Can green jackfruit be a silver bullet in fight against fatty liver, cancer?

For Dr Vinod Abichandani, it wasn’t any different from the rest of us. “Unnerving days with terrible news all around.” That is how he recalls the lockdown days during the pandemic. It was 2020, and Dr Abichandani was stuck at home.A diabetologist with an MD degree and an MSc in endocrinology from the University of South Wales, Dr Abichandani has had a busy practice in Ahmedabad for four decades. But he had to go slow during Covid. He used the free time during this period to revive his academic interests.That is when he came across the anti-diabetic properties of green jackfruit. That caught his interest. He had many patients, including the one at home — his dear wife.She suffered from diabetes, hypothyroidism, fatty liver and obesity. In Dr Abichandani’s words, “a complex metabolic milieu”. He straightaway made an order on Amazon and a pack of green jackfruit flour landed at his door in a couple of days.By the time Amazon delivered a pack of Jackfruit365 to him, there were thousands of customer reviews and numerous individual testimonials on its effectiveness in controlling blood sugar. Not to mention newspaper articles about its founder James Joseph’s pursuit to popularise jackfruit, which often got the tag of a ‘superfood’. You can read ET Prime’s two-part series in 2019 here and here.Joseph had already made some headway when Dr Abichandani made his tryst with green jackfruit. Joseph had won the central government’s National Startup Award. He presented a paper in the American Diabetes Association, and got it published in international scientific journal Nature. medium nocaptionhttps://youtu.be/VXIXs5sHq30?si=GxA0ODYvKXN8tFvaFrom early 2021, Dr Abichandani and his wife started taking two tablespoons of jackfruit powder daily. They would mix it with their chapati, buttermilk and lassi. He diligently tracked his wife’s health indicators, and saw a substantial reduction in her blood sugar, cholesterol, triglycerides and body weight. Among all these positive changes, a particular development turned out to be the most pleasant surprise — Mrs Abichandani’s fatty liver condition considerably reversed.She had grade 2 fatty liver, and it almost became normal after the daily intake of jackfruit flour for three months. From 66 IU, it had come down to 46 IU (45 international unit per litre in liver function test is considered normal range).“She came out of a tough situation,” says a happy Dr Abichandani. A good number of indicators returned to the normal range and the doctor decided to give his wife a drug holiday for many of her health issues. “Her medicine requirement came down to a third,” he says.Dr Abichandani became an ambassador of green jackfruit and gave his testimonials in various health forums.He told ET Prime that he prescribed jackfruit flour to 270-280 of his patients, and 90% of them showed remarkable improvement in at least one parameter.Public health concernNon-alcoholic fatty liver disease has an estimated prevalence among 38.4% adults in India. A third of fatty liver patients face the risk of getting inflicted with liver cirrhosis or in some cases even cancer. Therefore, this has become a major public health concern.The central government has taken note of the situation. Earlier last week, Dr Jitendra Singh, minister of state for science and technology, said: “As an endocrinologist myself, I understand the nuances of fatty liver and its relationship with diabetes and other metabolic disorders.”Doctors across the country have been looking for effective dietary and nutraceutical interventions in the absence of easily available drugs. It was only in April this year that Rezdiffra, the first drug for the treatment of non-alcoholic fatty liver to receive US Food and Drug Administration (FDA) approval, became available in the US. It has hit the Indian market but is yet to become widely available. Saroglitazar, a drug that is available in the Indian market, does not have FDA approval. medium nocaptionhttps://youtu.be/lGP9hNk64tg?si=6VS1M_y8r_EtbolfDoctors generally advise lifestyle changes and dietary control to fatty liver patients. It is in this context that some positive outcomes like Dr Abichandani’s clinical experience came to the attention of a section of the scientific community. But the Indian health sector, which is in constant battle with folk-cure practices and quackery, approaches such food-based solutions with a high degree of scepticism. To earn widespread acceptance, such nutraceutical interventions require very