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Bitter Melon

Scientific Name(s): Momordicacharantia L.
Common Name(s): Art pumpkin, Balsam apple, Balsam pear, Bitter cucumber, Bitter gourd, Carilla cundeamor, Cerasee, Corilla, Karela, Kor-kuly, Ku gua, Ku kua karela, Melaode sao caetano, Papailla, Para-aki, Pare, Peria, Peria La at, Salsamino, Sorossis borossieb, Soru

Clinical Overview

Use

Medical literature documents numerous studies of bitter melon use, primarily for its antidiabetic activity, but results are conflicting and inconclusive. There is insufficient evidence to recommend the use of bitter melon as a therapeutic option in type 2 diabetes.

Dosing

Diabetes: Bitter melon juice has been administered for type 2 diabetes at daily doses of 50 to 100 mL; 5 g of dried fruit given 3 times/day has also been used. There is insufficient clinical evidence to substantiate these doses.

Contraindications

Patients deficient in glucose-6-phosphate dehydrogenase should avoid consumption of bitter melon preparations due to the presence of vicine in the seeds.

Pregnancy/Lactation

Avoid use. Documentation of emmenagogue and abortifacient effects exists.

Interactions

None well documented.

Adverse Reactions

Bitter melon generally causes few adverse reactions. GI effects (eg, abdominal pain, diarrhea) and headache have been reported. Case reports of hypoglycemic coma and atrial fibrillation associated with bitter melon intake exist. Bitter melon should be used with caution in patients with impaired hepatic function.

Toxicology

Toxicity resulting in death has been reported in one case report of a child ingesting the red arils around bitter melon seeds.

Botany

Bitter melon is a member of the Cucurbitaceae family. It is cultivated in tropical areas, including the Amazon, Africa, Asia, India, South America, and the Caribbean. The plant is a climbing, flowering, perennial vine that grows up to 5 m in height. Its fruit is cucumber-shaped with surface bumps. The leaves are simple, alternate, and 4 to 12 cm in width, with 3 to 7 separated lobes. In the Northern Hemisphere, the plant produces yellow flowers during June and July, and produces fruit September through November. The unripe fruit is white or green in color and bitter in taste. The bitterness becomes more intense as the fruit ripens. However, the pith becomes sweet and is deep red in color.Chevallier 1996, Tcheghebe 2016, USDA 2017

History

The unripe fruit is commonly consumed as a vegetable and is a culinary fruit in Asia. Extracts of various parts of bitter melon are used in traditional African medicine. Fruit extracts have been used to treat diabetes, dyslipidemia, infections, and cancer. The plant seeds, fruits, leaves, and roots have been used in traditional medicine to treat indigestion, intestinal gas, menstrual conditions, wounds, inflammation, fever, and hypertension, as well as for their laxative and emetic properties. In Guyana traditional medicine, a leaf extract tea has been used in diabetes and as an antiviral. The leaf tea has also been used topically for sores and wounds, and has been administered orally and topically for worms and parasites. The leaves have been administered orally for the treatment of leprosy, hemorrhoids, and jaundice. The leaves act as a galactogogue to promote or increase milk supply, and may be applied around the eye socket for night blindness. The leaf juice may be applied to the soles of the feet to help reduce burning sensation. In Cambodia, the leaves are considered to have antipyretic activity. The fruit has been used to treat asthma, colic, constipation, cough, gout, helminthiases, inflammation, leprosy, and ulcers. The root has been used to treat syphilis, rheumatism, boils, and septic swellings. In Uganda, an infusion of the leaf and roots is used as an abortifacient.Bauman 2016, Chevallier 1996, Cunnick 1993, Duke 1989, Tcheghebe 2016, USDA 2010

Chemistry

Chemical constituents from the whole plant, fruit, and seeds of bitter melon have been isolated and described. Bitter melon fruit contains triterpene glycosides, including the characteristic mormordin and charantin. Other triterpene glycosides (momordicosides), vitamins (eg, beta carotene, ascorbic acid, niacin, thiamin), elemental compounds (eg, iron, iodine, magnesium, sodium, calcium), and fatty acids (eg, stearic, palmitic, oleic) are also present.Duke 1989 Insulin-like compounds, or compounds exerting hypoglycemic activity, have been described.Khanna 1981, Ng 1986, Raman 1996

Bitter melon seeds and the pericarp contain the phenolics catechin and epicatechin; gallic, gentisic, and vanillic acids; and lutein, lycopene, carotenes, xanthins, momordicosides, and vicine.Duke 1989, Horax 2010 The seed essential oil contains sesquiterpenes, phenylpropanoids, and monoterpenes, including nerolidol.Braca 2008, Cunnick 1993

Uses and Pharmacology

Medical literature documents numerous animal and clinical studies of bitter melon use, primarily for its antidiabetic activity. Results of clinical trials are conflicting and inconclusive.

