Bilimbi: Uses, Benefits and Side Effects By Dr. Rajeev Singh

Introduction:

Have you ever noticed a bright green flower-shaped segmented fruit growing on the trees? The fruit is called Bilimbi in English. The scientific name of bilimbi is Averrhoa bilimbi, which belongs to the Oxalidaceae family. It is known as blimblim in French, mimbro in Spanish, belimbing asam in Malay and kaling pring in Thai. Bililmbi fruits are often eaten raw, used to make wine, vinegar and pickles and substitute for tamarind in dishes and also be used as a flavouring agent. In Thailand, Malaya and Singapore, bilimbi is very common. It is frequently grown in gardens across the plains of India and thrives in all the country’s warmest regions. Bilimbi or Averrhoa bilimbi, is a folk remedy for many ailments.^1,2 Let us have a look at some of them. 

Nutritional Value of Bilimbi:

Bilimbi may contain bioactive compounds like amino acids, citric acid, cyanidin–3–O–h–D–glucoside, phenolics and sugars.² Additionally, 100 gm ripened fruit of bilimbi may contain the following nutritional components: 

• Protein: 0.9 g
• Carbohydrates: 9.75 g
• Fibres: 0.96 g
• Energy: 135.02 KJ
• Lipids: 0.27 g
• Oxalic acid: 8.45-10.8 mg
• Vitamin C (ascorbic acid): 60.95 mg
• Vitamin B1 (thiamine): 0.02 mg
• Vitamin B2 (riboflavin): 0.04 mg
• Vitamin B3 (niacin): 0.302 mg
• Vitamin A: 105 UI
• Sodium: 2.1 mg
• Potassium: 103.03 mg
• Calcium: 2.03 mg
• Phosphorus: 15.4 mg
• Magnesium: 3.45 mg
• Iron: 0.74 mg
• Copper: 0.79 mg
• Zinc: 0.22 mg
• Manganese: 0.02 mg

*unit is per 100g unless otherwise stated 

Properties of Bilimbi:

Several studies have shown that bilimbi may have the following properties:³ 

• It may fight against microbes. 
• It may be an antioxidant.  
• It may improve liver health.  
• It may help to heal wounds.  
• It may lower blood sugar levels. 
• It may lower cholesterol. 
• It may improve heart health. 

Potential Uses of Bilimbi for Overall Health:

Some of the potential uses of bilimbi are: 

1. Potential Uses of Bilimbi for Liver Health 

Bilimbi may help to improve liver health. The results of a study by Nagmoti et al. in 2010 suggested a significant increase in the activity of liver enzymes (SGOT, SGPT, ALP) and serum bilirubin levels. Increased levels of these enzymes may cause various liver diseases.⁶ However, further studies are required to check if bilimbi can protect the liver. Therefore, you must consult your doctor if you have any symptoms of liver disease. 

2. Potential Uses of Bilimbi for Cancer 

Leaf extracts of bilimbi may have anticancer properties against breast cancer. Bioactive compounds like terpenoids, flavonoids, tannins and saponins may kill cancer-causing cells (apoptosis and programmed cell death) and inhibit the growth of cancer-causing cells (proliferation).⁷ However, further studies are required to check if bilimbi may help in the case of breast cancer. Cancer is a dangerous disease; therefore, you must consult your doctor if you suspect any symptoms of cancer instead of self-medicating. 

3. Potential Uses of Bilimbi for Lowering Blood Sugar Levels 

According to the study conducted in 2004 by Tan et al., bilimbi may be beneficial in the case of diabetes mellitus. Bilimbi may reduce blood glucose levels.⁸ However, further studies are required to check if bilimbi can be beneficial in the case of diabetes. Therefore, you must check your blood sugar levels regularly and consult your doctor in case of abnormal blood glucose levels instead of relying on bilimbi fruit. 

4. Potential Uses of Bilimbi for Lowering Cholesterol 

Bilimbi may reduce bad cholesterol (LDL, VLDL) and increase good cholesterol levels (HDL) due to bioactive compounds like terpenoids, tannins, phenols and flavonoids. This was shown in a study conducted by Mohan et al. in 2016.⁹ However; more studies are required to check if bilimbi can be beneficial for lowering cholesterol levels. Therefore, you must check your cholesterol levels regularly and consult your doctor in case of high cholesterol levels. Bilimbi is in no way a solution to high cholesterol. 

5. Potential Uses of Bilimbi for Lowering Blood Pressure 

Flavonoids present in bilimbi may be responsible for lowering blood pressure, according to the studies conducted by Rafida et al. in 2021. The flavonoids may dilate the blood vessels and decrease the resistance to blood flow.¹⁰ However, further studies are required to check if bilimbi is beneficial for lowering blood pressure. Therefore, you must check your blood pressure regularly and consult your doctor in case of high blood pressure. 

6. Other Potential Uses of Bilimbi 

• Bilimbi may be used for microbial infections. It may be beneficial for microbial infections like pneumonia caused by Pseudomonas aeruginosa and urinary tract infection caused by Escherichia coli. It may also act against gram-positive bacteria (Bacillus cereus and Bacillus megaterium) and fungi (Aspergillus ochraceous and Cryptococcus neoformans).^3,4 
• The flavonoids and phenols in bilimbi may show antioxidant properties. It may deactivate the free radicals (harmful molecules present in the body) and protect them from various damages.⁵ 
• Bilimbi may be used to heal oral wounds. It might increase the number of fibroblasts to reduce the wounds. Fibroblast is a type of cell that is involved in the process of forming connective tissue, which is a fibrous cellular material that supports and connects various body tissues or organs.³ 

Though studies show the benefits of bilimbi in various conditions, these are insufficient and there is a need for further studies to establish the true extent of the benefits of bilimbi on human health. 

Of all the traditional uses of bilimbi that I have seen, one notable application is making infusions and decoctions of its leaves. These may be used as a protective medicine after childbirth.

Dr. Siddharth Gupta, B.A.M.S, M.D (Ayu)

How to Use Bilimbi?

You can use bilimbi in the following ways: 

• Grated bilimbi fruit with a little salt can be applied on the skin in case of pimples.³ 
• Fresh fruit of bilimbi can be eaten raw. 
• Pounded fresh bilimbi leaves yield juice through squeezing, which is provided once daily.¹¹ 

You must consult a qualified doctor before taking bilimbi in large quantities or any herbal supplements. Do not discontinue or replace an ongoing treatment of modern medicine with an ayurvedic/herbal preparation without consulting a qualified doctor 

Based on what I have noticed, the fruit juice of bilimbi is believed to have beneficial effects in addressing many health concerns. It has potentially been used in traditional remedies to manage various conditions such as whooping cough, scurvy, and even obesity.

Dr. Rajeev Singh, BAMS

Side Effects of Bilimbi:

A case study of a 65 year-old woman by Chiang et al. in 2020 showed that bilimbi might hamper the nervous system and show the following symptoms: ¹² 

• It may cause uncontrollable hiccups. 
• It may cause mental confusion. 
• It may cause seizures. 

If you notice any reaction to consuming bilimbi, seek immediate medical attention. Consult your ayurvedic physician who has prescribed it to you; they will be able to identify the cause and treat it effectively. 

According to some literature I came across, a syrup made from bilimbi fruit is believed to have medicinal properties. It is taken as a potential remedy for fever and inflammation, and it is also used to address rectal bleeding and provide relief from internal haemorrhoids.

Dr. Smita Barode, B.A.M.S, M.S.

Precautions to Take with Bilimbi:

The following precautions should be taken before eating bilimbi: 

• High oxalate levels on the consumption of bilimbi may cause the deposition of calcium oxalate crystals. Therefore, people with existing kidney disorders should be more cautious before consuming bilimbi.^12,13 

It is advised to consult your doctor before consuming bilimbi if you have any pre-existing diseases. 

Let me share an interesting observation. In Malaysia, people use either fresh or fermented bilimbi leaves for the management of venereal diseases, which are infections or conditions transmitted through sexual contact. It is a traditional remedy believed to be effective in addressing these specific health concerns.

Dr. Anuja Bodhare, B.A.M.S, M.D (Ayu)

Interactions with Other Drugs:

Since not much data is available on the drug interactions with Bilimbi, let us know about the drug interactions of the fruits belonging to the genus of Bilimbi (Averrhoa). 

• They may interact with Bosutinib, which is a drug used in the case of leukemia (skin cancer).¹⁴ 
• They may interact with Panobinostat, which is a drug used in the case of bone marrow cancer.¹⁵ 

You must consult your doctor before consuming bilimbi if you are on any other medication. 

