Mora

Mulberry (Morus spp.): A Comprehensive Reference Article

1. Identity, Botanical Classification, and Natural Sources

Genus and family: Mulberry belongs to the genus Morus, family Moraceae. The species most extensively studied in pharmacological and clinical contexts is Morus alba L. (white mulberry, also known in traditional Chinese medicine as sang shu). The plant is also known locally in South Asia as Shahtoot.

Major species in commerce and medicine:

• Morus alba L. (white mulberry) — originating in Asia, the most studied medicinal and sericulture species.
• Morus nigra (black mulberry) — native to Western Asia and historically brought to Europe by the Romans for cultivation.
• Morus rubra (red mulberry) — indigenous to North America, particularly the east coast to the Great Plains, with deep cultural history among some Native American tribes.
• Morus australis (Korean mulberry) — thriving in Korea and parts of Japan, used in traditional Korean medicine.

Botanical description: Morus alba is a fast-growing shrub or medium-sized tree with a straight, cylindrical trunk. Medicinally, whole plants, leaves, fruits, branches, and roots have been employed.

Plant parts used: The branches (Mori Ramulus), leaves (Mori Folium), roots and barks (Mori Cortex), and fruits (Mori Fructus) of M. alba are rich in chemical components and possess diverse pharmacological activities.

Common forms and preparations: Mulberry is available commercially in several forms. Oral preparations for blood glucose management include tablets, capsules, and powders made from mulberry leaf extract. For topical and dermatological use, formulations may include creams, ointments, lotions, milky liquids, emulsions, mucilages, pastes, foams, aerosols, and anhydrous solid preparations such as stick-shaped products. Traditionally, leaves have also been brewed as an herbal tea, and the fruit is consumed fresh or processed into dried powders, juices, jams, and food products. The fruits have been made into a variety of food products, and the leaves have been used as animal feed for livestock.

2. Traditional and Historical Use

China and East Asia

Records of 3,000 years of mulberry cultivation have been found in China, where the mulberry tree was utilized by ancient Chinese for food, paper production, silkworm farming, and medicinal purposes. The mulberry foliage has remained the primary food for silkworms for centuries.

Traditional Chinese Medicine (TCM) employed every part of the mulberry tree, including the root bark, leaves, and fruit, to treat ailments ranging from fevers and coughs to hypertension and high blood sugar. More specifically, mulberry leaves (Morus alba) have been widely prescribed in TCM to "cool the blood," treat fever, and relieve coughs and sore throats. The berries themselves were used to nourish the blood, improve liver and kidney function, and combat fatigue and premature graying of hair.

The fruits of M. alba have traditionally been used as an analgesic, anthelmintic, antibacterial, anti-rheumatic, diuretic, hypotensive, hypoglycemic, purgative, restorative, sedative tonic, and blood stimulant. Various plant parts were used as cooling, sedating, diuretic, tonic, and astringent agents to treat nerve disorders.

Mulberry root bark is traditionally used in TCM to drain Lung Heat and direct rebellious Qi downward, addressing cough, wheezing, chest fullness, and fluid accumulation. Mulberry root bark was also used as a diuretic and expectorant, aiding in the treatment of edema and asthma.

In old Chinese medicine, mulberry was used for the treatment of a number of diseases including cancer, inflammation, and viral infections.

India and Ayurvedic Tradition

Morus indica, prevalent in India, is cherished for its medicinal properties in Ayurvedic medicine, where it is used to treat various ailments from diabetes to heart conditions.

West Asia and Persia

West Asia, including Persia (modern Iran), has a rich tradition with mulberries. Shahtoot, or Persian red mulberries (Morus nigra), are a traditional delicacy, often dried and used in cooking or eaten fresh in spring, to help cleanse and renew the body. Persian literature and cuisine are replete with references to mulberries, indicating their cultural significance.

Europe

Mulberries were highly valued and eaten at feasts in Roman times. The mulberry tree was included among the large number of useful plants ordered by Charlemagne (812 AD) to be cultivated on the imperial farm.

North America

Morus rubra, the red mulberry, has a long-standing relationship with many indigenous peoples of North America.

3. Key Constituents and Active Compounds

The different plant parts of Morus alba contain distinct chemical profiles.

Leaves (Mori Folium)

With flavonoids as major constituents, mulberry leaves possess various biological activities, including antioxidant, antimicrobial, skin-whitening, cytotoxic, anti-diabetic, glucosidase inhibition, anti-hyperlipidemic, anti-atherosclerotic, anti-obesity, cardioprotective, and cognitive enhancement activities.

