Herbfacts
Artichoke

Artichoke

Latin name Cynara scolymus,

Pharmacopoeial name: cyanarae folium

Other names; globe artichoke

About Artichoke

Artichoke is a native plant to southern Europe, northern Africa, and the Canary Islands. Artichoke is a member of the Asteraceae, or daisy, family and is thought to be one of the oldest used medicinal plants. It has been pictured in ancient Egyptian drawings and was used by the ancient Greeks and Romans to aid in digestion. The portion of the artichoke plant used as a medicinal remedy is the leaf extract (1-4) Artichoke leaf extract consists of up to 2% phenolic acids (chlorogenic acid, cynarin, and caffeic acid), up to 4% sesquiterpene lactones, and 1% flavonoids (scolymoside, cynaroside, and luteolin). Artichoke also contains phytosterols, tannins, sugars, starch, and inulin.

Uses

Hyperlipidemia/cholesterol

The effect of Artichoke leaf extract has been investigated on the lipid levels of patients with familial type IIa or type IIb hyperlipidemia (5). Over the three-month study period, patients received 250 mg or 750mg of artichoke leaf extract daily. None of the results were statistically significant. The artichoke leaf extract dosage was then increased to 1.5 g daily for three to six months in a small subgroup.The authors concluded that artichoke leaf extract has no lipid-lowering effect in familial type II hyperlipidemia.

In another study of patients with hyperlipidemia, a series of three related prospective randomized trials were conducted (6). The artichoke leaf extract was prepared from artichoke fresh leaves and flower buds; therefore, it was not a commercially available preparation. Although the results of this study were not statistically significant, patients’ cholesterol levels were reduced with artichoke leaf extract treatment and the author concluded that there may be value in using artichoke leaf extract for hyperlipidemia treatment for a longer duration.

Petrowicz et al. conducted a study of artichoke leaf extract using healthy volunteers without hyperlipidemia (7).
In 12 week randomized, placebo-controlled, double-blind, pilot study, 44 volunteers were given either artichoke leaf extract as 640-mg capsules three times daily or placebo. Subgroup data analysis showed that patients with a baseline total cholesterol concentration of >200 mg/dL had significantly greater reductions in total cholesterol than patients with lower baseline levels. Mean HDL cholesterol levels increased with treatment, though not significantly. No major adverse effects were observed or reported.

Englisch et al. enrolled 143 patients with hyperlipidemia into a randomized, placebo-controlled, double-blind, multicentre, Phase III clinical trial conducted over six weeks to evaluate the cholesterol-reducing properties and clinical efficacy of artichoke leaf extract (8). At six weeks, the mean total cholesterol concentration decreased from 299 to 244 mg/dL in the treatment group and decreased from 297 to 271 mg/dL in the placebo group. Mean LDL cholesterol decreased from 212 to 164 mg/dL in the treatment group and from 201 to 188 mg/dL in the placebo group. The mean triglyceride concentration decreased in the treatment group from 202 to 190 mg/dL and in the placebo group from 201 to 181 mg/dL. Mean HDL cholesterol slightly decreased in the treatment group, from 45 to 44 mg/dL, and slightly increased from 46 to 47 mg/dL in the placebo group. Changes in triglycerides, HDL cholesterol, GGT, AST, and ALT were not statistically significant. A total of 28 adverse effects were reported and occurred with similar frequency in both groups.

Patients with moderate hyperlipidemia were included in a matched control study by Lupattelli et al (9).Patients were given 20 mL/day of frozen artichoke juice. The changes in total cholesterol, LDL cholesterol, HDL cholesterol, and brachial FMV were not statistically significant between groups. No adverse effects were reported during the study.

Dyspepsia.

The efficacy of artichoke leaf extract was evaluated in a randomized, open-label, dose-ranging study of healthy patients with self-reported dyspepsia (10). A total of 516 participants were randomized to receive either 320 or 640 mg of artichoke leaf extract daily for two months. In both groups, a significant reduction in all dyspeptic symptoms occurred. The mean global dyspepsia score was reduced by about 40% in both groups. A significant increase in quality-of-life scores occurred in both groups. Quality-of-life scores were higher in the 640-mg treatment group than in those receiving 320 mg; however, the difference was not statistically significant. A statistically significant reduction in state and trait anxiety scores occurred in both groups. In state (but not trait) anxiety scores, there was a statistically significant difference between the dosage groups, with patients receiving 640 mg having a greater reduction in anxiety than those receiving 320 mg (p = 0.03).

