Strawberry

Generic name: Fragaria Ananassa, Fragaria X Ananassa, Duch.
Brand names: Strawberry

Usage of Strawberry

The consumption of strawberries has been related to the maintenance of well-being and the prevention of several chronic diseases because of the high contents of antioxidants and phytochemicals present in the fruit. Several biological effects have been explained through the total antioxidant capacity exerted by these bioactive compounds. It has been reported that strawberry phenolics are able to exert anti-inflammatory, anticarcinogenic, antiproliferative, and antiatherosclerotic activities, acting on specific molecular pathways related to antioxidant defenses, metabolism, survival, and proliferation.(Giampieri 2017)

Antihyperlipidemic effects

Clinical data

In a randomized, crossover study of hyperlipidemic patients (N=28) randomized to receive a 1 lb dietary strawberry daily supplement (454 g/day) or calorie-equivalent oat bran bread per 2,000 kcal/day diet for 1 month (as replacements for desserts, cakes, muffins, pastries, and cookies) following a long-term (mean duration, 2.5 years) single-phase, open-label, cholesterol-lowering dietary intervention study, no difference in blood lipids occurred between treatments compared with baseline. However, a significant reduction in oxidative damage to low-density lipoprotein (LDL) cholesterol was observed after 4 weeks of consumption of strawberries (but not of oat bran bread), reflecting a potential reduction in atherogenicity. Additionally, no change was observed for blood pressure, hematologic parameters, C-reactive protein, serum electrolytes, fasting glucose, or renal or liver function in either group.(Jenkins 2008) In contrast, a 7-week double-blind, randomized, crossover, pilot study in 31 obese subjects (body mass index [BMI] 30 to 40 kg/m2) evaluated the effect of strawberries on cardiometabolic risk factors or other health risks known to be associated with morbidity and mortality in obese individuals. All meals were provided to participants; breakfast and dinner were supervised. Exclusion criteria included vegetarianism and use of antihyperlipidemics, steroids, thyroid-regulating medications, or weight loss products. Participants consumed the equivalent of 320 g/day of strawberries in the form of a powder mixed as a milk shake, in yogurt, in cream cheese, or in a water-based sweetened beverage. Controls contained strawberry flavoring and red food coloring. Of the 31 subjects, 5 dropped out because of dislike of the provided meals and 6 for reasons unrelated to the study. Compared with the control intervention, dietary strawberry produced improvements in blood sodium and carbon dioxide (P<0.05 each), serum cholesterol (P=0.0438), small HDL particles and small HDL cholesterol (P<0.05 each), and mean LDL particle size (P<0.05). Acute-phase protein fibrinogen was increased in subjects receiving strawberry powder but remained within normal limits, and no differences in other inflammatory markers or antioxidant status were observed between the 2 dietary groups.(Zunino 2012) Similarly, a randomized, controlled, dose-response study (N=60) evaluated the effect of freeze-dried strawberry supplement beverage (kosher, nonorganic, standardized to polyphenol content) on cardiometabolic parameters in hyperlipidemic patients with abdominal adiposity. Changes in total serum cholesterol (−33 mg/dL), LDL cholesterol (−27.5 mg/dL), and nuclear magnetic resonance–derived small LDL particles (−301 nmol/L) were significantly better over 12 weeks with administration of high-dose freeze-dried strawberry (50 g/day [25 g twice daily]) compared with low-dose freeze-dried strawberry (25 g/day [12.5 g twice daily]) (P<0.05 for each). Only high-dose strawberry supplementation produced significant improvements in total and LDL cholesterol (P<0.05) compared with controls. Reductions in the lipid oxidation biomarker malondialdehyde (MDA) were also observed with both the high and low doses of the strawberry beverage (P<0.01 and P<0.001, respectively). No differences were noted in blood pressure, anthropometrics, or measures of glycemia between the 2 groups.(Basu 2014) This study built on an earlier randomized controlled study (N=30) by the same author, in which dietary supplementation of 50 g/day (25 g twice daily) of strawberry beverage (equivalent to 500 g of fresh strawberries) was administered for 8 weeks to patients with clinically significant obesity (BMI greater than 35 kg/m2) and metabolic syndrome. Strawberry supplementation improved total cholesterol, LDL cholesterol, small LDL particle concentrations, and vascular cell adhesion molecule-1 (P<0.5 for all) but had no effect on features of metabolic syndrome (eg, waist circumference, blood pressure, fasting glucose) or other lipid parameters.(Basu 2010)

