Sour Cherry

Generic name: Prunus Cerasus L.
Brand names: Montmorency Cherry, Morello Cherry, Pie Cherry, Red Cherry, Sour Cherry, Tart Cherry

Usage of Sour Cherry

Anti-inflammatory effects

Cherry-derived anthocyanins have anti-inflammatory effects that are likely related to inhibition of cyclooxygenase-1 (COX-1) and COX-2 enzymes, and to antioxidant activity.(Saric 2009, Vitale 2017, Walzer 2015) Sweet cherries may demonstrate greater COX inhibition than sour cherries; the anthocyanins from sweet and sour cherries possess varying levels of activity compared to the conventional nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxen.(Mulabagal 2009, Ou 2012, Seeram 2001, Tall 2004)

Animal and in vitro data

In rats and in vitro, inhibition of prostaglandin E2 has been described for sour cherry.(He 2006, Khoo 2012) Studies have also evaluated the effect of sour cherry on C-reactive protein (CRP), interleukins (IL-6, IL-8, and IL-10), and tumor necrosis factor alpha (TNF-alpha).(He 2006, Nguyen 2018, Walzer 2015)

Clinical data

Arthritis

A small, possibly underpowered (N=58) crossover study evaluated the effects of 240 mL of a sour cherry juice blend twice daily for 6 weeks in patients with mild to moderate knee osteoarthritis. Although CRP levels decreased, resulting in Western Ontario McMaster Osteoarthritis Index (WOMAC) score improvement in the study group, no difference in symptomatic relief compared with placebo could be determined. Treatment with the tart cherry juice blend did not affect acetaminophen use, walking time, plasma urate, or serum creatinine.(Schumacher 2013, Walzer 2015) Another clinical study (N=20) evaluated the efficacy of 315 mL of sour cherry fruit juice twice daily over 21 days in women with osteoarthritis. The study reported a significant reduction in CRP with sour cherry juice (P<0.05); however, there was no change in other biomarkers (interleukins or TNF-alpha).(Kuehl 2012) A phase 1 clinical trial evaluated topical application of a sour cherry seed extract emulsion over 2 months in 20 adults with osteoarthritis. Reduced joint pain was reported as well as decreased inflammatory biomarkers.(Mahmoud 2015)

Exercise-induced inflammation

A literature review evaluated clinical studies (published through December 2016) of sour cherry juice use in athletes.(Vitale 2017) Despite heterogeneity in patient population, sport/activity, and intervention protocols, the authors concluded that anti-inflammatory and antioxidant effects were attributed to the observed reductions in pain and improved recovery of muscle strength after strenuous exercise.(Vitale 2017) While sour cherry juice is unlikely to enhance athletic performance,(Vitale 2017) findings from a study conducted after the review inclusion date (N=10) suggest "end-sprint performance" in the participating cyclists may have improved due to acute supplementation with sour cherry juice. Time to exhaustion was not different between intervention and control arms of the study.(Keane 2018) Further studies provide support for a role in attenuating the symptoms of muscle damage and improving recovery following exercise.(Brown 2018) However, concerns that inhibiting the initial inflammatory response (adaptation) and thereby preventing muscle protein synthesis after exercise via excessive antioxidant ingestion exist.(Vitale 2017)

Cardiovascular effects

Documented antioxidant activity may suggest a cardioprotective role, including antihyperlipidemic effects possibly related to polyphenolic composition of the fruit juice.(Bialasiewicz 2018, Papp 2015)

Animal and in vitro data

Limited studies in rats report protective effects of sour cherry seed extract on reperfusion-related injury, with a decrease in infarct size observed in one,(Czompa 2014) and potential capacity to prevent ischemia/reperfusion–induced retinal damage in the diabetic setting suggested in another.(Varga 2017) Positive effects with respect to anti-atherosclerotic markers were demonstrated in vitro.(Keane 2016)

Clinical data

Limited small clinical studies report positive effects, mainly on systolic blood pressure (BP). A small clinical study (N=37) of older adults (65 to 80 years of age) reported decreased low-density lipoprotein (LDL), total cholesterol, and systolic BP following 12 weeks of supplementation with sour cherry juice. Blood glucose levels and body mass index (BMI) increased, with no effect on diastolic BP or insulin resistance.(Chai 2018) In a study of healthy adults (N=11), Montmorency tart cherry juice consumed over 20 days showed no effect on BP, glucose, or lipid profiles, aside from a decrease in high-density lipoprotein (HDL). There was also no effect on fat oxidation.(Desai 2018) A 12-week randomized controlled trial assessed the effect of daily sour cherry fruit juice in elderly patients (older than 70 years) with mild to moderate dementia (N=49). A reduction in systolic BP was noted, with a trend toward decreased diastolic BP; however, markers of inflammation (CRP and IL-6) were unchanged.(Kent 2017)

