Scientific Name(s): Laurus persea L., Persea americana Mill., Persea gratissima Gaertn
Common Name(s): Ahuacate, Alligator pear, Avocado, Avocado soybean unsaponifiable (ASU), Avocato
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.
ASU fraction has been studied for osteoarthritis of the knee at 300 to 600 mg daily dosage.
Contraindications have not yet been identified.
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.
None well documented.
An allergen cross-sensitivity to natural rubber latex and some plant-derived foods (eg, avocado, melons, peaches) may exist.
Reports of toxicity are rare, although poisoning in grazing animals that have ingested avocado leaves has been reported.
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
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
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
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
There are no clinical data regarding the use of extracts from P. americana for antimicrobial activity.
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
There are no clinical data regarding the use of extracts from P. americana for the prevention or treatment of cancer.
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
There are no recent clinical data regarding the use of extracts from P. americana for dermatological applications.
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
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
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
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
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
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.
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.
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
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
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