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Mona Vie Acai Berry:  
Also Known As:
Acai Palm, Amazon Acai, Assai Palm, Cabbage Palm.
CAUTION: See separate listing for Acacia.
Scientific Name:
Euterpe oleracea, synonym Euterpe badiocarpa.
Family: Arecaceae/Palmae.
People Use This For:
Orally, acai is used for osteoarthritis, hypercholesterolemia, and for improving general health.
As a food, the acai berry is consumed raw and as a juice. The juice is also used commercially as a beverage and in ice cream, jelly, and liquors.
In manufacturing, acai berry is used as a natural food colorant.
Safety:
There is insufficient reliable information available about the safety of acai.
Pregnancy and Lactation: Insufficient reliable information available; avoid using.
Effectiveness:
There is insufficient reliable information available about the effectiveness of acai.
Mechanism of Action:
The applicable part of acai is the fruit or berry. Acai juice is often prepared by macerating the fruit. The juice is viscous and contains about 2.4% protein and 5.9% lipids (13087). The fruit pulp contains about 4% protein and 12% lipids. Other nutrients include calcium, vitamin A, phosphorus, iron, and thiamine.
Acai berry contains several anthocyanins, proanthocyanidins, and other flavonoids. The most abundant are cyanidin-3-glucoside, cyanidin-3-rutinoside, ferulic acid, epicatechin, p-hydroxy benzoic acid, and pelargonidin-3-glucoside. Others include cyanidin 3-sambubioside, peonidin 3-glucoside, and peonidin 3-rutinoside, gallic acid and several derivatives, catechin, and ellagic acid.
The anthocyanins are pigments that give the ripe fruit its purple color. Anthocyanins are also potent antioxidants. Acai fruit pulp has a very high antioxidant capacity. It has more antioxidant content than cranberry, raspberry, blackberry, strawberry, or blueberry.
A specific freeze-dried acai fruit pulp and skin powder (OptiAcai, K2A LLC) has potent in vitro antioxidant activity against superoxide and peroxyl radical which is higher than other fruits. But has only mild antioxidant activity against peroxynitrite and hydroxyl radical. This extract also appears to inhibit cyclooxygenase-1 (COX-1) and COX-2 in vitro.
Acai berry also contains several fatty acids. The most abundant is the monounsaturated fatty acid (MUFA) oleic acid. The second most abundant is the saturated fatty acid palmitic acid. The third most abundant is the polyunsaturated fatty acid (PUFA) linoleic acid.

Adverse Reactions:
None reported.
Interactions with Herbs & Supplements:
None known.
Interactions with Drugs:
None known.
Interactions with Foods:
None known.
Editor's Comments:
Acai is pronounced AH-sigh-EE. Acai is a palm tree widely distributed in the northern area of South America. Acai gained popularity in North America after being promoted by Dr. Nicholas Perricone as a "Superfood for Age-Defying Beauty" on the Oprah Winfrey show.

ACAI
Also Known As:
Acai Palm, Amazon Acai, Assai Palm, Cabbage Palm.
CAUTION: See separate listing for Acacia.
Scientific Name:
Euterpe oleracea, synonym Euterpe badiocarpa.
Family: Arecaceae/Palmae.
People Use This For:
Orally, acai is used for osteoarthritis, hypercholesterolemia, and for improving general health.
As a food, the acai berry is consumed raw and as a juice. The juice is also used commercially as a beverage and in ice cream, jelly, and liquors.
In manufacturing, acai berry is used as a natural food colorant.
Safety:
There is insufficient reliable information available about the safety of acai.
Pregnancy and Lactation: Insufficient reliable information available; avoid using.
Effectiveness:
There is insufficient reliable information available about the effectiveness of acai.
Mechanism of Action:
The applicable part of acai is the fruit or berry. Acai juice is often prepared by macerating the fruit. The juice is viscous and contains about 2.4% protein and 5.9% lipids (13087). The fruit pulp contains about 4% protein and 12% lipids. Other nutrients include calcium, vitamin A, phosphorus, iron, and thiamine (13088, 15050).
Acai berry contains several anthocyanins, proanthocyanidins, and other flavonoids. The most abundant are cyanidin-3-glucoside, cyanidin-3-rutinoside, ferulic acid, epicatechin, p-hydroxy benzoic acid, and pelargonidin-3-glucoside. Others include cyanidin 3-sambubioside, peonidin 3-glucoside, and peonidin 3-rutinoside, gallic acid and several derivatives, catechin, and ellagic acid (13087, 15050).
The anthocyanins are pigments that give the ripe fruit its purple color. Anthocyanins are also potent antioxidants. Acai fruit pulp has a very high antioxidant capacity. It has more antioxidant content than cranberry, raspberry, blackberry, strawberry, or blueberry (13087).
A specific freeze-dried acai fruit pulp and skin powder (OptiAcai, K2A LLC) has potent in vitro antioxidant activity against superoxide and peroxyl radical which is higher than other fruits. But has only mild antioxidant activity against peroxynitrite and hydroxyl radical. This extract also appears to inhibit cyclooxygenase-1 (COX-1) and COX-2 in vitro (15051).
Acai berry also contains several fatty acids. The most abundant is the monounsaturated fatty acid (MUFA) oleic acid. The second most abundant is the saturated fatty acid palmitic acid. The third most abundant is the polyunsaturated fatty acid (PUFA) linoleic acid (15050).
Adverse Reactions:
None reported.
Interactions with Herbs & Supplements:
None known.
Interactions with Drugs:
None known.
Interactions with Foods:
None known.
Interactions with Lab Tests:
MAGNETIC RESONANCE IMAGING (MRI): Consumption of acai fruit might increase T1-weighted MRI signal and decrease T2-weighted MRI signal in imaging studies of the gastrointestinal tract (13088).
Interactions with Diseases or Conditions:
None known.
Dosage/Administration:
No typical dosage.
Editor's Comments:
Acai is pronounced AH-sigh-EE. Acai is a palm tree widely distributed in the northern area of South America. Acai gained popularity in North America after being promoted by Dr. Nicholas Perricone as a "Superfood for Age-Defying Beauty" on the Oprah Winfrey show.
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 Mona Vie Active by Monarch
Ingredients:
Reconstituted Puree from Proprietary Blend: Acai fruit, White Grape, Nashi Pear, Acerola, Aronia, Purple Grape, Cranberry, Passion fruit, Banana, Apricot, Prune, Kiwi, Blueberry, Bilberry, Camu Camu, Wolfberry, Pomegranate, Lychee fruit • Glucosamine • Celadrin brand CMO. Other Ingredients: Citric Acid, Natural Flavor, Sodium Benzoate.

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Effectiveness:
Below is general information about the effectiveness of the known ingredients contained in the brand name product Mona Vie Active . Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product.
ACAI
There is insufficient reliable information available about the effectiveness of acai.

ACEROLA
POSSIBLY EFFECTIVE for Scurvy.
POSSIBLY EFFECTIVE Scurvy. Taking acerola orally might prevent scurvy due to its vitamin C content
There is insufficient reliable information available about the effectiveness of acerola for its other uses.

APRICOT
There is insufficient reliable information available about the effectiveness of apricot.

BILBERRY
POSSIBLY EFFECTIVE for Retinopathy.
POSSIBLY INEFFECTIVE for Night vision.
POSSIBLY EFFECTIVE Retinopathy. Taking bilberry fruit orally seems to improve retinal lesions from diabetic or hypertensive retinopathy. Clinical studies of bilberry's effectiveness have used formulations containing 25% of the bioflavonoid complex anthocyanoside.
POSSIBLY INEFFECTIVE Night vision. There is contradictory evidence about the effectiveness of bilberry for improving night vision; however, much on the research is of poor quality. The most rigorous research suggests that bilberry is not effective for improving night vision.
There is insufficient reliable information available about the effectiveness of bilberry for its other uses.

BLUEBERRY
There is insufficient reliable information available about the effectiveness of blueberry.

CETYLATED FATTY ACIDS (CMO)
POSSIBLY EFFECTIVE Osteoarthritis. Taking a specific blend of cetylated fatty acids (Celadrin, Proprietary Nutritionals, Inc.) 350 mg combined with 50 mg soy lecithin and 75 mg fish oil seems to decrease pain and improve knee range of motion and function in patients with knee osteoarthritis; however, it does not appear to improve morning stiffness. Applying the same specific blend of cetylated fatty acids topically either alone or in combination with menthol also seems to decrease pain and improve functionality in patients with knee osteoarthritis.
There is insufficient reliable information available about the effectiveness of cetylated fatty acids for their other uses.

CRANBERRY
POSSIBLY EFFECTIVE for Urinary odorUrinary tract infections (UTIs).
POSSIBLY INEFFECTIVE for Diabetes.
POSSIBLY EFFECTIVE Urinary odor. Cranberry juice appears to reduce urinary odors when given orally on a regular basis to patients with urinary incontinence.
Urinary tract infections (UTIs). Daily consumption of cranberry juice 10 oz (300 mL) seems to prevent recurrent UTIs in some young and elderly women. A combination product containing cranberry juice plus alpine cranberry (Vaccinium vitis-idaea) also seems to be helpful for prevention. But neither cranberry juice nor cranberry extract seem to prevent UTI in adults or children related to neurogenic bladder.
Tell patients not to try cranberry juice for treating UTIs. There's not enough evidence it works.
Some patients are trying encapsulated forms of concentrated cranberry. So far, there is little reliable evidence that these preparations offer the same benefits as the juice. Tell women interested in trying cranberry for UTI prevention to stick with the juice.
POSSIBLY INEFFECTIVE for Diabetes. Taking cranberry supplements orally doesn't seem to improve fasting serum glucose, glycosylated hemoglobin (HbA1c), fructosamine, triglyceride, high-density lipoprotein (HDL) cholesterol, or low-density lipoprotein (LDL) cholesterol levels in patients with type 2 diabetes.
There is insufficient reliable information available about the effectiveness of cranberry for its other uses.