Mulberry leaves contain various bioactive phenolic compounds; in particular, chlorogenic acid (CGA) is a major bioactive ingredient. The bioactive compounds flavonoids, alkaloids, polysaccharides, polyphenols, volatile oils, sterols, amino acids, and a variety of inorganic trace elements and vitamins have been found to be abundant in mulberry leaves. Among these, flavonoids, alkaloids, polysaccharides, and polyphenols have a stronger link to diabetes.

A critical alkaloid constituent is 1-deoxynojirimycin (DNJ): a potent glucosidase inhibitor, DNJ has been hypothesized to be beneficial for the suppression of abnormally high blood glucose levels and thereby prevention of diabetes mellitus. Naturally occurring DNJ, a kind of azasugar, was first isolated from mulberry roots by Yagi et al. in 1976. DNJ is a glucose analogue with a secondary amine group instead of an oxygen atom in the pyranose ring of glucose. DNJ potently inhibits α-glucosidase in the small intestine by binding to the active center of α-glucosidase.

Morus alba contains a variety of prenylated flavonoids (sanggenon C, morin, morusin, kuwanon G), flavonols (isoquercitrin, quercetin, kaempferol, rutin), and alkaloids (1-deoxynojirimycin).

Mulberry leaf extracts contain the stilbene oxyresveratrol in measurable quantities, while resveratrol itself was not detected in some analyses. Oxyresveratrol is a stilbene polyphenol widely found in mulberry. Its biological activities are similar to resveratrol, including anti-inflammatory, antioxidant, antitumor, and neuroprotective activities. Researchers have found that oxyresveratrol has better water solubility, faster oral absorption rate, and longer metabolism time than resveratrol.

Root Bark (Mori Cortex)

The root bark of mulberry, containing flavonoids, alkaloids, and stilbenoids, has antimicrobial, skin-whitening, cytotoxic, anti-inflammatory, and anti-hyperlipidemic properties.

From different parts of Morus alba, constituents such as prenylated flavonoid (moralbanone), stilbene glucoside (oxyresveratrol 3′-O-beta-glucopyranoside), mulberroside A, cis-mulberroside A, oxyresveratrol, kuwanon A, B, C, E, G, J, R, S, and T, mulberroside C, and cyclomorus have been successfully isolated.

Fruit (Mori Fructus)

Rich in anthocyanins and alkaloids, mulberry fruits have pharmacological properties such as antioxidant, anti-diabetic, anti-atherosclerotic, anti-obesity, and hepatoprotective activities. Mulberry fruits contain anthocyanins including cyanidin 3-O-glucoside and cyanidin 3-O-rutinoside, and flavonols such as quercetin.

Whole Plant

The plant broadly contains tannins, steroids, phytosterols, sitosterol, glycosides, alkaloids, carbohydrates, proteins, and amino acids, as well as saponins, triterpenes, phenolics, flavonoids, benzofuran derivatives, anthocyanins, and anthraquinones.

4. Established Mechanisms of Action

Alpha-Glucosidase and Alpha-Amylase Inhibition (Glycemic Regulation)

Mulberry extracts can reduce postprandial blood glucose and insulin responses by slowing rates of glucose uptake following carbohydrate-rich meals. The presumed mechanism is the inhibition of intestinal alpha-glucosidase, mainly attributed to 1-deoxynojirimycin (DNJ) in the extracts. DNJ exhibits strong α-glucosidase inhibitory activity that effectively slows carbohydrate digestion and reduces postprandial blood glucose spikes. Mulberry plant materials also comprise fagomine and GABA among their physiologically active components.

Network pharmacology analysis has revealed that morusin, kuwanon C, and morusyunnansin L are main active compounds of mulberry leaf flavonoids that amend insulin resistance and glycemia via the PI3K-Akt signaling pathway, lipid and atherosclerosis pathways, and the AGE-RAGE signaling pathway. DNJ, fagomine, and N-methyl-1-deoxynojirimycin are primary active ingredients that target carbohydrate metabolism and regulate alpha-glucosidase activity to produce a potent anti-diabetic effect.

Additionally, DNJ may enhance insulin sensitivity, further supporting blood glucose regulation and potentially alleviating the strain on pancreatic β-cells.

