Acm 2017 0083 PDF
Acm 2017 0083 PDF
ORIGINAL ARTICLES
Abstract
Aim: The aim of this article is to review the current literature on the therapeutic uses and efficacy of Triphala.
Herbal remedies are among the most ancient medicines used in traditional systems of healthcare such as
Ayurveda. Triphala, a well-recognized and highly efficacious polyherbal Ayurvedic medicine consisting of
fruits of the plant species Emblica officinalis (Amalaki), Terminalia bellerica (Bibhitaki), and Terminalia
chebula (Haritaki), is a cornerstone of gastrointestinal and rejuvenative treatment.
Methods: A search of the PubMed database was conducted.
Results: In addition, numerous additional therapeutic uses described both in the Ayurvedic medical literature
and anecdotally are being validated scientifically. In addition to laxative action, Triphala research has found the
formula to be potentially effective for several clinical uses such as appetite stimulation, reduction of hyperacidity,
antioxidant, anti-inflammatory, immunomodulating, antibacterial, antimutagenic, adaptogenic, hypoglycemic,
antineoplastic, chemoprotective, and radioprotective effects, and prevention of dental caries. Polyphenols in
Triphala modulate the human gut microbiome and thereby promote the growth of beneficial Bifidobacteria and
Lactobacillus while inhibiting the growth of undesirable gut microbes. The bioactivity of Triphala is elicited by
gut microbiota to generate a variety of anti-inflammatory compounds.
Conclusions: This review summarizes recent data on pharmacological properties and clinical effects of
Triphala while highlighting areas in need of additional investigation and clinical development.
1
Department of Family Medicine and Public Health, UC San Diego School of Medicine, Center of Excellence for Research
and Training in Integrative Health, La Jolla, CA.
2
Chopra Foundation, Department of Ayurveda and Yoga Research, Carlsbad, CA.
3
Department of Naturopathic Medicine, Bastyr University, San Diego, CA.
ª Christine Tara Peterson et al., 2017; Published by Mary Ann Liebert, Inc. This is an Open Access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
607
608 PETERSON ET AL.
As both Ayurveda and Western medicine agree that Triphala in gastrointestinal health
health and disease begin in the gut,1,3 Triphala represents an Triphala is perhaps most well known for its use in general
essential foundational formula as it promotes efficient di- gastrointestinal health. Animal studies have shown that both
gestion, absorption, elimination, and rejuvenation. Numer- aqueous and alcohol-based extracts of Triphala prevent di-
ous references in well-respected Ayurvedic medical texts arrhea.9 Triphala also induces enteroprotective effects,
make clear that Triphala is revered as a multiuse therapeutic which are likely due, at least in part, to the high antioxidant
and perhaps even panacea historically.1,2 content. In a rodent model, Triphala replenished depleted
Ayurvedic Classification protein in the intestinal villi of the brush border as well as
glutathione and phospholipid levels; the formula simulta-
Triphala is classified as a tridoshic rasayana, meaning neously decreased myeloperoxidase and xanthine oxidase
that the energetics are appropriate for Vata, Pitta, and Ka- levels in intestinal epithelium.10 In rats, Triphala exerted a
pha or all types of patients. Charak describes rasayanas as gastroprotective effect on stress-induced ulcer.11 One human
having the qualities of supporting strength and immunity.1 clinical trial that investigated the use of Triphala in patients
Given these qualities and the tonic energetics, Triphala can with gastrointestinal disorders reported that treatment reduced
be considered for use in the very young, the infirmed, and constipation, mucous, abdominal pain, hyperacidity, and flat-
the elderly. Other classical Ayurvedic classifications attrib- ulence while improving the frequency, yield, and consistency
uted to the formula are shukrala, digestive, mild laxative at of stool.12 Triphala also reduced colitis in a mouse model, and
normal doses, bowel tonic at low dose, purgative at high the treatment effect was attributed to antioxidant effects and