A randomized controlled trial in adults with moderate hypercholesterolemia showed that strawberries may improve vascular health, independent of other metabolic changes. The effect may be related to changes in microbial-derived phenolic metabolites after strawberry consumption, which influences endothelial function. Significant intervention in terms of flow-mediated dilation (FMD) (P=0.03) and blood pressure (BP; P=0.05) revealed increased FMD at 1 hour after strawberry compared with control by 1.5 ± 0.38% (P=0.0008) and attenuated systolic BP at 2 hours by 3.1 ± 0.99 mm Hg (P=0.02).(Huang 2021)

Anti-inflammatory effects

Strawberries have shown promising results in reducing pain and inflammation in experimental models and in human clinical studies of arthritis. There is also some evidence on the role of specific fruit polyphenols, such as quercetin and citrus flavonoids in alleviating rheumatoid arthritis symptoms.(Basu 2018)

Clinical data

Some anti-inflammatory activity has been reported with dietary strawberry supplementation in antitumor and cardiometabolic studies.(Chen 2012, Edirisinghe 2011) In a 6-month, phase 2, randomized, controlled, unblinded study investigating the effects of 2 doses of freeze-dried strawberries in adults older than 40 years (N=75) with esophageal dysplastic lesions, protein expression of inflammatory biomarkers in esophageal mucosa was reduced with 60 g/day of freeze-dried strawberry powder but not with 30 g/day.(Chen 2012) Similarly, in a single-blind, randomized, placebo-controlled, crossover trial (N=26) in at-risk overweight adults, the addition of a milk-based strawberry beverage made from 10 g of freeze-dried strawberry powder (equivalent to 100 g of fresh strawberries) to a single high-carbohydrate, moderate-fat test meal (bagel, margarine, cream cheese, cantaloupe, and egg) significantly improved postprandial plasma inflammation biomarkers such as high-sensitivity C-reactive protein (hs-CRP; P=0.02) and interleukin 6 (IL-6) (P<0.05).(Edirisinghe 2011)

A large integrative review of the effects of nutritional interventions in the control of musculoskeletal pain concluded that besides pain improvement, nutritional interventions, including the consumption of strawberries and vitamin D gel capsules, decrease the levels of several inflammatory markers.(Mendonça 2020)

Antioxidant effects

Strawberries are among the most commonly consumed fruits in the United States and, along with apples, are reported to be the largest contributor to dietary cellular antioxidant activity. They have the highest oxygen radical absorbance capacity (ORAC), followed by black raspberries, blackberries, and red raspberries.(Basu 2014) Antioxidant activity may result from the direct binding to and neutralization of free radicals, indirectly via various signaling pathways, or by cellular processes that are completely independent of antioxidant mechanisms.(Prior 2007) Key phytochemicals which are present in berries, as well as their biological actions prevent oxidative stress and carcinogenesis.(Baby 2017) For example, in vitro experiments have shown that strawberry fruit (Fragaria x ananassa Romina) juice attenuates oxidative imbalance with concomitant modulation of metabolic indices linked to male infertility in testicular oxidative injury. This implies that strawberry fruits may exhibit protective potential against testicular oxidative injury.(Erukainure 2021)

