Cabbage (Brassica oleracea var. capitata)
1. Identity: Botanical Name, Classification, and Common Forms
The Brassicaceae family includes a wide range of horticultural crops of economic and traditional importance, consumed either fresh, cooked, or fermented. Cabbage (Brassica oleracea var. capitata) is one of the most important crops of the family. The genus Brassica belongs to the family Brassicaceae (also historically called Cruciferae), and cabbage is one of numerous cultivated forms of the species Brassica oleracea L.
The Capitata group consists of four different forms: alba (white cabbage), rubra (red cabbage), sabauda (Savoy cabbage), and acuta (conical cabbage), varying in their morphological characteristics. White cabbages display a smooth leaf texture that forms tight round or flat heads that are green, or pale green to white in color; pointed cabbages also display smooth textures but form cone-shaped heads; Savoy cabbages present rough leaf textures and form looser heads; red cabbages form compact heads with often oblong shapes and are characterized by their purple color.
Cabbage form and cultivars significantly affect phytochemical compositions. B. oleraceae var. capitata f. rubra cultivars are generally great sources of phenolic compounds, especially anthocyanins, whereas B. oleraceae var. capitata f. alba cultivars display the highest concentration of glucosinolates; nevertheless, their levels are also dependent on the specific cultivar.
Common forms and preparations include:
- Fresh/raw leaves and heads, consumed directly in salads or as juice
- Cooked (boiled, steamed, stir-fried, or roasted)
- Fermented preparations such as German sauerkraut, Korean kimchi, and Eastern European varieties
- Topical application of whole fresh leaves (used externally as compresses or wraps)
- Concentrated juice extracts and standardized cabbage extract preparations used in clinical studies
- Indole-3-carbinol (I3C), a key cabbage-derived compound, is also available without a prescription as a dietary supplement, alone or in combination products.
2. Traditional and Historical Use
Ancient Mediterranean Civilizations
Cabbage has been cultivated, and even revered, as a vegetable by the ancient Greeks as far back as 2600 years ago, and it has also had a long history of medicinal use. There are scores of references to its use for such diverse purposes as the prevention of drunkenness, headache, stomach ailments, and even cancer.
The Ancient Greeks recommended consuming the vegetable as a laxative, and used cabbage juice as an antidote for mushroom poisoning, for eye salves, and for liniments for bruises. The ancient Roman, Pliny the Elder, described both culinary and medicinal properties of the vegetable.
In the Roman world, cabbage was actively promoted by Cato the Elder (234–149 BCE). The more traditionalist Cato the Elder, espousing a simple Republican life, ate his cabbage cooked or raw and dressed with vinegar; he said it surpassed all other vegetables, and approvingly distinguished three varieties; he also gave directions for its medicinal use.
The Greeks and Romans claimed medicinal usages for their cabbage varieties that included relief from gout, headaches and the symptoms of poisonous mushroom ingestion. Cabbage continued to figure in the materia medica of antiquity as well as at table: in the first century AD Dioscorides mentions two kinds of coleworts with medical uses, the cultivated and the wild, and his opinions continued to be paraphrased in herbals right through the 17th century.
Spread Through Europe and the Middle Ages
The Romans were instrumental in spreading cabbage throughout Europe, recognizing its nutritional value and versatility. They cultivated various varieties and used it not only for food but also for medicinal purposes. By the Middle Ages, cabbage had spread throughout Europe, finding favor in various countries.
Asian Traditions
Ancient Greeks and Romans used it medicinally, as well as the Chinese, who prescribed it for treating ailments such as the common cold, constipation, hot flashes, and more. It became a staple crop in many Asian countries, including Korea, Japan, and Southeast Asia, where it was used in a variety of dishes, including kimchi, stir-fries, and braises. The versatility and nutritional value of cabbage made it an ideal crop for many Asian cultures, where it was often used in combination with other ingredients to create flavorful and nutritious meals.
Traditional Topical and Digestive Uses
In traditional herbal medicine, cabbage leaves were often applied externally to relieve swelling, bruising, and inflammation. The juice extracted from cabbage was also consumed as a remedy for digestive issues, such as ulcers and constipation.