doses, carminative, expectorant, antispasmodic, and bron- high levels of flavonoids contained in Triphala.13
chodilator. In addition, myriad other uses are described both
in the Ayurvedic medical literature and anecdotally. Stress-reducing potential of Triphala
Ayurvedic Pharmacology Stress-induced disorders such as anxiety represent the
Dravya guna or Ayurvedic pharmacology describes the leading causes of adult disability worldwide.14 Stress is a state
attributes of herbs. The rasa or taste of Triphala is sweet, sour, of disharmony caused by perceived threat that is counteracted
by an adaptive response to reestablish homeostasis and is
pungent, bitter, and astringent; the only taste not contained
within the formula is salty. The virya, or potency and action, is associated with many chronic diseases. Animal studies have
neutral, and the vipaka, or postdigestive effect of the formula, shown that Triphala protected against cold-induced stress and
reversed stress-induced behavioral alterations and biochem-
is sweet. Triphala has a prabhav, meaning special action or
trophism, for all doshas (energetics and mind–body types) ical changes such as increased lipid peroxidation and corti-
and thus is balancing for all doshas and constitutions. The costerone levels.15 Triphala also prevented noise-induced
gunas, or qualities, of Amalaki are heavy and dry, and both stress.16 In rats, Triphala prevented the noise-induced meta-
bolic changes by mediating the antioxidant and cell-mediated
Haritaki and Bhibitaki are considered light and dry.4
immune response, and it was hypothesized that the biological
Therapeutic Uses and Studies mechanism is related to its antioxidant properties.6,16–19
Modern humans experience high levels of stress, thus adap-
Ayurvedic medicine uses Triphala as a pillar of gastroin- togenic treatments are needed more extensively in clinical
testinal treatment; however, the complexity of the three ra- practice.
sayanas, or rejuvenative herbs, in the formulation allows for
many applications. Moreover, studies have validated a number
Antiobesogenic and antidiabetic potential of Triphala
of potential uses of Triphala, which include free radical scav-
enging, antioxidant, anti-inflammatory, immunomodulating, Deregulation of eating behavior is common in industri-
appetite stimulation, gastric hyperacidity reduction, dental caries alized countries. Studies have demonstrated the potential of
prevention, antipyretic, analgesic, antibacterial, antimutagenic, Triphala as a therapeutic agent for weight loss and reduction
wound healing, anticariogenic, antistress, adaptogenic, hypo- of body fat. In an animal study, Triphala was administered
glycemic, anticancer, hepatoprotective, chemoprotective, radio- for 10 weeks to diet-induced obese mice.20 Triphala treat-
protective, and chemopreventive effects.4 Triphala may also ment decreased the percentage of body fat, body weight, and
promote proper digestion and absorption of food, reduce serum energy intake. Triphala also decreased total cholesterol,
cholesterol levels, improve circulation, relax bile ducts, prevent triglycerides, and low-density lipoprotein cholesterol in the
immunosenescence, maintain homeostasis of the endocrine sys- experimental group compared with the control group. In a
tem, and increase production of red blood cells and hemoglobin.4 12-week, double-blind, randomized placebo-controlled trial,
The major constituents of the formula are the tannins, human subjects treated with Triphala lost *5 kg compared
gallic acid, ellagic acid, and chebulinic acid, which are with the placebo control group.21 Mean fasting blood sugar
potent antioxidants that may account, at least in part, for the and fasting serum insulin levels were also reduced in the
observed immunomodulatory activity of the formula.5–7 treated compared with control subjects. Given the global
Triphala also contains other bioactive compounds such as obesity epidemic, more treatment options are necessary to
flavonoids (e.g., quercetin and luteolin), saponins, anthra- reduce the associated healthcare burden.
