Of Dengue, Papaya Leaves, and Crab Soup

Written on 7th October 2014

Recently there has been a sensationalisation of the humble papaya leaf extracts and other traditional remedies for dengue treatment by our local newspapers (the star, the sun etc). So much so that it caused quite a stir in the medical profession, and of course, social media. I even had a customer who came into my pharmacy, offering her "recipe" for crab soup that allegedly boosted her back to health, when she was down with dengue.


So the million dollar question is, DO PAPAYA LEAVES AND CRAB SOUP CURE DENGUE?


While there is no simple answer to the question, let me break it down as simply as possible. For the people interested in the details, you can read the [scientific jargon] section. For the rest for the world, you can read the "IN ENGLISH"section presented in the picture boxes below.


[Scientific Jargon Section Ahead]

1. That 50grams of C. papaya leaves of the the sekaki variant can speed up (if not cure) dengue fever. A study done by IMR Malaysia involved giving freshly extracted papaya leaf juice (tastes bitter as hell) to Grade 1 and Grade 2 Dengue patients. These patients showed significantly raised PTAFR genes (13.42 fold) compared to those receiving standard treatment. This is in turn translated as a potential for improving outcome in Dengue patients, because increased platelet count usually means that the patient is getting better.

2. Giving crab soup (2 crabs per meal) to dengue patients will improve their condition, within a day or 2.

The belief was given a rocket boost when local newspapers like The Sun (http://www.thesundaily.my/node/274646) and The Star published articles that were very much in favour of the claim.


The social media took it one step further by giving out a step-by step formula on how to prepare Papaya juice extracts (see pictures below)

These were taken of a facebook page called "Table for 2. or more", which struck me as superbly well written (and not to mention amazing photography).


So, what is the problem with people just sharing a treatment that could save lives?



 [Scientific Jargon ahead]

The main problem of the studies using papaya juice, is that the studies DO NOT MEASURE mortality rate, nor did they do their tests in severely ill patients. Quoting a rather blunt biochemist:

" Why didn't they isolate the active compound before doing the study?"

"How were they allowed to do human trials without 1st determining the dosage and side effects?"

Simply put, we do not know which compound in the papaya leaves caused the rise in platelets, nor do we know the side effects profile of such an agent when given to humans. Allergic reactions? Effects on the elderly? Pregnant ladies? Infants? Kidney impaired? All these important questions go unanswered.


Furthermore, we are missing an important point here, which is whether Papaya leaf extract does indeed aid in patient recovery. All that was measured in the study was platelet increase. As you may know, dengue is generally a self-limiting disease and the disease-incuded thrombocytopenia usually reverses within 24-48 hours after it dives down. So, did the patients get better because of the juice? Or did they just get a lot more Platetlets than the control group?

Some may argue that Increased platelets should theoretically reduce the risk of hemorrhage or risk of bleeding. But quoting Ong Tee Chuan,


"Low platelet count accompanies the other manifestations of severe complications of Dengue, but scientific studies showed that – (1) The number of platelet does NOT correlate with risk of bleeding, and (2) Giving platelet transfusion to increase the level of platelet in a patient with no major bleeding does NOT prevent Dengue shock or improve the outcome."


Instead of looking at the platelets, we should be monitoring for a rise in packed cell volumes. This is because the most lethal/critical stage in dengue fever is the stage where the plasma starts to leak out, causing insufficient oxygenation to our cells, then lactic acid builds up, and eventually shock, bleeding and death.



I would strongly advice all dengue patients NOT to self-treat dengue at home, and always go to a doctor when you suspect that you might have dengue. The doctor might or might not ward you, depending on his clinical judgement, and the stage of disease you are in.

The reason for this is, if you are one of the unlucky patients that go into the plasma leaking phase, taking Papaya leaf extract alone at home might cost you your life.

 Having said that, up till today, there haven't been any reported cases of severe side effects after taking Papaya leaf extract (not that I know of that is). So if you really want to take this juice, do it in conjunction with standard medical care.


But wait! where is the crab soup part?


Well, the notion that crab soup can help in Dengue recovery may not be too far fetched after all. Taking a quote from the star, Malaysian Dietician Association president Prof Dr Winnie Chee said calorie and protein intake should be increased by as much as 50% of the daily requirement.

“A high calorie diet with frequent feeding should be given as soon as fever is controlled but one should avoid fried and oily foods during fever,” she said.

Easily digested protein such as milk, eggs, fish, poultry and legumes was necessary to replenish loss of tissue proteins during fever, she said.

“As soon as the temperature comes down, readily digestible bland food should be given to the patient for better digestion and rapid absorption,” she said, adding that iron supplements might be necessary for those recovering from dengue haemorrhagic fever.


So for those patients with difficulty in buying or cooking Luxurious crabs, food like milk, eggs and chicken may serve the purpose just as well! 


So there you have it, the end.