Written by Karen Pilkington and the CAM-Cancer Consortium.
Updated March 15, 2017

Noni (Morinda citrifolia)

Is it safe?

Adverse events

Limited assessment of safety has been carried out but there have been few adverse effects reported after using Noni and the fruit has been consumed as food for many years.1,2,11 In 2002, a review of safety of one Noni juice product by the European Scientific Committee on Food concluded that there were no indications of adverse effects from animal studies on subacute and subchronic toxicity, genotoxicity and allergenicity.11 A double-blind safety study of Noni fruit juice sponsored by a manufacturer carried out in 96 healthy volunteers did not reveal any significant adverse effects with up to 750ml noni juice daily for 28 days.28

Between 2005 and 2011, 7 cases of hepatotoxicity in previously healthy people were reported, 2 involving a tea or other herbal product, 4 involving a Noni juice and 1 involving an energy drink.2 It is unclear whether Noni juice was the cause of liver toxicity. Liver function tests improved once the Noni product was stopped but other ingredients or treatments may have been responsible. The possibility of product contamination during production was also raised as the root and bark contain anthraquinones.10 Subsequent analyses did not detect anthraquinones in the juice and several studies did not reveal toxicity.28-30 A review of the first 4 cases by the European Food Safety Authority (EFSA) in 2006 concluded that there was ‘no convincing evidence for a causal relationship between the acute hepatitis observed in the case studies reported and the consumption of noni juice’.19 In 2008 an EFSA Panel concluded that, on the basis of data provided, the use of dried Noni leaves for preparation of infusions was safe.21

Noni contains relatively high levels of potassium (similar to levels in orange and tomato juice) and a case of hyperkalaemia was reported in a patient with chronic renal insufficiency.7 Mineral content of commercial noni juices has been shown to vary widely.31

Contraindications

It is recommended that Noni is avoided in people with liver dysfunction.1,2 It is also suggested people with hyperkalaemia, kidney dysfunction, on low potassium diets, taking potassium-sparing diuretics or other drugs that increase potassium levels such as ACE inhibitors avoid using it.1,2 Toxicity tests in animals did not find evidence of toxicity from Noni juice to developing embryos and foetuses.32 However, large amounts of the fruit have been reported to cause an abortion and historically Noni root bark has been used as an abortifacient indicating it may be unsafe in pregnancy.

Interactions

Due to the potassium content of some Noni juice products, there is a potential for interaction with drugs causing increased potassium levels.7, 31

One case has been reported of resistance to the anticoagulant, coumadin, due to the vitamin K content of the particular Noni product being used by the patient.33

A single-dose, randomized, open-label and 2-period crossover study in 20 healthy volunteers showed that the aqueous fruit extract influenced the motor activity of the gastrointestinal tract. The fruit extract enhanced the rate and the extent of ranitidine absorption, partly due the ability of its active component scopoletin to stimulate the 5-HT4 receptor.34

 

Other problems or complications

Commercial preparations of Noni occasionally contain Morinda officinalis as well as Morinda citrifolia which have been reported to stimulate the kidneys and can exacerbate urinary difficulties.

Citation

Karen Pilkington, CAM-Cancer Consortium. Noni [online document]. http://cam-cancer.org/The-Summaries/Herbal-products/Noni. March 15, 2017.

Document history

Assessed as up to date in March 2017 by Barbara Wider.
Assessed as up to date in April 2016 by Barbara Wider.
Assessed as up to date in January 2015 by Barbara Wider.
Assessed as up to date in August 2013 by Barbara Wider.
Summary first published in September 2012, authored by Karen Pilkington.

