AccScience Publishing / JCTR / Online First / DOI: 10.36922/JCTR025360061
Submit to JCTR
Cite this article
3
Download
24
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
ORIGINAL ARTICLE

Grewia tenax fruits as a traditional remedy for iron deficiency anemia: A comparative clinical study with ferrous salt

Randa Alsadig Almahdi1* ,  Sami Ahmed Khalid2*
Show Less
1 Department of Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Omdurman, Khartoum State, Sudan
2 Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Science and Technology, Omdurman, Khartoum State, Sudan
JCTR, 025360061 https://doi.org/10.36922/JCTR025360061
Received: 3 September 2025 | Revised: 25 September 2025 | Accepted: 9 October 2025 | Published online: 7 November 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Download PDF
XML
Cite
Abstract

Background: Iron deficiency anemia (IDA) remains a significant global public health concern, particularly among vulnerable populations such as children and menstruating women. Although standard oral iron supplements are effective in replenishing iron stores, their use is often limited by gastrointestinal side effects that negatively impact adherence. Grewia tenax fruits, a traditional Sudanese remedy, are widely used for managing IDA; however, their clinical efficacy has not been rigorously evaluated. Method: This open-label study compared G. tenax chewable tablets with ferrous gluconate in 34 adult females (18–50 years) with confirmed IDA (hemoglobin <12 g/dL). Participants received either G. tenax (five tablets twice daily) or ferrous gluconate (one tablet twice daily) for a period of 4 weeks. Hematological parameters were monitored weekly, and iron profile markers were assessed at baseline and at week 4. Results: Ferrous gluconate produced significantly greater increases in hemoglobin and serum iron levels. Although G. tenax showed more modest hemoglobin improvements, it yielded higher post-treatment ferritin levels (7.82 vs. 7.43 μg/L) and greater reductions in total iron-binding capacity, suggesting enhanced iron storage and regulation. A transient rise in reticulocyte counts observed in the G. tenax group indicates early erythropoietic stimulation. Variability in individual response to G. tenax may be attributed to differences in absorption or metabolism, underscoring the need for personalized approaches. Conclusion: These findings challenge the usual iron dose, highlighting the unique pharmacological effects of G. tenax. Further research is warranted to explore its mechanisms, long-term benefits, and role as a culturally acceptable adjunct or alternative in the management of IDA. Relevance for patients: The study population reflects women who are disproportionately affected by IDA in Sudan, making the findings highly relevant to communities that traditionally rely on G. tenax as a culturally rooted remedy.

Graphical abstract
Keywords
Iron deficiency anemia
Grewia tenax
Iron bioavailability
Iron supplementation
Traditional practice in Sudan
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Muñoz M, Villar I, García-Erce JA. An update on iron physiology. World J Gastroenterol. 2009;15(37):4617-4626. doi: 10.3748/wjg.15.4617

 

  1. Theil EC, Chen H, Miranda C, et al. Absorption of iron from ferritin is independent of heme iron and ferrous salts in women and rat intestinal segments. J Nutr. 2012;142(3): 478-483. doi: 10.3945/jn.111.145854

 

  1. Warner MJ, Kamran MT. Iron deficiency anemia. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023.

 

  1. Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013;121(14):2607-2617. doi: 10.1182/blood-2012-09-453522

 

  1. Umbreit J. Iron deficiency: A concise review. Am J Hematol. 2005;78(3):225-231. doi: 10.1002/ajh.20249

 

  1. Fernandez-Jimenez MC, Moreno G, Wright I, Shih PC, Vaquero MP, Remacha AF. Iron deficiency in menstruating adult women: Much more than anemia. Womens Health Rep (New Rochelle). 2020;1(1):26-35. doi: 10.1089/whr.2019.0011

 

  1. O’ Brayant CL, Sompson LA. Chapter 12. Anemias. In: Young LY and Koda-Kimble MA, editor. Applied Therapeutics: The Clinical Use of Drugs. 9th ed. Vancouver, WA: Applied Therapeutics Inc; 2008. p. 90-94.

 

  1. Benito P, Miller D. Iron absorption and bioavailability: An updated review. Nutr Res. 1998;18:581-603. doi: 10.1016/S0271-5317(98)00044-X

 

  1. Ems T, Kayla SL, Huechler MR. Biochemistry of iron absorption book. In: StatPeals. Treasure Island, FL: Stat Publishing; 2023.

