Noni juice (Morinda citrifolia) is an increasingly popular wellness drink claimed to be beneficial for many illnesses. The herb is classified as a liver toxic herb and therefore requires doctor’s supervision.

Doctors at the Clinical Division of Gastroenterology and Hepatology, Medical University of Innsbruck, Austria, have reported a 45-year-old patient with highly elevated transaminases (liver enzymes SGOT, SGPT) and elevated lactate dehydrogenase. There was no evidence for viral hepatitis, Epstein-Barr virus or Cytomegalovirus, autoimmune hepatitis, Budd-Chiari syndrome, Hemochromatosis or Wilson’s disease. He has been drinking juice of Noni during the preceding 3 weeks. The herbal toxicity was confirmed by a liver biopsy. After ceasing the ingestion of Noni, transaminase levels normalized quickly and were within normal ranges one month after the first presentation. (1-2)

Doctors at the Department of Internal Medicine, Medical University Graz, Austria have described two cases of liver toxicity with NONI juice. The first patient, 29-year-old man with previous toxic hepatitis associated with small doses of paracetamol developed sub-acute hepatic failure following consumption of 1.5 L NONI juice over 3 wk necessitating urgent liver transplantation. Second was a 62-year-old woman without evidence of previous liver disease who developed an episode of self-limited acute hepatitis following consumption of 2 L NONI juice for over 3 months.

Doctors at the department of Internal Medicine II, Ludwig Maximilians University of Munich, Germany reported a 24-year-old female with mild elevations of serum liver enzymes and bilirubin levels. Because of multiple sclerosis, she was treated with interferon beta-1a for 6 weeks. After exclusion of viral hepatitis due to hepatitis A-E, interferon beta-1a was withdrawn under the suspicion of drug-induced hepatitis. One week later, she was admitted again to her community hospital with severe jaundice. The liver enzymess and bilirubin levels were highly elevated, and a beginning impairment of the liver synthesis was expressed by a reduced prothrombin time. She developed fulminant hepatitis and acute liver failure. There was no evidence for hepatitis due to potentially liver toxic viruses, alcoholic hepatitis, Budd-Chiari syndrome, hemochromatosis, and Wilson’s disease. Fine-needle aspiration biopsy of the liver ruled out an autoimmune hepatitis but showed signs of drug-induced toxicity. During the interview, she admitted that for ‘general immune system stimulation’ she had been drinking Noni juice, during the past 4 weeks. After cessation of the Noni juice ingestion, her liver enzyme levels normalized quickly and were in the normal range within 1 month.(3-5)

References
1. Millonig G; Stadlmann S; Vogel W: Herbal hepatotoxicity: acute hepatitis caused by a Noni preparation (Morinda citrifolia). Eur J Gastroenterol Hepatol. 2005 Apr;17(4):445-7.
2. Stadlbauer V, Weiss S, Payer F, Stauber RE. Herbal does not at all mean innocuous: the sixth case of hepatotoxicity associated with morinda citrifolia (noni). Am J Gastroenterol. 2008 Sep;103(9):2406-7.
3. Stadlbauer V, Fickert P, Lackner C, Schmerlaib J, Krisper P, Trauner M, Stauber RE. Hepatotoxicity of NONI juice: report of two cases World J Gastroenterol. 2005 Aug 14;11(30):4758-60.
4. Hepatotoxicity caused by a Noni (Morinda citrifolia) preparation: López-Cepero Andrada JM, Lerma Castilla S, Fernández Olvera MD, Amaya Vidal A. Rev Esp Enferm Dig. 2007 Mar;99(3):179-81.
5. Hepatitis induced by Noni juice from Morinda citrifolia: a rare cause of hepatotoxicity or the tip of the iceberg : Yuce B, Gulberg V, Diebold J, Gerbes AL. Digestion. 2006; 74(1):47-8.