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Moringa oleifera: A Review of the Medical Evidence for Its Nutritional, Therapeutic, and Prophylactic Properties. Part 1.
Jed W. Fahey, Sc.D. Johns Hopkins School of Medicine, Department of Pharmacology and Molecular Sciences, Lewis B. and Dorothy Cullman Cancer Chemoprotection Center, 725 N. Wolfe Street, 406 WBSB, Baltimore, Maryland, USA 21205-2185 Abstract Moringa oleifera, or the horseradish tree, is a pan-tropical species that is known by such regional names as benzolive, drumstick tree, kelor, marango, mlonge, mulangay, nébéday, saijhan, and sajna. Over the past two decades, many reports have appeared in mainstream scientific journals describing its nutritional and medicinal properties. Its utility as a non-food product has also been extensively described, but will not be discussed herein, (e.g. lumber, charcoal, fencing, water clarification, lubricating oil). As with many reports of the nutritional or medicinal value of a natural product, there are an alarming number of purveyors of “healthful” food who are now promoting M. oleifera as a panacea. While much of this recent enthusiasm indeed appears to be justified, it is critical to separate rigorous scientific evidence from anecdote. Those who charge a premium for products containing Moringa spp. must be held to a high standard. Those who promote the cultivation and use of Moringa spp. in regions where hope is in short supply must be provided with the best available evidence, so as not to raise false hopes and to encourage the most fruitful use of scarce research capital. It is the purpose of this series of brief reviews to: (a) critically evaluate the published scientific evidence on M. oleifera, (b) highlight claims from the traditional and tribal medicinal lore and from non-peer reviewed sources that would benefit from further, rigorous scientific evaluation, and (c) suggest directions for future clinical research that could be carried out by local investigators in developing regions.
This is the first of four planned papers on the nutritional, therapeutic, and prophylactic properties of Moringa oleifera. In this introductory paper, the scientific evidence for health effects are summarized in tabular format, and the strength of evidence is discussed in very general terms. A second paper will address a select few uses of Moringa in greater detail than they can be dealt with in the context of this paper. A third paper will probe the phytochemical components of Moringa in more depth. A fourth paper will lay out a number Copyright: ©2005 Jed W. Fahey of suggested research projects that can be initiated at a very small scale and This is an Open Access article distributed under with very limited resources, in geographic regions which are suitable for the terms of the Creative Commons Attribution License which permits unrestricted use, Moringa cultivation and utilization. In advance of this fourth paper in the distribution, and reproduction in any medium, series, the author solicits suggestions and will gladly acknowledge provided the original work is properly cited. contributions that are incorporated into the final manuscript. It is the intent Contact: Jed W. Fahey and hope of the journal’s editors that such a network of small-scale, locally Email: firstname.lastname@example.org executed investigations might be successfully woven into a greater fabric which Received: September 15, 2005 will have enhanced scientific power over similar small studies conducted and Accepted: November 20, 2005 reported in isolation. Such an approach will have the added benefit that Published: December 1, 2005 statistically sound planning, peer review, and multi-center coordination brings to a scientific investigation. The electronic version of this article is the The following paper is intended to be useful for both scientific and lay audiences. Since various terms used herein are likely not familiar to the lay reader, nor are many of the references readily available to either scientific or lay audiences, we encourage active on-line dialog between readers and both the author and the journal staff. Both will attempt to answer questions and to direct readers to the experts in an open and public manner.
