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Bilberry

Medically reviewed by Drugs.com. Last updated on Aug 23, 2018.

Scientific Name(s): Fructus myrtilli, Vaccinium myrtillus L.
Common Name(s): Bilberry , Bog bilberry, Heidelbeere, Huckleberry, Whortleberry

Clinical Overview

Use

Clinical studies are limited. Interest has focused on antioxidant potential in cancer and cardiovascular conditions, and other applications may exist in diabetes, as well as in inflammatory bowel and ocular conditions.

Dosing

Typical bilberry products are standardized to 25% anthocyanoside content, and 100 g of fresh fruit contains anthocyanin content 300 to 700 mg. Limited clinical studies have evaluated supplemental bilberry 100 to 500 g over 1 to 8 weeks’ duration.

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

Generally recognized as safe (GRAS) when used as food. Avoid doses above those found in food because safety and efficacy are unproven.

Interactions

None well documented.

Adverse Reactions

Information is lacking.

Toxicology

Information is lacking. Long-term use of bilberry leaves is suspected to lead to adverse effects.

Scientific Family

  • Ericaceae (heath)

Botany

The bilberry plant originates from Europe and has been naturalized in the North American Rocky Mountains. The small deciduous shrub differs from the North American blueberry (Vaccinium corymbosum and Vaccinium angustifolium) and grows best in shady, moist conditions. The plant bears bluish-black berries that are 5 to 9 mm in diameter and contain many small, shiny brownish-red seeds that are somewhat caustic and sweet-tasting. The bright green leaves are short, petiolate, and elliptic to round, and are 10 to 30 mm long.1, 2, 3 Other Vaccinium species include cranberries, blueberries, and whortleberries.

History

Traditional uses of dried bilberry fruit include supportive treatment of short-term, nonspecific diarrhea when administered as a tea, and as a topical decoction for inflammation of the mucous membranes of the mouth and throat. Folkloric use of the berries in cough preparations in the 15th century and use in diabetes at the end of the 19th century has been reported.

During World War II, British Royal Air Force pilots ate bilberry preserves before night missions in the belief that bilberry would improve their vision. Some European health care providers later recommended bilberry extracts for other eye complaints.2, 4, 5

Chemistry

Bilberry fruit consists of up to 10% tannins, most of which are catechol tannins. In addition, the fruit contains at least anthocyanins, flavonoids, organic and phenolic acids, invert sugars, and pectins. Triterpenoids, steroids, triterpenes, and esters have been elucidated in the fruit by processes such as high-pressure liquid chromatography.2, 6, 7, 8, 9 The leaves of the bilberry plant contain large amounts of chromium.6

Anthocyanin content of the fruit varies with geographical location, as well as growing and processing conditions,3, 7, 9 and is greater than that found in strawberries, cranberries, elderberries, and sour cherries.6

Uses and Pharmacology

Antioxidant effect

Animal data

Bilberry anthocyanins are natural antioxidants (scavengers and chelators), and in vitro studies have shown protective effects against oxidative damage. Animal studies, however, have produced conflicting data, with some studies demonstrating a protective effect and others showing no effect on oxidative markers.10, 11, 12, 13

Clinical data

Studies among healthy volunteers suggest no effect of bilberry on lipid peroxidation.6, 14 Despite fresh bilberries being a rich source of anthocyanins, and thus of antioxidants, variation in the content of commercial preparations has been noted as well lack of standardization, which must be considered in extrapolating antioxidant activity to clinical benefits.2, 3, 6, 14

Anti-inflammatory/Allergy

Animal data

Oral, topical, and intravenous bilberry administration have demonstrated an anti-inflammatory response in rodents and rabbits. Interruption of the inflammatory response, interference with proinflammatory mediators, antioxidant action, and direct effects on mast cell degradation have been reported to be responsible for reductions in pruritus and swelling in mice with induced contact allergic dermatitis.2, 6, 15, 16, 17

Clinical data

Preliminary data in recreationally trained runners reflected possible negative effects related to short-term consumption of bilberry juice as observed by moderate, transient increases in muscle soreness and inflammation.54 Information regarding the use of bilberry in the treatment of allergies is limited.