GLUCOSAMINE HYDROCHLORIDE
INSUFFICIENT RELIABLE EVIDENCE to RATE for Knee painOsteoarthritis.
INSUFFICIENT RELIABLE EVIDENCE to RATE Knee pain. Preliminary evidence suggests that glucosamine hydrochloride 2000 mg daily might provide some subjective improvement in knee pain when taken by people who have regularly occurring knee pain as a result of previous articular injury.
Osteoarthritis. There is conflicting evidence about the effectiveness of glucosamine hydrochloride for osteoarthritis. Evidence supporting glucosamine hydrochloride primarily involves a specific combination product, which contains glucosamine hydrochloride, chondroitin sulfate, and manganese ascorbate (CosaminDS, Nutramax Laboratories). Some evidence suggests that this combination can improve both objective and subjective measures of pain in patients with osteoarthritis of the knee. This combination might be more effective in patients with mild-to-moderate osteoarthritis compared to patients with severe osteoarthritis.
Other research suggests that taking a noncommercial preparation of glucosamine hydrochloride alone or in combination with chondroitin sulfate is not helpful overall for reducing pain in patients with osteoarthritis of the knee; however, surprisingly, the combination did seem to be beneficial for reducing pain in a subgroup of patients with moderate-to-severe osteoarthritis of knee. But the validity of this research is in question due to a very high placebo response rate of about 60%.
In another trial, taking glucosamine hydrochloride in combination with chondroitin for 6 months also does not significantly decrease pain or physical function in older adults with osteoarthritis.
Additional evidence suggests that taking glucosamine hydrochloride alone might reduce some subjective assessments of pain, but does not seem to reduce objective measures on the WOMAC pain scale.
Significantly more research has been done using the glucosamine sulfate formulation compared to glucosamine hydrochloride. There is some debate about whether glucosamine sulfate is more effective than glucosamine hydrochloride. One head-to-head clinical study comparing the sulfate and hydrochloride salts of glucosamine showed no difference between the two forms of glucosamine. However, the study may not be a reliable comparison. The study lasted only 4 weeks and did not use a placebo control. Also, the glucosamine salts were dosed 3 times daily rather than once daily, the regimen which has been most commonly studied for glucosamine sulfate. Whether longer duration of treatment or once daily dosing would show differences between the salts is unknown.
More evidence is needed to rate glucosamine hydrochloride for these uses.

GLUCOSAMINE SULFATE LIKELY EFFECTIVE for Osteoarthritis.
POSSIBLY EFFECTIVE for Temporomandibular joint (TMJ) arthritis.
LIKELY EFFECTIVE Osteoarthritis. Taking glucosamine sulfate orally significantly improves symptoms of pain and functionality in patients with osteoarthritis of the knee in studies lasting up to 3 years. Glucosamine sulfate seems to decrease pain scores by about 28% to 41% and improve functionality scores by 21% to 46%.
Some evidence suggests that glucosamine sulfate is comparable to the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen and piroxicam (Feldene) for symptom relief; however, NSAIDs appear to relieve symptoms within 2 weeks compared to 4-8 weeks with glucosamine sulfate. Other research suggests glucosamine sulfate 1500 mg daily might be more effective than acetaminophen 1 gram 3 times daily.
Glucosamine might have disease-modifying activity and slow joint degeneration in patients with osteoarthritis. Patients taking glucosamine for up to 3 years seem to have significantly less knee joint degeneration, less joint space narrowing, and significant symptom improvement when compared with placebo. A meta-analysis suggests that glucosamine sulfate might reduce the risk of osteoarthritis progression by up to 54%.
Although glucosamine sulfate appears to decrease pain and improve functionality, it might not prevent disease flare-ups. Patients are still likely to need a rapid acting analgesic for flare-ups.
Most studies have evaluated glucosamine sulfate only for osteoarthritis of the knee; however, some evidence suggests that it also might help osteoarthritis of the hip and osteoarthritis of the lumbar spine.
Intramuscular glucosamine sulfate also seems to help. When given twice per week for 6 weeks, it reduces the severity of symptoms of knee osteoarthritis in patients with mild to moderately severe disease (radiological stage I-III) compared to placebo.
Not all research has been positive. Glucosamine sulfate might not be very effective for more severe, long-standing osteoarthritis; and osteoarthritis in older and heavier patients.
Despite some negative findings, when the results from all studies are pooled, glucosamine sulfate still seems to significantly decrease pain and improve joint function. When findings from subgroups of studies were pooled, there were some interesting patterns. Studies using the Lequesne index to assess efficacy tend to suggest that glucosamine sulfate is effective; however, studies using the WOMAC scale tend to suggest that that glucosamine sulfate is not effective. Further, studies using a particular glucosamine sulfate product (Dona, Rotta Pharmaceuticals) tend to suggest effectiveness, whereas studies using other formulations tend to suggest ineffectiveness. The reason for these disparate findings is not clear.
There is a report that a topical preparation of glucosamine sulfate in combination with chondroitin sulfate, shark cartilage, and camphor reduces osteoarthritis symptoms. But any symptom relief is most likely due to the counterirritant effect of camphor and not the other ingredients. There's no research showing that glucosamine is absorbed topically. Don't recommend topical glucosamine products.
There is some debate about whether glucosamine sulfate is more effective than glucosamine hydrochloride. One head-to-head clinical study comparing the sulfate and hydrochloride salts of glucosamine showed no difference between the two forms of glucosamine. However, the study may not be a reliable comparison because it lasted only 4 weeks and did not use a placebo control. Also, the glucosamine salts were dosed 3 times daily rather than once daily, the regimen which has been most commonly studied for glucosamine sulfate. Whether longer duration of treatment or once daily dosing would show differences between the salts is unknown.
Glucosamine sulfate is often combined with chondroitin, but it's not known if this combination is any more effective than the individual ingredients.
Most clinical trials have used a specific patented oral formulation of glucosamine sulfate (Dona, Viartril-S, Rotta Pharmaceuticals, Italy).
POSSIBLY EFFECTIVE Temporomandibular joint (TMJ) arthritis. Taking glucosamine sulfate orally appears to be at least as effective as analgesic doses of ibuprofen for relieving pain and improving TMJ function such as chewing, yawning, talking, and laughing. In some patients pain relief persists for up to 90 days after glucosamine sulfate is discontinued.
There is insufficient reliable information available about the effectiveness of glucosamine sulfate for its other uses.

GRAPE
POSSIBLY EFFECTIVE for Chronic venous insufficiencyOcular stress.
POSSIBLY INEFFECTIVE for Allergic rhinitis (hayfever).
INSUFFICIENT RELIABLE EVIDENCE to RATE for Cardiovascular disease Hypertension Night vision.
POSSIBLY EFFECTIVE Chronic venous insufficiency. Taking grape seed extract or its proanthocyanidin constituents orally seems to reduce subjective symptoms of chronic venous insufficiency and improve venous tone. Additionally, in one clinical trial, a specific grape leaf extract, known as red vine leaf extract (AS 195, Antistax, Boehringer Ingelheim), was given orally to patients with stage I and stage II chronic venous insufficiency. Leg edema significantly decreased after 6 weeks of treatment compared to placebo. Doses of 360 mg and 720 mg daily were both effective, but the higher dose produced a slightly greater effect. Patients also reported significant decreases in subjective complaints such as tired or heavy legs, tension, and tingling and pain after 12 weeks of treatment.
Ocular stress. Taking grape seed extract containing proanthocyanidin constituents orally might help decrease ocular stress from glare.
POSSIBLY INEFFECTIVE Allergic rhinitis (hayfever). Grape seed extract taken for 8 weeks before ragweed pollen season doesn't seem to decrease seasonal allergic rhinitis symptoms or antihistamine usage.
INSUFFICIENT RELIABLE EVIDENCE to RATE Cardiovascular disease. There is preliminary evidence that consumption of purple grape products, such as purple grape juice and red wine, might improve endothelium-dependent vasodilation, prevent LDL oxidation, and suppress platelet-mediated thrombosis. Theoretically, chronic ingestion of these products might reduce the risk of cardiovascular disease.
Hypertension. Preliminary evidence suggests that grape seed polyphenols 1000 mg/day does not have a significant effect on blood pressure in hypertensive patients.
Night vision. Preliminary research suggests grape seed extract containing proanthocyanidins might also be beneficial for improving night vision.
More evidence is needed to rate grape for these uses.

KIWI
INSUFFICIENT RELIABLE EVIDENCE to RATE Asthma. There is some evidence that consumption of vitamin C-rich citrus fruits, including kiwi and others, might improve lung function in people with asthma. Intake of citrus fruits 1-2 times per week has produced this benefit in some studies (6049,6055,6056). However, other studies have not found this benefit. More evidence is needed to rate the kiwi for this use.

LYCIUM (Wolfberry)
There is insufficient reliable information available about the effectiveness of lycium.

N-ACETYL GLUCOSAMINE
INSUFFICIENT RELIABLE EVIDENCE to RATE Inflammatory bowel disease (IBD). There is preliminary evidence that oral or rectal N-acetyl glucosamine might decrease symptoms of IBD in children with Crohn's disease or ulcerative colitis). More evidence is needed to rate N-acetyl glucosamine for this use.
Read more about N-ACETYL GLUCOSAMINE
PEAR
There is insufficient reliable information available about the effectiveness of pear.

POMEGRANATE
POSSIBLY INEFFECTIVE for Chronic obstructive pulmonary disease (COPD).