Cabbage leaves have long been used as poultices for application to tumors, and even in modern times, they have been under investigation as a means for preventing or treating breast engorgement in nursing mothers.
In traditional medicine, cabbage has been used to treat a range of ailments, including digestive issues, arthritis, and skin conditions. Throughout history, cabbage has been used in various forms, including as a poultice, a tea, and a juice.
3. Key Constituents and Active Compounds
Macronutrients and Micronutrients
Cabbage (Brassica oleracea) belongs to the cruciferous vegetable family and offers an impressive nutritional profile with minimal caloric density — approximately 25 calories per 100 g. Cabbage provides significant amounts of vitamin C, vitamin K, folate, and dietary fibre (approximately 2.5 g per 100 g, predominantly insoluble), all of which contribute to overall metabolic health.
One hundred grams of edible portion of cabbage contains about 1.8 g protein, 0.1 g fat, 4.6 g carbohydrate, 0.6 g mineral, 29 mg calcium, 0.8 mg iron, 14.1 mg sodium, and vitamins including 53 μg folate, 36.6 mg vitamin C, and 76 μg vitamin K.
Glucosinolates
Glucosinolates are well-studied sulfur-containing compounds which break down into bioactive isothiocyanates and indoles when vegetables are damaged (via chewing, cutting, or other processing). Isothiocyanates (like sulforaphane) are of significant interest as far as human health is concerned.
The main glucosinolate side-chains occurring in cabbage are 2-propenyl- (sinigrin), 3-methylsulfinylpropyl- (iberin), and indolylmethyl- (glucobrassicin), and they are present at respective concentrations of 0.04–1.6, 0.05–2.6, and 0.09–2 mmol kg⁻¹ fresh cabbage biomass. The main indole glucosinolate in cabbage is glucobrassicin.
Sulforaphane, iberin, indole-3-carbinol, and ascorbigen resulting from the hydrolysis of glucosinolates were found in cabbage cultivars. The decomposition products sulforaphane, iberin, indole-3-carbinol, and ascorbigen detected improve its health-promoting qualities and represent a suitable component of the human diet.
Indole-3-Carbinol (I3C)
The potential health benefits of consuming cruciferous vegetables are attributed to compounds derived from the enzymatic hydrolysis (breakdown) of glucosinolates. Among these compounds is indole-3-carbinol (I3C), a compound derived from the degradation of an indole glucosinolate commonly known as glucobrassicin.
Indole-3-carbinol breaks down into 3,3′-diindolylmethane (DIM), which is known for its anti-inflammatory, immune system-modulating, cancer-prevention, and estrogen metabolism benefits.
Sulforaphane
During the preparation, chewing, and digestion of foods, sulphurous vegetables are broken down to form biologically active compounds such as glucosinolates, indoles, nitriles, thiocyanates, and isothiocyanates. Indole-3-carbinol (an indole) and sulforaphane (a type of isothiocyanate) are the compounds most frequently studied for anticancer effects.
Sulforaphane and indole-3-carbinol, derived from glucosinolates, have been shown in animal and cellular studies to support hepatic xenobiotic-metabolising enzyme pathways (including Phase II enzymes involved in neutralising and eliminating toxins). These compounds may also reduce oxidative stress, a key factor in the progression of liver disease.
Phenolic Compounds and Anthocyanins
Cruciferous vegetables are also rich in various carotenoids (beta-carotene, lutein, and zeaxanthin), flavonoids, anthocyanins, coumarins, therapeutic antioxidant enzymes, terpenes, vitamins C, E, K, and folate, and minerals such as potassium, calcium, and selenium, and are a good source of fiber.
Seventeen phenolic compounds were identified in Tronchuda cabbage (Brassica oleracea L. var. costata DC) mainly belonging to derivatives of quercetin and kaempferol, while anthocyanin derivatives were associated with colored varieties of cabbage such as red cabbage.
"Vitamin U" (S-Methylmethionine)
Early studies recognized the effectiveness of raw cabbage juice in normalizing gastric and intestinal functioning. Glutamine and methionine derivatives present in the juice are believed to be the active principals. Specific attention has been focused on methionine S-methyl sulfonium (MMS) in the chlorinated form. This compound, historically termed "vitamin U," is not a true vitamin but rather a naturally occurring sulfonium compound found abundantly in raw cabbage.