Cancer

Animal data

In vitro studies using human colon cancer cells lines suggest bilberry extract might interfere with topoisomerase in protecting DNA. Anti-inflammatory and antioxidant actions have also been suggested as mechanisms for observed reductions in rat intestinal adenoma and induced retinopathy. Reduced angiogenesis has also been observed in vitro.6, 18, 19, 20

Clinical data

A pilot study conducted in patients with colorectal cancer used bilberry anthocyanins 0.5 to 2 g daily for 7 days before surgery and found a decreased rate of proliferation of cancerous tissue. Metabolites of the bilberry anthocyanins were found in the tumor tissue.6

Cardiovascular effects

Animal data

In vitro studies and data from animal models and experiments suggest bilberry extract or its chemical constituents are able to inhibit smooth muscle contraction, platelet aggregation, ischemic perfusion injury, and vascular permeability.2, 6, 21, 22, 23

Clinical data

Limited, small studies among participants with elevated cardiovascular disease risk factors have found a decrease in C-reactive protein and other inflammatory markers, including interleukin-6.6, 14, 24 The studies evaluated supplemental bilberry 100 to 400 g over 4 to 8 weeks.6, 24 In overweight participants, decreased weight was accompanied by improvements in vascular cell adhesion and brachial flow mediated dilation, but effects were equivocal on the lipid profile.6, 25, 26, 46

Diabetes

Animal data

In vitro studies on rodent pancreatic cells have shown increased insulin secretion and glucose transport, postulated to be consequent to an effect on alpha-glucosidase.6 Studies in mice with induced diabetes consistently report decreased plasma glucose and increased insulin sensitivity with extracts of bilberry leaves (high in chromium content).5, 6, 27 Older studies were also reported in cats, rabbits, and dogs.5

Clinical data

Studies in diabetic patients are lacking; older studies lack adequate methodological robustness.5, 6 Studies in participants with elevated cardiovascular disease risk factors have shown small25 to no changes6, 24 in plasma glucose or insulin. In the Sysdimet (Dietary Modulation of Gene Expression and Metabolic Pathways in Glucose Metabolism) study, a combination of whole-grain foods, fish oils, and bilberries improved glucose metabolism.28

GI effects

Animal data

Mice with induced acute colitis that were fed bilberries or anthocyanins showed improved histological outcomes; however, efficacy in chronic colitis was not as important.29 Bilberries showed a protective action against induced gastric ulcers in mice.30

Clinical data

Despite folklore use of bilberries for diarrhea, limited clinical trials have been reported. Open-label, pilot studies have been conducted in patients with mild to moderate colitis31 and with diarrhea-associated irritable bowel syndrome.32 The majority of patients consuming anthocyanin-rich bilberry extract showed a positive response; however, these studies need to be confirmed using blind, randomized, controlled protocols.

Ophthalmic effects

Animal data

Studies in mice suggest bilberry exerts a protective effect against induced-retinal inflammation and uveitis6, 33, 34 and may play a role in upregulation of crystallins induced by a high-fat diet and, therefore, may be relevant to diabetic retinopathy.35 Corneal epithelial cells showed increased cell viability in the presence of bilberry extract.36

Clinical data

Results from early clinical studies conducted on pilots in World War II have not been replicated in more recent, small clinical trials.2, 6 An experiment conducted among United States Navy SEALs found no difference in night vision acuity or contrast sensitivity after 3 weeks (standardized to 25%) of supplemental bilberry extract 160 mg.2 Other clinical studies have used combinations of bilberry and vitamin E.2, 6 Improved measures of visual acuity were reported after a mean duration of 24 months of supplemental bilberry anthocyanins 120 mg in glaucoma-free participants versus placebo.37 Further clinical trials may be warranted.6 A small, 4 week study of 200 mg daily of fermented billberry extract conducted in middle-aged, myopic patients found significant improvement in mean amplitude of accommodation mesopic contrast sensitivity.47

