Grapes

A grape is a perennial and deciduous woody vine found almost everywhere around the world – Please see Figure 2. Its berries can be consumed raw or made into sweets due to their delicious taste: juice, jam, health drink jelly, and even raisins. It can be added to salad or frozen as a refreshment (Center for Healing, 2023). The phytochemical constituents in grapes, resveratrol, quercetin, and catechins are implicated in various cancers, where they inhibit growth and increase apoptosis (cancer cell death) (American Institute for Cancer Research, 2021). Both resveratrol and quercetin are antioxidants that have shown anti-inflammatory responses by preventing DNA mutations and damage, evading cancer cell growth, and decreasing oxidative stress.

The inflammatory response stimulates the recruitment of immune cells, notably mast cells and white blood cells, to the damaged site, where a high demand for oxygen uptake is required – Please see Figure 3. This causes ROS accumulation that further increases the damage. The intensification of the inflammatory response is mastered by cytokines, chemokines, and metabolites of arachidonic acids and COX-2 that shift the cell to a malignant phenotype (Kristo, Klimis-Zacas, and Sikalidis, 2016). A congregation of signalling agents in the microenvironment of the damaged location perpetuates the cellular stress, sustaining the damage to a chronic state, particularly chemokines interleukin IL-8 and chemokine receptor 4 (CXCR4) and cytokines such as tumour necrosis factor alpha (TNF-alpha). Polyphenols modify the cancer microenvironment and suppress inflammation, rendering it to higher cytotoxic levels and apoptosis.

Grape seeds are found in the centre of grapes and are illustrated in Figure 4. An in vivo study using rodent models has shed light on the positive use of grape seed extract in lowering growth of colon and prostate cancer cells (Cancer Center for Healing, 2023). This may be attributed to quercetin where previous studies revealed its anti-tumour properties in patients with prostate and lung cancer (Cancer Center for Healing, 2023). 

Dragon Fruit

This pink-skinned fruit pictured in Figure 5 is highly concentrated with phytoalbumin antioxidants. Amongst its chemical composition is lycopene, which holds a dual effect in contributing to the rich colour and has a chemopreventative role in cancers of the skin, lung, breast, prostate, and liver (National Federation For Cancer Research, 2021). Other beneficial dietary compounds are carbohydrate fibers, minerals (calcium, phosphorus), and water-soluble vitamins (C and B2). In turn, this increases the output of metal toxins from the body.

Dragon fruit (pitaya) is derived from the cactus species in the genus Hylocereus and Stenocereus (Dasaemamoh, Youravonf, and Wichienchor, 2016). Hylocereus has three main types that vary in colour: Hylocereus polyrhizus consists of red pulp with red-magenta skin, whereas Hylocereus undatus has a similar skin colour but has white pulp. Hylocereus megalanthus has white flesh with yellow skin (Ariffin et al., 2008; National Federation for Cancer Research, 2021). Please see Figure 5B.

From the flesh of the dragon fruit, non-digestible oligosaccharides (sugars) are resistant to hydrolysis or breakdown by the amylase enzyme and, therefore, can be extracted and fermented (Dasaemamoh, Youravonf, and Wichienchor, 2016); please see Figure 6. Experimental studies discovered that the cell-free broth after fermentation for 24 hours contained various chemical compounds. One of these compounds discovered is butyrate, which inhibited tumour cell growth and proliferation by evading DNA methylation. This is consistent with previous studies that reported a concentration between 1 – 5 mM without affecting non-cancerous cells in the intestinal area (Dasaemamoh, Youravonf, and Wichienchor, 2016; Archer et al., 1998).

Citrus Fruits

Exemplary types of citrus fruits are oranges, lemons, and grapefruits – please see Figure 7. It contains many bioflavonoids, which can enhance the activity of certain enzymes in the human skin, lung, stomach, and liver that alter the fat-soluble carcinogens into water-soluble. This helps to make it easy to be absorbed and expelled from the body. At the same time, the flavonoids can enhance the absorptive capacity of vitamin C in the human body. This vitamin can boost the immune system and prevent the formation of nitrosamines, a strong carcinogen implicated in gastrointestinal cancers. Other biological effects of flavonoids include antiproliferation and key roles in cell communication, regulation, and preventing angiogenesis, where cancer cells can gain a nutrient supply via blood vessels – please see Figure 8 (Cuttler et al., 2008).

