Benefits
Stool output and bowel habits in an Indian outpatient trial
In a 160-patient trial at an Ayurvedic hospital in Kolkata, three triphala powders at 2.5 g twice daily gave heavier stools, higher stool consistency scores and lower flatulence and mucus scores than a control group after about a month. Randomization, blinding and baseline values were not reported, and daily stool frequency was lower, not higher, with triphala.
Gut bacteria in a 4-week placebo-controlled study
In 31 healthy adults given 2,000 mg a day of triphala, the herb manjistha or placebo for 4 weeks, changes in stool bacteria were highly individual and no bacterial group changed in the same direction across people. Both herb groups had fewer Rikenellaceae bacteria and a trend toward more Akkermansia muciniphila, with 9 people analyzed on triphala. The reported gut outcome was bacterial makeup, not bowel habits.
Body weight and waist size in a 12-week placebo-controlled trial
In a double-blind trial in Iran, 62 people aged 16 to 60 with obesity took 5 g twice daily of Itrifal Saghir, a traditional confection of the three fruits kneaded with almond oil and honey, or a look-alike placebo. Weight fell about 4.4 kg versus a slight gain on placebo, and waist size fell more. Early dropouts were replaced, and the result has not been repeated.
Cholesterol and fasting blood sugar in small randomized trials
A systematic review of 12 small randomized trials (749 people) found lower LDL, total cholesterol and triglycerides in 6 of them, and lower fasting glucose in people with diabetes but not in people without it. Most trials were small and short. In a 90-person double-blind Italian trial, triphala combined with guggul was no better than placebo for cholesterol.
Oxidative stress and inflammation markers in a placebo-controlled trial
In 74 adults with lingering symptoms after COVID-19, triphala 1,000 mg a day on 5 days a week for 8 weeks lowered oxidative stress and inflammation markers from starting levels, but the triphala and placebo groups did not differ on any primary outcome. In a related trial, triphala added no measurable benefit to interval exercise.
Mechanism of action
A tannin and gallic acid rich fruit blend
Triphala is classically made from equal parts of the three dried fruits. Gallic acid measured about 11 to 14 mg per gram in three triphala powders, and a lab analysis of a triphala extract found it rich in hydrolyzable tannins. Ayurvedic texts class triphala as a mild laxative at normal doses and a purgative at high doses; which compounds drive any bowel effect has not been shown in people.
Shifts in gut bacteria in lab cultures of human stool
When triphala was added to cultures of human stool bacteria in the lab, Bifidobacterium, Lactobacillus and butyrate-producing species increased; two of that study's authors are tied to the Chopra Foundation. In a separate lab model using stool from adults with obesity, triphala extract changed many bacterial metabolites but not the bacterial profile. In people, a 4-week pilot found no consistent shift.
Liver enzyme (CYP) inhibition in lab and rat studies
Triphala extract inhibited the drug-metabolizing enzymes CYP1A2, CYP3A4, CYP2C9 and CYP2D6 in human liver tissue in the lab, and in rats it raised blood levels of the test drugs phenacetin and midazolam by about 61% and 41%. This has not been measured in people, but it is the basis for the drug interaction caution.
Clinical trials
Four-group clinical study at J. B. Roy State Ayurvedic Medical College and Hospital, Kolkata: two marketed triphala powders and one in-house powder (equal parts of the three fruits, standardized to gallic acid) at 2.5 g twice daily for 1 month (the abstract says 45 days), compared with a control group the methods call placebo. Randomization and blinding were not described. Funded by the Drug Information Association, USA. (Mukherjee et al. 2006, Iranian Journal of Pharmacology and Therapeutics)
160 outpatients (40 per group), described as having constipated bowel habits; the age range is given as 16 to 52 in the abstract and 15 to 75 in the methods.
Compared with the control group, all three triphala groups had heavier stools (about 235 to 240 g vs 178 g), higher stool consistency scores and lower mucus and flatulence scores. Daily stool frequency was lower with triphala (1.1 to 1.3 vs 2.1). Scores were arbitrary, baseline values were not reported, separate groups were compared with paired t-tests, and well-being measures such as sleep and appetite did not differ significantly. No adverse reactions were seen.