4. Scientific Evidence by Area of Use
4.1 Gastrointestinal Health: Peptic Ulcer
Historical clinical studies: Thirteen patients with peptic ulcer were treated with fresh cabbage juice, which, experiments have indicated, contains an anti-peptic ulcer factor. This factor ("vitamin U") prevents the development of histamine-induced peptic ulcers in guinea pigs. The average crater healing time for seven of these patients who had duodenal ulcer was only 10.4 days, while the average time as reported in the literature, in 62 patients treated by standard therapy, was 37 days. The average crater healing time for six patients with gastric ulcer treated with cabbage juice was only 7.3 days, compared with 42 days, as reported in the literature, for six patients treated by standard therapy.
Double-blind controlled study: A clinical study was undertaken to evaluate the effectiveness of concentrated cabbage juice in the treatment of peptic ulcers. Patients at San Quentin Prison with a diagnosed ulcer crater were treated in a double-blind control experiment. They were given either concentrated cabbage juice or placebo facsimile. The evaluation of the merit of this treatment was based upon repeated x-ray examinations of the ulcer crater. A period of 22 days was allowed for ulcer crater healing time. The results of this experiment indicated concentrated cabbage juice to be effective in healing of peptic ulcer.
Evidence characterization: The foundational clinical studies on cabbage juice for peptic ulcer are now decades old (1940s–1960s) and were conducted without modern controls for Helicobacter pylori status, which is now recognized as the primary driver of most peptic ulcer disease. The sample sizes were small (13 patients in the landmark Cheney study). Results were promising but the body of controlled human evidence remains limited. Modern replication with rigorous RCT designs has not been conducted.
4.2 Topical Use: Breast Engorgement
Clinical and randomized trials: Cabbage (Brassica oleracea) leaves have been applied topically to the breasts to treat breast engorgement and as an adjunct to treatment of mastitis. Some investigators cut out a hole in the leaves to keep the nipples dry. Leaves have been applied frozen, refrigerated or at room temperature. Various studies found cabbage leaves beneficial for reducing breast engorgement and pain regardless of temperature. However, a meta-analysis concluded that there is no good evidence that topical cabbage leaves were better than no treatment, because engorgement tends to improve over time regardless of treatment.
Cochrane review (2010): A Cochrane review included eight studies with 744 women. Trials examined a range of different treatments for breast engorgement, including acupuncture (two studies), cabbage leaves (two studies), cold gel packs (one study), pharmacological treatments (two studies), and ultrasound (one study). For several interventions including cabbage leaves, there was no statistically significant evidence that interventions were more effective than control.
Randomized controlled trial (Singapore, 2017): A randomized controlled three-group pre-test and repeated post-test study was conducted at a private maternal and children's hospital in Singapore. Mothers (n = 227) with breast engorgement within 14 days after delivery were randomly assigned into either cold cabbage leaves, cold gel packs, or the control group. While cold cabbage leaves and cold gel packs can relieve pain and hardness in breast engorgement, the former had better effect, which can be recommended to postnatal mothers to manage breast engorgement.
Extract cream study: In a double-blind experiment with a pretest/posttest design, 21 participants received a cream containing cabbage leaf extract, while 18 received placebo cream. The placebo group received equal relief to the treated group, with the two groups showing no difference on all outcome measures. However, mothers perceived both creams to be effective in relieving discomfort. Feeding had a greater effect than the application of cream on relieving discomfort and decreasing tissue hardness.
Evidence characterization: According to the Cochrane Library, there is uncertainty about cold cabbage leaves compared to room temperature cabbage leaves, and cabbage leaf extract cream compared to placebo cream for breast hardness, and cold cabbage leaves may be more effective than routine care. Overall, the evidence base is mixed: whole cold cabbage leaves show more favorable results in some RCTs compared to no treatment, but head-to-head comparisons with other standard interventions and meta-analyses show modest or non-significant effects. High-quality RCTs with adequate blinding remain limited.