Antimicrobial

In vitro data

Bitter melon roots, leaves, and seeds have demonstrated antibiotic and antiviral activity in vitro, including inhibition of HIV integrase.Basch 2003, Duke 1989, Pongthanapisith 2013 Synergism with aminoglycosides has been demonstrated in methicillin-resistant strains of Staphylococcus aureus.Coutinho 2010 Antibacterial activity has been attributed to the nerolidol content of the essential seed oil.Ooi 2012

Antioxidant activity

In vitro data

Free-radical scavenging activity attributed to the phenolic content has been demonstrated in vitro.Dong 2009, Horax 2010 In hyperammonemic rats, the oxidant-antioxidant imbalance was restored by administration of bitter melon fruit extract.Thenmozhi 2010

Cancer

Animal and in vitro data

Anticancer effects of bitter melon on 13 cancer lines has been documented in a review article. Several in vitro and animal studies document anticancer properties related to cell-cycle arrest, expression of serum factors associated with immunity, and apoptosis.Boetse 2011, Coutinho 2010, Hsu 2012, Li 2012, Raina 2016, Ray 2010, Waiyaput 2012, Weng 2013

Diabetes

Animal and in vitro data

The hypoglycemic effects of bitter melon have been established in animal studies.Bauman 2016 Hypoglycemic activity may be related to decreased gluconeogenesis, enhanced insulin secretion, protection of islet beta-cells, and inhibition of intestinal alpha-glucosidase and glucose transport. The expression of peroxisome proliferator-activated receptors involved with metabolism may also be activated or upregulated.Choudhary 2012, Huang 2013, Leung 2009, Wang 2017

Clinical data

While bitter melon has traditionally been used for treatment of type 2 diabetes, medical literature documents inconsistent results and poor methodology among clinical trials evaluating its effects in diabetes.Bauman 2016, Ching 2013, Ocvirk 2013, Ooi 2012, Patel 2012, Riszi 2013

A recent data collection and analysis concluded current evidence does not warrant the use of bitter melon in treating type 2 diabetes. The review included 4 randomized controlled trials (N=479), with treatment durations up to 3 months. There was no statistically significant difference in glycemic control with bitter melon preparations compared with placebo. There was also no change in glycemic control for participants treated with bitter melon compared with metformin or glibenclamide. No serious adverse effects were reported.Ooi 2012

Immune system

In vitro data

Crude lectin extracted or isolated from M. charantia seed upregulated immune response in vitro,Huang 2008, Huang 2008 while a pulp extract increased the production of hepatocyte growth factor.Ono 2009

Dosing

Commercially available products include juices, capsules, and teas. However, scientifically proven documentation regarding the safety, appropriate dosage, or effectiveness of most products is lacking.

Diabetes

Bitter melon juice has been administered at daily doses of 50 to 100 mL, but it may be bitter and difficult to drink; 5 g of dried fruit 3 times per day has also been used. There is insufficient clinical evidence to substantiate these doses.Basch 2003 Subcutaneous preparations of bitter melon as a vegetable insulin have also been used in older clinical studies, but safety and efficacy data are lacking.Basch 2003 Although encapsulated dry powder dosage forms may be easier to administer, the standard dose is 3 to 15 g daily, a large dose in capsule form. A standardized, encapsulated extract dose ranges from 100 to 200 mg 3 times daily.Momordica charantia 2007 A transdermal dosage form (10 mg/patch) has also been evaluated.Bhujbal 2011

Pregnancy / Lactation

Avoid use. Documentation of emmenagogue and abortifacient effects exists.Ernst 2002 Antifertility actions in animals have also been described.Basch 2003, Chang 1995

Interactions

An increased hypoglycemic effect with coadministered pharmaceutical agents, such as hypoglycemic medications, has been postulated due to effects observed in animal studies. In a clinical trial, chloroform/benzene karela extract (400 mg) coadministered with metformin or glibenclamide (at 50% of clinical doses) produced a greater hypoglycemic effect compared to full doses of either antidiabetic alone.Gupta 2017, Tongia 2004

Individuals with diabetes should be advised to closely monitor blood sugar if adding bitter melon to their treatment regimen. Minor effects on cytochrome P450 enzymes and glutathione S-transferase were observed in one experiment.Appiah-Opong 2008

Adverse Reactions

Bitter melon is generally well tolerated. GI effects (eg, abdominal pain, diarrhea) and headache have been reported in clinical trials.Basch 2003, Ooi 2012

Increases in liver enzymes have been observed experimentally, but without histological changes. Bitter melon should be used with caution in patients with impaired hepatic function.Basch 2003, Raman 1996

Toxicology

An acute toxicity study reviewed the effects of a bitter melon extract administered orally to rats at 2 different doses: 300 mg/kg and 2,000 mg/kg of body weight. Within 30 minutes, both treatment groups showed signs of dizziness and depression. However, no difference was documented in feeding patterns of either treatment group. Hemoglobin count and liver weight of rats receiving the 2,000 mg/kg extract decreased.Husna 2013

There are no published reports of serious reactions in adults given the usual oral dose of 50 mL. Antifertility action (decreased spermatogenesis) has been observed in mice, rats, and dogs fed bitter melon fruit extract.Basch 2003, Chang 1995

In individuals with glucose-6-phosphate dehydrogenase deficiency, the seed constituent vicine may induce favism , an acute condition characterized by onset of hemolytic anemia and symptoms such as headache, fever, abdominal pain, and coma.Basch 2003, Raman 1996 Those deficient in glucose-6-phosphate dehydrogenase should avoid consumption of bitter melon preparations due to the presence of vicine in the seeds.