Anti-Inflammatory Mechanisms

The potent anti-inflammatory properties of mulberry leaf extracts and its compounds, resveratrol and oxyresveratrol, suppressed LPS-stimulated inflammatory responses in macrophage cells by significantly reducing nitric oxide production in a concentration-dependent manner. These compounds further inhibited interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) production and suppressed the mRNA and protein expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2).

Mulberroside A exhibits anti-inflammatory and anti-apoptotic effects by decreasing the IL-6, IL-1β, and TNF-α expression and inhibiting activation of NALP3, caspase-1, and NF-κB.

Lipid Metabolism

Mulberry extract inhibits the inflammation in foam cells by suppressing p38 MAPK signaling pathway-mediated inflammasome activation and stimulates ABCA1/ABCG1-mediated cholesterol efflux of foam cells to decrease their formation. Mulberry fruit extract inhibited hepatic sterol-regulatory element binding protein (Srebp) 2 gene expression and upregulated hepatic mRNA levels of liver X receptor alpha (Lxr-α), ATP-binding cassette transporter 5 (Abcg5), and cholesterol 7 alpha-hydroxylase (Cyp7a1), which are involved in hepatic bile acid synthesis and cholesterol metabolism.

Antioxidant Activity

Morus alba is a natural source of bioactive compounds with antioxidant, anti-inflammatory, and lipid-regulating properties. In animal and in vitro studies, mulberry extracts have been shown to inhibit α-glucosidase activity, reduce lipid accumulation, and suppress inflammatory cytokines such as TNF-α and IL-6.

Neuroprotective Mechanisms

Chlorogenic acid (CGA) and neochlorogenic acid (NCGA) from mulberry leaf extract demonstrated the ability to enhance the activities of antioxidant enzymes superoxide dismutase and glutathione peroxidase, and attenuate inflammation via regulating Nrf2, NF-κB, and inflammatory cytokines, protecting neuronal cells from oxidative damage. CGA and NCGA were also found to decrease the expression of proinflammatory proteins α-synuclein and amyloid-β, and increase the expression of tyrosine hydroxylase and brain-derived neurotrophic factor (BDNF).

Oxyresveratrol, one of the active ingredients derived from mulberry branch, can improve cognitive impairments and episodic-like memory through alleviating neuroinflammation and regulating the PI3K-Akt signaling pathway.

5. Scientific Evidence by Area of Health Application

5.1 Blood Glucose and Diabetes

Evidence strength: Moderate — multiple small to medium-sized randomized controlled trials (RCTs) exist in humans, with some consistency, but larger and longer-duration trials are needed.

A human study indicated that single oral administration of 0.8 g and 1.2 g of DNJ-enriched mulberry powder significantly suppressed the elevation of postprandial blood glucose and secretion of insulin in healthy volunteers.

In study 1 of a two-part clinical investigation, a randomized, double-blind, crossover trial assessed the effects of single ingestion of mulberry leaf extract (3, 6, or 9 mg DNJ) or placebo on blood glucose and insulin concentrations during 2 hours after a carbohydrate challenge (200 g boiled white rice) in 12 subjects with fasting plasma glucose in the range of 100–140 mg/dL. Study 2 was a randomized, double-blind, placebo-controlled trial assessing the efficacy of 12-week extract supplementation (6 mg DNJ, three times daily) for long-term glycemic control in 76 subjects with fasting plasma glucose in the range of 110–140 mg/dL. Long-term ingestion of mulberry leaf extract with enriched DNJ content could result in improved postprandial glycemic control in individuals with impaired glucose metabolism.

A previous randomized controlled clinical study of mulberry DNJ found that 12 mg of mulberry DNJ was an optimal dose to reduce postprandial hyperglycemia, with no reported side effects. Long-term ingestion of mulberry leaves also showed a decrease in fasting plasma glucose.

A 2025 randomized trial examined bioequivalence in detail. Healthy adults (n=84) participated in a balanced-order, double-blind, placebo-controlled study assessing postprandial blood glucose and insulin following addition of mulberry fruit extract (MFE; 0.75 g, containing 2.90 mg DNJ), pure DNJ (2.90 mg), or placebo to rice meals. This study confirms the bioequivalence of DNJ and MFE for reducing postprandial glucose responses in humans; however, although DNJ is largely responsible for this effect, other components of MFE — particularly 2-O-alpha-D-galactopyranosyl-deoxynojirimycin as a precursor of DNJ — may contribute to its observed efficacy.

