Artichoke

artičoka
From a delicious delicacy to a bitter extract. More than once, it has happened to me that professionals are confused and forget that you’re supposed to eat the flower and use the leaf for medical purposes. Artichoke is an impressive plant, very robust and the silvery color of its leaves is so striking. Her bitterness is also impressive. We lightly give up the bitter taste. Is it because we are ashamed of our own bitterness in life? The artichoke primarily nurtures the gallbladder, an organ that we so easily give up today, as if in this way we symbolically want to erase the bitterness of life that has accumulated. In vain. Bile is mysterious – without it there is no good digestion, and at the same time it is very aggressive towards the mucous membrane. This fine balance goes beyond the physiology of bile. Without the bitterness of life, there is no wisdom, but if we exaggerate just a little, we become cynics who make fun of the values of life and quench the enthusiasm of others
Botanical name:

Cynara scolimus L. = C. cardunculus L. ssp flavescens Wikl. = C. cardunculus L. ssp. cardunculus (L.) Hay., Asteraceae

Species name:

Croat. artičoka
Engl. artichoke; Fr. artichaut, bérigoule; Germ. Artischoke

Family:

Asteraceae

Genus:

Cynara

Medicinal part of the plant:
Leaf
Traditional application:
Better digestion, constipation, better liver and bile function
Modern application:
Digestive disorders (stomach pain, nausea, the feeling of full stomach, bloating), hepatobiliary disorders. Adjuvant therapy of mild to moderate dyslipidemia.
When to be careful:
Caution with gallstones, ask for advice on use.
Nutritional value:
Artichoke flower is used as food.
Possibility of confusion:
Rarely. It bears very little resemblance to the species of the genera Carduus, Silybum, Onopordum, although the appearance of the leaves of the artichoke, mostly a cultivated plant, is very characteristic.
Interesting facts:
Artichoke is a typical cultivated species. Wild relatives are still found in North Africa, but since the time of ancient Greece and Rome, cultivars of the larger flower have been chosen. Arab culture brought new cultivars that spread through France and Italy. Unlike flowers that are moderately bitter, the leaves are very bitter. Remember: flowers are used in the diet, leaves in phytotherapy.
Botanical data

Artichoke is a strong biennial or sometimes perennial plant up to 2 meters tall, bare or finely hairy. The leaves are very large, up to 70 cm long, single to triple pinnately divided with broad segments or almost undivided, with or without purple thorns. The flower heads are single, very large, up to 10 cm in diameter with a fleshy inflorescence bottom. The flowers are bluish purple to reddish purple. The sheath leaves are also fleshy at the bottom, with almost no thorns at the top. Artichoke has long been cultivated and originates from the Mediterranean.

Official parts of the plant

Leaf harvested in the first year after flowering. The flower used as food and has no action like the leaf does.

Quality

According to Ph. Eur. 01/2013:
1866 Cynarae folium

  • at least 0.8% chlorogenic acid
  • macroscopic and microscopic identification
  • identification by thin layer chromatography with luteolin-7-glucoside and chlorogenic acid as reference substances
  • total ash: maximum 20.0%
  • drying loss: maximum 12% (1,000g of nebulized drug, drying for 2 hours at 105 °C)
Chemical composition

Flavonoids(0.5%): luteolin-7-glucoside (cinaroside), luteolin-7-rutinoside (scolimozide), luteolin-7-gentobioside. Phenols and acids : chlorogenic acid esters (0.02-2%). 1,5-dicaveoylquinic acid (cinnarine). Sesquiterpene lactones (0-4%): cinaropicrin. Organic acids : malates, succinates, lactates, fumarates, citrates. Sesquiterpene lactones give a bitter taste.

True cinnarine (1,5-dicaveoylquinic acid) is found only in fresh leaves and fresh plant preparations. Drying and aqueous extraction lead to transesterification and the formation of 1,3-dicaveoylquinic acid. Many manufacturers, and in some scientific papers cite 1,3-dicaveoylquinic acid as cinnarine or 1,5-dicaveoylkininic acid due to a previous error in the nomenclature and a wrong name inconsistent with the IUPAC nomenclature (ESCOP, Bruneton, Wichtl / Anton).

Indications/use

Commission E: dyspepsia.

ESCOP: digestive disorders (stomach pain, nausea, feeling of full stomach, bloating), hepatobiliary disorders. Adjuvant therapy of mild to moderate dyslipidemia.

Other and traditional uses: functional dyspepsia, obesity, seasonal courses of “cleansing” the liver and bile, long-term prevention of allergic and skin diseases.

Types of extracts and posology

Infusion and decoction are very rarely used due to their extremely bitter taste. Fresh plant tincture, dry standardized extracts, SIPF, EPS. Fresh plant extracts are preferred.

Posology

Commission E: 6g of dry drug per day or preparations of equivalent dose.

ESCOP: 5-10g of dry drug per day as a dry extract or infusion.

Other equivalent extracts:

SIPF, 5mL in a glass of water, before meals 2-3x a day.