Open-label, single-group, 14-day study of TLPL/AY/01/2008, a proprietary powder of psyllium (isabgol) husk, senna extract and triphala extract, 10 g in water at bedtime. Sponsored by the maker, Tulip Lab; three authors worked with the sponsor. (Munshi et al. 2011, J Ayurveda Integr Med)
34 adults with functional constipation by Rome III criteria in Mumbai; 31 completed.
Weekly bowel movements rose from about 10.2 to 18.3 by day 14, stool form on the Bristol scale improved, and time on the toilet fell, all against each person's own baseline. No adverse events were reported. Senna is a stimulant laxative and psyllium a bulk fiber, so the result cannot be credited to triphala, and there was no placebo.
Randomized, double-blind, placebo-controlled 3-arm pilot at UC Davis (NCT03477825): 2,000 mg/day of triphala, manjistha (Rubia cordifolia) or placebo for 4 weeks, with stool 16S rRNA profiling. (Peterson et al. 2020, J Altern Complement Med)
31 healthy adults randomized; 29 analyzed (triphala 9, manjistha 9, placebo 11).
Responses were highly personalized and no bacterial taxa were uniformly altered. Both herb groups showed a trend toward a lower Firmicutes to Bacteroidetes ratio and more Akkermansia muciniphila, and both reduced Rikenellaceae (mainly Alistipes). Bowel habits and symptoms were not reported as outcomes in the abstract. Very small groups.
Randomized, double-blind, placebo-controlled parallel trial in Tehran: 5 g twice daily of Itrifal Saghir, equal parts of the three fruits blended with almond oil and kneaded with honey, or a look-alike carbomer confection, for 12 weeks; participants were asked to keep their usual diet and lifestyle. (Kamali et al. 2012, Daru)
62 people aged 16 to 60 with obesity (31 per group); people who left before the first follow-up visit were replaced.
Mean weight went from 96.9 to 92.5 kg with Itrifal Saghir and from 96.6 to 97.0 kg on placebo, a between-group difference of 4.82 kg (95% CI 3.52 to 6.11). Waist and hip circumference also fell more (4.01 cm and 3.21 cm), and fasting glucose fell slightly versus a rise on placebo, although HbA1c rose from 4.40% to 5.26% on Itrifal Saghir (4.57% to 4.63% on placebo). The full text reports no notable adverse events, similar rates of minor side effects in both groups and no significant liver or kidney test changes. A single trial of a honey-based traditional preparation.
Open-label, single-arm phase I safety trial at Thammasat University, Thailand (TCTR20180423002): triphala water extract, five 500 mg capsules (2,500 mg) once daily at bedtime for 4 weeks, with weekly exams and blood tests and a day-35 follow-up. (Phetkate et al. 2020, J Integr Med)
20 healthy volunteers (10 men, 10 women).
No serious adverse effects were reported. HDL cholesterol was higher on day 35 and blood sugar lower on days 14 and 35 than at the start. With no placebo group and 20 people, the lab changes are exploratory; the study's main purpose was short-term safety.
Parallel randomized, double-blind, placebo-controlled trial in Italy: guggulu (Commiphora mukul) plus triphala or placebo three times daily for 3 months, with 3 months of follow-up. (Donato et al. 2021, Complement Med Res)
90 adults with high cholesterol at low to moderate cardiovascular risk (46 treatment, 44 placebo).
Null for the primary outcomes. Total cholesterol fell 3.3% on treatment and 1.9% on placebo, and LDL fell 4.8% and 4.9%, with no difference between groups; BMI and waist size also did not differ. Two people on treatment developed a hypersensitivity rash, none on placebo. Because guggul was included, the trial does not isolate triphala.
Preliminary randomized, double-blind, placebo-controlled trial in Thailand: triphala capsules 1,000 mg/day or placebo, 5 days a week for 8 weeks. Outcomes were malondialdehyde, protein carbonyl, superoxide dismutase, interferon-gamma and TNF-alpha. (Intakhiao et al. 2025, Glob Adv Integr Med Health)
74 adults aged 18 to 53 with post-COVID-19 condition (37 per group).
Null between groups: the triphala and placebo groups did not differ significantly on any primary outcome. Within the triphala group, malondialdehyde, protein carbonyl, interferon-gamma and TNF-alpha fell and superoxide dismutase rose from baseline; in the placebo group superoxide dismutase also rose.