meta-analysisEvidence: limited
Cholesterol, blood sugar and CRP (pooled)
5 RCTs of amla supplementation in adults aged about 40-58 years, intervention 3 to 12 weeks
Pooled results showed significantly lower CRP, fasting glucose, LDL-C, total cholesterol and triglycerides, and higher HDL-C. The authors call amla 'promising' and say more investigation is warranted.[5]
Limitations: Few and short trials using different products; the abstract does not describe study quality, and effect sizes are in the paper, not repeated here.
meta-analysisEvidence: limited
Cardiovascular risk factors (pooled)
9 RCTs, n=535, parallel (6) and crossover (3) designs; 500-1,500 mg/day for 14 to 84 days
Compared with placebo, mean LDL-C was 15.08 mg/dL lower (95% CI -25.43 to -4.73), VLDL-C 5.43 mg/dL lower, triglycerides 22.35 mg/dL lower and hsCRP 1.70 mg/L lower. The authors advise that the results be interpreted with caution.[6]
Limitations: High heterogeneity for LDL-C (I2 77%) and triglycerides (I2 62%); the prediction intervals for LDL-C (-48.29 to 18.13) and triglycerides (-73.47 to 28.77) cross zero, so a benefit in a new trial is not assured.
systematic reviewEvidence: preliminary
Cardiovascular pharmacology (systematic review)
19 in vitro, animal and clinical studies of amla fruit (searches 1966-2017); clinical quality scored on the Jadad scale
The review reports antiatherogenic, hypolipidemic, antihypertensive, antioxidant, antiplatelet and vasodilatory effects, and improved endothelial function. Much of this rests on in vitro and animal studies.[7]
Limitations: Mixes in vitro, animal and human data; the abstract does not separate human effect sizes.
RCTEvidence: limited
Hyperlipidemia vs simvastatin (Indian J Pharmacol)
n=60 people with type II hyperlipidemia (TC >240 mg%, LDL >130 mg%); amla capsule 500 mg daily (n=40) vs simvastatin 20 mg daily (n=20) for 42 days
Both treatments significantly lowered total cholesterol, LDL, triglycerides and VLDL and raised HDL. Blood pressure fell in both groups, more in the amla group. The authors suggest amla might be added to lipid-lowering therapy.[9]
Limitations: Not blinded and no placebo; unequal groups (40 v 20); 6 weeks; no direct statistical comparison of the two drugs is given in the abstract.
RCTEvidence: moderate
Dyslipidemia (Indian multicentre trial)
n=98 dyslipidemic adults; amla extract 500 mg twice daily vs matching placebo for 12 weeks; double-blind, 3 Indian hospital sites (Mysore, Bangalore), registered with CTRI
At 12 weeks total cholesterol, triglycerides, LDL-C and VLDL-C were lower than placebo (p = 0.0003, 0.0003, 0.0064, 0.0001) and the atherogenic index of plasma fell by 39%. The Apo B/Apo A1 ratio did not differ significantly (p = 0.0866) and CoQ10 did not change.[10]
Limitations: One branded extract; 12 weeks; the abstract's claims about 'scope to treat' dyslipidemia and relative to statins are the authors' interpretation, not shown by this trial.
RCTEvidence: moderate
Metabolic syndrome: vascular function and lipids (Indian trial)
n=59 adults with metabolic syndrome, Nizam's Institute of Medical Sciences, Hyderabad; standardised aqueous extract 250 mg or 500 mg twice daily vs placebo, 12 weeks; double-blind, CTRI-registered
Reflection index (endothelial function), oxidative-stress markers, hsCRP and lipids improved against baseline and placebo, most at 500 mg twice daily. hsCRP fell 39.7% and 53.8% at the two doses. No participant stopped because of adverse events.[11]
Limitations: Small, 12 weeks, one extract, surrogate markers rather than cardiac events.
RCTEvidence: limited
Type 2 diabetes: endothelial function vs atorvastatin
n=80 completers with type 2 diabetes; standardised aqueous extract 250 mg or 500 mg twice daily vs atorvastatin 10 mg vs placebo for 12 weeks
The extract and atorvastatin each significantly reduced the reflection index, improved oxidative-stress and inflammation markers, lipids and HbA1c compared with baseline and placebo. All treatments were well tolerated.[12]
Limitations: Surrogate markers; 12 weeks; a standardised extract, so results do not carry over to powder.
RCTEvidence: moderate
Blood pressure and pleiotropic markers (Indian null trial)
n=150 patients with essential hypertension on usual medicines at JIPMER, Puducherry; aqueous extract capsule 500 mg twice daily vs placebo, add-on, 12 weeks; double-blind
The extract had a good safety profile but produced no additional reduction in systolic or diastolic blood pressure and did not improve oxidant status, antioxidant capacity, lipids, HbA1c, arterial stiffness or hs-CRP.[13]
Limitations: A well-sized negative trial; the extract was a different product from some positive trials, and it was an add-on to blood-pressure medicines.
