Written by Alexander Kalisch, Markus Horneber and the CAM-Cancer Consortium.
Updated February 8, 2017

Fermented wheat germ extract

What is it ?


Wheat germ is the embryo portion of the wheat kernel. It is a concentrated source of vitamins, minerals, and protein, and is sustained by the larger, starch storage region of the kernel—the endosperm. During the production of wheat flour, the wheat germ is usually removed. In whole wheat products, however, the wheat germ is either not removed or added again after processing. Fermented wheat germ extract (FWGE) is industrially produced and in clinical use.

Scientific names/brand names

FWGE involves fermenting wheat germs of the genus Triticum vulgaris by adding baker's yeast (Saccharomyces cerevisiae). FWGE is produced as an over-the-counter drug in more than ten countries and sold under the names Avemar, Avemar pulvis, Ave Ultra, MSC and Avé.


The production of FWGE involves fermenting (i.e. transforming sugar into ethanol by microorganisms) wheat germs of the genus Triticum vulgaris by adding baker`s yeast (Saccharomyces cerevisiae), adding filtered air and controlling the pH-level and temperature. The process takes about 18 hours. The dried product which is available on the market contains 63.2% FWGE and as technological addatives 35% maltodextrin and 1.8% kolloidal silicondioxid.1 2,6 Dimethoxy-p-benzoquinone is used to standardize and robustify the production process and amounts up to 0.4 mg/g are found in the final product. 2-Methoxy benzoquinone can also be detected in the final product.2

Application and dosage

FWGE is dissolved in water and applied orally. The author’s of clinical trials used dosages of FWGE ranging from 8.5 g once to 9 g twice daily.3-6 In a study of children the authors administred 12 g/m2/day.4 A dose of 8.5 g/day contains 1.7 mg of 2,6-dimethoxy-p-benzoquinone which is equivalent to the consumption of 700 g of whole wheat bread.7 According to the U.S. Department of Agriculture, individuals who are on a diet primarily based on whole wheat products have a daily intake of about 15 g wheat germ.8-10

History and providers

The idea of using FWGE for medical purposes was introduced by Hungarian Nobel laureate for medicine Dr. Albert Szent-Györgyi. He proposed the conjecture, that the benzoquinone found in wheat germ might act antiproliferative because of its high redox potential.11 Later, a way of industrially producing FWGE was invented and patented by Hungarian biochemist Mate Hidvegi.

Mechanism of action/alleged indications/claims of efficacy

No single substance has been found that could explain the claimed antimetastatic, apoptotic and immune modulatory effect of FWGE. While Szent-Györgyi attributed the main effect to benzoquinones, it seems now most unlikely that these are the main active ingredients.2,11

n vitro studies and animal studies (partly unpublished) suggest different mechanisms of action. Explanations of the effectiveness of FWGE include, i) impeding the repair mechanisms of chemotherapy-induced damage in the DNA (inactivation of poly (ADP-ribose) polymerase) 12, ii) improving the tumor defence of the body (impeding major histocompatibility complex class 1 expression 13, increasing intercellular adhesion molecule 1 expression 14 or iii) impeding the growth of malignant cells by changing the metabolism (change in pentose phosphate pathway). 12,13 Apoptosis induced by FWGE 12,15 and additive/synergistic effects of FWGE with 5-FU, Oxaliplatin and Irinotecan on different human cell cultures were observed in several in vitro studies.16 FWGE is used as a supplement to chemo- and radiotherapy in the treatment of solid, malignant tumors, as it is believed to improve both the success of treatment, as well as patients` quality of life. 3-6,17 Furthermore, there are claims that FWGE can be used in chemotherapy to reduce the risk of neutropenic fever.18

Prevalence of use

The exact prevalence of use of FWGE is not known.

Legal issues

FWGE is available as a nutrient supplement in many countries.

Cost and expenditure

Daily dosage costs up to 4 at current prices.

Citation Alexander Kalisch, Markus Horneber, CAM-Cancer Consortium. Fermented wheat germ extract [online document]. http://ws.cam-cancer.org/The-Summaries/Dietary-approaches/Fermented-wheat-germ-extract. February 8, 2017.