INSUFFICIENT RELIABLE EVIDENCE to RATE for Atherosclerosis Coronary heart disease Hyperlipidemia Hypertension Periodontitis Prostate Cancer Stomatitis.
 
Safety and Effectiveness Rating
Safety

For each natural medicine monograph in the Database you get an evidence-based Safety Rating. These are PRACTICAL ratings that are STANDARDIZED throughout the Natural Medicines Comprehensive Database.

You will see that different routes of administration of a product often get different safety ratings. For example, camphor is rated "LIKELY SAFE" when used topically, but it is rated "UNSAFE" when used orally.

Questions often come up about using products during pregnancy or lactation, or in children. If there are safety considerations that apply specifically to children, a special mention in the safety field will address the concern. Every listing also includes a Safety Rating for pregnancy and lactation.

Our team meticulously analyzes the medical literature to assign the Safety Ratings. Each rating is assigned according to specific criteria:
LIKELY SAFE:
This product has a very high level of reliable clinical evidence showing its safe use when used appropriately. Products rated Likely Safe are generally considered appropriate to recommend.

To achieve this Safety Rating a product is supported by all of the following:

* Safety data is available from multiple (2+) randomized clinical trials or meta-analysis or large-scale post-marketing surveillance including several hundred patients (level of evidence = A). Or the product has undergone a safety review consistent with or equivalent to passing a review by the Food and Drug Administration (FDA), Health Canada, or similarly rigorous approval process.
* Studies have a low risk of bias and high level of validity by meeting stringent assessment criteria (quality rating = A).
* Studies adequately measure and report safety and adverse outcomes data and consistently show no significant serious adverse effects without valid evidence to the contrary.

POSSIBLY SAFE:
This product has some clinical evidence showing its safe use when used appropriately; however, the evidence is limited by quantity, quality, or contradictory findings. Products rated "Possibly Safe" appear to be safe, but do not have enough high-quality evidence to recommend for most people.

To achieve this Safety Rating a product is supported by all of the following:

* Safety data is available from one or more randomized clinical trials, meta-analysis (level of evidence = A or B), case series, two or more population based or epidemiological studies (level of evidence = B), or limited post-marketing surveillance data.
* Studies have a low to moderate risk of bias and moderate to high level of validity by meeting or partially meeting assessment criteria (quality rating A or B).
* Studies adequately measure and report safety and adverse outcomes data and show no significant serious adverse effects without substantial evidence to the contrary. Some contrary evidence may exist; however, valid evidence supporting safety outweighs contrary evidence.

POSSIBLY UNSAFE:
This product has some clinical evidence showing safety concerns or significant adverse outcomes; however, the evidence is limited by quantity, quality, or contradictory findings. People should be advised NOT to take products with a "Possibly Unsafe" rating.

To achieve this Safety Rating a product is supported by all of the following:

* Safety data is available from one or more randomized clinical trials, meta-analysis (level of evidence = A or B), two or more population based or epidemiological studies (level of evidence = B), or limited post-marketing surveillance data. Or multiple, reliable case reports show a potential causal relationship between a product and serious adverse outcome.
* Studies have a low to moderate risk of bias and moderate to high level of validity by meeting or partially meeting assessment criteria (quality rating A or B).
* Studies adequately measure and report safety and adverse outcomes data and show significant serious adverse effects without substantial evidence to the contrary. Some contrary evidence may exist; however, valid evidence supporting potential safety concerns outweigh contrary evidence.

LIKELY UNSAFE:
This product has a very high level of reliable clinical evidence showing safety concerns or significant adverse outcomes. People should be discouraged from taking products with a "Likely Unsafe" rating.

To achieve this Safety Rating a product is supported by all of the following:

* Safety data is available from multiple (2+) randomized clinical trials, meta-analysis, or large-scale post-marketing surveillance including several hundred patients to several thousand patients (level of evidence = A).
* Studies have a low risk of bias and high level of validity by meeting stringent assessment criteria (quality rating = A).
* Studies adequately measure and report safety and adverse outcomes data and consistently show significant serious adverse effects without valid evidence to the contrary.

UNSAFE:
This product has a very high level of reliable clinical evidence showing safety concerns or significant adverse outcomes. People should be discouraged from taking products with an Unsafe rating.

To achieve this Safety Rating a product is supported by all of the following:

* Safety data is available from multiple (2+) randomized clinical trials, meta-analysis, or large-scale post-marketing surveillance including several hundred to several thousand patients (level of evidence = A).
* Studies have a low risk of bias and high level of validity by meeting stringent assessment criteria (quality rating = A).
* Studies adequately measure and report safety and adverse outcomes data and consistently show significant serious adverse effects without valid evidence to the contrary.

INSUFFICIENT EVIDENCE:
There is not enough reliable scientific evidence to provide a Safety Rating.
Effectiveness

Effectiveness Ratings are assigned for specific indications. A product might be rated “Possibly Effective” for one condition, but be rated “Likely Ineffective” for another condition, depending on the evidence.

The evidence-based criteria for Effectiveness Ratings is as follows:
EFFECTIVE:
This product has a very high level of reliable clinical evidence supporting its use for a specific indication. Products rated Effective are generally considered appropriate to recommend.

To achieve this Effectiveness Rating a product is supported by all of the following:

* Evidence consistent with or equivalent to passing a review by the Food and Drug Administration (FDA), Health Canada, or similarly rigorous approval process.
* Evidence from multiple (2+) randomized clinical trials or meta-analysis including several hundred to several thousand patients (level of evidence = A).
* Studies have a low risk of bias and high level of validity by meeting stringent assessment criteria (quality rating = A).
* Evidence consistently shows POSITIVE outcomes for a given indication without valid evidence to the contrary.

LIKELY EFFECTIVE:
This product has a very high level of reliable clinical evidence supporting its use for a specific indication. Products rated "Likely Effective" are generally considered appropriate to recommend.

To achieve this Effectiveness Rating a product is supported by all of the following:

* Evidence from multiple (2+) randomized clinical trials or meta-analysis including several hundred patients (level of evidence = A).
* Studies have a low risk of bias and high level of validity by meeting stringent assessment criteria (quality rating = A).
* Evidence consistently shows POSITIVE outcomes for a given indication without significant valid evidence to the contrary.

POSSIBLY EFFECTIVE:
This product has some clinical evidence supporting its use for a specific indication; however, the evidence is limited by quantity, quality, or contradictory findings. Products rated "Possibly Effective" might be beneficial, but do not have enough high-quality evidence to recommend for most people.

To achieve this Effectiveness Rating a product is supported by all of the following:

* One or more randomized clinical trials or meta-analysis (level of evidence = A or B) or two or more population based or epidemiological studies (level of evidence = B).
* Studies have a low to moderate risk of bias and moderate to high level of validity by meeting or partially meeting assessment criteria (quality rating A or B).
* Evidence shows POSITIVE outcomes for a given indication without substantial valid evidence to the contrary. Some contrary evidence may exist; however, valid positive evidence outweighs contrary evidence.

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POSSIBLY INEFFECTIVE:
This product has some clinical evidence showing ineffectiveness for a specific indication; however, the evidence is limited by quantity, quality, or contradictory findings. People should be advised NOT to take products with a "Possibly Ineffective" rating.

To achieve this Effectiveness Rating a product is supported by all of the following:

* One or more randomized clinical trials or meta-analysis (level of evidence = A or B) or two or more population based or epidemiological studies (level of evidence = B).
* Studies have a low to moderate risk of bias and moderate to high level of validity by meeting or partially meeting assessment criteria (quality rating A or B).
* Evidence shows NEGATIVE outcomes for a given indication without substantial valid evidence to the contrary. Some contrary evidence may exist; however, valid positive evidence outweighs contrary evidence.

LIKELY INEFFECTIVE:
This product has a very high level of reliable clinical evidence showing ineffectiveness for its use for a specific indication. People should be discouraged from taking products with a "Likely Ineffective" rating.

To achieve this Effectiveness Rating a product is supported by all of the following:

* Evidence from multiple (2+) randomized clinical trials or meta-analysis including several hundred patients (level of evidence = A).
* Studies have a low risk of bias and high level of validity by meeting stringent assessment criteria (quality rating = A).
* Evidence consistently shows NEGATIVE outcomes for a given indication without significant valid evidence to the contrary.

INEFFECTIVE:
This product has a very high level of reliable clinical evidence showing ineffectiveness for its use for a specific indication. People should be discouraged from taking products with an "Ineffective" rating.

To achieve this Effectiveness Rating a product is supported by all of the following:

* Evidence from multiple (2+) randomized clinical trials or meta-analysis including several hundred to several thousand patients (level of evidence = A).
* Studies have a low risk of bias and high level of validity by meeting stringent assessment criteria (quality rating = A).
* Evidence consistently shows NEGATIVE outcomes for a given indication without valid evidence to the contrary.

INSUFFICIENT EVIDENCE:
There is not enough reliable scientific evidence to provide an Effectiveness Rating.

For more details on our evidence-based approach, see our Editorial Process and Evidence-Based Approach.

It is important to keep in mind that different studies often use different product extracts or formulations. Results from studies using specific product formulations can only be applied to that one formulation of the product and cannot be extrapolated to other extracts or product formulations. In some cases, different study results are found when different product formulas are used.

In the Effectiveness section of each monograph, we identify the SPECIFIC FORMULA OR EXTRACT that was used in the clinical studies. A good example of this is ginkgo. Natural Medicines Comprehensive Database states that the formulations of ginkgo that contain Egb 761 (Tanakan) or LI 1370 (Lichtwer Pharma), consisting of 24-25% flavone glycosides and 6% terpene lactones, are the formulations in the prominent studies that were shown to have beneficial effect. It cannot be inferred from this that other formulations of ginkgo will also have the same effect.