Objective and subjective measurements of video display-induced eye fatigue were evaluated in a prospective, randomized, double-blind, placebo-controlled trial that administered bilberry extract (480 mg/day) for 8 weeks to Japanese office workers who complained of eye fatigue caused by use of video display terminals. Objective ophthalmic signs were assessed by measuring critical flicker fusion (CFF) and near point accommodation (NPA), whereas subjective symptoms were assessed through a self-reported questionnaire. Bilberry extract supplements (480 mg/day) or placebo were administered once daily after breakfast. At 8 weeks, the range of variation in CFF was significantly reduced in only the bilberry group; however, the difference in reduction range between groups was not significant. No difference in NPA was observed. Subjective symptoms improved significantly within the bilberry group as well as compared to placebo. At 8 weeks, dry eye sensation, double vision, and uncomfortable sensation all improved compared to baseline with bilberry (P < 0.05). Additionally, variations and eye fatigue (eg, ocular fatigue sensation, ocular pain, uncomfortable sensation, foreign body sensation) were significantly improved compared to placebo as early as week 4. Minor adverse events were reported in both groups; less frequent effects that occurred with bilberry included gastritis and gastric distress.49

Other uses

A clinical study from 1985 reported symptomatic improvement in dysmenorrhea with anthocyanosides 115 mg/day.2 Bilberry reduced bacterial adhesion to a lesser extent than cranberry and showed efficacy against Streptococcus pneumoniae and Staphylococcus aureus.38 Bilberry showed a dose-dependent effect on periods of immobility in mice with stress-induced chronic depression, suggested to be related to an antioxidant action.12

Gingivitis

The effect of bilberry supplementation on routine dental clinical parameters of inflammation was evaluated in a randomized placebo-controlled trial in 24 healthy adults. Participants received standard of care (debridement and oral hygiene instructions), placebo, or 1 of 2 doses of bilberries 250 g/day or 500 g/day for 7 days. The 500 g/day bilberry and standard of care groups experienced a similar mean reduction in bleeding on probing (59% and 58%, respectively), while the lower dosed bilberry group and placebo group exhibited a 41% and 31% reduction, respectively. The difference between the 500 g/day bilberry group and placebo group was statistically and clinically significant. Additionally, significant differences were also observed in 3 cytokines (interleukin [IL]-1-beta, IL-6, and vascular endothelial growth factor) in the higher dose bilberry group compared to baseline. No adverse events were reported.48

Dosing

Traditional dosages range from dried berries 20 to 60 g /day, or fresh berries 100 to 300 g/day.39

Limited clinical studies have evaluated daily supplemental bilberry 100 to 400 g over 4 to 8 weeks’ duration.6, 24

Typical bilberry products are standardized to 25% anthocyanoside content (approximately 36% anthocyanin), and 100 g of fresh fruit contains between 300 to 700 mg anthocyanin.6

Storage and processing of the fresh berries leads to degradation of anthocyanin content,3, 7, 9 and variations in bioavailability have been observed.39

Pregnancy / Lactation

GRAS status when used as food. Avoid doses above those found in food because safety and efficacy are unproven.

Interactions

Agents with Antiplatelet Properties: Herbs (Anticoagulant/Antiplatelet Properties) may enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Consider therapy modification.40, 41, 42, 43, 50, 52

Anticoagulants: Herbs (Anticoagulant/Antiplatelet Properties) may enhance the adverse/toxic effect of Anticoagulants. Bleeding may occur. Consider therapy modification.40, 41, 42, 43, 50, 51, 52, 53

Herbs (Anticoagulant/Antiplatelet Properties): May enhance the adverse/toxic effect of other Herbs (Anticoagulant/Antiplatelet Properties). Bleeding may occur. Consider therapy modification.40, 41, 42, 43, 50, 52

Hypoglycemic Agents: Herbs (Hypoglycemic Properties) may enhance the hypoglycemic effect of Hypoglycemic Agents. Monitor therapy.44

Nonsteroidal Anti-Inflammatory Agents: Herbs (Anticoagulant/Antiplatelet Properties) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Consider therapy modification.40, 41, 42, 43, 50, 52

Salicylates: Herbs (Anticoagulant/Antiplatelet Properties) may enhance the adverse/toxic effect of Salicylates. Bleeding may occur. Consider therapy modification.42, 43, 50, 52

Thrombolytic Agents: Herbs (Anticoagulant/Antiplatelet Properties) may enhance the adverse/toxic effect of Thrombolytic Agents. Bleeding may occur. Consider therapy modification.40, 41, 42, 43, 50, 52

Adverse Reactions

Information regarding adverse reactions with the use of bilberry is limited.

