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Almindelig papaja (Danish), arbre aux melon (French), arsenic, ascorbic acid, Baummelone (German), benzyl isothiocyanate, benzyl ITC, beta-carotene, beta-cryptoxanthin, beta-D-hexosaminidases, BITC, calcium, Caraica papaya carbohydrates, Carica papaya, Carica papaya bark, Carica papaya fruit, Carica papaya leaves, Carica papaya roots, Carica papaya seed extract, caricain, carotene, Cerica papaya, chambur© (Portuguese), chymodiactin, chymopapain, crude fiber, cryptoxanthin, dinnyefa (Hungarian), dudu (Vietnamese), exotic fruit, fan mu gua (Chinese), fermented papaya, fruits of papaya, galactose, glutaminyl cyclase, glycyl endopeptidase, green papaya, harilik papaia (Estonian), houng (Laotian), iron, kapaya (Tagalog), khaknuan papaya, lapaya (Tagalog), lechosa (Spanish), loko (Thai), lycopene, lysine, ma kuai thet (Thai), magnesium, majan (Kelabit), malako (Thai), malakor (Thai), mam©o (Portuguese), mamoeiro (Portuguese), mam©n (Spanish), Mangifera indica, meloenboom (Dutch), meloenboom sort (Dutch), mel©n zapote (Spanish), Melonenbaum (German), melonowiec wlasciwy (Polish), Melontr©d (Swedish), melontrae (Danish), methionine, mewa (Nepali), mukua-wan-shou-kuo (Chinese), niacin, orange fruits, papago (French), papaia (Portuguese), papaija (Finnish), papain, papaiya (Japanese), pap©ja (Hungarian), papaja (Polish, Slovene), pap©ja melounov© (Czech), pap©ja obecn© (Czech), Papajabaum (German), Papajapflanze (German), papaya cream, papaya cysteine proteinases, papaya-derived antioxidant, papaya fruit, papaya juice, papaya latex, papaya latex glutamine cyclotransferase, papaya milk, papaya proteinase IV, papaya proteinases, papaya QC enzymes, papaya salad, papaya seed extract, papaya shoot, papaya sort (Dutch), papaya sublimate, papaya trees, Papayabaum (German), papaye (French), papayer (French), papayero (Spanish), papayo (Spanish), papiitaa (Hindi, Urdu), pappali (Tamil), phosphoric acid, phosphorous, popoo (Japanese), provitamin A, pureed papaya, riboflavin, rungan (Russian), sa kui se (Thai), som tam pla ra (Thai), sound fruits, thiamine, thimbaw (Burmese), tropical fruits, tropical plant extracts, tryptophan, Uzbek papaya.
Combination product examples: Immun'Age© (fermented papaya, yeast, and dextrose), Bionormalizer© (biofermentation products of Carica papaya, Pennisetum purpureum, and Sechium edule), Wobenzym© (ingredients: pancreatin, bromelain, papain, lipase, amylase, trypsin, alpha chymotrypsin, and rutin).
Note: This monograph is primarily concerned with the leaves, seeds, and fruit of the papaya tree. Papain, an enzyme contained in papaya, is also discussed briefly when relevant; however, for a more in-depth review of papain, a separate monograph is available in the Natural Standard Herb & Supplements database.
BACKGROUND
Papaya (Carica papaya) is a fruit-bearing tree grown in tropical regions around the world. Commonly eaten parts of the plant include the fruit and leaves. Traditionally, juice from the papaya fruit and root has been used to treat boils, burns, and warts. The leaves have been used to treat ulcers and, together with papaya seeds, intestinal parasites. Unripened papaya fruit also has been used for wound healing, colds, and indigestion; the roots and seeds have been used for hemorrhoids and to induce abortion. Papaya also has been used as a folk remedy for birth control and as a digestive aid.
The fruit and leaves contain the protein-digesting enzymes papain and chymopapain, which have been isolated and studied for their effects on injured skin tissue. Results of research suggest that the papaya fruit, enzymes, and seed extracts may have other therapeutic properties such as anticancer, antifungal, antiparasitic, blood lipid-lowering, blood sugar-lowering, birth control, and immune system effects. Despite a wealth of positive early research, high quality human trials supporting the use of papaya for any human condition remain lacking.
EVIDENCE TABLE
Conditions
| Uses disclaimer: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. | Grade* |
AntioxidantPapaya has been shown to have potent antioxidant properties. Although early research results are encouraging, further studies are required before any conclusion can be made. | C |
Burn treatmentPapaya applied directly on a wound appears effective in removing damaged tissue from wounds and in limiting burn wound infection. While preliminary and traditional evidence is promising, further clinical research is required before a conclusion can be made. | C |
Cancer preventionPapaya extract and papaya products have been shown to have potential anticancer properties. Additional research is required before a firm conclusion can be made. | C |
Human papillomavirusPreliminary study revealed that consumption of papaya at least once weekly was associated with a decreased risk of persistent human papillomavirus (HPV) infection. Human clinical trials are needed before a conclusion can be made. | C |
Hyperglycemia (high blood sugar)Early study showed that a fermented papaya preparation effectively lowered blood sugar levels in healthy and type 2 diabetic subjects. Although these findings are encouraging, additional research is needed. | C |
Skin ulcersPapaya has been used as a folk remedy for wound management in several regions of the world. Preliminary human study indicates that papaya may aid skin ulcer healing. Further study is needed. | C |
Vitamin A deficiencyPreliminary study showed that papaya, which is rich in carotenes (provitamin A), may improve vitamin A status in breastfeeding women. Evidence regarding papaya's ability to treat vitamin A deficiency remains limited. Additional research is required before any conclusion can be made. | C |
*Key to grades: A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work). | |
TRADITION
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Abortifacient (uterine contraction stimulant/abortion inducer), adjunct in surgery, Alzheimer's disease, anti-aging, anti-inflammatory, antimicrobial, cancer, antiparasitic, bleeding disorders, bruises, colds, birth control, deficiency (glucose-6-phosphate dehydrogenase), degenerative disk disease, digestive aid, digestive disorders, dry eye syndrome, energy booster, breast milk stimulant, gum disease, hemorrhoids, immune enhancement, immune system deficiencies, inflammation, lead toxicity, liver disease, lower back pain, lymphatic disorders, malaria, metabolic disorders (galactosemia), scar healing, sciatica, sickle cell anemia, soft-tissue injury, swelling, typhoid fever, vaccine adjunct, vascular spasm, venous disorders, vitamin B12 deficiency, warts, wound healing.DOSING
disclaimer: The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
There is no proven safe or effective dose of papaya in adults.
As an antioxidant, a dose of 9 grams of fermented papaya preparation has been taken by mouth daily for three months.
For cancer prevention, a dose of 6 grams of Immun'Age© (a product containing fermented papaya, yeast, and dextrose) has been taken by mouth daily for six months in patients with atrophic gastritis (a type of stomach inflammation).
For human papillomavirus treatment, papaya has been taken by mouth one or more times weekly.
For hyperglycemia (high blood sugar), a dose of 3 grams of a fermented papaya preparation has been taken by mouth daily for two months.
For vitamin A deficiency, a dose of 650 grams of pureed papaya has been taken by mouth daily by breastfeeding women for 60 days.
Children (under 18 years old)
There is no proven safe or effective dose of papaya in children.
For burn treatment, a cold paste of mashed papaya, excluding the skin and seeds, has been applied via a gauze pad to burnt skin one to two times daily, until the risk of infection had passed.
SAFETY
disclaimer: The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Avoid in patients with a known allergy or hypersensitivity to papaya, its components (including papaya juice, papaya flower pollen, papain, and chymopapain), members of the Caricaceae family, or latex. Cross sensitivity between kiwi and papaya, as well as papain, has been reported.
Allergic reactions, including asthma, respiratory allergies, and contact dermatitis (skin inflammation from contact with an allergen or irritant), have been observed in people who have ingested, inhaled or have had skin contact with papaya flower pollen, papaya fruit, or papaya juice. Sensitivity to the papaya enzyme chymopapain has been reported.
Cases of airway sensitivity, angioedema (swelling under the skin), and anaphylaxis (a life-threatening allergic reaction) have been reported in individuals exposed to papain, an enzyme present in papaya.
Anaphylactic reactions to papain have been reported in approximately 1% of children receiving papain for burn treatment.
Side Effects and Warnings
Papaya is likely safe when consumed as part of a normal diet.
Fermented papaya is possibly safe when used medicinally for up to three months, and when the mashed fruit pulp is applied daily to burns until risk of infection has passed; however, severe allergic reactions to papain have been reported in approximately 1% of children receiving papain for burn treatment.
Papaya may interact with anticoagulants such as warfarin (Coumadin©) and increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
Papaya may lower blood sugar levels. However, papaya fruit contains carbohydrates and may theoretically increase blood sugar. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
Use the papaya enzyme papain cautiously, as it may induce stomach ulcer, a hole in the esophagus, and high blood sodium.
Use cautiously in individuals with autoimmune disorders or in those using immunosuppressants.
Use cautiously with beta-carotene or carotene-containing foods, as carotenemia (yellow skin, often from excess carotene ingestion) has been associated with ingestion of papaya. Use cautiously in patients using vitamin A or retinoids, as based on human study, 650g of papaya daily significantly increased serum retinol levels.
Use cautiously with iron or iron-rich foods, sodium, potassium supplements, or agents that alter potassium levels.
Avoid high amounts of papaya seeds in women who are pregnant, breastfeeding, or trying to become pregnant.
Avoid in patients with a known allergy or hypersensitivity to papaya, its components (including papaya juice, papaya flower pollen, papain, and chymopapain), members of the Caricaceae family, or latex. Cross sensitivity between kiwi and papaya, as well as papain, has been reported.
Pregnancy and Breastfeeding
Avoid high amounts of papaya seeds in women who are pregnant, breastfeeding, or trying to become pregnant. High doses of papaya seed extract may result in abortion-inducing effects and disrupt fetal growth and development. In breastfeeding women, the use of papaya-containing nipple creams may be a potential risk factor for mastitis.
INTERACTIONS
disclaimer: Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Papaya may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Papaya may interact with anticoagulants ("blood thinners") such as warfarin (Coumadin©) or heparin. Other drugs that may increase the risk of bleeding include aspirin, anti-platelet drugs such as clopidogrel (Plavix©), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin©, Advil©) or naproxen (Naprosyn©, Aleve©).
Papaya may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Papaya may also interact with anticancer agents, anti-inflammatory agents, blood vessel-widening or narrowing agents, cardiovascular agents, cyanocobalamin (vitamin B12), drugs that affect the immune system, iron salts, potassium salts, retinoids, and sodium.
Interactions with Herbs and Dietary Supplements
Papaya may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding, such as anticoagulant herbs and supplements ("blood thinners"). Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Papaya may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Papaya may also interact with herbs and supplements that narrow or widen blood vessels, anticancer herbs and supplements, anti-inflammatory herbs and supplements, beta-carotene, carotene-containing foods, cardiovascular herbs and supplements, herbs and supplements that affect the immune system, iron, kiwi, potassium, sodium, vitamin A, and vitamin B12.
ATTRIBUTION
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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Copyright © 2011 Natural Standard (www.naturalstandard.com)
Copyright © 2011 Natural Standard (www.naturalstandard.com)
