With the onset of the monsoon, dengue is on the rise, and so is the demand for papayas and papaya leaf extract capsules.
Does drinking papaya leaf juice or taking papaya leaf extract help dengue patients in increasing platelet count? (Wikimedia Commons)
With almost all the southern states being hit by rain, there is a significant increase in cases of dengue, a prevalent mosquito-borne viral infection that gravely affects one’s platelet count.
While demand for platelets has increased in some states like Telangana and Kerala, a similar demand has increased for papaya, papaya leaves, extracts of papaya leaves in the form of capsules, etc.
South First spoke to medical experts to know if there is an iota of truth to the concept of papaya leaves being recommended as a viable cure for low platelet count in a dengue patient.
“One can actually see that a lot of proprietary company products, which include papaya leaf extracts, being sold like hotcakes during dengue fever season. A lot of people just buy papaya leaf extract capsules or make papaya leaf juice themselves at home to increase their platelet count. Everyone does it without even understanding if this actually helps. In some cases, even doctors of modern medicine prescribe this,” Dr Cyriac Abby Philips, hepatologist and clinician scientist, told South First.
Doctors South First spoke to explained that in the context of dengue, a low platelet count — clinically called thrombocytopenia — is a common haematological manifestation.
Platelets are blood cells responsible for clotting and preventing excessive bleeding. When a person is infected with the dengue virus, it can directly affect the bone marrow, where platelets are produced, leading to a decrease in platelet count.
Dengue rash. (Creative Commons)
“Thrombocytopenia is a hallmark symptom of dengue fever and is often observed during the acute phase of the illness. A normal platelet count ranges from 1,50,000 to 4,50,000 platelets per microlitre of blood. In dengue fever, the platelet count may drop significantly, sometimes falling below 1,00,000 or even 50,000 platelets per microlitre of blood,” explained Dr Abhay G, a physician from Sevakshetra Hospital in Bengaluru.
A low platelet count in dengue can result in increased bleeding tendencies. It can manifest as small red or purple spots on the skin, bleeding from the nose or gums, etc. In severe cases, when the platelet count drops to critically low levels, it may lead to spontaneous bleeding, such as gastrointestinal bleeding or haemorrhagic manifestations.
However, not everyone with dengue will experience the same level of severity or drop in platelet count.
Medical professionals closely monitor the platelet count in individuals with dengue to detect any significant drops and assess the risk of bleeding.
Treatment primarily focuses on supportive care, including maintaining fluid balance and managing symptoms. In severe cases, hospitalisation and close monitoring is done to provide appropriate interventions, such as blood transfusions, if necessary, to maintain stable platelet levels and prevent complications.
According to a few research papers, the belief that an extract of Carica papaya leaves is a potential remedy for dengue stems from traditional medicine practices.
Proponents of this remedy argue that the leaves contain enzymes that can boost platelet count, thereby improving the condition of dengue patients.
This belief has strong in regions where dengue is prevalent, such as Southeast Asia, where traditional remedies are often passed down through generations.
Consequently, individuals affected by dengue often turn to papaya leaves, seeking relief from its symptoms.
Despite the widespread belief in papaya leaves as a dengue cure, medical experts have consistently refuted this claim.
“There is no evidence that papaya leaf extract improves survival in dengue fever cases. The drop in platelet count is almost invariably reversible, temporary, and without complications,” explained Dr Rajeev Jayadevan, Convener, Scientific Committee and past president of the Indian Medical Association (Kochi Chapter).
However, there are a few studies that have shown that platelets have increased with the use of papaya leaf extract. “But are these studies done in a very controlled manner?” questioned Dr Philips, popularly known by his handle TheLiverDoc on Twitter.
Papaya leaf extract capsules. (Wikimedia Commons)
He added, “A decrease in platelet count may be attributed to infections such as dengue fever or malaria, as well as chronic liver diseases that endure over-extended periods. Additionally, immune-mediated thrombocytopenia can occur, wherein the immune cells target and destroy platelets, leading to a decline in platelet counts. As a result, the potential causes for low platelet count are diverse and varied.”
