Scientific Name(s): Prunus cerasus L.
Common Name(s): Morello cherry, Pie cherry, Red cherry, Sour cherry, Tart cherry
There are about 270 varieties of sour cherries, a few of which are of commercial importance (eg, Montmorency, Richmond, English Morello, Balaton). The sour cherry tree is smaller than the sweet cherry tree (Prunus avium) and is more tolerant of temperature extremes.1 The sour cherry originated in Europe, but is widely cultivated in America. The trees may reach about 12 m in height, with a trunk diameter of 30 to 45 cm. The bark is a grayish-brown with white to pale pink flowers; and ovate leaves with serrated edging.2 Sour cherry fruits can grow to 20 mm in length and 18 mm in width. They are cordate drupes, with color ranging from light to dark red, and enveloping a light brown seed.3 An older synonym for this species is Cerasus vulgaris Mill.
The Greek botanist Theophrastus described the cherry circa 300 BC, although, it is believed to have been cultivated even earlier. In 70 AD, the Roman naturalist Pliny indicated that cherry trees were located in Rome, Germany, England, and France. By the mid-1800s, cherries were being cultivated in Oregon. The first commercial cherry orchard was planted in the late 1800s. By the early 1900s, the sour cherry industry was flourishing. As of the late 1900s, 36,000 tons of sour cherries were produced in the US each year.1 In 2012, top producers of sour cherries included Turkey, Russia, Ukraine, Poland, and Iran.4
Cherries contain 80% to 85% water. Sour cherries have 58 calories per 100 grams, which contain 1,000 international units of vitamin A (per 100 g) compared with 110 international units in sweet cherries.1 Nutrients and other constituents found per 100 g of dried sour cherries include potassium, vitamin A, vitamin C, calcium, iron, phosphorus, sugars, fiber, and carbohydrates.5 Citric acid, amygdalin, malic acid, tannin, dextrose, sucrose, quercetin, and anthocyanin are all present in juice prepared from the fruit.2 The antioxidants kaempferol and quercetin are found in the fruits, as are about 15 other compounds with antioxidant properties.6
More recent studies have detected other compounds. The pigment cyanidin-3-glycoside has been isolated from the sour cherry.10 Polyprenol patterns have been found in the leaves of the plant.11 Chlorogenic acid methyl ester and the new compounds 2-hydroxy-3-(0-hydroxyphenol) propanoic acid, 1-(3′,4′-dihydroxycinnamoyl)-cyclopenta-2,5-diol and 1-(3′,4′-dihydroxycinnamoyl)-cyclopenta-2,3-diol have also been identified by spectral data.6 A high concentration of melatonin was found in Montmorency cherries when compared with Balaton cherries.12
Uses and Pharmacology
Anthocyanins in sour cherries have anti-inflammatory and antioxidant activity.6 These properties may prove useful in the management of arthritis, gout, and muscle pain associated with strenuous exercise. Some sour cherry cultivars contain melatonin, which may prove useful in the management of insomnia. Based on in vitro and animal studies, sour cherries have the potential to inhibit tumor growth, slow cardiovascular disease, and possibly retard the aging process. However, these potential uses have not been studied in clinical trials.
In vitro studies
Sour cherries have anti-inflammatory effects that are likely related to inhibition of cyclooxygenase (COX)-1 and COX-2 by anthocyanins. An in vitro study compared inhibition of COX-1 and COX-2 by ibuprofen, naproxen, and anthocyanins in sweet and sour cherries.13 Inhibition of COX-1 was greatest for naproxen (54%), followed by ibuprofen (48%), sweet cherries (29%), Balaton (27%), and Montmorency sour cherries (25%). Inhibition of COX-2 was greatest for sweet cherries (47%), followed by naproxen (41%), ibuprofen (39%), Balaton (38%), and Montmorency sour cherries (37%). Another study confirms inhibition of COX-1 and COX-2 by extracts of Balaton and Montmorency sour cherry cultivars.14 Danish cultivars of sour cherry have demonstrated inhibition of prostaglandin E2 (PGE2) comparable with that of indomethacin.15 A study that evaluated in vitro COX-1 and COX-2 inhibition of processed sour cherry products ranked juice concentrate as most potent, followed by frozen cherries, and then canned cherries.16 None of these products inhibited COX-2. Dried cherries did not demonstrate COX-1 or COX-2 inhibition.