Clinical data

Smaller clinical studies (N=7 to 54) conducted in healthy volunteers demonstrated the ability of strawberry consumption to increase plasma antioxidant capacity when assayed by various methods. Studies have evaluated either the addition of a single dose of strawberries or daily supplementation added to the participant's usual diet for up to 30 days.(Bialasiewicz 2014, Henning 2010, Prior 2007) Following a single meal of 300 g of strawberries without added macronutrients, a significant increase in antioxidant capacity (by 7% to 9.5%) was observed when the whole plasma assay method was used but not when the traditional protein extraction assay method was used. Overall, data from a coordinated series of 5 clinical trials (N=35) indicated that consumption of certain berries, including strawberries, and fruits increased postprandial plasma antioxidant capacity, and that consumption of macronutrients without antioxidants was associated with a decline in plasma antioxidant capacity.(Prior 2007) In another study, a modest increase in antioxidant capacity by 20% (via lipid peroxidation protection) was documented subsequent to consumption of 250 g of thawed strawberries eaten with breakfast for 3 weeks (plain or as part of an undefined smoothie preparation). Plasma concentrations of the various anthocyanin metabolites were highly variable among the participants. Protection of DNA from oxidation was not found to change following strawberry consumption.(Henning 2010) In another study, consumption of 500 g of sustainably grown strawberries added to the participant's usual diet for 30 days produced a significant decrease in the generation of reactive oxygen species by circulating phagocytes compared with baseline (by 38.2%; P<0.05). This improvement in systemic oxidative stress disappeared during the 10-day washout period and partially returned (18.7%, not statistically significant) upon reintroduction of the same dose of organically grown strawberries.(Bialasiewicz 2014)

Another study examined the effects of strawberry pulp on paraoxonase-1 (PON-1) enzyme activity and lipid levels in nonobese healthy adult subjects.(Zasowska-Nowak 2016) A dose of 500 mg/day was given for 30 days, and after a 10-day washout period was followed by a second treatment course for 30 days. PON-1 activity was decreased by 5.4% after the first course (not significant) and by 11.6% (P<0.05) after the second course of treatment. Total cholesterol levels, but not other lipid levels, were transiently decreased during the first course of treatment.

Antitumor effects

Clinical data

A phase 2 randomized, controlled, unblinded study in China investigated the effects of 2 doses of freeze-dried strawberries on esophageal dysplastic lesions in adults older than 40 years (N=75) living in high-risk regions for esophageal squamous cell carcinoma. The effect of dietary strawberry consumption was measured according to histologic grade of precancerous lesions and biomarkers of cell proliferation, inflammation, and gene transcription. Strawberries sourced from California were freeze dried and lyophilized; the powder was mixed with 240 mL of water and administered at a dose of 30 or 60 g/day. Among patients receiving 60 g of strawberries, a significant decrease in histologic grade occurred in 84% (26 of 31) of patients with mild dysplasia and 60% (3 of 5) of patients with moderate dysplasia after 6 months of treatment (P<0.0001). Overall, a decrease in histological grade was observed in 80.6% of participants in the 60 g/day group, while no significant changes in precancerous growth were observed with 30 g/day. Protein expression of inflammatory biomarkers in esophageal mucosa as well as cell proliferation were also reduced in the 60 g/day group but not the 30 g/day group.(Chen 2012)

Cardiovascular effects

A meta-analysis of 11 randomised controlled trials on the effects of strawberry intervention on cardiovascular risk factors was investigated. Overall, the strawberry interventions significantly reduced C-reactive protein (CRP) levels by 0.63 mg/L (95% confidence interval [CI], −1.04, −0.22) but did not affect blood pressure, lipid profile, or fasting blood glucose in the main analyses. The analysis, which was stratified by baseline end point levels, showed that strawberry interventions significantly reduced total cholesterol in people with baseline levels more than 5 mmol/L (−0.52 mmol/L [95% CI, −0.88, −0.15]) and reduced LDL-cholesterol in people with baseline levels more than 3 mmol/L (−0.31 mmol/L [95% CI, −0.6, −0.02]). There was little evidence of heterogeneity in the analysis and no evidence of publication bias. In summary, strawberry interventions significantly reduced CRP levels and may improve total cholesterol and LDL-cholesterol in individuals with high baseline levels.(Gao 2020)

Diabetes

Studies in individuals with type 2 diabetes are lacking. Nevertheless, existing evidence suggests that berries have an emerging role in dietary strategies for the prevention of diabetes and its complications in adults. The beneficial effects of berries on diabetes prevention and management should be a part of a healthy and balanced diet.(Calvano 2019)

