Indications
Emblica officinalis, Terminalia bellirica and Terminalia chebula are the three fruits that make up Triphala churna, a combination containing potent antioxidant and anti-diabetic properties.1a
Hyperlipidemia, atherosclerosis, diabetes, obesity, digestive disorders, dyspepsia, diarrhea, dysentery, joint pain, and osteoarthritis. Also used as an anti-inflammatory and antimicrobial.1b
Mechanism of Action
Triphala inhibits lipid peroxide and promotes scavenging of hydroxyl and superoxide radicals in vitro.1b The precise mechanisms of its antiobesity effects have not yet been elucidated.
Evidence-Based Research
A systematic review of 12 studies comprised of 749 patients treated with triphala showed decreased low-density lipoprotein-cholesterol, total cholesterol and triglyceride in 6 studies; reduced body weight, body mass index and waist circumference in 5 randomized clinical trials of obese patients; and reduced fasting blood glucose in patients with diabetes but not in those without diabetes.2
A randomized controlled trial compared triphala to placebo in a study of obese subjects. Participants received 5 g/day of triphala or a placebo. Baseline and posttreatment levels of glucose and fasting insulin were recorded. Participants were also evaluated for weight, body mass index, waist circumference, and hip circumference monthly for 12 weeks. The study found that triphala supplementation supported weight loss and promoted an average loss of 4 cm in waist circumference and 3 cm in hip circumference. No comparable changes were noted in the placebo group.3
Triphala polyphenols contain anti-inflammatory activity. Triphala can also help attenuate cognitive dysfunction and anxiety stemming from chronic sleep deprivation.4 Research also suggests triphala to be protective against ionizing radiation5 and be antimutagenic in certain doses.6
Triphala has demonstrated oral hygienic support. In a study of 27 intellectually disabled (ID) children, triphala toothwipes demonstrated effectiveness against Streptococcus mutans compared to placebo toothwipes, thus indicating triphala toothwipes to be an adjunct aid to routine oral hygiene for those lacking psychomotor skills or those who are dependent on others for oral hygiene maintenance.7
Triphala may support skin health. In an 8-week patient and outcome assessor-blinded, randomized, placebo-controlled trial of 80 patients with scalp seborrhea aged 14-50 years, participants administered triphala noticed greater improvement in scalp sebum levels.7b Triphala polyphenols also modulate the human gut microbiome. They encourage the growth of beneficial Bifidobacteria and Lactobacillus and inhibit the growth of undesirable gut microbes.7c
Safety in Pregnancy and Breastfeeding
There have been no published studies on the use of triphala in pregnancy and lactation.
General Safety
One study dosing triphala at 5 g/day for 12 weeks reported no significant side effects and no alteration in lab markers of renal and liver function.3
An open-label, single-arm trial was conducted that enrolled 10 male and 10 female healthy volunteers, all of which were given Triphala water extract at five capsules of 500 mg each per day for four consecutive weeks.
This oral dose of 2500 mg/d of Triphala did not cause any serious adverse effects in the volunteers.8
Triphala protects nuclear material from a variety of genotoxins9; yet, it may significantly increase DNA damage at concentrations above 500 ppm.10 Thus, both mutagenic and antimutagenic properties have been demonstrated, depending on the dosage and the test performed.6
Triphala inhibits cytochromes p45011 and may interfere with some pharmaceutical agents.
Dosage
Five grams per day was used in a clinical trial of obesity. Smaller amounts are used in herbal formulas for synergistic effect, especially formulas containing Commiphora spp. Triphala has been used in animal studies at doses of 300, 600, and 1200 mg/kg.
Traditional Uses
Triphala means “three fruits.” It is an age-old herbal combination known in the Ayurvedic medical system as “Itrifal Saghir,” and it has been traditionally used for diabetes,12,13 obesity, and diarrhea9 and to promote digestion and satiety.
Additional consideration for Triphala
Because those with hypothyroid function can suffer lipid accumulation and elevated lipid and glucose levels because of low metabolic rate, triphala can potentially be a supportive herb to include in formulas for metabolic insufficiency.
