Cardamom

Cardamom (Elettaria cardamomum)

1. Identity: Botanical Classification, Natural Source, and Common Forms

Botanical and Chemical Identity

Small cardamom [Elettaria cardamomum (L.) Maton], also known as the "Queen of Spices," belongs to the family Zingiberaceae. It is a spice consisting of whole or ground dried fruits, or seeds, of Elettaria cardamomum, a herbaceous perennial plant of the ginger family (Zingiberaceae). It is native to Indonesia and the Indian subcontinent, Pakistan, Burma, Bangladesh, and tropical and subtropical Asia. Native to the evergreen forests of the Western Ghats in southern India, this perennial herb thrives in the warm and humid conditions of tropical climates.

It is a perennial, herbaceous monocot reaching 4–5 m in height. The plant bears long, lance-shaped leaves and produces clusters of small, aromatic flowers, but it is the seeds enclosed in its pods that hold the primary value.

Two botanical varieties have been formally distinguished: based on the size of the fruits, one is designated for wild taxa (Elettaria cardamomum var. major Thw.), comprising the wild indigenous cardamom of Sri Lanka, also known as greater oblong or long cardamom; the other (Elettaria cardamomum var. minor Watt) comprises all cultivated groups, which can be further grouped into many cultivar groups, the two most important being Malabar and Mysore.

It is important to distinguish E. cardamomum (green or true cardamom) from black cardamom, which belongs to a different genus (Amomum subulatum). The present article focuses on Elettaria cardamomum unless otherwise specified.

Common Forms and Preparations

The essential oil and other bioactive metabolites accumulated in cardamom capsules contribute to their characteristic aroma and utility as a functional food, pharmaceutical, and nutraceutical. Commercially, cardamom is encountered in the following forms:

• Whole pods (capsules): The intact dried trilocular fruit is used in cooking and brewing.
• Seeds: Extracted from pods and used whole or ground. The seed, which is where the essential oils are mainly found, has potential applications as an antimicrobial, antibacterial, and antioxidant.
• Ground powder: The most common supplement form used in clinical trials. Most clinical studies administered cardamom powder at 1.5–3 g/d as an intervention.
• Essential oil (CEO): Obtained by steam distillation of seeds. The essential oil (EO) content of cardamom capsules varies from 6 to 14% depending upon the type and processing methods.
• Encapsulated supplements: Many cardamom capsules or tablets list a dosage of 400–500 mg of dried herb per pill.
• Aqueous extracts and tinctures: Used in traditional preparations and some research settings.

2. Traditional and Historical Use

Origin and Ancient History

Cardamom is one of the oldest known spices, with references found in ancient Sanskrit texts, Ayurvedic treatises, and early Greek and Roman medical writings. Some of the early references to cardamom's medicinal uses are found in Sumer, and in the Ayurvedic literature of India, where suggested historical uses included treating infection and serving as a digestive aid.

Cardamom began its journey around the world thanks to the spice trade routes and was known and highly valued in ancient civilizations such as the Egyptian, Greek, and Roman, not only for its culinary qualities but also for its medicinal and ritual properties. The ancient Egyptians used cardamom in embalming rituals and to freshen breath, while the Greeks and Romans imported it at great expense to use in cooking and as medicine, appreciating its stimulating effect on digestion and its diuretic properties.

It is said that the Vikings first discovered cardamom during their travels and brought it back to Scandinavia, and thus it was brought to Europe. The ancient Greeks also thought highly of this spice; the Greek physicians Dioscorides and Hippocrates wrote about its therapeutic properties in historical texts, identifying it as a digestive aid.

Ayurvedic Tradition (India)

In Ayurvedic practice, cardamom is favored for its aromatic qualities and is regularly included in spice blends, herbal preparations, and daily cooking. Texts describe it as a warming, yet balancing spice commonly added to teas, milk-based drinks, and digestive spice-mixtures such as churnas and masalas. In India, it was used not only as a spice and medicine but also as a breath freshener and digestive aid after meals.