complete one and can be found online at: http://www.TFLJournal.org/article.php/200512011 24931586 Trees for Life Journal 2005, 1:5 PEER REVIEWED
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the word refers to only those chemicals which may have an impact on health. animal forage (leaves and treated seed-cake). East and South Africa. honey (flower nectar). Ethiopia. 4-(α-L-rhamnopyranosyloxy)benzyl isothiocyanate . roasted. It is already an important crop in India. This tree has in recent times been advocated as an outstanding indigenous source of highly digestible protein. Moringa is especially promising as a food source in the tropics because the
tree is in full leaf at the end of the dry season when other foods are typically scarce. cooked. the Philippines and the Sudan. Florida and the Pacific Islands. Moringa leaves contain more Vitamin A than carrots. and it is rich in a fairly unique group of compounds called glucosinolates and isothiocyanates (10.123. According to Fuglie (47) the many uses for Moringa include: alley cropping (biomass production). one of the best known uses for Moringa is the use of powdered seeds to flocculate contaminants and purify drinking water (11. more Vitamin C than oranges. Nonetheless. Ca. ornamental plantings. green manure (from leaves). drumstick tree. in the strictest sense of the word.48). leaves. for fine machine lubrication. is a sweet non-sticking. roots. A large number of reports on the nutritional qualities of Moringa now exist in both the scientific and the popular literature. this plant family is rich in compounds containing the simple sugar. and more potassium than bananas.g. tropical Asia. texture. In the West. differenttiation between food and medicinal uses of plants (e. chemicals produced by plants. Fe. seeds. kelor. tannin for tanning hides (bark and gum). who reports (and has extensively documented on video) countless instances of lifesaving nutritional rescue that are attributed to Moringa (47. benzolive tree. Table 1 in this review captures both nutritional and medicinal references as they relate to Moringa. but the seeds are also eaten green. powdered and steeped for tea or used in curries (50). honey. that “ounce-for-ounce.org
. mulangay. benzyl isothiocyanate .50. niazimicin . or color of the plants. pterygospermin . was utilized by the ancient Romans. In particular. The interested reader is also directed to the very comprehensive reviews of the nutritional attributes of Moringa prepared by the NGOs mentioned earlier (in particular. In many cultures throughout the tropics. marango. In fact. Phytochemistry Phytochemicals are. non-drying oil that resists rancidity. nuts. nébéday. An examination of the phytochemicals of Moringa species affords the opportunity to examine a range of fairly unique compounds. biogas (from leaves). fencing (living trees). also known as Ben oil. It has been used in salads. the Caribbean. smell. It is a perennial softwood tree with timber of low quality. and in the manufacture of perfume and hair care products (158). rhamnose. Thus. is very difficult since plant uses span both categories and this is deeply ingrained in the traditions and the fabric of the community (85). sajna or Ben oil tree). flowers). fruit. mlonge. Any readers who are familiar with Moringa will recognize the oft-reproduced characterization made many years ago by the Trees for Life organization. or on flavor.” and that the protein quality of Moringa leaves rivals that of milk and eggs. pulp (wood). anticancer. domestic cleaning agent (crushed leaves). see references 47. foliar nutrient (juice expressed from the leaves). saijhan. biopesticide (soil incorporation of leaves to prevent seedling damping off). and antibacterial activity include 4(4'-O-acetyl-α-L-rhamnopyranosyloxy)benzyl isothiocyanate . but are not required by humans as essential nutrients. and is being grown in West.38).” Leaves can be eaten fresh. blue dye (wood). This rapidly-growing tree (also known as the horseradish tree. tubers.113).and sugar cane juice-clarifier (powdered seeds). These readers will also recognize the oral histories recorded by Lowell Fuglie in Senegal and throughout West Africa. but which for centuries has been advocated for traditional medicinal and industrial uses. water purification (powdered seeds). medicine (all plant parts). moonga. especially among infants and nursing mothers. and carotenoids suitable for utilization in many of the socalled “developing” regions of the world where undernourishment is a major concern. rope (bark). and 4-(α-L-rhamnopyranosyloxy)
Trees for Life Journal | www. Church World Service and Educational Concerns for Hunger Organization—have advocated Moringa as “natural nutrition for the tropics. Greeks and Egyptians. or stored as dried powder for many months without refrigeration. that is native to the sub-Himalayan tracts of India. bark. Vitamin C. Nutrition Moringa trees have been used to combat malnutrition. the nutritional properties of Moringa are now so well known that there seems to be little doubt of the substantial health benefit to be realized by consumption of Moringa leaf powder in situations where starvation is imminent. whilst avoiding most of the better known agro-forestry and water purification applications of this plant. the outcomes of well controlled and well documented clinical studies are still clearly of great value. fertilizer (seed-cake). it is now widely cultivated and has become naturalized in many locations in the tropics. Latin America. Pakistan. Commonly. and reportedly without loss of nutritional value. Bangladesh and Afghanistan. more iron than spinach. though. gum (from tree trunks). specific components of Moringa preparations that have been reported to have hypotensive.Introduction Moringa oleifera is the most widely cultivated species of a monogeneric family.TFLJournal. more calcium than milk. All parts of the Moringa tree are edible and have long been consumed by humans. Three non-governmental organizations in particular—Trees for Life. For example.157). Moringa seed oil (yield 30-40% by weight). the Moringaceae.