4.3 Topical Use: Knee Osteoarthritis
Randomized controlled trial (Germany, 2016): Patients with osteoarthritis of the knee at stages II to III (Kellgren-Lawrence) were randomly assigned to 4 weeks of treatment with cabbage leaf wraps (daily, minimum 2 hours), topical pain gel (10 mg diclofenac/g, minimum once daily), or usual care. The primary outcome measure was pain intensity (VAS) after 4 weeks. Secondary outcomes included functional disability (WOMAC), quality of life (SF-36), self-efficacy (ASES-D), physical function (30 s Chair Stand Test), pressure pain sensitivity (PPT), satisfaction, and safety after 4 and 12 weeks. In total, 81 patients were included (42 women, 65.9 ± 10.3 years). After 4 weeks, patients in the cabbage leaf wrap group reported significantly less pain compared with those in the usual care group.
Conclusions from this trial: cabbage leaf wraps are more effective for knee osteoarthritis than usual care, but not compared with diclofenac gel. Therefore, they might be recommended for patients with osteoarthritis of the knee. Further research is warranted.
Additional randomized trial (2022): This study aimed to establish the efficacy of cabbage leaf application in alleviating pain-related distress and positively improving osteoarthritis conditions. Patients with moderate to severe (grades 3–4) osteoarthritis by the Kellgren and Lawrence grading system were selected. The participants were divided into three intervention groups: the cooling gel pad group for 20 minutes duration once a day (n = 20), the diclofenac gel group for 4 times a day (n = 20), and the cabbage leaf group for 1-hour duration once a day (n = 20). It is clinically demonstrated that cabbage leaf application and cooling gel pad application showed similar improvements in reducing osteoarthritis symptoms in terms of the overall NRS score and Oxford Knee Score.
Evidence characterization: Two RCTs and several controlled trials support topical cabbage leaf wraps for pain reduction in knee osteoarthritis. These studies are positive and relatively well-designed, though small in sample size. The mechanism of action is not fully elucidated. Evidence is promising but not yet sufficient to establish definitive clinical recommendations.
4.4 Cancer Prevention: Epidemiological and Mechanistic Evidence
The National Cancer Institute reports that diets rich in cruciferous vegetables are associated with lower risks of some cancers, including colorectal and lung, though further human studies are needed to confirm causality.
Gastric cancer (meta-analysis): Sixteen case-control and six prospective studies were included in a meta-analysis. When all studies were pooled, a significantly inverse association between cruciferous vegetable intake (relative risk = 0.81; 95% confidence interval, 0.75–0.88) and gastric cancer risk was identified, with little heterogeneity. Specific analysis for cabbage intake yielded a similar result.
Colorectal cancer (meta-analysis): Twenty-four case-control and 11 prospective studies were included. When all studies were pooled, a significantly inverse association between cruciferous vegetable intake (RR: 0.82; 95% confidence interval 0.75–0.90) and colorectal cancer risk was identified. Specific analysis for cabbage and broccoli yielded a similar result. When separately analyzed, case-control studies of cruciferous vegetable intake yield similar results, and the results from the prospective studies showed borderline statistical significance.
Lung cancer: Cohort studies in Europe, the Netherlands, and the United States have had varying results. Most studies have reported little association, but one U.S. analysis — using data from the Nurses' Health Study and the Health Professionals' Follow-up Study — showed that women who ate more than 5 servings of cruciferous vegetables per week had a lower risk of lung cancer.
Breast cancer: One case-control study found that women who ate greater amounts of cruciferous vegetables had a lower risk of breast cancer. A meta-analysis of studies conducted in the United States, Canada, Sweden, and the Netherlands found no association between cruciferous vegetable intake and breast cancer risk. An additional cohort study of women in the United States similarly showed only a weak association with breast cancer risk. More specifically, one study reported an inverse association between broccoli or cauliflower intake and ER− breast cancer, as well as cabbage and cauliflower intake with ER+ breast cancer.
Mechanistic basis (preclinical): Research on various organs of rats and mice, including the bladder, breast, colon, liver, lung, and stomach, has reported that indoles and isothiocyanates inhibit the growth of cancer in these organs. Glucosinolates present in cabbage are known to possess anti-cancer activities and regular consumption is shown to be effective in reducing the risks of colon and lung cancer.
