Clinical Briefs-With Comments from John La Puma, MD, FACP

Noni Juice and Renal Patients

May 2000; Volume 3; 60

Source: Mueller BA, et al. Noni juice (Morinda citrifolia): Hidden potential for hyperkalemia? Am J Kidney Dis 2000;35:310-312.

"We report the case of a man with chronic renal insufficiency who self-medicated with an alternative medicine product known as noni juice (Morinda citrifolia). The patient presented to the clinic with hyperkalemia despite claiming adherence to a low-potassium diet. The potassium concentration in noni juice samples was determined and found to be 56.3 mEq/L, similar to that in orange juice and tomato juice. Herbal remedies and alternative medicine products may be surreptitious sources of potassium in patients with renal disease."

COMMENT

These Purdue and Indiana University authors report, and an editorial comments upon, a surreptitious source of hyperkalemia in a patient with chronic renal insufficiency. The editorial notes a Chinese herbal nephropathy, associated with carcinogenic phytotoxins.

Even without toxic herbs, juices, and medications, patients with kidney disease do not have it easy. Most of their nutritional prescriptions are hard to follow, perhaps especially so in these days of high-protein, fast-food craziness. Either these patients have to watch everything they eat, or they have to change their way of cooking, eating, and shopping so that they learn how to plan, and make eating in a low-protein, low-potassium, usually low-sodium, low-calorie, high-calcium way second nature. Many aren’t able to do this. Their kidney function deteriorates; they develop complications; they require dialysis; they get a new kidney; or they don’t; they die, or stay on dialysis.

Noni juice is available refrigerated or frozen in some health food and specialty markets. It is often, as it was in this case, sweetened with white grape juice. The noni tree grows in India, Samoa, Tahiti, Southeast Asia, and Australia, and the juice of its fruit is reported to be a cure all. Though 1 oz/d is recommended, containing only 1.66 mEq of potassium, popular daily usage is (and testimonials report) much greater quantities.

Recommendation

Who knows what’s really in noni juice? But suspect supplementation of juices and other processed dietary supplements when a renal patient’s numbers don’t make sense.