A study published in the Journal of Nutrition and Cancer, discovered that people consume high levels of flavonoids and proanthocyanidins, a subgroup of flavonoids. This significantly lowered the development of cancers: 44 percent less likely to develop oral cancer, 40 percent less likely to develop laryngeal cancer, and 30 percent less likely to develop colon cancer compared to other types of cancer. However, the protective effects of flavonoids has statistically shown no significance in patients with bladder and breast cancer (Neuhouser, 2004).

Avocado

Avocado (Persea Americana) is a green, rich, creamy fruit with a dark green/black leathery outer layered skin. Analogically, this may explain why it is referred to as alligator pear – please see Figure 12. It originates in Central and South America for thousands of years. Avocados uphold a strong nutritional content, namely proteins, fiber, fats, and low sugar (AlKhalaf et al., 2019). The presence of omega-3 fatty acids lowers cholesterol and improves the circulatory system – Figure 14.  It contains water-soluble vitamins (B5) and fat-soluble vitamins (E and K) to maintain body regulation. Other reports discovered additional vitamins (C, B1, B2, B6, and B9) and essential minerals are also found, particularly, potassium, sodium, magnesium, iron, and zinc (AlKhalaf et al., 2019; Oluwole et al., 2013). It is estimated that half an avocado a day contains 6.7 g of monounsaturated fatty acids, 345 mg of potassium, 1.3 mg of Vitamin E, and 4.6 g of dietary fiber (Dreher and Davenport, 2013; Ericsson et al., 2023). Some of the functions of vitamins and minerals are presented in Figure 15 and 16 respectively.

The abundance of phytochemicals in avocados exhibits both antioxidant and anti-inflammatory effects in prostate, skin, and mouth cancer, leading to cell cycle arrest and cancer cell death (D’Ambrosio et al., 2011). Antioxidants helps to neutralise and kill cancer cells – Please see Figure 17. Profounding evidence in in vitro and in vivo experimental studies presented low viability and proliferation of cancer cells, whereas in vivo studies revealed a reduction in the tumour size, volume, and number (Ericsson et al. 2023).

The dark-green area (pith) is heavily concentrated with oxygenated carotenoids, lycopene, and beta-carotene. The structure of the avocado is presented in Figure 18. They exert their antioxidant effects and decrease cellular damage, preventing cancer (AlKhalaf et al., 2019). Lu et al. (2010) discovered that carotenoids play a big role in preventing cancer. Lutein accounts for 70% of carotenoids found in avocado. Vitamin E, also present in avocados, can prevent the growth of androgen-dependent (LNCaP) and androgen-independent (PC-3) prostate cancer cell lines. It leads cancer cells to G2/M cell cycle arrest and increases p27 protein expression. An inverse relationship was also illustrated between total circulating carotenoid and the following cancers: bladder, breast, colorectal adenoma, and prostate (Wu et al. 2020; Eliassen et al., 2012; Jung et al. 2013). This signifies the medical applications of carotenoids in cancer therapy.

Carotenoids can also protect eyes from fatal non-cancerous conditions, for instance, cataracts and macular degeneration. Macular degeneration affects the macula lutea, a yellow spot on the retina at the back of the eye – please see Figure 19. A cataract is the cloudiness of the lens of the eye – please see Figure 20. Both conditions can limit vision.

Furthermore, the high levels of monounsaturated fats in the avocado can help lutein and other bioactive carotenoids to be absorbed into the blood, lowering cancer risk (AlKhalaf et al., 2019). It is estimated that 17% of edible seed oils containing monounsaturated fats are found in the avocado seed (AlKhalaf et al., 2019). Please see Figure 21 that compares the content of avocado and olive oil. Both are similar nutritionally, however, olive oil consists of additional vitamins (Moore, 2023.