Small cardamom capsules (fruits) have been used for traditional medicine applications including for the control of asthma, teeth and gum infections, cataracts, nausea, diarrhea, as well as cardiac, digestive and kidney disorders. In Ayurveda, cardamom was widely used to treat food poisoning as well as an antidote for snake and scorpion venom. In Tibetan and Chinese traditional medicines, cardamom capsules were also applied to treat obesity and liver conditions.

Traditional Chinese Medicine and Other Asian Traditions

In ancient traditional medicines, cardamom was used to alleviate digestive disorders and obesity, and even today, it is used in local cultures for individuals with ailments such as bronchitis, depression, dysentery, influenza, and infections. Medicinally, cardamom has been used locally in India and some other Asian countries to treat depression, some heart disorders, dysentery, and diarrhea. It has also been used to counter vomiting and nausea.

Middle Eastern and Culinary Traditions

Cardamom still holds a central place in Indian and Middle Eastern cooking. It is essential to masala chai and appears in Saudi Arabian cardamom coffee (qahwa bil hal). In these traditions, it is valued both as a flavoring agent and as a digestive aid to accompany strong beverages.

3. Key Constituents and Active Compounds

Essential Oil Composition

Cardamom's essential oil is dominated by monoterpenes such as 1,8-cineole, α-terpinyl acetate, linalool, limonene, and sabinene, complemented by a diverse array of flavonoids, phenolic acids, tannins, saponins, sterols, and micronutrients.

The major compounds in the essential oil (as identified by chromatographic analysis) are 1,8-cineole (45.6%), α-terpinyl acetate (33.7%), sabinene (3.8%), 4-terpineol (2.4%), and myrcene (2.2%).

Chromatographic analysis of cardamom phytochemicals indicates that α-terpinyl acetate and 1,8-cineole (a potent antioxidant) are the major bioactive constituents in green and black cardamom, contributing pleasant and pungent aroma, respectively. In addition, various other bioactive constituents including sabinene, linalool acetate, nerolidol, thujene, pinene, cymene, limonene, geranial, and myrcene are also present.

The EO of cardamom capsules possesses predominantly monoterpene constituents, such as 1,8-cineole, α-pinene, α-terpineol, linalool, linalyl acetate and nerolidol and the ester constituent α-terpinyl acetate, all of which have therapeutic benefits including antioxidant, anticancer, antidiabetic, anti-inflammatory, antifungal, antiviral and gastroprotective activities.

Non-Volatile Phytochemicals

Cardamom has been described as possessing compounds such as phenols, starch, tannins, terpenoids, flavonoids, proteins, sterols, anthocyanins, and alkaloids. Thin-layer chromatographic (TLC) analysis of methanolic extracts has shown the presence of the flavonoids kaempferol, rutin, and quercetin.

Chemical compounds in cardamom include limonene, cymene, pinene, linalool, borneol, cardamonin, indole-3-carbinol, and diindolylmethane.

Established and Proposed Mechanisms of Action

The spice demonstrates robust antioxidant and anti-inflammatory effects through modulation of reactive oxygen species, enhancement of endogenous antioxidant enzymes, and suppression of pro-inflammatory cytokines and COX/LOX pathways.

One of the major compounds in cardamom is 1,8-cineole, which possesses anti-inflammatory and antioxidant properties, as well as protective effects against cardiovascular disease. Specifically, 1,8-cineole inhibits NF-κB phosphorylation and its transfer into the nucleus, regulating the expression of important transcription factors such as NF-κB and Nrf2, which can potentially regulate the inflammatory response.

Cardamom exhibits significant pharmacological actions, including antidiabetic activity via enhancement of insulin sensitivity and inhibition of carbohydrate-digesting enzymes, cardioprotective effects through vasodilation, lipid regulation and antithrombotic mechanisms, and gastroprotective actions.

