Home Ingredients Ayuric® (Terminalia bellirica Extract for Uric Acid — Natreon)
Joint HealthKidney/Urinary Tract

Ayuric® (Terminalia bellirica Extract for Uric Acid — Natreon)

Terminalia bellirica
Evidence Level
Limited
1 Clinical Trial
3 Documented Benefits
2/5 Evidence Score

Ayuric® is a standardized extract of the fruit of Terminalia bellirica (bibhitaki), a tree fruit used in Ayurveda. It is studied for supporting healthy uric acid levels by inhibiting xanthine oxidase, an enzyme involved in producing uric acid. In two 24-week trials it lowered serum uric acid, though by roughly a third to a half of what the prescription drug febuxostat achieved in the same studies. Diagnosed gout or kidney disease needs a doctor, and prescribed uric-acid medication should not be stopped without medical advice.

Studied Dose 500 mg twice daily, about 1 g per day, is the dose used in both published trials. The kidney trial also tested 1000 mg twice daily, which lowered uric acid by about 34 percent against about 20 percent for 500 mg twice daily.
Active Compound Standardized Terminalia bellirica fruit extract, a tannin-rich natural xanthine oxidase inhibitor.

Benefits

Healthy uric acid levels

In a 24-week randomized pilot in 110 adults with high uric acid, 500 mg twice daily lowered serum uric acid from 8.1 to 5.8 mg/dL while the placebo group drifted slightly upward, from 7.6 to 8.0. Febuxostat 40 mg lowered it further, to 4.3. A second 24-week trial in adults with chronic kidney disease had no placebo arm and compared the extract only against febuxostat, where it cut uric acid by about 20 percent at 500 mg twice daily and 34 percent at 1000 mg twice daily against 64 percent for the drug. Both trials measured laboratory markers only, with no joint or symptom outcome.

Supported by Trial 1

Joint relevance is indirect

This is an inference from a blood marker, not a measured result. Neither published trial measured joint pain, joint function, stiffness, or gout flares, and the kidney trial specifically excluded people who were having gout flares. What is established is that the extract lowers uric acid and that high uric acid can crystallize in joints. The step between those two facts has not been tested.

Supported by Trial 1

Antioxidant support

The kidney trial did measure oxidative stress and inflammation markers and they improved. The catch is that they improved in every arm of that trial, including the febuxostat arm, and the trial had no placebo group, so the change cannot be credited to the extract specifically. Treat this as a plausible tannin effect that has not been separated from ordinary trial effects.

Supported by Trial 1

Mechanism of action

1

Xanthine oxidase inhibition

Terminalia bellirica compounds inhibit xanthine oxidase, the enzyme that produces uric acid, reducing uric-acid synthesis.

2

Antioxidant action

The extract's tannins and gallic acid scavenge free radicals in laboratory tests. Whether that produces a meaningful antioxidant effect in people has not been separated from placebo in the published trials.

Clinical trials

1
Terminalia bellirica and uric acid in chronic kidney disease
PubMed

Randomized, double-blind, positive-controlled dose-response study. Positive-controlled means the comparison was against an active drug, febuxostat 40 mg daily, and there was no placebo group. Around 20 people per arm, sized to detect differences between arms and not designed or powered as a non-inferiority study, so where two arms did not differ statistically that is not proof they are equivalent. (Pingali et al. 2020, BMC Complementary Medicine and Therapies)

59 adults with chronic kidney disease and hyperuricemia, 55 of whom completed 24 weeks. This is a diagnosed disease population, not healthy adults, and people experiencing gout flares were excluded.

Terminalia bellirica extract reduced uric acid from baseline at both doses, but by less than the drug it was compared against. At 24 weeks the falls were 63.7 percent with febuxostat 40 mg, 33.9 percent with the extract at 1000 mg twice daily, and 19.8 percent at 500 mg twice daily, which the authors summarized as the extract being roughly one third and more than half as effective as febuxostat. Serum creatinine fell and estimated glomerular filtration rate rose in all three arms. With no placebo arm, none of these within-arm changes can be separated from the passage of time and trial participation.

Side effects and drug interactions

Common Potential side effects

Generally well tolerated across two 24-week trials, with no serious adverse effects reported. Digestive symptoms are the most common complaint.
Mild stomach upset is reported occasionally. Terminalia bellirica is bibhitaki, one of the three fruits in triphala, and tannin-rich fruit extracts can loosen stools or cause stomach discomfort. Tannins also bind non-heme iron in the gut, so take it apart from iron supplements.
Discontinue if any unusual reaction occurs.

Important Drug interactions

Uric-acid medication (allopurinol, febuxostat) — possible additive effect; consult a doctor.
Diabetes medication — monitor blood sugar.
Gout and chronic kidney disease are diagnosed medical conditions that need a doctor. Do not use this in place of prescribed urate-lowering therapy and do not stop that therapy on your own, because uncontrolled uric acid damages joints and kidneys over time.

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Frequently asked questions about Ayuric® (Terminalia bellirica Extract for Uric Acid — Natreon)

What is Ayuric?