If a specific formulation is not listed, then the study likely didn’t use a well-described product or used a non-commercial product.
 
Reference: http://www.naturaldatabase.com  
Mona Vie Active by Monarch
Ingredients:
Reconstituted Puree from Proprietary Blend: Acai fruit, White Grape, Nashi Pear, Acerola, Aronia, Purple Grape, Cranberry, Passion fruit, Banana, Apricot, Prune, Kiwi, Blueberry, Bilberry, Camu Camu, Wolfberry, Pomegranate, Lychee fruit • Glucosamine • Celadrin brand CMO. Other Ingredients: Citric Acid, Natural Flavor, Sodium Benzoate.
Brand name products often contain multiple ingredients.

Safety

Below is general information about the safety of the known ingredients contained in the brand name product Mona Vie Active . Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product.

ACAI
There is insufficient reliable information available about the safety of acai.
Pregnancy and Lactation: Insufficient reliable information available; avoid using.

ACEROLA
POSSIBLY SAFE when used orally.
PREGNANCY AND LACTATION
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when used orally.
PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.

APRICOT
LIKELY SAFE
when apricot fruit or fruit juice is consumed as food.
PREGNANCY AND LACTATION
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when apricot fruit or fruit juice is consumed as food.
There is insufficient reliable information available about the safety of apricot when used for medicinal purposes.
PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.

BILBERRY
LIKELY SAFE
when the fruit is used in amounts commonly found in foods.
POSSIBLY SAFE
when fruit products are used orally and appropriate for medicinal purposes.
POSSIBLY UNSAFE
when the leaves are used orally in high doses or for prolonged use.
PREGNANCY AND LACTATION
There is insufficient reliable information available about the safety of bilberry fruit used in medicinal amounts during pregnancy and lactation.
LIKELY SAFE ...when the fruit is used in amounts commonly found in foods. Bilberry has Generally Recognized As Safe status (GRAS) for use in foods in the US.
POSSIBLY SAFE ...when fruit products are used orally and appropriate for medicinal purposes. Bilberry fruit powder or extracts have been used in clinical trials.
POSSIBLY UNSAFE ...when the leaves are used orally in high doses or for prolonged use. Death can occur with chronic use of 1.5 g/kg/day.
PREGNANCY AND LACTATION: There is insufficient reliable information available about the safety of bilberry fruit used in medicinal amounts during pregnancy and lactation.

BLUEBERRY
LIKELY SAFE
when used in amounts commonly found in foods There is insufficient reliable information available about the safety of blueberry for medicinal uses.
PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods .
LIKELY SAFE ...when used in amounts commonly found in foods.
There is insufficient reliable information available about the safety of blueberry for medicinal uses.
PREGNANCY AND LACTATION: LIKELY SAFE ...when used orally in amounts commonly found in foods (13533). There is insufficient reliable information available about the safety of blueberry for medicinal use; avoid using.

CETYLATED FATTY ACIDS (CMO)
POSSIBLY SAFE
when used orally or topically and appropriately.
PREGNANCY AND LACTATION
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when used orally or topically and appropriately. A blend of cetylated fatty acids (Celadrin, Proprietary Nutritionals, Inc.) has been used safely when taken orally for 68 days. A topical cream containing a cetylated fatty acid blend (Celadrin, Proprietary Nutritionals, Inc.) has also been safely used when applied twice daily for up to 30 days.
PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.
Read more about CETYLATED FATTY ACIDS (CMO)
CRANBERRY
LIKELY SAFE
when used orally and appropriately.
CHILDREN: LIKELY SAFE
when used orally and appropriately.
PREGNANCY AND LACTATION
There is insufficient reliable information available about the safety of cranberry when used therapeutically during pregnancy or lactation; avoid using.
LIKELY SAFE ...when used orally and appropriately.
CHILDREN: LIKELY SAFE ...when used orally and appropriately.
PREGNANCY AND LACTATION: There is insufficient reliable information available about the safety of cranberry when used therapeutically during pregnancy or lactation; avoid using.

GLUCOSAMINE HYDROCHLORIDE
POSSIBLY SAFE
when used orally and appropriately, short-term. There is insufficient reliable information available about the safety of long-term use of glucosamine hydrochloride.
PREGNANCY AND LACTATION
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when used orally and appropriately, short-term. Glucosamine hydrochloride has been used safely in studies lasting up to 24 weeks.
There is insufficient reliable information available about the safety of long-term use of glucosamine hydrochloride.
PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.

GLUCOSAMINE SULFATE
LIKELY SAFE
when used orally and appropriately.
POSSIBLY SAFE
when used intramuscularly and appropriately, short-term.
PREGNANCY AND LACTATION
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used orally and appropriately. Glucosamine has been used safely in multiple clinical trials lasting from 4 weeks to 3 years.
POSSIBLY SAFE ...when used intramuscularly and appropriately, short-term. Intramuscular glucosamine seems to be well tolerated when given twice weekly for up to six weeks. ...when used topically and appropriately, short term. Glucosamine sulfate in combination with chondroitin sulfate, shark cartilage, and camphor appears to be safe when applied topically on an as-needed basis for up to eight weeks.
PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.

GRAPE
LIKELY SAFE
when used orally in amounts commonly found in foods.
POSSIBLY SAFE
when used orally and appropriately in medicinal amounts.
PREGNANCY AND LACTATION
There is insufficient reliable information available about the safety of medicinal amounts of grape during pregnancy and breast-feeding; avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Grapes and grape skin extracts have Generally Recognized As Safe status (GRAS) for use in foods in the US.
POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts. Grape seed extracts have been safely used for up to 8 weeks in clinical studies. Grape leaf extract has been safely used for up to 12 weeks in a clinical study.
PREGNANCY AND LACTATION: There is insufficient reliable information available about the safety of medicinal amounts of grape during pregnancy and breast-feeding; avoid using.

KIWI
LIKELY SAFE
when used in food amounts.
PREGNANCY AND LACTATION: LIKELY SAFE
when used in food amounts .
LIKELY SAFE ...when used in food amounts.
PREGNANCY AND LACTATION: LIKELY SAFE ...when used in food amounts.

LYCIUM (Wolfberry)
POSSIBLY SAFE
when used orally and appropriately .
PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally.
POSSIBLY SAFE ...when used orally and appropriately.
PREGNANCY AND LACTATION: LIKELY UNSAFE ...when used orally. Lycium contains betaine, which is an emmenagogue and abortifacient; avoid using.

N-ACETYL GLUCOSAMINE
There is insufficient reliable information available about the safety of N-acetyl glucosamine.
Pregnancy and Lactation: Insufficient reliable information available; avoid using.

PEAR
LIKELY SAFE
when used orally There is insufficient reliable information available about the safety of pear fruit for its other uses.
PREGNANCY AND LACTATION: LIKELY SAFE
when consumed in amounts commonly found in foods .
LIKELY SAFE ...when used orally.
There is insufficient reliable information available about the safety of pear fruit for its other uses.
PREGNANCY AND LACTATION: LIKELY SAFE ...when consumed in amounts commonly found in foods.

POMEGRANATE
LIKELY SAFE
when the fruit juice is used orally and appropriately.
POSSIBLY SAFE
when pomegranate extract is used topically on oral mucosa.
POSSIBLY UNSAFE
when the root and stem are used orally in large amounts.

PREGNANCY AND LACTATION: POSSIBLY SAFE
when the fruit or fruit juice is consumed orally and appropriately .
 
Interactions with Drugs:

Definitions:
Major = Do not use combination; contraindicated; strongly discourage patients from using this combination; a serious adverse outcome could occur.

Moderate = Use cautiously or avoid combination; warn patients that a significant interaction or adverse outcome could occur.

Minor = Be aware that there is a chance of an interaction; advise patients to watch for warning signs of a potential interaction.

Likelihood of Occurrence

Likely = Clinical research indicates that this interaction is likely to occur in most patients.

Probable = Clinical research or pharmacokinetic studies in humans suggests that this interaction will occur in a significant portion of patients.

Possible = Clinical research, pharmacokinetic data in humans or animals, or in vitro research suggest that this might occur in some patients.
Unlikely = Clinical research, pharmacokinetic data in humans or animals, or in vitro research suggest that this interaction can occur, but is not likely to occur in many patients.

Severity

High = Life threatening or severe impairment possible

Moderate = Moderate impairment or significant discomfort possible

Mild = Mild impairment or mild discomfort possible
Insignificant = Drug levels may be affected, but a clinically significant interaction is not likely.

Ingredient:
ACAI
None known.

ACEROLA
ESTROGENS <<interacts with>> ACEROLA
Interaction Rating = Minor Be watchful with this combination
Severity = Mild • Occurrence = Possible • Level of Evidence = D
FLUPHENAZINE (Prolixin) <<interacts with>> ACEROLA
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
WARFARIN (Coumadin) <<interacts with>> ACEROLA
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
ESTROGENS <<interacts with>> ACEROLA
Interaction Rating = Minor Be watchful with this combination
Severity = Mild • Occurrence = Possible • Level of Evidence = D
Concomitant use of estrogens with acerola might increase absorption and therapeutic effects due to vitamin C content (129,130).
FLUPHENAZINE (Prolixin) <<interacts with>> ACEROLA
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
Concomitant use with acerola decreases blood levels due to vitamin C content (15).
WARFARIN (Coumadin) <<interacts with>> ACEROLA
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
Concomitant use with acerola can reduce anticoagulant activity of warfarin due to its vitamin C content (506).

APRICOT
None known.

