7 Juices with Biologic Activity and Drug Interactions
Grapefruit juice is not the only juice pharmacists should mention to patients.
What are 7 juices with biologic activity and drug interactions that are similar to grapefruit?
They are cranberry, gogi, mangosteen, noni, acai, pomegranate, and sea buckthorn. When most of us think of juice, we think “healthy and safe,” but when these 7 are consumed in large amounts they can have very powerful effects on the body. These effects can be good or bad, depending on the situation.
Some of these juices are unique. For example, Noni juice has a foul smell and taste. Historically, it was said that only very sick people were motivated enough to drink this foul-smelling liquid. Now with modern technology, juice companies can mask the foul taste and smell caused by caproic acid, which may explain its foul odor.
Acai berry can “stain” the inside of the gastrointestinal tract and various abdominal organs and illuminate an MRI scan. It almost got turned into a medical product for use in the hospital. It is very important for patients to tell their doctors that they are taking acai berry before an MRI so that there is no surprise when certain body parts are illuminated during the tests.
None of these juices are proven to be safe during pregnancy or while breast-feeding. Two of the juices can cause miscarriages and were used historically as abortifacients.
All the juices report anti-inflammatory and antioxidant effects. Many experts think that hidden inflammation and free radical damage is the cause of premature aging and chronic diseases such as heart disease, cancer, diabetes, arthritis, and other diseases.
These juices were used for hundreds of years in developing countries prior to the invention of modern medicine. Are they really anti-aging elixirs? What is their role now? Can we use them to become healthier? Knowledge is key.
The Natural Medicines Comprehensive Database1 has the most extensive collection of scientific research literature on these juices. The information is mixed with data about the entire fruit and parts of the plant such as the leaves, stem, and roots. Some fruits have low glycemic properties and are used to treat obesity and diabetes. But when processed into a juice form, those no longer apply. It is important not to assume that benefits from different parts of plant have the same effect in the juice form. However, sometimes ground plant parts are used to make the liquid and then sold as a juice.
Many of these scientific papers search for the active ingredients in these juices. They have found that these juices are high in multivitamins and minerals such as potassium. Some contain oils (fatty acids) and proteins (amino acids). All the juices are high in carbohydrates and natural sugars.
Some juices have magical molecules with names such as anthraquinones, beta-sitosterol, anthocyanins, polyphenols, flavone, glycosides, linoleic acid, ursolic acid, and rutin. Some juices have active molecules that do not have names. Researchers still don’t know exactly how all the chemicals in these juices work.
It is important to identify exaggerated claims from the juice manufacturers. The FDA has cracked down on manufacturers' websites that have claims not backed by scientific data. Some old review articles on juices still have those links posted, but they are now mysterious dead ends.
Consumer Labs, an organization that tests products to see if they are what they say they are on their labels, cautions consumers about products that have very little of the active ingredients. Some of these products are watered down or diluted with other juices and contain very little of the original product. Consumer Labs lists its findings on its website, and for a small fee the website is available to the public. Their website also includes review articles like this one and a newsletter with current newsworthy discoveries. The website was founded and s run by medical professionals to help the general public find high-quality natural products.
Information for the following chart was collected from Natural Medicines Comprehensive Database.
Name of Juice and Origin
Used to Improve the Following Conditions but Not Strong Enough or Consistent Enough to Be Used as Treatment
Adverse effects reported
Cranberry from North America
Contains multiple molecules that “coat” the surface of the bacteria and prevent it from adhering to biological tissues; it does not acidify the urine as previously thought
Bladder infections; being investigated to treat gastric ulcers caused by Helicobacter pylori; prevents adhesion of plaque to teeth.
Eight ounces or more a day can lead to excessive bleeding while on warfarin. It can also increase the elimination of painkillers and antidepressants, lowering the effect.
Goji from China
Betaine (uterine stimulant), vitamins, minerals, more than 100 constituents have been identified. Some plant varieties have trace amounts of atropine.
Hepatoprotective properties. Increases mental alertness. Increases well-being.
The root can lower blood pressure and blood sugar but the juice does not.
(weak inhabitation of CYP2C9 in the lab). Avoid use with blood thinners. Can cause miscarriage.
Cross allergies with tomatoes, peaches, and nuts.
Mangosteen from Asian tropics
astringent to dry up tissues and secretions
Intestinal health and diarrhea
No major drug interactions; use cautiously with blood thinners
Morinda (Noni) from the Pacific Islands, Southeast Asia, Australia, and India.
Vitamin C, A, carotene, potassium (56 meq/L if the product is 100% pure and not watered down.)
Can cause miscarriages; lowers CRP (a marker of inflammation); it is studied as an immune system booster in the treatment of HIV, parasitic infections, cancer, and bacterial infections; it can lower blood pressure in certain people.
Liver failure has occurred. Use cautiously with drugs that increase potassium levels (ACE inhibitors, angiotensin receptor blockers, potassium-sparing diuretics, and in renal failure).
Acai from South America
Vitamins and minerals, proteins, oils, and antioxidants
The whole fruit: low glycemic/blood pressure effects.
No known drug interactions or adverse effects with acai.
Pomegranate from the Mediterranean region2
Vitamins C, A, E, folic acid, antioxidants, potassium (about 30 meq/L in 100% pure pomegranate juice which is difficult to find)
Cholesterol: Reduces formation by liver
Reduce the activity of angiotensin converting enzyme (ACE).
HIV: viral entry into cells.
Infections: antibacterial and antifungal activity; thought to increase fertility
Drug interactions inhibits CYP3A4 allergic reactions. Angioedema, which is swelling of the face and tongue, can occur without warning in people who have other plant allergies yet have eaten this fruit for years.
from the Altai Territory in Russia
Vitamins A, B1, B2, B6, C& E, fatty acids, amino acids, and tannins
Whole berries and oil extract lowers CRP (marker of inflammation); oil used topically for eczema; it is a natural sun screen; and promotes wound healing. Often found in cosmetics. Helps with liver cirrhosis and high blood pressure.
Oil extract can thin the blood. Theoretically, it can cause hypotension when combined with antihypertensive drugs.
1. Natural Medicines Comprehensive Database. Noni, acai, sea buckthorn, mangosteen, pomegranate, goji, cranberry. http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND; subscription required to view.
2. National Institutes of Health. Pomegranate. https://nccih.nih.gov/health/pomegranate/at-a-glance. Updated September 2016. Accessed September 18, 2017.