Clinical data

Results from randomized controlled studies on the consumption of dietary strawberries and their effects on postprandial insulin and glucose concentrations are equivocal.(Jenkins 2008, Basu 2014, Edirisinghe 2011, Ellis 2011, Moazen 2013) In a single-blind, randomized, placebo-controlled, crossover trial (N=26) in at-risk overweight adults, effects of strawberry antioxidants on postprandial inflammation and insulin sensitivity were documented. Exclusion criteria included use of antihyperlipidemic or anti-inflammatory medications or supplements, diabetes, atherosclerotic or other chronic inflammatory disease, and uncontrolled hypertension that would limit extrapolation of the results. Overweight or obese adult participants (mean BMI, 29 kg/m2) consumed a single test meal with a strawberry milk-based beverage made from freeze-dried strawberry powder or a placebo milk-based strawberry-flavored beverage. Addition of strawberry to the high-carbohydrate, moderate-fat test meal (bagel, margarine, cream cheese, cantaloupe, and egg) significantly improved postprandial plasma inflammation biomarkers such as hs-CRP (P=0.02) and IL-6 (P<0.05), as well as insulin concentrations (P=0.01). The strawberry beverage was equivalent to 100 g of fresh strawberries, delivering 94.7 mg of total phenols with an ORAC of 5,163 microM Trolox equivalents.(Edirisinghe 2011) In a follow-up study, the same study population was randomized to receive placebo or the milk-based strawberry beverage with the test meal for 6 weeks to assess the fasting and postprandial prothrombotic and proinflammatory responses to longer-term strawberry consumption. After 6 weeks, no significant differences were found in fasting glucose, insulin, hs-CRP, IL-6, IL-1beta, tumor necrosis factor (TNF)-alpha, or plasminogen activator inhibitor-1 (PAI-1) within or between groups. However, consumption of the strawberry beverage significantly attenuated meal-induced postprandial PAI-1 compared with placebo (P=0.002); this was most notable at 6 hours after the meal. Attenuation of postprandial IL-1beta and IL-6 was also observed but was not significant when corrected for baseline variability.(Ellis 2011) In a 6-week, double-blind, randomized, controlled trial of 40 patients diagnosed with type 2 diabetes for more than 1 year, freeze-dried strawberry powder (25 g) was dissolved in water and consumed twice daily, at least 6 hours apart, as a supplement to the patients' usual diet (equivalent to 500 g/day of fresh strawberries). A statistically significant decrease in hemoglobin A1c (HbA1c) (from 7% at baseline to 6.72%) was demonstrated with freeze-dried strawberry compared with control; this change was statistically significant between groups (P<0.5). No changes were noted in serum glucose concentrations or anthropometric indices. Also, when evaluating treatment effects on metabolic complications of type 2 diabetes, significant within-group and between-group improvements in total antioxidant status (P=0.025 and P=0.001, respectively), plasma hs-CRP (P=0.003 and P=0.02), and lipid peroxidation via MDA levels (P=0.001 and P=0.013) were observed with strawberry supplementation.(Moazen 2013)

In a randomized, crossover trial in 12 healthy volunteers (10 women), a purée of bilberries, blackcurrants, cranberries, and strawberries (150 g total; 37.5 g of each berry) with 35 g of sucrose improved plasma glucose, serum insulin, and the glycemic profile compared with a control meal. Maximum glucose concentrations were almost 30% lower after the berry meal; serum insulin levels were lower at 15 minutes and higher at 90 minutes. However, no difference was noted in area under the curve (AUC).(Törrönen 2012) Likewise, in a similar randomized, controlled, crossover study in up to 20 women, strawberries and berry purée ingested with white wheat bread significantly improved the glycemic profile compared with white bread alone (P<0.05 and P=0.005, respectively).(Törrönen 2013) A similar and significant response was observed with strawberries on postprandial insulin. Compared with rye bread alone, the berry purée improved glucose AUC at 0 to 30 minutes (P=0.026); increased the value of the glycemic profile (P=0.05); and reduced the maximum insulin increase from baseline (P=0.001) as well as insulin AUC at 30, 60, and 120 minutes (P<0.001, P<0.001, and P=0.03, respectively).