BILBERRY
ANTIDIABETES DRUGS <<interacts with>> BILBERRY
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
ANTIDIABETES DRUGS <<interacts with>> BILBERRY
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
Theoretically, concomitant use of bilberry leaf might require dosing adjustment of anti-diabetes drugs. Preliminary evidence suggests that bilberry leaf extract might have blood glucose lowering activity; monitor closely.

BLUEBERRY
ANTIDIABETES DRUGS <<interacts with>> BLUEBERRY
Interaction Rating = Minor Be watchful with this combination
Severity = Moderate • Occurrence = Unlikely • Level of Evidence = D
ANTIDIABETES DRUGS <<interacts with>> BLUEBERRY
Interaction Rating = Minor Be watchful with this combination
Severity = Moderate • Occurrence = Unlikely • Level of Evidence = D
Theoretically, blueberry leaf might lower blood glucose (909); however, this effect has not yet been reported in humans. Until more is known, monitor blood glucose levels more closely in patients with diabetes who are taking blueberry. Dose adjustments may be necessary in patients taking diabetes medications.

CETYLATED FATTY ACIDS (CMO)
None known.
Read more about CETYLATED FATTY ACIDS (CMO)
CRANBERRY
CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES <<interacts with>> CRANBERRY
Interaction Rating = Minor Be watchful with this combination
Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B
WARFARIN (Coumadin) <<interacts with>> CRANBERRY
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Unlikely • Level of Evidence = B
CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES <<interacts with>> CRANBERRY
Interaction Rating = Minor Be watchful with this combination
Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B
There is contradictory evidence about the effect of cranberry on cytochrome P450 2C9 (CYP2C9) enzymes. Preliminary evidence suggests that flavonoids in cranberry inhibits CYP2C9 enzymes in vitro. However, clinical research shows that cranberry juice does not significantly affect flurbiprofen (Ansaid) plasma levels, metabolism, or elimination. Drinking cranberry juice 250 mL daily for 7 days in stable warfarin patients also does not significantly increase the anticoagulant activity of warfarin (15374). Both flurbiprofen and warfarin are CYP2C9 substrates. Based on this clinical research, this potential interaction seems unlikely to occur.
Some drugs metabolized by CYP2C9 include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.
WARFARIN (Coumadin) <<interacts with>> CRANBERRY
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Unlikely • Level of Evidence = B
There is contradictory evidence about the effect of drinking cranberry juice on warfarin. Case reports have linked cranberry juice consumption to increases in the international normalized ratio (INR) in patients taking warfarin, resulting in severe spontaneous bleeding and excessive post-surgical bleeding. However, more reliable clinical research shows that drinking cranberry juice 250 mL daily for 7 days in stable warfarin patients does not significantly increase INR.
Researchers speculated that flavonoids in cranberry might inhibit the cytochrome P450 2C9 (CYP2C9) isoenzyme, which could reduce the metabolism of warfarin and increase the anticoagulant effect. However, contradictory pharmacokinetic research shows that drinking cranberry juice 240 mL daily or 600 mL daily does not significantly affect CYP2C9 in humans.
Another theoretical mechanism proposed for this interaction is that cranberry juice has an anti-platelet effect due to the salicylic acid contained in cranberries. Many vegetables, fruits, and berries, including cranberries contain a high concentration of salicylic acid. In people with a high intake of food from plant sources, serum salicylate levels are about the same as those in patients taking aspirin 75 mg daily. Cranberry juice contains about 7 mg salicylic acid per liter. Two weeks of ingesting 750 mL of cranberry juice per day increases serum salicylate levels.
Based on reliable clinical and pharmacokinetic research, this potential interaction appears unlikely to occur; however, patients on warfarin should be advised to be cautious when any significant dietary change is made, including adding or discontinuing cranberry juice from the diet.

GLUCOSAMINE HYDROCHLORIDE
ACETAMINOPHEN (Tylenol, others) <<interacts with>> GLUCOSAMINE HYDROCHLORIDE
Interaction Rating = Minor Be watchful with this combination
Severity = Mild • Occurrence = Possible • Level of Evidence = B
ANTIDIABETES DRUGS <<interacts with>> GLUCOSAMINE HYDROCHLORIDE
Interaction Rating = Minor Be watchful with this combination
Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B
ANTIMITOTIC CHEMOTHERAPY <<interacts with>> GLUCOSAMINE HYDROCHLORIDE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
WARFARIN (Coumadin) <<interacts with>> GLUCOSAMINE HYDROCHLORIDE
Interaction Rating = Major Do not use this combination
Severity = High • Occurrence = Probable • Level of Evidence = D
ACETAMINOPHEN (Tylenol, others) <<interacts with>> GLUCOSAMINE HYDROCHLORIDE
Interaction Rating = Minor Be watchful with this combination
Severity = Mild • Occurrence = Possible • Level of Evidence = B
Anecdotal reports suggest that adding glucosamine to an acetaminophen regimen might decrease pain control in patients with osteoarthritis (14806). However, the mechanism of this potential interaction is not clear.
ANTIDIABETES DRUGS <<interacts with>> GLUCOSAMINE HYDROCHLORIDE
Interaction Rating = Minor Be watchful with this combination
Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B
Preliminary research has suggested that glucosamine might increase insulin resistance or decrease insulin production. This has raised concerns that taking glucosamine might worsen diabetes and decrease the effectiveness of diabetes drugs. However, clinical research suggests that glucosamine does not have adverse effects on blood glucose or hemoglobin A1C (HbA1c) in healthy, obese, or type 2 diabetes patients. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.
ANTIMITOTIC CHEMOTHERAPY <<interacts with>> GLUCOSAMINE HYDROCHLORIDE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
Theoretically, glucosamine might induce resistance to etoposide (VP16, VePesid) and doxorubicin (Adriamycin) by reducing the drugs' inhibition of topoisomerase II, an enzyme required for DNA replication in tumor cells.
WARFARIN (Coumadin) <<interacts with>> GLUCOSAMINE HYDROCHLORIDE
Interaction Rating = Major Do not use this combination
Severity = High • Occurrence = Probable • Level of Evidence = D
Taking glucosamine alone or in combination with chondroitin might increase the anticoagulant effects of warfarin (Coumadin) and increase the risk of bruising and bleeding. In one case, a 71 year-old man taking warfarin had his international normalized ratio (INR) increase from 2.3 to 4.7 after increasing the dose of a glucosamine-chondroitin supplement from glucosamine hydrochloride 500 mg and chondroitin sulfate 400 mg to glucosamine hydrochloride 1500 mg and chondroitin sulfate 1200 mg daily. In another case, very high-dose glucosamine (3000 mg/day) plus high-dose chondroitin sulfate (2400 mg/day) combined with warfarin resulted in a significantly increased INR. Additionally, 20 voluntary case reports to the U.S. Food & Drug Administration (FDA) have linked glucosamine plus chondroitin with increased INR, bruising, and bleeding events in patients who were also taking warfarin. There have also been 20 additional case reports to the World Health Organization (WHO) that link glucosamine alone to increased INR in patients taking warfarin.
Chondroitin is a small component of a heparinoid and might have weak anticoagulant activity. Glucosamine is also a small component of heparin, but is not thought to have anticoagulant activity; however, preliminary animal model research suggests that it might have antiplatelet activity.
Patients taking warfarin should be advised to avoid or use glucosamine cautiously.

GLUCOSAMINE SULFATE
ACETAMINOPHEN (Tylenol, others) <<interacts with>> GLUCOSAMINE SULFATE
Interaction Rating = Minor Be watchful with this combination
Severity = Insignificant • Occurrence = Possible • Level of Evidence = B
ANTIDIABETES DRUGS <<interacts with>> GLUCOSAMINE SULFATE
Interaction Rating = Minor Be watchful with this combination
Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B
ANTIMITOTIC CHEMOTHERAPY <<interacts with>> GLUCOSAMINE SULFATE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
WARFARIN (Coumadin) <<interacts with>> GLUCOSAMINE SULFATE
Interaction Rating = Major Do not use this combination
Severity = High • Occurrence = Probable • Level of Evidence = D
ACETAMINOPHEN (Tylenol, others) <<interacts with>> GLUCOSAMINE SULFATE
Interaction Rating = Minor Be watchful with this combination
Severity = Insignificant • Occurrence = Possible • Level of Evidence = B
Anecdotal reports suggest that adding glucosamine to an acetaminophen regimen might decrease pain control in patients with osteoarthritis. Some research suggests that the sulfate portion of glucosamine sulfate might contribute to its effect in osteoarthritis. Since acetaminophen metabolism requires sulfur and reduces serum sulfate concentrations, acetaminophen could theoretically interfere with the action of glucosamine sulfate. Conversely, the administration of sulfate could theoretically decrease the effectiveness of acetaminophen in sulfate-deficient people by increasing its clearance.
ANTIDIABETES DRUGS <<interacts with>> GLUCOSAMINE SULFATE
Interaction Rating = Minor Be watchful with this combination
Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B
Preliminary research has suggested that glucosamine might increase insulin resistance or decrease insulin production. This has raised concerns that taking glucosamine might worsen diabetes and decrease the effectiveness of diabetes drugs. However, clinical research suggests that glucosamine does not have adverse effects on blood glucose or hemoglobin A1C (HbA1c) in healthy, obese, or type 2 diabetes patients. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.
ANTIMITOTIC CHEMOTHERAPY <<interacts with>> GLUCOSAMINE SULFATE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
Theoretically, glucosamine might induce resistance to etoposide (VP16, VePesid), teniposide (VM26), and doxorubicin (Adriamycin). Glucosamine sulfate might contribute to the development of chemotherapeutic resistance by reducing the drugs' inhibition of topoisomerase II, an enzyme required for DNA replication in tumor cells.
WARFARIN (Coumadin) <<interacts with>> GLUCOSAMINE SULFATE
Interaction Rating = Major Do not use this combination
Severity = High • Occurrence = Probable • Level of Evidence = D
Taking glucosamine alone or in combination with chondroitin might increase the anticoagulant effects of warfarin (Coumadin) and increase the risk of bruising and bleeding. In one case, a 71 year-old man taking warfarin had his international normalized ratio (INR) increase from 2.3 to 4.7 after increasing the dose of a glucosamine-chondroitin supplement from glucosamine hydrochloride 500 mg and chondroitin sulfate 400 mg to glucosamine hydrochloride 1500 mg and chondroitin sulfate 1200 mg daily. In another case, very high-dose glucosamine (3000 mg/day) plus high-dose chondroitin sulfate (2400 mg/day) combined with warfarin resulted in a significantly increased INR. Additionally, 20 voluntary case reports to the U.S. Food & Drug Administration (FDA) have linked glucosamine plus chondroitin with increased INR, bruising, and bleeding events in patients who were also taking warfarin. There have also been 20 additional case reports to the World Health Organization (WHO) that link glucosamine alone to increased INR in patients taking warfarin.
Chondroitin is a small component of a heparinoid and might have weak anticoagulant activity. Glucosamine is also a small component of heparin, but is not thought to have anticoagulant activity; however, preliminary animal model research suggests that it might have antiplatelet activity.
Patients taking warfarin should be advised to avoid or use glucosamine cautiously.

