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Hoodia

Scientific Name(s): Hoodia gordonii (Masson) Sweet ex Decne.
Common Name(s): Bushman's hat, Queen of the Namib, Xhoba (San)

Clinical Overview

Use

Hoodia products have been marketed worldwide for weight loss; however, there is little published clinical evidence to support this application, and concerns exist regarding adverse effects.

Dosing

Information is lacking; neither an effective nor safe dose has been established.

Contraindications

No information is available. Caution is advised in patients with cardiovascular conditions or compromised hepatic function.

Pregnancy/Lactation

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

Interactions

None well documented.

Adverse Reactions

Moderately severe nausea, vomiting, and altered skin sensation have been reported. Cardiovascular and hepatic concerns also exist.

Toxicology

Limited data suggest H. gordonii extracts are not genotoxic.

Botany

H. gordonii is a rare, succulent plant found in the Kalahari Desert of southern Africa. The leafless, swollen, spiny stem is similar to that of a columnar cactus and is topped by showy, saucer-shaped flowers. The flowers emit a carrion-like odor that attracts pollinating insects. H. gordonii is considered an endangered species because of the high potential for over-exploitation and is listed in Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES).1 Commercial plantations have been established in South Africa to provide for anticipated demand for the plant, although the plant's slow growth makes commercial cultivation difficult. Hoodia was formerly categorized in the Asclepiadaceae (milkweed) family, but it has been subsumed into the Apocynaceae (dogbane) family.2 Other species in the genera Hoodia and Trichocaulon are said to have biological activity similar to that of H. gordonii.

History

Hoodia was not well known to the Western world until recently. Ethnobotanical reports date to 1796, but Hoodia received little attention until a South African scientific project evaluated its appetite suppressant effects in 1963. In the 1980s, modern techniques in plant structure analysis revealed the bioactive oxypregnane steroidal glycoside P57. As a result, a patent was filed by the Council for Scientific and Industrial Research (CSIR) in 1995 in South Africa3; the council further developed extraction and quality control procedures.4, 5 At the same time, CSIR signed a licensing agreement with Phytopharm, a small British company specializing in the development of phytomedicines. A sublicense was granted to Pfizer for further clinical development of P57, which Pfizer relinquished in 2003. In 2003, CSIR responded to criticism of its appropriation of San (southern Africa's oldest human inhabitants) indigenous knowledge by signing a memorandum of understanding with the South African San Council. The memorandum provided benefit sharing of Hoodia royalties.6 In the meantime, a thriving, yet illicit, worldwide market has emerged that offers Hoodia herbal products as dietary supplements.7

Chemistry

Pregnane steroidal glycosides, including gordonosides, pregnanone, and hoodigogenin, have been isolated from the aerial plant parts and described. However, information is limited due to plant protection and patent rights as well as to poor yields (0.003% to 0.02%).8, 9, 10 A compound unique to H. gordonii and responsible for purported appetite suppression has not been defined, and adulteration of herbal preparations is common.5, 11 High-performance liquid chromatography with ultraviolet and other chromatographic methods for quantification have been used.12, 13, 14

Uses and Pharmacology

Obesity/Appetite suppression

Animal data

Ex vivo studies in rats and in vitro human cells suggest stimulation of cholecystokinin secretion as a possible mechanism of action.15 The patent application suggests that modulation of hypothalamic adenosine triphosphatase activity as well as antagonism of melanocortin-4 receptors play a role.3, 16, 17 Experiments in rats have shown decreased body mass (adipose tissue and muscle) with supplemental H. gordonii extracts.18, 19 Further experiments in rabbits suggest a dose-related response, while limited effect was observed in chickens.20, 21

Clinical data

In a small clinical study (N = 50), no difference was found in food intake and body weight between placebo and 1 g of H. gordonii extract twice daily for 15 days.22 A review of the topic suggests the claimed effects on appetite and weight loss might be secondary symptoms of the serious adverse effects associated with the high-dose consumption required to achieve therapeutic clinical effect.23

Other uses

Studies with isolated rat uterine ring tissue revealed relaxant effects on smooth muscle and activity at beta-adrenergic receptors. This effect may be responsible for observed cardiovascular adverse effects.24

There are no clinical studies to support claims of gastric acid secretion control and management of diabetes.

Dosing

Information is lacking; neither an effective nor safe dose has been established.25

One clinical trial used doses of 1 g of the herb extract twice daily before meals.22 Pharmacokinetic studies suggest that bioavailability is poor.5

Pregnancy / Lactation

Avoid use. Information on safety is lacking. At higher doses only, adverse effects, including ossification of fetal bones and reduced uterine weight, has been seen in rodents.21, 26

Interactions

None well documented.

