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Western herbalism

PapayaCarica papaya

One placebo-controlled trial of a papaya preparation found less constipation and flatulence in 40 days; papain, its enzyme, has no standalone gut trial we could find.

Botanical name
Carica papaya
Part used
ripe fruit, unripe-fruit latex (papain), seed and leaf
Also called
Pawpaw, Papain (the enzyme from the latex), Fermented papaya preparation
Used in
Western herbalism
Taken for
Indigestion, Constipation, Bloating, Antimicrobial use
Sold as
fresh, powder, tablets, capsules, juice, whole seed

What papaya is

Papaya is the tropical fruit of Carica papaya, a tree now grown throughout the tropics. Supplements draw on four parts. The ripe fruit is sold as dried fruit, powder, chewable tablets and juice. The milky latex of the unripe fruit is the source of papain, a protein-digesting enzyme used in digestive-enzyme blends. The seeds, dried and ground, are sold as a whole-seed or powder remedy and appear in some gut-cleanse products. The leaf is taken as a juice or tea, mostly outside the gut context.

Papain is a cysteine protease, an enzyme that cuts proteins at specific points, so it is sold as an aid for the breakdown of dietary protein. Some products use a fermented papaya preparation, a fermented ripe-fruit preparation studied for its antioxidant activity. These forms have separate evidence and separate risks, and the fruit, the enzyme and the seeds should not be read as the same product.

What the traditions use it for

Western herbalism

Papaya is a food and folk medicine in the tropics, and the ripe fruit is eaten across the world. The Natural Medicines database lists traditional uses of the plant for gastrointestinal disorders, intestinal parasites, sedation and as a diuretic. A study of papaya seeds notes that seed preparations are used in traditional medicine to expel intestinal worms in humans and ruminants, and the paper traces the activity to benzyl isothiocyanate in the seeds. Western herbal and supplement practice uses papain as a digestive enzyme, with the idea that it supports protein digestion when the stomach and pancreas do not.

The constituents

The latex holds papain and chymopapain, proteases that digest protein. The seeds contain benzyl isothiocyanate (BITC), the compound credited with their worm-killing action. In rabbit intestine in a dish, a papaya seed extract and BITC weakened jejunal contractions and BITC caused marked tissue damage, which the authors suggest could impair the intestine at the toxic level needed to kill worms in vivo. A rat study cited in the Caricol paper found that papain by mouth lowered gastric acid secretion. Those are laboratory and animal findings; the human trials below tested whole preparations.

The human evidence

The main controlled trial of a papaya preparation, Caricol, was double-blind and placebo-controlled: 139 volunteers with chronic indigestion and bowel complaints were recruited, 126 completed, and they took 20 ml a day for 40 days. Among those who returned within two days of finishing, 82 percent in the papaya group improved on constipation against 47 percent on placebo (p = 0.031), 93 percent against 50 percent on painful straining (p = 0.016) and 78 percent against 43 percent on flatulence (p = 0.017). Heartburn did not reach significance (13 people evaluable, p = 0.114), and the benefit vanished in those who returned several days later. Twenty-two symptoms were scored, so some single results may be chance. A papaya-and-oats product, Caricol-Gastro, was tested in 60 people with endoscopically confirmed mild chronic gastritis, 20 g twice a day for 30 days; symptoms improved in both groups, with a larger pain reduction on the product (p = 0.048).

An open-label study of 91 people with functional dyspepsia after H. pylori treatment tested a blend of alginate, calcium carbonate, pineapple, papaya, ginger, alpha-galactosidase and fennel. All 55 treated people stayed off proton pump inhibitors against 86.1 percent of 36 untreated (P = 0.008). That study had no placebo and cannot isolate papaya.

For worms, the evidence is on the seed. In 60 Nigerian children with parasites, a seed-and-honey elixir cleared stool parasites in 23 of 30 (76.7 percent) against 5 of 30 (16.7 percent) with honey alone. What has not been tested: papain as a stand-alone capsule against placebo in indigestion, and the ripe fruit for constipation.

StudyDoseWhat it found
Double-blind placebo-controlled trial of Caricol, 139 recruited and 126 completed, chronic indigestion and bowel complaints PMID 2352462220 ml a day for 40 daysEarly returnees: constipation improved in 82% vs 47% (p = 0.031), painful straining 93% vs 50% (p = 0.016), flatulence 78% vs 43% (p = 0.017); heartburn not significant
Randomized double-blind trial of Caricol-Gastro (papaya plus oats), 60 people with mild chronic gastritis PMID 2960462020 g twice a day for 30 daysSymptoms improved in both groups; larger reduction in pain load on the product (p = 0.048)
Open-label study, 91 people with functional dyspepsia after H. pylori treatment (multi-ingredient blend with papaya, no placebo) PMID 25384804Blend of alginate, calcium carbonate, pineapple, papaya, ginger, alpha-galactosidase and fennel for 30 days55 of 55 treated avoided PPIs vs 31 of 36 untreated (P = 0.008); symptom score up 1.78 vs down 0.08 points
Randomized trial of air-dried papaya seeds, 60 Nigerian children with stool parasites (seeds, not fruit) PMID 1747248720 ml seed-and-honey elixir, single dose; stool check at 7 daysStool cleared in 23 of 30 (76.7%) vs 5 of 30 (16.7%) on honey; no harmful effects reported
Randomized school study, 326 Kenyan children (seed-fortified porridge, retrospectively registered) PMID 30526582300 ml of porridge daily for 2 monthsAscaris egg count down 63.9% vs 78.8% with albendazole; control group rose
Randomized pilot of a fermented papaya preparation in 60 elderly people with atrophic gastritis (biomarkers, not symptoms) PMID 152470136 g a day for 6 monthsLowered the DNA-damage marker 8-OHdG, the only one of the three supplements to do so (P < 0.05)

Doses, in trials and in practice

Doses come from the preparations tested. Caricol was 20 ml a day for 40 days, Caricol-Gastro 20 g twice a day for 30 days, the Nigerian seed elixir a single 20 ml dose, the Kenyan seed porridge 300 ml a day for two months, and the fermented papaya preparation 6 g a day for six months. The Natural Medicines database states there is not enough scientific information to determine an appropriate range of doses. Traditional forms are the ripe fruit, dried or ground seed, leaf tea or juice, and papain as an extract or tablet.