GRAPE
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES <<interacts with>> GRAPE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = B
PHENACETIN <<interacts with>> GRAPE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = B
WARFARIN (Coumadin) <<interacts with>> GRAPE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Unlikely • Level of Evidence = D
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES <<interacts with>> GRAPE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = B
Grape juice is thought to induce cytochrome P450 1A2 (CYP1A2) metabolism and may decrease plasma levels of CYP1A2 substrates. Drugs metabolized by CYP1A2 include amitriptyline (Elavil), caffeine, chlordiazepoxide (Librium), clomipramine (Anafranil), clopidogrel (Plavix), clozapine (Clozaril), cyclobenzaprine (Flexaril), desipramine (Norpramin), diazepam (Valium), estradiol (Estrace, others), flutamide (Eulexin), fluvoxamine (Luvox), grepafloxacin (Raxar), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), mirtazapine (Remeron), naproxen (Naprosyn), nortriptyline (Pamelor), olanzapine (Zyprexa), ondansetron (Zofran), propafenone (Rythmol), propranolol (Inderal), riluzole (Rilutek), ropinirole (Requip), ropivacaine (Naropin), tacrine (Cognex), theophylline (Theo-Dur, others), verapamil (Calan, Covera-HS, others), warfarin (Coumadin), and zileuton (Zyflo).
PHENACETIN <<interacts with>> GRAPE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = B
Grape juice decreases phenacetin, but not acetaminophen plasma levels. It may decrease levels by inducing cytochrome P450 1A2 (CYP1A2) metabolism.
WARFARIN (Coumadin) <<interacts with>> GRAPE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Unlikely • Level of Evidence = D
Theoretically, due to the tocopherol content of grape seed oil, concomitant use with warfarin might increase warfarin's effects and the risk of bleeding; use with caution.

KIWI
None known.

LYCIUM (Wolfberry)
ANTIDIABETES DRUGS <<interacts with>> LYCIUM (Wolfberry)
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
ANTIHYPERTENSIVE DRUGS <<interacts with>> LYCIUM (Wolfberry)
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES <<interacts with>> LYCIUM (Wolfberry)
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
WARFARIN (Coumadin) <<interacts with>> LYCIUM (Wolfberry)
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
ANTIDIABETES DRUGS <<interacts with>> LYCIUM (Wolfberry)
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
Lycium root bark might have hypoglycemic effects. Theoretically, concomitant use with drugs used for diabetes might enhance blood glucose lowering effects and increase the risk of hypoglycemia. Monitor blood glucose levels closely. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (Diabeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.
ANTIHYPERTENSIVE DRUGS <<interacts with>> LYCIUM (Wolfberry)
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
Lycium root bark might have hypotensive effects. Theoretically, concomitant use with antihypertensives might have additive effects on blood pressure and increase the risk of hypotension.
CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES <<interacts with>> LYCIUM (Wolfberry)
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
There is some evidence that lycium can inhibit CYP2C9. Watch for an increase in the levels of drugs metabolized by CYP2C9 in patients taking lycium. Some drugs metabolized by CYP2C9 include amitriptyline (Elavil), diazepam (Valium), estradiol (Estrace), tacrine (Cognex), verapamil (Calan), warfarin (Coumadin), zileuton (Zyflo), and others.
WARFARIN (Coumadin) <<interacts with>> LYCIUM (Wolfberry)
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
There is some evidence that lycium can increase the effects of warfarin and possibly increase the risk of bleeding. International normalized ratio (INR) can increase in patients stabilized on warfarin who begin taking lycium. Researchers think that lycium inhibits cytochrome P450 2C9 (CYP2C9) metabolism of warfarin and increases warfarin levels. Use with caution. Warfarin dose adjustments may be necessary.

N-ACETYL GLUCOSAMINE
ACETAMINOPHEN (Tylenol, others) <<interacts with>> N-ACETYL GLUCOSAMINE
Interaction Rating = Minor Be watchful with this combination
Severity = Mild • Occurrence = Possible • Level of Evidence = B
ANTIDIABETES DRUGS <<interacts with>> N-ACETYL GLUCOSAMINE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = B
CHEMOTHERAPY <<interacts with>> N-ACETYL GLUCOSAMINE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
WARFARIN (Coumadin) <<interacts with>> N-ACETYL GLUCOSAMINE
Interaction Rating = Major Do not use this combination
Severity = High • Occurrence = Probable • Level of Evidence = D
ACETAMINOPHEN (Tylenol, others) <<interacts with>> N-ACETYL GLUCOSAMINE
Interaction Rating = Minor Be watchful with this combination
Severity = Mild • Occurrence = Possible • Level of Evidence = B
Anecdotal reports suggest that adding glucosamine to an acetaminophen regimen might decrease pain control in patients with osteoarthritis. However, the mechanism of this potential interaction is not clear.
ANTIDIABETES DRUGS <<interacts with>> N-ACETYL GLUCOSAMINE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = B
Preliminary research has suggested that glucosamine might increase insulin resistance or decrease insulin production. This has raised concerns that taking glucosamine might worsen diabetes and decrease the effectiveness of diabetes drugs. However, clinical research suggests that glucosamine does not have adverse effects on blood glucose or hemoglobin A1c (HbA1c) in healthy, obese, or type 2 diabetes patients. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.
CHEMOTHERAPY <<interacts with>> N-ACETYL GLUCOSAMINE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
Theoretically, glucosamine might induce resistance to etoposide (VP16, VePesid) and doxorubicin (Adriamycin) by reducing the drugs' inhibition of topoisomerase II, an enzyme required for DNA replication in tumor cells.
WARFARIN (Coumadin) <<interacts with>> N-ACETYL GLUCOSAMINE
Interaction Rating = Major Do not use this combination
Severity = High • Occurrence = Probable • Level of Evidence = D
Taking glucosamine alone or in combination with chondroitin might increase the anticoagulant effects of warfarin (Coumadin) and increase the risk of bruising and bleeding. In one case, a 71 year-old man taking warfarin had his international normalized ratio (INR) increase from 2.3 to 4.7 after increasing the dose of a glucosamine-chondroitin supplement from glucosamine hydrochloride 500 mg and chondroitin sulfate 400 mg to glucosamine hydrochloride 1500 mg and chondroitin sulfate 1200 mg daily. In another case, very high-dose glucosamine (3000 mg/day) plus high-dose chondroitin sulfate (2400 mg/day) combined with warfarin resulted in a significantly increased INR. Additionally, 20 voluntary case reports to the U.S. Food & Drug Administration (FDA) have linked glucosamine plus chondroitin with increased INR, bruising, and bleeding events in patients who were also taking warfarin. There have also been 20 additional case reports to the World Health Organization (WHO) that link glucosamine alone to increased INR in patients taking warfarin.
Chondroitin is a small component of a heparinoid and might have weak anticoagulant activity. Glucosamine is also a small component of heparin, but is not thought to have anticoagulant activity; however, preliminary animal model research suggests that it might have antiplatelet activity.
Patients taking warfarin should be advised to avoid or use glucosamine cautiously.

PEAR
None known.

POMEGRANATE
ACE INHIBITORS (ACEIs) <<interacts with>> POMEGRANATE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = B
ANTIHYPERTENSIVE DRUGS <<interacts with>> POMEGRANATE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = B
CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES <<interacts with>> POMEGRANATE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES <<interacts with>> POMEGRANATE
Interaction Rating = Moderate Be cautious with this combination
Severity = Moderate • Occurrence = Possible • Level of Evidence = D
ROSUVASTATIN (Crestor) <<interacts with>> POMEGRANATE
Interaction Rating = Moderate Be cautious with this combination
Severity = High • Occurrence = Possible • Level of Evidence = D
 
Adverse Reactions:

ACAI
None reported.

