Hepatotoxicity of NONI juice: Report of two cases

Abstract

NONI juice (Morinda citrifolia) is an increasingly popular wellness drink claimed to be beneficial for many illnesses. No overt toxicity has been reported to date. We present two cases of novel hepatotoxicity of NONI juice. Causality of liver injury by NONI juice was asses-sed. Routine laboratory tests and transjugular or percutaneous liver biopsy were performed. The first patient underwent successful liver transplantation while the second patient recovered spontaneously after cessation of NONI juice. A 29-year-old man with previous toxic hepatitis associated with small doses of paracetamol developed sub-acute hepatic failure following consumption of 1.5 L NONI juice over 3 wk necessitating urgent liver transplantation. A 62-year-old woman without evidence of previous liver disease developed an episode of self-limited acute hepatitis following consumption of 2 L NONI juice for over 3 mo. The most likely hepatotoxic components of Morinda citrifolia were anthraquinones. Physicians should be aware of potential hepatotoxicity of NONI juice.

Effects of Consumption of Noni (Morinda citrifolia) in Rats Fed a High-Fat Diet

“…Although the present study did not identify any indication of hepatic injury, there are reports of toxicity due to its consumption in humans (Millonig et al, 2005;Stadlbauer et al, 2005;Andrada et al, 2007, Yu et al, 2011. In rats, fruit ingestion has been shown to impair prenatal development (Müller et al, 2009;Marques et al, 2010).…”

Hepatotoxic Botanicals - An Evidence-based Systematic Review

“…The patient required a liver transplantation. Moreover, a 62-year-old woman who drank 2 L of noni juice developed acute hepatitis and recovered after cessation of herbal drink (180). Another case of toxicity associated with noni juice involved a 45-year-old man who had a glass of noni juice daily for few weeks for prophylactic reason.…”

“…However, noni juice has been associated with several hepatotoxicity events. The potential toxic constituent of M. citrifolia is anthraquinones like moridone, nordamnacanthal, rubiadin, rubiadin-1-methyl ether, anthraquinone glycoside, which are known for their hepatotoxic potential (180,182). According to Stadlbauer et al (180), a 29-yearold man who previously had acute hepatitis due to paracetamol developed sub acute hepatic failure after consumption of 1.5 L of noni juice for more than 3 weeks.…”

“…Fruit, roots and leaves of M. citrifolia has been used for more than 2000 years as a herbal remedy and wellness drink (178,179,180). Additionally, it has ben used for treating many health problems including cancer, AIDS, elevated blood pressure and mental depression (178,181).…”

A Toxic Hepatitis Caused the Kombucha Tea – Case Report

“…The most likely hepatic toxic components of Morinda citrifolia were anthrax-quinones. Physicians should be aware of potential hepatic toxicity of NONI-juice as the one of toxic-plant [5,6].…”