Toxicology

Mutagenicity has not been observed.6 The plant's leaves are not approved for therapeutic use in German Commission E Monographs. Long-term use of bilberry leaves is suspected to be hazardous.45 No cytotoxic effect was seen on corneal epithelial cells exposed to bilberry extract.36 Low concentrations of bilberry extract were protective in animal models of reperfusion injury; however, high concentrations increased sequelae of the reperfusion injury.21

References

1. Bilberry. USDA, NRCS. 2013. The PLANTS Database (http://plants.usda.gov, 7 March 2013). National Plant Data Center, Baton Rouge, LA 70874-4490 USA. Accessed March 7, 2013.
2. WHO Monographs on Selected Medicinal Plants. Vol. 4. Geneva, Switzerland: World Health Organization; 2009. http://www.who.int/medicines/areas/traditional/selecmonv4/en/index.html.
3. Martz F, Jaakola L, Julkunen-Tiitto R, Stark S. Phenolic composition and antioxidant capacity of bilberry (Vaccinium myrtillus) leaves in Northern Europe following foliar development and along environmental gradients. J Chem Ecol. 2010;36(9):1017-1028.20721607
4. Szakiel A, Paczkowski C, Huttunen S. Triterpenoid content of berries and leaves of bilberry Vaccinium myrtillus from Finland and Poland. J Agric Food Chem. 2012;60(48):11839-11849.23157739
5. Helmstädter A, Schuster N. Vaccinium myrtillus as an antidiabetic medicinal plant research through the ages. Pharmazie. 2010;65(5):315-321.20503920
6. Chu W, Cheung SCM, Lau RAW, Benzie IFF. Bilberry (Vaccinium myrtillus L.). In: Benzie IFF, Wachtel-Galor S, eds. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd ed. Boca Raton, FL: Taylor and Francis Group; 2011.
7. Uleberg E, Rohloff J, Jaakola L, et al. Effects of temperature and photoperiod on yield and chemical composition of northern and southern clones of bilberry (Vaccinium myrtillus L.). J Agric Food Chem. 2012;60(42):10406-10414.23033879
8. Müller D, Schantz M, Richling E. High performance liquid chromatography analysis of anthocyanins in bilberries (Vaccinium myrtillus L.), blueberries (Vaccinium corymbosum L.), and corresponding juices. J Food Sci. 2012;77(4):C340-C345.22394068
9. Buckow R, Kastell A, Terefe NS, Versteeg C. Pressure and temperature effects on degradation kinetics and storage stability of total anthocyanins in blueberry juice. J Agric Food Chem. 2010;58(18):10076-10084.20735132
10. Choi EH, Park JH, Kim MK, Chun HS. Alleviation of doxorubicin-induced toxicities by anthocyanin-rich bilberry (Vaccinium myrtillus L.) extract in rats and mice. Biofactors. 2010;36(4):319-327.2063509
11. Bao L, Abe K, Tsang P, et al. Bilberry extract protect restraint stress-induced liver damage through attenuating mitochondrial dysfunction. Fitoterapia. 2010;81(8):1094-1101.20620202
12. Kumar B, Arora V, Kuhad A, Chopra K. Vaccinium myrtillus ameliorates unpredictable chronic mild stress induced depression: Possible involvement of nitric oxide pathway. Phytother Res. 2012;26(4):488-497.22488796
13. Domitrovíc R, Jakovac H. Effects of standardized bilberry fruit extract (Mirtoselect) on resolution of CCl4-induced liver fibrosis in mice. Food Chem Toxicol. 2011;49(4):848-854.21163320
14. Karlsen A, Paur I, Bohn SK, et al. Bilberry juice modulates plasma concentration of NF-kappaB related inflammatory markers in subjects at increased risk of CVD. Eur J Nutr. 2010;49(6):345-355.20119859
15. Triebel S, Trieu HL, Richling E. Modulation of inflammatory gene expression by a bilberry (Vaccinium myrtillus L.) extract and single anthocyanins considering their limited stability under cell culture conditions. J Agric Food Chem. 2012;60(36):8902-8910.22913378
