In my ongoing series of articles about herbal medicine for breast cancer, this article covers amla (Phyllanthus officinalis, P. emblica) also known as amalaki or Indian Gooseberry.

Amla has been used extensively in Indian Ayurvedic medicine for centuries. It is a key ingredient of two traditional Indian herbal formulations to bolster good health – Triphala and Chyawanprash. In this article, I’ll share with you some of the benefits amla offers breast cancer patients and survivors, and as usual I will include the research.

Amla is a golf-ball sized fruit that grows on a tree throughout India. The amla tree is venerated in India and considered sacred. The tree bears light green flowers that develop into small, green and very sour but edible fruit. The name amla means “sour” in Hindi.

Other nicknames exist for amla or amalaki — names that mean “nurse”, “mother,” and “immortality”. This gives you some idea as to the importance of this medicinal plant and the healing capacity the fruit conveys.

Amla has an incredible amount of antioxidants, with somewhere around 20 times more vitamin C content than an orange. It also has some impressive cancer-fighting phytochemicals (plant-based compounds) including delphinidin, beta-carotene, epigallocatechin-3-gallate (EGCG), ellagic acid, chebulinic acid, gallic acid, chebulagic acid, kaempferol, quercetin, and corilagin. These phytochemicals and nutrients are what gives amla its healing properties.

Amla’s Importance in Herbal Medicine

Amla is considered an adaptogenic herb (among other things) – meaning it has the potential to help your body adapt to stress, anxiety, and fatigue. Over the centuries, amla has also been used by herbalists to increase vitality, promote longevity, aid digestion, ease symptoms of asthma, improve coughs, balance blood sugar levels, regulate the immune system, and reduce high cholesterol. It has also been found to be anti-inflammatory and antiviral.

The Research on Amla

The research that has been done on amla reveals that it has adaptogenic, analgesic (pain relieving), anti-diabetic, anti-bacterial, anti-viral, anti-fungal, anti-inflammatory, cardioprotective, liver protective, vision improvement, and immune regulating activities. It also has cancer-fighting benefits, and that is the main focus of this article.

In terms of amla and breast cancer, as usual few studies have been done with actual human patients having breast cancer, but we do have quite a few preliminary test tube and animal studies which are promising. Notwithstanding lack of evidence through clinical trials, as I mentioned before, we have centuries of traditional use by herbalists to draw upon. At some point we have to trust this – if certain herbs didn’t work, they would simply pass out of favor and that has certainly not been the case with amla. It remains one of the most powerful and widely used herbal medicines in Ayurvedic medicine.

Here are the main ways amla can help us.

1. Protects DNA, Organs and Tissues from Damage by Chemotherapy and Radiation

In a preliminary 2017 cell study [1], amla improved the anti-cancer effects of two chemotherapy drugs, Mitomycin C and cisplatin. It also protected healthy cells from the genotoxic (DNA damaging) effects of these drugs.

In a 2007 animal study [2], rats given amla fruit pulp for seven days prior to what would have been a lethal dose of radiation increased their survival rate from 0% to 87.5%.

Three other studies [3]-[5] found that amla had protective effects on DNA against caustic chemicals and radiation.

2. Prevents Cancer, Kills Cancer Cells

There are some interesting studies on amla as a whole fruit or fruit pulp and/or juice and its effects on breast cancer, but be sure to keep reading this entire article for a listing of some of the more well-studied phytochemicals within amla – the phytochemicals by themselves have more research on them than does amla.

A 2010 animal study [6] found that amla induced apoptosis, inhibited the promotion of tumors and invasiveness of six different types of human cancer cells, including triple negative breast cancer cells. Dr Michael Greger, my favorite nutrition doctor, talks about this study in this video: Amla versus Cancer Cell Growth .

A 2011 review of medical studies [7] listed all of the various health issues amla can assist, calling it the “most important medicinal plant in the Indian traditional system of medicine”. Researchers also stated “This review for the first time summarizes the results related to these properties and also emphasizes the aspects that warrant future research to establish its activity and utility as a cancer preventive and therapeutic drug in humans.”

A 2015 review of medical studies [8] also found amla to have cancer preventive properties.