In studies in men with mild hypertension (N=15(Keane 2016) and N=27(Keane 2016)), single doses of Montmorency tart cherry concentrate 60 mL decreased systolic BP, with no impact on arterial stiffness. In a small double-blind, randomized, placebo-controlled study conducted in 23 healthy normotensive young adults (mean age, 24 years), consumption of Montmorency tart cherry (Prunus cerasus) concentrate (30 mL per 100 mL water) twice daily for 4 weeks had no significant effect on vascular indices (ie, systolic or diastolic blood pressure, heart rate, mean arterial pressure, pulse wave velocity, pulse stiffness or reflection index) compared with placebo.(Kimble 2021)

CNS

Cognitive function

Clinical data

Limited clinical studies evaluating use of sour cherry juice to improve cognitive performance have been conducted. A 12-week randomized, placebo-controlled trial assessed the effects of daily sour cherry fruit juice in elderly patients (older than 70 years) with mild to moderate dementia (N=49). Improvements were reported for verbal fluency and short- and long-term memory.(Kent 2017) Single-dose studies reported no effect on cognitive performance; in a small clinical study, cognitive function and mood of middle-aged volunteers 45 to 60 years of age (N=27) were not affected by a single 60 mL dose of Montmorency tart cherry concentrate.(Keane 2016)

Insomnia

Sour cherries may have beneficial effects in sleep disorders and insomnia by providing a dietary source of melatonin, possibly via interference with inflammatory cytokines that modulate sleep.(Burkhardt 2001, Howatson 2012, Pigeon 2010)

Clinical data

Limited and small clinical studies evaluating effects of sour cherry on insomnia report positive findings.(Howatson 2012, Losso 2018, Pigeon 2010) All the studies employed a double-blind, crossover design with small numbers of participants (elderly patients [65 years of age and older] with insomnia [N=15],(Pigeon 2010) healthy volunteers with insomnia [N=20],(Howatson 2012) and adults with chronic insomnia [N=8](Losso 2018)). All studies used sour (tart) cherry juice as the intervention, with dosages of 240 mL twice daily for 2 weeks(Losso 2018, Pigeon 2010) or 30 mL of the juice concentrate twice daily over 7 days.(Howatson 2012) Outcomes based on sleep diaries generally improved against baseline measures.(Howatson 2012) Actigraphy showed an increase in time in bed, total sleep time, and total sleep efficiency,(Howatson 2012) while polysomnography showed increased sleep time (by 84 minutes).(Losso 2018) Sour cherry juice increased total urinary melatonin but did not affect melatonin circadian rhythm(Howatson 2012, Losso 2018); in the study of healthy volunteers, sour cherry juice also increased tryptophan levels.(Losso 2018) Fatigue, depression, and anxiety did not improve with sour cherry juice.(Pigeon 2010)

Diabetes

Animal and in vitro data

In vitro, the juice extract has demonstrated activity against alpha-glucosidase and dipeptidyl peptidase IV, enzymes implicated in diabetes.(Casedas 2016) Studies in rodents suggest a protective role of extracts of sour cherry (both fruit and seed extracts) on diabetes.(Saleh 2017, Snyder 2016, Varga 2017) In a study of Zucker diabetic fatty rats, a protective effect of sour cherry seed extract on recovery of ischemia/reperfusion–induced retinal damage was suggested.(Varga 2017)

Clinical data

Clinical trials specifically designed to evaluate the effects of sour cherry fruit or seed extract in diabetes are lacking. In a small clinical study (N=37) of subjects 65 to 80 years of age designed to evaluate the effects of supplemental sour cherry juice for 12 weeks on dyslipidemia and hypertension, increases in blood glucose levels and BMI were observed, with no effect on measures of insulin resistance.(Chai 2018)

Gout

Anthocyanins in sour cherries have a potential role in treatment of gout via anti-inflammatory and antioxidant effects. The anti-inflammatory effects of sour cherry anthocyanins may be mediated by COX-1 and COX-2 inhibition.(Seeram 2001) Macrophages modulate the inflammatory response in acute gout by releasing nitric oxide and other proinflammatory substances.