4-(-L-rhamnopyranosyloxy)benzyl isothiocyanate . The readers of this review are encouraged to examine two recent papers that do an excellent job of contrasting the dilemma of balancing evidence from complementary and alternative medicine (e. it is also rich in a number of vitamins and minerals as well as other more commonly recognized phytochemicals such as the
carotenoids (including β-carotene or pro-vitamin A). and will be the subject of a future review in this series. and scientific validation of these popular uses is developing to
Trees for Life Journal | www. poultices. niazimicin . Widespread claims of the medicinal effectiveness of various Moringa tree preparations have encouraged the author and his colleagues at The Johns Hopkins University to further investigate some of these possibilities.org
. A plethora of traditional medicine references attest to its curative power. oils. benzyl isothiocyanate .g. emollients. and it is useful to review the claims that have been made and to assess the quality of evidence available for the more well-documented claims. powders. Although the oral history here is also voluminous. salves. Structures of selected phytochemicals from Moringa spp. While these compounds are relatively unique to the Moringa family. traditional medicine.
H3C O H3C O HO O
N C S O
C S N C O
N O C S C
O H3C HO HO O OH
N C S
N C S
H S C O CH2 CH3
H3C O HO OH
O H3C HO HO O OH
C N OSO3
Figure 1. oral histories and anecdotes) with the burden of proof required in order to make sound scientific judgments on the efficacy of these traditional cures (138.g. Clearly much more research is justified. it has been subject to much less intense scientific scrutiny. porridges) are not quite so well known (116). but just as clearly this will be a very fruitful field of endeavor for both basic and applied researchers over the next decade.
tribal lore.: 4-(4'-O-acetyl-α-Lrhamnopyranosyloxy)benzyl isothiocyanate .154).benzyl glucosinolate . These attributes are all discussed extensively by Lowell Fuglie (47) and others.TFLJournal. and 4-(α-L-rhamnopyranosyloxy)benzyl glucosinolate 
Disease Treatment and Prevention The benefits for the treatment or prevention of disease or infection that may accrue from either dietary or topical administration of Moringa preparations (e. decoctions. creams. pterygospermin . extracts.
For example. claim efficacy of leaf. the in-vitro (bacterial cultures) and observational studies provide a very plausible mechanistic underpinning for the plethora of efficacy claims that have accumulated over the years (see Table 1). It is a major cause of gastritis. practitioners may not be expected to embrace Moringa for its antibiotic properties.131).H. we examined compounds  and  for their cancer preventive potential (39). and amongst the poorest of poor populations worldwide. pylori at concentrations up to 1000-fold lower than those which had been used in earlier studies against a wide range of bacteria and fungi. and the prototypical isothiocyanate has already demonstrated some efficacy in pilot studies (49. The scientific evidence has now been available for over 50 years.O. antibiosis and even reduction of Schistosome cercariae titer (see Table 1). it turned out.60). but performed extensive and elegant characterization of its mode of antimicrobial action in the mid 1950’s. compounds containing the 6carbon simple sugar.168). and flowers against a variety of dermal and internal infections. These compounds had antibiotic activity against H. identified a compound they called pterygospermin  a compound which they reported readily dissociated into two molecules of benzyl isothiocyanate  (23.34). although much of it is completely unknown to western scientists.”) Although others were to show that pterygospermin and extracts of the Moringa plants from which it was isolated were antibacterial against a variety of microbes.78. and the Department of Biochemistry at the Indian Institute of Science in Bangalore (PLN Rao).  and the related compound  were shown to be potent inhibitors of phorbol ester
Trees for Life Journal | www. Thus. Unfortunately. were extraordinarily susceptible to . Unfortunately. many of these reports of efficacy in human beings are not supported by placebo controlled. The extension of this finding to human H.108). from U Eilert and colleagues in Braunschweig. many of the reports of antibiotic efficacy in humans are not supported by placebo controlled. In the late 1940’s and early 1950’s a team from the University of Bombay (BR Das). Recently.TFLJournal.24. and of gastric and duodenal ulcers. This bacterium was not discovered until the mid-1980’s. Aware of the reported antibiotic activity of . Extensive field reports and ecological studies (see Table 1) forming part of a rich traditional medicine history. They re-isolated and confirmed the identity of 4-(α-L-rhamnopyranosyloxy)benzyl glucosinolate  and its cognate isothiocyanate  and verified the activity of the latter compound against a wide range of bacteria and fungi.