strong evidence and scientific explanation.A small section of doctors, scientists and researchers found that clinically proving the efficacy of green jackfruit in fighting fatty liver is at least worth a try. The anti-diabetic properties of green jackfruit have already got evidence, then why not check its potency in the case of other related ailments?Mice from HyderabadSixty healthy and well-groomed mice were transported from Hylasco Bio in Hyderabad to a neatly set-up biochemistry lab at JSS Medical College, Mysuru, in December 2022. Hylasco is a licensee of US-headquartered Charles River, the world leader providing a host of laboratory services to the pharmaceutical industry, especially animals for research and development.The mice were inbred with each costing ₹1,200. Their diet was specifically developed and prepared by Research Diet in the US. The specially prepared diet was imported by Labex.It was Divya P Kumar, an associate professor at JSS, who brought these mice to Mysuru. Kumar, a PhD from Virginia Commonwealth University, had conducted extensive biomedical research on fatty liver in the US and India. It took six months for her to design the animal study, set up the infrastructure and bring the mice to her laboratory.The idea was to find if what Dr Abichandani saw in his patients could be replicated in the noise-free pre-clinical model — the mice would be free of any confounding factors. Thirty mice were given a normal chow diet or generic grain/cereal diet used for rodent studies. The other 30 were given the western diet — a high-fat diet with a lot of sugar. In layman terms, it was a McDonald’s diet; equivalent to a fat burger and a large glass of Coke. It contained 41% sugar and 21% fat.By the 12th week, the weight of the mice that were fed the western diet was double that of their counterparts. From the 12th week, half of the mice in these two groups were given a small amount of green jackfruit flour as part of their daily diet. medium nocaptionhttps://youtu.be/nCiSizwlxa0?si=2Qp2lH3JIZd2-7DOSimply put, the mice were divided into four groups now.1. Mice that were fed normal diet2. Mice that were fed normal diet and green jackfruit flour3. Mice that were fed western diet and green jackfruit flour4. Mice that were fed western diet and wheatAt the end of the 24th week, between the first two groups — the mice that were fed normal diet and their counterparts that were fed normal diet mixed with green jackfruit flour — there weren’t any differences.But among the western diet-fed mice — the third and fourth groups — the ones that had 5% jackfruit in their food showed significantly lower body weight than the other group. Their average body weight was about 8gm lower than that of the mice that did not have green jackfruit on their menu. The average liver weight was 3.04gm for mice consuming western diet and jackfruit against 3.72gm for those having western diet and wheat.Kumar also conducted a study on the effect of jackfruit on liver tumour for a section of those mice. She found that among the fat western diet-fed mice, the ones that did not have jackfruit flour in their diet, they had six times more liver tumours than their jackfruit-eating counterparts.“Jackfruit significantly reduced body weight, liver injury, insulin resistance, and alleviated obesity, steatosis, inflammation, fibrosis and tumour development in western-diet mice compared to placebo groups,” according to the paper on this animal study produced by Kumar and her team of researchers. Placebo group here refers to the mice that were fed western diet and wheat.The scientific evidenceTheir study found that jackfruit activated AMPK, an enzyme that reduces fat storage, and inhibited MAPK, an enzyme that is responsible for cellular proliferation or tumour. To put it simply, green jackfruit reduced fatty liver and stopped liver tumour in Kumar’s mice study.“Our findings present strong evidence of jackfruit’s therapeutic potential in the prevention of MASH (metabolic dysfunction-associated steatohepatitis or advanced fatty liver disease) and MASH-HCC (hepatocellular carcinoma or liver cancer),” the paper said.The post-animal study analysis took another six months, and the research paper became ready in May this year.Joseph, who partnered with Kumar for the nearly two year-long study, presented the paper that showed evidence of green jackfruit preventing obesity and fatty liver at the American Society for Nutrition conference in Chicago recently. Four years ago, he had presented the paper on the efficacy of green jackfruit in medical nutrition