 

  1. Sheikh NA, Desai T, Kosalge BS. Natural Fe chelators as potential therapeutic agents for iron overload diseases. In: Trace Elements and Their Effects on Human Health and Conditions. London: IntechOpen; 2021. doi: 10.5.772/IntechOpen.98749

 

  1. Jomova K, Valko M. Importance of iron chelation in free radical induced oxidative stress and human disease. Curr Pharm Des. 2011;17(31):3460-3473. doi: 10.2174/138161211798072463

 

  1. Arollado EC, Osi MO. Hematinic activity of Alternanthera sessils (L.) R. Br. (Armarnthaceae) in mice and rats. E Int Sci Res J. 2010;2(2):110-161.

 

  1. Wang X, Li Y, Han L, Li J, Liu C, Sun C. Role of flavonoids in the treatment of iron overload. Front Cell Dev Biol. 2021;9:685364. doi: 10.3389/fcell.2021.685364

 

  1. Madhikarmi NL, Murthy KR. Antioxidant enzymes and oxidative stress in the erythrocytes of iron deficiency anemic patients supplemented with vitamins. Iran Biomed J. 2014;18(2):82-87.

 

  1. Falade OS, Otemuyiwa IO, Oladipo A, Oyedapo OO, Akinpelu BA, Adewusi SR. The chemical composition and membrane stability activity of some herbs used in local therapy for anemia. J Ethnopharmacol. 2005;102(1):15-22. doi: 10.1016/j.jep.2005.04.034

 

  1. Puntarulo S. Iron, oxidative stress and human health. Mol Aspects Med. 2005;26(4-5):299-312. doi: 10.1016/j.mam.2005.07.001

 

  1. Pan Y, Qin R, Hon M. The Interactions of polyphenols with Fe and their applications in fenton/fenton-like reactions. Sep Purif Technol. 2022;300:121831. doi: 10.1016/j.seppur.2022.121831

 

  1. Babayan S, Aslanyan G, Amroyan E, et al. Comparative study of Femineral® and Floradix® in women in childbearing ages and adolescent girls with iron deficiency anemia. Sci Pharmaceutica. 2008;76:725-742. doi: 10.3797//Scipharm.0807-17

 

  1. Chobot V, Huber C, Trettenhahn G, Hadacek F. (+/-)-Catechin: Chemical weapon, antioxidant, or stress regulator?. J Chem Ecol. 2009;35(8):980-996. doi: 10.1007/s10886-009-9681-x

 

  1. Isemura M. Catechin in human health and disease. Molecules. 2019;24(3):528. doi: 10.3390/molecules24030528

 

  1. Abdallah FB, Fetoui H, Fakhfakh F, Keskes L. Caffeic acid and quercetin protect erythrocytes against the oxidative stress and the genotoxic effects of lambda-cyhalothrin in vitro. Hum Exp Toxicol. 2012;31(1):92-100. doi: 10.1177/0960327111424303

 

  1. Benariba N, Djaziri R, Bellakhdar W, et al. Phytochemical screening and free radical scavenging activity of Citrullus colocynthis seeds extracts. Asian Pac J Trop Biomed. 2013;3(1):35-40. doi: 10.1016/S22211691(13)60020-9

 

  1. Imam MU, Zhang S, Ma J, Wang H, Wang F. Antioxidants mediate both iron homeostasis and oxidative stress. Nutrients. 2017;9(7):671. doi: 10.3390/nu9070671

 

  1. Elmardi KA, Adam I, Malik EM, et al. Prevalence and determinants of anaemia in women of reproductive age in Sudan: Analysis of a cross-sectional household survey. BMC Public Health. 2020;20:1125. doi: 10.1186/s12889-020-09252-w

 

  1. Ahmed ME, Hamid HBB, Babiker HE, et al. Effects of Grewia tenax (Goddeim) as a natural food on the hemoglobin level and growth among displaced children of Darfur State, Western Sudan. J Med Med Sci. 2012;3(11):729-733.

 

  1. Ebrahim AM, Eltayeb MH, Khalid H, et al. Study on selected trace elements and heavy metals in some popular medicinal plants from Sudan. J Nat Med. 2012;66(4):671-679. doi: 10.1007/s11418-012-0630-6

 

  1. Sharma N, Patni V. Grewia tenax (Frosk.) Fiori.- A traditional medicinal plant with enormous economic prospectives. AJPCR. 2012;5(3):28-32.