Immunomodulation

Clinical data

A 7-week, double-blind, randomized, controlled, crossover trial investigated the effects of dietary strawberries on the function of specific cell types of the innate and adaptive immune systems in obese volunteers (20 to 50 years of age; BMI of 30 to 40 kg/m2).(Zunino 2013) Volunteers received foods containing freeze-dried strawberry powder (equivalent to 4 servings/day of frozen strawberries) or strawberry flavoring for 3 weeks, and were then crossed over to the other intervention for 3 weeks. Proliferation of CD4+ cells was decreased modestly but significantly during the strawberry phase (P=0.016), and an increase in the proliferative response of CD8+ T-cells was also observed (P=0.029). TNF-alpha production also increased in activated monocytes of participants who consumed the dietary strawberry powder. No differences were observed in IL-1beta, IL-6, IL-8, or cytokine production by T-lymphocyte subsets. Additionally, changes in gene expression for an array of genes important in modulating immune responsiveness were documented; 18 genes were upregulated and 14 genes were downregulated by dietary strawberry consumption compared with controls.

Neuronal function

Animal data

Dietary supplementation with freeze-dried strawberry and blueberry significantly improved motor performance, cognition, short-term memory, neurogenesis, and insulinlike growth factor 1 (IGF-1) in male Fisher rats (N=44). Only the blueberry diet had a significant benefit in 1 of the 5 psychomotor tests compared with controls (P<0.05). Both the strawberry (P=0.05) and the blueberry (P=0.007) groups showed improvement in cognitive performance, specifically with regards to working (ie, short-term) memory. Only rats in the strawberry diet group showed increases in the number of cells surviving in the dentate gyrus of the hippocampus compared with controls (P<0.05). IGF-1 levels increased with both berry diets (P<0.05), and levels in the strawberry group were higher than in the blueberry group (P<0.05). Although both berry groups exhibited improvements in neurocognitive function, the berries appear to have acted by different mechanisms. For example, the strawberry group was better with general balance and coordination, whereas the blueberry group was better with psychomotor coordination and vestibular integrity.(Shukitt-Hale 2015)

Other uses

In vivo studies have shown that California strawberry consumption increased the abundance of gut microorganisms related to lean body weight, health, and longevity, and increased fecal lithocholic acid at week 6 in healthy study participants.(Ezzat-Zadeh 2021)

Strawberry side effects

Strawberry supplementation in rats for 16 weeks did not result in any negative effects related to animal development.(Diamanti 2014) In clinical studies assessing adverse effects of dietary supplementation with strawberries, no adverse events occurred with 6 to 12 weeks of supplementation.(Basu 2014, Basu 2010, Moazen 2013)

A case of a local reaction to a strawberry-scented anesthetic face mask was reported in a 9-year-old girl with a known allergy to the artificially flavored strawberry drink mix Nesquik. It should be noted that the mask did not contain strawberries or any ingredients related to strawberries.(von Ungern-Sternberg 2012)

Strawberries are one of the 10 most common fruits identified in fruit allergy reports. Fruit allergies are most commonly related to the cross-sensitivity to antibodies against homologous proteins found in plant foods and pollens, and this is observed with a few rare fruits (eg, tropical fruits, berries) in susceptible individuals. Foods belonging to the Rosaceae family (eg, apple, pear, peach, strawberry, almond) most commonly cause allergic symptoms in individuals with birch pollen allergies. The strawberry Fra a 1 allergen (specifically Fra a 1.02) is a homolog of the major birch (Betula verrucosa) pollen allergen Bet v 1 (an isoflavone reductase) and is found in red ripe strawberry fruit but not in the white strawberry mutated genotype; the latter has been shown to be tolerated by strawberry-allergic individuals. The main clinical symptoms are oral allergic reactions, itching, and dermatitis; systemic reactions (eg, asthma, anaphylaxis) are rare.(Franz-Oberdorf 2016, Hassan 2016) A population-based survey of Mexican elementary school children documented a 0.6% (6 of 1,049) incidence of food allergy to strawberries as reported by parents, with 0.2% (2 of 1,049) experiencing an anaphylactic reaction.(Ontiveros 2016)

Before taking Strawberry

Information regarding safety and efficacy in pregnancy and lactation is lacking.

