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Concerted Action for Complementary and Alternative Medicine Assessment in the Cancer Field (CAM-Cancer) 

www.cam-cancer.org 
Project initiated under the European Commission 5th Framework Program "Quality of Life", now hosted by the National 
Information Center for Complementary and Alternative Medicine in Tromsø, Norway. 
Scientific Co-ordinator Barbara Wider . contact@cam-cancer.org 

Noni (Morinda citrifolia) 


Abstract and key points 
Noni ( ), also known as Morinda citrifolia , Cheese Fruit and Indian Ba Ji Tian Mulberry, is a 
Polynesian plant that has traditionally been used in medicinal remedies. Noni fruit juice has been 
the main focus of attention in recent years. 
A wide range of indications have been proposed for Noni juice and it has been marketed as a 
general cure-all for conditions including cancer, depression, diabetes, drug addiction, heart 
disease and obesity. It is also claimed that Noni has general benefits on health. 
In vitro and animal studies have shown potential antioxidant action, immune function 
stimulation, and anti-tumour activity but there have been few trials in humans for any condition 
and no randomised controlled trials in cancer patients. Preliminary studies have suggested 
protective effects in heavy smokers. 
Few adverse effects have been reported although assessment of safety has been limited to date. 
Several cases of liver toxicity have been reported but these have not been documented to be 
caused by Noni juice. The potassium content in some noni juice products may cause problems in 
people with renal insufficiency, on low potassium diets or taking drugs likely to increase 
potassium levels. 
While apparently widely used, evidence on the proposed benefits in cancer patients is lacking 
and assessment of safety is limited. 
Read about the regulation, supervision and reimbursement of herbal medicine at NAFKAMs 
website CAM Regulation. 

What it is? 
Description 
Noni is a small evergreen tree or shrub that grows in Pacific regions including Polynesia, 
Southeast Asia, 
Written by and the CAM-Cancer Consortium. Karen Pilkington Updated March 15, 2017 