16. Yamaura K, Ishiwatari M, Yamamoto M, Shimada M, Bi Y, Ueno K. Anthocyanins, but not anthocyanidins, from bilberry (Vaccinium myrtillus L.) alleviate pruritus via inhibition of mast cell degranulation. J Food Sci. 2012;77(12):H262-H267.23164040
17. Yamaura K, Shimada M, Ueno K. Anthocyanins from bilberry (Vaccinium myrtillus L.) alleviate pruritus in a mouse model of chronic allergic contact dermatitis. Pharmacognosy Res. 2011;3(3):173-177.22022165
18. Esselen M, Fritz J, Hutter M, et al. Anthocyanin-rich extracts suppress the DNA-damaging effects of topoisomerase poisons in human colon cancer cells. Mol Nutr Food Res. 2011;55 Suppl 1:S143-S153.21280204
19. Matsunaga N, Chikaraishi Y, Shimazawa M, Yokota S, Hara H. Vaccinium myrtillus (bilberry) extracts reduce angiogenesis in vitro and in vivo. Evid Based Complement Alternat Med. 2010;7(1):47-56.18955266
20. Nguyen V, Tang J, Oroudjev E, et al. Cytotoxic effects of bilberry extract on MCF7-GFP-tubulin breast cancer cells. J Med Food. 2010;13(2):278-285.20132040
21. Ziberna L, Lunder M, Moze S, et al. Acute cardioprotective and cardiotoxic effects of bilberry anthocyanins in ischemia-reperfusion injury: beyond concentration-dependent antioxidant activity. Cardiovasc Toxicol. 2010;10(4):283-294.20978867
22. Mauray A, Felgines C, Morand C, Mazur A, Scalbert A, Milenkovic D. Bilberry anthocyanin-rich extract alters expression of genes related to atherosclerosis development in aorta of apo E-deficient mice. Nutr Metab Cardiovasc Dis. 2012;22(1):72-80.20678907
23. Trumbeckaité S, Burdulis D, Raudone L, Liobikas J, Toleikis A, Janulis V. Direct effects of Vaccinium myrtillus L. fruit extracts on rat heart mitochondrial functions. Phytother Res. 2013;27(4):499-506.22628017
24. Kolehmainen M, Mykkänen O, Kirjavainen PV, et al. Bilberries reduce low-grade inflammation in individuals with features of metabolic syndrome. Mol Nutr Food Res. 2012;56(10):1501-1510.22961907
25. Lehtonen HM, Suomela JP, Tahvonen R, et al. Different berries and berry fractions have various but slightly positive effects on the associated variables of metabolic diseases on overweight and obese women. Eur J Clin Nutr. 2011;65(3):394-401.21224867
26. Zhu Y, Xia M, Yang Y, et al. Purified anthocyanin supplementation improves endothelial function via NO-cGMP activation in hypercholesterolemic individuals. Clin Chem. 2011;57(11):1524-1533.21926181
27. Takikawa M, Inoue S, Horio F, Tsuda T. Dietary anthocyanin-rich bilberry extract ameliorates hyperglycemia and insulin sensitivity via activation of AMP-activated protein kinase in diabetic mice. J Nutr. 2010;140(3):527-533.20089785
28. Lankinen M, Schwab U, Kolehmainen M, et al. Whole grain products, fish and bilberries alter glucose and lipid metabolism in a randomized, controlled trial: The sysdimet study. PLoS One. 2011;6(8):e22646.21901116
29. Piberger H, Oehme A, Hofmann C, et al. Bilberries and their anthocyanins ameliorate experimental colitis. Mol Nutr Food Res. 2011;55(11):1724-1729.21957076
30. Ogawa K, Oyagi A, Tanaka J, Kobayashi S, Hara H. The protective effect and action mechanism of Vaccinium myrtillus L. on gastric ulcer in mice. Phytother Res. 2011;25(8):1160-1165.21290441
31. Biedermann L, Mwinyi J, Scharl M, et al. Bilberry ingestion improves disease activity in mild to moderate ulcerative colitis - an open pilot study. J Crohns Colitis. 2013;7(4):271-279.22883440
32. Hawrelak JA, Myers SP. Effects of two natural medicine formulations on irritable bowel syndrome symptoms: a pilot study. J Altern Complement Med. 2010;16(10):1065-1071.20954962