In a rat study, oral anthocyanins from sour cherries caused dose-dependent reductions in thermal hyperalgesia and edema that were comparable with that of indomethacin.17 In a study of Freund's adjuvant-induced arthritis in rats, anthocyanins from sour cherries caused a dose-dependent reduction in serum concentrations of tumor necrosis factor alpha (TNFalpha) and paw concentrations of PGE2.18 In a study employing Freund's adjuvant in mice, dietary supplementation with sour cherry juice inhibited COX-2 in the liver and blood, but not in the brain.19
The only randomized, controlled trial to evaluate sour cherry juice for osteoarthritis failed to demonstrate a significant improvement in pain, possibly due to the small sample size used in the trial. The crossover study randomized 58 patients with mild to moderate knee osteoarthritis to receive placebo or 240 mL of sour cherry juice made from Montmorency cherries and equivalent to 50 cherries per dose twice daily for 6 weeks.20 Treatment periods were separated by a 1-week washout period. The Western Ontario McMaster Osteoarthritis Index (WOMAC) score was the primary outcome measure; secondary outcomes included plasma urate, serum creatinine, high sensitivity C-reactive protein (hsCRP), acetaminophen use, and a timed walking test. The study was powered to detect a difference in WOMAC scores of 5.5; however, a difference of 4.4 was detected. Compared with baseline, the total WOMAC score improved significantly with sour cherry juice (P = 0.002), but did not change with placebo (P = 0.46). There was no statistically significant difference between treatments in the change in WOMAC scores (15% improvement with sour cherry juice vs 6% with placebo, P = 0.16). There was a positive treatment response based on WOMAC scores in 21 of 53 patients with cherry juice, compared with 11 of 53 patients with placebo (P = 0.06). Treatment did not affect acetaminophen use, walking time, plasma urate, or serum creatinine. Cherry juice decreased hsCRP by 23% (P = 0.043), while placebo increased hsCRP by 51% (P = 0.004). Reductions in hsCRP during cherry juice treatment were associated with improvements in WOMAC scores. Both cherry juice and placebo were well tolerated.
A double-blind, clinical trial randomized 20 women with inflammatory osteoarthritis to receive 315 mL of sour cherry juice or placebo twice daily for 21 days.21 The juice was made from Montmorency cherries, with each dose equivalent to 50 to 60 cherries. Patients assessed their pain level at baseline and after the intervention with the WOMAC and a 100-point visual analog scale (VAS). The study assessed levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and TNFalpha. There was a significant reduction in CRP with sour cherry juice (−3.42 mg/L vs +0.94 mg/L with placebo, P < 0.05), but there was no change in other biomarkers of inflammation. Although methodology and power calculations for pain measurements were reported, results for pain assessments were not.
In vitro studies
Anthocyanins in sour cherries have the potential to affect gout via anti-inflammatory and antioxidant effects. The anti-inflammatory effects of sour cherry anthocyanins may be mediated by COX-1 and COX-2 inhibition.13 Macrophages modulate the inflammatory response in acute gout by releasing nitric oxide and other proinflammatory substances. In vitro, anthocyanins from sour cherries strongly inhibit nitric oxide production from macrophages, with inhibitory activity comparable with quercetin.6
In a study of hyperuricemic rats, sour cherry juice inhibited xanthine oxidase and reduced serum uric acid levels, but allopurinol had more potent effects on both measures.22
Cherries were first advocated as a preventive measure for gout in 1950 by Dr. Ludwig Blau who reported that eating ½ lb (227 g) of cherries daily lowered uric acid levels and prevented exacerbations in 12 patients with gout.23 A study conducted in 10 healthy women reported a reduction in plasma uric acid and an increase in urinary excretion of uric acid in women after ingestion of sweet Bing cherries.24
Internet-based, case-crossover study was conducted to examine risk factors for recurrent gout attacks.25 Prospectively recruited gout patients (N = 633) who had experienced a gout exacerbation in the previous year were monitored online for 1 year. Participants, serving as their own controls, recorded potential risk factors during the 2 days before a gout attack and during prespecified 2-day control periods. A half cup, or 10 to 12 cherries, was defined as a serving of cherries, with no differentiation between sweet and sour cherries. Conditional logistic regression, with multivariate analysis, was used to estimate the risk of recurrent gout attacks. Cherry consumption was associated with a 35% reduction in the risk of recurrent gout attacks (multivariate odds ratio [OR] 0.65; 95% confidence interval [CI]: 0.5 to 0.85). Consumption of cherry extract also reduced the risk of recurrent gout attacks (multivariate OR 0.55; 95% CI: 0.3 to 0.98). The combination of allopurinol and cherry consumption reduced the risk of recurrent gout attacks by 75% compared with either factor alone (OR 0.25; 95% CI: 0.15 to 0.42). There was a modest dose-response to cherry consumption, with an adjusted OR of 0.52 (95% CI: 0.34 to 0.79) for 2 servings/day and an adjusted OR of 0.39 (95% CI: 0.2 to 0.77) for 3 servings/day. The benefit was attenuated with 4 or more servings/day (adjusted OR 0.62; 95% CI: 0.38 to 1).