RCTEvidence: limited
Blood sugar and lipids in newly diagnosed diabetic dyslipidemia
Randomised, open-label comparison of Emblica extract (10% beta-glucogallin) 1 g or 2 g a day vs metformin 500 mg for 90 days
Fasting and postprandial glucose, HbA1c and lipids fell in all three groups. Glucose and HbA1c were significantly lower with 2 g than with metformin or 1 g. No serious adverse effects were observed.[14]
Limitations: Open-label, no placebo arm, single product; numbers per group are not given in the abstract.
RCTEvidence: preliminary
Prediabetes: turmeric-amla combination (Indian trial)
n=62 prediabetic adults (58 completed); Nisha-Amalaki (turmeric plus amla) 500 mg capsule twice daily vs placebo for 6 months; single-blind
Fasting and post-OGTT glucose, insulin, HbA1c, HOMA-IR and oxidative markers fell significantly at 6 months compared with placebo.[15]
Limitations: Two-herb combination, so no effect can be attributed to amla alone; single-blind; the authors declare a conflict of interest regarding study funding.
RCTEvidence: limited
Gum disease: local gel (Indian trial)
n=46 patients with chronic periodontitis, Post Graduate Institute of Dental Sciences, Rohtak; 10% amla sustained-release gel placed in the pocket after scaling and root planing vs placebo gel; 3 months
Test sites had significantly greater reduction in probing pocket depth and bleeding index and more attachment gain at 2 and 3 months (p < 0.05). The authors conclude the gel may reduce inflammation and destruction as an adjunct to scaling.[16]
Limitations: Small; analysed by site (528 sites in 46 patients); a locally placed gel, not an oral supplement.
RCTEvidence: limited
Non-erosive reflux disease
Double-blind, placebo-controlled trial in patients with non-erosive reflux disease, Tehran University of Medical Sciences; registered IRCT2016061428469N1
Frequency and severity of heartburn and regurgitation fell in both groups; the reduction was significantly greater in the amla group than placebo (P < 0.001).[17]
Limitations: Iranian trial; patient-reported symptoms; the abstract used here does not give sample size or dose.
RCTEvidence: preliminary
Female pattern hair loss
n=60 women with androgenetic alopecia (52 completed); amla syrup 10 cc three times a day vs placebo for 12 weeks; triple-blind; TrichoScan
The anagen-to-telogen ratio rose more than with placebo (F = 10.4, P = 0.002), and physician and patient satisfaction were higher. One case of mild constipation was reported.[19]
Limitations: Small, 12 weeks, Iranian trial; the authors call for further study.
RCTEvidence: preliminary
COVID-19 add-on (Iranian trial)
n=61 hospitalised COVID-19 patients; Amla tea add-on (n=31) vs control (n=30)
Mean hospital stay was 4.44 days vs 7.18 days (P < 0.001), and fever, cough, breathlessness and myalgia scores and CRP improved more. RT-PCR results (P = 0.07) and degree of lung involvement did not differ significantly between arms.[18]
Limitations: Small; the abstract's phrase 'controlled' does not describe a placebo; relevance to current COVID-19 care is limited.
RCTEvidence: preliminary
Healthy adults: vascular function and safety markers
n=15 healthy adults, randomised crossover, amla 500 mg/day vs placebo over 18 weeks
Blood fluidity improved, along with von Willebrand factor, oxidative-stress markers, HDL and LDL. Liver tests, urinalysis and haematology did not change substantially, and no adverse events were observed.[20]
Limitations: Only 15 participants, so safety conclusions are limited.
observationalEvidence: preliminary
Overweight adults: lipids, CRP, platelet aggregation
Overweight or class 1 obese US adults took a standardised extract (CAPROS) 500 mg twice daily for 12 weeks, compared with their own baseline visits, then 2-week washout
Calculated LDL-C, total cholesterol/HDL ratio and hs-CRP fell, and ADP- and collagen-induced platelet aggregation was reduced after 12 weeks.[22]
Limitations: Compared with baseline, with no placebo group (as described in the abstract); sample size not given in the abstract; one branded extract.
observationalEvidence: preliminary
Blood sugar and lipids with powder (powder study)
Healthy and type 2 diabetic volunteers took 1, 2 or 3 g of amla fruit powder a day for 21 days
Fasting and 2-hour glucose fell in both groups at all three doses, and lipids and HDL/LDL improved at 2 or 3 g, compared with baseline values.[23]
Limitations: Comparison with baseline, not a placebo-controlled design as presented in the abstract; short and small.
RCTEvidence: preliminary
Fitness and cardiometabolic markers with chromium and shilajit
166 sedentary adults with metabolic-syndrome risk factors (109 completed); chromium, amla extract and shilajit supplements, or amla alone, vs placebo during a 12-week exercise and diet programme; funded by Kerry Inc.
The authors report that amla with chromium, and with chromium plus shilajit, may enhance some changes in markers of health; differences were more consistent at 6 weeks than 12 weeks.[25]
Limitations: Industry-funded and multi-ingredient; the benefits cannot be assigned to amla alone.