Holtmann et al. conducted a randomized, double-blind, placebo controlled trial to evaluate the efficacy of artichoke leaf extract in treating functional dyspepsia (11). A total of 247 patients with functional dyspepsia were randomized to receive two 320-mg artichoke leaf extract capsules or two placebo capsules three times daily for six weeks. Patients receiving artichoke leaf extract had greater improvement in sum scores of dyspeptic symptoms than did patients receiving placebo. Patients receiving artichoke leaf extract had statistically significant decreases in the intensity of fullness, flatulence, and early satiety, but did not have significant decreases in the intensity of nausea, vomiting, or epigastric pain compared with patients receiving placebo. Patients receiving artichoke leaf extract had greater improvement in quality-of-life scores than did those receiving placebo.

IBS.

Data from a postmarketing surveillance study of patients with dyspeptic syndrome who were treated with two 320-mg capsules of artichoke leaf extract three times daily for six weeks were used to evaluate a subset of patients with IBS (12). Individual symptoms, overall effectiveness, and adverse effects were assessed. Significant decreases in the severity of all symptoms (abdominal pain, abdominal cramps, bloating, flatulence, and constipation) were achieved. Approximately 84% of physicians and patients rated the overall effectiveness of artichoke leaf extract as good or excellent.

Data from a randomized, open label, dose-ranging study of healthy patients with self-reported dyspepsia were used to evaluate a subset of patients with IBS (13). A total of 208 participants from that study were identified as having IBS. The frequency of IBS, bowel patterns, and NDI score were assessed before and two months after treatment with 320 or 640 mg of artichoke leaf extract. After treatment, the rate of IBS decreased by 26.4%. At baseline, 18% of patients reported “normal” bowel patterns; after treatment, 39% reported normal bowel patterns. The NDI total symptom score decreased by 41% and the total quality-of-life score increased by 20% after treatment.

Alcohol-induced hangovers.

Pittler et al. conducted a randomized, doubleblind, placebo-controlled trial to evaluate the effectiveness of artichoke leaf extract in preventing alcohol-induced hangovers (14). Adult volunteers (10 women and 5 men) were randomized to receive three 320-mg artichoke leaf extract capsules for a total dose of 960 mg or three placebo capsules immediately before and after one drinking episode (the type and amount of alcohol required to induce a hangover were predefined by each patient). After a one-week washout period, the participants received the opposite treatment for a second drinking episode. Participants consumed the same food before each drinking episode. No significant differences were detected between the treatments for any of the endpoints.

Safety

Artichoke leaf extract may cause an allergic reaction in patients, especially those sensitive to plants from the Asteraceae family). Allergic contact dermatitis can occur after handling the artichoke plant. Acute oedema of the tongue, allergic rhinitis, asthma attacks, and urticaria have been associated with artichoke ingestion (15,16) Patients with bile-duct obstruction or gallstones should not take artichoke leaf extract, as it may worsen either of these conditions due to the potential for bileflow stimulation.

Keywords: artichoke; hyperlipidaemia; dyspepsia; IBS, hangovers

Monograph

http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_Community_herbal_monograph/2011/12/WC500119942.pdf

Assessment report

http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_HMPC_assessment_report/2011/12/WC500119940.pdf

References

http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_List_of_references_supporting_the_assessment_report/2011/12/WC500119941.pdf

References

1. Barrett M, ed. The handbook of clinically tested herbal remedies. New York: Haworth Press; 2004:151-61.
2. Jellin JM, Gregory PJ, Batz F et al. Artichoke. www.naturaldatabase.com .
3. Omara N. Pharm Lett. 2000; 16:1607-9.
4. Facts and comparisons. Artichoke. www. efactsonline.com
5. Heckers H, Dittmar K, Schmahl FW Atherosclerosis. 1977; 26:249-53.
6. Dorn M. Br J Phytother. 1995; 4:21-6.
7. Petrowicz O, Gebhardt R, Donner M Atherosclerosis. 1997; 129:Abstract 147.
8. Englisch W, Beckers C, Unkauf M Arzneimittelforschung. 2000; 50:260-5.
9. Lupattelli G, Marchesi S, Lombardini R Life Sci. 2004; 76:775-82.
10. Marakis G, Walker AF, Middleton RW Phytomedicine. 2002; 9:694-9.
11. Holtmann G, Adam B, Haag S et al. Aliment Pharmacol Ther. 2003; 18:1099-105.
12. Walker AF, Middleton RW, Petrowicz O. Phytother Res. 2001; 15:58-61.
13. Bundy R, Walker AF, Middleton RW et al. J Altern Complement Med. 2004; 10:667-9.
14. Pittler MH, White AR, Stevinson C CMAJ. 2003; 169:1269-73.
15. Gadban H, Gilbey P, Talmon Y et al. Ann Otol Rhinol Laryngol. 2003; 112:651-3.
16. Miralles JC, Garcia-Sells J, Bartolome BAnn Allergy Asthma Immunol. 2003; 91:92-5.