Another clinical trial evaluated a cherry juice concentrate for the prevention of gout attacks.26 Eighteen gout patients were randomized to receive 15 mL of cherry juice concentrate or pomegranate juice concentrate twice daily for 4 months. Continuation of daily colchicine or allopurinol was permitted. A power calculation was not provided. Four patients (2 in each group) dropped out of the study. The study compared patient-reported flares for 4 months before the study with flares documented during the 4-month study. Other outcomes included the percentage of patients with gout flares during the study, serum urate, and serum creatinine. With cherry juice concentrate (n = 9), gout flares during the 4 months dropped from a patient-reported baseline of 4.99 ± 1.53 to 1.56 ± .88 (P < 0.05). With pomegranate juice concentrate (n = 5), the number of gout flares dropped from a baseline of 5.06 ± 2.83 to 3.6 ± 2.2 (P-value not reported). Over 4 months, the incidence of gout flares was 45% with cherry juice concentrate and 80% with pomegranate juice concentrate. Neither product had an effect on serum urate or serum creatinine.
In 2012, an American College of Rheumatology guideline for the management of gout made dietary recommendations for the reduction of gout flares, but did not address consumption of cherries.27 Patients are advised to limit their consumption of purine-rich meat and seafood, drinks sweetened with high-fructose corn syrup, and alcohol. They are encouraged to consume low- or nonfat dairy products. The guideline also noted that a variety of complementary or alternative medicine regimens, including cherry juice, are inappropriate for the management of an acute gout attack.28
In vitro studies
Sour cherries may improve insomnia by providing a dietary source of melatonin. A high concentration of melatonin was found in Montmorency cherries (13.46 ng/g) compared with Balaton cherries (2.06 ng/g).12 An alternative explanation may be interference with inflammatory cytokines that modulate sleep.29, 30
A double-blind, crossover study randomized 15 older adults with chronic insomnia to receive 240 mL of sour cherry juice or placebo twice daily in 2-week study periods separated by a 2-week washout.29 The sour cherry juice made from Montmorency cherries was equivalent to 50 cherries per dose. Primary outcomes of the study included improvements from baseline in the Insomnia Severity Index (ISI), sleep latency, wake after sleep onset, total sleep time, and sleep efficiency obtained from patient sleep diaries. Compared with baseline, sour cherry juice significantly improved the ISI (P < 0.05), sleep latency (P < 0.05), wake after sleep onset (P < 0.01), total sleep time (P < 0.01), and sleep efficiency (P < 0.05), with moderate effect sizes. Compared with placebo, sour cherry juice significantly improved the ISI (P < 0.05) and wake after sleep onset (P < 0.01) with moderate effect sizes. Fatigue, depression, and anxiety did not improve with sour cherry juice.
A double-blind, crossover study randomized 20 young, healthy volunteers to receive 30 mL of a sour cherry juice concentrate or fruit cordial twice daily for 7 days.30 The sour cherry juice concentrate was made from Montmorency cherries, with each dose providing the equivalent of 90 to 100 cherries. Urinary excretion of melatonin was measured. Sleep quality was evaluated with actigraphy and subjective sleep questionnaires. Sour cherry juice significantly increased total urinary melatonin (P > 0.05), but did not affect the timing of the melatonin circadian rhythm. Sleep diaries showed a decrease in napping with sour cherry juice. Actigraphy showed a significant increase in time in bed, total sleep time, and total sleep efficiency (P < 0.05 for each outcome).