Noni ( ) is a medicinal plant from Morinda citrifolia Pacific regions Evidence on the effects in 
cancer patients is lacking Few adverse effects have been reported 
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India and Australia. The fruits, leaves, flowers, stems, bark, and roots have all been used in 
traditional 1,2 remedies. Currently, most interest is in the yellow-green fruit, which produce a 
pungent odour while 2 ripening (hence ‘Cheese Fruit’) and are used to produce juice. 
Scientific and other names 
Morinda citrifolia L. (a member of Rubiaceae, the coffee family).3 
Morinda bracteata Roxb., , canary wood, Cheese Fruit, , Hawaiian Noni, hog apple, Ba Ji Tian 
Hai Ba Ji Indian Mulberry, Noni juice, Tahitian Noni.1,2 
Ingredient(s)/Components 
A wide range of components have been identified in the Noni plant. These include alkaloids, 
anthraquinones, beta-sitosterol, carotene, flavonol glycosides including rutin, iridoids, linoleic 
acid, ursolic acid and vitamins A and C. Two fatty acids, caproic (hexanoic) and caprylic 
(octanoic) acid may be 4 responsible for the pungent odour of the fruit. New anthraquinones and 
saccharide fatty acid esters have also been isolated. The unfermented juice also contains glucose, 
fructose, proteins, lipids, calcium, magnesium, 5 potassium and sodium. Two novel constituents, 
xeronine and proxeronine, were apparently identified by 6,7 a researcher in Hawaii but have not 
been subsequently characterised or reported. Recently five new 8 saccharide fatty acid esters, 
named nonioside P, nonioside Q, nonioside R, nonioside S, and nonioside T, and one new 
succinic acid ester were isolated, along with known compounds, from an extract of the fruit. 
Some of these showed inhibitory activities against melanogenesis in B16 melanoma cells 
induced with -melanocyte-stimulating hormone (-MSH).9 
Application and dosage 
Noni is administered both orally and topically. The fruit and juice are taken orally for a range of 
health reasons. The fruit and leaves are used in preparations for topical use in conditions such as 
arthritis, headaches, burns, sores and wounds. 10 Noni seed oil has also been promoted as a 
moisturiser for use in skin conditions and joint pain. Various dose regimens for the fruit juice are 
recommended by suppliers but 1 no typical dosage has been established. One ounce 
(approximately 30ml) every 12 hours has been 2 suggested for ‘overall health maintenance’. An 
application to the European Scientific Committee on Food 4 for approval of ‘Tahitian Noni 
juice’ described the product as a mixture of 89% Noni fruit, 11% common grape and blueberry 
juice concentrates and natural flavours. The suggested consumption was 30 ml/day. 11 
Commercially manufactured capsules containing 500mg ripe Noni fruit extract have been used in 
trials in patients with advanced cancer based on a maximum recommended dose of 4 capsules (2 
grams) daily.12 
History/providers 
Noni has been used by Polynesians for at least 2000 years and is considered one of the more 
important traditional Polynesian medicinal plants and is still produced locally. Preparations of 
Noni were applied 8 
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topically, the roots were also to produce a clothes dye while the fruit was eaten as a food. The 
whole plant 4 (roots, stems, bark, leaves, flowers and fruits) has been used in the preparation of 
medicinal remedies of which around 40 have been recorded. These were used to treat a range of 
common diseases and to maintain 8 overall health.4 
Various parts of the plant are still used to make remedies but patterns of use have changed. The 
main focus 8 is on the fruit juice which is now manufactured on a large-scale and can be 
purchased from health food shops, other stores or via numerous websites. 
Claims of efficacy 
Manufacturers of Noni juice have claimed a wide range of therapeutic effects. Noni juice 
supposedly 4 ‘helps support the body's natural defences, protects the body from free radicals and 
supports physical performance’. There are also claims on various websites of beneficial effects in 
cancer. Traditional use is 13 8 based on claims of beneficial effects in wound healing and 
treating inflammation and infection.8 
Alleged indications 
A wide range of potential indications have been proposed for Noni juice and it has been 
marketed as a general cure-all for various chronic conditions. Among the indications for which 
Noni is promoted are 14 cancer, depression, diabetes, drug addiction, heart disease and obesity. 
An application for approval of a Noni juice product in Europe did not specify any indications 
other than general health benefits similar to those of other fruit juices.11 
Mechanisms of action 
Studies of the pharmacology of Noni and its constituents have focused on three main areas: 
cancer, inflammation and metabolic diseases although research is preliminary. Two constituents, 
a fatty acid 6 glycoside and an iridoid, were reported to inhibit neoplastic cell transformation in 
mouse cells. A6 polysaccharide fraction obtained from the fruit juice, inhibited tumour activity 
and stimulated cytokine release. Prevention of the initiation of carcinogenesis, antimutagenic 
activity, and inhibition of 15 angiogenesis with capillary vessel degeneration and apoptosis have 
all been reported. Inhibition of the 6 growth of several cancer cell types has also been recorded in 
vitro using high concentrations of the extract.6 An anthraquinone isolated from Noni appears to 
be a potent inducer of an enzyme, quinone reductase, known to be protective against cancer due 
to its involvement in metabolism and elimination of carcinogens. 16 
Prevalence of use 
Traditionally used in Polynesia and South East Asia, Noni has been marketed in Australia, 
Canada, Hong Kong, Japan, Mexico, Norway and the USA. Substantial increases in sales in the 
USA have been reported 11 but it is not possible to substantiate these claims. Use has also 
increased in Western Europe. Women 6,14 11 
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in the USA have reported utilizing noni for the prevention and treatment of breast cancer and as 
a secondary course of treatment following conventional chemotherapy.17 
Legal issues 
Food or drink products derived from Noni require authorisation in Europe. Several Noni 
products have been approved as novel food products in Europe. These include Noni juice in 
various forms: fresh, puree, concentrated, frozen, dried and mixed with other juices. The dried 
and roasted leaves have also been 18-20 approved as a new novel food ingredient for the 
preparation of infusions.21 
Cost and expenditures 
The cost of Noni products varies, an average cost for Noni juice (based on online prices April 
2012) is approximately 15 to 18 Euros per litre. Costs in the USA are within a similar range. A 
week’s supply based on 30ml per day would cost between 3 and 4 Euros. 

