Rhus coriaria

Rhus coriaria (Sumac): A Comprehensive Reference

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

Rhus coriaria, commonly called Sicilian sumac, tanner's sumach, or elm-leaved sumach, is a deciduous shrub to small tree in the cashew family Anacardiaceae. It is native to southern Europe and western Asia, including the Eastern Mediterranean, Crimea, Caucasus, and northern Iran, but is now naturalized in most of the Mediterranean Basin as well as Macaronesia.

Rhus coriaria is a hardy, drought-tolerant, deciduous shrub growing to 3 metres (10 ft) at a medium rate or to a small tree up to 5 m (16 ft) high. It is frost-sensitive and can be grown in USDA hardiness zones 8–11, and will grow in any type of soil that is deep and well-drained, including poor, rocky, alkaline, or slightly acidic soils. It grows with pinnate leaves arranged in pairs of 6 or 8 small leaflets, with a cluster of white flowers at terminal inflorescences.

The word "sumac" originally comes from Hebrew סמק, then through the Aramaic summāqā meaning "red," via Arabic, Latin, and French. The genus Rhus has over 91 accepted species names in the Anacardiaceae family; Rhus coriaria L. is the only species in Iraq that grows wild and/or is cultivated near villages in the north of the country.

Common Forms and Preparations

For a long time, R. coriaria has been used as a spice by grinding the dried fruits with salt, and it has also been widely used as a medicinal herb in traditional medicine. The fruit has a sour taste; dried and crushed, it is a popular spice in the Middle East, used especially in the spice mixture za'atar. Although the fresh fruits of sumac can be used to make tea, more often they are dried and ground into the characteristically dark-red powder familiar in culinary use.

It has a characteristic taste and morphological features, making it one of the popular flavoring spices, drinks, appetizers, and acidulants in food recipes, in addition to its role as a plant medicine. In experimental and clinical research contexts, the plant material has been prepared and administered as encapsulated dried fruit powder or as standardized aqueous, hydroalcoholic, or ethanolic extracts.

2. Traditional and Historical Use

Rhus coriaria L. (Sumac) has been used as folk medicine since ancient times. Mature fruits were known well before lemons to the Europeans since the times of the ancient Romans, who appreciated their sourness and used them in vinaigrettes like lemons in modern times.

Owing to its bountiful beneficial values, sumac has been used in traditional medicine for the management and treatment of many ailments including hemorrhoids, wound healing, diarrhea, ulcer, and eye inflammation. The bark powder of Rhus coriaria has been used as an effective teeth-cleaning agent, while its infusion has been used to treat viral eye infections. The powdered spice product from the dried fruit was sprinkled on boiled eggs and consumed for diarrhea treatment. A fruit decoction has been traditionally administered for the treatment of hepatic diseases, urinary system disorders, and diarrhea.

The leaves and bark were traditionally used in leather tanning and contain tannic acid. From an industrial point of view, R. coriaria is employed in the textile field as a tanning agent, especially for leather, and as a natural dye, with high fixation, retention, and fungal resistance properties.

Its use has also been indicated for cholesterol reduction, in the treatment of sore throat, and as an abortifacient. Several parts of sumac — including leaves, bark, and flowers — contain functional compounds used for tinctures in the local ethnobotanical tradition; they are rich in gallic acid, (bi)flavonoids, sugars, and essential oils.

Due to its easy collection and remarkable biological activities, R. coriaria has been used both as food and medicine in some parts of the world, especially Iran. In recent years, utilization of Rhus coriaria L. (sumac) has been upgrading not only in culinary use and human nutrition, but also in the pharmaceutical industry, food industry, and veterinary practices, driven by accumulating evidence that supports the ethnobotanical use of this plant.

3. Key Constituents and Active Compounds

As of the time of recent reviews, over 200 phytochemicals have been isolated from Rhus coriaria, including organic acids, phenolic acids, phenolic compounds conjugated with malic acid derivatives, flavonoids, isoflavonoids, hydrolysable tannins, anthocyanins, terpenoids, and other compounds such as butein, iridoid, and coumarin derivatives.