In a 2013 animal study [9] amla was found to have antiproliferative effects, which means it slows or inhibits the rapid replication of cells, commonly seen in cancer cells. Researchers stated “These studies indicate that active constituent or combination of phytochemicals in amla fruit juice could suppress mammary tumor and thereby, it may be used as a pharmaceutical tool in cancer subjects.”

A 2015 review of medical studies on amla and its polyphenols [10] found that it had chemopreventive (cancer preventive) properties. It inhibited proliferation (rapid growth) and promoted apoptosis (planned cell death, absent in cancer cells) in triple negative breast cancer cells.

3. Amla Enhances Immunity

First of all, amla is packed full of vitamin C, a nutrient we already know boosts immunity.

A 1994 animal study [11] found that amla enhanced natural killer cell activity, a component of the immune system responsible for secreting lethal substances which kill cancer cells – and cancer stem cells, in some instances.

A 2017 study [12] revealed that a polysaccharide isolated from amla had immunomodulatory properties in mice. This is important because if the immune system is over-reacting as it does in auto immune disorders and allergies, amla may be of service in helping to dampen that over-reaction. If the immune system is under-reacting as it does in health issues like cancer, amla may be able to boost it.

A 2019 review of medical studies [13] focused on the significance of Phyllanthus species and their phytochemicals in the regulation of both innate and adaptive functions of the immune system, and discussed their possible therapeutic benefits for treatment of immune-related diseases

4. Amla Reduces Cholesterol

We do have a clinical trial for this health claim [14]. I include it here because there appears to be a correlation with high cholesterol and breast cancer. Also, I’ve personally noticed that a lot of foods and natural substances that fight breast cancer also lower cholesterol levels and feel that there is a correlation.

In a small 2019 clinical trial [14] involving 98 patients with high cholesterol, the ones receiving the amla had significantly lower levels of total cholesterol, triglycerides, low density lipoprotein and very low density lipoprotein.

The Research on the Phytochemicals in Amla

We have quite a few studies on the phytochemicals present in amla, and their effects on breast cancer.

DELPHINIDIN

Delphinidin is an anthocyanidin, which is a pigment that imparts brilliant colors to fruits and vegetables. It is a potent antioxidant with anti-inflammatory and anticancer properties.

Delphinidin has been shown to:

• inhibit proliferation in ER+/PR+ metastatic breast cancer cells [15]
• inhibit BCRP (Breast Cancer Resistance Protein), a gene that has the ability to recognize and transport out of the cell numerous anticancer drugs including conventional chemotherapy and targeted therapies like Herceptin, eliminating them from the system. BCRP is thought to be responsible for causing multi-drug resistance by cancer cells [16]
• inhibit proliferation, block the growth of, and induce apoptosis in ER+, ER- and HER2+ breast cancer cell lines [17], [19], [22]
• inhibit EGFR and VEGFR2 signalling in breast cancer cells. EGFR (Epidermal Growth Factor Receptor) is a protein-coding gene, the overexpression of which has been found to be implicated in at least 30% of breast cancers, and is associated with a poor prognosis, resistance to chemotherapy, hormone therapy, and radiation.VEGFR2 (Vascular Endothelial Growth Factor Receptor 2) is a type of receptor on cells, a growth factor, and known to be a cancer promoter. [18]
• reduce the invasiveness of ER+/PR+ metastatic breast cancer cells by blocking MMP-9 gene expression. MMPs (Matrix Metalloproteases) are a collection of enzymes that have been shown to be involved in the invasion (metastasis) of other tissues, thus leading to the spread of breast cancer. [20]
• suppress the carcinogenesis process, resulting in a chemopreventive effect [21]

EGCG – EPIGALLOCATECHIN-3-GALLATE

EGCG is a dietary polyphenol found in both amla and green tea with dozens of studies which attest to its anticancer effects. EGCG is strongly anti-inflammatory and research shows that it has all of these wonderful effects for breast cancer patients:

• suppresses carcinogens and DNA damage [23]
• helps to regulate cell signalling pathways [23]
• opposes the action of estrogen [23], [24]
• helps to restore estrogen receptor alpha in ER- breast cancer cells [25]
• downregulates (suppresses) estrogen receptor alpha in ER+ breast cancer cells [24]
• binds to many target proteins that inhibit breast cancer [25], [26]
• inhibits DNA methylation [23]
• inhibits angiogenesis (the creation of new blood vessels necessary to feed a growing tumor), migration, proliferation and invasiveness of breast cancer cells [25]-[27]
• induces apoptosis in ER+/PR+ metastatic breast cancer cells and triple negative breast cancer cells [23], [25], [27]
• downregulates HER2 oncogene and other genes associated with breast cancer, and inhibits HER2 positive breast cancer cells that are resistant to trastuzumab, (a/k/a Herceptin a targeted breast cancer drug) [28]-[30]
• works synergistically with chemotherapy drugs to help kill cancer cells [29]

When EGCG is combined with other therapeutic agents, it has even more interesting benefits. A 2004 test tube study [31] investigated the anticancer effects of several polyphenols including EGCG and Tamoxifen on three lines of breast cancer cells, namely ER+/PR+ metastatic breast cancer, triple negative breast cancer and ER+/PR+/HER2- breast cancer. They stated that the most striking results came from EGCG, which produced a greater cytotoxic effect on triple negative breast cancer cells than did the Tamoxifen, and the two worked synergistically against this cell line.

Another study released in 2017 [32] found that EGCG worked as well as, or better than, Tamoxifen against ER+/PR+ human breast cancer cells.

EGCG also works well with curcumin to inhibit breast cancer stem cells [33].

GALLIC ACID

Gallic acid is another impressive phytochemical found in amla. It is a polyphenol with antioxidant and anticancer activity. Gallic acid has all of these activities against breast cancer cells:

• inhibits proliferation of ER+/PR+ metastatic breast cancer cells [34]
• works in several different ways to reduce the invasiveness and metastatic potential of ER+/PR+ metastatic breast cancer cells [35]
• inhibits triple negative breast cancer cells by inducing cell cycle arrest, promoting apoptosis, downregulating genes known to promote breast cancer and promoting genes known to suppress breast cancer [36]

QUERCETIN

Quercetin is a widely-present flavonoid in many foods with potent antioxidant and anti-inflammatory benefits. Research shows quercetin has all of these good benefits for breast cancer:

• it is bone-protective [37]
• it is DNA protective [38]
• it fights against all forms of breast cancer including ER+, ER- and HER2+ [39], [41], [43]- [45], [46]
• it is potently anti-inflammatory [40]
• it is a natural aromatase inhibitor [42]
• it inhibits angiogenesis and metastasis [40]
• it enhances the effects of certain chemotherapy drugs while also protecting against the toxicity of the drugs [47]
• inhibits breast cancer stem cells [48], [49]

Safety of Amla

Amla does come with a couple of warnings.

1. Due to its anti-platelet properties, amla may thin your blood and prevent normal blood clotting. If you are on blood thinners or have a bleeding disorder, do not take amla. Also do not take amla prior to surgery for the same reasons.

2. Amla may also lower blood sugar levels, so if you have type 1 or type 2 diabetes or other blood sugar management conditions, be aware of this.

Dosage and Safety:

I would recommend taking only organic amla to make sure it is not contaminated with anything else. It can be eaten as a fresh fruit, however in most parts of the world where it does not grow, it can be taken as a powder, either in capsule form or the powder can be used to make herbal tea or added to juices and smoothies. Be careful with dosages though until you get used to its intense sourness/bitterness.

Most supplements contain 500–1,000 mg of amla powder per serving and it is generally accepted that 500 mg taken twice daily is a good dose, but be sure to check with your health professional before taking it to ensure this dose is appropriate for you.

Please do not consider amla as a stand-alone therapy against breast cancer. As with any natural therapy, be sure to consult with a naturopath or herbalist for advice for your particular health challenge.

References:

[1] Phyllanthus emblica Linn. fruit extract potentiates the anticancer efficacy of mitomycin C and cisplatin and reduces their genotoxicity to normal cells in vitro – https://www.ncbi.nlm.nih.gov/pubmed/29204983
[2] Radioprotective Potential of Plants and Herbs against the Effects of Ionizing Radiation – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127223/
[3] Effect of seven Indian plant extracts on Fenton reaction-mediated damage to DNA constituents – https://www.ncbi.nlm.nih.gov/pubmed/27691720
[4] Composition and biological activities of hydrolyzable tannins of fruits of Phyllanthus emblica – https://www.ncbi.nlm.nih.gov/pubmed/24369850
[5] Anticancer Properties of Phyllanthus emblica (Indian Gooseberry) – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477227/
[6] Antitumour Effects of Phyllanthus emblica L.: Induction of Cancer Cell Apoptosis and Inhibition of In Vivo Tumour Promotion and In Vitro Invasion of Human Cancer Cells – https://www.researchgate.net/publication/46111930_Antitumour_Effects_of_Phyllanthus_emblica_L_Induction_of_Cancer_Cell_Apoptosis_and_Inhibition_of_In_Vivo_Tumour_Promotion_and_In_Vitro_Invasion_of_Human_Cancer_Cells
[7] Amla (Emblica officinalis Gaertn), a wonder berry in the treatment and prevention of cancer – https://www.ncbi.nlm.nih.gov/pubmed/21317655
[8] Anticancer Properties of Phyllanthus emblica (Indian Gooseberry) –
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477227/
[9] Chemo preventive potential of fruit juice of Phyllanthus emblica Linn. (amla) against mammary cancer by altering oxidant/antioxidant status, lipid profile levels and estrogen/progesterone receptor status in female Sprague–Dawley rats – https://www.sciencedirect.com/science/article/abs/pii/S2210523913000688
[10] Anticancer Properties of Phyllanthus emblica (Indian Gooseberry) – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477227/
[11] Augmentation of murine natural killer cell and antibody dependent cellular cytotoxicity activities by Phyllanthus emblica, a new immunomodulator – https://www.ncbi.nlm.nih.gov/pubmed/7990505
[12] Structural characterization and biological activities of a novel polysaccharide from Phyllanthus emblica – https://pubmed.ncbi.nlm.nih.gov/28442657/
[13] An Insight Into the Modulatory Effects and Mechanisms of Action of Phyllanthus Species and Their Bioactive Metabolites on the Immune System – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693410/.
[14] A randomized, double blind, placebo controlled, multicenter clinical trial to assess the efficacy and safety of Emblica officinalis extract in patients with dyslipidemia – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341673/
[15] Human tumor cell growth inhibition by nontoxic anthocyanidins, the pigments in fruits and vegetables – https://www.ncbi.nlm.nih.gov/pubmed/15680311
[16] Berry anthocyanins and anthocyanidins exhibit distinct affinities for the efflux transporters BCRP and MDR1 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807656/
[17] Delphinidin Inhibits HER2 and Erk1/2 Signaling and Suppresses Growth of HER2-Overexpressing and Triple Negative Breast Cancer Cell Lines — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140266/
[18] Delphinidin Reduces Cell Proliferation and Induces Apoptosis of Non-Small-Cell Lung Cancer Cells by Targeting EGFR/VEGFR2 Signaling Pathways – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790876
[19] Delphinidin inhibits cell proliferation and induces apoptosis in MDA-MB-231 human breast cancer cell lines — http://synapse.koreamed.org/DOIx.php?id=10.4163/jnh.2013.46.6.503
[20] Delphinidin suppresses PMA-induced MMP-9 expression by blocking the NF-kB activation through MAPK signaling pathways in MCF-7 human breast carcinoma cells – https://www.ncbi.nlm.nih.gov/pubmed/25000305
[21] Delphinidin-3-glucoside suppresses breast carcinogenesis by inactivating the Akt/HOTAIR signaling pathway – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937537/
[22] Delphinidin induced protective autophagy via mTOR pathway suppression and AMPK pathway activation in HER-2 positive breast cancer cells – https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-4231-y
[23] Suppressive Effects of Tea Catechins on Breast Cancer –
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997373/
[24] The regulation of steroid receptors by epigallocatechin-3-gallate in breast cancer cells – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447698/
[25] Epigenetic diet: impact on the epigenome and cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197720/