Does it work? 
Systematic reviews, meta-analyses 
No systematic reviews of Noni have been published. 
Narrative reviews 
Several narrative reviews have been published. Of those published recently, one concluded that 
some research suggested ‘broad potential health benefits’ and promising results had been 
reported for several constituents but increased use of Noni was probably due to effective 
marketing. A second review of the 14 literature reached similar conclusions, highlighting the fact 
that knowledge about the chemistry of Noni had increased but there was still a lack of clinical 
research.6 
Clinical trials 
No randomised controlled trials have been conducted to assess the effects of Noni in cancer 
patients. 
Two trials assessed the effects of Noni on levels of substances thought to increase the risk of 
developing cancer. A double-blind, placebo-controlled trial was conducted to assess antioxidant 
activity of Noni in smokers. A total of 285 heavy smokers were randomly allocated to placebo, 
29.5ml (1 fluid ounce) Noni 22 juice or 118ml (4 ounces) Noni juice per day for 30 days. Levels 
of plasma superoxide anion radicals and lipid hydroperoxide were reported to have decreased in 
the Noni groups. A second related study assessed levels of aromatic DNA adducts, a surrogate 
biomarker for risk of lung cancer, again in smokers who drank Noni juice for a month. Of 283 
smokers recruited for the trial, 203 completed the study. The results 23 indicated that Noni juice 
daily may reduce cancer risk in heavy cigarette smokers by blocking 
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carcinogen-DNA binding or removing DNA adducts from genomic DNA. Both were preliminary 
studies. Over 25% of participants did not complete the trial although all patients were included in 
the analysis. Noni juice and the placebo seemed well matched but contained a mixture of grape 
and blueberry juice which could have contributed to some of the beneficial effects reported. 
A phase 1 dose finding trial was carried out in 29 cancer patients. Patients with advanced cancer 
were 12 treated with capsules containing 500mg of ripe Noni fruit extract. A dose of 2g was used 
initially then doses were increased by 2g to a maximum of 10g (20 capsules) daily. A minimum 
of 5 patients were observed at each dose level for 28 days. Quality of life, symptom status, 
response, toxicity and pharmacokinetics were measured. Effects on several quality of life 
measures were reported although these did not reach statistical significance, except for decrease 
in pain. No adverse effects or tumour response attributable to Noni were ob served. 
Pre-clinical studies 
Pre-clinical studies have shown a range of actions potentially beneficial in cancer. Several of 
these are described under Mechanism of action. Preventative effects based on anti-carcinogenic 
activity via inhibition of TPA, tumour cell-selective anti-proliferative effects,24 anti-angiogenic 
activity, and stimulation of the 5 25 immune system have all been reported. A recent report 
describes that Noni Juice was useful in 26 suppressing tumour growth in a mice model for 
HER2/neu breast cancer in amounts equivalent to human dosages below 90 ml/day. Other 
actions not directly related to cancer have also been reported. 27 

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. In 2002, a 
review of safety of one 1,2,11 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. 
It is unclear whether 2 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. Subsequent analyses did 10 not detect anthraquinones in 
the juice and several studies did not reveal toxicity. A review of the first 4 28-30 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’. In 2008 an EFSA Panel concluded that, on the basis 
of data provided, the use 19 of dried Noni leaves for preparation of infusions was safe.21 
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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://www.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. 
Published with Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License 
www.cam-cancer.org / 6 9 
 
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. 
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34. 
citrifolia aqueous fruit extract and its possible mechanism of action in human and rat models. 
Journal of Ethnopharmacology 2012; 142: 354–361. 
Legal notice The present documentation has been compiled by the CAM-CANCER Project with all due 
care and expert knowledge. However, the CAM-CANCER Project provides no assurance, guarantee or 
promise with regard to the correctness, accuracy, up-to-date status or completeness of the information it 
contains. This information is designed for health professionals. Readers are strongly advised to discuss 
the information with their physician. Accordingly, the CAM-CANCER Project shall not be liable for 
damage or loss caused because anyone relies on the information. 
Please visit the CAM-Cancer website for more information about the project: 
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