With respect to antimicrobial mechanisms: the bacterial cell membrane may be the target of cardamom, causing leakage of intracellular proteins, ATP, and DNA. Both 1,8-cineole and α-terpinyl acetate show antimicrobial activities against pathogenic bacterial and fungal strains; 1,8-cineole shows strong antimicrobial activity against P. acnes, L. monocytogenes, S. aureus, E. coli, and S. typhimurium.

4. Scientific Evidence by Area of Use

4.1 Anti-Inflammatory Effects

In a systematic review and meta-analysis of clinical trials assessing the effect of Elettaria cardamomum (green cardamom) on inflammatory indices and blood pressure, the findings showed that supplementation with green cardamom reduces the levels of inflammatory factors, including TNF-α, hs-CRP, and IL-6, as well as blood pressure measures, including systolic blood pressure (SBP) and diastolic blood pressure (DBP).

This meta-analysis (Heydarian et al., 2024) systematically searched PubMed, Scopus, and ISI Web of Sciences for papers published up to October 2022, and eight eligible studies were included. The results showed that cardamom significantly reduced hs-CRP (SMD: −0.60 mg/dL; 95% CI: −0.78 to −0.42), IL-6 (WMD: −1.25 mg/dL; 95% CI: −1.48 to −1.03), and TNF-α (WMD: −2.10; 95% CI: −2.36 to −1.84, p < .001).

Subgroup analyses showed a significant reduction in IL-6 for both shorter and longer study durations. Although hs-CRP did not change significantly in studies lasting fewer than 10 weeks, a significant reduction was observed in studies conducted for greater than or equal to 10 weeks.

The meta-analysis concluded that cardamom can help reduce inflammation, but, due to the limited number of studies, caution must be exercised when interpreting these results.

In a supporting clinical trial, 3 g of cardamom combined with a low-calorie diet over 16 weeks reduced serum levels of inflammatory factors including TNF-α, IL-6, and hs-CRP.

Evidence strength: Moderate, based on meta-analyses of RCTs; however, total study numbers remain small, most trials were conducted in Iran, and there was some heterogeneity across studies.

4.2 Cardiovascular Health: Blood Pressure

A separate systematic review and meta-analysis found that green cardamom significantly decreased diastolic blood pressure (WMD: −0.91 mmHg, 95% CI: −1.19, −0.62), high-sensitivity C-reactive protein (WMD: −1.21 mg/L, 95% CI: −2.18, −0.24), and interleukin-6 levels (WMD: −2.41 ng/L, 95% CI: −4.35, −0.47). Of 625 clinical trials screened, eight reports with 595 patients (299 in intervention group and 296 in control group) were included.

A single-arm study showed that daily consumption of 3 g of cardamom for 3 months led to a decrease in SBP and DBP among patients with stage 1 hypertension. Another single-arm study found that supplementing with 3 g of cardamom powder for 3 months significantly reduced SBP, DBP, and mean blood pressure in patients with stage 1 hypertension.

In a clinical trial on 20 people with high blood pressure, a 3-month course of green cardamom powder supplements increased their antioxidant status by 90%.

Evidence strength: Preliminary to moderate. Reductions in blood pressure measures are statistically significant across meta-analyses, but the absolute magnitudes (e.g., approximately 0.9 mmHg in DBP) are modest. Studies are predominantly from one region, sample sizes are small, and most lacked blinding in both the participant and outcome-assessor. More large-scale RCTs are needed.

4.3 Lipid Profile and Cardiovascular Metabolic Biomarkers

A meta-analysis of RCTs showed that cardamom consumption could improve total cholesterol (WMD = −8.56 mg/dL; 95% CI: −14.90 to −2.22), triglycerides (WMD = −14.09 mg/dL; 95% CI: −24.01 to −4.17), hs-CRP (WMD = −1.01 ng/mL; 95% CI: −1.81 to −0.22), and interleukin-6 (WMD = −1.81 pg/mL; 95% CI: −3.06 to −0.56), but did not have significant influences on HDL-C or LDL-C. In conclusion, cardamom consumption can improve specific cardiovascular metabolic biomarkers and potentially confer protective effects on cardiovascular health.