Chromatographic analysis by AlKhalaf et al. (2019) discovered the fruit extract was richer in oleic acid (75.16%) compared to the seed (25.3%). This corresponds to the weight of the avocado seed that contributes to ca. 15% of the total weight of the fruit. The results were consistent with Marovic et al. (2024), where oleic acid was most abundant in fresh avocados, with a concentration between 41.28% and 57.93%.

In vitro studies in colon and liver cancer cell lines detected the prevalence of anti-inflammatory and anti-tumour activities present in the seed and fruit extracts than the bulb. The inhibitory concentration 50% (IC50) was in proximity to the reference values of Sorafenib (AlKhalaf et al. 2019). The IC50 is a quantitative measure of the concentration of a chemical required to prevent biological processes by 50% – please see Figure 22. Sorafenib is a multi-targeted small-molecule kinase inhibitor commonly used in the treatment of hepatocellular carcinoma (liver cancer) – please see Figure 23. Inversely association between increased intake of monounsaturated fats and cancer risk was linked with decreased risk of oral, pancreatic, pharyngeal, and prostate cancer (Garavello et al., 2009; Ghamarzad et al, 2021; Dianatinisab et al., 2022; Jackson et al., 2012). This highlights the potent effect of the neglected seed, which is commonly unutilized and non-edible.

Other parts of the avocado fruit have also presented cancer-preventative properties, where the leaf increased the formation of free oxygen radicals in patients with larynx carcinoma (Collignon et al., 2023). Another anti-cancer constituent in avocado is glutathione. This can lower the risk of oral and pharyngeal cancer (Ericcson et al. 2023).

Lee et al. (2014) noticed that Avocatin B, a fat found in avocado, induces cell death in patients with Acute Myeloid Leukaemia (AML) without affecting normal peripheral blood stem cells, especially at concentrations as 20µM, and targets the mitochondria where it is oxidized into fatty acids. AML is an aggressive malignant disease where there are poor patient clinical outcomes and suboptimal chemotherapeutic response (Lee et al. 2014). Cells that do not contain mitochondria, an organelle involved in respiration to produce energy, were insensitive to Avocatin B. Similarly, cells that do not have the enzyme CPT1, whose normal function is to help transport mitochondrial lipids. Avocatin B can prevent oxidation of fatty acids and can decrease levels of the chemical compound Nicotinamide Adenine Dinucleotide Phosphate (NADPH) by 50%. NADPH is a co-factor produced during fatty acid oxidation that undergoes catabolic processes during cellular proliferation. This ultimately causes reactive oxygen species (ROS)- dependent death of leukaemia cells (Lee et al., 2014).

Moreover, Avocatin B induces cell death in primary AML cells with half maximal effective concentration (EC50), where there is a biological response halfway after a specified exposure time. The EC50 was within the range of 1.5 and 5.0 µM. This suggests Avocatin B is a useful anti-leukemic agent with selective toxicity causing apoptosis.

However, contrasting results were found in studies by the NHS, where multivariable analysis presented no direct proportionality between consuming avocado and lowering the risk of many site-specific cancers linked with women, except patients with breast cancer (Ericcson et al., 2023). Post-menopausal women, non-diabetic patients, and mammogram screening had a positive association with decreased incidence of avocado consumption. Similar results were also indicated in the large prospective study where Ericsson et al. (2023) revealed that men who consumed avocados had a significantly reduced risk of cancer compared to women.

Overall, the positive outcomes accomplished from the clinical studies signify that avocados’ nutritional profile is predominantly found in the seed, pith, pulp (mesocarp), and leaf extracts, with increased anti-carcinogenic properties and well-established benefits. Further randomized trials are needed to promote the anti-cancer properties of the avocado-derived phytochemicals.