 

  1. Osman MA. Nutrient composition and antinutritional factors of fiori (Grewia tenax) fruit. J Saud Soc Agric Asci. 2003;3(1):38-49. doi: 10.29328/journal.jhcr.1001026

 

  1. Khemiss F, Ghoul-Mazgar S, Moshtaghie AA, Saidane D. Study of the effect of aqueous extract of Grewia tenax fruit on iron absorption by everted gut sac. J Ethnopharmacol. 2006;103(1):90-98. doi: 10.1016/j.jep.2005.07.017

 

  1. Al Shaer MK, Ahmed AN, Mera NAM. The Effects of tinnas grewia on hemoglobin levels in the females of white rats. J Home Econ. 2021;31(3):74-86. doi: 10.21608/mkas.2021.87888.1062

 

  1. Tanaka N, Kashiwada Y. Phytochemical studies on traditional herbal medicines based on the ethnopharmacological information obtained by field studies. J Nat Med. 2021;75(4):762-783. doi: 10.1007/s11418-021-01545-7

 

  1. Almahdi RA, Ali HAR, Khalid SA. Mechanism of action and validation of the traditional medicinal use of Grewia tenax fruits in Sudan to encounter iron deficiency anemia. J Hematol Clin Res. 2023;7:29-38. doi: 10.29328/journal.jhcr.1001026

 

  1. Freedman R. Famine foods, 1998: Center for New Crops and Plant Products, Tilaceae. United States: Purdue University. Available from: https://www.purdue.edu/purdue/search. php?q=Grewia+tenax [Last accessed on 2022 Jan 11].

 

  1. Yagi SM, Al Hassan GOM. Nutritional composition of Grewia tenax species (G.tenax (Forsk.) Fiori, G.fl avescens Juss and G. viollsa) wild fruits”. IJFST. 2010;2(3):159-162.

 

  1. Abdel-Rahman NA, Awad IA, Abdelrahman EE. A study of some Sudanese Edible forest fruits and their nectars. JAAS Journal. 2014;22:39-44.

 

  1. Abuagarib EAA, Yang R, Hua X, Siddeeg A. Chemical composition, nutritional properties and volatile compounds of goddeim (G. tenax. Forssk) Fiori fruits. J Food Nutr Res. 2014;2(4):187-192.

 

  1. Almahdi RA, Khalid SA. An insight into the practice of iron therapy: Contribution to the on-going debate with special reference to low and middle-income countries. SJMS. 2021;16(1):8934. doi: 10.18502/sjms/16i1.8934

 

  1. Gera T, Sachdev HP, Nestel P, Sachdev SS. Effect of iron supplementation on haemoglobin response in children: Systematic review of randomized controlled trials. J Pediatr Gastroenterol Nutr. 2007;44(4):468-486. doi: 10.1097/01.mpg.0000243440.85452.38

 

  1. Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med. 2008;121(11):943-948. doi: 10.1016/j.amjmed.2008.07.012

 

  1. Okam MM, Koch TA, Tran MH. Iron supplementation, response in iron-deficiency anemia: Analysis of five trials. Am J Med. 2017;130(8):991.e1-991.e8. doi: 10.1016/j.amjmed.2017.03.045

 

  1. Hawkins RC. Total iron binding capacity or transferrin concentration alone outperforms iron and saturation indices in predicting iron deficiency. Clin Chim Acta. 2007;380(1- 2):203-207. doi: 10.1016/j.cca.2007.02.032

 

  1. Ma J, Wen X, Mo F, Wang X, Shen Z, Li M. Effects of different doses and duration of iron supplementation on curing iron deficiency anemia: An experimental study. Biol Trace Elem Res. 2014;162(1-3):242-251. doi: 10.1007/s12011-014-0115-4

 

  1. Salman Z, Yilmaz T, Mehmetcik G. The Relationship between ferritin levels and oxidative stress parameters in serum of β-thalassemia major patients. Arch Biochem Biophys. 2018;659(1):42-46. doi: 10.1016/j.abb.2018.09.020
Next article in this issue
Share
Back to top
Journal of Clinical and Translational Research, Electronic ISSN: 2424-810X Print ISSN: 2382-6533, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept