Globe Artichoke

Artichoke was used as both food and medicine by the ancient Egyptians, Greeks and Romans. The leaf has been used in European medicine as a choleretic (to increase bile) and a diuretic since Roman times ^{28Reference 28European Medicines Agency · 2018Assessment report on Cynara cardunculus L. (synView study →}.

For centuries it has been a liver and gallbladder remedy across Europe. Recorded folk uses include poor bile flow, indigestion, gallbladder complaints, jaundice, liver disorders and nausea ^{28Reference 28European Medicines Agency · 2018Assessment report on Cynara cardunculus L. (synView study →}.

An alcoholic extract of the leaf, the basis of bitter liqueurs, is a traditional folk remedy for indigestion ^{28Reference 28European Medicines Agency · 2018Assessment report on Cynara cardunculus L. (synView study →}.

In Germany the leaf is prescribed as a choleretic, for its lipid-lowering and liver-stimulating actions and to stimulate appetite. German paediatric practice uses it for poor appetite, because its bitterness is relatively mild ^{28Reference 28European Medicines Agency · 2018Assessment report on Cynara cardunculus L. (synView study →}. Leaf extracts have been in pharmaceutical use in France for at least 35 years ^{28Reference 28European Medicines Agency · 2018Assessment report on Cynara cardunculus L. (synView study →}.

Modern European practice uses the leaf for indigestion with fullness, bloating and flatulence ^{27Reference 27European Medicines Agency · 2018ReviewEuropean Union herbal monograph on Cynara cardunculus L. (synView study →}. Lowering cholesterol is a more recent use, built on twentieth-century trials of the leaf extract.

In Brazil, where the plant is called alcachofra, leaf preparations are used for liver and gallbladder problems, diabetes, high cholesterol, high blood pressure, anaemia, diarrhoea, fevers, ulcers and gout ^{28Reference 28European Medicines Agency · 2018Assessment report on Cynara cardunculus L. (synView study →}.

A meta-analysis of 9 RCTs (702 subjects) found that artichoke extract lowered total cholesterol by about 17.6 mg/dL, LDL by about 14.9 mg/dL and triglycerides by about 9.2 mg/dL, with no change in HDL. The LDL effect was larger in people with higher baseline LDL ^{1Reference 1Sahebkar A et al. · 2018Meta-analysisLipid-lowering activity of artichoke extracts — systematic review and meta-analysisView study →}.

A later dose-response meta-analysis of 14 studies found falls of about 17 mg/dL in each of total cholesterol, LDL and triglycerides ^{2Reference 2Shahinfar H et al. · 2021Meta-analysisEffects of artichoke leaf extract supplementation or artichoke juice on lipid profile — systematic review and dose-response meta-analysis of randomised controlled trialsView study →}. A 2025 cardiometabolic synthesis again found reductions in all three ^{3Reference 3Jafari A et al. · 2025Artichoke and cardiometabolic health — systematic and meta-analytic synthesisView study →}.

Individual double-blind RCTs support this. In 143 patients with high cholesterol, 1,800 mg/day of a dry leaf extract for six weeks lowered total cholesterol by 18.5% and LDL by 22.9%, against 8.6% and 6.3% on placebo ^{6Reference 6Englisch W et al. · 2000RCTEfficacy of artichoke dry extract in patients with hyperlipoproteinemia — randomised, double-blind, placebo-controlled trialView study →}. In 75 otherwise healthy adults, 1,280 mg/day for 12 weeks lowered total cholesterol by 4.2%, while it rose by 1.9% on placebo; LDL, HDL and triglycerides did not differ between groups ^{5Reference 5Bundy R et al. · 2008RCTArtichoke leaf extract reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults — randomised, double-blind, placebo-controlled trialView study →}.

A Cochrane review of three RCTs (262 participants) was withdrawn in 2016 because the editors ranked the topic as low priority, not because of new evidence ^{4Reference 4Wider B et al. · 2013Systematic reviewArtichoke leaf extract for treating hypercholesterolaemia — Cochrane systematic review (pub3)View study →}.

In cultured rat liver cells, artichoke extract inhibited cholesterol synthesis. The effect came mainly from luteolin and its glucoside cynaroside; cynarin had no significant effect ^{7Reference 7Gebhardt R · 1998In vitroInhibition of cholesterol biosynthesis in primary cultured rat hepatocytes by artichoke extracts — in vitroView study →}.

Gap: effect sizes are modest and heterogeneous between products; trials are short (6–12 weeks) with no cardiovascular-outcome data, and the boiled edible head has not been shown to reproduce the extract’s effect.

A meta-analysis of 5 RCTs (333 patients with fatty liver disease) found that leaf extract lowered ALT and AST, along with total cholesterol, LDL and triglycerides ^{8Reference 8Kamel AM et al. · 2022Meta-analysisTherapeutic potential of artichoke in the treatment of fatty liver — systematic review and meta-analysis of randomised controlled trialsView study →}. A separate meta-analysis of 8 trials confirmed the fall in liver enzymes, most clearly in fatty liver disease and in overweight subjects ^{9Reference 9Moradi S et al. · 2021Meta-analysisEffects of Cynara scolymus L. supplementation on liver enzymes — systematic review and meta-analysisView study →}.