Strawberries

The anti-tumour effects of berries correlate with the concentration of polyphenols and induce oxidative stress. Key examples are Vitamin C, flavonoids, anthocyanins, and hydroxycinnamic acids. However, the definitive mechanism is unknown, where research studies suggest it can modulate genes and metabolise enzymes (Somasagara et al., 2012). Phytochemicals can also promote apoptosis (cell death) predominantly via the intrinsic pathways stimulated by DNA damage and generation of Reactive Oxygen Species (ROS) – please see Figure 24. Other mediators of the intrinsic apoptotic pathway are radiation and growth factors. The imbalance of the BCL2 family of preapoptotic and antiapoptotic proteins can damage the mitochondrial membrane – please see Figure 25. The methanolic extract of the strawberry (MESB) increased the expression of the protein BAX and APAF1, causing the release of cytochrome C (cyto C) and activation of the enzyme Caspase 9 (Casp 9). This escalates the downstream signalling events of apoptosis.

Histological and immunohistochemical studies suggest MESB can modulate the expression of tumour suppressors, p73, and the mutation of p53 can activate the mitochondrial apoptotic pathway to halt cancer cell proliferation, especially in patients with breast cancer (Somasagara et al., 2012). This signifies that the mechanism of MESB has molecular and cellular significance.

The toxic effects of the powerful carcinogen N-nitrosomethylbenzylamine (NMBA) were associated with the high incidence and mortality of patients with oesophageal cancer in developing countries. There are two subtypes of oesophageal cancer where higher rates are found in the oesophageal squamous cell carcinoma rather than oesophageal adenocarcinoma – please see Figure 26. Robust suppression of tumour multiplicity in the squamous epithelial cell population that lines the oesophagus (food pipe) when combining 5% strawberry extracts with 0.01% low-dose aspirin (75-81 mg/day) than alone.

However, as a sole pharmacological agent, aspirin is an irreversible inhibitor of the enzyme cyclooxygenase (COX-1), and COX-2 can evoke its protective effects in colorectal cancer, lung cancer, and cardiovascular disease (Pasche et al., 2014) – please see Figure 27. High doses of aspirin (325-600mg/day) have an analgesic effect (Pan et al., 2018). The essential role of COX is to produce prostaglandins, which are responsible for the inflammatory response (Eustice, 2024). COX-1 is predominantly in most tissues, especially the gastrointestinal tract, where it maintains the lining of the tract as a protective measure for the enzymes. Other contributing roles of COX-1 are to function in the kidney and platelets. In contrast, COX-2 preserves an inflammatory response (Eustice, 2024).

The recognition of the antiproliferative effects of strawberry was substantiated by evidence of its biological effects in patients with prostate cancer, gynaecological (cervical, ovarian), blood cancers (leukaemia), skin cancer (melanoma), and liver cancer (hepatoma) (Giampieri et al., 2017). The mechanism did not involve the enzymes, COX-1, and COX-2, nor alterations in the cell cycle regulation, despite evidence suggesting strawberries can inhibit COX-2 expression in the oesophagus (Chen et al., 2012).

The nutraceutical potential of Ellagic acid appears to prevent the activation of carcinogenic substances into cellular toxins, causing them to lose their ability to react with DNA and induce mutations capable of triggering the onset of cancer. The phenolic compound derived from ellagitannin, found in plant cell vacuoles in free and bound forms in the seeds (achenes), nuts, fruits, especially berries – please see Figure 28. The concentration of total ellagic acid is between 0.63-0.70 mg/g in strawberries, but the highest level resides in black berries (Daniel et al., 1989; Williner, Pirovani, and Guemes, 2003; Muthukumaran et al., 2017).

Compiling evidence suggests that ellagic acid and total phenolic content (41.1%) are more concentrated in the achenes on the outer surface of the fruit rather than the pulp (Muthukumaran et al., 2017). The structure of the strawberries are presented in Figure 29. It may indicate there is a higher antioxidant capacity in the achenes than in other locations of the strawberry, where it is estimated within the range of 45 to 81% in comparison to the roots because of the low total phenolic concentration (Ariza et al., 2016; Simirgiotis and Schmeda-Hirschmann, 2010).  In the realm of the health benefits of fruits, this research evidence proclaims the anti-carcinogenic properties of strawberries.