[26] Green tea catechins inhibit angiogenesis through suppression of STAT3 activation – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664280/
[27] Green tea polyphenol and epigallocatechin gallate induce apoptosis and inhibit invasion in human breast cancer cells – https://www.ncbi.nlm.nih.gov/pubmed/18059161
[28] Trastuzumab-resistant HER2-driven breast cancer cells are sensitive to epigallocatechin-3 gallate – https://www.ncbi.nlm.nih.gov/pubmed/17909003
[29] Epigallocatechin-3-gallate Inhibits Activation of HER-2/neu and Downstream Signaling Pathways in Human Head and Neck and Breast Carcinoma Cells – https://pdfs.semanticscholar.org/0ca3/811f96d0c7a2a79faa1eb55bb0da7ae1a240.pdf
[30] Dual Fatty Acid Synthase and HER2 Signaling Blockade Shows Marked Antitumor Activity against Breast Cancer Models Resistant to Anti-HER2 Drugs – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479882/
[31] Tamoxifen and epigallocatechin gallate are synergistically cytotoxic to MDA-MB-231 human breast cancer cells – https://www.ncbi.nlm.nih.gov/pubmed/15457130
[32] Epigallocatechin-3-gallate promotes apoptosis in human breast cancer T47D cells through down-regulation of PI3K/AKT and Telomerase –
https://www.ncbi.nlm.nih.gov/pubmed/28646740
[33] Curcumin and Epigallocatechin Gallate Inhibit the Cancer Stem Cell Phenotype via Down-regulation of STAT3–NFkB signaling – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290892/
[34] Anticancer Activity of Phenolic Antioxidants against Breast Cancer Cells and a Spontaneous Mammary Tumor – http://www.ijpsonline.com/articles/anticancer-activity-of-phenolic-antioxidants-against-breast-cancer-cells-and-a-spontaneous-mammary-tumor.pdf
[35] Gallic acid abolishes the EGFR/Src/Akt/Erk-mediated expression of matrix metalloproteinase-9 in MCF-7 breast cancer cells – https://www.ncbi.nlm.nih.gov/pubmed/27087131
[36] Gallic acid induces G1 phase arrest and apoptosis of triple-negative breast cancer cell MDA-MB-231 via p38 mitogen-activated protein kinase/p21/p27 axis – https://www.ncbi.nlm.nih.gov/pubmed/28938245
[37] Stimulatory effect of naturally occurring flavonols quercetin and kaempferol on alkaline phosphatase activity in MG-63 human osteoblasts through ERK and estrogen receptor pathway – https://www.sciencedirect.com/science/article/abs/pii/S0006295203009006
[38] Quercetin, a Natural Flavonoid Interacts with DNA, Arrests Cell Cycle and Causes Tumor Regression by Activating Mitochondrial Pathway of Apoptosis – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828642/
[39] Quercetin-induced ubiquitination and down-regulation of Her-2/neu – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575035/
[40] Quercetin Suppresses Cyclooxygenase-2 Expression and Angiogenesis through Inactivation of P300 Signaling – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152552/
[41] Effects of quercetin on the proliferation of breast cancer cells and expression of survivin in vitro – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820718/
[42] Inhibitory Aromatase Effects of Flavonoids from Ginkgo Biloba Extracts on Estrogen Biosynthesis – https://www.ncbi.nlm.nih.gov/pubmed/26434836
[43] Quercetin induces caspase-dependent extrinsic apoptosis through inhibition of signal transducer and activator of transcription 3 signaling in HER2-overexpressing BT-474 breast cancer cells – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899028/
[44] Quercetin induces apoptosis and necroptosis in MCF-7 breast cancer cells – https://www.ncbi.nlm.nih.gov/pubmed/28814095
[45] Protective Effects of Six Selected Dietary Compounds against Leptin-Induced Proliferation of Oestrogen Receptor Positive (MCF-7) Breast Cancer Cells – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622391/
[46] Quercetin induces apoptosis and cell cycle arrest in triple-negative breast cancer cells through modulation of Foxo3a activity – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343054/
[47] Quercetin enhances chemotherapeutic effect of doxorubicin against human breast cancer cells while reducing toxic side effects of it – https://www.ncbi.nlm.nih.gov/pubmed/29475141
[48] Quercetin Inhibits Breast Cancer Stem Cells via Downregulation of Aldehyde Dehydrogenase 1A1 (ALDH1A1), Chemokine Receptor Type 4 (CXCR4), Mucin 1 (MUC1), and Epithelial Cell Adhesion Molecule (EpCAM) – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788241/
[49] Quercetin-3-methyl ether suppresses human breast cancer stem cell formation by inhibiting the Notch1 and PI3K/Akt signaling pathways – https://www.spandidos-publications.com/10.3892/ijmm.2018.3741