Animal and in vitro data

In vitro, anthocyanins from sour cherries strongly inhibited nitric oxide production from macrophages, with inhibitory activity comparable with quercetin.(Wang 1999) In a study of hyperuricemic rats, sour cherry juice inhibited xanthine oxidase and reduced serum uric acid levels, but allopurinol had more potent effects on both measures.(Haidari 2009)

Clinical data

Limited small clinical studies have reported reductions in plasma uric acid levels, increases in urinary urate excretion, and reduced rates of gout exacerbation with consumption of sour cherry fruit or juice extract.(Gelber 2012, Jacob 2003, Schlesinger 2012) A larger internet-based study (N=633) was conducted over 1 year to examine the relationship between cherry intake and the risk for recurrent gout attacks, with participants acting as their own controls. However, type of cherry used in this study was not specified. Cherry fruit (10 to 12 cherries) or cherry extract consumption was associated with a reduction in the risk of recurrent gout attacks. A modest dose response to cherry consumption was reported, with benefit observed with 4 or more servings per day.(Zhang 2012)

The 2012 American College of Rheumatology guideline for the management of gout notes that a variety of complementary or alternative medicine regimens, including cherry juice, are inappropriate for the management of an acute gout attack.(Khanna 2012, Khanna 2012) This guideline is due for update in 2019.

Hematological parameters

Clinical data

Healthy volunteers consuming a sour cherry seed extract preparation showed hematological changes, including increased mean cell volume, serum transferrin, and mean peroxidase index, and decreases in circulating neutrophils and ferritin levels. The study sample size was too small to make clinical inferences.(Csiki 2015)

Dental carries

Clinical data

Sour cherry fruit extract decreased levels of Streptococcus mutans in human saliva and also reduced salivary alpha-amylase activity.(Homoki 2018)

Sour Cherry side effects

Case reports are lacking. The potential for alterations in hematological laboratory indices (mean cell volume, serum transferrin, and neutrophil and ferritin levels) may exist due to consumption of sour cherry seed extract.Csiki 2015

Allergy to cherries, including anaphylaxis has been reported.ACAAI 2006, Escribano 1996 In patients with oral allergy syndrome, crossreactivity has been reported between apricot, cherry, and plum.ACAAI 2006

In clinical studies, sour cherry fruit juice and the concentrate were generally well tolerated.Schumacher 2013

A case of reversible acute renal failure was attributed to daily ingestion of cherry juice concentrate. An elderly man with stage 3 nonproteinuric chronic kidney disease (estimated glomerular filtration rate [eGFR] 30 mL/min/1.73 m2) was hospitalized with hyperkalemia (6 mEq/L) and an acute decline in renal function (eGFR 16 mL/min/1.73 m2). The only recognized change in the patient's routine was that a month earlier, he started drinking 60 to 120 mL of cherry juice concentrate daily to prevent gout. After discontinuation of the cherry juice concentrate, renal function gradually returned to baseline over the following month. The case report did not indicate whether the product consumed was a concentrate of sweet or sour cherries. It reported the anthocyanin content to be 6 mg per 30 mL. The authors proposed that inhibition of renal COX enzymes by anthocyanins in the cherry juice concentrate led to a decrease in renal prostaglandin function, analogous to reversible renal impairment induced by NSAIDs.Luciano 2014

Before taking Sour Cherry

Sour cherry has GRAS status when used as food. Avoid dosages above those found in food because safety and efficacy are unproven.

A study in mice reported an increased expression of progesterone receptors and of hyaluronan synthase within cumulus cells as a result of sour cherry consumption, as well as an increased oocyte fertilization rate. The study did not identify whether the whole fruit was used or the fleshy parts only.Namvar Vansofla 2016

How to use Sour Cherry

Limited clinical trials have evaluated oral administration of various formulations of sour cherry juice, juice blend, or concentrate, the majority of which were made from Montmorency cherries. Anthocyanin concentrations varied among products and formulations.

Clinical trials evaluating use in a variety of conditions (eg, arthritis, muscle strength recovery in athletes, insomnia) employed juice or juice blend dosages ranging from 240 to 360 mL twice daily (anthocyanins 60 to 180 mg/day) for up to 6 weeks. The most common volume of concentrate used was 30 mL twice daily; treatment durations varied and concentrate was typically diluted before administration.Howatson 2012, Kuehl 2012, Losso 2018, Pigeon 2010, Schumacher 2013, Vitale 2017

A phase 1 clinical trial evaluated topical application of a sour cherry seed extract emulsion in adults with osteoarthritis.Mahmoud 2015

Warnings

Data regarding toxicity with clinical use of sour cherry fruit products are limited. Limited studies evaluating toxicity of the seed extract report no adverse effects in rodents or healthy volunteers based on kidney and liver function evaluations.Csiki 2015

What other drugs will affect Sour Cherry

In vitro, sour cherry juice inhibited monoamine oxidase A.Casedas 2016

A case report theorized the potentiation of adverse effects of anti-inflammatory COX inhibitors by cherry juice concentrate.Luciano 2014

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