Garcinia gummi-gutta

Common Names

Garcinia
Tamarind
Brindleberry
Hydroxycitric acid
HCA
Hydroxycut

How It Works
Garcinia gummi-gutta and one of its active compounds, hydroxycitric acid (HCA), have been promoted for weight loss or body building, but evidence is insufficient and mixed.
Garcinia gummi-gutta, better known by its older name Garcinia cambogia, is a plant native to Southeast Asia. The fruit rinds are used as a flavoring agent and in traditional medicine. The extract and its active compound, hydroxycitric acid (HCA), can be found in many products promoted for weight loss or body building.
Although animal studies suggest some benefits on weight loss, human studies have mixed results. HCA did not decrease caloric intake or control appetite and hunger. In a study of healthy subjects, it did appear to benefit exercised muscles and improve insulin sensitivity.
G. cambogia and HCA supplements may cause liver toxicity. Patients who have cancer, diabetes, depression, or other chronic diseases should use garcinia with caution as it may interact with medications.
Purported Uses
- Appetite suppression
  A few studies in humans found that HCA did not decrease caloric intake or control appetite and hunger.
- Gastrointestinal problems
  Although garcinia has been used in traditional medicine, studies on its effects for digestive problems have not been conducted.
- Obesity, weight loss
  Controlled trials are mixed and show no benefit with garcinia over placebo for weight reduction.
Do Not Take If
- You are taking antidepressants: A number of case reports have described manias and potential interactions with antidepressants.
- You have diabetes: G. cambogia can decrease insulin levels and affect blood sugar levels.
- You are taking CYP2B6 substrate drugs: Laboratory studies suggest potential interactions with drugs metabolized by this enzyme and garcinia. A number of drug classes may be affected, including antitumor drugs (cyclophosphamide, ifosphamide, and sorafenib), antimalarials (artemisinin), antidepressants (bupropion, selegiline), antivirals (efavirenz), analgesics (methadone, meperidine), and anticonvulsants (valproic acid).
- You have liver problems: G. cambogia and HCA supplements have been associated with liver toxicity.
- You are pregnant: G. cambogia has not been tested in pregnant woman.
- You are having lab tests to measure cholesterol or blood sugar levels: Taking garcinia may cause results to be inaccurate.
Side Effects
Common: nausea, headache, GI discomfort
Rare: itching around the mouth, upper respiratory tract symptoms
Case Reports
Liver toxicity: From the use of an herbal supplement that contained HCA from G. cambogia. Liver function returned when the supplement was stopped. The supplement also had other compounds in it, making it hard to determine the exact cause.
Liver failure requiring transplant: In a 52-year-old woman and a 34-year old man, both associated with the use of G. cambogia.
Acute hepatitis: In a 42-year-old woman likely secondary to G. cambogia.
Skeletal muscle damage: In an 18-year-old man, possibly associated with the ingestion of an herbal supplement that contained HCA in addition to his increased exercise regimen.
Acute kidney injury: In a 38-year-old obese woman after long-term use of an HCA-containing supplement.
Suspected serotonin toxicity: In a 35-year-old woman taking serotonin reuptake inhibitors (SSRIs) along with a nutritional supplement containing G. cambogia and HCA.
Cardiovascular toxicity: In a previously healthy 48-year-old woman taking G. cambogia extract.
Diabetic complications, pancreatic inflammation, and severe heart muscle weakness: In a 56-year-old woman with a complex medical history and whose outpatient medication had not been adjusted in the last 3 years. These events occurred after several weeks of G. cambogia consumption and sudden weight loss, and was therefore felt to be possibly related.
Induced mania with psychosis: In a young woman with no history of bipolar disorder, about 1 week after G. cambogia supplements and a detox cleanse. Following treatment and supplement discontinuation, the patient stabilized and was discharged after 1 week.
Mania case series: In 3 stable patients both with and without psychiatric histories, manias emerged with the use of G. cambogia.
Mild mania: Irritability, agitation, increased energy, and decreased need for sleep in a 51-year-old woman with long-term history of bipolar disorder who took G. cambogia supplements. Symptoms resolved after supplement discontinuation while maintaining the same prescription medications she had been taking.
Special Point
Garcinia cambogia should not be confused with Garcinia mangostana (Mangosteen).
Scientific Name
Garcinia gummi-gutta, Garcinia cambogia
Clinical Summary
Garcinia gummi-gutta, better known by its older name Garcinia cambogia, is a plant native to Southeast Asia. The fruit rinds have antioxidant and anticholinesterase activities ⁽¹⁾, and are used as a flavoring agent and in traditional medicine to treat gastrointestinal ailments. The extract, rich in hydroxycitric acid (HCA), can be found in many products promoted for weight loss or body building.
In animal studies, high-dose HCA suppressed epididymal fat accumulation leading to testicular atrophy ⁽²⁾. G. cambogia increased satiety, fatty acid oxidation, and weight loss ⁽³⁾ ⁽⁴⁾ and protected against damaging effects of high-fat and high-sugar diets ⁽⁵⁾ ⁽⁶⁾. An ethanol extract of garcinia also has erythropoietic effects ⁽⁷⁾.
In humans, clinical trials suggest HCA does not decrease caloric intake, promote satiety, or affect fat oxidation ⁽⁸⁾ ⁽⁹⁾ ⁽¹⁰⁾. However, HCA supplementation improved glycogen synthesis in skeletal muscle and improved post-meal insulin sensitivity in healthy volunteers ⁽¹¹⁾. Garcinia may improve HDL levels, but effects on other plasma lipids are minimal ⁽⁸⁾. Results from randomized controlled trials are mixed and show no significant effect of G. cambogia extract over placebo for weight reduction ⁽¹²⁾ ⁽¹³⁾. A combination of G. cambogia with orlistat had more effects on cardiometabolic profiles and visceral adiposity index than orlistat alone in obese patients ⁽¹⁴⁾.
Garcinia has also been promoted to cancer patients, although its anticancer effects remain unclear. In vitro, G. cambogia extract and xanthone compounds present in other Garcinia species may have a tumoricidal effect on cancer cells ⁽¹⁵⁾ ⁽¹⁶⁾. Murine models show that the combination of HCA and alpha-lipoic acid reduced tumor size for lung carcinoma, bladder transitional cell carcinoma, and melanoma ⁽¹⁷⁾. These effects have not been investigated in humans.
G. cambogia and HCA supplements have been associated with liver toxicity, mania, and other herb-drug interactions. Patients who have cancer, diabetes, depression, or other chronic diseases, or women who are pregnant should use G. cambogia with caution.
G. cambogia should not be confused with Garcinia mangostana (Mangosteen).
Purported Uses
- Appetite suppression
- Gastrointestinal ailments
- Obesity, weight loss
Mechanism of Action
The negative isomer of hydroxycitric acid ((-)-HCA), is thought to be the most active chemical compound of G. cambogia fruit rind. HCA is theorized to affect weight loss via decreased fatty acid synthesis, appetite suppression, and increased fatty acid metabolism. HCA competitively inhibits ATP-citrate lyase, the enzyme that catalyzes the conversion of citrate to substrates for fatty acid synthesis ⁽³⁾. Increased citrates in the cytoplasm may reduce glycolysis and increase glycogen synthesis. ATP-citrate lyase is also upregulated in cancer cells with high levels of aerobic glycolysis ⁽¹⁸⁾.
An animal study observed decreases in leptin and insulin levels in obese mice treated with HCA, which may suggest alterations in glucose metabolism ⁽⁴⁾. The iron contents in G. cambogia may contribute to the erythropoietic effect observed in animals ⁽⁷⁾.
Warnings
- Do not use if you have diabetes ⁽⁴⁾, or are pregnant.
- Do not use if you are taking insulin as G. cambogia can affect insulin and glucose levels.
Contraindications
- Diabetes: Studies show that G. cambogia can lower insulin levels in animals ⁽⁴⁾.
- Pregnant and lactating women: G. cambogia has not been tested in pregnant women ⁽³⁸⁾.