quinones, amino acids, fatty acids, and various carbohydrates.6 Triphala exerts hypoglycemic effects. Patients with type 2
In addition, Triphala-derived polyphenols such as chebu- diabetes are likely to have high postprandial blood glucose
linic acid are also transformed by the human gut microbiota levels, especially after consuming carbohydrates. Elevated
into bioactive metabolites, which have demonstrated po- blood glucose results from the breakdown of carbohydrates by
tential in vitro to prevent oxidative damage.8 the digestive enzymes, alpha-amylase and alpha-glucosidase,
THERAPEUTIC USES OF TRIPHALA 609
and the reduced ability of cells to take in glucose from the blood. agents with high efficacy. Both Triphala water decoctions
Past studies report that Triphala may exert actions similar to (12%) and ethanol extracts (14%) have demonstrated anti-
diabetic pharmaceutical drugs by inhibiting digestive enzymes bacterial activity in vitro against bacterial isolates derived
and may decrease absorption of glucose through inhibition of from patients infected with human immunodeficiency vi-
glycolytic enzymes, thereby reducing blood glucose levels. One rus28; the ethanol extracts were reported to have greater in vitro
study demonstrated the inhibitory potential of Triphala on antimicrobial action against these species compared with the
pancreatic glycolytic enzymes, namely alpha-amylase and aqueous extracts, which may indicate lower solubility of the
alpha-glucosidase, which break down larger polysaccharides aromatic antibiotic compounds.
into glucose molecules that enter the blood stream.20 In addition, other studies report that these extracts also
The role that Triphala plays in inhibiting starch digestion exert broad-spectrum antimicrobial action against antibiotic-
and absorption, thereby decreasing postprandial hypergly- resistant bacteria isolated from human subjects. The aqueous
cemia, is similar to that of diabetes pharmaceutical drugs, extracts (1:6) have demonstrated greater efficacy compared
such as miglitol and acarbose, which also target these gly- with the ethanol extracts (1:6) on pathogenic bacteria such
colytic enzymes. In addition, Triphala decreased serum as Escherichia coli and Staphylococcus aureus.29 In vitro,
glucose levels in normal and alloxan-induced diabetic rats.22 ethanol extracts of Triphala (100 mg/mL) components ex-
A clinical study of noninsulin-dependent diabetes mellitus hibited specific antimicrobial activity against multidrug-
patients revealed that supplementation with 5 g of Triphala resistant clinical bacterial isolates.30 Thus, Triphala was
powder for 45 days significantly lowered blood glucose reported to exert antibacterial effects on both gram-positive
levels.23 Both fasting and postprandial blood glucose were and gram-negative species in vitro and demonstrated po-
reduced, which may be due to active ingredients such as tential for further investigation as a complementary or ad-
sorbitol. Constituents in Triphala, including ellagitannins junct antimicrobial therapy.
and gallotannins, also enhance both PPAR-alpha and - In addition to antimicrobial effects against oral bacteria,
gamma signaling, which increase insulin responsiveness and Triphala has also demonstrated the potential to eradicate en-
glucose uptake without inducing adipogenesis.24 These teric pathogens in vitro. One study tested the effects of Tri-
polyphenols may also promote decreased blood glucose and phala aqueous extract (200 mg/mL) against enteric bacterial
insulin levels in diabetic patients. pathogens in vitro and found that Triphala possesses strong
Triphala may also protect diabetics and those predisposed antibacterial effects against Staphylococcus epidermidis and
to diabetes through inhibition of glycation enzymes. Ele- S. aureus and moderate effects against Proteus vulgaris,
vated blood glucose can cause severe damage through the Pseudomonas aeruginosa, and Salmonella typhi.30 In addition
process of glycation, in which sugar molecules compromise to antibacterial effects, Triphala is also known to exhibit
protein molecules in the body, which may in turn lead to antifungal properties. Triphala exerts antifungal action
nerve damage or blindness. Due to the presence of tannins, against Asperigillus species and has been reported to in-
Triphala extract was found to effectively inhibit protein hibit the fungus by up to 37.96% in vitro. In particular, the
glycation in vitro.25 Triphala may also prevent glycation aqueous extracts (1:1) of fresh fruits were found to be more
through promotion of lower blood glucose levels. As dia- effective than dry fruits.31 Thus, the formula represents a
betes is the most prevalent endocrine disease globally, in- promising antimicrobial candidate in need of further study.
creased access to complementary hypoglycemic therapies The Potential of Triphala in Oral Care: Triphala has been
for integrative care is needed. used traditionally in Ayurvedic medicine as an antimicrobial
agent.32 Numerous controlled clinical trials have shown that
Triphala and cardiovascular health Triphala significantly reduces the abundance of oral bacte-
ria, dental plaque, and gingivitis in human subjects.33–38 For
Cardiovascular disease is a leading cause of mortality and
example, Triphala is effective against Enterococcus faeca-
morbidity worldwide, and hypercholesteremia is an impor-
lis, one of the most difficult to eliminate oral pathogens that
tant risk factor. Animal studies have reported the hyperc-
are commonly isolated in chronic periodontitis. One study
holesteremic effects of Triphala. In one study, Triphala
revealed that Triphala (5 mg/mL) in 10% dimethyl sulfoxide
reduced the total cholesterol, low-density lipoprotein, very
(DMSO) was equally or more effective at eliminating E.
low-density lipoprotein, and free fatty acid levels in rats fed
faecalis in vitro compared with NaOCl, a common irrigant
an atherogenic diet for 48 days.26 Another study in rats fed
used during root canals.39 Triphala was more effective than
an atherogenic diet revealed that Haritaki, one of the herbs
0.5% and 1% NaOCl solution, but equally effective as 2.5%
in Triphala, induced hypolipidemic effects in the herb-
and 5% solutions.
treated group. A reduction in total cholesterol, triglycerides,
In addition, another group reported that Triphala in
and total protein and elevation of high-density lipoprotein
10% DMSO was more effective than 5.25% NaOCl solu-
cholesterol were found in the herb-treated group compared
tion against E. faecalis biofilms on ex vivo tooth substrate
with control group.27 Triphala is a powerful herb to address
and suggested the extract as an alternative in the context of
imbalances in the gastrointestinal tract and cardiovascular
clinical root canal irrigation.40,41 A study using human pri-
system and should be more widely studied in the context of
mary teeth ex vivo revealed that Triphala suspended in 10%
these common diseases.
DMSO (1:3) exhibited significant antibacterial activity
compared with control as well as higher antibacterial ac-
Antimicrobial potential of Triphala
tivity compared with 3% NaOCl.42 In vitro studies using
Overadministration of antibiotics has led to widespread Triphala ethanol extract have reported similar antimicrobial
drug resistance, thus it is becoming imperative that clinical effects against E. faecalis compared with 2.5% NaOCl.43
researchers discover alternative and adjunctive antimicrobial Thus, Triphala may represent a potential therapy to eliminate
610 PETERSON ET AL.
E. faecalis as more side-effects and larger risk are associated ditional clinical trials should be performed to identify the
with NaOCl solution treatment. potential for integration in dentistry.
Dental caries, or cavities of the teeth, is a common in-
fection associated with humans. Examining the use of Triphala Radioprotective effects of Triphala
as an oral antimicrobial agent, one study reported that Triphala
Studies have concluded that Triphala may help prevent and
dissolved in 10% DMSO exhibited a significant antibacterial
reverse DNA damage and mutagenesis.53 The prevention of
effect ex vivo on extracted human mandibular premolars
DNA damage is important given that it is often an initiating
against Streptococcus mutans, which is one of the most
event in carcinogenesis. Research in animal models and
prevalent oral pathogens responsible for dental cavities.44
in vitro has shown that Triphala is effective in prevention
Human clinical trials using Triphala water decoction as a
of mutagenesis induced by both chemical- and radiation-
mouthwash report that it exerts comparable efficacy com-
induced damage.54–56 An in vitro study found that Triphala
pared with chlorhexidine gluconate germicidal mouthwash
eliminated reactive oxygen species in HeLa cells exposed
in the prevention of dental caries.45,46 For example, a study
to ionizing X-radiation or bleomycin, both of which gener-
in human subjects revealed that Triphala (6%) mouthwash
ate DNA strand breaks through the generation of reactive ox-
promoted a significant reduction in oral streptococcus col-
ygen species.57 In addition, gamma-radiation-induced plasmid
onies. Oral streptococcus levels were measured after using
DNA strand break was inhibited by Triphala in vitro. The
a 6% Triphala mouthwash or 0.2% chlorhexidine mouth-
rasayana formulation also inhibited radiation-induced lipid
wash twice per day for 48 h and for 7 days; Streptococcus
peroxidation in rat liver microsomes and demonstrated the
levels were reduced by 17% and 44%, respectively, in the
ability to scavenge free radicals such as superoxide. Importantly,
Triphala-treated group.33 The researchers concluded that
the high levels of phenolic compounds such as gallic acid
Triphala was as effective as 0.2% chlorhexidine mouthwash
were attributed to the free radical scavenging activity.56
given that the results of the Triphala treatment were similar to
In animal models, Triphala intervention reduced radiation-
the chlorhexidine-treated group. Another double-blind hu-
induced mortality by 60% in mice fed Triphala for only 7 days
man clinical trial also reported significant reductions in oral
before whole-body gamma-irradiation.54 Triphala reversed
streptococcus levels at 5 and 60 min after rinsing with 15 mL
the increased xanthine oxidoreductase and decreased the su-
aqueous Triphala extract (10%) mouthwash.47
peroxide dismutase activity that was observed post-irradiation.
In addition, a double-blind, randomized human clinical
Treatment with Triphala also prevented DNA damage in
trial reported that Triphala (10%) mouthwash is effective
murine white blood cells and spleen cells post-irradiation.
against dental plaque and gingivitis in teenagers.48 The
Triphala may play a protective role against oxidation, even
study reported Triphala as equally effective in antiplaque
when administered after exposure.
and antigingivitis activity compared with chlorhexidine.
In addition, other animal studies have reported significantly
Moreover, a clinical study in children on the effects of
reduced acute intestinal damage after ionizing radiation ex-
Triphala (0.6%) mouthwash on dental plaque, gingival in-
posure in groups fed Triphala (1 kg/g) for at least 5 days
flammation, and microbial growth also compared its efficacy
before radiation treatment.58 Moreover, studies have dem-
with a commercially available chlorhexidine mouthwash.
onstrated that Triphala feeding before gamma-radiation ex-
The results indicated that both the germicidal chlorhexidine
posure reduced radiation sickness and mortality in mice.59
(0.1%) and Triphala mouthwash were equally effective in
Triphala was reported to scavenge hydroxyl, superoxide an-
reducing plaque and increasing gingival health after 9
ion, and nitric oxide free radicals in a dose-dependent manner
months; however, Triphala was more effective than chlor-
in vitro.59 Triphala aqueous extract feeding for 5 days before
hexidine in reducing microbial cell counts.49 A double-blind,
exposure was also reported as protective against gamma-
randomized clinical trial in young adults also compared
radiation in mice at a dose of 10 mg/kg, which was 1/28 of
the efficacy of Triphala (0.6%) and chlorhexidine (0.12%)
the calculated LD50 dose.60 Thus, the antioxidant and free
mouthwash for 21 days and reported a similar reduction in
radical scavenging activities of Triphala were concluded to
both plaque and gingival scores for both the Triphala- and
serve a role in its protective effect against ionizing radiation.
chlorhexidine-treated groups.50 Triphala mouthwash treat-
Human clinical trials to further elucidate the mechanisms of
ment has also shown promise to reverse precancerous oral
radioprotective action and clinical utility are required.
lesions associated with tobacco use in young adults.51
In periodontal diseases, matrix metalloproteinases (MMPs)
Antineoplastic activity of Triphala
degrade extracellular matrix proteins in a spectrum of pro-
cesses that include tissue remodeling such as the connective Triphala has been investigated as a potential antineoplastic
tissue destruction observed in periodontitis. Ex vivo Triphala agent.61 Numerous studies have been performed in this con-
studies using extracted gingival tissue have demonstrated a text and have shown that Triphala exerts an antineoplastic
greater reduction of MMP-9 activity in patient-derived white effect on many cancer cell lines, including those of the breast,
blood cells treated with Triphala compared with patient- prostate, colon, and pancreas.62–64 Data in cell lines show
derived cells treated with the standard antibiotic drug.52 In that Triphala has a differential modulatory effect on normal
treated tissue extracts, Triphala (1.5 mg/mL) reduced MMP-9 and cancer cell lines. Triphala induces cytotoxicity in cancer
activity by 77%, while doxycycline (300 mg/mL) reduced cells, which showed increases in intracellular reactive oxygen
MMP-9 activity by 59%. Thus, MMP inhibitors are important species, but not normal cells. Excised tumor tissue from
adjunctive therapies in periodontitis treatment and Triphala Triphala-fed mice compared with controls suggested that ap-
may represent a candidate to investigate in greater detail in optosis induction may have mediated reduced tumor growth.65
this context. In addition, given the observed effectiveness of Preclinical studies using in vitro and in vivo models report
Triphala mouthwash compared with standard treatment, ad- that Triphala inhibits cancer growth in both cell and in vivo
THERAPEUTIC USES OF TRIPHALA 611
models and the effects are mediated through the ERK and Triphala-treated group compared with controls.72 The anti-
p53 pathways.63 In addition, methanol extract of Triphala inflammatory effects of Triphala should be investigated in
suppressed proliferation and induced p53-independent apo- greater detail.
ptosis in human colon cancer stem cells.64 Triphala sup-
pressed the expression of oncogenes, c-Myc and Cyclin D1, Antiaging effects of Triphala
and thus Wnt pathway signaling to reduce proliferation and
resistance to apoptosis. Triphala-induced apoptotic induc- Triphala extract exerted highly protective antiaging ef-
tion occurred through the intrinsic mitochondrial apoptotic fects on human skin cells in vitro. Triphala extract affects
signaling pathway. Moreover, one clinical trial reported that gene expression of human skin cells, stimulating collagen-1
Triphala powder treatment in healthy humans increased cy- and elastin-synthesizing genes and antioxidant genes re-
totoxic T cells and NK cells in the experimental group sponsible for the cellular antioxidant, SOD-2. Triphala
compared with the control group.66 Thus, Triphala shows extract was found to inhibit melanin production and hyper-
potential as an antineoplastic agent and thus should be sys- pigmentation due to the presence of protective phytochem-
tematically explored for potential as an adjunct therapy in the icals. Furthermore, Triphala extract exhibited significant
management of colon and other cancers. free radical scavenging activity on hydrogen peroxide-
induced cell damage and senescence.73 These results dem-
Antioxidant activity of Triphala and eye health onstrate potential dermal antiaging effects of Triphala, such
as increasing collagen and elastin, increasing cellular anti-
Antioxidant effects of Triphala have the potential to help oxidants, and decreasing hyperpigmentation.