Frequently Asked Questions (FAQs):

References:

1. Rymbai H, Deshmukh N, Anjani K, Patel RS & Paul, Debanjoy P, Patel V. BILIMBI (Averrhoa bilimbi L.). 2019 Aug. Available from: https://www.researchgate.net/publication/335240608_BILIMBI_Averrhoa_bilimbi_L 

2. Kumar KA, Gousia SK, Anupama MA, Latha JN. A review on phytochemical constituents and biological assays of Averrhoa bilimbi. Int J Pharm Pharm Sci Res. 2013;3(4):136-9. Available from: https://www.researchgate.net/profile/Jeevigunta-Naveena-Lavanya-Latha/publication/322701172

3. Alhassan AM, Ahmed QU. Averrhoa bilimbi Linn.: A review of its ethnomedicinal uses, phytochemistry and pharmacology. Journal of pharmacy & bioallied sciences. 2016 Oct;8(4):265. Available from: https://www.researchgate.net/publication/313223217_

4. Mackeen MM, Ali AM, El-Sharkawy SH, Manap MY, Salleh KM, Lajis NH, Kawazu K. Antimicrobial and cytotoxic properties of some Malaysian traditional vegetables (ulam). International Journal of Pharmacognosy. 1997 Jan 1;35(3):174-8. Available from: https://www.tandfonline.com/doi/pdf

5. Iwansyah AC, Desnilasari D, Agustina W, Pramesti D, Indriati A, Mayasti NK andriana Y, Kormin FB. Evaluation on the physicochemical properties and mineral contents of Averrhoa bilimbi L. leaves dried extract and its antioxidant and antibacterial capacities. Food Science and Technology. 2021 Mar 8;41:987-92. Available from: https://www.scielo.br/j/cta/a

6. Nagmoti DM, Yeshwante SB, Wankhede SS, Juvekar AR. Hepatoprotective effect of Averrhoa bilimbi Linn. against carbon tetrachloride induced hepatic damage in rats. Pharmacologyonline. 2010;3:1-6. Available from: https://www.researchgate.net/profile/Shekhar-Yeshwante/publication/265401741

7. Nair MS, Soren K, Singh V, Boro B. Anticancer activity of fruit and leaf extracts of Averrhoa bilimbi on mcf-7 human breast cancer cell lines: a preliminary study. Austin J Pharmacol Ther. 2016;4(2):1082. Available from: http://repository.iitr.ac.in/handle/123456789/1489 

8. Tan BK, Tan CH, Pushparaj PN. Anti–diabetic activity of the semi–purified fractions of Averrhoa bilimbi in high fat diet fed–streptozotocin–induced diabetic rats. Life sciences. 2005 Apr 29;76(24):2827-39. Available from: https://www.sciencedirect.com/science/article/pii/S0024320505000743 

9. Arya MK, Mohammed SP, Ganesan PS. In vitro hypolipidemic activity of Averrhoa bilimbi flower extract. The Pharma Innovation. 2016 Oct 1;5(10, Part A):23. Available from: https://www.thepharmajournal.com/archives/2016/vol5issue10/PartA/5-9-13-584.pdf 

10. Rafida M, Safitri AH, Tyagita N. Effect of Averrhoa bilimbi Fruit Extract on Blood Pressure and Mean Arterial Pressure of NaCl Induced Hypertensive Rats. Bangladesh Journal of Medical Science. 2021 Apr 4;20(3):631-6. Available from: https://www.banglajol.info/index.php/BJMS/article/download/52806/37435 

11. Ediriweera ER, Ratnasooriya WD. A review on herbs used in treatment of diabetes mellitus by Sri Lankan ayurvedic and traditional physicians. Ayu. 2009 Oct 1;30(4):373-91. Available from: https://www.researchgate.net/profile/E-R-H-S-S

12. Chiang M, Yabut MR. Is Excessive Intake of Kamias Fruit (Averrhoa bilimbi) Bad for Your Heath? A Case Report and Review. International Journal of Clinical Case Reports and Reviews. 2020;3(5). Available from: https://pdfs.semanticscholar.org/bfe9/b281e69909ee69388cc93351ab48bee63e15.pdf 

13. Wong KW, Lansing MG. Case of acute kidney injury due to bilimbi fruit ingestion. BMJ Case Reports CP. 2021 Jul 1;14(7):e242325. Available from: https://casereports.bmj.com/content/bmjcr/14/7/e242325.full.pdf 

14. Product monograph – s3.pgkb.org [Internet]. [cited 2023Feb1]. Available from: https://s3.pgkb.org/attachment/Bosutinib_HCSC_07_29_15.pdf 

15. Faridak panobinostat capsules, for oral use [Internet]. [cited 2023Feb1]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/205353s000lbl.pdf 

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