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Garcinia

Scientific Name(s): Garcinia cambogia (Gaertn.) Desr.
Common Name(s): Malabar tamarind

Clinical Overview

Use

The medical literature primarily documents weight loss and lipid-lowering activity for G. cambogia, although trials supporting its use are limited. In short-term clinical trials lasting 12 weeks or less, G. cambogia was ineffective or moderately effective for weight loss in overweight subjects. Results have been inconsistent in studies evaluating the effect of G. cambogia on lipids.

Dosing

The dosages of G. cambogia extract used in clinical trials ranged from 1,500 to 4,667 mg/day (25 to 78 mg/kg/day). The equivalent hydroxycitric acid (HCA) (the active consituent of G. cambogia) dosage in the trials ranged from 900 to 2,800 mg/day (15 to 47 mg/kg/day). G. cambogia is available in capsule or tablet form with a maximum dosage of 1,500 mg/day.

Contraindications

Avoid use if there is a known allergy or hypersensitivity to any components of G. cambogia.

Pregnancy/Lactation

Avoid use during pregnancy and lactation. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

The herb has documented drug interactions.

Adverse Reactions

Fifteen clinical studies involving approximately 900 patients documented very mild adverse reactions, with the most common adverse reactions including headache, dizziness, dry mouth, and GI complaints such as nausea and diarrhea. Hydroxycut dietary supplements for weight loss were voluntarily recalled from the US market in 2009 because of concerns about hepatotoxicity. Although G. cambogia was an ingredient in some formulations of Hydroxycut, its role in cases of hepatotoxicity associated with Hydroxycut is unclear. Other cases of hepatotoxicity have been reported as "probably" related to ingestion of G. cambogia supplements.

Toxicology

Toxicology studies showed no toxicity or deaths in animals given dosages of HCA 5,000 mg/kg, equivalent to HCA 350 g in humans, or 233 times the maximum recommended human dosage of HCA 1.5 g/day.

Scientific Family

Clusiaceae (Guttiferae)

Botany

G. cambogia is most commonly found in the evergreen or semi-evergreen forests of southwest India, where 36 other species of Garcinia have been documented, as well as in Malaysia and Africa.1, 2 G. cambogia has variability in its branching pattern, fruit color, shape, and size,1 and the tree is small to medium with drooping branches. The leaves are dark green, glossy, and oval-shaped with a narrow end; they are 5 to 12 cm in length and 2 to 7 cm around. The tree is tolerant to drought and flowers during the hot season. The yellow, orange, or red fruit, which contains HCA, ripens during the rainy season. It is ovoid in shape, measures 5 cm around, and has 6 to 8 seeds. The fruit of G. cambogia is listed in the US Department of Agriculture’s inventory of perennial edible fruits of the tropics.2 HCA is a common ingredient in weight loss products.

History

Throughout Southeast Asia, dried fruit rinds have been used extensively for centuries as condiments and flavoring agents in place of tamarind or lemon. Additional culinary uses include the flavoring of curries, meat, and seafood. The fruit extract has been used as a flavoring agent for beverages and gourmet spices, as well as a carminative, helping to prevent the formation of gas in the GI tract after a meal. When combined with salt, HCA and other organic acids from the dried rind help to lower pH and provide a bacteriostatic effect used in curing fish. In the traditional Ayurvedic medical system, the herb is considered beneficial for overall health. Rheumatism and bowel complaints have been treated with a decoction of the fruit rind. HCA has become popular as an ingredient in weight-loss products.2, 3, 4 A rinse from the herbal extract is also used in veterinary medicine for some diseases of the mouth in cattle.

Chemistry

HCA is the primary medicinal component contained in the fruit rinds of G. cambogia.5 HCA is present up to 30% by weight in the pericarp of G. cambogia fruit.6 At a dosage of 4,500 mg/day, the calcium-potassium salt of HCA (HCA-SX), which are water soluble and bioavailable, provides 495 mg of calcium and 720 mg of potassium.7 Studies also document potential production of HCA by using microorganisms.8, 9 Xanthones, xanthone derivatives, and polyisoprenylated benzophenones have been isolated.6, 10 Garcinol, otherwise known as camboginol, is another component of the fruit rinds of G. cambogia.11

Uses and Pharmacology

The medical literature primarily documents research on the weight loss and lipid-lowering activity of the plant.

Dyslipidemia

In vitro and animal data

In 2 experiments using the human hepatoma cell line HepG2, overnight exposure to G. cambogia extract caused an upregulation of low-density lipoprotein receptor activity and an upregulation of the level of HMG-CoA reductase, resulting in decreased cholesterol synthesis.12 Flavonoids from the plant reduced lipid levels in normal and hypercholesterolemic rats.10 Reductions were also documented in triglycerides, phospholipids, and free fatty acids. The mechanism of action for the flavonoids may involve decreasing the rate of lipogenesis via a reduction in the activities of lipogenic enzymes, glucose-6-phosphate dehydrogenase, and isocitrate dehydrogenase and increasing the rate of degradation of cholesterol, leading to higher levels of hepatic and fecal bile acids, as well as neutral sterols in rats treated with the herb. Whereas dexamethasone typically elevates lipid profiles, G. cambogia extract maintained normal lipid levels in rats administered dexamethasone.13

