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- Triphala (Phyllanthus emblica; Terminalia chebula; Terminalia bellerica)
- Cancer Prevention and Treatment
| Date:
02-15-2011 | HC# 011141-418
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Re: Triphala in the Prevention and Treatment of Cancer - Review of the Evidence
Baliga
MS. Triphala, Ayurvedic formulation
for treating and preventing cancer: a review. J Altern Complement Med. 2010;16(12):1301-1308.
doi:10.1089/acm.2009.0633.
Made
from three fruits (amla [Phyllanthus
emblica], chebulic myrobalan [Terminalia
chebula], and belleric myrobalan [Terminalia
bellerica]), Triphala is one of the most common
Ayurvedic preparations. It is formulated in two variations: one uses equal
portions of all three fruits; the other, one part chebulic myrobalan, two parts
belleric myrobalan, and four parts amla. In Ayurveda, Triphala is a tridoshic
rasayan, balancing and strengthening the three elements of human life: vata, pitta, and kapha. (See an
explanation of these concepts from the Ayurvedic Foundation at: http://www.ayur.com/dosha/tridosha.html.)
In practice, Triphala is used for
gastric and digestive issues, cardiovascular problems, vision disorders, liver
problems, and inflammation. It has been reported effective for anemia, jaundice,
asthma, fever, chronic ulcers, leucorrhea, and pyorrhea. Triphala exhibits antibacterial, antimalarial, antifungal,
antiallergic, and antiviral effects. Triphala
is a cardiotonic and reduces myocardial necrosis and serum cholesterol. It is hepatoprotective,
and has also been reported to have antiaging effects and to improve mental
function. It further potentiates adrenergic function, important in stress
recovery.
Studies
performed since 2000 suggest that Triphala
may be antioxidant, antimutagenic, antineoplastic, chemoprotective,
radioprotective, and chemopreventive, with a possible role in cancer prevention
and treatment. This article summarizes the recent findings.
In
vitro studies found dose- and time-dependent cytotoxic effects of Triphala extracts and constituents on a
variety of cultured cancer cell lines, while equal concentrations did not harm
cultured normal cells. In several cancer cell lines, Triphala and its ingredients inhibited DNA synthesis, decreasing
replication and proliferation. An extract of chebulic myrobalan was most
effective, followed by Triphala, then
amla, then belleric myrobalan.
Triphala treatment of two
human breast cancer cell lines caused reproductive cell death. One line (MCF-7)
was more sensitive to Triphala than
the other (T47D). Apoptosis was induced in various cancer cell lines, again
with no effect on healthy cells. MCF-7, a p53+/+ cell line, was more sensitive
to apoptosis than T47D, a p53-/- cell line. Treatment of MCF-7 cells with
pifithrin α, an inhibitor of p53,
reversed Triphala's effects and, with
similar observations in other cell lines, confirms the role of p53 in Triphala-induced apoptosis. Similarly,
while Triphala increased
intracellular reactive oxygen species (ROS) in some cancer cells compared with
normal cells, pretreatment with antioxidants inhibited this effect. In some
cell lines, Triphala-induced
apoptosis was linked to phosphorylation of p53 at Ser-15 and ERK at
Thr-202/Tyr-204. This effect was reversed with pretreatment of an antioxidant,
N-acetylcysteine (NAC).
In
cancer-bearing research animals, feeding Triphala
significantly increased apoptosis, leading to tumor regression and decreased
tumor volume. Animals fed Triphala
showed no impaired movement or discomfort, suggesting absence of systemic or
cognitive toxicity. Triphala's
chemoprotective potential is seen in coadministration with methotrexate, an
antifolate often used as an anticancer and immunosuppressive drug. While very
useful, methotrexate is an enterotoxin. Both Triphala formulas significantly restored intestinal brush border
membranes in methotrexate-damaged rats. The 1:2:4 formula was more effective,
with significant decreases in permeation clearance of phenol red, attenuation
of histopathological changes, level of disaccharides in brush border membrane
vesicles, and lipid peroxidation of intestinal mucosa over the equal parts
formula. Triphala protected against
ionizing radiation with peritoneal or oral dosing in animal studies. It was ineffective
when administered after radiation. In two studies, mortality was delayed and
reduced, and symptoms of radiation sickness decreased; in one, radiation
tolerance increased by 1.4 Gy, giving rise to a dose reduction factor of 1.15.
In the other, radiation-induced mortality decreased 60% in mice given 1g/kg
body weight, with less oxidative stress, less DNA damage, and increased
antioxidant defenses.
Triphala may also have
chemopreventive effects. In preclinical studies, feeding Triphala reduced induced forestomach papillomagenesis in mice in a
time- and dose-dependent manner. Feeding Triphala
before, after, and during carcinogen exposure reduced tumor incidence by
77.77%. Longer term feeding brought further decreases. A 2.5% Triphala diet was more effective than
the same percentage of any of the three fruits alone, suggesting a synergistic
or additive effect.
Several
mechanisms may contribute to Triphala's
anticancer effects, including free radical scavenging, increased antioxidant
enzyme production, reduced cellular damage, inhibition of lipid peroxidation,
and anti-inflammatory, antimutagenic, anticlastogenic, and immunomodulatory
effects. All have been seen in preclinical studies. Most studies of Triphala and its ingredients have been
in vivo. More animal, in vitro, and eventually human studies are needed to
clarify its mode or modes of action and the contribution of each ingredient and
its compounds to Triphala's effects. In
view of the considerable variation in the chemical composition of Triphala, the author recommends rigorous
quality control regarding authenticity and quantification of active
phytochemicals in the combination. Triphala's
apparent safety also argues for more study.
—Mariann
Garner-Wizard
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