Noni

The market for noni products is approaching $100M, but how much of this is driven by product hype versus scientific evidence? I explore the science and medical history of this medicinal plant.

Nov 30, 2023

Noni (scientific name: Morinda citrifolia) is an edible and medicinal plant found in the coffee family (Rubiaceae). It is a tree native to Southeast Asia that reaches heights of up to 6 meters and is adorned with bright green, oval leaves. Noni is notable for its distinct fruit, which is ovoid and, upon ripening, emits a strong, unpleasant odor reminiscent of butyric acid and with an astringent flavor. A unique feature of its seeds is the presence of an air sac at one end, contributing to their buoyancy and aiding in the widespread distribution of noni trees across the Indo-Pacific islands.

Noni has been a staple in traditional medicine, with each part, from roots to seeds, finding use in various remedies. Research on the plant has explored several therapeutic applications.

Medicinal History

Noni is used in traditional medicine for both internal and external ailments, utilizing its root, stem, bark, leaves, and fruit. It has been used as a medicinal plant throughout Polynesia, Southeast Asia, parts of Australia and the Caribbean. Of note, the leaves are most prevalently used in medical preparations, which is in contrast to the predominant use of noni fruit juice in Western commercial markets.

Externally, noni is traditionally applied as a poultice for sores, cuts, inflammation, stings, and headaches, while internally, it is used as an infusion for various conditions, including menstrual regulation and cancer treatment. The preparation of noni often involves fermentation, and it is increasingly used in Western markets for a wide array of health issues.

Noni and the Dietary Supplements Market

The surge in popularity of noni as a dietary supplement, particularly evident in North America and Western Europe, has been remarkable, with its market presence expanding from health food stores to pharmacies and online platforms. By 2005, noni juice sales in the USA alone reached an estimated $250 million USD, a significant jump from $33 million in 1999. More recently, the noni market was $71 million in 2022 and is forecasted to reach $109 million by 2028.

This growth has been fueled largely by aggressive marketing and the promotion of noni as a universal remedy for various chronic conditions, supported by a mix of anecdotal claims and preliminary scientific studies. Key to this rise is the widespread attribution of noni's benefits to an alkaloid called xeronine, despite the lack of robust scientific evidence to confirm its presence or efficacy in noni. As noted in a 2007 paper, the theory of xeronine, popularized through various media including books and websites, has not been substantiated in peer-reviewed scientific literature, reflecting a gap between the marketed claims and verified scientific data.

Scientific Studies

As mentioned above, while there is a lot of hype about noni, the scientific evidence lacks depth, with few clinical trials having been completed. At the same time, there have been many different studies conducted in cell (test tube) models exploring the potential of noni against everything from cancer to infection, metabolic disease, and inflammatory disease.

I describe some of its most notable medicinal properties as determined by laboratory and clinical studies. Importantly, the findings made in a test tube do not always translate into what happens in a human taking formulations made from this plant.

In vitro = in test tube; in vivo/animal = in vertebrate animal models; clinical = in humans

This summary is based on findings reported in a comprehensive review paper on noni.

CANCER

Antitumor Activity

In vitro and animal studies: Noni has demonstrated antiproliferative effects on various cancer cell lines, including lung, breast, and colorectal cancer. It works through mechanisms like COX2 suppression and inhibition of gene mutations.
Clinical trials: Limited human trials have been conducted, such as a phase I trial assessing the effect of noni on stage 4 cancer patients, showing some potential but also side effects.

GASTROINTESTINAL

Antiemetic and Anti-nausea Activity

Clinical trials: Noni extract reduced postoperative nausea in patients.

Anti-Gastric Ulcer and Esophagitis

Animal studies: Noni extract and the compound scopoletin showed protective effects against gastro-esophageal inflammation in rat models.

INFECTION

Antibacterial and Anti-Septic Activities

In vitro and in limited in vivo applications: Noni has shown activity against various bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), and has been used in dental applications and in animal production.

Antifungal Activity

In vitro: Noni extract has demonstrated inhibitory effects against Candida albicans.

Antiviral Activity

In vitro: Limited evidence of antiviral activity, including against hepatitis C and Epstein-Barr virus, but no anti-HIV activity observed.

Immunostimulatory Activity

In vitro and animal studies: Noni's immunomodulatory activities have been observed in both cellular and humoral immune responses, including the modulation of cytokine production and lymphocyte activity. These effects have been confirmed in various studies on mice and in cell cultures.
Clinical relevance: Potential therapeutic benefits in various infectious diseases and cancer, though specific human clinical trials are lacking.

Leishmanicidal Activity

In vitro and animal studies: Noni has shown effectiveness against Leishmania species, with significant results in mouse models. (Leishmania is an infectious protozoan).
Clinical trials: Two trials involving human patients with cutaneous leishmaniasis showed mixed results in lesion improvement with noni extract application.

INFLAMMATION

Antiallergic Activity

Animal studies: Noni extracts reduced allergic reactions in mice models, indicating some potential against atopic dermatitis (eczema).

Anti-inflammatory Activity

In vitro and animal studies: Noni juice demonstrated anti-inflammatory effects by inhibiting COX-1, COX-2, and reducing nitric oxide and prostaglandin E2 production. Damnacanthal, a compound in noni, also showed anti-inflammatory effects in rat and mice models.

Antinociceptive and Analgesic Activity

Animal studies: Noni extracts exhibited significant analgesic (pain relief) effects in mice, including reduction of pain in arthritis models.

Antioxidant Activity

In vitro and human studies: Noni juice and extracts have shown antioxidant properties. In humans, it decreased tissue acidosis and improved mitochondrial redox activity.

Anti-Wrinkle Activity

In vitro studies: A compound from noni fruit extract showed potential as an anti-wrinkle agent by increasing collagen production in human fibroblasts.

Neuroprotective Activity

Animal and in vitro studies: Noni juice showed protective effects against neurodegenerative disorders in animal models. It also demonstrated effects against cognitive dysfunction and improved memory in mice models.

Photoprotective Activity

In vitro and clinical trials: Noni extracts provided protection against UV radiation in skin models and human trials.

Wound Healing Activity

Animal studies: Noni extracts accelerated wound healing processes in various animal models.

METABOLIC SYNDROME

Antidiabetic Activity

Animal studies: Noni juice and extracts have shown hypoglycemic effects in diabetic mice and rats, improving glucose metabolism and reducing blood glucose levels.

Antiobesity Activity

In vitro and animal studies: Noni extracts have been found to inhibit lipoprotein lipase and reduce body fat and cholesterol levels in animal models.

The Takeaway

Noni has shown a range of potential medicinal properties, with most evidence coming from in vitro (lab test tube) and animal studies. Clinical trials in humans are limited and further research is needed to fully understand and confirm these benefits in human health applications.

Would I take a noni supplement? At this point—based on the lack of depth in the evidence—no. I’m more likely to use a fresh leaf poultice topically to treat a cut or sore than I am to drink the juice or take a supplement of it.

Yours in health, Dr. Quave

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