Clinical data

A double-blind clinical trial evaluated the effect of G. cambogia extract on the lipid profile of overweight women.14 Women with a body mass index (BMI) of 25 kg/m² or greater were randomized to receive G. cambogia extract (n = 30) or placebo (n = 13) for 60 days. The dosage of G. cambogia extract (50% HCA) was 800 mg 3 times daily, 30 minutes before meals. Participants received an individualized diet with an average calorie reduction to 1,523 ± 185 kcal/day. There was a significant reduction in triglycerides in women receiving the G. cambogia extract (−22.9 ± 5.34 mg/dL) compared with placebo (+4.53 ± 33.4 mg/dL; P = 0.04). There was no difference in other components of the lipid profile, body weight, BMI, or calorimetric indices.

A 10-week, double-blind, parallel-group trial compared Glycine max (soy) leaf extract with G. cambogia extract for the promotion of weight loss and lowering of plasma cholesterol.15 The study randomized 86 overweight adults to receive 2 g/day of Glycine max extract, 2 g/day of G. cambogia extract (60% HCA), or placebo. Primary outcome measures of the study were percent body fat and total cholesterol. Secondary outcome measures included components of the lipid profile, adipocytokines, and antioxidants. After 10 weeks, the Glycine max leaf extract group had 6% lower total cholesterol than that of the placebo group, the clinical importance of which is unclear because total cholesterol increased during the study in all treatment groups. Aside from an unspecified increase in high-density lipoprotein cholesterol for the Glycine max leaf extract, the supplements had no effect on other components of the lipid profile, adipocytokines, or antioxidants.

Obesity

G. cambogia's suggested mechanism of action in obesity involves HCA-inhibiting lipogenesis, increase in lipid oxidation, and reduction of food intake.3, 16 HCA competitively inhibits adenosine triphosphate-citrate (pro-3S)-lyase, an extra-mitochondrial enzyme that plays a role in fatty acid biosynthesis.17

Animal data

A study in obese rats found that high doses of HCA-containing G. cambogia (HCA 154 mmol/kg diet) were effective in suppressing epididymal adipose tissue. This same study also found testicular atrophy and toxicity at dosages of HCA 778 mg/kg body weight/day (HCA 102 mmol/kg diet) and higher.4 In another study in rats, administration of a high-fat diet and a mixture of G. cambogia extract, soy peptide, and L-carnitine led to a reduction in body weight and accumulation of visceral fat mass.18 The mixture also improved blood and hepatic lipid concentrations and improved dyslipidemia in rats with induced obesity. Other combination products with G. cambogia were also effective in reducing weight gain and improving dyslipidemia, hyperinsulinemia, hyperleptinemia, and fatty liver in mice. The antiobesity effect involved modulation of several genes associated with visceral adipogenesis.19 However, one study in adult nonobese cats found that G. cambogia had no effect on fat-free mass or energy expenditure.20

Clinical data

In a 12-week, randomized, double-blind, placebo-controlled study, 40 obese patients were treated with a combination supplement containing G. cambogia accompanied by a 1,200 kcal/day diet.21 Subjects on active treatment received Phaseolus vulgaris extract 400 mg, inulin 400 mg, and G. cambogia 100 mg 3 times daily after meals. Statistical analysis was applied to changes in body weight and fat compared with baseline but not to changes in body weight between groups. The treatment group attained a weight loss of 3.5 kg versus 1.2 kg on placebo. Body composition measurements assessed with near-infrared technique and bioimpedance indicated that more than 85% of weight loss in the active treatment group was due to a loss of body fat. Changes in body fat were not reported for the placebo group. The majority of the active group participants did not follow the diet regimen.21

In a 12-week, double-blind, placebo-controlled, parallel group trial, 89 mildly overweight women were given a 1,200 kcal diet along with 2 caplets of G. cambogia (HCA 50%) 400 mg or matched placebo 3 times a day before each meal. At the end of the trial, both groups lost weight, but the group treated with G. cambogia achieved a greater reduction in body weight (3.7 ± 3.1 kg vs 2.4 ± 2.9 kg; P = 0.026), although the weight loss was minimal. G. cambogia had no effect on appetitive variables or fat mass.16

A double-blind trial randomized 135 overweight adults with a mean BMI of 32 kg/m² to 12 weeks of treatment with placebo or G. cambogia (50% HCA) 1,000 mg 3 times per day before meals.17 Subjects were given a high-fiber, 5,040 kJ/day diet plan. The primary outcomes of the study were effects on body weight and fat mass. The study was estimated to have 80% power at the 2-tailed alpha level of 0.05 to detect a significant difference in body weight. Forty-two patients in each group completed the study. By intention-to-treat analysis, weight loss was not significantly different for G. cambogia versus placebo (3.2 ± 3.3 kg vs 4.1 ± 3.9 kg, respectively; P = 0.14). Changes in body fat were also not significantly different. No patient discontinued treatment because of an adverse effect. Critics of the study raised concerns that the use of a high-fiber diet could have impaired the bioavailability of HCA, that no bioavailability data was available for HCA, and that the dose of HCA may have been too low to demonstrate weight loss.2

A double-blind study randomized 44 obese subjects with a visceral fat area greater than 90 cm² to receive a dosage of G. cambogia providing 1,000 mg/day of HCA or placebo.22 Men received a 2,250 kcal/day diet and women received an 1,800 kcal/day diet. Subjects received treatment for 12 weeks and were observed for an additional 4 weeks to detect whether there was rebound fat accumulation after discontinuation of G. cambogia. The primary endpoint of the study was visceral fat accumulation as measured by CT scan. Secondary endpoints included body weight, BMI, and lipid levels. Compared with placebo, G. cambogia significantly reduced visceral, subcutaneous, and total fat (P < 0.001 for all) with no rebound after discontinuation. However, there was no significant difference in body weight, BMI, or lipid levels.

A 10-week, double-blind, parallel group trial compared the ability of soy leaf and G. cambogia extracts to promote weight loss and lower plasma cholesterol.15 The study randomized 86 overweight adults to receive soy leaf extract 2 g/day, G. cambogia extract (60% HCA) 2 g/day, or placebo. Primary outcomes of the study were percent body fat and plasma total cholesterol. Neither supplement caused weight loss or a clinically important change in percent body fat.

An 8-week study randomized moderately obese subjects (BMI greater than 26 kg/m²) to receive HCA-SX alone, a formula of HCA-SX combined with Gymnema sylvestre and niacin-bound chromium, or placebo.23 The total daily dose of HCA-SX 4,667 mg (60% HCA) was divided 3 times per day and given 30 to 60 minutes before meals. All subjects were given a 2,000 kcal/day diet and participated in a supervised exercise program. Study outcomes included changes in body weight, BMI, and appetite from baseline. The study did not compare weight loss among groups. Reduction in body weight was 4.53 kg with HCA-SX alone, 5.69 kg with the HCA-SX formula, and 1.6 kg with placebo. Reduction in BMI was 5%, 6.1%, and 2%, respectively. Appetite decreased by 15.6% with HCA-SX alone and 21.2% with the HCA-SX formula but did not change with placebo.

Some studies on herbal coffee supplements with HCA showed an increase in resting energy expenditure to enhance metabolic rates and promote weight and fat loss.24, 25

Meta-analyses

A meta-analysis evaluated the efficacy of G. cambogia extract for weight loss in randomized, double-blind, placebo-controlled trials.26 Studies that included other interventions or enrolled nonobese patients were excluded. The meta-analysis included 12 clinical trials. There was significantly greater weight loss with G. cambogia extract than with placebo (approximately 1% body weight loss with G. cambogia compared with placebo), but the effect size was small (mean difference, −0.88 kg; 95% confidence interval [CI], −1.75 to 0; P = 0.05). There was considerable heterogeneity among trials, with wide variation in the duration of treatment (2 to 12 weeks) and the dosage of G. cambogia extract (range, 1 to 2.8 g/day). An analysis restricted to the 2 studies with good methodological quality17, 23 found no significant difference in weight loss between G. cambogia extract and placebo (mean difference, +0.88 kg; 95% CI, −0.33 to 2.10). In the 4 studies that evaluated changes in BMI as an outcome, G. cambogia extract did not have an effect on BMI.

A second meta-analysis evaluated the weight-loss efficacy of natural plant extracts.27 It included double-blind, randomized studies lasting more than 2 weeks with a placebo or control intervention and with measurable outcomes on appetite or food intake and anthropometry that enrolled at least 20 adult participants (18 to 65 years of age) who were overweight or obese. Fourteen studies with an overall quality rating of 7.9 (range, 6 to 10) were included. Five of these studies evaluated extracts that included G. cambogia. One study that used a higher dose of HCA-SX reported a significant reduction in appetite (effect size, 2.79) and body weight (effect size, 0.61) for HCA-SX alone or in combination with niacin-bound chromium and G. sylvestre extract compared with placebo. The other 4 studies did not support an HCA effect on satiety. The authors concluded that the evidence for weight loss with HCA as a single ingredient is not compelling.

Obesity guidelines

A guideline for the management of overweight and obesity from the American Heart Association, the American College of Cardiology, and the Obesity Society considers drug therapy as an adjunct to lifestyle interventions for motivated individuals with a BMI of 30 or more or with a BMI of 27 or more with at least 1 obesity-related comorbid condition.28 Based on expert opinion, the guideline advises that clinicians use drugs that are Food and Drug Administration (FDA)–approved for weight loss. The panel did not review comprehensive evidence for weight-loss pharmacotherapy. This guideline does not address the use of natural product extracts such as G. cambogia or HCA.

Other pharmacologic activity

Antioxidant

Supplementation with G. cambogia may reduce oxidative damage.29

Cancer

The fruit of G. cambogia contains xanthones, which inhibit preneoplastic lesions in mammary and colon cancer, and may also induce apoptosis in mouth, leukemia, breast, gastric, and lung cancer cell lines in vitro.30 Garcinol, a component of G. cambogia fruit rind, inhibited cell proliferation and induced apoptosis in cell lines for leukemia and breast, colon, prostate, and pancreatic cancer.31 Garcinol may have anticarcinogenic effects that are mediated by inhibition of histone acetyltransferases and modulation of 5-lipoxygenase and microsomal prostaglandin PGE2 synthase.

Combined therapy with lipoic acid and HCA (METABLOC™) has been proposed as an antineoplastic regimen that shifts the metabolism of cancer cells from aerobic glycolysis (the Warburg effect) to respiration. Combined lipoic acid and HCA were evaluated alone and in combination with cisplatin or methotrexate in a mouse syngeneic cancer model with LL/2 lung carcinoma, B16-F10 melanoma, and MBT-2 bladder carcinoma.32 Several case series and a case report describe the treatment of patients with advanced metastatic cancer with a combination regimen of lipoic acid and oral HCA in addition to standard chemotherapy; randomized clinical trials are needed.32, 33, 34

Diabetes

Mice treated with G. cambogia had lowered serum insulin levels, suggesting possible improvement in glucose metabolism with G. cambogia administration. Leptin is a hormone associated with appetite control; G. cambogia may have leptin-like activity because mice treated with G. cambogia had decreased serum leptin levels and a reduced leptin:white adipose tissue ratio.35 HCA treatment delayed and reduced intestinal glucose absorption in rats; the treatment caused delayed intestinal absorption of glucose rather than delayed gastric emptying.36

Exercise endurance

HCA promoted lipid oxidation and reduced carbohydrate use in mice at rest and during running.37 The use of respiratory gases was reduced for mice treated with HCA at rest and during exercise.

GI disorders

Antiulcer activity was observed against induced gastric mucosal injury in rats when they were pretreated with G. cambogia extract, which decreased the volume and acidity of gastric juice.38 A similar study in rats found activity against indomethacin-induced gastric ulcers.39 The anti-inflammatory activity of G. cambogia protected against induced colitis in rats.40

Red blood cell count

A G. cambogia extract caused an increase in the red blood cell count in rat tissue. The activity may be associated with the iron in G. cambogia, because iron is an erythropoietic agent; its antioxidant activity, which may decrease the rate of oxidant-induced hemolysis, increasing the life span of the red blood cell; or the content of bioflavonoids in the plant, which may increase the level of peripheral testosterone, a potential stimulant of erythropoiesis in humans.41

Dosing

The dosages of G. cambogia extract used in clinical trials ranged from 1,500 to 4,667 mg/day (25 to 78 mg/kg/day). The equivalent HCA dosage used in the trials ranged from 900 to 2,800 mg/day (15 to 47 mg/kg/day).2, 16, 17, 21, 22, 42 G. cambogia is available in capsule or tablet form with a maximum dose of 1,500 mg/day.

Pregnancy / Lactation

Avoid use during pregnancy and lactation due to a lack of clinical and scientific information. One study in rats documented decreased maternal body weight gain during gestation.43

Interactions

Hypoglycemia-associated agents/Herbs (hypoglycemic properties): Herbs (hypoglycemic properties) may enhance the hypoglycemic effect of hypoglycemia-associated agents. Monitor therapy. 35, 36, 69

Iron: G. cambogia contains iron and thus may have additive adverse reactions for patients taking medications for anemia.41

Montelukast (or leukotriene receptor antagonists): One case report documented fatal liver failure in a patient taking montelukast and 2 dietary supplements, one of which included G. cambogia and citrus derivatives.45

Potassium and calcium supplements: Some commercial G. cambogia products contain adequate amounts of potassium and calcium.7 Caution is advised for patients taking medications for heart disease, high blood pressure, or arrhythmia while supplementing with any product containing this herb.

Serotonin: A mouse study using a commercial polyherbal product containing G. cambogia found a potential serotonergic effect on food intake. Caution is advised for patients being treated for pain or taking medications for any psychiatric condition.44 A case report documented suspected serotonin toxicity in a 35-year-old female who had been stable on escitalopram for over a year and developed serotonin toxicity 1 to 2 months after starting a G. cambogia supplement.67

Statins: A case report of rhabdomyolysis was documented in a patient taking a combination herbal medicine containing G. cambogia.46 Concern is raised for coadministration of statins with other drugs that can cause rhabdomyolysis.