Evidence characterization: The overall human evidence is largely observational (case-control and prospective cohort studies, and meta-analyses of these). Associations are statistically significant for gastric and colorectal cancer in pooled analyses, but causality cannot be established from epidemiological studies alone. Evidence for lung and breast cancer is inconsistent. Preclinical mechanistic data (animal and cell models) is extensive but does not directly translate to established clinical benefit in humans.
4.5 Cardiovascular Health
The anti-inflammatory activities of an anthocyanin-rich extract from red Chinese cabbage (ArCC) were demonstrated in cultured endothelial cells and hyperlipidemic apolipoprotein E-deficient mice. ArCC treatment suppressed monocyte adhesion to tumor necrosis factor-α-stimulated endothelial cells. This was validated by ArCC's ability to downregulate the expression and transcription of endothelial adhesion molecules. The regulation of adhesion molecules was accompanied by transcriptional inhibition of nuclear factor-κB.
Administration of ArCC (150 or 300 mg/kg/day) inhibited aortic inflammation in hyperlipidemic apolipoprotein E-deficient mice, as shown by in vivo imaging. Immunohistochemistry and plasma analysis showed that the aortas from these mice exhibited markedly lower leukocyte infiltration, reduced plaque formation, and lower concentrations of blood inflammatory cytokines than those observed in the control mice. The results suggest that the consumption of anthocyanin-rich red Chinese cabbage is closely correlated with lowering the risk of vascular inflammatory diseases.
Red cabbage extract demonstrated a beneficial effect against hypercholesterolemia and hypertriglyceridemia in animal models, demonstrating its potential therapeutic effect on these risk factors of cardiovascular diseases.
Evidence characterization: Cardiovascular evidence for cabbage is almost entirely preclinical (animal and cell culture studies). No well-designed human RCTs specifically examining cabbage intake and cardiovascular outcomes have been identified. Evidence from animal models, while mechanistically informative, cannot be directly extrapolated to clinical recommendations.
4.6 Liver Health
The potential mechanisms by which cabbage may support liver health relate primarily to its bioactive compounds and their effects on metabolic processes. Sulforaphane and indole-3-carbinol, derived from glucosinolates, have been shown in animal and cellular studies to support hepatic xenobiotic-metabolising enzyme pathways (including Phase II enzymes involved in neutralising and eliminating toxins). These compounds may also reduce oxidative stress, a key factor in the progression of liver disease. Laboratory research suggests that cruciferous vegetables may influence lipid metabolism within hepatocytes.
Evidence characterization: Evidence for liver health benefits from cabbage is currently limited to in vitro and animal models. Human clinical data specifically targeting cabbage and hepatic outcomes are lacking.
4.7 Antioxidant Activity
Plant-based foods are a rich source of bioactive compounds, including phytochemicals, which exert beneficial effects on human health. Phytochemicals are secondary metabolites of low molecular weight that occur naturally in plants as a response to biotic and abiotic stresses. They possess antioxidant activity, and exhibit antimicrobial, antidiarrheal, antiallergenic, antiviral, and anticonvulsant properties.
The beneficial effects of cabbage have been attributed to the antioxidant-activity compounds such as ascorbic acid and glucosinolates. Cabbage is an important source of ascorbic acid and glucosinolates in the human diet.
5. Body Systems Associated with Cabbage
- Gastrointestinal system: Historically and clinically studied for peptic ulcer healing (via juice and "vitamin U"); dietary fiber supporting bowel function.
- Musculoskeletal system: Topical leaf wraps studied in RCTs for osteoarthritis pain management.
- Breast/lactation: Topical leaves used for postpartum breast engorgement, studied in multiple RCTs and Cochrane reviews.
- Oncological prevention: Epidemiological associations between cabbage and cruciferous vegetable intake and reduced risk of gastric, colorectal, and (more weakly) lung and breast cancers.
- Cardiovascular system: Preclinical evidence for anti-atherogenic and lipid-lowering properties, primarily via anthocyanins and polyphenols.
- Hepatic system: Preclinical evidence for hepatoprotective and detoxification enzyme-modulating effects via glucosinolate-derived metabolites.