A review of two small trials (N=20 each) reported significant improvements in acute blood glucose in patients with type 2 diabetes after consumption of single doses of mulberry leaf extract 1 g or 3.3 g compared with controls. However, in obese patients with impaired glucose metabolism enrolled in a randomized controlled study (N=85), administration of 4.6 g of mulberry leaf powder (12 mg DNJ) three times daily for 12 weeks in combination with nutritional counselling resulted in no significant difference in blood glucose compared with nutritional counselling alone, though mulberry supplementation did result in improvements from baseline for fasting plasma glucose.

Gastrointestinal side effects have been reported with DNJ-containing preparations, in particular flatulence and diarrhea, due to the fact that it also inhibits alpha-amylase activity.

5.2 Lipid Profiles and Cardiovascular Risk Factors

Evidence strength: Preliminary to moderate — there are positive signals from small human clinical trials and robust animal/in vitro data, but evidence remains limited by small sample sizes.

An open-label, single-group study was conducted in 10 subjects with initial serum triglyceride (TG) level ≥200 mg/dL. Subjects ingested capsules containing DNJ-rich mulberry leaf extract at 12 mg three times daily before meals for 12 weeks. Findings showed a modest decrease in serum TG level and beneficial changes in the lipoprotein profile. No significant changes in hematological or biochemical parameters were observed during the study period, and no adverse events associated with DNJ-rich mulberry leaf extract occurred.

A clinical study indicated that mulberry leaf tablet therapy is more effective than diet control alone for controlling lipid profile in mild dyslipidemia patients, as shown by a significant fall in serum triglycerides and LDL as well as total cholesterol/HDL ratio. It also showed a rise in HDL in all patients.

In a crossover trial in individuals with obesity, consumption of a mulberry drink significantly reduced systolic and diastolic blood pressure and mean arterial pressure. While total cholesterol, LDL-C, and HDL-C remained unchanged, triglycerides were significantly lower during mulberry consumption. Fasting plasma glucose levels were stable during mulberry consumption but increased significantly with placebo. C-reactive protein levels were also significantly lower during mulberry consumption compared to placebo.

A review and subgroup analysis found that greater benefits were associated with shorter treatment durations and doses below 500 mg per day. Extracts from different parts of the mulberry plant showed varying effects on lipid and glucose metabolism. None of the included trials directly measured cognitive or neurovascular outcomes, so any potential neurovascular protection is inferred from changes in metabolic and inflammatory markers rather than demonstrated.

Animal data support these signals: four-week supplementation with mulberry fruit extract in rats significantly decreased serum and hepatic cholesterol (TC), serum LDL-C, and fecal bile acid levels without changes in body weight and food intake.

5.3 Antioxidant Activity

Evidence strength: Preliminary — strong in vitro and animal data; limited direct human clinical trials specifically measuring antioxidant endpoints.

Abundant evidence suggests anthocyanins found in mulberry can reduce cardiovascular risk, improve inflammation, and protect against chemical toxicity and cerebral ischemic damage. In human dyslipidemia studies, mulberry leaf supplementation was associated with reduced oxidation and CRP levels, indicating an anti-inflammatory antioxidant effect in a clinical population.

5.4 Cognitive Function and Neuroprotection

Evidence strength: Preliminary — largely animal and in vitro studies; no robust human RCTs on cognitive endpoints as of available evidence.

Daily oral administration of mulberry fruit ethanol extract (MFE; 100 mg/kg body weight, for 1.5–3 weeks) remarkably improved spatial memory and learning ability of APP/PS1 transgenic mice (an Alzheimer's disease model). Histological observations showed that MFE reduced amyloid-β plaques and neuron apoptosis in the cortex and hippocampus. MFE treatment alleviated neuroinflammation, as indicated by decreased numbers of astrocytes. These findings were further confirmed by elevation of anti-inflammatory cytokines (IL-4) and reduction of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) in treated animals. Collectively, MFE exhibits a good neuroprotective effect in this model.

In a mouse model, oxyresveratrol (50 and 100 mg/kg) significantly reversed cognitive impairments and alleviated neuronal injuries caused by neuroinflammation, and this effect was mediated via the PI3K-Akt pathway.

In a rat model of menopause with metabolic syndrome, microencapsulated mulberry fruit extract decreased memory impairment, oxidative stress, and acetylcholinesterase activity, while increasing neuron density and Erk phosphorylation in the hippocampus. The neuroprotective and memory-enhancing effects may partly involve enhanced cholinergic function. However, further research, especially clinical trials, is still considered necessary.