Prevention of exercise-induced muscle damage or pain
A series of studies evaluated the effects of sour cherry juice products on muscle soreness and muscle strength recovery after strenuous exercise. For the end point of muscle soreness, the results of these studies are conflicting. Two studies reported a reduction in muscle pain with sour cherry juice in long-distance relay racers and after eccentric elbow flexion exercise.31, 32 Two studies involving knee extension exercise and recreational marathon runners reported no improvement.33, 34 Some of these studies suggest that sour cherry juice improves recovery of muscle strength after strenuous exercise.31, 33, 34
A crossover study randomized 14 male college students to drink 360 mL of a sour cherry juice blend or placebo twice daily for 8 days.31 The Montmorency cherry juice blend provided the equivalent of 50 to 60 cherries per dose. On the fourth day of supplementation, subjects performed eccentric elbow flexion contractions in order to cause delayed-onset muscle soreness. Isometric elbow flexion strength, pain, muscle tenderness, and relaxed elbow angle were recorded before and for 4 days after the eccentric elbow exercise. Cherry juice was associated with significantly less pain (P = 0.017) and loss of strength (4% for cherry vs 22% for placebo; P < 0.0001). Pain peaked at 24 hours with cherry juice and declined thereafter, while pain peaked at 48 hours with placebo and declined more slowly. There was no significant difference between cherry juice and placebo for loss of motion and muscle tenderness.
A placebo-controlled study evaluated the effect of a sour cherry juice blend on muscle damage, inflammation, and oxidative stress in 20 recreational marathon runners.33 The study was not randomized; subjects were assigned to treatment in order to balance enrollment by gender and anticipated marathon completion time. Subjects consumed 240 mL of cherry juice or placebo twice daily from 5 days before the marathon until 48 hours after it. The product was made from Montmorency cherries and provided the equivalent of 50 to 60 cherries per dose. The study evaluated markers of muscle damage (creatine kinase [CK], lactate dehydrogenase, delayed-onset muscle soreness, maximum voluntary isometric contraction), inflammation (IL-6, CRP, urate), and anti-oxidative state (total antioxidant status [TAS], thiobarbituric acid reactive species [TBARS], protein carbonyls [PC]) before and after the race. Isometric strength recovered more quickly with sour cherry juice (P = 0.024), but other indices of muscle damage were not significantly different from placebo. Indices of inflammation were significantly lower with cherry juice, including IL-6 (P < 0.001), CRP (P < 0.01) and uric acid (P < 0.05). While cherry juice was associated with 10% higher TAS (P < 0.05) and significantly lower TBARS 48 hours after the race (P < 0.05), there was no significant difference in PC.
A double-blind study randomized 54 runners in a long-distance relay race to receive 315 mL of sour cherry juice or placebo twice daily for 7 days before the race and on the day of the race.32 Subjects were randomized to treatment, with the exception that relay team members assigned to the same group. Cherry juice made from Montmorency cherries provided the equivalent of 45 to 50 cherries per dose. Pain was assessed on a 100 mm VAS at baseline, before the race, and after the race. At baseline, subjects in the sour cherry juice group had significantly higher pain scores (P < 0.01). Before the race, there was no difference in pain scores between the sour cherry juice group and the placebo group. After the race, pain was significantly reduced in the sour cherry juice group (12 ± 18 mm vs 37 ± 20 mm for placebo; P < 0.001).
A double-blind, crossover study in 10 male athletes evaluated the effect of sour cherry juice concentrate on muscle damage after intensive resistance knee exercise.34 Subjects received 30 mL of a fruit concentrate or cherry juice concentrate twice daily for 10-day treatment periods separated by a 2-week washout period. The Montmorency sour cherry juice concentrate provided the equivalent of 90 cherries per dose. Knee extension exercise testing was performed on day 8 of each treatment period. Knee extension maximum voluntary contractions (MVC) were used to measure muscle recovery and pressure pain threshold was used to assess muscle soreness. Other outcomes included CK, hsCRP, total nitrotyrosine, total antioxidant capacity, and PC. The cherry juice concentrate demonstrated more rapid MVC recovery (P < 0.05) and lower PC (P = 0.013). There was no difference between treatments for pressure pain threshold, CK, hsCRP, total nitrotyrosine, or total antioxidant capacity. The authors interpreted the results as an improvement in muscle recovery, but no protection against muscle damage with sour cherry juice.