The fruits and leaves of Rhus coriaria contain various phenolic acids such as gallic acid, ellagic acid, caffeic acid, and chlorogenic acid; flavonoids including quercetin, rutin, kaempferol, luteolin, and apigenin; as well as anthocyanins such as cyanidin, delphinidin, and peonidin.

Most of the antioxidant potential and therapeutic roles of sumac are increasingly attributed to its constituent tannins, flavonoids, and phenolic acids. Hydroxyphenyl pyranoanthocyanins and other anthocyanins are responsible for the highly desired red pigments, accounting for the strong pigmentation capacity and colorant ability of sumac.

A total of 263 volatile compounds, including terpene hydrocarbons, acids, and aldehydes, as well as 83 polyphenolic compounds, mainly gallic acid derivatives, have been positively identified through comprehensive chromatographic characterization of sumac fruit samples. In one identification study of volatile constituents, the main compounds were identified as α-pinene (44%), limonene (20%), and β-pinene (11.4%).

The overall composition of the dried sumac fruit is mainly composed of moisture (6–11.8%), essential oil content (1.0%), protein (2.3–2.6%), fiber (14.6–22.15%), ash (1.5–2.66%), water-soluble extract (63.8%), and fatty oil (17.4%).

The most abundant mineral compound in R. coriaria extract is potassium, and oleic acid is the most abundant fatty acid. Vitamin B6 and glutamic acid are the most abundant vitamin and amino acid, respectively. The most abundant flavonoids are quercetin and the phenolic compound gallic acid.

Chemical compositions documented in systematic reviews for R. coriaria include proximate composition, minerals, fatty acids, vitamins, amino acids, and organic acids.

The anthocyanin fraction has been found to contain pelargonidin, petunidin, peonidin, cyanidin, and delphinidin glucosides and coumarates, while gallic acid was the major phenolic acid in extracts. The aqueous extract of Rhus coriaria fruits is particularly concentrated in anthocyanins, flavonoids, and phenols. Hydrolyzable tannins (38.1%), gallic acid (21.8%), and quercetin (15.8%) have been reported as the most active components present in higher amounts, followed by lowest amounts of myricetin (10.1%).

4. Mechanisms of Action

Antioxidant Activity

All sumac samples examined by comprehensive phytochemical characterization showed significant antioxidant activity by means of oxygen radical absorbance capacity, in line with their polyphenolic content and composition. Rhus coriaria appears to exert its protective effects by increasing the activities of detoxifying enzymes — overall glutathione S-transferase (GST) and the two isozymes GST-α and GST-π — in plasma of human subjects treated with sumac extract. Rhus coriaria may also reduce DNA damage through direct ROS scavenging activity. Gallic acid, a major constituent in sumac fruit, was shown to reduce H₂O₂-induced DNA damage in human lymphocytes at a level comparable to whole sumac extract.

Antidiabetic Mechanisms

Results of some studies showed benefits of sumac consumption on decreasing blood glucose by inhibiting the α-glucosidase enzyme activity in small intestine tissue of diabetic rats, and reducing serum cholesterol levels by increasing the activity of cholesterol-7-alpha-hydroxylase (CYP7A1), which converts cholesterol into bile acids. Potential mechanisms for glycemic effects were essentially limited to enhanced antioxidant defenses, inhibition of α-glucosidase, maltase, and sucrase activities, and suppression of production of proinflammatory mediators.

Antimicrobial Mechanisms

The MIC for Rhus coriaria in antimicrobial studies was 1.95–31.25 mg/ml. According to research results, tannins may be the main antimicrobial agent of the plant. The antimicrobial, anti-inflammatory, and antioxidant activity of Rhus coriaria extract suggests its importance as a target for the formulation of novel drugs against many microbial infections with minimal side effects.

Anticancer Mechanisms

Sumac suppressed tumor growth, metastasis, and neovascularity in the MDA-MB-231 breast cancer cell line by targeting the STAT3, NFκB, and nitric oxide signaling pathways. The same research group described the induction of senescence and autophagic cell death by sumac in MDA-MB-231 cells through a mechanism involving p38 and ERK1/2 signaling activation.