ACEROLA
Orally, the vitamin C in acerola can cause nausea, abdominal cramps, fatigue, insomnia, and sleepiness. Doses greater than 1 gram might cause diarrhea
Also Known As:
Barbados Cherry, Puerto Rican Cherry, West Indian Cherry.
CAUTION: See separate listings for Cherokee Rosehip, Rose Hip, and Vitamin C.
Scientific Name:
Malpighia glabra; Malpighia punicifolia.
Family: Malpighiaceae.
People Use This For:
Orally, acerola is used to treat or prevent scurvy, colds, heart disease, cancer, pressure sores, retinal hemorrhages, tooth decay, gum infections, atherosclerosis, depression, hay fever, for preventing blood clots, collagen disorders, and to enhance physical endurance.
Safety:
POSSIBLY SAFE ...when used orally.
PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.
Effectiveness:
POSSIBLY EFFECTIVE
Scurvy. Taking acerola orally might prevent scurvy due to its vitamin C content.
There is insufficient reliable information available about the effectiveness of acerola for its other uses.
Mechanism of Action:
The applicable part of acerola is the fruit. Acerola contains 1000-2330 mg of vitamin C per 100 grams. Vitamin C is an essential coenzyme required for normal metabolic function. It is important for collagen formation and tissue repair. Vitamin C is involved in tyrosine metabolism, folic acid conversion, carbohydrate metabolism, synthesis of lipids and proteins, iron metabolism, resistance to infections, and cellular respiration. Vitamin C also acts as an antioxidant. It regenerates and restores oxidized vitamin E. Acerola fruit also contains vitamin A, thiamine, riboflavin, and niacin.

APRICOT
None reported.

BILBERRY
None reported.

BLUEBERRY
None reported.

CETYLATED FATTY
None reported.

CRANBERRY
Orally, cranberry is usually well tolerated. However, in very large doses, for example 3-4 L per day of juice, cranberry can cause gastrointestinal upset and diarrhea. Consuming more than 1 L per day over a prolonged period of time might also increase the risk of uric acid kidney stone formation.
Also Known As:
American Cranberry, Arandano Americano, Arandano Trepador, Cranberry Extract, Cranberry Fruit, Cranberry Fruit Juice, Cranberry Juice, Cranberry Juice Cocktail, Cranberry Juice Concentrate, Cranberry Powder, Cranberry Powdered Extract, European Cranberry, Grosse Moosbeere, Kranbeere, Large Cranberry, Moosebeere, Mossberry, Ronce d'Amerique, Small Cranberry, Trailing Swamp Cranberry, Tsuru-kokemomo.
CAUTION: See separate listings for Alpine Cranberry, Cramp Bark (European Cranberry-Bush), and Uva Ursi (Mountain Cranberry).
Scientific Name:
Vaccinium macrocarpon, synonym Oxycoccus macrocarpos; Vaccinium oxycoccos, synonyms Oxycoccus hagerupii, Oxycoccus microcarpus, Oxycoccus palustris, Oxycoccus quadripetalus, Vaccinium hagerupii, Vaccinium microcarpum, Vaccinium palustre.
Family: Ericaceae.
People Use This For:
Orally, cranberry is used for prevention and treatment of urinary tract infections, neurogenic bladder, as a urinary deodorizer for people with incontinence, prevention of urinary catheter blockage, and to heal skin around urostomy stomas. Cranberry is also used for type 2 diabetes, chronic fatigue syndrome (CFS), scurvy, pleurisy, as a diuretic, antiseptic, antipyretic, and for cancer.
In foods, cranberry fruit is used in fruit juice, jelly, and sauce.
Safety:
LIKELY SAFE ...when used orally and appropriately.
CHILDREN: LIKELY SAFE ...when used orally and appropriately.
PREGNANCY AND LACTATION: There is insufficient reliable information available about the safety of cranberry when used therapeutically during pregnancy or lactation; avoid using.
Effectiveness:
POSSIBLY EFFECTIVE
Urinary odor. Cranberry juice appears to reduce urinary odors when given orally on a regular basis to patients with urinary incontinence.
Urinary tract infections (UTIs). Daily consumption of cranberry juice 10 oz (300 mL) seems to prevent recurrent UTIs in some young and elderly women. A combination product containing cranberry juice plus alpine cranberry (Vaccinium vitis-idaea) also seems to be helpful for prevention. But neither cranberry juice nor cranberry extract seem to prevent UTI in adults or children related to neurogenic bladder.
Tell patients not to try cranberry juice for treating UTIs. There's not enough evidence it works.
Some patients are trying encapsulated forms of concentrated cranberry. So far, there is little reliable evidence that these preparations offer the same benefits as the juice. Tell women interested in trying cranberry for UTI prevention to stick with the juice.
POSSIBLY INEFFECTIVE
Diabetes. Taking cranberry supplements orally doesn't seem to improve fasting serum glucose, glycosylated hemoglobin (HbA1c), fructosamine, triglyceride, high-density lipoprotein (HDL) cholesterol, or low-density lipoprotein (LDL) cholesterol levels in patients with type 2 diabetes.
There is insufficient reliable information available about the effectiveness of cranberry for its other uses.
Mechanism of Action:
The applicable part of the cranberry plant is the fruit. Cranberry contains anthocyanidins, ellagitannins, flavonols such as quercetin and kaempferol, catechins, and phenolic acids. Other constituents include ascorbic acid, beta-carotene, chlorogenic acid, glutathione, and alpha-tocopherol.
Cranberry is acidic, but does not acidify the urine as previously thought. Cranberries contain proanthocyanidins, also known as condensed tannins, and a high-molecular weight compound that has not yet been identified. These constituents seem to interfere with bacterial adherence to the urinary tract epithelial cells. For example, proanthocyanidins seem to be capable of "wrapping" around Escherichia coli (E. coli), which is the cause of most urinary tract infections (UTIs), and preventing it from adhering to the urinary tract wall. It probably also has this effect against other urinary tract pathogens. Cranberry, however, does not seem to have the ability to release bacteria which are already adhered to the urinary tract epithelial cells. Laboratory evidence suggests that fructose in cranberries might also contribute to the anti-infective activity. Cranberry juice has shown antibacterial activity in culture medium against E. coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis. Whether urinary concentrations of the active constituents reach bactericidal levels is currently a topic of research.

Preliminary data suggest that a high molecular weight cranberry constituent might prevent adhesion of plaque bacteria that cause periodontal disease. Cranberry compounds might also prevent adhesion of Helicobacter pylori (H. pylori) in the stomach. Early evidence shows that cranberry juice might increase the antioxidant capacity of plasma. There is also preliminary evidence that the proanthocyanidin fraction of cranberry might have anticarcinogenic activity.

Cranberry, as well as many other fruits and vegetables, contains significant amounts of salicylic acid. Salicylic acid, the active metabolite of aspirin, has anti-inflammatory, antiplatelet, and antitumor effects. Cranberry juice contains about 7 mg of salicylic acid per liter. Drinking three 250 mL servings of cranberry juice daily for two weeks increases serum salicylate levels. It also increases excretion of salicylic and salicyluric acids (a salicylic acid metabolite) in the urine.

There is some preliminary data that suggests cranberry juice might inhibit cytochrome P450 2C9 (CYP2C9) enzymes in vitro. However, preliminary clinical research that suggests cranberry juice does not significantly affect flurbiprofen plasma levels, metabolism, or elimination. Flurbiprofen is a cytochrome P450 2C9 substrate. Additional clinical research shows drinking cranberry juice 250 mL daily for 7 days, in stable warfarin patients, does not significantly increase warfarin anticoagulant activity. Warfarin is also a CYP2C9 substrate. This clinical research suggests that cranberry juice likely does not significantly affect CYP2C9.
Additionally, pharmacokinetic research shows that drinking cranberry juice 200 mL three times daily does not significantly affect the pharmacokinetic profiles of warfarin, tizanidine, or midazolam, which are probes for CYP2C9, CYP1A2, and CYP3A4 respectively. This suggests that cranberry juice does not significantly alter the activity of these enzymes.

GLUCOSAMINE HYDROCHLORIDE
Orally, glucosamine hydrochloride can cause mild gastrointestinal (GI) symptoms such as gas, abdominal bloating, and cramps. Anecdotal reports have associated glucosamine with renal toxicity, but changes in renal function have not been reported in long-term studies.

Orally, glucosamine hydrochloride can cause mild gastrointestinal (GI) symptoms such as gas, abdominal bloating, and cramps. Anecdotal reports have associated glucosamine with renal toxicity, but changes in renal function have not been reported in long-term studies.
Elevated blood glucose levels in patients with diabetes have also been reported. However, taking glucosamine for up to 3 months does not seem to affect hemoglobin A1C or blood glucose levels in healthy or obese people or patients with type 2 diabetes.

There has been concern that glucosamine might increase the risk of metabolic disturbances resulting in increased cholesterol levels and blood pressure. However, glucosamine does not appear to increase the risk of these adverse effects. Taking glucosamine for up to 3 years does not significantly increase blood glucose or lipid levels, or cause any other disturbances in metabolism.
Advise patients to watch for glucosamine plus chondroitin combination products that also contain manganese (e.g., CosaminDS). Remind patients to adhere to product directions. When taken at doses slightly higher than the recommended dose, these products can sometimes supply greater than the tolerable upper limit (UL) for manganese which is 11 mg/day. Ingestion of more than 11 mg/day of manganese might cause significant central nervous system toxicity.

GLUCOSAMINE SULFATE
Orally, glucosamine sulfate can commonly cause mild gastrointestinal (GI) problems including nausea, heartburn, diarrhea, and constipation. Drowsiness, skin reactions, and headache have also been reported. However, adverse effects in clinical studies have generally been comparable to placebo. Glucosamine sulfate 1500 mg per day is tolerated at least as well as the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen 1200 mg per day, and it is better tolerated than piroxicam (Feldene) 20 mg daily.