A pilot double-blind RCT in 100 patients with fatty liver disease gave 600 mg/day for two months. It reported smaller liver size, better hepatic vein flow and lower ALT and AST ^{10Reference 10Panahi Y et al. · 2018RCTEfficacy of artichoke leaf extract in non-alcoholic fatty liver disease — pilot double-blind randomised controlled trialView study →}.

A placebo-controlled pilot trial in 40 patients awaiting bariatric surgery measured liver fat by FibroScan. Six weeks of extract reduced liver fat and liver size, with changes visible after three weeks. AST rose in the extract group, unlike in earlier trials ^{11Reference 11Holländer S et al. · 2026RCTArtichoke leaf extract reduces steatosis and decreases liver size in pre-bariatric patients (SteatoChoke) — randomised placebo-controlled trialView study →}.

In isolated rat liver cells, cynarin and caffeic acid protected against carbon tetrachloride toxicity ^{28Reference 28European Medicines Agency · 2018Assessment report on Cynara cardunculus L. (synView study →}.

Gap: trials are short and mostly small/pilot-grade, endpoints are surrogate (enzymes, ultrasound/FibroScan) rather than biopsy, and the divergent transaminase response in obese patients ^{11Reference 11Holländer S et al. · 2026RCTArtichoke leaf extract reduces steatosis and decreases liver size in pre-bariatric patients (SteatoChoke) — randomised placebo-controlled trialView study →} means the hepatic effect may not be uniform across populations.

A double-blind, placebo-controlled, multicentre RCT in 247 patients with functional dyspepsia gave 640 mg of leaf extract three times daily for six weeks. Symptoms improved significantly more than on placebo, and quality-of-life scores were better ^{12Reference 12Holtmann G et al. · 2003RCTEfficacy of artichoke leaf extract in functional dyspepsia — six-week placebo-controlled, double-blind, multicentre randomised trialView study →}.

An earlier open study of 516 volunteers (454 completers) compared 320 and 640 mg daily for two months. Dyspepsia scores fell by about 40% from baseline in both groups, with no difference between the two doses ^{13Reference 13Marakis G et al. · 2002Artichoke leaf extract reduces mild dyspepsia in an open studyView study →}. A subset analysis of 208 of these volunteers with irritable bowel symptoms reported fewer symptoms after treatment ^{14Reference 14Bundy R et al. · 2004Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life — subset analysisView study →}.

Gap: the pivotal evidence is a single rigorous RCT; the supporting studies are open-label or surveillance-grade and prone to placebo response, which runs high in dyspepsia.

In a randomised, placebo-controlled, double-blind crossover pilot (n=20), a single 1.92 g dose of standardised extract was given directly into the duodenum. Bile secretion rose by 127% at 30 minutes and 152% at 60 minutes compared with its starting level, and stayed significantly above placebo for up to 150 minutes ^{15Reference 15Kirchhoff R et al. · 1994RCTIncrease in choleresis by means of artichoke extract — randomised placebo-controlled double-blind crossover studyView study →}. The authors proposed this bile-flow effect as the basis for the use of artichoke in dyspepsia ^{15Reference 15Kirchhoff R et al. · 1994RCTIncrease in choleresis by means of artichoke extract — randomised placebo-controlled double-blind crossover studyView study →}.

The extract was standardised on cynarin ^{15Reference 15Kirchhoff R et al. · 1994RCTIncrease in choleresis by means of artichoke extract — randomised placebo-controlled double-blind crossover studyView study →}. In a rat study, cynarin and chlorogenic acid given as pure compounds did not increase bile flow ^{28Reference 28European Medicines Agency · 2018Assessment report on Cynara cardunculus L. (synView study →}.

Gap: the direct human evidence is a single small pilot using an intraduodenal dose; the effect of ordinary oral dosing over time on bile dynamics is inferred rather than measured.

A systematic review of 39 studies (2 human, 23 animal, 14 in vitro) meta-analysed the animal data. Extract raised superoxide dismutase, catalase, glutathione and glutathione peroxidase and lowered malondialdehyde, a marker of lipid peroxidation, in liver and plasma. The two human trials showed no change or only a slight improvement in antioxidant status ^{16Reference 16Salekzamani S et al. · 2019Meta-analysisThe antioxidant activity of artichoke (Cynara scolymus) — systematic review and meta-analysis of animal studiesView study →}.

In cultured endothelial cells and monocytes, aqueous and ethanolic extracts reduced the reactive oxygen species produced in response to oxidised LDL and inflammatory signals ^{17Reference 17Zapolska-Downar D et al. · 2002In vitroProtective properties of artichoke against oxidative stress induced in cultured endothelial cells and monocytes — in vitroView study →}.

A meta-analysis of 9 RCTs found that artichoke lowered fasting blood sugar by about 5.3 mg/dL but did not change fasting insulin, HOMA-IR or HbA1c ^{18Reference 18Jalili C et al. · 2020Meta-analysisEffects of Cynara scolymus L. on glycemic indices — systematic review and meta-analysis of randomised clinical trialsView study →}.