therapy in diabetes treatment at the American Diabetes Association (ADA) conference.That time, he had presented the study conducted by a team of diabetologists among 40 patients. The randomised double-blind study — where participants and researchers are unaware of the treatment they have received until the end of clinical trial — was published in the ADA journal and Nature. medium111748082Despite the customer love and doctors’ endorsements, from a startup trajectory point of view, Joseph’s reaching a breakout stage is arduously long. But what encourages him is the fact that from an accidental discovery of low glycemic load of green jackfruit 10 years ago, the scientific discovery and clinical study of jackfruit’s therapeutic potential have achieved serious momentum.A former Microsoft executive, Joseph started his entrepreneurial life by selling freeze-dried jackfruit pods. Then he stumbled on a health incident. A family friend, an acutely diabetic Catholic priest, collapsed in a heap after a fulsome green jackfruit dinner. A scientific investigation proved that this priest’s daily insulin injection and the green jackfruit meal — a common Kerala diet during summers — turned out to be a double-dose of anti-diabetic intake.Since then, starting with taking green jackfruit to Sydney University to measure its glycemic index, Joseph spent much of his time establishing the science of jackfruit.Joseph’s green jackfruit powder, branded as Jackfruit365, is sold as a food supplement. Therefore, it does not require a rigorous clinical trial to be on the racks of retail shops and e-commerce sites. The product is widely sold in the market, but he opts for the pharmacology route to prove jackfruit’s efficacy.“Doctors are the custodians of public health, and it is important to win their trust. The only way to win their trust is via scientific evidence,” says Joseph. Slowly but surely, Joseph and jackfruit are winning the confidence of doctors.Multi-centre clinical trialKumar, the biomedical researcher who led the mice study, has proposed an elaborate multi-centre clinical trial and is awaiting grant from the Indian Council for Medical Research (ICMR). The research team will have a hepatologist, endocrinologist, gastroenterologist, community medicine expert and biochemist. According to her, several leading doctors, including globally renowned medical scientists, have shown interest in collaboration.“This is a good start,” says Dr Ajay Duseja, secretary general, Indian National Association for Study of the Liver (INASL). Dr Duseja, professor and head of hepatology at the Postgraduate Institute of Medical Education and Research (PGIMR), Chandigarh, too is involved in the study. If the success of the mice study can be replicated in humans, that will be a breakthrough, he says.“This is a proof-of-concept study and will need more validation. Unfortunately, across the globe, we have not been able to find a pharmacological solution for fatty liver that is commonly available. But if there is a dietary solution, there is nothing like it,” says Dr Duseja. medium nocaptionhttps://youtu.be/HSBvtmtIcBE?si=OB6CuRM2QrzYV3x8While green jackfruit’s efficacy in treating serious lifestyle ailments from diabetes to fatty liver is being tested out, its potency in fighting something as life-threatening as cancer too is being explored by doctors.Dr Thomas Varughese, a surgical oncologist, noticed how the high fibre in jackfruit helped prevent chemotherapy side-effects. Following some evidence, Dr Varughese started advising his patients to take green jackfruit flour during their post-chemotherapy phase. The side-effects were much less in those patients.Kochi-based Dr Varughese, who has been treating cancer patients for 35 years, found there was more to it than reducing chemo side-effects when it came to green jackfruit. There is a positive response in terms of tumour necrosis or shrinkage. With the use of green jackfruit flour, Dr Varughese says, “In addition to preventing side-effects, I have observed, tumours are shrinking much better than expected.”No wonder Dr Varughese has turned out to be a big votary of green jackfruit flour and an investor to support further research. He is super convinced that his day begins with gulping a glass of water mixed with a tablespoon of green jackfruit flour on an empty stomach. That seems to be the case with anyone who comes across the science of jackfruit. Kumar has green jackfruit with her yogurt daily in the morning. Dr Abichandani and family have it with their daily roti. He says, “It is a nutritional gem.”