Clinical trials on the efficiency of M. alba extracts in enhancing cognitive ability have been conducted, though these remain limited in scale and scope.

5.5 Anti-Obesity and Body Weight

Evidence strength: Preliminary — mainly animal models and limited human studies; evidence insufficient to establish a definitive clinical effect.

Studies have centred around mulberry's anti-visceral-obesity and lipid-reducing effects, with interventions spanning 8–12 weeks and employing modest oral doses — ranging from 10 to 800 mg/kg of body weight per day — of mulberry extracts, powders, or freeze-dried fruits.

In conclusion, mulberry extract can be used to reduce body weight, serum lipids, and lipid levels, based on animal models. In a human crossover trial in participants with obesity, no significant changes in body composition were observed following mulberry drink consumption, underscoring that human evidence on weight loss per se remains limited.

5.6 Anti-Cancer Properties

Evidence strength: Preliminary — in vitro data only; no established clinical evidence in humans.

Mulberry leaf extracts contain chlorogenic acid and other bioactive phenolic compounds. Dichloromethane extracts exhibited cytotoxicity against HuCCA-1, MCF-7, and A-549 cells with IC50 values of 59.18, 62.20, and 103.25 μg/mL, respectively. CGA selectively inhibited the growth of MCF-7 cells with an IC50 value of 26.75 μg/mL. These are in vitro findings only; no clinical translation to cancer treatment has been established.

Mulberry extract modulates several apoptotic pathways and matrix metalloproteinases (MMPs) to block cancer progression in preclinical models. This research is exploratory and does not represent clinical efficacy.

5.7 Hepatoprotection

Evidence strength: Preliminary — primarily animal and in vitro data.

Mulberry extract has been shown to reduce lipid oxidative stress, inflammation, and lipid accumulation in the liver and help ameliorate lipid metabolism disorders in a nonalcoholic fatty liver rat model.

5.8 Antimicrobial Activity

Evidence strength: In vitro and limited preclinical data only.

The root bark of mulberry, containing flavonoids, alkaloids, and stilbenoids, has antimicrobial properties. Other pharmacological properties of M. alba include anti-platelet, anxiolytic, anti-asthmatic, anthelmintic, antidepressant, cardioprotective, and immunomodulatory activities, based largely on in vitro and animal studies.

6. Body Systems and Health Areas Associated with Mulberry

• Endocrine / Metabolic System: Blood glucose regulation, insulin sensitivity, anti-diabetic action (alpha-glucosidase inhibition via DNJ).
• Cardiovascular System: Lipid modulation (LDL reduction, HDL promotion, triglyceride reduction), anti-atherosclerotic effects, blood pressure reduction, anti-platelet activity.
• Central Nervous System / Neurology: Cognitive enhancement, neuroprotection, potential anti-neuroinflammatory activity (oxyresveratrol, chlorogenic acid).
• Hepatic System: Hepatoprotective and anti-steatotic effects.
• Immune System: Immunomodulatory and anti-inflammatory activity.
• Respiratory System: Root bark traditionally used for cough, wheezing, asthma.
• Integumentary System: Skin-whitening (tyrosinase inhibition by mulberroside A and oxyresveratrol).
• Gastrointestinal System: Laxative effects from fruit; alpha-amylase and alpha-glucosidase inhibition affecting carbohydrate digestion.

7. Dosage Forms and Doses Reported in Clinical Studies

Dosages reported here are as stated in the cited research sources and are not prescriptive recommendations.

• Single oral administration of 0.8 g and 1.2 g of DNJ-enriched powder significantly suppressed the elevation of postprandial blood glucose and the secretion of insulin in a human study.
• In a randomized, double-blind, crossover trial, single ingestion of mulberry leaf extract at doses of 3, 6, or 9 mg DNJ was tested for acute glycemic effects in subjects with impaired fasting glucose.
• A separate 12-week randomized, double-blind, placebo-controlled trial used 6 mg DNJ, three times daily, in 76 subjects with fasting plasma glucose in the range of 110–140 mg/dL.
• An open-label lipid study in 10 subjects with elevated triglycerides used capsules containing DNJ-rich mulberry leaf extract at 12 mg three times daily before meals for 12 weeks.
• In a 2025 double-blind, placebo-controlled bioequivalence trial (n=84), mulberry fruit extract (MFE; 0.75 g, containing 2.90 mg DNJ) was compared to pure DNJ (2.90 mg) and placebo added to rice meals.
• Results from a small study evaluating effects on mild dyslipidemia suggested a dosage of approximately 1 g of white mulberry leaf powder tablets 3 times a day before meals.
• Two small trials (N=20 each) used single doses of mulberry leaf extract of 1 g or 3.3 g.
• In an N=85 RCT, 4.6 g of mulberry leaf powder (containing 12 mg DNJ) three times daily for 12 weeks was studied in obese patients with impaired glucose metabolism.