- Endocrine/thyroid system: Relevant because of goitrogenic compound content (see Safety section).
- Immune system: Anthocyanins, the most prevalent flavonoids in red/purple fruits and vegetables, are known to improve immune responses and reduce chronic disease risks.
6. Dosage Forms and Dosages Reported in Studies
- Fresh cabbage juice (peptic ulcer): One of the landmark studies by Dr. Garnett Cheney, a Stanford University medical professor, treated 13 patients suffering from peptic ulcers with fresh cabbage juice. Each patient consumed one liter of juice daily. Patients with peptic ulcer disease in this tradition consumed 1 litre of fresh cabbage juice every day for 7–10 days.
- Concentrated cabbage juice (peptic ulcer, double-blind trial): The evaluation of the merit of treatment was based upon repeated x-ray examinations of the ulcer crater. A period of 22 days was allowed for ulcer crater healing time.
- Cabbage leaf wraps (knee osteoarthritis): Patients with osteoarthritis of the knee at stages II to III (Kellgren-Lawrence) were randomly assigned to 4 weeks of treatment with cabbage leaf wraps (daily for at least 2 hours), topical pain gel (10 mg diclofenac/g, at least once daily), or usual care.
- Cabbage leaf application (knee osteoarthritis, 2022 trial): The cabbage leaf group received treatment for 1-hour duration once a day (n = 20).
- Topical cabbage leaves (breast engorgement): Some investigators cut out a hole in the leaves to keep the nipples dry. Leaves have been applied frozen, refrigerated or at room temperature.
- Red cabbage anthocyanin extract (animal studies): Administration of ArCC (150 or 300 mg/kg/day) inhibited aortic inflammation in hyperlipidemic apolipoprotein E-deficient mice. (These are animal doses and cannot be directly translated to human use.)
7. Safety Considerations and Drug Interactions
Vitamin K and Anticoagulant Drugs (Warfarin)
Warfarin works by inhibiting the action of vitamin K, thereby reducing the body's ability to form blood clots. Consuming foods high in vitamin K, such as cabbage, can counteract the effect of warfarin and reduce its anticoagulant activity. Sudden increases in cabbage or other vitamin K-rich foods can lower the effectiveness of warfarin, while sudden decreases can increase the risk of bleeding.
Because warfarin has a narrow therapeutic window and is sensitive to changes in vitamin K intake, patients are advised to maintain a consistent intake of vitamin K from foods like cabbage. Sudden changes in the amount of cabbage or other leafy greens consumed can lead to fluctuations in the international normalized ratio (INR), increasing the risk of either clotting or bleeding complications.
Goitrogenic Effects and Thyroid Interactions
Cabbage, a widely consumed cruciferous vegetable, is known for its nutritional value. However, it also contains goitrogens, compounds that can interfere with thyroid function. Despite its many health benefits, the presence of goitrogens in cabbage has raised concerns regarding its impact on thyroid health.
Goitrogenic foods can act like an antithyroid drug in disabling thyroid function. They prevent the thyroid from using available iodine. It is thought that the enzymes involved in the formation of goitrogenic materials in plants can be destroyed by cooking, so thorough cooking of Brussels sprouts, rutabaga, turnip, cauliflower, cabbage, and kale can mitigate this effect.
CYP Enzyme Interactions
Theoretically, cabbage might decrease levels of drugs metabolized by CYP1A2. Some animal research suggests that components of cruciferous vegetables and their constituents may affect drug-metabolizing enzymes involved in bioactivation. These interactions are not firmly established in humans at typical dietary intake levels, and available evidence largely derives from animal studies or theoretical pharmacological data.
General Safety Profile
Cabbage offers an impressive nutritional profile with minimal caloric density — approximately 25 calories per 100 g. At dietary intake levels, cabbage is generally well tolerated. In clinical trials of topical cabbage leaf application, patients were satisfied with both active interventions, and except for two adverse events in both groups the applications were well accepted. No significant systemic adverse effects have been documented in clinical studies at dietary or typical supplementary doses. The primary documented safety concerns relate to its interactions with medications, particularly anticoagulants (warfarin) and thyroid medications, specifically in the context of high or inconsistent intake.
References
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