Anecdotal reports have associated glucosamine with renal toxicity, but changes in renal function have not been reported in long-term studies.
Elevated blood glucose levels in patients with diabetes have also been reported. However, taking glucosamine for up to 3 months does not seem to affect hemoglobin A1C or blood glucose levels in healthy or obese people or patients with type 2 diabetes.
There has been concern that glucosamine might increase the risk of metabolic disturbances resulting in increased cholesterol levels and blood pressure. However, glucosamine does not appear to increase the risk of these adverse effects. Taking glucosamine sulfate for up to 3 years does not significantly increase blood glucose or lipid levels, or cause any other disturbances in metabolism.
There is concern that glucosamine products might cause allergic reactions in people who are sensitive to shellfish. Glucosamine is derived from the exoskeletons of shrimp, lobster, and crabs. But allergic reactions in people with shellfish allergy are caused by IgE antibodies to antigens in the meat of shellfish, not to antigens in the shell. There are no documented reports of allergic reaction to glucosamine in shellfish allergic patients. There is also some evidence that patients with shellfish allergy can safely take glucosamine products.

GRAPE
Orally, grape seed extract is well tolerated. Headache, abdominal pain, sore throat, nausea, and cough have been reported with used of grape seed, but these effects occur at rates similar to placebo.
Excessive consumption of grapes, dried grapes, raisins, or sultanas might cause diarrhea due to laxative effects.
There is one report of an anaphylactic reaction to grape skin extract, which included urticaria and angioedema.
Grape leaves have been reported to cause gastrointestinal discomfort, diarrhea, dyspepsia, dry mouth, and retching. Other adverse effects included infections, headache, and musculoskeletal disorders. One case of leg hematoma following a minor trauma was also reported in a person using grape leaf extract.

KIWI
Orally, eating kiwi fruit or drinking the juice can lead to hypersensitivity reactions of the mouth, including dysphagia, urticaria, and vomiting immediately following ingestion (6).
Topically, use can cause contact urticaria. Kiwi may cause hypersensitivity reactions, which are more common in patients who are allergic to latex.

LYCIUM (Wolfberry)
Orally, the dried root bark has been associated with nausea and vomiting.

N-ACETYL GLUCOSAMINE
Orally, N-acetyl glucosamine might cause mild gastrointestinal (GI) problems, including nausea, heartburn, diarrhea, and constipation; similar to the effects seen with glucosamine sulfate. Drowsiness, skin reactions, and headaches have also been reported. Anecdotal reports have associated glucosamine with renal toxicity, but changes in renal function have not been reported in long-term studies.

Elevated blood glucose levels in patients with diabetes have also been reported. However, taking glucosamine for up to 3 months does not seem to affect hemoglobin A1C or blood glucose levels in healthy or obese people or patients with type 2 diabetes.
There has been concern that glucosamine might increase the risk of metabolic disturbances resulting in increased cholesterol levels and blood pressure. However, glucosamine does not appear to increase the risk of these adverse effects. Taking glucosamine sulfate for up to 3 years does not significantly increase blood glucose or lipid levels, or cause any other disturbances in metabolism.
There is concern that use of N-acetyl glucosamine products derived from marine exoskeletons might cause reactions in people allergic to shellfish, although no reactions have been reported. Until more is known, and because the source of N-acetyl glucosamine products is not listed on product labels, use N-acetyl glucosamine with caution in people with shellfish allergy.

PEAR
None reported.

POMEGRANATE
Orally, pomegranate is generally well tolerated. There are no adverse reactions reported in clinical trials ; however, studies to date have enrolled a relatively small number of patients.
 
Brand Names:
ACAI:
Search Results for: acai 2 Herbal/Supplement matches, 57 Brand matches
Results:
Herbal/Supplements:
ACACIA Also Known As
ACAI
Brand Names:

Acai Brand Name, Ingredients of Brand Name
Acai 1000 mg Brand Name, Ingredients of Brand Name
Acai 500 mg Brand Name, Ingredients of Brand Name
Acai Appeal Brand Name, Ingredients of Brand Name
Acai Berry Extract (4:1) Brand Name, Ingredients of Brand Name
Acai Juice Blend Brand Name, Ingredients of Brand Name
Acai Lite Brand Name, Ingredients of Brand Name
Acai Max Blend Brand Name, Ingredients of Brand Name
Best Acai Brand Name, Ingredients of Brand Name
Brazilian Body Diet & Energy Shot Ingredients of Brand Name
Cardio Burn Ingredients of Brand Name
Cocogevity Ingredients of Brand Name
Earth's Promise, strawberry medley flavor Ingredients of Brand Name
Emerald Laboratories Acai Berry X Brand Name, Ingredients of Brand Name
Emerald Laboratories Acai Berry X Powder Brand Name, Ingredients of Brand Name
Essential Daily Nutrients Ingredients of Brand Name
EXO Ingredients of Brand Name
Forte Ingredients of Brand Name
Frut A Vie Ingredients of Brand Name
Green Defense Ingredients of Brand Name
Greens 4 Health Ingredients of Brand Name
Guaraviton Ingredients of Brand Name
IsaFruits Ingredients of Brand Name
Isotonix Acai Brand Name, Ingredients of Brand Name
Jigsaw Complete Essential Daily Packets Ingredients of Brand Name
Liquid 1st Choice Ingredients of Brand Name
Miracle Reds Ingredients of Brand Name
Mona Vie Ingredients of Brand Name
Mona Vie Active Ingredients of Brand Name
Mona Vie Active Gel Ingredients of Brand Name
MonaVie Ingredients of Brand Name
MonaVie Active Ingredients of Brand Name
MonaVie Active Gel Ingredients of Brand Name
Naturally Acai Xtra Brand Name, Ingredients of Brand Name
New Greens Berry Fusion Ingredients of Brand Name
Ola Acai Brand Name, Ingredients of Brand Name
Orovo Ingredients of Brand Name
Perfect Purples Ingredients of Brand Name
Radical Rainforest Defense Ingredients of Brand Name
Shaman Smoothies, acai berry adventure flavor Brand Name, Ingredients of Brand Name
Spectra Purples Ingredients of Brand Name
Spring Valley Acai Softgels Brand Name, Ingredients of Brand Name
Super Berry Upgrade Ingredients of Brand Name
Super Fruit Ingredients of Brand Name
Super Trio Ingredients of Brand Name
To Go Acai Natural Energy Boost Brand Name, Ingredients of Brand Name
To Go Go Greens Ingredients of Brand Name
Transfer Factor Rio Vida Ingredients of Brand Name
VIBE Ingredients of Brand Name
VitaTropic Ingredients of Brand Name
YourLife Acai 500 mg Brand Name, Ingredients of Brand Name
YourLife LiquiMax Complete Nutrition Multivitamin Formula Ingredients of Brand Name

Also Known As:
Acai Palm, Amazon Acai, Assai Palm, Cabbage Palm.
CAUTION: See separate listing for Acacia.
Scientific Name:
Euterpe oleracea, synonym Euterpe badiocarpa.
Family: Arecaceae/Palmae.
People Use This For:
Orally, acai is used for osteoarthritis, hypercholesterolemia, and for improving general health.
As a food, the acai berry is consumed raw and as a juice. The juice is also used commercially as a beverage and in ice cream, jelly, and liquors.
In manufacturing, acai berry is used as a natural food colorant.
Safety:
There is insufficient reliable information available about the safety of acai.
Pregnancy and Lactation: Insufficient reliable information available; avoid using.
Effectiveness:
There is insufficient reliable information available about the effectiveness of acai.
Mechanism of Action:
The applicable part of acai is the fruit or berry. Acai juice is often prepared by macerating the fruit. The juice is viscous and contains about 2.4% protein and 5.9% lipids. The fruit pulp contains about 4% protein and 12% lipids. Other nutrients include calcium, vitamin A, phosphorus, iron, and thiamine.

Acai berry contains several anthocyanins, proanthocyanidins, and other flavonoids. The most abundant are cyanidin-3-glucoside, cyanidin-3-rutinoside, ferulic acid, epicatechin, p-hydroxy benzoic acid, and pelargonidin-3-glucoside. Others include cyanidin 3-sambubioside, peonidin 3-glucoside, and peonidin 3-rutinoside, gallic acid and several derivatives, catechin, and ellagic acid.
The anthocyanins are pigments that give the ripe fruit its purple color. Anthocyanins are also potent antioxidants. Acai fruit pulp has a very high antioxidant capacity. It has more antioxidant content than cranberry, raspberry, blackberry, strawberry, or blueberry.
A specific freeze-dried acai fruit pulp and skin powder (OptiAcai, K2A LLC) has potent in vitro antioxidant activity against superoxide and peroxyl radical which is higher than other fruits. But has only mild antioxidant activity against peroxynitrite and hydroxyl radical. This extract also appears to inhibit cyclooxygenase-1 (COX-1) and COX-2 in vitro.
Acai berry also contains several fatty acids. The most abundant is the monounsaturated fatty acid (MUFA) oleic acid. The second most abundant is the saturated fatty acid palmitic acid. The third most abundant is the polyunsaturated fatty acid (PUFA) linoleic acid.
Adverse Reactions:
None reported.
Interactions with Herbs & Supplements:
None known.
Interactions with Drugs:
None known.
Interactions with Foods:
None known.
Interactions with Lab Tests:
MAGNETIC RESONANCE IMAGING (MRI): Consumption of acai fruit might increase T1-weighted MRI signal and decrease T2-weighted MRI signal in imaging studies of the gastrointestinal tract.
Interactions with Diseases or Conditions: return to top
None known.
Dosage/Administration:
No typical dosage.
Editor's Comments:
Acai is pronounced AH-sigh-EE. Acai is a palm tree widely distributed in the northern area of South America. Acai gained popularity in North America after being promoted by Dr. Nicholas Perricone as a "Superfood for Age-Defying Beauty" on the Oprah Winfrey show.
 
   
   
   
   
   
   
   
   
   
   
   
   
   
   

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