Garcinia (Garcinia cambogia), Hydroxycitric acid

Category

Herbs & Supplements

Synonyms

Bitter kola, brindal berry, brindall berry, brindleberry, Cambodia, Camboge, Cambogia gummi-guta L., Cambogia gutta L., Cambogia gutta Lindl., CitriLean, CitriMax®, citrin, Citrinate, Criton K, desoxygambogenin, gambodge, gamboge (French), gambogellic acid, gambogenic acid, gambogin, gambogenin, gambogenin dimethyl acetal, Gambogium, gambooge, ganburin, Garcinia atroviridis, Garcinia bracteata, Garcinia Cambogi, Garcinia Cambogia, Garcinia hanburyi, Garcinia hunburyi, Garcinia indica, Garcinia kola, Garcinia mangostana, Garcinia multiflora, Garcinia neglecta, Garcinia puat, Garcinia pyrifera, garushinia kanbogia (Japanese), geelhars (Dutch), Gomaguta, Gomma guta, Gomme Gutte, gomme-gutte (French), gorikapuli, Gumme gutte, Gummigut, Gummigutt (German), Gummiguttbaum (German), gummi-gutti (Italian), gummiguttræ (Danish), gummiharpiks (Danish), Gummi-resina gutti, Gutta gamba, guttegom (Dutch), Gutti, Guttiferae (family), hydroxycitrate, (-)-hydroxycitric acid (HCA), isogambogenin, isomoreollin B, korakkaipuli (Sinhalese), Malabar tamarind, Mangostana cambogia (Gaertn.), mangosteen, Mangoustanier du Cambodge (French), morellin dimethyl acetal, moreollic acid, rubber resin, Tamarinier de Malabar (French), uppagi.

Background

Garcinia (Garcinia cambogia) is a diminutive purple fruit native to India and Southeast Asia. It is used as a weight loss aid, but the evidence is inconclusive. The rind is rich in hydroxycitric acid (HCA) and has been used for centuries throughout Southeast Asia as a food preservative, flavoring agent and carminative (induces expulsion of gas from stomach or intestines). According to Indian folk tradition, Garcinia cambogia is used for rheumatism and bowel complaints.

Neither acute nor chronic toxicity is reported with regular consumption of garcinia products as either food or tonics. These products have been used routinely in the coastal areas of South Asia for centuries and they continue to be consumed in large amounts. There is preliminary evidence for the use of garcinia in exercise performance and weight loss, although current, available evidence is mixed.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Exercise performance: Hydroxycitric acid, a constituent in garcinia, may increase fat metabolism and enhance exercise performance. Additional study is needed to confirm these results.
Grade: C

Weight loss: Evidence supporting hydroxycitric acid, the active ingredient in Garcinia cambogia, for weight loss is mixed. Additional study is warranted to clarify early findings.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Anthelmintic (expels worms), antibacterial, antifungal, anti-inflammatory, antimicrobial, antioxidant, antitumor, antiviral, appetite suppressant, bowel disorders, bronchodilator (relaxes the muscles of the airways), cancer, carminative (reduces gas), catarrh (inflammation of mucous membrane), cathartic (produces bowel movements), constipation, diabetes, diuretic, dropsy (edema), dysmenorrhea (painful menstruation), edema (swelling), Ebola virus (Garcinia kola), flavoring agent, food uses, gastric ulcer prophylaxis, hepatoprotection (liver protection), HIV, influenza (Garcinia kola), intestinal motility disorders, menstrual disorders, rheumatism, sore throat, tumors, urinary tract disorders, uterus disorders.

Dosing

Adults (over 18 years old)

Dosing evidence is conflicting, and there is no proven effective dose for garcinia. There is sufficient available scientific evidence suggesting that intake of hydroxycitric acid at levels up to 2,800 milligrams per day is safe for human consumption. Garcinia has been well tolerated for up to 12 weeks in available human trials.

For exercise performance, 250 milligrams of hydroxycitric acid capsules administered for five days may be beneficial. However, a dose of 3,000 milligrams was not effective in three doses daily for three days in adult untrained males. For weight loss, 1,500 milligrams of hydroxycitric acid per day (three times daily as 500-milligram-caplets) given in combination with a high-fiber, low-energy diet has been studied with no effect on weight loss. However, hydroxycitric acid given three times daily 30-60 minutes before meals for a total of 4,667 milligrams per day reduced body weight index and body mass index in 60 moderately obese subjects.

Children (under 18 years old)

There is no proven safe or effective dose for garcinia in children, and use is not recommended.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to Garcinia cambogia.

Side Effects and Warnings

Garcinia has been well tolerated for up to 12 weeks in available human trials. Hydroxycitric acid from the rind given by mouth is likely safe in recommended doses.