Warfarin: In one case report, the international normalized ratio of a patient returned to normal after he stopped taking a combination herbal product containing G. cambogia.47

Adverse Reactions

Fifteen clinical studies involving approximately 900 patients documented very mild adverse reactions, with the most common including headache, dizziness, dry mouth, and GI complaints such as nausea and diarrhea.2, 48

In 2009, the FDA announced a voluntary recall of all Hydroxycut dietary supplements for weight loss and warned consumers that the products may cause potentially fatal hepatotoxicity.49 These actions were prompted by 23 cases of hepatic injury reported to the agency, including liver damage severe enough to necessitate liver transplant, as well as 1 death. The recall involved 14 multi-ingredient products with different formulations. Prior to the recall, the primary ingredients of Hydroxycut products included G. cambogia, G. sylvestre, chromium polynicotinate, caffeine, and green tea extract.50 Since 2009, reformulated Hydroxycut products do not contain G. cambogia.51

Criteria from the Drug-Induced Liver Injury Network study were applied to 17 cases of hepatotoxicity linked to Hydroxycut, most with hepatocellular damage, including 9 of the cases reported to the FDA.52 Causality was considered definite in 8 cases, highly likely in 5 cases, probable in 2 cases, and possible in 2 cases. Severity was moderate in 11 cases, was severe in 2 cases, required liver transplant in 4 cases, and was fatal in 1 case. Although G. cambogia was an ingredient in some formulations of Hydroxycut, its role in cases of hepatotoxicity associated with Hydroxycut is unclear.50, 51, 52, 53, 54, 55 A case of acute onset of abdominal pain was reported after ingestion of pure G. cambogia in an obese 42-year-old female with hypertension, stage V chronic kidney disease, and hemochromatosis.66 In the 1 case of fatal hepatotoxicity, the patient had taken montelukast for 5 years and had recently started taking 2 weight-loss dietary supplements that contained G. cambogia and citrus derivatives.43, 45 Acute liver failure in a 52-year-old woman who presented to a hepatology clinic with mild abdominal distention, jaundice, and elevated liver enzymes was attributed as probably due to G. cambogia supplement (60% HCA per serving) that the patient had started taking approximately 3 weeks previously for weight loss. Her condition deteriorated and approximately 50 days after initial symptom onset, she underwent successful liver transplantation.68 Similarly, fulminant hepatic failure with near total necrosis requiring liver transplant was reported in a 34-year-old man who consumed a G. cambogia supplement (160 mg/day) for 5 months.71 Various methods have been used to assess adverse hepatotoxicity causality to the use of weight-loss supplements containing G. cambogia. Reports of hepatotoxicity from case studies and case series have documented 13% to 25% of events as certainly and 50% to 80% as probably related to consumption of Garcinia. Causality, however, is difficult to determine from the small number of reports because in the majority of cases, patients were consuming more than one supplement and/or a multi-ingredient supplement.70

Other serious adverse effects associated with Hydroxycut products that were reported to the FDA included seizures, rhabdomyolysis, and cardiovascular disorders.49 Hydroxycut and other weight-loss dietary supplements containing G. cambogia have been associated with case reports of atrial fibrillation, hypertensive retinopathy, and acute renal failure.56, 57, 58

A near-fatal case of acute necrotizing eosinophilic myocarditis was believed to be associated with G. camobia supplementation in a previously healthy 48-year-old woman. Despite early complications, including acute kidney injury and sustained ventricular tachycardia that required cardiopulmonary resuscitation, she survived and stabilized quickly within 24 hours of high-dose corticosteroid therapy.65

Toxicology

Toxicology studies resulted in no toxicity or deaths in animals at dosages of HCA 5,000 mg/kg, equivalent to 350 g in humans, or 233 times the maximum recommended human dosage of HCA 1.5 g/day.5

Some animal studies document testicular toxicity with G. cambogia,4, 59 whereas other studies do not.60, 61

A study in obesity-prone mice evaluated long-term supplementation of a high-fat diet with G. cambogia.62 Although G. cambogia reduced adiposity and glucose intolerance, it increased hepatic collagen accumulation, cytokine expression, and hepatic transaminase levels. The study suggests that long-term ingestion of G. cambogia could cause hepatic fibrosis and inflammation.

No unusual electrocardiographic effects (QTc interval or other electrocardiograph variables) were seen over 5 hours in patients taking half the recommended dose of a multicomponent weight loss supplement containing G. cambogia.63 Patients receiving 1,667.3 mg/kg of G. cambogia extract (equivalent to HCA 1,000 mg/day) for 12 weeks exhibited no reproductive toxicity on serum testosterone, estrone, and estradiol levels.64

References

1. Abraham Z, Malik SK, Rao GE, Narayanan SL, Biju S. Collection and characterization of Malabar tamarind [Garcinia cambogia (Gaertn.) Desr.]. Genet Resour Crop Evol. 2006;53(2):401-406.

2. Soni MG, Burdock GA, Preuss HG, Stohs SJ, Ohia SE, Bagchi D. Safety assessment of (-)-hydroxycitric acid and Super CitriMax, a novel calcium/potassium salt. Food Chem Toxicol. 2004;42(9):1513-1529.15234082

3. Ohia SE, Opere CA, LeDay AM, Bagchi M, Bagchi D, Stohs SJ. Safety and mechanism of appetite suppression by a novel hydroxycitric acid extract (HCA-SX). Mol Cell Biochem. 2002;238(1-2):89-103.12349913

4. Saito M, Ueno M, Ogino S, Kubo K, Nagata J, Takeuchi M. High dose of Garcinia cambogia is effective in suppressing fat accumulation in developing male Zucker obese rats, but highly toxic to the testis. Food Chem Toxicol. 2005;43(3):411-419.15680676

5. Jena BS, Jayaprakasha GK, Singh RP, Sakariah KK. Chemistry and biochemistry of (-)-hydroxycitric acid from Garcinia. J Agric Food Chem. 2002;50(1):10-22.11754536

6. Masullo M, Bassarello C, Suzuki H, Pizza C, Piacente S. Polyisoprenylated benzophenones and an unusual polyisoprenylated tetracyclic xanthone from the fruits of Garcinia cambogia. J Agric Food Chem. 2008;56(13):5205-5210.18533663

7. Downs BW, Bagchi M, Subbaraju GV, Shara MA, Preuss HG, Bagchi D. Bioefficacy of a novel calcium-potassium salt of (-)-hydroxycitric acid. Mutat Res. 2005;579(1-2):149-162.16055158

8. Hida H, Yamada T, Yamada Y. Production of hydroxycitric acid by microorganisms. Biosci Biotechnol Biochem. 2005;69(8):1555-1561.16116285

9. Yamada T, Hida H, Yamada Y. Chemistry, physiological properties, and microbial production of hydroxycitric acid. Appl Microbiol Biotechnol. 2007;75(5):977-982.17476502

10. Koshy AS, Anila L, Vijayalakshmi NR. Flavonoids from Garcinia cambogia lower lipid levels in hypercholesterolemic rats. Food Chem. 2001;72(3):289-294.

11. Padhye S, Ahmad A, Oswal N, Sarkar FH. Emerging role of garcinol, the antioxidant chalcone from Garcinia indica Choisy and its synthetic analogs. J Hematol Oncol. 2009;2:38.19725977

12. Berkhout TA, Havekes LM, Pearce NJ, Groot PH. The effect of (-)-hydroxycitrate on the activity of the low-density-lipoprotein receptor and 3-hydroxy-3-methylglutaryl-CoA reductase levels in the human hepatoma cell line Hep G2. Biochem J. 1990;272(1):181-186.2176080

13. Mahendran P, Devi CS. Effect of Garcinia cambogia extract on lipids and lipoprotein composition in dexamethasone administered rats. Indian J Physiol Pharmacol. 2001;45(3):345-350.11881574

14. Vasques CA, Schneider R, Klein-Júnior LC, Falavigna A, Piazza I, Rossetto S. Hypolipemic effect of Garcinia cambogia in obese women. Phytother Res. 2014;28(6):887-891.24133059

15. Kim JE, Jeon SM, Park KH, et al. Does Glycine max leaves or Garcinia cambogia promote weight-loss or lower plasma cholesterol in overweight individuals: a randomized control trial. Nutr J. 2011;10:94.21936892

16. Mattes RD, Bormann L. Effects of (-)-hydroxycitric acid on appetitive variables. Physiol Behav. 2000;71(1-2):87-94.11134690

17. Heymsfield SB, Allison DB, Vasselli JR, Pietrobelli A, Greenfield D, Nunez C. Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomized controlled trial. JAMA. 1998;280(18):1596-1600.9820262

18. Kim YJ, Kim KY, Kim MS, Lee JH, Lee KP, Park T. A mixture of the aqueous extract of Garcinia cambogia, soy peptide and L: -carnitine reduces the accumulation of visceral fat mass in rats rendered obese by a high fat diet. Genes Nutr. 2008;2(4):353-358.18850230

19. Kim KY, Lee HN, Kim YJ, Park T. Garcinia cambogia extract ameliorates visceral adiposity in C57BL/6J mice fed on a high-fat diet. Biosci Biotechnol Biochem. 2008;72(7):1772-1780.18603810

20. Leray V, Dumon H, Martin L, et al. No effect of conjugated linoleic acid or Garcinia cambogia on fat-free mass, and energy expenditure in normal cats. J Nutr. 2006;136(7 suppl):1982S-1984S.16772473

21. Thom E. A randomized, double-blind, placebo-controlled trial of a new weight-reducing agent of natural origin. J Int Med Res. 2000;28(5):229-233.11092233

22. Hayamizu K, Ishii Y, Kaneko I, et al. Effects of Garcinia cambogia (hydroxycitric acid) on visceral fat accumulation: a double-blind, randomized, placebo-controlled trial. Curr Ther Res Clin Exp. 2003;64(8):551-567.24944404

23. Preuss HG, Rao CV, Garis R, et al. An overview of the safety and efficacy of a novel, natural(-)-hydroxycitric acid extract (HCA-SX) for weight management. J Med. 2004;35(1-6):33-48.18084863

24. Hoffman JR, Kang J, Ratamess NA, Jennings PF, Mangine G, Faigenbaum AD. Thermogenic effect from nutritionally enriched coffee consumption. J Int Soc Sports Nutr. 2006;3:35-41.18500961

25. Taylor LW, Wilborn CD, Harvey T, Wismann J, Willoughby DS. Acute effects of ingesting Java Fittrade mark energy extreme functional coffee on resting energy expenditure and hemodynamic responses in male and female coffee drinkers. J Int Soc Sports Nutr. 2007;4:10.17919327

26. Onakpoya I, Hung SK, Perry R, Wider B, Ernst E. The use of Garcinia extract (hydroxycitric acid) as a weight loss supplement: a systematic review and meta-analysis of randomised clinical trials. J Obes. 2011;2011:509038.21197150

27. Astell KJ, Mathai ML, Su XQ. Plant extracts with appetite suppressing properties for body weight control: a systematic review of double blind randomized controlled clinical trials. Complement Ther Med. 2013;21(4):407-416.23876572

28. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25)(suppl 2):S102-S138.24222017

29. Yonei Y, Takahashi Y, Hibino S, Watanabe M, Yoshioka T. Effects on the human body of a dietary supplement containing L-carnitine and Garcinia cambogia extract: a study using double-blind tests. J Clin Biochem Nutr. 2008;42(2):89-103.18385825

30. Mazzio EA, Soliman KF. In vitro screening for the tumoricidal properties of international medicinal herbs. Phytother Res. 2009;23(3):385-398.18844256

31. Saadat N, Gupta SV. Potential role of garcinol as an anticancer agent. J Oncol. 2012;2012:647206.22745638

32. Guais A, Baronzio G, Sanders E, et al. Adding a combination of hydroxycitrate and lipoic acid (METABLOC™) to chemotherapy improves effectiveness against tumor development: experimental results and case report. Invest New Drugs. 2012;30(1):200-211.20931262

33. Baronzio G, Schwartz L, Crespi E, et al. Early clinical and toxicological results of a combination of natural glycolysis inhibitors (METABLOC™) on cancer patients. Biomed Res 2012;23:SI219-SI223.

34. Schwartz L, Buhler L, Icard P, Lincet H, Steyaert JM. Metabolic treatment of cancer: intermediate results of a prospective case series. Anticancer Res. 2014;34(2):973-980.24511042

35. Hayamizu K, Hirakawa H, Oikawa D, et al. Effect of Garcinia cambogia extract on serum leptin and insulin in mice. Fitoterapia. 2003;74(3):267-273.12727492

36. Wielinga PY, Wachters-Hagedoorn RE, Bouter B, et al. Hydroxycitric acid delays intestinal glucose absorption in rats. Am J Physiol Gastrointest Liver Physiol. 2005;288(6):G1144-G1149.15604199

37. Ishihara K, Oyaizu S, Onuki K, Lim K, Fushiki T. Chronic (-)-hydroxycitrate administration spares carbohydrate utilization and promotes lipid oxidation during exercise in mice. J Nutr. 2000;130(12):2990-2995.11110858

38. Mahendran P, Sabitha KE, Devi CS. Prevention of HCl-ethanol induced gastric mucosal injury in rats by Garcinia cambogia extract and its possible mechanism of action. Indian J Exp Biol. 2002;40(1):58-62.12561970

39. Mahendran P, Vanisree AJ, Shyamala Devi CS. The antiulcer activity of Garcinia cambogia extract against indomethacin-induced gastric ulcer in rats. Phytother Res. 2002;16(1):80-83.11807973

40. dos Reis SB, de Oliveira CC, Acedo SC, et al. Attenuation of colitis injury in rats using Garcinia cambogia extract. Phytother Res. 2009;23(3):324-329.18979524

41. Oluyemi KA, Omotuyi IO, Jimoh OR, Adesanya OA, Saalu CL, Josiah SJ. Erythropoietic and anti-obesity effects of Garcinia cambogia (bitter kola) in Wistar rats. Biotechnol Appl Biochem. 2007;46(pt 1):69-72.16984227

42. Lau FC, Bagchi M, Sen C, Roy S, Bagchi D. Nutrigenomic analysis of diet-gene interactions on functional supplements for weight management. Curr Genomics. 2008;9(4):239-251.19452041

43. Deshmukh NS, Bagchi M, Yasmin T, Bagchi D. Safety of a novel calcium/potassium salt of (-)-hydroxycitric acid (HCA-SX): II. developmental toxicity study in rats. Toxicol Mech Methods. 2008;18(5):443-451.20020869

44. Kaur G, Kulkarni SK. Investigations on possible serotonergic involvement in effects of OB-200G (polyherbal preparation) on food intake in female mice. Eur J Nutr. 2001;40(3):127-133.11697445

45. Actis GC, Bugianesi E, Ottobrelli A, Rizzetto M. Fatal liver failure following food supplements during chronic treatment with montelukast. Dig Liver Dis. 2007;39(10):953-955.17157086

46. Mansi IA, Huang J. Rhabdomyolysis in response to weight-loss herbal medicine. [Published correction appears in: Am J Med Sci. 2004;328(2):129.] Am J Med Sci. 2004;327(6):356-357.15201651

47. Ferris DJ. Interaction between warfarin and Garcinia cambogia (Fat Burner); a case report. ASHP Midyear Clinical Meeting. 38(DEC): p P-404(D). 2003.

48. Pittler MH, Schmidt K, Ernst E. Adverse events of herbal food supplements for body weight reduction: systematic review. Obes Rev. 2005;6(2):93-111.15836459

49. United States Food and Drug Administration. Warning on Hydroxycut products. Available online at: http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM152222.pdf. Accessed February 27, 2014.