A parallel-group trial evaluated the effect of sour cherry concentrate on oxidative stress, inflammation, and muscle damage after simulated road cycle racing.35 Sixteen trained cyclists were divided into 2 groups that received 30 mL of sour cherry concentrate or placebo twice daily for 7 days. The Montmorency sour cherry juice concentrate provided the equivalent of 90 cherries per dose. Participants completed a simulated 109-minute road race on days 5, 6, and 7. At baseline and immediately before and after the races, values were obtained for lipid hydroperoxides (LOOH), IL-6, TNFalpha, interleukin-8 (IL-8), IL-1beta, hsCRP, and CK. With sour cherry juice, there were significantly lower levels of LOOH (P < 0.01), IL-6 (P < 0.05), and hsCRP (P < 0.05). There were no statistically significant differences between sour cherry juice and placebo for other markers of inflammation or oxidation.
Clinical trials have evaluated twice daily oral administration of various formulations of sour cherry juice, juice blend, or concentrate, the majority of which made from Montmorency cherries. The volume of juice or juice blend ranged from 240 to 360 mL per dose. The volume of concentrate ranged from 15 to 30 mL per dose, typically diluted before administration. Dosage regimens for specific indications are summarized in the following sections.
In a study evaluating treatment of knee osteoarthritis, 240 mL of a sour cherry juice blend made from Montmorency cherries was given orally twice daily.20 Each dose provided the equivalent of 50 cherries and at least anthocyanins 30 mg.
Prevention of gout
A study evaluating a cherry juice concentrate for prevention of recurrent gout attacks did not specifically identify sour cherries as the source of the product.26 However, the concentrate was provided by a supplier using Montmorency cherries. The dose of cherry juice concentrate was 15 mL twice daily, estimated to provide the equivalent of 45 to 60 cherries per dose.
A study evaluating chronic insomnia in older adults used a sour cherry juice blend at a dose of 240 mL orally twice daily.29 The juice, made from Montmorency cherries, provided the equivalent of 50 cherries per dose. Another study evaluating effects on sleep in healthy young people used a sour cherry juice concentrate at a dose of 30 mL orally twice daily, further diluted with 200 mL of water.30 The sour cherry juice concentrate, made from Montmorency cherries, provided the equivalent of 90 to 100 cherries per dose.
Improvement of muscle pain and strength after strenuous exercise
A study evaluating muscle strength recovery in college students used a dose of 360 mL of a cherry juice blend taken orally twice daily.31 The Montmorency cherry product provided the equivalent of 50 to 60 cherries per dose. Another study gave marathon runners 240 mL of a cherry juice blend twice daily,33 made from Montmorency cherries, provided the equivalent of 50 to 60 cherries per dose. A study evaluating pain in long-distance relay racers used a dose of 315 mL of sour cherry juice twice daily.32 The Montmorency cherry juice provided a minimum of anthocyanins 40 mg and the equivalent of 45 to 50 cherries per dose. Two studies investigating isometric leg exercises and high-intensity cycling used 30 mL of sour cherry juice concentrate twice daily, diluted with 100 mL of water.34, 35 The Montmorency cherry product contained 9 mg/mL of total anthocyanins and provided the equivalent of 90 cherries per dose.
Pregnancy / Lactation
GRAS or used as food. Avoid dosages above those found in food because safety and efficacy are unproven.
None well documented.
People who are allergic to cherries should not ingest sour cherries or products derived from them.36 Anaphylaxis to cherries has been reported.37 In patients with oral allergy syndrome, cross-reactivity has been reported between apricot, cherry, and plum.36
A case of reversible acute renal failure was attributed to daily ingestion of a cherry juice concentrate.38 An elderly man with stage 3 nonproteinuric chronic kidney disease (epidermal growth factor receptor [eGFR] 30 mL/min/1.73 m2) was hospitalized with hyperkalemia (6 mEq/L) and an acute decline in renal function (eGFR 16 mL/min/1.73 m2). The only recognized change in the patient's routine was that he started drinking 60 to 120 mL of cherry juice concentrate daily to prevent gout a month earlier. After discontinuation of the cherry juice concentrate, renal function returned to baseline gradually over the following month. The case report did not indicate whether the product consumed was a concentrate of sweet or sour cherries. It reported the anthocyanin content to be 6 mg/30 mL. The authors proposed that inhibition of renal COX enzymes by anthocyanins in the cherry juice concentrate led to a decrease in renal prostaglandin function, analogous to reversible renal impairment induced by nonsteroidal antiinflammatory drugs.
Research is limited regarding toxicology with the use of sour cherry.
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.
Copyright © 2018 Wolters Kluwer Health
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.