A randomized controlled clinical study identified 12 mg of mulberry DNJ as an optimal dose to reduce postprandial hyperglycemia, with no side effects reported at this level.

8. Safety Considerations and Drug Interactions

General Toxicological Profile

Toxicity studies showed no adverse reactions in acute, subacute, and genotoxicity tests. The acute toxicity LD50 was greater than 15.0 g/kg body weight. In acute toxicity study, no mortality or behavioral changes were observed, indicating the LD50 is higher than 15.0 g/kg bw. In the subacute toxicity test, no significant changes were observed in hematological, biochemical, or histopathological parameters. The no-observed-adverse-effect level (NOAEL) in the subacute toxicity study was considered to be 7.50 g/kg bw/day, the highest dose tested.

In the genotoxicity study, mulberry leaf extract showed no mutagenic activity in the Ames assay and no evidence of potential to induce chromosome aberrations or sperm abnormalities in mice exposed to 10 g/kg bw.

In a 90-day oral sub-chronic study using mulberry fruit extract, no abnormalities were detected in body weights, food intake, ophthalmological, hematological, coagulation, clinical chemistry, and organ weight parameters. Discoloration of urine (red, purple, and brown) and feces (black) were observed in the 4200 mg/kg group. Microscopic examination revealed brown granules in the renal tubular cells at 4200 and 1400 mg/kg groups, with the NOAEL determined as 4200 mg/kg/day.

Adverse Effects Reported in Human Studies

One clinical study found that some patients experienced mild diarrhea, dizziness, constipation, and bloating. Gastrointestinal side effects, in particular flatulence and diarrhea, have been reported with DNJ-containing preparations due to the fact that it also inhibits alpha-amylase activity.

One subacute toxicity study in mice observed a specific hepatic signal: administration of mulberry leaf extract caused mild hepatotoxicity correlated with kaempferol and chlorogenic acid compounds, though the 125 mg/kg dose was considered safe with a no-observed-adverse-effect level (NOAEL). Another study reported that administration of mulberry leaf increased liver enzyme activity in humans.

Allergic Reactions

The pollen extract of white mulberry may cause airborne contact urticaria, and patients with nasobronchial allergies may be sensitive to the pollen extract.

Drug Interactions

Mulberry (Morus alba) is a food supplement that may cause herb–drug interactions (HDIs).

• Antidiabetic medications: White mulberry may enhance the glucose-lowering effects of metformin, sulphonylureas, insulin, and other antidiabetic agents, increasing hypoglycemia risk. Patients with diabetes should monitor blood glucose closely and may require medication dose adjustments.
• Alpha-glucosidase inhibitors: Concurrent use of mulberry with acarbose and other alpha-glucosidase inhibitors is not recommended due to overlapping mechanisms and increased risk of gastrointestinal adverse effects.
• Anticoagulants and antiplatelet agents: Limited evidence suggests white mulberry may possess mild antiplatelet activity, though clinical relevance is unclear. Patients taking warfarin, direct oral anticoagulants, or antiplatelet agents should exercise caution, and INR monitoring should continue as usual; patients should watch for signs of bleeding or bruising.

Although the vast majority of available evidence suggests that herbal medicines are relatively safe, one case report showed that a patient with type 2 diabetes who was treated with the combination of metformin and repaglinide experienced hypoglycaemia, suggesting that patients and clinicians should be alert to this possibility. Further research is required to examine the potential for hypoglycaemia in patients who are concurrently administered antidiabetic drugs.

Limitations of Current Safety Evidence

Only limited research has been done on the toxicological profiling of mulberry extract for its safety evaluation, and the available data are considered inconclusive. The studies highlight the importance of further investigation to determine safe doses for herbal medicines and prevent potential adverse effects on organs. The toxicological impact of an extract can be altered by various factors, including dosage, method of extraction, type of plant, and geographical origin.

References

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