Subsequent elegant and very thorough work.81. but it provides the reader with no source of comparison (no control subjects). we undertook to determine whether some of them were also active as antibiotics against Helicobacter pylori. seed. randomized clinical trials. randomized clinical trials. pylori.org
. Moringa has not yet been and will not be embraced by Westerntrained medical practitioners for either its medicinal or nutritional properties.77. and other isothiocyanates and plants containing them. In many cases. in 1993). hypocholesterolemic. Seminal reports on the antibiotic activity of the primary rhamnosylated compound then followed. Travancore University (PA Kurup). as well as having considerable efficacy in water purification by flocculation. anti-inflammatory. however. rhamnose) (8). oleifera.79. For example. nor have they been published in high visibility journals. H. (They identified the tree from which they isolated this substance as “Moringa pterygosperma. a discovery for which the 2005 Nobel Prize in Medicine was just awarded. on the surface a report published almost 25 years ago (141) appears to establish Moringa as a powerful cure for urinary tract infection. hypotensive. antispasmodic. This group not only identified pterygospermin.76. in keeping with Western medical prejudices. The identity of these compounds was not available in the refereed scientific literature until “re-discovered” 15 years later by Kjaer and co-workers (73). pylori is an omnipresent pathogen of human beings in medically underserved areas of the world.” now regarded as an archaic designation for “M. and it is a major risk factor for gastric cancer (having been classified as a carcinogen by the W. pylori infection is now being pursued in the clinic. In this case. sedimentation. identified a number of glyosylated derivatives of benzyl isothiocyanate  (e. Since Moringa species have long been recognized by folk medicine practitioners as having value in tumor therapy (61). root.26. Cancer Prevention.support at least some of the claims.40.g. bark. Moringa preparations have been cited in the scientific literature as having antibiotic. and to a number of other isothiocyanates (37. Benzyl isothiocyanate was already understood at that time to have antimicrobial properties.25. antitrypanosomal. published in 1964 as a PhD thesis by Bennie Badgett (a student of the well known chemist Martin Ettlinger). to the extent to which this is antithetical to Western medicine. the identity of pterygospermin has since been challenged (34) as an artifact of isolation or structural determination. Antibiotic Activity. numerous studies now point to the elevation of a variety of detoxication and antioxidant enzymes and biomarkers as a result of treatment with Moringa or with phytochemicals isolated from Moringa (39. Germany (33. antiulcer. published in-vitro (cultured cells) and in-vivo (animal) trials do provide a degree of mechanistic support for some of the claims that have sprung from the traditional medicine lore. Cultures of H. . This is clearly the area in which the preponderance of evidence—both classical scientific and extensive anecdotal evidence—is overwhelming.80. and hypoglycemic activities. I shall briefly introduce antibiosis and cancer prevention as just two examples of areas of Moringa research for which the existing scientific evidence appears to be particularly strong. Again.
13. 55. and Dorothy Cullman Foundation for providing unrestricted research funds that facilitated preparation of this review and work on Moringa in my laboratory. 34. 19. Modern practitioners have used crude extracts and isolated bioactive compounds. 114. 140.(TPA)-induced Epstein-Barr virus early antigen activation in lymphoblastoid (Burkitt’s lymphoma) cells (57. 26. traditional practice has long suggested that cancer prevention and therapy may be achievable with native plants. Bharali and colleagues have examined skin tumor prevention following ingestion of drumstick (Moringa seedpod) extracts (12). 50. 169
Trees for Life Journal | www. Does this mean that it doesn’t work? No. 63. 27. REPORTED NUTRITIONAL. I gratefully acknowledge the Lewis B. 151 160. 31. 161. 104. 162 25. In an even more recent study. Mark Olson for his encouragement and collaboration early in my research involvement with Moringa (joint publications are still pending). It may well work. 75. The proof required by modern medicine has not been realized because neither the prevention of cancer nor the modification of relevant biomarkers of the protected
state has been adequately demonstrated in human subjects. a dramatic reduction in skin papillomas was demonstrated. a cancer preventative plant. in this case. which included appropriate positive and negative controls. 115. 126. 111
Bacterial Dental Caries/Toothache Infection Syphilis Typhoid Urinary Tract Infection Fungal/ Mycoses Thrush Viral Common cold Epstein-Barr Virus (EBV) Herpes Simplex Virus (HSV-1) HIV-AIDS Warts Parasites Dranunculiasis (guinea-worm) Helminths Schistosomes Trypanosomes Other / Not Attributed to a Specific Pathogen Bronchitis Earache External Sores/Ulcers Fever Hepatic Skin (Dermal) Throat Infection Water treatment (general)
LFS RBG LF G G L O
FRB L L L S
47 104 84 1. In this mouse model. 77 .  also inhibited tumor promotion in a mouse two-stage DMBA-TPA tumor model (104). 124 47
LFP S LR
36 47 113 95
L G LFRB LRGS L OS F S
47 47 15 47 6 15 47 11. 24. Acknowledgements I thank Dr. 100. funding was also provided by the American Institute for Cancer Research and the NCI (Grant # R01 CA93780). but more rigorous study is required in order to achieve a level of proof required for full biomedical endorsement of Moringa as. 68.