Adverse Reactions
Common: nausea, headache, GI discomfort ⁽³⁾ ⁽¹²⁾ ⁽¹⁹⁾
Rare: itching around the mouth, upper respiratory tract symptoms ⁽³⁾ ⁽¹⁹⁾
In RCTs, adverse events were not significantly different than placebo ⁽³⁾ ⁽²⁰⁾ .
Case Reports
Hepatotoxicity: From a polyherbal supplement containing HCA from G. cambogia, with return of liver function when the supplement was stopped ⁽²¹⁾. Other herbal components may play a role ⁽²²⁾.
Liver failure requiring transplant: In a 52-year-old woman ⁽²³⁾ and a 34-year old man ⁽²⁴⁾, both associated with the use of G. cambogia.
Acute hepatitis: In a 42-year-old woman likely secondary to G. cambogia  ⁽²⁵⁾ ⁽²⁶⁾.
Skeletal muscle damage: In an 18-year-old man, possibly associated with the ingestion of a supplement containing HCA in addition to his increased exercise regimen ⁽²⁷⁾.
Nephropathy: In a 38-year-old obese woman after long-term use of an HCA-containing supplement ⁽²⁸⁾.
Suspected serotonin toxicity: In a 35-year-old woman taking serotonin reuptake inhibitors (SSRIs) along with a nutritional supplement containing G. cambogia and HCA. The patient presented with stuttering speech, profuse sweating, hypertension, and tachycardia. Although G. cambogia could not be proven as the direct cause, the patient had already used escitalopram without symptoms for over 1 year and developed serotonin toxicity only after the addition of G. cambogia  ⁽²⁹⁾.
Acute necrotizing eosinophilic myocarditis: In a previously healthy 48-year-old woman taking G.cambogia extract ⁽³⁰⁾.
Diabetic ketoacidosis, pancreatitis, and stress cardiomyopathy: In a 56-year-old woman with a complex medical history and whose outpatient medications had not been adjusted in the last 3 years. These events transpired after several weeks of G. cambogia consumption and sudden weight loss, and was therefore felt to be possibly related ⁽³¹⁾.
Induced mania with psychosis: In a young woman with no history of bipolar disorder approximately 1 week after G. cambogia supplements and a detox cleanse. Following treatment and supplement discontinuations, the patient experienced rapid mood stabilization and was discharged after 1 week ⁽³²⁾.
Mania case series: In 3 stable patients both with and without psychiatric histories, manias emerged with use of G. cambogia  ⁽³³⁾.
Hypomania: Induced by a G. cambogia supplement in a 51-year-old woman with long-term history of bipolar disorder ⁽³⁴⁾. Symptoms resolved after discontinuation of the supplement while maintaining the same prescription medications she had been taking.
Herb-Drug Interactions
Insulin: G. cambogia and HCA may decrease blood sugar levels and can lower insulin levels ⁽⁴⁾.
Antidepressants: HCA may increase serotonin release, which may interact with drugs that affect the serotoninergic system ⁽²⁹⁾ ⁽³⁵⁾.
Leukotriene receptor antagonists: A case report noted fatal liver failure when G. cambogia extract and another weight loss supplement was used along with the leukotriene receptor antagonist montelukast, but it is unclear if liver failure was due to G. cambogia ⁽³⁶⁾.
CYP2B6 substrate drugs: In vitro studies suggest G. cambogia extract could modulate the pharmacokinetics of these drugs, potentially causing interactions ⁽³⁷⁾. A number of drug classes may be affected, including antitumor drugs (cyclophosphamide, ifosphamide, and sorafenib), antimalarials (artemisinin), antidepressants (bupropion, selegiline), antivirals (efavirenz) analgesics (methadone, meperidine), and anticonvulsants (valproic acid). However, HCA did not exhibit significant effects on CYP450.
Herb Lab Interactions
- May decrease serum total cholesterol, triglycerides, and NEFA and lower insulin levels ⁽⁴⁾.
- May increase levels of HDL-C ⁽⁸⁾.
References
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