Data support benefit of emblica supplementation in dyslipidemic patients as well as antioxidant and anti-inflammatory activity. There is limited robust clinical evidence to support the use of emblica for any other indication.
Dosing
There are few clinical studies to guide dosages. Diabetes/hyperlipidemia: 1 to 3 g of powdered, dried fruit was consumed daily in 30 mL of water for 21 days in 1 clinical trial. Another trial used amla 300 mg tablets (each containing 50% amla extract and 50% dextrin) 3 times per day. Hypercholesterolemia/hyperlipidemia: 500 mg standardized extract of Phyllanthus embilica twice daily.
Contraindications
Contraindications have not been identified.
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
None well documented.
Adverse Reactions
Research reveals little or no information regarding adverse reactions with the use of this product.
Toxicology
No major toxicities have been reported.
Scientific Family
Euphorbiaceae
Botany
Emblica is a small to medium-sized deciduous tree native to tropical southeastern Asia. Its leaves are simple, feather-like, and closely set along the branchlets. Flowers are green-yellow, and the round, greenish-yellow fruits are smooth and hard in appearance. The fruits, which ripen in autumn and are harvested by hand, are commonly used in the Indian diet.1, 2, 3 A common synonym is Emblica officinalis Gaertn.
History
A method of emblica preparation was described in the first century AD in Sanskrit. Records of the medicinal use of emblica also have been found in Arabic, Tibetan, and Egyptian texts, as well as in the Sidha (Indian), Ayurvedic, and Unani systems of medicine. All parts of the plant including the fruit, seed, leaves, root, bark, and flowers are used in both dried and fresh forms. In the Ayurvedic system, the amla fruit is noted for its light and dry qualities, as well as being cooling in energy. In India, the fruit is commonly eaten as a pickle.2, 3
Chemistry
The fruits contain a high concentration of ascorbic acid, which degrades with heating or cooking. In addition, they contain phenols, including ellagic acid, gallic acid, quercetin, kaempferol, corilagin, geraniin, furosin, gallotanins, emblicanins, flavonoids, glycosides, and proanthocyanidins.4, 5, 6, 7, 8, 9, 10 The roots contain glycosides and tannins.11, 12
Most of the properties assigned to emblica are attributed to its strong antioxidant action.8, 13, 14, 15, 16 The ascorbic acid content of the fruit has been assayed at approximately 1 g per 100 mL of fresh fruit juice and accounts for 45% to 70% of the antioxidant activity.17 The Ayurvedic process of preparing the amla berry results in a 3-fold increase of ascorbic acid and an increase in the concentration of polyphenols. This dried fruit powder is mixed with fresh emblica juice for a few hours, and then dried and powdered again. Repeated up to 21 times, this method of fruit processing is nutritionally beneficial.17 Other compounds having antioxidant properties include the emblicanins, gallic acid, methyl gallate, corilagin, furosin, and geraniin.6, 17, 18
Uses and Pharmacology
Few quality controlled clinical trials are documented despite the widespread use of emblica in traditional health systems.
Analgesic/Antipyretic
Alcohol and aqueous extracts of emblica fruit were tested for analgesic and antipyretic activity in mice. Results were similar to those of aspirin, except for response to heat pain model in which emblica had no activity.83
Anti-inflammatory effects
Animal and in vitro data
Animal models of acute and chronic inflammation show limited anti-inflammatory effects, with reduced edema and granulomatous tissue at higher dosages.19, 20 In vitro studies using bronchial epithelial cells extracted from a patient with cystic fibrosis demonstrated inhibition of pro-inflammatory cytokine expression.21 Inhibition of collagenase and hyaluronidase by dried emblica fruit extract using donor cartilage from osteoarthritic patients were also demonstrated in vitro.22 Crude extracts have also induced apoptotic cell death of mature osteoclasts without affecting osteoclastogenesis, possibly via modulation of transcription factors.23, 24
Clinical data
A significant decrease was reported in high-sensitivity C-reactive protein levels (P<0.001) compared with baseline in obese (body mass index [BMI] 25 to 35) adults following 12 weeks supplementation of a standardized P. embilica extract (CAPROS) 500 mg twice daily.94 Similar improvements in hs-CRP were observed with CAPROS 250 mg and 500 mg given for 12 weeks, with the 500 mg dose performing significantly better than the lower dose (P<0.05) in another double-blind, randomized, placebo-controlled study that enrolled 59 patients with metabolic syndrome and confirmed endothelial dysfunction.98
Antimicrobial effects
Animal data
Induced Klebsiella pneumoniae in mice responded in the long term (30 days) to dietary supplementation with powdered fruit. However, colonization was not prevented in the short term (15 days).32 Alcoholic and aqueous extracts of emblica showed positive results against common human pathogens, including bacteria, viruses, and fungi. Activity appears to be stronger against gram-positive bacteria, and only limited efficacy against fungi.25, 26, 27, 28 Activity against herpes simplex viruses 1 and 2 has been attributed to the phenolic content29 while activity against the coxsackie virus was found for phyllaemblicin B extracted from the roots of the plant.30, 31
Clinical data
Total oral bacteria as well as levels of Streptococcus mutans and Porphyromonas gingivalis were significantly reduced after chewing 10% emblica fruit extract gum when compared to baseline and placebo in a single-blind, randomized, placebo-controlled cross-over in 20 healthy volunteers.95
In patients with chronic periodontitis, an infectious disease that results in inflammatory degradation of tissues that support the teeth, subgingival application of 10% emblica sustained-release gel as an adjunct to scaling and root planing produced significantly greater improvements in several periodontal parameters at 3 months compared to placebo enrolled in a double-blind, randomized, placebo-controlled study (N=46).96
Antitussive
An alcoholic extract of the fruits showed a dose-dependent effect similar to that of dropropizine in cats, but was less active than codeine.84
Antivenom
An alcoholic extract of emblica roots showed neutralizing capacity against the hemorrhagic action of snake venom in mice.85
Cancer
Much interest surrounds the potential for emblica use in treating cancer; however, there are no published clinical trials or epidemiological data.
Animal data
In response to heavy metal carcinogens (arsenic, chromium, nickel), rats given emblica extracts showed a reduction in the number of chromosomal aberrations, number of damaged cells, frequency of micronuclei in bone marrow cells, free radical production, and increased cell survival.33, 34, 35, 36 Rodents fed emblica extracts showed an increase in activity of natural killer cells, antibody-dependent cellular cytotoxicity, and survival in response to tumor cells (lymphoma and mammary carcinoma).37, 38, 39 In 1 of these experiments, there was no effect on tumor development, but a decrease in tumor volume was shown.33 Cytotoxicity to tumor cells has been demonstrated by organic acid gallates and hydrolysable tannins.7 One report has been published in which emblica had no effect in reducing lung cancer parameters in mice.40 Emblica extracts protected irradiated mice from radiation sickness, increased the 30-day survival rate, and decreased total mortality.41, 42, 43
Clinical data
Research reveals no clinical trial data regarding the use of emblica in cancerous conditions. However, in vitro studies using human cancer cell lines including lung, liver, cervical, ovarian, and breast cells have been conducted.44, 45, 46, 47 Various extracts of emblica inhibited hepatocarcinogenesis as measured by parameters such as tumor incidence, enzyme measurements, and other liver injury markers.37, 48, 49, 50, 51
Cardiac effects
The emblica fruits showed a protective effect against ischemic reperfusion injury in rats.86 In another study, the emblicanins were demonstrated to prevent oxidative stress.9
CNS
Studies in rats have demonstrated improved memory and reversal of drug-induced amnesia with the Ayurvedic preparation anwala churna.87, 88 Aqueous fruit extract exerted a protective effect on alcohol-induced brain mitochondrial dysfunction in rats.89
Dermatology
Animal data
Animal experiments have been conducted, as well as in vitro studies using human skin fibroblasts demonstrating increased cell proliferation and collagen production at wound and ultraviolet B light (UBV) photo-aged sites.52, 53, 54
Clinical data
Limited clinical studies have been conducted using emblica extracts in combination with other agents in skin-lightening creams as an alternative to hydroquinone.55
Diabetes
Animal data
In single- and multidose experiments, emblica decreased blood glucose levels in rats with an induced diabetic state.13, 14, 15, 73Triphala (a mixed herbal preparation containing emblica) showed a stronger effect than emblica alone79 and another mixed preparation reduced blood glucose in a manner similar to that of glibenclamide.14 Serum creatinine was reduced, and serum albumin increased within 20 days in rats fed emblica.14 In rats with induced diabetes, neuropathic pain was reduced with supplemental emblica possibly via an antioxidative mechanism.80 In vitro studies also suggest inhibition of alpha-amylase and glucosidase as potential mechanisms.81 However, in another study in rats with diabetes, dried fruits did not prevent hyperglycemia despite delaying cataract progression.82
Clinical data
Decreases in fasting and 2-hour postprandial serum glucose were demonstrated in a clinical study using both healthy and type 2 diabetic volunteers. One to 3 g of powdered, dried fruit was consumed daily in 30 mL of water for 21 days.78 In another study in patients with ESRD and uremia, no effect on diabetic indices was observed.72
GI effects
Animal data
Alcoholic and aqueous extracts of emblica have shown protective and healing effects in induced gastric ulcers in animal experiments.56, 57, 58 One experiment, however, established a biphasic effect with healing observed at lower doses of ethanolic fruit extracts and ulceration evident on histology with higher doses.59
In vitro studies using rodent jejunum and ileum as well as in live mice show antidiarrheal and spasmolytic effects on castor oil-induced diarrhea, possibly due to muscarinic action and calcium channel blockade.60
Clinical data
Research reveals no clinical data regarding the use of emblica in gastric ulcers or diarrhea.
Hepato- and renal-protective effects
Animal data
Alcoholic and aqueous extracts of emblica fruits have shown hepatoprotective properties in experiments in rats. Hepatic insults include antituberculosis drugs, arsenic, ethanol, thiacetamide, carbon tetrachloride, and cyclophosphamide. The experiments demonstrated histological and/or enzymatic protective and restorative effects. A decreased severity of hepatic fibrosis was also demonstrated, and some studies included improved renal and pancreatic indices.61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71
Clinical data
Research reveals no clinical data regarding the use of emblica in renal disease; however, in patients with uremia consequent to end-stage renal disease (ESRD), emblica reduced markers of oxidative stress. No effect on hepatic, renal, or diabetic indices was observed.72
Hyperlipidemia
Animal data
A number of animal experiments report improved lipid profiles.73, 74, 75 Flavonoid extracts from the fruits of emblica inhibited synthesis and enhanced degradation of cholesterol via increased hepatic HMG-CoA reductase.10 Fresh emblica fruit juice administered to rabbits resulted in induced aortic plaques regressing to near normal, while serum and tissue lipids decreased76 and ethanol extract of emblica improved the lipid profile, as well as reduced hypertension in induced metabolic syndrome in rats.74
Clinical data
In a human clinical trial, healthy and hypercholesterolemic men (35 to 55 years of age) given emblica supplementation for 28 days experienced a decrease in serum cholesterol levels. The condition was reversible upon discontinuation of the supplement.77 Similar results were observed in dyslipidemic adults given emblica extract 500 mg/day for 12 weeks plus lifestyle advice in a double-blind, randomized, placebo-controlled trial (N=98). Based on data presented in tables (which were not fully congruent with results summarized in text), triglycerides (P=0.0003), total cholesterol (P=0.0003), low-density lipoprotein (LDL) (P=0.0064), high-density lipoprotein (HDL) (P=0.0149), very LDL (P=0.0001), and atherogenic index of plasma (P=0.0177) were significantly improved with emblica compared to placebo. Whereas ApoB:ApoA1 was significantly improved only within the emblica group and no significant changes were seen between groups for CoQ10, homocysteine, thyroid-stimulating hormone, and fasting blood glucose.97 In volunteers with and without type 2 diabetes, 2 to 3 g daily of powdered, dried emblica fruit improved the lipid profile (decreased total cholesterol, LDL, and triglycerides; increased HDL) at 21 days. Only among the volunteers with diabetes was there a decrease in total lipids at the 3 g daily dose.78 In obese (BMI 25 to 35) adults not on statin therapy, significant decreases in calculated LDL-cholesterol (P=0.023) and total cholesterol/HDL (P=0.006) compared with baseline were seen following 12 weeks supplementation of a standardized P. embilica extract (CAPROS) 500 mg twice daily.94 Supplementation with CAPROS 250 and 500 mg twice daily for 12 weeks significantly improved endothelial function and all lipid parameters. Oxidative stress and systemic inflammatory biomarkers significantly improved, as well, compared to placebo (P<0.001 for each dose, except P<0.05 for HDL at 250 mg), with the 500 mg dose performing significantly better than the lower dose (P<0.05) in another double-blind, randomized, placebo-controlled study that enrolled 59 patients with metabolic syndrome and confirmed endothelial dysfunction.97
Immune
Rats exposed to noise stress for 15 days and given Triphala showed an increased neutrophil function and lowered cortisone release.90 However, in another experiment, an aqueous extract of emblica fruits had no effect on cold stress-induced cortisone release.91
Ophthalmic
Emblica is one component of a mixed herbal eye drop formulation (Ophthacare) that showed activity in mild infections and inflammatory eye conditions in a clinical study; however, the quality of study methodology was limited.92
Oral microbiome
Chewing 10% emblica fruit extract sugar-free gum was found to significantly increase salivary flow during the first 10 minutes and significantly reduce malodorous compounds after 15 minutes compared to placebo in 20 healthy volunteers. Additionally, total bacteria as well as levels of Streptococcus mutans and Porphyromonas gingivalis were significantly reduced when compared to baseline and placebo in this single-blind, randomized, placebo-controlled crossover.95
Platelet aggregation
ADP- and collagen-induced platelet aggregation were significantly down-regulated compared with baseline following 12 weeks of supplementation with 500 mg twice daily of a standardized extract of P. emblica (CAPROS) in obese adults 21 to 70 years of age with a BMI of 25 to 35. The significant effect on collagen-induced platelet aggregation was sustained beyond the 12 weeks of supplementation through the 2 week wash-out period, as well.94
Spermatotoxicity
Sperm count, motility, and viability were increased in mice and in human sperm with ripe emblica fruit extract.93
Dosing
Few clinical studies with robust data to support benefit are available to guide dosage.
Dyslipidemia
250 mg or 500 mg standardized extract of Phyllanthus embilica twice daily has been given for up to 12 weeks.94, 97, 98
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
None well documented.
Adverse Reactions
Research reveals little or no information regarding adverse reactions with the use of this product. Experiments in animals have shown no reported adverse reactions.
Toxicology
No major reported toxicities have been associated with the fruit. In toxicity studies in rats, no toxicity was observed in single- or longer-term–dose administration. Additionally, no detrimental effect was noted on liver or renal function.91 No chromosomal aberrations were found following 7- and 14-day treatment regimens in rats with crude fruit extract.48 In another experiment, no toxicity or mutagenicity were observed in rats even at the highest doses.44
Index Terms
Emblica officinalis Gaertn
References
Disclaimer
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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