33. Miyake S, Takahashi N, Sasaki M, Kobayashi S, Tsubota K, Ozawa Y. Vision preservation during retinal inflammation by anthocyanin-rich bilberry extract: cellular and molecular mechanism. Lab Invest. 2012;92(1):102-109.21894150
34. Yao N, Lan F, He RR, Kurihara H. Protective effects of bilberry (Vaccinium myrtillus L.) extract against endotoxin-induced uveitis in mice. J Agric Food Chem. 2010;58(8):4731-4736.20222750
35. Mykkänen OT, Kalesnykas G, Adriaens M, Evelo CT, Törrönen R, Kaarniranta K. Bilberries potentially alleviate stress-related retinal gene expression induced by a high-fat diet in mice. Mol Vis. 2012;18:2338-2351.22993483
36. Song J, Li Y, Ge J, et al. Protective effect of bilberry (Vaccinium myrtillus L.) extracts on cultured human corneal limbal epithelial cells (HCLEC). Phytother Res. 2010;24(4):520-524.20077406
37. Shim SH, Kim JM, Choi CY, Kim CY, Park KH. Ginkgo biloba extract and bilberry anthocyanins improve visual function in patients with normal tension glaucoma. J Med Food. 2012;15(9):818-823.22870951
38. Huttunen S, Toivanen M, Arkko S, Ruponen M, Tikkanen-Kaukanen C. Inhibition activity of wild berry juice fractions against Streptococcus pneumoniae binding to human bronchial cells. Phytother Res. 2011;25(1):122-127.20625989
39. Koli R, Erlund I, Jula A, Marniemi J, Mattila P, Alfthan G. Bioavailability of various polyphenols from a diet containing moderate amounts of berries. J Agric Food Chem. 2010;58(7):3927-3932.20073463
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43. Ulbricht C, Chao W, Costa D, et al. Clinical evidence of herb-drug interactions: a systematic review by the Natural Standard Research Collaboration. Curr Drug Metab. 2008;9(10):1063-120.19075623
44. Hui H, Tang G, Go VL. Hypoglycemic herbs and their action mechanisms. Chin Med. 2009;4:11.19523223
45. Duke JA. Handbook of Medicinal Herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002.
46. Larmo PS, Kangas AJ, Soininen P, et al. Effects of sea buckthorn and bilberry on serum metabolites differ according to baseline metabolic profiles in overweight women: a randomized crossover trial. Am J Clin Nutr. 2013;98(4):941-951.10.3945/ajcn.113.060590
47. Kamiya K, Kobashi H, Fujiwara K, Ando W, Shimizu K. Effect of fermented bilberry extracts on visual outcomes in eyes with myopia: a prospective, randomized, placebo-controlled study. J Ocul Pharmacol Ther. 2013;29(3):356-359.10.1089/jop.2012.0098
48. Widen C, Coleman M, Criten S, Karlgren-Andersson P, Renvert S, Persson GR. Consumption of bilberries controls gingival inflammation. Int J Mol Sci. 2015;16:10665-10673.25970751
49. Ozawa Y, Kawashima M, Inoue S, et al. Bilberry extract supplementation for preventing eye fatigue in video display terminal workers. J Nutr Health Aging. 2015;19(5):548-554.25923485
50. Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27(6):391-401.12472978
51. Aktas C, Senkal V, Sarikaya S, Karti S. Bilberry potentiates warfarin effect? Turk Geriatr Dergisi. 2011;14(1):79-81.
52. Ernst E. Cardiovascular adverse effects of herbal medicines: a systematic review of the recent literature. Can J Cardiol. 2003;19(7):818-827.12813616
53. Djuv A, Nilsen OG, Steinsbekk A. The co-use of conventional drugs and herbs among patients in Norwegian general practice: a cross-sectional study. BMC Complement Altern Med. 2013;13:295.24171723
54. Lynn A, Garner S, Nelson N, Simper TN, Hall AC, Ranchordas MK. Effect of bilberry juice on indices of muscle damage and inflammation in runners completing a half-marathon: a randomised, placebo-controlled trial. J Int Soc Sports Nutr. 2018;15:22.29743826

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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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