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Updated 18 February 2013

Carob (Ceratonia siliqua)

Carob (Ceratonia siliqua) is a leguminous evergreen tree of the family Leguminosae (pulse family). Although it was originally native to Mediterranean regions, it is now cultivated in many warm climates, including Florida and California. The pods may be ground into a flour, which is often used as a cocoa substitute because it has a somewhat similar taste to chocolate and one-third the calories.

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BACKGROUND

Carob (Ceratonia siliqua) is a leguminous evergreen tree of the family Leguminosae (pulse family). Although it was originally native to Mediterranean regions, it is now cultivated in many warm climates, including Florida and California. The pods may be ground into a flour, which is often used as a cocoa substitute because it has a somewhat similar taste to chocolate and one-third the calories.

Carob has been used to treat infantile diarrhea and carob bean gum has been used to control hyperlipidemia (high cholesterol) and as a dietary adjunct to elevated plasma cholesterol management.

There is conflicting data on the effect of carob bean gum as a formula thickener and its effect on regurgitation frequency. The use of soluble dietary fibers, such as carob bean gum, has been shown to alter food structure, texture and viscosity, the rate of starch degradation during digestion, and the regulation of postprandial blood sugar and insulin levels.

As a food, the U.S. Food and Drug Administration (FDA) has given carob generally recognized as safe (GRAS) status.

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*

Hypercholesterolemia (high cholesterol)

Fiber, such as oat fiber, has been shown to reduce serum cholesterol levels. Carob pod fiber or carob bean gum may also have this ability, although additional research is needed to confirm these findings.

B

Diarrhea in children

Traditionally, carob has been used for the treatment of gastrointestinal conditions, especially diarrhea. Preliminary study used different types of carob products as an adjunct to oral rehydrating solution and showed promising results. Additional study is needed in this area.

C

Gastroesophageal reflux disease (in infants)

Locust bean gum is a common food thickener and may prove helpful in infantile gastroesophageal reflux. However, additional study is needed in this area.

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. Anthelmintic (expels worms), antioxidant, antiviral, cancer, celiac disease, cough (retching, in infants), demulcent (soothing agent), diabetes, diarrhea (in adults), digestive disorders, dyspepsia (upset stomach), eye infections, flavoring agent, food uses, improve eyesight, laxative, nausea and vomiting during pregnancy, nutritional deficiencies, obesity, stomach pain, vomiting (in infants).

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 for carob. Traditionally, 20 grams carob daily with plenty of water has been used. As a powder, 20-30 grams added to water, tea, or milk taken once daily has also been used.

Children (younger than 18 years)

There is no proven safe or effective dose for carob in children, and use is not recommended.

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 individuals with a known allergy or hypersensitivity to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Pollen from the carob tree has been reported as an important inhalant allergen. Asthma and rhinitis to carob bean flour have been reported. Explosive vomiting, urticaria (hives), and a rash have also been reported following allergy to an anti-regurgitation milk formula containing carob bean gum in an infant. Individuals allergic to peanuts may also have cross-sensitivity to raw carob pulp.

Side Effects and Warnings

There are no reports of serious adverse effects related to the consumption of carob. The consumption in designated therapeutic doses can be generally considered as safe, although side effects may include a feeling of fullness. Carob is likely safe when consumed in amounts usually found in foods; in the United States carob has generally recognized as safe (GRAS) status.

Carob is possibly unsafe when used uncontrolled and unreflected in infants with gastroesophageal reflux, in pregnant women, or in patients with anemia, diabetes, hyperlipidemia (high cholesterol), hypouricemia (low uric acid), known allergies to members of the Fabaceae family, peanuts, or other nuts, or who have experienced previous complications with powdered, bulk forming laxative drinks. Carobis is also possibly safe when used by patients taking herbs or drugs by mouth, as carob bean gum may decrease bowel transit time. Use cautiously in patients with diabetes as locust bean gum may decrease glucose response and glycemic index.

In patients with renal (kidney) failure, ingestion of locust bean gum showed laxative effects, decreased high blood pressure, and caused a fall in serum urea, creatinine, and phosphorus.

A five month-old child who was allergic to an anti-regurgitation milk formula containing carob bean gum experienced urticaria (hives) and a rash within 30 minutes of administration of the formula. Thickening milk feeds (Carobel©) may cause necrotizing enterocolitis (a serious intestinal illness in babies that may cause tissue damage to the intestines) in low birth-weight infants.

Avoid in patients with a chromium, cobalt, copper, iron, or zinc disorder or deficiency as carob bean gum may reduce absorption of these minerals. Use cautiously in patients with anemia (red blood cell deficiency) as carob bean gum may reduce the absorption of iron. Avoid in patients with metabolic disorders, with acute diarrhea or in underweight infants.

Pregnancy and Breastfeeding

Carob is not recommended in pregnant or breastfeeding women due to a lack of available scientific data.

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

Carob may alter blood sugar levels. Caution is advised when using medications that may also affect blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.

Carob bean gum may reduce hyperlipidemia (high cholesterol) in adults and LDL ("bad") cholesterol levels in children and adolescents with elevated plasma LDL cholesterol levels. Caution is advised in patients taking cholesterol-lowering agents due to additive effects.