The amounts above are what trials and pharmacopoeias record, not a dose for you; your medicines and conditions change the answer, and a clinician or pharmacist who knows them is the person to ask.

What is known about safety

The Natural Medicines database rates the fruit likely safe in food amounts, medicinal amounts possibly safe, and large oral amounts possibly unsafe because they could damage the esophagus. It rates oral use in pregnancy possibly unsafe, says unprocessed papain might harm the fetus, and advises avoiding amounts above food levels while breastfeeding. People allergic to papain, or to latex (who have a good chance of reacting to papaya), are told to avoid it. Papain dust caused asthma in food workers in a 1975 report, and papaya seed extract damaged rabbit intestine in a dish. A review of papaya leaf found short-term use well tolerated in adults, with animal concerns about liver and reproductive toxicity in long-term use.

Where it meets prescription medicines

Natural Medicines rates papaya moderate with warfarin, since papaya might increase its effects and the chance of bruising and bleeding, and the site lists papain with warfarin as well. It rates fermented papaya moderate with diabetes medicines because it may lower blood sugar further. The site’s own rules also flag papaya extract with amiodarone and large amounts of papaya with levothyroxine, on a theoretical basis. A review of papaya leaf reported unfavorable herb-drug interactions with metformin, glimepiride, digoxin, ciprofloxacin and artemisinin.

Medicines the site’s own interaction rules flag with papaya

The quiz applies these rules when someone names a medicine. They come from published interaction references and are a reason to ask a pharmacist, not a diagnosis:

Catalog entries that list papaya

If you want papaya in a product rather than as a loose herb, these are the entries that carry it, with the label amounts and the reviews read.

Zenwise Digestive Enzymes 4.4 out of 5 from 67,600 ratings from Amazon · $0.33 a day NOW Foods Super Enzymes 4.7 out of 5 from 54,431 ratings from iHerb · $0.16 a day American Health Super Papaya Enzyme Plus Chewable Tablets 4.6 out of 5 from 11,030 ratings from Amazon · ~$0.11 for a 2-tablet dose after a meal Love Wellness Bye Bye Bloat 4.1 out of 5 from 9,956 ratings from Amazon · $0.83 a day Physician's CHOICE Digestive Enzymes, Multi Enzymes 4.3 out of 5 from 8,980 ratings from Amazon · $0.34 a day BioSchwartz Advanced Prebiotics and Probiotics 4.5 out of 5 from 6,820 ratings from Amazon · $0.67 a day Almape Papaya Seeds Gut Reset Formula 4.82 out of 5 from 6,379 ratings from tryalmape.com · $1.13 a day Vitalitown Probiotics 120 Billion CFU, 36 Strains 4.6 out of 5 from 6,320 ratings from Amazon · $0.55 a day NatureBell Probiotics 200 Billion CFU, 40 Strains 4.6 out of 5 from 1,784 ratings from Amazon · $0.22 a day Jupi Debloat & Hydration Powder 4.1 out of 5 from 1,568 ratings from Amazon · $1.40 a day Totaria 5-in-1 Probiotic, Prebiotic and Postbiotic, 60 Billion CFU 4.5 out of 5 from 1,246 ratings from Amazon · $0.19 a day Organics Ocean Better Fiber with Psyllium Husk and Slippery Elm 4.4 out of 5 from 726 ratings from Amazon · $1.20 a day

8 more entries list it; the full catalog is grouped by the job each product does.

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Herbs that sit beside it

Ayurvedic / TCM / Western Ginger Zingiber officinale Ayurvedic / TCM / Western Fennel Foeniculum vulgare Western Peppermint Mentha x piperita Western Artichoke Cynara cardunculus (syn. Cynara scolymus) Ayurvedic / Western Psyllium Plantago ovata

Common questions

Does papaya help constipation?

One double-blind, placebo-controlled trial of the papaya preparation Caricol found 82 percent of early returnees improved on constipation against 47 percent on placebo (p = 0.031) over 40 days. The benefit vanished in people who returned several days after finishing. We could find no other placebo-controlled trial.

Is papain the same as papaya?

No. Papain is a protein-digesting enzyme from the latex of unripe papaya. We could find no stand-alone trial of papain in indigestion, and it has its own risks, including occupational asthma from papain dust in food workers and an allergy that overlaps with latex.

Do papaya seeds kill intestinal worms?

In 60 Nigerian children, a seed-and-honey elixir cleared stool parasites in 23 of 30 against 5 of 30 on honey. A lab study of the seed’s active compound, benzyl isothiocyanate, found it damaged rabbit intestine in a dish, so the seeds are a separate question from the fruit.

Is papaya safe with warfarin?

Natural Medicines rates papaya moderate with warfarin, because it might increase warfarin’s effects and the chance of bruising and bleeding, and it advises regular blood-level checks. The site lists papain with warfarin as well.

Can people with a latex allergy eat papaya?

The Natural Medicines database says people allergic to latex have a good chance of being allergic to papaya and should avoid it. It gives the same advice for people allergic to papain.

Sources