Acai Berries

The abundant presence of Acai in South and Central America is another example of a dietary berry whose extracts have anti-oxidant potential, inducing cancer cell death, particularly in patients with leukaemia over 24-hour period (Beatcancer.org, 2025). This is attributed to the high concentration of the non-nutritive bioactive phenolic compounds, anthocyanins. Other phytochemicals are also present at low concentration (Kristo, Klimis-Zacas, and Sikalidis, 2016). These antioxidants are found two-fold higher than in blueberries. Other beneficial contents of acai are lipids (48%), protein (13%), amino acids (8%), carbohydrate sugars and vitamins (A, B1, B2, B3, C and E) total composition of 25% (Alessandra-Perini et al., 2018)‌.

 Anthocyanins give acai berries a distinctive colour pigmentation and are localized in the skin, seeds, and leaves (Kristo, Klimis-Zacas and Sikalidis, 2016). The structure of the acai fruit is presented in Figure 25. The highest concentration of polyphenols is found in the seed (28.3%), and in descending order, whole fruit 25.5% and bark (15.7%). Synergistically, it also confers molecular and cellular protection against DNA damage, inflammation, preventing angiogenesis, and apoptosis.

In experimental cancer models, there was a reduction in tumour cell proliferation and the size of the tumours. In oesophageal cancer cells, there was a decrease in interleukin 5 and interleukin 8, but higher levels of interferon gamma following the addition of acai for 35 weeks. However, the serum levels of other interferons 1, 4, and 13, and tumour necrosis factor-alpha were merely affected by the presence of acai (Stoner et al., 2010).

Furthermore, there was a decreased expression of p63, Ki-67, and proliferating cell nuclear antigen (PCNA) in post-acai treatment in bladder cancer cells. They are commonly involved in tumour progression, metastasis, and survival (Kristo, Klimis-Zacas and Sikalidis, 2016). This indicates the increased anti-proliferative capacity embedded in the acai. The addition of acai for 10 weeks did not affect the levels of beta-catenin (Fragoso et al., 2012). The pro-apoptotic mechanism involved activation and cleavage of caspase-3 and downregulation of Bcl2. This was observed in leukaemia and colon cancer cells. Conversely, immunohistochemical analysis decreased levels of caspase-3 in colon tissue. This demonstrates the discrepancy in identifying the state of the levels of caspase 3 post-Acai treatment.

The antitumour potential of acai berries was also reported in other experimental models, such as melanoma and colon cancer – please see Figure 34. Acai berry altered its role in photosynthesis in melanoma, significantly increasing the necrotic tissue. Similarly, in colon cancer, there was a down-regulation of pro-inflammatory cytokines and COX-2 whereas Interferon gamma upregulates (Kristo, Klimis-Zacas, and Sikalidis, 2016). Toxicological studies revealed neither DNA damage nor genotoxic effects found in glioma and breast cancer. It has a protective effect on DNA damage induced by doxorubicin as an anthracycline – please see Figure 35. This illustrates the chemoprotective effects, notably antiproliferative, proapoptotic, and antioxidant, and the functional relevance of acai in cancer therapy (Kristo, Klimis-Zacas and Sikalidis, 2016).

Noni fruit

Morinda citrifolia, otherwise referred to as Noni, is a member of the Rubiaceae family; a small evergreen tree. Please see Figure 36. It contains carbohydrates, dietary fibers, niacin, calcium, iron, and potassium. Similar to the stated natural fruits, noni presents anti-cancer, antiangiogenesis, anti-inflammatory, antiproliferative, and immunomodulatory potential in experimental model studies (lung, cervical, and breast cancer cells). Apoptosis is stimulated by the AKT/NF-ĸb signalling pathway. Like acai berry, there is a downregulation of Ki67, PCNA, and BCL2, but increased expression of caspase 3. It can also affect cellular migration to prevent metastasis (Kumar et al. 2022).