How to use Strawberry

Metabolism and absorption of pelargonidin-3-glucoside, the major anthocyanin in strawberries, as well as its 3 monoglucuronide metabolites, occurred in a dose-dependent manner, with maximum urinary output of anthocyanins occurring within 12 hours of consumption (greater than 50% by 4 hours and greater than 90% by 10 hours). Approximately 2% of the dose was recovered within 24 hours.(Carkeet 2008) In clinical studies, 1 g of freeze-dried strawberries was equivalent to approximately 10 g of fresh strawberries.

Antihyperlipidemic

A daily dietary strawberry supplement of 1 pound (454 g) per 2,000 kcal/day diet for 1 month has been used as a replacement for desserts, cakes, muffins, pastries, and cookies.(Jenkins 2008) In a study of hyperlipidemic adults with abdominal adiposity, 50 g/day (high dose) or 25 g/day (low dose) of freeze-dried strawberry powder beverage (kosher, nonorganic, standardized to polyphenol content) was given for 12 weeks to improve total and LDL cholesterol.(Basu 2014) Obese subjects (BMI 30 to 40 kg/m2) were given dietary freeze-dried strawberry powder (equivalent to 320 g/day of strawberries) mixed as a milkshake, in yogurt, in cream cheese, or as a water-based sweetened beverage.(Zunino 2012) In clinical trials, phytosterols have been shown to improve lipid parameters at an average dose of 2 g/day. Fresh strawberries provide approximately 0.7 mg of total phytosterols per 6 g of strawberries, whereas freeze-dried strawberries (10% of fresh weight) provide 50 mg of phytosterols per 50 g of freeze-dried strawberries.(Basu 2014)

Anti-inflammatory

60 g/day of freeze-dried strawberry powder for 6 months has been used to reduce protein expression of inflammatory biomarkers in esophageal mucosa in adults with esophageal dysplastic lesions.(Jenkins 2008) In another study, a milk-based strawberry beverage from 10 g of freeze-dried strawberry powder (equivalent to 100 g of fresh strawberries delivering 94.7 mg of total phenols, with an ORAC of 5,163 mcM Trolox equivalents) was added to a single, high-carbohydrate, moderate-fat test meal to improve postprandial plasma inflammation biomarkers in at-risk overweight adults(Edirisinghe 2011); the same beverage was administered for 6 weeks in a follow-up trial.(Ellis 2011)

Antioxidant

Beneficial antioxidant effects have been noted in healthy volunteers with a single meal of 300 g of strawberries(Prior 2007); 250 g of thawed strawberries eaten with breakfast for 3 weeks (plain or as part of an undefined smoothie preparation)(Henning 2010); or 500 g of sustainably grown strawberries added to usual diet for 30 days.(Bialasiewicz 2014)

Antitumor

60 g/day of freeze-dried strawberry powder for 6 months has been used in patients with mild and severe dysplastic precancerous lesions.(Chen 2012)

Diabetes

A milk-based strawberry beverage (equivalent to 100 g of fresh strawberries delivering 94.7 mg of total phenols with an ORAC of 5,163 mcM Trolox equivalents) added to a single high-carbohydrate, moderate-fat test meal (bagel, margarine, cream cheese, cantaloupe, and egg) has been administered to improve postprandial plasma insulin concentrations in overweight and obese participants(Edirisinghe 2011); however, no difference was found when this beverage was given over 6 weeks.(Ellis 2011) However, 25 g twice daily of freeze-dried strawberries (equivalent to 500 g/day of fresh strawberries) for 6 weeks reduced HbA1c from 7% to 6.72% in patients with type 2 diabetes mellitus.(Moazen 2013)

Immunomodulation

Freeze-dried strawberry powder equivalent to 4 servings/day of frozen strawberries was consumed with meals for 3 weeks to evaluate changes in innate and adaptive immune systems in obese volunteers.(Zunino 2013)

Warnings

No data.

What other drugs will affect Strawberry

Data from an in vitro transport study on P-glycoprotein demonstrated inconclusive results for the effect of strawberry extract on cimetidine transport across intestinal epithelial; however, contrary results were observed in the 2 different models studied.(Tarirai 2012)

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