  1. Pfeifer B. Avemar. Onkologie integrativ. München: Elsevier, Urban and Fischer; 2006: 226-29.
  2. Hidvegi, M., Farkas R, Lapis K, and Raso E. Immunmodulatory and metastasis inhibiting fermented vegetal material, United States Patent, Patent No. 6355474B1. 2002.
  3. Barabas J, Nemeth Z. [Recommendation of the Hungarian Society for Face, Mandible and Oral Surgery in the indication of supportive therapy with Avemar]. Orv Hetil. 2006;147:1709-11.
  4. Demidov LV, Manziuk LV, Kharkevitch GY, Pirogova NA, Artamonova EV. Adjuvant fermented wheat germ extract (Avemar) nutraceutical improves survival of high-risk skin melanoma patients: a randomized, pilot, phase II clinical study with a 7-year follow-up. Cancer Biother Radiopharm. 2008;23:477-82.
  5. Jakab F, Shoenfeld Y, Balogh A, Nichelatti M, Hoffmann A, Kahan Z et al. A medical nutriment has supportive value in the treatment of colorectal cancer. Br J Cancer. 2003;89:465-69.
  6. Sukkar SG, Cella F, Rovera GM, Nichelatti M, Ragni G, Chiavenna G et al. A multicentric prospective open trial on the quality of life and oxidative stress in patients affected by advanced head and neck cancer treated with a new benzoquinone-rich product derived from fermented wheat germ (Avemar). Mediterr J Nutr Metab. 2008;1:37–42.
  7. Posner, ES. The technology of wheat germ separation in flour mills. Assoc Operative Millers Bull Suppl 1,2. 1985. Ref Type: Abstract
  8. Heimbach JT, Sebestyen G, Semjen G, Kennepohl E. Safety studies regarding a standardized extract of fermented wheat germ. Int J Toxicol. 2007;26:253-59.
  9. Tömösközi-Farkas R, Daood HG. Modification of chromatographic method for the determination of benzoquinones in cereal products. Chromatographia. 2004;60:227-30.
  10. U.S.Department of Agriculture, Economic Research Service USDA ERS. U.S. per capita foodconsumption https://www.ers.usda.gov/data/foodconsumption/ accessed 8 February 2017.
  11. Johanning GL, Wang-Johanning F. Efficacy of a medical nutriment in the treatment of cancer. Altern Ther Health Med. 2007;13:56-63.
  12. Comin-Anduix B, Boros LG, Marin S, Boren J, Callol-Massot C, Centelles JJ et al. Fermented wheat germ extract inhibits glycolysis/pentose cycle enzymes and induces apoptosis through poly(ADP-ribose) polymerase activation in Jurkat T-cell leukemia tumor cells. J Biol Chem. 2002;277:46408-14.
  13. Boros LG, Nichelatti M, Shoenfeld Y. Fermented wheat germ extract (Avemar) in the treatment of cancer and autoimmune diseases. Ann N Y Acad Sci. 2005;1051:529-42.
  14. Telekes A, Kiss-Toth E, Nagy T, Qwarnstrom EE, Kusz E, Polgar T et al. Synergistic effect of Avemar on proinflammatory cytokine production and Ras-mediated cell activation. Ann N Y Acad Sci. 2005;1051:515-28.
  15. Lee sn, Park H, and Lee KE. Ctyotoxic activities of fermented wheat germ extract on human gastric carcinoma cells by induction of apoptosis. Journal of Clinical Oncology. ASCO Annual Meeting Proceedings 23(16S), 4254. 2005.
  16. Mueller T, Jordan K, Voigt W. Promising cytotoxic activity profile of fermented wheat germ extract (Avemar(R)) in human cancer cell lines. J Exp Clin Cancer Res. 2011;30:42.
  17. Balogh, A. Supportive Effects of Avemar in breast cancer http://www.fda.gov/ohrms/dockets/dockets/95s0316/95s-0316-rpt0260-08-vol189.pdf 1999. online document accessed 8 February 2017
  18. Garami M, Schuler D, Babosa M, Borgulya G, Hauser P, Muller J et al. Fermented wheat germ extract reduces chemotherapy-induced febrile neutropenia in pediatric cancer patients. J Pediatr Hematol Oncol. 2004;26:631-35.
  19. Hidvegi, M, Moldvay J, and Lapis K. Fermented wheat germ extract improves quality of life in lung cancer patients. (In Hungarian.) (Medicus Anonymus/Pulmono 11: 13-14). 2003.
  20. Szende B, Marcsek Z, Kocsis Z, Tompa A. Effect of simultaneous administration of Avemar and cytostatic drugs on viability of cell cultures, growth of experimental tumors, and survival tumor-bearing mice. Cancer Biother Radiopharm. 2004;19:343-49.