References
1a Biomed Pharmacother. 2022 Apr;148:112711. Triphala churna ameliorates retinopathy in diabetic rats. Suryavanshi SV, Barve K, Utpat SV, et al.
1b Ethnopharmacol 2002;81(2):155–60. Anti-diabetic activity of medicinal plants and its relationship with their antioxidant property. Sabu MC, Kuttan R.
2 Altern Ther Health Med. 2012;18(6):38–45. Triphala and its constituents ameliorate visceral adiposity from a high-fat diet in mice with diet-induced obesity. Gurjar S, Pal A, Kapur S.
3 Daru. 2012;20(1):33. Efficacy of ‘Itrifal Saghir’, a combination of three medicinal plants in the treatment of obesity; A randomized controlled trial. Kamali SH, Khalaj AR, Hasani-Ranjbar S, Esfehani MM, Kamalinejad M, Soheil O, Kamali SA.
4 Int Immunopharmacol. 2024 Dec 5;142(Pt B):113179. Triphala ameliorates cognitive deficits and anxiety via activation of the Nrf2/HO-1 axis in chronic sleep-deprived mice. Wang W, He M, Rangji C, et al. Sireeratawong S, Jaijoy K, Soonthornchareonnon N.
5 Mutat Res. 2006;609(1):17–25. Protection against radiation oxidative damage in mice by Triphala. Sandhya T, Lathika KM, Pandey BN, Bhilwade HN, Chaubey RC, Priyadarsini KI, Mishra KP.
6 Food Chem Toxicol. 2002;40(4):527–34. The in vitro antimutagenic activity of Triphala–an Indian herbal drug. Kaur S, Arora S, Kaur K, Kumar S.
7 Biol Pharm Bull. 2005;28(8):1398–403. Immunomodulatory activity of triphala on neutrophil functions. Srikumar R, Jeya Parthasarathy N, Sheela Devi R.
7b Dermatolog Treat. 2022 Mar;33(2):1011-1016. Effect of oral administration of Triphala, a polyphenol-rich prebiotic, on scalp sebum in patients with scalp seborrhea a randomized clinical trial. Zareie E, Mansouri P, Hosseini H, et al.
7c Altern Complement Med. 2017 Aug;23(8):607-614. Therapeutic Uses of Triphala in Ayurvedic Medicine. Peterson CT, Denniston K, Chopra D.
8 J Herb Pharmacother. 2007;7(3–4):203–12. Evaluation of anti-diarrhoeal property and acute toxicity of Triphala Mashi, an Ayurvedic formulation. Biradar YS, Singh R, Sharma K, Dhalwal K, Bodhankar SL, Khandelwal KR.
9 Food Chem Toxicol. 2013;62:521–7. Genotoxic, antigenotoxic and phytochemical assessment of Terminalia actinophylla ethanolic extract. Pádua PF, Dihl RR, Lehmann M, de Abreu BR, Richter MF, de Andrade HH.
10 J Environ Pathol Toxicol Oncol. 2005;24(3):193–200. Evaluation of genotoxicity of medicinal plant extracts by the comet and VITOTOX tests. Arora S, Brits E, Kaur S, Kaur K, Sohi RS, Kumar S, Verschaeve L.
11 J Ethnopharmacol. 2011;133(1):120–5. Cytochrome P450 inhibitory potential of Triphala–a Rasayana from Ayurveda. Ponnusankar S, Pandit S, Babu R, Bandyopadhyay A, Mukherjee PK.
12 Anc Sci Life. 2008;27(3):45–9. Hypoglycemic effect of triphala on selected non insulin dependent Diabetes mellitus subjects. Rajan SS, Antony S.
13 J Ethnopharmacol. 2013;149(2):490–8. Constituents from Terminalia species increase PPARα and PPARγ levels and stimulate glucose uptake without enhancing adipocyte differentiation. Yang MH, Vasquez Y, Ali Z, Khan IA, Khan SI.