Anti-inflammatory Mechanisms

Sumac has been indicated to exert favorable effects in the management of different diseases, and it also possesses high anti-inflammatory and antioxidant properties. Rich in bioactive molecules including polyphenols, tannins, and flavonoids, sumac shows potent free radical scavenging activity, and may fight oxidative stress, which is recognized as the main cause of neurodegenerative ailments.

5. Scientific Evidence by Area of Use

5.1 Glycemic Control and Type 2 Diabetes

This is one of the best-studied areas in human clinical trials for Rhus coriaria. One double-blind randomized controlled clinical trial investigated the effects of sumac (R. coriaria) on serum glycemic status, apolipoprotein (apo) B, apoA-I, and total antioxidant capacity (TAC) in type 2 diabetic patients. The study was conducted on 41 type 2 diabetic volunteers randomly assigned to 3 g/day sumac powder (n=22) or placebo (n=19) groups over 3 months. There were significant decreases in serum glucose and HbA1c and also apoB levels at the end of the study compared with initial values (P<0.0001, P=0.002, and P<0.0001, respectively).

At the meta-analytic level, a pooled analysis of 16 trials showed that sumac consumption led to a significant reduction in fasting blood glucose (WMD: −6.03 mg/dl; 95% CI: −9.67 to −2.39), hemoglobin A1c (WMD: −0.45%; 95% CI: −0.59 to −0.31), triglycerides (WMD: −9.07 mg/dL; 95% CI: −16.19 to −1.94), and low-density lipoprotein cholesterol.

Reviewing 23 relevant studies demonstrated that R. coriaria is able to decrease the level of blood glucose, glycated haemoglobin, serum insulin, and insulin resistance. However, well-designed, larger randomized controlled trials evaluating the effects of multiple doses of sumac for extended durations of intervention on clearly defined and relevant outcomes in subjects sharing more homogeneous health conditions are needed.

A 2026 systematic review and meta-analysis published in Endocrinology, Diabetes & Metabolism summarizing trials to March 2025 concluded that sumac supplementation improved lipid profile and glycemic parameters, suggesting potential benefits in addressing cardiovascular risk factors, despite no significant effects on inflammatory parameters.

5.2 Lipid Profile and Dyslipidemia

Rhus coriaria, with the general name sumac, is a medicinal spice especially in Middle Eastern countries that is well known as an anti-lipid spice. Studies aimed to summarize existing findings regarding the effect of R. coriaria on lipid profile, and randomized controlled trials assessing the effect of R. coriaria on blood lipids were included in systematic reviews. Several studies have investigated the lipid-lowering effects of R. coriaria and yielded positive effects on the lipid profile, though further trials are needed before conclusive claims can be made.

Sumac (Rhus coriaria L.) supplementation enhances glycemic control and lipid metabolism, indicating potential cardiometabolic benefits in reducing cardiovascular disease risk factors. Rhus coriaria is rich in various classes of phytochemicals including flavonoids, tannins, polyphenolic compounds, and organic acids, and may be beneficial for cardiovascular disease risk factors.

Cardiovascular disease is a pressing public health issue worldwide, and primary and secondary CVD prevention are essential. Many clinical trials have investigated the effects of sumac supplementation on CVD risk factors; however, these studies have yielded contradictory findings. A 2025 meta-analysis in BMC Complementary Medicine and Therapies searched MEDLINE/PubMed, EMBASE, CENTRAL, and Web of Science for relevant studies in any language until March 2025 to comprehensively assess the impact of sumac supplementation on CVD risk factors.