In a case report, atrial fibrillation occurred a 22-year-old man following consumption of juice from crushed M. charantia fruit.Erden 2010

Two case reports exist of hypoglycemic coma and convulsions in children following administration of a bitter melon tea.Basch 2003, Chevallier 1996

The red arils around bitter melon seeds may be toxic to children. In one report of a child given the juice, vomiting, diarrhea, and eventual death occurred.Duke 1989

References

Appiah-Opong R, Commandeur JN, Axson C, Vermeulen NP. Interactions between cytochromes P450, glutathione S-transferases and Ghanaian medicinal plants. Food Chem Toxicol. 2008;46(12):3598-3603.18822337
Basch E, Gabardi S, Ulbricht C. Bitter melon (Momordica charantia): a review of efficacy and safety. Am J Health Syst Pharm. 2003;60(4):356-359.12625217
Bauman H, Markides B. Food as medicine: Bitter melon (Momordica charantia, Cucurbitaceae). HerbalEGram. 2016;13(9).
Bhujbal SS, Hadawale SS, Kulkarni PA, et al. A novel herbal formulation in the management of diabetes. Int J Pharm Investig. 2011;1(4):222-226.23071947
Boetse YO, Ikechukwu DF, Olugbenga OA, Ayodele OA, Caramel NC. Histomorphological alterations in the prostate gland and epithelium of seminiferous tubule of Sprague-Dawley rats treated with methanolic extract of Momordica charantia seeds. Iran J Med Sci. 2011;36(4):266-272.23115411
Braca A, Siciliano T, D'Arrigo M, Germanò MP. Chemical composition and antimicrobial activity of Momordica charantia seed essential oil. Fitoterapia. 2008;79(2):123-125.18164872
Chang F, et al. Studies on the antifertility chemical constituents of balsam pear. Chin Tradit Herb Drugs. 1995;26:281-284.
Chevallier A. The Encyclopedia of Medicinal Plants. New York, NY: DK Publishing; 1996:234.
Ching SM, Zakaria ZA, Paimin F, Jalalian M. Complementary alternative medicine use among patients with type 2 diabetes mellitus in the primary care setting: a cross-sectional study in Malaysia. BMC Complement Altern Med. 2013;13:148.23802882
Choudhary SK, Chhabra G, Sharma D, Vashishta A, Ohri S, Dixit A. Comprehensive evaluation of anti-hyperglycemic activity of fractionated Momordica charantia seed extract in alloxan-induced diabetic rats. Evid Based Complement Alternat Med. 2012;2012:293650.23320026
Coutinho HD, Costa JG, Falcão-Silva VS, Siqueira-Júnior JP, Lima EO. Effect of Momordica charantia L. in the resistance to aminoglycosides in methicilin-resistant Staphylococcus aureus. Comp Immunol Microbiol Infect Dis. 2010;33(6):467-47119732954
Cunnick J, et al. Bitter Melon (Momordica charantia). J Nat Med. 1993;4:16-21.
Dong CJ, Yang XD, Liu JY. Enzymatic properties of a recombinant phospholipid hydroperoxide glutathione peroxidase from Momordica charantia and its complementation function in yeast. Biochemistry (Mosc). 2009;74(5):502-508.19538123
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Erden I, Ordu S, Erden EC, Caglar SO. A case of atrial fibrillation due to Momordica charantia (bitter melon). Ann Saudi Med. 2010;30(1):86-87.20103967
Ernst E. Herbal medicinal products during pregnancy: are they safe? BJOG. 2002;109(3):227-235.11950176
Gupta RC, Chang D, Nammi S, Bensoussan A, Bilinski K, Roufogalis BD. Interactions between antidiabetic drugs and herbs: an overview of mechanisms of action and clinical implications. Diabetol Metab Syndr. 2017;9:59.28770011
Horax R, Hettiarachchy N, Chen P. Extraction, quantification, and antioxidant activities of phenolics from pericarp and seeds of bitter melons (Momordica charantia) harvested at three maturity stages (immature, mature, and ripe). J Agric Food Chem. 2010;58(7):4428-4433.20225855
Hsu HY, Lin JH, Li CJ, et al. Antimigratory effects of the methanol extract from Momordica charantia on human lung adenocarcinoma CL1 cells. Evid Based Complement Alternat Med. 2012;2012:819632.23320038
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Ono T, Tsuji T, Sakai M, et al. Induction of hepatocyte growth factor production in human dermal fibroblasts and their proliferation by the extract of bitter melon pulp. Cytokine. 2009;46(1):119-126.19223201
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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.

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