Dr Philips explained that in dengue, there are multiple factors that contribute to a decrease in platelet count. However, the primary focus of treatment for low platelet count revolves around addressing the dengue infection itself. By providing supportive care and effectively managing the infection, the platelet count is expected to gradually increase.
He explained that in the course of a disease, it typically progresses, reaches a peak, and then begins to subside.
In the case of dengue, patients experience severe symptoms such as high fever, vomiting, nausea, body ache, and skin rash during the first four days. It is on day three and four that the platelet count starts to decrease, with a significant drop on the fourth, fifth, and sixth day.
From the seventh day onward, with supportive care, as the infection subsides, the platelet count naturally begins to rise.
Dr Philips clarified that individuals who consume papaya leaf extract may do so when their platelet count is low, usually around the third day of the illness. They continue taking the extract for the fourth, fifth, and sixth days, observing an increase in platelet count on the seventh day.
However, Dr Philips emphasised that this increase would have occurred regardless of the papaya leaf extract, as it is a natural part of the recovery process.
While there are a few studies that show an increase in the platelet count after consuming the papaya leaf extract, Dr Jayadevan argued that the mild reported increase in platelets in the limited studies available need not necessarily be due to a correction of the underlying factors.
“These were patients who would have survived anyway, even without the leaf extract. For instance, their platelet counts were only average for anyone with dengue fever — around 60,000 — for which no medical intervention is necessary anyway,” he explained.
Dr Jayadevan added that, in fact, inflammation alone is known to increase platelet count.
The ALOX12 gene activity reported in some studies could be a marker of increased inflammation triggered by the extract itself and cannot be assumed to be a reversal of the actual disease process, he explained.
Although very low platelets — below 10,000 — could lead to bleeding, fatality comes from capillary leakage, organ damage, and uncontrolled immune response in some individuals. For severe thrombocytopenia in dengue, platelet transfusion is the standard care.
Dr Jayadevan said that published studies using carefully controlled doses, packaged in glass vials, have not reported serious side effects. But a real danger is the uncontrolled home-based use of these products by the general public, which could lead to overdose and unknown complications.
An example of this phenomenon is the series of kidney failure cases in Kerala that followed the overuse of bilimbi fruit, based on a fake social media claim.
Dr Philips highlighted that in many studies, papaya leaf extract is administered when the platelet count is decreasing. However, there are limited randomised studies available.
Upon reviewing a meta-analysis study conducted in Sri Lanka in 2019, it was observed that although some studies had acceptable quality, the majority lacked proper methodology.
Some studies included a small number of patients, while others administered papaya leaf extract just before the anticipated drop in platelet count, which may hinder the ability to identify positive outcomes. In fact, the meta-analysis indicated that papaya leaf extract did not demonstrate a significant improvement in platelet counts as expected.
Doctors and researchers argued that the belief in the effectiveness of papaya leaves primarily relies on anecdotal evidence, lacking the necessary support from rigorous scientific studies.
In contrast to unproven claims surrounding papaya leaves, evidence-based treatments for dengue have been extensively studied and established. Medical intervention in dengue cases primarily revolves around supportive care aimed at managing symptoms and preventing complications.
“One of the key aspects of dengue fever management is fluid replacement therapy. Adequate hydration helps maintain blood pressure, stabilise organ function, and reduce the risk of severe complications. Additionally, pain relievers such as acetaminophen can be used to alleviate fever and discomfort. However, it is important to avoid non-steroidal anti-inflammatory drugs (NSAIDs) that can increase the risk of bleeding,” Sevakshetra Hospital’s Dr Abhay added.
Close monitoring of patients is crucial to identify signs of severe dengue, which may require hospitalisation. In severe cases, blood transfusions or intravenous fluids may be necessary to maintain stable blood volume and platelet levels.
Doctors explained that dengue occurs globally and if there was concrete evidence on platelet improvement with papaya leaf extract, it would be part of the WHO’s treatment guidelines or the guidelines of the Centers for Disease Control.
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