There is minimal evidence on the side effects of noni on the human body, causing liver and kidney injuries due to hepatotoxicity and nephrotoxicity, respectively. A Phase 1 clinical study discovered that a dose of 500 mg of noni fruit that was dehydrated, was administered to advanced cancer patients, can cause toxicity, but it is independent of the dose. This is concurrent with previous studies on the noni leaf and fruit extracts, where no liver injury was observed. Sufficient data on the safety and clinical efficacy are presented on Noni as a medicinal plant (Kumar et al., 2022).

Goji Berries

Mounting evidence reveals the medicinal application of Lycium Barbarum (Goji berry) as a cancer treatment and has been extensively used as a staple in traditional Chinese medicine to treat inflammatory and infectious diseases (National Foundation for Cancer Research, 2021; Sanghavi et al., 2023). One of the trace minerals found in goji berries is selenium, which acts as an antioxidant to neutralize free radicals that damage cells and cause cancer. Goji berries are also rich in other minerals like calcium, potassium, iron, zinc, and riboflavin.

The Goji berry contains high levels of phytoconstituents (flavonoids, beta-carotene, zeaxanthin) whose ethanolic extract fractions have been effective against breast carcinoma, oral, liver, colon, prostate, and cervix without affecting normal cells (Sanghavi et al., 2023).  At a concentration of 100µg, the ethanolic extracts have decreased the viability of cancer cells by 65.5% compared to 91.7% of the control group. At 72 hours, a decrease in the migration of oral cancer cells was observed, where 42.8% of the wound remained (Sanghavi et al., 2023). This highlights its ability to control the adhesion of cancer cells.

In breast cancer cells, gogi modulates the metabolism of the oestrogen hormone, which stimulates the protein of extracellular signal-reduced kinase 1 and 2 (ERK) and increases expression of the tumour suppressor p53 (Wawruszak, Halasa and Okla, 2021). A decrease in the phosphorylation of ERK1/2 and AKT elevates the antiproliferative activity. AKT stimulates and even inhibits the expression of pro-apoptotic proteins, e.g., Bad and Bax. The caspases involved in the apoptotic pathways are halted, increasing cancer survival.

Furthermore, there is concomitant downregulation of cyclin D1 and cadherin 2 and vimentin and upregulation of cadherin 1 in the epithelial-mesenchymal transition – please see Figure 40. The distinctive features between Epithelial and Mesenchymal cells are presented in Figure 41. This highlights the anti-invasive and anti-metastatic role of the Goji berry (Sanghavi et al. 2023).

Mangosteen

The existence of xanthones, a class of phytochemicals in the mangosteen fruit Garcinia mangostana, has reportedly exhibited pro-apoptotic and anti-tumour activities. Mangosteen is a purple tropical fruit native to Southeast Asia and is largely attributed to the outer white flesh/pulp called the pericarp. It contains 3 to 6 ovoid-oblong shaped seeds (Kalick et al., 2023). The pericarp, leaves, and seeds are said to decrease the size of tumours. However, research efforts are more interested in the roots, stem, and rind, shown effectiveness against T cell leukaemia (Kalick et al., 2023; Nauman and Johnson, 2021).

Mangostin is the most prominent xanthone that possesses great potency. They can modulate ROS and the proteins STAT3, cyclin-dependent kinases (CDK), and matrix metalloproteinases (MMP). STAT3 is a transcription factor that promotes apoptosis in gastric adenocarcinoma, hepatocellular carcinoma, and pancreatic cancer cells after α-mangostin (α-mangostin) treatment in vitro. (Nauman and Johnson, 2021). Cyclin-dependent kinases bind specifically with proteins called cyclins to regulate the cell cycle, Cancer cells can arrest at the G1 phase, significantly impacting the proliferation rate because it is a regulatory point that depends the fate for quiescence, proliferation, differentiation and apoptosis (Diehl, 2002). Matrix metalloproteinases, notably MMP-2 and MMP-9, increased levels, whilst E-cadherin decreased. This prevents migratory and invasive abilities (Nauman and Johnson, 2021).