5.3 Blood Pressure

A key clinical trial assessed the antihypertensive potential of R. coriaria as an adjunctive treatment. This randomized, double-blind, placebo-controlled clinical trial was conducted on 80 hypertensive patients who were receiving captopril (25 mg/day). The patients were randomly divided into 2 groups: the first group received R. coriaria fruit capsules (500 mg twice a day) and captopril (25 mg once a day), and the second received placebo capsules (500 mg starch twice a day) and captopril (25 mg once a day), for 8 weeks. Results indicated that hypertension was decreased significantly in the R. coriaria group compared to baseline and placebo groups after 8 weeks, but BMI did not demonstrate a marked change. The most abundant phenolic compounds identified in R. coriaria fruits were luteolin, apigenin, and quercetin flavonoids. The finding suggests that R. coriaria fruits could be used as an effective natural remedy for management of hypertension, with its antihypertensive activity attributed to these flavonoid compounds.

At the meta-analytic level, fifteen RCTs were included in one meta-analysis (to January 2024). The pooled findings showed that sumac consumption significantly reduced diastolic blood pressure (DBP) (WMD = −2.88 mmHg; 95% CI, −4.22 to −1.54; P = 0.001), fasting blood glucose (FBG) (WMD = −5.15 mg/dL; 95% CI, −8.73 to −1.57; P = 0.005), and insulin.

5.4 Non-Alcoholic Fatty Liver Disease (NAFLD)

A randomized, double-blind, placebo-controlled clinical trial specifically examined the effects of sumac in NAFLD. This trial involved 80 NAFLD subjects and was approved by Iran University of Medical Sciences Local Ethics Committee. A separate smaller trial also addressed NAFLD: in this double-blind randomized controlled trial, 45 NAFLD patients were randomly divided into two groups. The intervention group received sumac capsules (3 g/day) with a balanced diet for 8 weeks, while the placebo group received placebo with a balanced diet. Anthropometric indices, lipid profile, fasting blood glucose, insulin, HOMA-IR, AST, ALT, high-sensitivity C-reactive protein, and malondialdehyde were measured at baseline and at the end of the study.

5.5 Antioxidant Effects in Humans

All examined sumac samples showed significant antioxidant activity by means of oxygen radical absorbance capacity, in line with their polyphenolic content and composition. Such findings set a solid ground to support the utilization of this plant as an attractive target for novel nutraceutical approaches and for drug discovery. Rhus coriaria appears to exert its protective effects by increasing the activities of detoxifying enzymes — overall glutathione S-transferase (GST) and the two isozymes GST-α and GST-π — in plasma of human subjects treated with sumac extract.

5.6 Antimicrobial Effects

In a systematic review, the most prominent biological activity of R. coriaria was related to antimicrobial effects (11 studies), antioxidant effects (7 studies), as well as neuroprotective and anticancer effects. Hydrolyzable tannins, gallic acid, quercetin, and myricetin were the most common active components of aqueous extract. In vitro, the extract and its components were effective against a set of microbes, especially Staphylococcus aureus, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA). These antimicrobial findings remain largely at the in vitro level; clinical evidence in humans for antimicrobial applications is limited.

5.7 Anticancer Activity

Anticancer research for R. coriaria is primarily preclinical. Scientific reports have provided evidence of the inhibitory role of sumac on tumor growth and survival. El Hasasna and colleagues revealed the anti-breast cancer activity of sumac extracts using various breast cancer cell lines, reporting that sumac extracts promoted senescence and autophagic cell death, suppressed cell migration, invasion, and metastasis. These observations were later confirmed in vivo using a chick embryo tumor growth assay. The authors proposed that the underlying mechanism of the anticancer activity of sumac may involve inhibition of NFκB, STAT3, and NO pathways.

In a rodent breast carcinoma model, R. coriaria at a higher dose significantly reduced tumor incidence by 20% and in lower dose non-significantly reduced tumor frequency by 29% when compared to controls. Evaluations of the mechanism of oncostatic action demonstrated several positive alterations in rat tumor cells after the treatment, with histopathological analysis showing a robust dose-dependent decrease in the ratio of high-/low-grade carcinomas by 66% and 73% compared to controls. In treated rat carcinomas, significant caspase-3, Bax, and Bax/Bcl-2 expression increases were found, alongside significant down-regulation of Bcl-2, Ki67, CD24, ALDH1, and EpCam expressions and MDA levels. No randomized clinical trials evaluating anticancer endpoints in humans have been reported.