A specific RCT contributing to this body of evidence: eighty overweight or obese pre-diabetic women were randomly allocated to two groups; the intervention group received 3 g of green cardamom and the placebo group received 3 g of rusk powder for 2 months. Results disclosed that mean total cholesterol (from 192.6 to 183.7 mg/dL) and LDL-C (from 118.1 to 110.5 mg/dL) were significantly reduced, and a protective effect on HDL-C was also observed.

Another study reported that cardamom supplementation (3 g, 10 weeks) could significantly decrease triglycerides (from 158.4 to 125.8 mg/dL) in type 2 diabetes (T2DM) patients compared with the placebo group.

Evidence strength: Preliminary. Effects on total cholesterol and triglycerides appear consistent across a limited number of trials, but effects on LDL-C and HDL-C are inconsistent. The available trials are small in number and involve limited population diversity.

4.4 Glycemic Control and Metabolic Syndrome

A systematic review of studies examining the effects of cardamom on diabetes found 14 eligible articles from an initial pool of 241; 8 were in vivo studies and 6 were clinical trial studies. Most studies have indicated the beneficial effects of cardamom on insulin resistance, oxidative stress, and inflammation.

After a two-month intervention with 3 g/d green cardamom, mean total cholesterol and LDL-C significantly decreased, and insulin sensitivity significantly increased in the cardamom group compared to placebo.

In a clinical trial on 87 overweight people, green cardamom improved the grade of fatty liver in those with non-alcoholic fatty liver disease (NAFLD). Specifically, 87 participants were randomly divided into cardamom (n = 43) or placebo (n = 44) groups; supplementation was two 500 mg capsules 3 times/day with meals for 3 months.

Evidence strength: Preliminary. Human clinical data are sparse, and, while some trials demonstrate improvements in insulin sensitivity and glycemic indices, evidence is not yet sufficient to support recommendations for glycemic management.

4.5 Antioxidant Activity

Cardamom is a rich source of phenolic compounds, volatile oils, and fixed oils. Cardamom and its pharmacologically effective substances have shown broad-spectrum antioxidant activities. Narrative reviews have attributed antioxidant properties of green cardamom to the presence of polyphenol compounds.

In the laboratory, in-vitro MTT assay showed that alpha-terpinyl acetate significantly protected PC12 cells against H₂O₂-induced oxidative stress. Similarly, 1,8-cineole and α-pinene pre-treatment has been found to attenuate the loss of cell viability due to H₂O₂-induced oxidative stress in PC12 cells.

Evidence strength: Well-established in vitro and in animal models; limited direct human clinical data specifically for antioxidant endpoints, though antioxidant improvements have been reported as secondary outcomes in cardiovascular and metabolic trials.

4.6 Antimicrobial Activity

A study examined the chemical composition and antimicrobial activity of the essential oils of Elettaria cardamomum harvested in India and Guatemala. Monoterpenes were present in higher concentration in Indian cardamom (83.24%) than Guatemalan (73.03%). Minimum inhibitory concentrations (MICs) of 0.5 and 0.25 mg/mL were demonstrated against Pseudomonas aeruginosa, and 1 and 0.5 mg/mL against Escherichia coli.

In a study exploring the antimicrobial effects of cardamom extracts on oral bacteria, cardamom extracts were found to be effective against oral pathogenic bacteria like Streptococcus mutans and Candida albicans. Besides its antibacterial properties, its slightly pungent but pleasant taste stimulates salivary flow, and the fibrous outer coat helps in mechanical cleansing of the teeth.

One study found that cardamom fruit and seed extract effectively killed several different types of bacteria, particularly for periodontal infections such as gum disease. The researchers suggested that the cardamom's antibacterial activity may be due to its ability to damage the cell membrane of certain bacteria.

Evidence strength: Primarily in vitro and ex vivo laboratory data. There are no in vivo studies, to date, that have explored the possibilities of cardamom in the oral cavity in adequately powered clinical trials. Clinical translation remains unproven.

4.7 Anticancer Potential

Researchers have extracted and tested multiple phytochemicals from cardamom to assess their potential effectiveness against various types of human malignancy. These studies have indicated that cardamom can help overcome drug resistance to standard chemotherapy and protect against chemotherapy-induced toxicity due to its scavenging properties.

Chemical compounds in cardamom, including limonene, cymene, pinene, linalool, borneol, cardamonin, indole-3-carbinol, and diindolylmethane, primarily target the programmed cell death ligand-1 (PD-L1) gene, which is more prevalent in cancer cells than in healthy cells.

Based on previous preclinical studies, cardamom shows significant potential as an anti-cancer agent, but further exploration for clinical use is warranted due to its diverse mechanisms of action.

Evidence strength: Preclinical only (in vitro and animal models). There are no registered human clinical trials demonstrating anticancer efficacy of cardamom supplementation. This area remains speculative until human data are available.

4.8 Digestive and Gastrointestinal Effects

For centuries, cardamom has been used in traditional medicine to treat a variety of conditions such as tooth and gum infections, asthma, kidney and digestive disorders, diarrhea, nausea, cataracts, and cardiac disorders.

A study examined the antimicrobial and gastrointestinal activity of the essential oils of Elettaria cardamomum harvested in India and Guatemala. The essential oils demonstrated antidiarrheal and antispasmodic properties in preclinical models.

Early research suggests that applying a mixture of ginger, cardamom, and tarragon essential oils to the neck after anesthesia and surgery may help relieve nausea and prevent vomiting for up to 30 minutes in some people; however, the effect seems to vary depending on the number of vomit-causing drugs given during anesthesia or as pain relievers during and/or after surgery.

Evidence strength: Traditional use is well-documented, and preclinical data support antispasmodic and carminative activity. Human clinical evidence for gastrointestinal outcomes specifically is very limited and inconsistent.

4.9 Non-Alcoholic Fatty Liver Disease (NAFLD)

Despite reported health effects of cardamom on dyslipidemia, hepatomegaly, and fasting hyperglycemia, the potency of cardamom supplementation in NAFLD (as the hepatic part of metabolic syndrome) had not been extensively studied in humans prior to a dedicated RCT. In that double-blind, randomized, placebo-controlled clinical trial: 87 participants were randomly divided into cardamom (n = 43) or placebo (n = 44) groups; supplementation was two 500 mg capsules 3 times/day with meals for 3 months. This trial reported improvements in fatty liver grade, glucose indices, lipids, and serum irisin.

Evidence strength: A single, adequately powered RCT. Replication is needed.

5. Body Systems and Health Areas of Association

The therapeutic impacts of cardamom are due to its pharmacological effects including anti-oxidant, antimutagenic, antibacterial, anti-inflammatory, antidiabetic, cardioprotective, hepatoprotective, and chemoprotective properties.

• Cardiovascular system: Blood pressure modulation, lipid modification, antithrombotic and vasodilatory effects.
• Metabolic/endocrine system: Insulin sensitivity, glycemic regulation, effects on metabolic syndrome components.
• Gastrointestinal/digestive system: Carminative, antispasmodic, antiulcer, antidiarrheal, anti-nausea effects.
• Immune/inflammatory system: Reduction of pro-inflammatory cytokines (TNF-α, IL-6, hs-CRP) and NF-κB pathway modulation.
• Oral health: Antimicrobial activity against Streptococcus mutans, Candida albicans, and periodontal pathogens.
• Hepatic system: Hepatoprotective effects; evidence in NAFLD.
• Respiratory system: Traditionally used for asthma and bronchitis.
• Oncology (preclinical): PD-L1 pathway interactions and chemoprotective effects demonstrated in cell and animal models only.

6. Dosage Forms and Reported Dosages

There is no universally established clinical dosage for cardamom as a supplement. The following represent dosages as reported in identified research sources:

• In the clinical trials included in the 2024 meta-analysis on inflammation and blood pressure, the intervention duration ranged from 8 to 16 weeks, and the dosage of supplemented green cardamom across all included studies was 3,000 mg (3 g) per day.
• As a supplement, cardamom is most often taken by mouth as a dose of 3 grams daily for up to 4 weeks in adults, based on reported usage patterns.
• In the NAFLD trial, the supplementation was two 500 mg capsules 3 times per day with meals (totaling 3 g/day) for 3 months.
• In the pre-diabetic women RCT, the intervention group received 3 g of green cardamom daily and the placebo group received 3 g of rusk powder for 2 months.
• There is no officially established dosage for taking cardamom as a supplement. Many cardamom capsules or tablets list a dosage of 400–500 mg of dried herb per pill.
• Most clinical studies administered similar amounts of cardamom powder, specifically 1.5–3 g/d, as an intervention.

The predominant dosage across human clinical trials is thus 3 g/day of green cardamom powder, typically divided with meals, for periods ranging from 8 to 16 weeks.

7. Safety Considerations and Interactions

General Safety

When taken by mouth, cardamom is commonly consumed in foods and is possibly safe when taken in the larger amounts found in medicine. When inhaled, it is possibly safe to breathe the vapor from cardamom essential oil as aromatherapy.

Toxicological Data

In acute oral toxicity studies in Wistar rats, no toxicity symptoms were observed at 300 mg/kg; one rat showed mortality after receiving 2,000 mg/kg of cardamom oil due to abnormal motor functions and convulsions, while two other animals showed temporary mild toxicity signs. Based on these results, the LD₅₀ of cardamom oil was established as greater than 2,000 mg/kg. The repeated-dose toxicity study showed that cardamom oil was safe at all selected dose levels because there was no change in body weight, food intake, and water consumption after 28 days of treatment. These are animal data; human toxicological thresholds have not been formally established.

Drug Interactions

There is limited evidence of clinically significant interactions between cardamom supplements and prescription medications. Most research on cardamom focuses on its nutritional properties rather than drug-supplement interactions.

Based on its pharmacological properties (antihypertensive, antithrombotic, blood-glucose-lowering, platelet-aggregation-inhibiting), there is theoretical potential for additive effects with:

• Antihypertensive drugs: Cardamom has demonstrated modest blood pressure-lowering effects in clinical trials, raising the theoretical possibility of additive hypotension.
• Antiplatelet and anticoagulant agents: Cardamom seed extract has shown a protective effect on platelets against aggregation and lipid peroxidation in experimental models, suggesting a theoretical additive effect with antiplatelet or anticoagulant drugs.
• Antidiabetic medications: Given demonstrated improvements in insulin sensitivity, additive glucose-lowering effects are theoretically possible.

Pregnancy and Lactation

There is not enough reliable information about the safety of taking cardamom in medicinal amounts during pregnancy and breast-feeding. Use at levels beyond ordinary food consumption during these periods has not been adequately studied.

Gallstones

Some sources have noted a potential concern related to gallstone formation or obstruction with high cardamom consumption, though formal clinical evidence on this point is limited.

Allergic Reactions

Allergic reactions to cardamom are rare, but they can occur in some individuals. When they do, symptoms may include swelling of the throat, tongue or lips, along with itching, hives, or skin rashes. In very rare instances, a severe allergic reaction known as anaphylaxis may develop.

Evidence Quality and Limitations

The quality of published clinical trials on cardamom has varied, with study populations ranging from as few as 10 subjects per group to as many as 99 participants. Diverse cultural and ethnic representation has been lacking, as 6 of 9 trials in one review were conducted in Iran. In some cases, the extent of randomization and blinding was unclear. Inconsistent methods of statistical analysis were used, and one trial lacked a control group.

To date, the limited and inconsistent outcomes from these trials are insufficient to support recommendations for human use. This characterization reflects the current frontier of the evidence base and does not negate the preliminary positive signals observed across multiple outcome domains.

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