Green papaya and leaves to fight cancer

PAPAYA
Also Known As:
Banane de Prairie, Caricae Papayae Folium, Chirbhita, Erandachirbhita, Erand Karkati, Green Papaya, Mamaerie, Melon Tree, Melonenbaumblaetter, Papaw,Papaya Fruit, Papayas, Papaye, Papaye Verte, Papayer, Papita, Paw Paw, Pawpaw.
CAUTION: See separate listings for Papain and American Pawpaw.
Scientific Name:
Carica papaya, synonyms Papaya carica, Carica peltata, Carica posoposa, Paw Paw,Pawpaw.
Family: Caricaceae.
People Use This For:
Orally, papaya is used orally for preventing and treating gastrointestinal tract disorders, intestinal parasite infections, dengue fever, and aging skin. Papaya is also used for preventing cancer, treating diabetes, and preventing persistent human papilloma virus (HPV). It is also used as a sedative and diuretic.
Topically, papaya is used for periodontitis, wound healing, neuralgia, and elephantoid growths.
Safety:
LIKELY SAFE …when used orally in amounts commonly found in foods. Papaya has Generally Recognized as Safe (GRAS) status in the US (4912).
POSSIBLY SAFE …when used orally and appropriately in medicinal amounts (6).
POSSIBLY UNSAFE …when used orally in excessive amounts. Papaya latex contains papain, which can cause esophageal perforation (6, 93083). …when used topically. Papaya latex (raw papain) is a severe irritant and vesicant (6).
PREGNANCY: POSSIBLY UNSAFE …when used orally; avoid using. Crude papain shows evidence that it is teratogenic and embryotoxic (6); however, this might be due to extraneous substances rather than papain (11). Some evidence also shows that high doses of extract of papaya seeds has abortifacient activity and can adversely affect fetal development (67870); theoretically, eating large amounts of papaya seeds may have similar effects.
LACTATION: Insufficient reliable information available; avoid using.
Effectiveness:
INSUFFICIENT RELIABLE EVIDENCE to RATE

Cancer. Some population research has found that eating papaya fruit might prevent some types of cancer. In one population study, eating papaya fruit was associated with a 66% lower odds of developing gallbladder cancer (67871). In another population study, papaya fruit consumption was associated with a 42% lower odds of developing colorectal cancer (67941).
Diabetes. Preliminary clinical research suggests that consuming fermented papaya fruit 3 grams once daily for 2 months can reduce fasting and postprandial blood sugar levels by 13.3% and 10%, respectively, compared to baseline in patients with type 2 diabetes (67902).
Human papilloma virus (HPV). Some population research has found that people who eat papaya fruit at least once weekly have a 70% lower odds of persistent HPV infection compared to people who never eat papaya fruit (67881).
Periodontitis. Preliminary clinical research shows that applying fermented papaya gel 7 grams into intragingival pockets for 15 minutes daily for 10 days reduces bleeding after 7 days, plaque after 14 days, and gingivitis after 14 days compared to baseline in patients with moderate to severe periodontitis. Gingival pocket depth is reduced after 45 days (93090).
Wound healing. Preliminary clinical research shows that applying a wound dressing containing partially ripe papaya fruit 200 grams to the edges of gaped wound for 48 hours reduces the time needed for granulation tissue to develop by 3.7 days, reduces the duration of hospitalization by 6.3 days, and decreases the percentage of patients requiring post-surgical wound debridement by about 94% compared to treatment with hydrogen peroxide dressing in patients with postoperative wound gape (93091).
More evidence is needed to rate papaya for these uses.

Mechanism of Action:
The applicable part of papaya is the leaf. Papaya leaf contains 2% papain and carpain (6). Papain is a mixture of enzymes that degrade protein, carbohydrates, and fats (515). Papain is unstable in digestive juices, which raises questions about whether it can be effective when used orally (515). Carpain is thought to be amebicidal. It might cause bradycardia (4009) or have central nervous system depressant or paralytic effects.
Adverse Reactions:
Ingestion of large amounts of papain might cause esophageal perforation. Severe allergic reactions can occur in individuals sensitive to papain (6, 515). Papaya may cause hypersensitivity reactions, which occur more commonly in people who are allergic to latex (6197, 7853).
Interactions with Herbs & Supplements:
HERBS AND SUPPLEMENTS WITH HYPOGLYCEMIC POTENTIAL: Clinical research suggests that daily consumption of fermented papaya can decrease fasting and postprandial blood glucose levels (67902). Concomitant use with other herbs and supplements with hypoglycemic potential might increase the risk of blood glucose levels becoming too low. Some herbs and supplements with hypoglycemic potential include devil’s claw, fenugreek, guar gum, Panax ginseng, and Siberian ginseng.
PAPAIN: Concomitant use of papain and papaya can increase the effects and adverse effects of papain.
Interactions with Drugs:

AMIODARONE (Cordarone, Nexterone, Pacerone)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = D

Animal research shows that concomitant administration of amiodarone 50 mg/kg body weight orally plus papaya extract 1230 mg/kg body weight orally delays the maximum plasma concentration of amiodarone from being achieved, but does not affect systemic exposure to amiodarone. Therefore, this interaction is probably not clinically significant. However, taking papaya extract 1230 mg/kg body weight orally for 14 days prior to taking a single dose of amiodarone 50 mg/kg body weight increases the extent of systemic amiodarone exposure by 60% to 70% (93093). Theoretically, repeated intake of papaya extract along with amiodarone may increase the effects and adverse effects of amiodarone.

ANTIDIABETES DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = B

Clinical research shows that daily consumption of fermented papaya can decrease fasting and post-prandial blood glucose levels in type 2 diabetic patients using glybenclamide, necessitating a dose adjustment of glybenclamide in approximately 36% of the patients (67902). Monitor blood glucose levels in diabetic patients using fermented papaya, as dose adjustments of antidiabetes drugs may be needed. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.

LEVOTHYROXINE (Synthroid, Levothroid, Levoxyl, and others)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

A case of hypothyroidism has been reported for a 37 year-old man who was taking levothyroxine. The patient, who had undergone total thyroidectomy 5 years earlier, had been stably euthyroid with levothyroxine treatment. When questioned about possible changes to his diet, the patient reported eating five or six papaya fruits daily while on a recent vacation. Forty-five days after discontinuing papaya consumption, the patient’s serum thyrotropin levels returned to normal without adjusting levothyroxine dose (93087). Theoretically, concomitant use of papaya can interfere with levothyroxine or hypothyroid therapy.

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = B

Concomitant use might potentiate the effects of warfarin increasing the international normalization ratio (INR) (613, 6048, 49621).

Interactions with Foods:
None known.
Interactions with Lab Tests:
INTERNATIONAL NORMALIZED RATIO (INR): Papain, which is in papaya leaf, can increase INR in people maintained on warfarin (Coumadin) (613).
Interactions with Diseases or Conditions:
DIABETES: Fermented papaya can reduce blood glucose and have additive effects with diabetes medications in patients with type 2 diabetes (67902). Advise patients to closely monitor glucose levels after starting papaya. Dose adjustments to diabetes medications may be necessary.
HYPOGLYCEMIA: In healthy adults, consuming fermented papaya for 2 months can decrease postprandial blood glucose levels and can cause hypoglycemia in some individuals (67902). Theoretically, fermented papaya might increase the risk of blood glucose levels becoming too low in individuals who are already hypoglycemic.
HYPOTHYROIDISM: Theoretically, eating large amounts of papaya fruit might exacerbate hypothyroidism or interfere with therapy (93087).
LATEX ALLERGY: People who are allergic to latex should avoid eating papaya or taking papaya-containing products because of the possibility of cross hypersensitivity between latex and papaya (6197, 7853, 23831, 23832, 57497).
PAPAIN ALLERGY: Papaya contains papain. Theoretically, papaya may cause allergic reactions in individuals who are allergic to papain. If you are allergic to papain, avoid eating papaya or taking products that contain papaya.
SURGERY: Fermented papaya can reduce blood glucose levels (67902). Theoretically, papaya might interfere with blood glucose control during and after surgical procedures. Tell patients to discontinue papaya at least 2 weeks before elective surgical procedures.
Dosage/Administration:
ORAL: People typically use papaya with enzyme chewable tablets which contain 250 mg of papaya powder, 150 mg of dried pineapple juice powder, and 10 mg of papain (5024). One tablet is chewed up to three times daily, preferably after a meal(5024).
TOPICAL: No typical dosage.
Editor’s Comments:
Fermenting papaya leaves may make more potent, richer brewed teas (515).

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