50. Dara L, Hewett J, Lim JK. Hydroxycut hepatotoxicity: a case series and review of liver toxicity from herbal weight loss supplements. World J Gastroenterol. 2008;14(45):6999-7004.19058338

51. Lobb A. Hepatoxicity associated with weight-loss supplements: a case for better post-marketing surveillance. World J Gastroenterol. 2009;15(14):1786-1787.19360927

52. Fong TL, Klontz KC, Canas-Coto A, et al. Hepatotoxicity due to Hydroxycut: a case series. Am J Gastroenterol. 2010;105(7):1561-1566.20104221

53. Sharma T, Wong L, Tsai N, Wong RD. Hydroxycut® (herbal weight loss supplement) induced hepatotoxicity: a case report and review of literature. Hawaii Med J. 2010;69(8):188-190.20845283

54. Shim M, Saab S. Severe hepatotoxicity due to Hydroxycut: a case report. Dig Dis Sci. 2009;54(2):406-408.18661239

55. Stevens T, Qadri A, Zein NN. Two patients with acute liver injury associated with use of the herbal weight-loss supplement Hydroxycut. Ann Intern Med. 2005;142(6):477-478.15767636

56. Karth A, Holoshitz N, Kavinsky CJ, Trohman R, McBride BF. A case report of atrial fibrillation potentially induced by Hydroxycut: a multicomponent dietary weight loss supplement devoid of sympathomimetic amines. J Pharm Pract. 2010;23(3):245-249.21507821

57. Li JW, Bordelon P. Hydroxycitric acid dietary supplement-related herbal nephropathy. Am J Med. 2011;124(11):e5-e6.21531369

58. Willis SL, Moawad FJ, Hartzell JD, Iglesias M, Jackson WL. Hypertensive retinopathy associated with use of the ephedra-free weight-loss herbal supplement Hydroxycut. MedGenMed. 2006;8(3):82.17406200

59. Anno T, Oono H, Tamura K. Improvement of testicular toxicity in F/344DuCrj male rats fed Ca-type Garcinia cambogia extract by zinc supplemented diets. Nippon Shokuhin Kagaku Gakkaishi. 2005;12(3):121-127.

60. Shara M, Ohia SE, Yasmin T, et al. Dose- and time-dependent effects of a novel (-)-hydroxycitric acid extract on body weight, hepatic and testicular lipid peroxidation, DNA fragmentation and histopathological data over a period of 90 days. Mol Cell Biochem. 2003;254(1-2):339-346.14674714

61. Burdock G, Soni M, Bagchi M, Bagchi D. Garcinia cambogia toxicity is misleading. [Published correction appears in: Food Chem Toxicol. 2007;45(3):515.] Food Chem Toxicol. 2005;43(11):1683-1684; author reply 1685-1686.15993998

62. Kim YJ, Choi MS, Park YB, Kim SR, Lee MK, Jung UJ. Garcinia cambogia attenuates diet-induced adiposity but exacerbates hepatic collagen accumulation and inflammation. World J Gastroenterol. 2013;19(29):4689-4701.23922466

63. Min B, McBride BF, Kardas MJ, et al. Electrocardiographic effects of an ephedra-free, multicomponent weight-loss supplement in healthy volunteers. Pharmacotherapy. 2005;25(5):654-659.15899726

64. Hayamizu K, Tomi H, Kaneko I, Shen M, Soni MG, Yoshino G. Effects of Garcinia cambogia extract on serum sex hormones in overweight subjects. Fitoterapia. 2008;79(4):255-261.18316163

65. Allen SF, Godley RW, Evron JM, Heider A, Nicklas JM, Thomas MP. Acute necrotizing eosinophilic myocarditis in a patient taking Garcinia cambogia extract successfully treated with high-dose corticosteroids. Can J Cardiol. 2014;30:1732.e13-1732.e15.25475477

66. Melendez-Rosado J, Snipelisky D, Matcha G, Stancampiano F. Acute hepatitis induced by pure Garcinia cambogia. J Clin Gastroenterol. 2015;49(5):449-450.25811114

67. Lopez AM, Kornegay J, Hendrickson RG. Serotonin toxicity associated with Garcinia cambogia over-the-counter supplement. J Med Toxicol. 2014;10:399-401.24699886

68. Corey R, Werner KT, Singer A, et al. Acute liver failure associated with Garcinia cambogia use. Ann Hepatol. 2016;15(1):123-126.26626648

69. Hui H, Tang G and Go VL, “Hypoglycemic Herbs and Their Action Mechanisms,” Chin Med, 2009, 4:11.19523223

70. Crescioli G, Lombardi N, Bettiol A, et al. Acute liver injury following Garcinia cambogia weight-loss supplementation: case series and literature review. Intern Emerg Med. 2018;13(6):857-872.29802521

71. Lunsford KE, Bodzin AS, Reino DC, Wang HL, Busuttil RW. Dangerous dietary supplements: Garcinia cambogia-associated hepatic failure requiring transplantation. World J Gastroenterol. 2016;22(45):10071-10076.28018115

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