The 2025 cardiometabolic synthesis found the reverse pattern: lower insulin and HOMA-IR, with no effect on fasting glucose or HbA1c ^{3Reference 3Jafari A et al. · 2025Artichoke and cardiometabolic health — systematic and meta-analytic synthesisView study →}.

Gap: the glucose signal is small, endpoints disagree between meta-analyses, and there is no consistent effect on the markers (HbA1c, insulin resistance) that matter most for diabetes.

In 18 people with raised cholesterol, 20 mL/day of frozen artichoke juice for six weeks improved brachial flow-mediated dilation, a measure of how well blood vessels relax. Adhesion molecules linked to vessel inflammation fell. The 10 comparison patients, who followed the same diet without juice, showed no such change ^{21Reference 21Lupattelli G et al. · 2004Clinical trialArtichoke juice improves endothelial function in hyperlipemia — clinical trialView study →}.

In human endothelial cells, leaf extract raised the expression of endothelial nitric-oxide synthase (eNOS). The flavonoids luteolin and cynaroside produced this effect, while cynarin and chlorogenic acid did not ^{22Reference 22Li H et al. · 2004In vitroFlavonoids from artichoke (Cynara scolymus L.) up-regulate endothelial-type nitric-oxide synthase gene expression in human endothelial cells — in vitroView study →}. In coronary smooth-muscle cells, cynarin, cyanidin and luteolin lowered the inflammatory inducible nitric-oxide synthase (iNOS), with cynarin the most potent ^{23Reference 23Xia N et al. · 2014In vitroArtichoke, cynarin and cyanidin downregulate the expression of inducible nitric oxide synthase in human coronary smooth muscle cells — in vitroView study →}.

A meta-analysis of 8 RCTs found no overall effect on systolic or diastolic pressure. In the subgroup of people with hypertension, systolic pressure fell by about 3.2 mmHg and diastolic by about 2.3 mmHg, and 12-week interventions lowered diastolic pressure ^{19Reference 19Moradi M et al. · 2021Meta-analysisEffects of artichoke on blood pressure — systematic review and meta-analysisView study →}.

A 2025 synthesis pooled more trials and found small overall falls of about 2.5 mmHg systolic and 1.5 mmHg diastolic ^{3Reference 3Jafari A et al. · 2025Artichoke and cardiometabolic health — systematic and meta-analytic synthesisView study →}.

In an RCT of 40 hypertensive patients taking captopril, 500 mg of artichoke twice daily for eight weeks improved BMI, with no clear added effect on blood pressure ^{20Reference 20Ardalani H et al. · 2020RCTThe effect of Cynara scolymus on blood pressure and BMI in hypertensive patients — randomised, double-blind, placebo-controlled clinical trialView study →}.

In a cell-free enzyme assay, artichoke extract inhibited angiotensin-converting enzyme by 31% at 100 µg/mL ^{24Reference 24Villiger A et al. · 2015In vitroIn vitro inhibitory potential of Cynara scolymus, Silybum marianum, Taraxacum officinale, and Peumus boldus on key enzymes relevant to metabolic syndrome}.

Gap: the pooled results disagree, the mechanistic ACE finding is in vitro only, and no trial establishes artichoke as a stand-alone antihypertensive.

Side effects. Slight diarrhoea with abdominal cramps, nausea and heartburn have been reported, and allergic reactions can occur ^{27Reference 27European Medicines Agency · 2018ReviewEuropean Union herbal monograph on Cynara cardunculus L. (synView study →}.

Biliary and liver disease. The European herbal monograph contraindicates artichoke leaf in bile-duct obstruction, cholangitis, gallstones, other biliary disorders that need medical supervision, and liver disease ^{27Reference 27European Medicines Agency · 2018ReviewEuropean Union herbal monograph on Cynara cardunculus L. (synView study →}. Stimulating bile flow when the ducts are blocked or stones are present can worsen the problem.

Liver enzymes. In one trial in people with severe obesity awaiting bariatric surgery, AST rose on the extract, although liver fat fell ^{11Reference 11Holländer S et al. · 2026RCTArtichoke leaf extract reduces steatosis and decreases liver size in pre-bariatric patients (SteatoChoke) — randomised placebo-controlled trialView study →}.

Allergy. People allergic to plants of the daisy family (Asteraceae) should not take it ^{27Reference 27European Medicines Agency · 2018ReviewEuropean Union herbal monograph on Cynara cardunculus L. (synView study →}.

Children. Use under 12 years of age is not recommended, as there are not enough data ^{27Reference 27European Medicines Agency · 2018ReviewEuropean Union herbal monograph on Cynara cardunculus L. (synView study →}.

Interactions. No drug interactions have been reported ^{27Reference 27European Medicines Agency · 2018ReviewEuropean Union herbal monograph on Cynara cardunculus L. (synView study →}. An added effect with lipid-lowering or blood-pressure medication is possible in theory but has not been studied.