TABLE 1. 149 47 47 47 47 141 111 88. 64. Thus.org
.104). 86.TFLJournal. THERAPEUTIC &
Traditional Use a Condition/Effect (ANT) Antimicrobial / Biocidal
PROPHYLACTIC USES OF MORINGA OLEIFERA
Plant Part LFSPRBGO
8.81. In one of these studies.
9. 65. 104. 112. 45. 158. 41. 165 110. 53. 136 14. 51. 62 52. 152 85 2 16 5. 156. 101. 166 148 47 47 47 53 47 47. 57. 30. 135. 90. 139. 66. 131. 45. 53 47 47 47 6. 39. 43. 98. 42. 105. 137 47 6. 59. 48. 93 47. 128. 35. 18. 83. 22. 164. 48 132 12 56. 7. 96 14. 67. 163 88. 59. 89. 61. 47. 14.org
. 70. 167 6. 62. 28. 68. 92. 115 45. 31. 125 40. 87. 17.TFLJournal. 110. 161 28 47 47 47 69 69 28 58. 46. 45. 147 29. 62. 62.AST Asthma CAN Cancer Therapy / Protection Anti-tumor Prostate Radioprotective Skin CIR Circulatory/Endocrine Disorders Anti-anemic Anti-hypertensive Cardiotonic Diabetes/hypoglycemia Diuretic Hypocholestemia Thyroid Tonic Hepatorenal DET Detoxification Antipyretic Purgative Snakebite Scorpion-bite DIG Digestive Disorders For TRTMNT of: Colitis Diarrhea Digestif Dysentery Flatulence Ulcer / Gastritis INF Inflammation Rheumatism Joint Pain Edema Arthritis IMM Immunity Immune-stimulant Lupus NER Nervous Disorders Anti-spasmodic Epilepsy Hysteria Headache NUT Nuritional Antinutritional factors Antioxidant Carotenoids Energy Goitrogen Iron deficiency Oil quality Protein Vitamin/Mineral deficiency
RG LFPBS LFSB L L P LFSPR L LP R LP LFRG L L F LR BO O B B LSRBG LB LR B LG R LS LFSPRG LFSPRG P R S SO S O LFRBGO SR RB FRBO LRBG LSBO B LO L LSO S LS O LS LS
47 12. 44. 87 47. 102. 71. 28. 28. 115. 64 47 47 47 3. 85. 133. 48. 120 76. 160. 127. 54. 61. 110. 32. 94 153 47 93. 64. 116. 159 47 7. 119
Trees for Life Journal | www. 64. 56. 110.
g. Most other compendiums in recent publications or on commercial websites appear to be highly derivative of these seminal works. 107. 21.Back/Kidney Pain Scurvy Splenomegaly “Tonic”
LFPRBGO FRBG RB B L O LRSG L R S RG R LFSPRBO OS LF RO R L R LSRBO R LFPSO
44.TFLJournal. 117. 91. 122 106.g. 128. 74. Vitamin C) from sequelae (e. 161 47 47 15 47 47 4. 47 47 160. 20. 155 47 45. 118. 82. 64.org
. 163 47 47 47 47 47 47 47 47 47
It is very difficult in some cases to separate the effects of severe nutritional deficiencies (e. 123. 73. 103. 67. 53. 8. 142 . 92. 125. and Trees For Life (157). 6. (47)] and by Manuel Palada (116). 64. Fuglie. 68.
Trees for Life Journal | www. 102. 129.146. scurvy) which transcend categorization by organ systems or classification into single disease states. 134. 45. [and can be found in his excellent treatise entitled The Miracle Tree. 109. 130.REP Reproductive Health Abortifacient Aphrodisiac Birth Control Lactation Enhancer Prostate function SKI Skin Disorders Antiseptic Astringent Pyodermia Rubefacient Vesicant GEN General Disorders/Conditions Bladder Catarrh Gout Hepatamegaly Lactation Low. 121. 150. 116. 48. Julia Morton (102). Plant parts are designated by their first letters (in bold): Leaves Flowers Seeds Pods (drumsticks) Roots Bark Gum Oil (from seeds) Many of the original citations have been collected by Lowell J. 53. 66. 99.
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