5.8 Neuroprotection

Recent investigations have demonstrated during in vitro assays that Rhus coriaria might exert acetylcholinesterase inhibition activities, of interest in the context of therapeutic approaches for Alzheimer's disease associated with an increase of cholinergic neurotransmission supporting the cognitive processes. Furthermore, sumac's neuroprotective activity may regulate amyloid-β (Aβ) aggregation, an important phenomenon in the Alzheimer's disease brain.

In an animal model, treatment with sumac extracts exerted neuroprotective and anti-inflammatory effects on a mouse model of ischemic optic neuropathy, with findings suggesting the potential of sumac in ameliorating neuroinflammation and neurodegenerative diseases. Currently, there is no evidence about its possible neuroprotective action in Parkinson's disease (PD). A cell-biology study hypothesized that sumac could modulate mitochondrial functionality in fibroblasts of familial early-onset PD patients showing PARK2 mutations. There is very poor evidence about the neuroprotective effects of sumac extract, and none about a possible effect in PD in human subjects.

5.9 Wound Healing

In animal models of infected wounds, aqueous R. coriaria extract significantly improved wound contraction, deposition of collagen, and hydroxyproline levels, and reduced MMP-8 and MPO concentrations, with complete epithelization of wounds in 10–13 days compared to the saline-treated group. The results showed that antimicrobial, anti-inflammatory, and antioxidant activity of Rhus coriaria extract could play a good potential role in accelerating wound healing activity via promoting myofibroblast activity, increase of hydroxyproline and collagen deposition, and regulation of MMP-8 and MPO enzyme activities. Human clinical evidence for wound healing is absent.

5.10 Inflammation Markers (hsCRP)

Chronic low-grade inflammation is implicated in the development of various metabolic and cardiovascular disorders. A 2025 systematic review and dose-response meta-analysis focused specifically on sumac supplementation and high-sensitivity C-reactive protein (hsCRP) concentrations in adults. The 2026 meta-analysis on human metabolic health found that sumac supplementation did not produce significant effects on inflammatory parameters despite improving lipid and glycemic profiles. The evidence base for anti-inflammatory effects in humans remains mixed and requires further well-powered trials.

6. Body Systems and Health Areas of Association

Over the past recent years, several studies have demonstrated the wide range of pharmacological and biological activities of the different parts of Rhus coriaria. These activities include antioxidant, antimicrobial, antidiabetic, cardioprotective and antidyslipidemic, antinociceptive, neuroprotective, dental protection, and anticancer effects.

• Cardiovascular system: Lipid-lowering, antihypertensive, and cardioprotective effects have been investigated in multiple RCTs.
• Endocrine / metabolic system: Glycemic control, insulin sensitivity, and HbA1c reduction in type 2 diabetes have been studied in clinical trials.
• Gastrointestinal system: Traditionally used for bowel disorders; historically applied for diarrhea and digestive disturbances.
• Hepatic system: R. coriaria has been shown to have hepatoprotective effects. Clinical trials have examined its role in NAFLD.
• Immune / antimicrobial: The chemical composition of sumac makes it a promising food with desirable antifungal, anti-inflammatory, antimicrobial, antimutagenic, antithrombotic, antitumorigenic, oncostatic, antiviral, and neuroprotective bioactivities.
• Nervous system: Acetylcholinesterase inhibition, antioxidant neuroprotection, and amyloid-β modulation have been investigated in vitro and in preclinical models.
• Integumentary system: Wound healing and antimicrobial effects on skin wound tissues have been studied in animal models.
• Oral health: The bark powder has been used as an effective teeth-cleaning agent.