Ayuric® is a standardized extract of the fruit of Terminalia bellirica (bibhitaki), a tree fruit used in Ayurveda. It is studied for supporting healthy uric acid levels by inhibiting xanthine oxidase, an enzyme involved in producing uric acid.

What is Ayuric used for?

Ayuric is researched primarily for Joint Health and Kidney/Urinary Tract. In a 24-week randomized pilot in 110 adults with high uric acid, 500 mg twice daily lowered serum uric acid from 8.1 to 5.8 mg/dL while the placebo group drifted slightly upward, from 7.6 to 8.0. Febuxostat 40 mg lowered it further, to 4.3.

What is the recommended dosage of Ayuric?

The clinically studied dose is 500 mg twice daily, about 1 g per day, is the dose used in both published trials. The kidney trial also tested 1000 mg twice daily, which lowered uric acid by about 34 percent against about 20 percent for 500 mg twice daily. Always follow the product label and check with a healthcare provider for personal advice.

Is Ayuric safe, and does it have side effects?

For most healthy adults, Ayuric is well tolerated at studied doses. Reported effects can include: Generally well tolerated across two 24-week trials, with no serious adverse effects reported. Digestive symptoms are the most common complaint. Mild stomach upset is reported occasionally. It may also interact with some medications. Ayuric is not right for everyone, so check with a healthcare provider first if you are pregnant or breastfeeding, have a medical condition, or take prescription medication.

Does Ayuric interact with any medications?

Possible interactions include: Uric-acid medication (allopurinol, febuxostat) — possible additive effect; consult a doctor. Diabetes medication — monitor blood sugar. If you take prescription medication, check with a pharmacist or doctor before using it.

How strong is the scientific evidence for Ayuric?

NutraSmarts rates the evidence for Ayuric as Limited (2 out of 5). It is backed by 1 clinical trial and 3 cited references summarized on this page. A higher rating reflects more, larger, and better-designed human studies.

References(3 citations)

Evidence ratings on NutraSmarts are based on the totality of human clinical research, with emphasis on randomized controlled trials, meta-analyses, and systematic reviews. The references below directly support claims made throughout this page.

  1. Pingali U, Nutalapati C, Koilagundla N, et al. A randomized, double-blind, positive-controlled, prospective, dose-response clinical study to evaluate the efficacy and tolerability of an aqueous extract of Terminalia bellerica in lowering uric acid and creatinine levels in chronic kidney disease subjects with hyperuricemia. BMC Complement Med Ther. 2020;20(1):281..PubMedUsed to support: Active-controlled trial in 59 adults with chronic kidney disease and hyperuricemia, using Ayuric supplied by Natreon. Three arms, febuxostat 40 mg daily and the extract at 500 mg or 1000 mg twice daily, with no placebo group. Over 24 weeks uric acid fell 19.8 percent and 33.9 percent on the extract against 63.7 percent on the drug. Serum creatinine fell and estimated glomerular filtration rate rose in all arms. No joint, pain or gout flare outcome was measured, and gout-flare subjects were excluded.
  2. Usharani P, Nutalapati C, Pokuri VK, et al. A randomized, double-blind, placebo-, and positive-controlled clinical pilot study to evaluate the efficacy and tolerability of standardized aqueous extracts of Terminalia chebula and Terminalia bellerica in subjects with hyperuricemia. Clin Pharmacol. 2016;8:51-9..PubMedUsed to support: Twenty-four-week pilot in 110 adults with hyperuricemia, 88 completing, with five arms: Terminalia chebula 500 mg twice daily, Terminalia bellerica 250 mg twice daily, Terminalia bellerica 500 mg twice daily, placebo, and febuxostat 40 mg daily. The full text identifies the material as Ayuric from Natreon, Inc., and Natreon supplied both the capsules and the identical placebo. Serum uric acid at 24 weeks: T. bellerica 500 mg twice daily 8.07 to 5.78 mg/dL, T. bellerica 250 mg twice daily 8.09 to 6.92, febuxostat 8.53 to 4.28, placebo 7.55 to 8.04. This is the only placebo-controlled evidence for the ingredient and it is the correct source for the page's uric acid benefit, which had been resting on a trial with no placebo arm. About 18 people completed per arm, and no joint, pain, gout flare or kidney outcome was measured.
  3. Lin YJ, Lin SY, Lin CH, et al. Evaluation of urate-lowering therapy in hyperuricemia patients: a systematic review and Bayesian network meta-analysis of randomized controlled trials. Clin Rheumatol. 2020;39(5):1633-1648..PubMedUsed to support: Network meta-analysis of 39 randomized controlled trials in 19,401 patients with hyperuricemia. It includes the ingredient, which the paper describes as 'terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts', among the urate-lowering options compared, and concludes that febuxostat at 40 mg a day or more was superior to other single-agent urate-lowering therapies. This is the only independent, non-sponsor analysis that places the extract in the urate-lowering landscape, and it supports the page's corrected statement that the prescription drug lowers uric acid substantially more than the extract. Note that the analysis lists the dose as 500 mg a day whereas both source trials used 500 mg twice daily.