EPS 5mL 1-2x a day in a glass of water, before meals.

Contraindications

Biliary obstruction and allergic reactions to Asteraceae (ESCOP, Commission E).

Application time

There are no restrictions. Usually in the form of one-month cures, several times a year.

Drug Interactions

Unknown (Commission E, ESCOP).

Suspect: warfarin (unlikely).

Mechanism of action

The mechanism of action of artichoke has aroused interest for a long time because artichoke has been present in phytotherapy for centuries. Back in the 1960s, the Italian author Rocchieta S. and group of Polish authors Samochowiec et al. conclude that artichoke is interesting plant in the treatment and prevention of atherosclerosis, although at that time the mechanism of atherosclerosis and the implication of cholesterol levels in the pathogenesis of atherosclerosis were less known. Maros et al. and again Maros et al. prove that in animal models the extract artichoke leaves regenerate liver damaged by xenobiotics such as carbon tetrachloride, as confirmed by Adzet et al. . The same authors conclude that cinnarine, and to a lesser extent caffeic acid derivatives, are very important for the hepatoprotective effect. Based on research by the late 1990s, Kraft K. concludes how artichoke extract reduces oxidative stress, increases bile secretion and thus acts on functional dyspepsia (probably due to bitter sesquiterpene lactones) and reduces cholesterol biosynthesis (due to flavonoids, especially luteolin derivatives). Mehmetcik et al. show how artichoke extract reduces liver damage in rats and increases the level of glutathione peroxidase and glutathione transferase, two essential enzymes required in the redox processes in the liver necessary for the protection of liver cells and for phase II metabolism of xenobiotics (foreign substances) in the liver.

Gebhardt R. in an elegant experiment proves that artichoke extract reduces the increase insulin-induced β-hydroxymethyl-coenzyme-A-reductase activity without cytotoxic effect. This enzyme is crucial in cholesterol biosynthesis. A few years later, the same author examined the effects of the extract and active ingredients from artichoke and concludes that artichoke stimulates not only the secretion but also the formation of bile acids in hepatocytes, and the most active compound is luteolin. This dual mechanism- an increase in the breakdown of cholesterol into bile acids, and a decrease in biosynthesis, probably underlies the clinical use of artichoke in hypercholesterolemia. Choleretic activity in rats was also examined by Saenz-Rodriguez et al. and prove that artichoke extract is a stronger choleretic than the standard drug dehydrochloric acid. This is valuable preclinical data for the clinical use of artichoke.

Shimoda et al. addressed the use of artichoke in lowering triglycerides and not just cholesterol. Sesquiterpenes cyanopicrin, agverin B, and grosheimin reduce the level of triglycerides in the blood of mice whose food was enriched with olive oil, so we hold these compounds responsible for the regulation of triglycerides. This emphasizes the advantage of using the extract and not the purified substances because they act in synergy. In support of this fact, Speroni et al. proved that total artichoke extract is far more effective in choleretic action than purified chlorogenic acid which shows no choleretic effect.

Li et al. focus their research on the long-observed effect of leaves artichokes on the development of atherosclerosis. They suggest that one of the mechanisms of action is to increase the activity of endothelial nitric oxide synthase, which reduces the inflammatory process and the risk of atherosclerosis. The flavonoids cinaroside and luteolin have been shown to be more effective than chlorogenic acid and cinnarine. Similar results are published by Grande et al. “Dual” action – lowering cholesterol and triglycerides in guinea pigs – proved Qiang et al. Interestingly, Xia et al. found that artichoke extract stimulates endothelial nitric oxide synthase which is protective, and reduces the inducible nitric oxide synthase which is involved in inflammatory processes.

Surprisingly, artichoke also shows a spasmolytic effect on isolated guinea pig ileum that is comparable to papaverine published by Emendoerfer et al. and Emedoerfer et al. in two studies. This may partly explain another mechanism (from choleretic) when used in functional dyspepsia. But this turned out to be an oversimplified model and assumption. Verspohl et al. examined a hydrophilic extract rich in luteolin glycosides and a lipophilic extract rich in cinnarine, chlorogenic acid and luteolin. Hydrophilic extract via serotonin receptors (5-HT3 and 5-HT2) causes stronger contractions of the small intestine. Lipophilic extract causes bowel relaxation independent of muscarinic receptors. This unusual combination of action explains the positive effect in an irritable bowel where the balance of contraction and relaxation is extremely important.

As artichoke has traditionally been used in gastritis, Ishida et al. examined artichoke extract and chlorogenic acid in a rat gastritis model and showed a positive effect of the extract, in contrast to colorogenic acid which did not show such an effect.

Interestingly, Tanaka et al. examined artichoke extract and cinnaropicrin in model of skin aging caused by UV radiation. The extract and cinnaropicrin showed a good effect, primarily due to their effect on the transcription factor NF-kappa B. But whether this research will lead to the cosmetic application of artichoke, time will tell.