Recent in vitro studies discovered that after a 6-hour treatment with α-mangstin, there was a decrease in oestrogen activity and expression of MAPK signalling proteins at concentrations > 6µM. There was a decrease in AKT and increased ERK1/2 to lower cell viability, independent of the MAPK pathway. The IC50 in breast cancer cells was between 2 and 3.5 µM after 24 and 48 hours. The IC50 is ca. two-fold higher in colon cancer, 7.5 µM. The combination of mangostin with the anti-metabolite 5-fluorouracil (5-FU), commonly used to treat solid tumours, resulted in a more potent effect to induce apoptosis and increase the levels of p53. The mode of action of 5-FU is presented in Figure 45.

Other secondary metabolites, gartanin, garcinone (C and E), β-mangostin, and γ-mangostin, found in the pericarp, stem, and roots, have hypothetically been shown to hold anticancer and antineoplastic effects against human malignancies, but their activity is not well understood.

Soursop

Soursop, otherwise known as Annona muricata or graviola, is a spiny, long green superfruit in the rain forests that reside in South East Asia, South America, the Caribbean, and Africa – please see Figure 46. Its pulp has a sweet, distinctive flavour (City of Hope, 2017). The leaves and soursop can irritate the stomach and cause fever.

The Soursop fruit has an array of nutrients to maximise the efficacy in killing cells of different types of cancer. This is supported by the high content of Vitamins (B and C) and the minerals (calcium, magnesium, iron, and phosphorus (National Foundation for Cancer Research, 2021; Cancer Research UK, 2022). The predominant phytochemical is annonaceous acetogenins and has exerted its chemopreventive effects utilising liver, prostate, and breast cancer cells. City of Hope (2017). Senior researched advise that laboratory studies claim Sousop  eradicates the cancer cells, but has evidence of good safety and efficacy of its use (Oberlies, Chang, and McLaughlin, 1997).

Pomegranate

The high phenolic compounds present in pomegranate suppresses aromatase, an enzyme that converts androgen into estrogen, and was associated with the increased risk of breast cancer – please see Figure 48. The presence of ellagitannins releases the ellagic acid. Ellagic acid is converted into 3,8-dihydroxy-6H-dibenzo[b,d]pyran-6-one, otherwise known as urolithin, by microorganisms present in the gut microflora.  One of its subtypes, urolithin B, has presented potent inhibition of aromatase, lowering cancer cell proliferation in oestrogen-responsive breast cancers (Adams et al., 2010).

Furthermore, clinical trials have shown that pomegranate extracts can prevent prostate cancer in men. The profusion of Vitamin C and other antioxidants in pomegranates has shown preventative effects in patients with prostate cancer. The pomegranate juice is said to treat erectile dysfunction and high cholesterol. However, results are inconclusive, and further research is needed to determine its effectiveness (American Holistic Health Association, n.d.).

Kiwi Fruit

Actinidia deliciosa (Kiwi fruit) have been associated with favourable direct and indirect anticancer effects. The elevated levels of Vitamin C has significantly reduced DNA oxidative injury and induced cytotoxicity in several cancer cell lines in vitro. Amongst the hypothetical understanding is attributed to the increased bowel motion and presence of lactic acid-containing bacterial species in the faeces. Examples of normal, opportunistic and pathogenic bacteria found in the gut are illustrated in Figure 51. This lowers the risk of colorectal cancer and other malignancies (Lippi and Mattiuzzi, 2020).

A research study discovered that after a 24 hour incubation, Kiwi can ferment lactic acid bacteria lowering the simple sugars (glucose and fructose) and acidity (citric acid). One named example is Lactobacillus plantarum and has been found to increase the polyphenol content  and other acids (succinic, lactic, acetic). This paradoxical state of Lactobacillus plantarum fermentation of kiwi fruit contributes to the kiwi suppression of cancer cells and are influenced by dose and time factors (Kim et al., 2025).

Further evidence also suggests that there are active compounds that can block the formation of carcinogenic “nitrosamines” in the human body. As a result, it has a good effect in preventing cancer. Amongst the negative effects of nitrosamine are presented in Figure 52.