Garcinia may lower blood sugar levels. Caution is advised in patients with diabetes (high blood sugar) or hypoglycemia (low blood sugar), and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Rhabdomyolysis (serious and potentially fatal disease involving degeneration of skeletal muscle ) has been reported three hours after ingestion of a weight-loss herbal medicine containing ma huang (ephedrine), guarana (active alkaloid caffeine), chitosan, Gymnena sylvestre, Garcinia cambogia (50% HCA), and chromium. Since there were multiple substances, it cannot exclusively be attributed to Garcinia cambogia. Nevertheless, use cautiously in patients with a history of rhabdomyolysis or in patients taking HMG-CoA reductase inhibitors ("statins") as they may increase the risk for rhabdomyolysis.

Avoid in patients with Alzheimer's disease and other dementia syndromes due to the theoretical possibility of forming acetylcholine in the brain.

Pregnancy & Breastfeeding

Garcinia is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

Garcinia may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Taking hydroxycitric acid with statin medications, such as atorvastatin calcium (Lipitor®), may increase the risk of rhabdomyolysis (disease involving the degeneration of skeletal muscle). An incidence of rhabdomyolysis was reported in a case report of a patient taking a weight-loss herbal medicine that contained 50% hydroxycitric acid.

Interactions with Herbs & Dietary Supplements

Garcinia may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

The combination of HCA-SX (calcium/potassium-bound hydroxycitric acid complex) with niacin-bound chromium or Gymnema sylvestre may increase the effects on weight loss. Consult with a qualified healthcare professional, including a pharmacist, before combing therapies.

Attribution

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Abrams, PharmD (University of Rhode Island); Chi Dam, PharmD (Northeastern University); Catherine DeFranco Kirkwood, MPH, CCCJS-MAC (MD Anderson Cancer Center); Nicole Giese, MS (Natural Standard Research Collaboration); Tamara Milkin, PharmD (Northeastern University); Kristen Rafuse, BS (Northeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Wendy Weissner, BA (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Asano J, Chiba K, Tada M, et al. Cytotoxic xanthones from Garcinia hanburyi. Phytochemistry 1996;41(3):815-820.

Gopalakrishnan G, Balaganesan B. Two novel xanthones from Garcinia mangostana. Fitoterapia 2000;71(5):607-609.

Heymsfield SB, Allison DB, Vasselli JR, et al. Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomized controlled trial. JAMA 1998;280(18):1596-1600.

Ito C, Itoigawa M, Mishina Y, et al. Cancer chemopreventive agents. New depsidones from Garcinia plants. J Nat Prod 2001;64(2):147-150.

Jena BS, Jayaprakasha GK, Singh RP, et al. Chemistry and biochemistry of (-)-hydroxycitric acid from Garcinia. J Agric Food Chem 2002;50(1):10-22.

Kriketos AD, Thompson HR, Greene H, et al. (-)-Hydroxycitric acid does not affect energy expenditure and substrate oxidation in adult males in a post-absorptive state. Int J Obes Relat Metab Disord 1999;23(8):867-873.

Lim K, Ryu S, Nho HS, et al. (-)-Hydroxycitric acid ingestion increases fat utilization during exercise in untrained women. J Nutr Sci Vitaminol (Tokyo) 2003;49(3):163-167.

Lin YM, Anderson H, Flavin MT, et al. In vitro anti-HIV activity of biflavonoids isolated from Rhus succedanea and Garcinia multiflora. J Nat Prod 1997;60(9):884-888.

Mackeen MM, Ali AM, Lajis NH, et al. Antimicrobial, antioxidant, antitumour-promoting and cytotoxic activities of different plant part extracts of Garcinia atroviridis griff. ex T. anders. J Ethnopharmacol 2000;72(3):395-402.

Mansi IA, Huang J. Rhabdomyolysis in response to weight-loss herbal medicine. Am J Med Sci 2004;327(6):356-357.

Mattes RD, Bormann L. Effects of (-)-hydroxycitric acid on appetitive variables. Physiol Behav 2000;71(1-2):87-94.

Preuss HG, Bagchi D, Bagchi M, et al. Effects of a natural extract of (-)-hydroxycitric acid (HCA-SX) and a combination of HCA-SX plus niacin-bound chromium and Gymnema sylvestre extract on weight loss. Diabetes Obes Metab 2004;6(3):171-180.

Roux D, Hadi HA, Thoret S, et al. Structure-activity relationship of polyisoprenyl benzophenones from Garcinia pyrifera on the tubulin/microtubule system. J Nat Prod 2000;63(8):1070-1076.

Soni MG, Burdock GA, Preuss HG, et al. Safety assessment of (-)-hydroxycitric acid and Super CitriMax, a novel calcium/potassium salt. Food Chem Toxicol 2004;42(9):1513-1529.

Thoison O, Fahy J, Dumontet V, et al. Cytotoxic prenylxanthones from Garcinia bracteata. J Nat Prod 2000;63(4):441-446.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.