Clinical research

Based on traditional application and preclinical studies, the selection of artichoke clinical trials is not uncommon. Holtmann et al. in a placebo-controlled, double-blind study examine artichoke extract (dry extract, 640mg 3x daily) in functional dyspepsia. In the study, the extract showed a better effect than placebo. Sannia A. prospectively examines the effect in patients with functional dyspepsia which in addition to artichokes also contains turmeric, dandelion and rosemary. But as it is a complex mixture, it is difficult to draw a conclusion about the effectiveness of artichoke itself.

Several studies of the effect of artichoke leaf extract on liver function have been published. Pittler et al. examine the impact on hangovers, based on preclinical hepatoprotective effect study. The study, with a small number of participants, did not show a beneficial effect in hangovers. Artichoke also did not show a beneficial effect on transaminase levels in patients with chronic hepatitis C in a study Huber et al.. Both studies are not surprising in their results: artichoke is primarily acting as a choleretic and on lipid metabolism. Although it shows a hepatoprotective effect in some preclinical models, such an effect in humans is expected from milk thistle.

Several studies have shown beneficial effects in hyperlipidemias, including the study Bundy et al., Ogier et al., Rondanelli et al.. Cochrane database analyses these studies and concludes that artichoke leaf extract has potential in the treatment of mild to moderate hypercholesterolaemia, but considers that the impact is still not convincing enough.

Studies in other indications have also been published. Roghani-Dehkordi et al. report a beneficial effect in patients with mild hypertension.

Personal experiential practice

Artichoke is one of my favourite plants, probably due to its effect on the liver and overall metabolism, so it has a special place in my practice as one of the main “cleansers” of the organism. However, the main purpose of artichoke is elevated cholesterol, especially in those patients where there are objective signs of biliary insufficiency (bloating after a meal, indigestion). The reason for the action of artichokes is simple- increased bile secretion also allows increased catabolism (breakdown) of cholesterol into bile acids.

The most common question that both patients and professionals ask me is: is artichoke really enough as a monotherapy for hypercholesterolemia? After a lot of experience in hypercholesterolemia, I can empirically say that artichoke works well to increase the ratio of HDL vs. LDL cholesterol and can be monotherapy for not too high cholesterol (about 6-7 mM). However, in more pronounced hypercholesterolemia, artichoke is generally not sufficient as monotherapy. This is also true for people for whom hypercholesterolemia is the result of consuming carbohydrates. The standard combination usually includes either fenugreek (especially in the “carbohydrate” types) or the golden standard ang-khak rice mold (Monascus purpureus). It shows a strong synergistic effect with them. As with any choleretic herb, it is very important to ask the patient if there is a problem with constipation. Bile acids are reabsorbed into the portal bloodstream, so poor intestinal motility enhances the level of reabsorption and thus reduces cholesterol catabolism by a control mechanism via the FXR receptor. Artichoke is also not a monotherapy in metabolic syndrome and is almost regularly combined with fenugreek.

In my experience, artichoke is one of the strongest choleretics and an excellent plant for “cleansing” the body, especially in early spring. However, it really requires caution in cholelithiasis (gallstones), so you should think carefully before using it – start a longer initial therapy with Rowachol before using artichoke (2 capsules 3 times a day). Caution is required in both acute and chronic hepatitis, and toxic liver damage. Although it has been clinically tested many times in these indications and although there are a number of preclinical studies that support its hepatoportective effect, my suggestion is to start milk thistle therapy within a month before using artichoke (depending on the intensity of liver damage). However, milk thistle is a purely hepatoprotective plant, while artichoke is a choleretic and it is necessary to first help the liver parenchyma, and only then to stimulate the excretory role of the liver.

Artichoke is one of my favorite choices in obesity. Although it has a modest effect and is less clinically tested than other weight loss herbs, its effect on lipid metabolism is invaluable in weight loss treatments.

Given the breakdown of cinnarine during drying, EPS, SIPF, or fresh plant tincture is, in my opinion, a perfectly justified choice. The usual dose I recommend is 5mL of EPS or SIPF, 2x a day in water before meals. If necessary, the dose can be increased to 10mL over a shorter period of time (2-3 weeks), but this is true for fresh plant tincture and SIPF, EPS is more than enough to use in a dose of 5mL 2x. Another common question is how long can artichoke be used. Although it is a typical herb used in cures and not so much in chronic therapy, it is possible to use a dose of 5mL 1x a day for a long time, if there is a need for it.

Can artichoke be combined with other choleretic plants? Yes. Let’s be realistic, EPS or SIPF preparation is quite demanding financially, so very often I know to offer patients a variant where they make a decoction of dandelion root 1-2 times a day, and once a day use an artichoke preparation. This is also of practical importance for busy people, who usually work at a time when they also have the biggest meal, lunch, and don’t have time to cook a decoction at work.

As for contraindications, apart from the already mentioned suggestion of a protocol in gallstones and hepatitis, I have not encountered in my practice side effects of artichoke or allergic reactions to it.

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