7. Dosage Forms and Reported Dosages in Studies

Across published clinical trials, the following dosages have been explicitly reported:

• 3 g/day sumac powder in a double-blind, randomized, controlled clinical trial on 41 type 2 diabetic volunteers over 3 months, administered as powdered fruit capsules.
• 500 mg twice daily (1,000 mg/day) of R. coriaria fruit capsules as an adjunct to captopril 25 mg/day in 80 hypertensive patients for 8 weeks, in a randomized, double-blind, placebo-controlled design.
• 3 g/day sumac capsules with a balanced diet for 8 weeks, tested in a double-blind randomized controlled trial in 45 NAFLD patients.
• An 80-subject NAFLD trial registered on the Iranian Registry of Clinical Trials (IRCT201701162709N39) also used encapsulated sumac fruit powder, with the same common 3 g/day dose.

The most frequently reported dose across clinical studies is 3 g/day of dried sumac fruit powder in capsule form, administered for durations typically ranging from 8 weeks to 3 months. The 500 mg twice daily regimen (1 g/day) appears in the hypertension trial as an adjunctive dose. No single standardized supplemental dose has been established by a regulatory or pharmacopoeial body at the time of the most recent literature.

8. Safety Considerations and Interactions

General Safety Profile

Toxicity studies show that sumac is very safe to consume by humans and has little toxicity. From the search of available literature, sumac has maintained a good track record for safety, with little or no reported adverse effects. However, because sumac belongs to the cashew family Anacardiaceae, people with allergies to those foods may want to take caution in the use of sumac.

Confusion with Toxic Species

When considering Rhus coriaria, it is important to distinguish it from poisonous varieties of sumac, such as poison sumac (Toxicodendron vernix), poison ivy, and poison oak. While culinary sumac (Rhus coriaria) produces red, fuzzy berries, poison sumac has white berries. Poison sumac contains urushiol, a compound also found in poison ivy and poison oak, which can cause severe allergic skin reactions including rashes, redness, itching, and blisters upon contact.

Allergic Reactions

Allergy to sumac spice, derived from dried and ground berries of the Rhus coriaria plant, is a rare but notable condition. This hypersensitivity reaction may present with mild to severe symptoms, ranging from oral irritation to systemic responses. Given the culinary popularity of sumac spice in Middle Eastern and Mediterranean cuisines, understanding its allergenic potential is essential.

Individuals with known allergies to other members of the Anacardiaceae family, such as cashews, mangoes, or pistachios, may experience allergic reactions to sumac due to shared allergenic compounds. Such reactions, though rare, can range from oral irritation to more severe systemic responses like urticaria, eczema-like rashes, gastrointestinal symptoms, or, in rare instances, anaphylaxis.

Membership in a Tannin-Rich Family and Potential Interactions

Poison sumac (Toxicodendron vernix) belongs to the Anacardiaceae. The majority of species in this family contain toxic catechols, while a few species contain toxic resorcinols and sixteen species contain biflavonoids. Rhus coriaria itself does not carry the same toxic catechol load as its toxic relatives, but its tannin content may be of relevance in some contexts.

The high tannin content of R. coriaria has been discussed in the context of potential mineral-binding effects. While broadly used as a medicinal herb with noted atheroprotective and other beneficial effects, its pharmacologically active polyphenol content warrants attention in the context of concurrent use with medications whose absorption or metabolism might be influenced by tannins and flavonoids. Clinical studies to date — most conducted in hypertensive patients on captopril and in diabetic patients on standard medications — have not reported significant adverse drug interactions in the published trial literature, though the formal study of interactions remains limited.

Reproductive Safety

Its use has historically been indicated as an abortifacient in some traditional systems. No human clinical safety studies on pregnancy outcomes have been published, and this traditional abortifacient claim constitutes a safety signal warranting caution.

Evidence Limitations Across All Areas

Such evidence for sumac's pharmacological activities has been widely reported from in vitro and in vivo studies, and many have reached the stage of clinical trials in humans. Nevertheless, across all areas, the existing clinical trial base is limited by small sample sizes, relatively short durations, lack of dose standardization, and geographic concentration in Iran and Turkey. Well-designed, larger randomized controlled trials evaluating the effects of multiple doses of sumac for extended durations of intervention on clearly defined and relevant outcomes in subjects sharing more homogeneous health conditions are needed.

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