino E, et al. AV119, a natural sugar from avocado gratissima, modulates the LPS-induced proinflammatory response in human keratinocytes. Inflammation. 2011;34(6):568-575.20936426
18. de Oliveira AP, Franco Ede S, Rodrigues Barreto R, et al. Effect of semisolid formulation of Persea americana mill (avocado) oil on wound healing in rats. Evid Based Complement Alternat Med. 2013;2013:472382.23573130
19. Oryan A, Mohammadalipour A, Moshiri A, Tabandeh MR. Avocado/soybean unsaponifiables: a novel regulator of cutaneous wound healing, modelling and remodelling [published online December 10, 2013]. Int Wound J.24321012
20. Pahua-Ramos ME, Garduño-Siciliano L, Dorantes-Alvarez L, et al. Reduced-calorie avocado paste attenuates metabolic factors associated with a hypercholesterolemic-high fructose diet in rats. Plant Foods Hum Nutr. 2014;69(1):18-24.24249159
21. Pahua-Ramos ME, Ortiz-Moreno A, Chamorro-Cevallos G, et al. Hypolipidemic effect of avocado (Persea americana Mill) seed in a hypercholesterolemic mouse model. Plant Foods Hum Nutr. 2012;67(1):10-16.22383066
22. Lima CR, Vasconcelos CF, Costa-Silva JH, et al. Anti-diabetic activity of extract from Persea americana Mill. leaf via the activation of protein kinase B (PKB/Akt) in streptozotocin-induced diabetic rats. J Ethnopharmacol. 2012;141(1):517-525.22472105
23. Ezejiofor AN, Okorie A, Orisakwe OE. Hypoglycaemic and tissue-protective effects of the aqueous extract of Persea americana seeds on alloxan-induced albino rats. Malays J Med Sci. 2013;20(5):31-39.24643349
24. Fulgoni VL 3rd, Dreher M, Davenport AJ. Avocado consumption is associated with better diet quality and nutrient intake, and lower metabolic syndrome risk in US adults: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2008. Nutr J. 2013;12:1.23282226
25. Hartley L, Igbinedion E, Holmes J, et al. Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases. Cochrane Database Syst Rev. 2013;6:CD009874.23736950
26. Wien M, Haddad E, Oda K, Sabate J. A randomized 3x3 crossover study to evaluate the effect of Hass avocado intake on post-ingestive satiety, glucose and insulin levels, and subsequent energy intake in overweight adults. Nutr J. 2013;12:155.24279738
27. Li Z, Wong A, Henning SM, et al. Hass avocado modulates postprandial vascular reactivity and postprandial inflammatory responses to a hamburger meal in healthy volunteers. Food Funct. 2013;4(3):384-391.23196671
28. Martínez-Abundis E, González-Ortiz M, Mercado-Sesma AR, Reynoso-von-Drateln C, Moreno-Andrade A. Effect of avocado soybean unsaponifiables on insulin secretion and insulin sensitivity in patients with obesity. Obes Facts. 2013;6(5):443-448.24135894
29. Henrotin Y, Sanchez C, Balligand M. Pharmaceutical and nutraceutical management of canine osteoarthritis: present and future perspectives. Vet J. 2005;170(1):113-123.15993795
30. Kawcak CE, Frisbie DD, McIlwraith CW, Werpy NM, Park RD. Evaluation of avocado and soybean unsaponifiable extracts for treatment of horses with experimentally induced osteoarthritis. Am J Vet Res. 2007;68(6):598-604.17542691
31. Little CV, Parsons T, Logan S. Herbal therapy for treating osteoarthritis (Cochrane Review). In: The Cochrane Library. Chichester, UK: John Wiley & Sons, Ltd; 2004.
32. Zhang W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010;18(4):476-499. 20170770
33. Cameron M, Gagnier JJ, Little CV, Parsons TJ, Blümle A, Chrubasik S. Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part I: Osteoarthritis. Phytother Res. 2009;23(11):1497-1515.19856319
34. Christensen R, Bartels EM, Astrup A, Bliddal H. Symptomatic efficacy of avocado-soybean unsaponifiables (ASU) in osteoarthritis (OA) patients: a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage. 2008;16(4):399-408.18042410
35. Maheu E, Cadet C, Marty M, et al. Randomised, controlled trial of avocado-soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study. Ann Rheum Dis. 2014;73(2):376-384.23345601
36. Eser O, Songur A, Yaman M, et al. The protective effect of avocado soybean unsaponifilables on brain ischemia/reperfusion injury in rat prefrontal cortex. Br J Neurosurg. 2011;25(26):701-706.20874457
37. Panahi Y, Beiraghdar F, Kashani N, Baharie Javan N, Dadjo Y. Comparison of piascledine (avocado and soybean oil) and hormone replacement therapy in menopausal-induced hot flashing. Iran J Pharm Res. 2011;10(4):941-951.24250433
38. Dunjic BS, Axelson J, Hashmonai M, Bengmark S. Gastric mucosal protective capacity of avocado: phospholipids as an active principle? (A-3). Dig Dis Sci. 1996;41:431. Abstract.
39. Kawagishi H, Fukumoto Y, Hatakeyama M, et al. Liver injury suppressing compounds from avocado (Persea americana). J Agric Food Chem. 2001;49(5):2215-2221.11368579
40. Rodríguez-Carpena JG, Morcuende D, Petrón MJ, Estévez M. Inhibition of cholesterol oxidation products (COPs) formation in emulsified porcine patties by phenolic-rich avocado (Persea americana Mill.) extracts. J Agric Food Chem. 2012;60(9):2224-2230.22292505
41. Dabas D, Elias RJ, Lambert JD, Ziegler GR. A colored avocado seed extract as a potential natural colorant. J Food Sci. 2011;76(9):C1335-C1341.22416696
42. Rodríguez-Fragoso L, Martínez-Arismendi JL, Orozco-Bustos D, Reyes-Esparza J, Torres E, Burchiel SW. Potential risks resulting from fruit/vegetable-drug interactions: effects on drug-metabolizing enzymes and drug transporters. J Food Sci. 2011;76(4):R112-R124.22417366
43. Abrams EM, Becker AB, Gerstner TV. Anaphylaxis related to avocado ingestion: a case and review. Allergy Asthma Clin Immunol. 2011;7:12.21663642
44. Wagner S, Breiteneder H. The latex-fruit syndrome. Biochem Soc Trans. 2002;30(Pt 6):935-940.12440950
45. Craigmill AL, Eide RN, Shultz TA, Hedrick K. Toxicity of avocado (Persea americana [Guatamalan var]) leaves: review and preliminary report. Vet Hum Toxicol. 1984;26(5):381-383.6541397
46. Silva-Platas C, García N, Fernández-Sada E, et al. Cardiotoxicity of acetogenins from Persea americana occurs through the mitochondrial permeability transition pore and caspase-dependent apoptosis pathways. J Bioenerg Biomembr. 2012;44(4):461-471.22733015
47. Padilla-Camberos E, Martinez-Velázquez M, Flores-Fernández JM, Villanueva-Rodríguez S. Acute toxicity and genotoxic activity of avocado seed extract (Persea americana Mill., c.v. Hass). World Sci J. 2013;2013:245828.24298206
48. Kulkarni P, Paul R, Ganesh N. In vitro evaluation of genotoxicity of avocado (Persea americana) fruit and leaf extracts in human peripheral lymphocytes. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2010;28(3):172-187.20859823
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This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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