Although not well studied in humans, carob bean gum polysaccharides may block a step in rubella virus replication subsequent to virus attachment, and may interact with antiviral agents. Consult with a qualified healthcare professional, including a pharmacist, before combining therapies.

Carob leaf extracts may act as chemopreventive agents. Caution is advised when taking with other drugs with similar effects.

Carob bean gum may decrease bowel transit time or increase fecal weight. It may also reduce the adherence of Escherichia coli on intestinal epithelial. Thus, it may interact with laxatives or other agents taken by mouth, and caution is advised.

In children and infants with acute diarrhea, carob bean juice or carob pod powder may reduce the symptoms of infectious diarrhea. Caution is advised when taking carob with other agents that have similar effects.

Interactions with Herbs and Dietary Supplements

Based on a laboratory study, carob may reduce the adherence of Escherichia coli on intestinal epithelial.

Carob may lower blood sugar levels. Caution is advised when using herbs or supplements that can also alter blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Carob bean gum may reduce hyperlipidemia (high cholesterol) in adults and LDL ("bad") cholesterol levels in children and adolescents with elevated plasma LDL cholesterol levels. Caution is advised in patients taking cholesterol-lowering herbs, such as red yeast rice, due to additive effects.

Carob bean gum polysaccharides may block a step in rubella virus replication subsequent to virus attachment. Caution is advised in patients taking herbs with antiviral effects, due to possible additive effects.

Carob leaf extracts may act as chemopreventive agents. Caution is advised when taking with other herbs with similar effects.

Although not well studied in humans, carob bean gum may reduce the absorption of zinc, iron, copper, chromium and cobalt. Carob bean gum may decrease bowel transit time or increase fecal weight, and caution is advised when using with laxative herbs, such as psyllium.

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).

  • Aggett PJ, Agostoni C, Goulet O, et al. Antireflux or antiregurgitation milk products for infants and young children: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol. Nutr 2002;34(5):496-498. View abstract
  • Borrelli O, Salvia G, Campanozzi A, et al. Use of a new thickened formula for treatment of symptomatic gastrooesophageal reflux in infants. Ital J Gastroenterol.Hepatol. 1997;29(3):237-242. View abstract
  • Carroll AE, Garrison MM, Christakis DA. A systematic review of nonpharmacological and nonsurgical therapies for gastroesophageal reflux in infants. Arch Pediatr Adolesc.Med 2002;156(2):109-113. View abstract
  • Gruendel S, Garcia AL, Otto B, et al. Carob pulp preparation rich in insoluble dietary fiber and polyphenols enhances lipid oxidation and lowers postprandial acylated ghrelin in humans. J Nutr 2006;136(6):1533-1538. View abstract
  • Guggenbichler JP. Adherence of enterobacteria in infantile diarrhea and its prevention. Infection 1983;11(4):239-242. View abstract
  • Kwiterovich PO Jr. The role of fiber in the treatment of hypercholesterolemia in children and adolescents. Pediatrics 1995;96(5 Pt 2):1005-1009. View abstract
  • Loeb H, Vandenplas Y, Wursch P, et al. Tannin-rich carob pod for the treatment of acute-onset diarrhea. J.Pediatr.Gastroenterol.Nutr. 1989;8(4):480-485. View abstract
  • McPherson V, Wright ST, Bell AD. Clinical inquiries. What is the best treatment for gastroesophageal reflux and vomiting in infants? J Fam.Pract. 2005;54(4):372-375. View abstract
  • Miyazawa R, Tomomasa T, Kaneko H, et al. Effect of locust bean gum in anti-regurgitant milk on the regurgitation in uncomplicated gastroesophageal reflux. J.Pediatr.Gastroenterol.Nutr. 2004;38(5):479-483. View abstract
  • Puntis JW. Re: Effect of locust bean gum in anti-regurgitant milk on the regurgitation in uncomplicated gastroesophageal reflux. J Pediatr Gastroenterol.Nutr 2005;40(1):101-102. View abstract
  • Savino F, Muratore MC, Silvestro L, et al. Allergy to carob gum in an infant. J.Pediatr.Gastroenterol.Nutr. 1999;29(4):475-476. View abstract
  • Trommer H, Neubert RH. The examination of polysaccharides as potential antioxidative compounds for topical administration using a lipid model system. Int J Pharm 7-14-2005;298(1):153-163. View abstract
  • Turnbull LA, Santamaria S, Martorell T, et al. Seed size variability: from carob to carats. Biology Letters 2006;2:397-400.
  • Wenzl TG, Schneider S, Scheele F, et al. Effects of thickened feeding on gastroesophageal reflux in infants: a placebo-controlled crossover study using intraluminal impedance. Pediatrics 2003;111(4 Pt 1):e355-e359. View abstract
  • Zunft HJ, Luder W, Harde A, et al. Carob pulp preparation for treatment of hypercholesterolemia. Adv.Ther. 2001;18(5):230-236. View abstract
disclaimer: Natural Standard Bottom Line Monograph, Copyright © 2011 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions. disclaimer: While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy. disclaimer: The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

Copyright © 2011 Natural Standard (www.naturalstandard.com)



Copyright © 2011 Natural Standard (www.naturalstandard.com)
 
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