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Agave (Agave americana)
Natural Standard Bottom Line Monograph, Copyright © 2011 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
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Agaves are succulent plants from the family Agavaceae, which includes Beschorneria, Furcraea, Hesperaloe, Manfreda, Polianthes, Prochnyanthes and Yucca. Agave plants are common in the American southwest, Mexico, central and tropical South America, the Mediterranean and some parts of India. There are over 200 known species of agave; many produce musky odors that attract bats serve to pollinate them, while others produce sweet odors to attract insects.
Agave americana is also known as the American aloe, although it is not related to the true aloes. The leaves of the agave plant yield fibers suitable for textile production. The native people in Mexico used the agave spikes to make pens, nails and needles. Agave sisalana, the source of sisal fiber, is cultivated in plantations in Africa and Asia. The flowering stem can be dried or roasted and eaten; the seeds can be ground into flour to make bread or used as a thickener for soups. A sweet liquid (sap) called agua miel (honey water) gathers in the plant if the stem is cut before flowering. This sap is collected over a period of about two months, and can then be fermented to produce the alcoholic beverage pulque (octili), which Native Americans use in religious ceremonies. Further distillation creates Mescal (mezcal). A form of tequila is made when Mescal is produced from the blue agave (Agave tequilana) plant within the Tequila region of Mexico. This is the most important economic use of agave, worth millions of dollars to the Mexican economy. Mescal is often sold with the caterpillar of the agave moth in the bottle.
Agave is also useful as a sugar alternative because with a 90% fructose, it has a low glycemic index. Steroid hormone precursors are obtained from the leaves. Pulque prepared from Agave species was a food item studied intensively for nutrition potential among traditional and indigenous peoples, and is an example of how local food-based strategies can be used to ensure micronutrient nutrition. Traditional food strategies could be used not only for alleviating malnutrition, but also for developing locally relevant programs for stemming the nutrition transition and preventing chronic disease, particularly among indigenous and traditional peoples who retain knowledge of using food species in their local ecosystems.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
No available studies qualify for inclusion in the evidence table.
*Key to grades:
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
- Antibacterial, bruises, constipation, diabetes, diuretic, dysentery, flatulence (gas), hair-restorer, hemolytic activities, indigestion, insulin resistance, jaundice, laxative, nutritional supplement, parasites, steroid source, swelling, syndrome X.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (over 18 years old)
There is no proven safe or effective dose for agave in adults.
Children (under 18 years old)
There is no proven safe or effective dose for agave in children.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
People who have allergies to plants in Agavaceae family should be cautious in using agave. Contact dermatitis after exposure to the sap of Agave americana has been reported in rare cases.
Side Effects and Warnings
The stiff, erect leaves of some agave plants are tipped with sharp needles, which can cause injury upon contact. Multiple reports of skin rash from Agave americana exist.
Vascular damage from crystals in agave has been reported. There are reports of irritant contact dermatitis from Agave americana when used incorrectly as a hair-restorer.
Pulque consumption may be associated with liver disease (cirrhosis) and increased death rate.
Some constituents of Agave sisalana, have high hemolytic activity, and may be potentially toxic.
Calcium oxalate crystals, found in prickly pear and agave, may have caused microwear of human teeth.
Significant increases in homocysteine levels and a tendency to increase blood glucose concentration and to decrease insulin sensitivity were found in healthy, non-obese young men who consumed tequila daily.
Pregnancy and Breastfeeding
Women from rural areas of the central plateau of Mexico drink a mild alcoholic beverage called pulque as to stimulate breast milk flow (as a galactogogue). The relatively small amount of ethanol taken in by infants through milk is unlikely to have harmful effects. However, pulque intake during breastfeeding may have adverse influences on postnatal growth in some Mexican populations.
Anordin and dinordin, prepared with steroids derived from the sisal plants Agave sisilana and Agave americana have been used for their antifertility effects. These agents, whose anti-fertility properties have been confirmed by scientists in Sweden and the United States, constitute a potential new family of contraceptives promising the advantage of having to be taken only once or twice a month instead of the 20 times per month necessary with the ordinary pill.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Steroid hormone precursors are obtained from agave leaves. Caution is advised when taking agave with other steroidal agents.
Contraceptive and anti-fertility effects have been reported with the use of agave. In theory, caution is advised when taking agave with other contraceptive agents, such as birth control pills.
Agave may alter blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
Interactions with Herbs and Dietary Supplements
Steroid hormone precursors are obtained from agave leaves. Caution is advised when taking agave with other herbs with steroidal properties.
Agave may alter blood sugar levels. Caution is advised when using medications that may also alter blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
- Argote-Espinosa RM, Flores-Huerta S, Hernandez-Montes H, et al. [Plasma clearance of ethanol and its excretion in the milk of rural women who consume pulque]. Rev Invest Clin 1992;44(1):31-36. View Abstract
- Arizaga S, Ezcurra E, Peters E, et al. Pollination ecology of Agave macroacantha (Agavaceae) in a Mexican tropical desert. II. The role of pollinators. Am J Bot 2000;87(7):1011-1017. View Abstract
- Backstrand JR, Goodman AH, Allen LH, et al. Pulque intake during pregnancy and lactation in rural Mexico: alcohol and child growth from 1 to 57 months. Eur J Clin Nutr 2004;58(12):1626-1634. View Abstract
- Borup LH, Meehan JJ, Severson JM, et al. Terminal spine of agave plant extracted from patient's spinal cord. AJR Am J Roentgenol 2003;181(4):1155-1156. View Abstract
- Brazzelli V, Romano E, Balduzzi A, et al. Acute irritant contact dermatitis from Agave americana L. Contact Dermatitis 1995;33(1):60-61. View Abstract
- Cherpelis BS, Fenske NA. Purpuric irritant contact dermatitis induced by Agave americana. Cutis 2000;66(4):287-288. View Abstract
- Crabbe P. Mexican plants and human fertility. UNESCO Cour 1979;7:33-34. View Abstract
- de la Cueva P, Gonzalez-Carrascosa M, Campos M, Leis V, Suarez R, Lazaro P. [Contact dermatitis from Agave americana] Actas Dermosifiliogr. 2005 Oct;96(8):534-6. View Abstract
- Gonzalez-Ortiz M, Pascoe-Gonzalez S, Kam-Ramos AM, et al. Effect of tequila on homocysteine, insulin secretion, insulin sensitivity, and metabolic profile in healthy men. J Diabetes Complications 2005;19(3):155-159. View Abstract
- Hackman DA, Giese N, Markowitz JS, et al. Agave (Agave americana): an evidence-based systematic review by the natural standard research collaboration. J Herb Pharmacother. 2006;6(2):101-22. View Abstract
- High WA. Agave contact dermatitis. Am J Contact Dermat 2003;14(4):213-214. View Abstract
- Kerner J, Mitchell J, Maibach HI. Irritant contact dermatitis from Agave americana L. Incorrect use of sap as "hair restorer". Arch Dermatol 1973;108(1):102-103. View Abstract
- Narro-Robles J, Gutierrez-Avila JH, Lopez-Cervantes M, et al. [Liver cirrhosis mortality in Mexico. II. Excess mortality and pulque consumption]. Salud Publica Mex 1992;34(4):388-405. View Abstract
- Ricks MR, Vogel PS, Elston DM, et al. Purpuric agave dermatitis. J Am Acad Dermatol 1999;40(2 Pt 2):356-358. View Abstract
- Shatoian I, Golomozenko VF. [Contact dermatitis caused by agave used for therapeutic purposes]. Vestn Dermatol Venerol 1987;(2):63-64. View Abstract
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.