maintain eye health. Triphala is a rich source of vitamin
C and flavonoids. One study used Triphala as a pretreat- Variable efficacy of herbal therapies
ment in selenite-induced cataracts in mice. Triphala sig-
nificantly restored glutathione levels in eye lenses. Triphala A number of factors, including variability in herbal source,
also increased the activities of antioxidant enzymes, such as processing, bioavailability, digestion, and absorption of her-
superoxide dismutase, catalase, glutathione-S-transferase, bal components, cause the true efficacy of herbs on human
and glutathione peroxidase, in the lenses of the experimental health to be highly variable. This variability is known to be at
group when compared with the control group. While 100% least partially due to inherent variation in the gut microbiota
of the mice in the control group developed cataracts, only that act on the ingested components of herbal remedies
20% of the mice pretreated with Triphala developed cata- and transform them into compounds with increased bioab-
racts. This effect may be linked to the antioxidant activity of sorption and bioactivity. These features have confounded the
Triphala.67 true efficacy of herbal remedies as it pertains to the mainte-
nance of human health and/or the ability to reverse chronic
Anti-inflammatory effects of Triphala disease states.
Chronic inflammation is deleterious and affects most major
chronic health conditions. Triphala has shown promise as an
anti-inflammatory agent. In one study, Triphala performed
better or equivalent when compared with standard drug
treatment for a variety of biochemical measurements of in-
flammation.19 In addition, Triphala significantly reduced in-
flammatory markers as well as bone and cartilage degradation
in arthritic rats.68 In this study, Triphala extract was signifi-
cantly more effective than the nonsteroidal anti-inflammatory
drug, indomethacin, in ameliorating arthritic and inflam-
matory effects. Triphala reduced expression of inflamma-
tory mediators such as IL-17, COX-2, and RANKL through
inhibition of NF-kB activation. Another study found that
Triphala increased antioxidant levels and decreased lipid per-
oxidation in the tissues of arthritic rats.69
In lipopolysaccharide-stimulated macrophages, Triphala
treatment suppressed production of inflammatory media-
tors (such as TNFa, IL-1b, IL-6, MCP-1, VEGF, NO, and
PGE2), intracellular free radicals, inflammatory enzymes
(such as iNOS and COX-2), and lysosomal enzyme re- FIG. 1. The bioactivity of Triphala is elicited by gut micro-
lease.70 Chebulagic acid, a constituent in Triphala, was biota. The phytochemicals in Triphala promote the growth of
found to inhibit COX and 5-LOX, which are both major beneficial gut microbes such as Bifidobacteria and Lactobacillus
enzymes involved in inflammation and carcinogenesis.71 species while inhibiting the growth of less desirable and po-
tentially more inflammatory gut residents such as Escherichia
Triphala also increased antioxidant activity in mice after
coli. The enzymatic activity of lactic acid bacteria degrades
induction of nephrotoxicity from bromobenzene. Triphala tannins in Triphala such as gallic acid. Triphala-derived poly-
ameliorated nephrotoxic effects by upregulating antioxi- phenols such as chebulinic acid are also transformed by the
dant enzymes, superoxide dismutase, glutathione-S- human gut microbiota into metabolites such as urolithins, which
transferase, and glutathione peroxidase. Lipid peroxidation have the potential to prevent oxidative damage and inflamma-
and markers of kidney dysfunction were reduced in the tion. Illustration by Victor Hewitt; used with permission.
612 PETERSON ET AL.
The increased popularity of herbal remedies such as Tri- Exposition Based on Cakrap
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therapies such as Triphala is warranted to increase awareness of 16. Srikumar R, Parthasarathy NJ, Manikandan S, et al. Effect
these treatments for both clinical and healthy populations. of Triphala on oxidative stress and on cell-mediated im-
mune response against noise stress in rats. Mol Cell Bio-
Author Disclosure Statement chem 2006;283:67–74.
C.T.P. is a postdoctoral fellow at UCSD partially funded 17. Carlsen MH, et al. The total antioxidant content of more
by the Chopra Foundation. D.C. is a founder of the Chopra than 3100 foods, beverages, spices, herbs and supplements
Foundation and Chopra Center and a co-owner of the used worldwide. Nutr J 2010;9:3.
18. Kumari N, et al. Effects of ionizing radiation on microbial
Chopra Center.
decontamination, phenolic contents, and antioxidant prop-
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effect by ameliorating bone and cartilage degradation in in Integrative Health
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