References

  1. National Center for Complementary and Integrative Health (NCCIH). Herbs at a glance: Noni. (updated November 2016). Available at: https://nccih.nih.gov/health/noni. Accessed 15th March 2017.
  2. Natural Medicines Comprehensive Database. Noni monograph. [online]. Available at: http://naturaldatabase.therapeuticresearch.com. Accessed 15th March 2017.
  3. Kew Royal Botanic Gardens. Scientific Research and Data. Rubiaceae. Available at: http://www.kew.org/science-research-data/directory/teams/rubiaceae/index.htm. Accessed April 2012.
  4. Wang MY, West BJ, Jensen CJ, Nowicki D, Su C, Palu AK, Anderson G. Morinda citrifolia (Noni): a literature review and recent advances in Noni research. Acta Pharmacol Sin. 2002 Dec;23(12):1127-41.
  5. Akihisa T, Matsumoto K, Tokuda H, Yasukawa K, Seino K, Nakamoto K et al. Anti-inflammatory and potential cancer chemopreventive constituents of the fruits of Morinda citrifolia (Noni). J Nat Prod 2007; 70(5):754-757.
  6. Potterat O, Hamburger M. Morinda citrifolia (Noni) fruit--phytochemistry, pharmacology, safety. Planta Med. 2007 Mar;73(3):191-9. Epub 2007 Feb 7
  7. Mueller BA, Scott MK, Sowinski KM, Prag KA. Noni juice (Morinda citrifolia): hidden potential for hyperkalemia? Am J Kidney Dis. 2000 Feb;35(2):310-2.
  8. McClatchey W. From Polynesian healers to health food stores: changing perspectives of Morinda citrifolia (Rubiaceae). Integr Cancer Ther. 2002 Jun;1(2):110-20; discussion 120.
  9. Akihisa T, Tochizawa S, Takahashi N, Yamamoto A, Zhang J, Kikuchi T, Fukatsu M, Tokuda H, Suzuki N. Melanogenesis-Inhibitory Saccharide Fatty Acid Esters and Other Constituents of the Fruits of Morinda citrifolia (Noni). Chem Biodivers. 2012 Jun;9(6):1172-87.
  10. MD Anderson Cancer Center. Complementary/Alternative Medicine Education Resources, Therapies: Noni Juice. Available at: http://www.mdanderson.org/education-and-research/resources-for-professionals/clinical-tools-and-resources/cimer/therapies/herbal-plant-biologic-therapies/Noni.html. Accessed April 2012.
  11. European Commission Scientific Committee on Food. Opinion of the Scientific Committee on Food on Tahitian Noni® juice. 2002. Available at: www.noni-pei.ru/ec.pdf. Accessed April 2012.
  12. Issell BF, Gotay CC, Pagano I, Franke AA. Using Quality of Life Measures in a Phase I Clinical Trial of Noni in Patients With Advanced Cancer to Select a Phase II Dose. J Diet Suppl. 2009;6(4):347-59.
  13. Tahitian Noni International. Noni is the difference. Available at: http://research.tni.com/united_kingdom/uk_english/research/difference.html. Accessed April 2012.
  14. Pawlus AD, Kinghorn DA. Review of the ethnobotany, chemistry, biological activity and safety of the botanical dietary supplement Morinda citrifolia (noni). J Pharm Pharmacol. 2007 Dec;59(12):1587-609.
  15. Hirazumi A, Furusawa E. An immunomodulatory polysaccharide-rich substance from the fruit juice of Morinda citrifolia (noni) with antitumour activity.Phytother Res. 1999 Aug;13(5):380-7.
  16. Pawlus AD, Su BN, Keller WJ, Kinghorn AD. An anthraquinone with potent quinone reductase-inducing activity and other constituents of the fruits of Morinda citrifolia (noni). J Nat Prod. 2005 Dec;68(12):1720-2.
  17. Boon HS, Olatunde F, Zick SM, Trends in complementary/alternative medicine use by breast cancer survivors: comparing survey data from 1998 and 2005. BMC Women’s Health 2007, 7, article 4.
  18. National Archives Foods Standards Agency. Noni Product Accepted. 2006. Available at: http://food.gov.uk/news/newsarchive/2006/jan/nonihnllc. Accessed 15th March 2017.
  19. European Food Safety Authority. Opinion on a request from the Commission related to the safety of noni juice (juice of the fruits of Morinda citrifolia). The EFSA Journal 2006; 376: 1-12.
  20. European Food Safety Authority. Opinion on the safety of Tahitian Noni® ‘Morinda citrifolia (noni) fruit puree and concentrate’ as a novel food ingredient. The EFSA Journal 2009; 998: 1-16.
  21. European Food Safety Authority. Safety of ‘leaves from Morinda citrifolia L.’: Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies. The EFSA Journal 2008; 769: 1-17.
  22. Wang MY, Peng L, Lutfiyya MN, Henley E, Weidenbacher-Hoper V, Anderson G. Morinda citrifolia (noni) reduces cancer risk in current smokers by decreasing aromatic DNA adducts. Nutr Cancer. 2009;61(5):634-9.
  23. Wang MY, Lutfiyya MN, Weidenbacher-Hoper V, Anderson G, Su CX, West BJ. Antioxidant activity of noni juice in heavy smokers. Chem Cent J. 2009 Oct 6;3:13.
  24. Arpornsuwan T, Punjanon T. Tumor cell-selective antiproliferative effect of the extract from Morinda citrifolia fruits. Phytother Res 2006; 20(6):515-517.
  25. Beh HK, Seow LJ, Asmawi MZ, bdul Majid AM, Murugaiyah V, Ismail N et al. Anti-angiogenic activity of Morinda citrifolia extracts and its chemical constituents. Nat Prod Res 2012.
  26. Brown AC. Anticancer Activity of Morinda citrifolia (Noni) Fruit: A Review. Phytother Res 2012; 26(10):1427-40. .
  27. Clafshenkel P, King TL, Kotlarczyk MB,Cline JM, Foster WG, Davis VL,Witt-Enderby P. Morinda citrifolia (Noni) Juice Augments Mammary Gland Differentiation and Reduces Mammary Tumor Growth in Mice Expressing the Unactivated c-erb B2 Transgene. Evidence-Based Complementary and Alternative Medicine 2012; doi: 10.1155/2012/487423.
  28. West BJ, White LD, Jensen CJ, Palu AK. A double-blind clinical safety study of Noni fruit juice. Pac Health Dialog. 2009 Nov;15(2):21-32.
  29. West BJ, Jensen CJ, Westendorf J. Noni juice is not hepatotoxic. World J Gastroenterol. 2006 Jun 14;12(22):3616-9.
  30. West BJ, Su CX, Jensen CJ. Hepatotoxicity and subchronic toxicity tests of Morinda citrifolia (noni) fruit. J Toxicol Sci. 2009 Oct;34(5):581-5.
  31. West BJ, Tolson CB, Vest RG, Jensen S, Lundell TG. Mineral variability among 177 commercial noni juices. Int J Food Sci Nutr. 2006 Nov-Dec; 57(7-8):556-8.
  32. Wang MY, Hurn J, Peng L, Nowicki D, Anderson G. A multigeneration reproductive and developmental safety evaluation of authentic Morinda citrifolia (noni) juice. J Toxicol Sci. 2011 Jan;36(1):81-5.
  33. Carr ME, Klotz J, Bergeron M. Coumadin resistance and the vitamin supplement "Noni". Am J Hematol. 2004 Sep;77(1):103.
  34. Nima S, Kasiwong S, Ridtitid W, Thaenmanee N, Mahattanadul S. Gastrokinetic activity of Morinda citrifolia aqueous fruit extract and its possible mechanism of action in human and rat models. Journal of Ethnopharmacology 2012; 142: 354–361.