Adverse Reactions

Limited clinical data report moderately severe nausea, vomiting, and altered skin sensation. Increased blood pressure, pulse, and heart rate have also been noted.22, 23, 27

Data collected between 2004 and 2013 among 8 US centers in the Drug-induced Liver Injury Network revealed 15.5% (130) of hepatotoxicity cases was caused by herbals and dietary supplements whereas 85% (709) were related to medications. Of the 130 related cases of liver injury related to supplements, 65% were from non-bodybuilding supplements and occurred most often in Hispanic/Latinos compared to non-Hispanic whites and non-Hispanic blacks. Liver transplant was also more frequent with toxicity from non-bodybuilding supplements (13%) than with conventional medications (3%) (P<0.001). Overall, the number of severe liver injury cases was significantly higher from supplements than conventional medications (P=0.02). Of the 217 supplement products implicated in liver injury, H. gordonii was among the 22% (116) of the single-ingredient products.29

Toxicology

Information is limited; however, a clinical study found increases in bilirubin and alkaline phosphatase levels.22 H. gordonii extract has been shown to be nongenotoxic in 3 independent assays.28 At higher doses only, adverse effects, including ossification of fetal bones and reduced uterine weight, have been seen in rodents.20, 26

References

1. Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). Appendices I, II, and III. http://www.cites.org/eng/disc/what.php. Accessed January 26, 2015.
2. Sennblad B, Bremer B. Classification of Apocynaceae s.l. according to a new approach combining Linnaean and phylogenetic taxonomy. Syst Biol. 2002;51(3):389-409.12079641
3. van Heerden FR, Vleggaar R, Horak RM, et al. Pharmaceutical compositions having appetite suppressant activity. 2002;US Patent No. 6376657.
4. Vermaak I, Hamman JH, Viljoen AM. Hoodia gordonii: an up-to-date review of a commercially important anti-obesity plant. Planta Med. 2011;77(11):1149-1160.21259185
5. Knight TL, Swindells CM, Craddock AM, et al. Cultivation practices and manufacturing processes to produce Hoodia gordonii extract for weight management products. Food Chem Toxicol. 2012;50(suppl 1):S1-S5.22410259
6. Wynberg R. Rhetoric, realism and benefit-sharing: use of traditional knowledge of Hoodia species in the development of an appetite suppressant. J World Intellect Prop. 2004;7(6):851-876.
7. Gathier G, van der Niet T, Peelen T, van Vugt RR, Eurlings MC, Gravendeel B. Forensic identification of CITES protected slimming cactus (Hoodia) using DNA barcoding. J Forensic Sci. 2013;58(6):1467-1471.23865560
8. Shukla YJ, Pawar RS, Ding Y, Li XC, Ferreira D, Khan IA. Pregnane glycosides from Hoodia gordonii. Phytochemistry. 2009;70(5):675-683.19303614
9. Dall'Acqua S, Innocenti G. Steroidal glycosides from Hoodia gordonii. Steroids. 2007;72(6-7):559-568.17485103
10. Geoffroy P, Ressault B, Marchioni E, Miesch M. Synthesis of Hoodigogenin A, aglycone of natural appetite suppressant glycosteroids extracted from Hoodia gordonii. Steroids. 2011;76(7):702-708.21473873
11. van Heerden FR, Marthinus Horak R, Maharaj VJ, Vleggaar R, Senabe JV, Gunning PJ. An appetite suppressant from Hoodia species. Phytochemistry. 2007;68(20):2545-2553.17603088
12. Rumalla CS, Avula B, Shukla YJ, et al. Chemical fingerprint of Hoodia species, dietary supplements, and related genera by using HPTLC. J Sep Sci. 2008;31(22):3959-3964.19065611
13. Russell PJ, Swindells C. Chemical characterisation of Hoodia gordonii extract. Food Chem Toxicol. 2012;50(suppl 1):S6-S13.22410262
14. van Platerink CJ, Janssen HG, Graf B, Abrahamse L, Haverkamp J. Quantification of steroid glycosides from Hoodia gordonii in porcine plasma using high performance liquid chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2011;879(11-12):819-825.21398192
15. Le Nevé B, Foltz M, Daniel H, Gouka R. The steroid glycoside H.g.-12 from Hoodia gordonii activates the human bitter receptor TAS2R14 and induces CCK release from HuTu-80 cells. Am J Physiol Gastrointest Liver Physiol. 2010;299(6):G1368-G1375.20930049
16. MacLean DB, Luo LG. Increased ATP content/production in the hypothalamus may be a signal for energy-sensing of satiety: studies of the anorectic mechanism of a plant steroidal glycoside. Brain Res. 2004;1020(1-2):1-11.15312781
17. Nargund RP, Strack AM, Fong TM. Melanocortin-4 receptor (MC4R) agonists for the treatment of obesity. J Med Chem. 2006;49(14):4035-4043.16821763
18. Smith C, Krygsman A. Hoodia gordonii extract targets both adipose and muscle tissue to achieve weight loss in rats. J Ethnopharmacol. 2014;155(2):1284-1290.25066203
19. van Heerden FR. Hoodia gordonii: a natural appetite suppressant. J Ethnopharmacol. 2008;119(3):434-437.18804523
20. Dent MP, Wolterbeek AP, Russell PJ, Bradford R. Safety profile of Hoodia gordonii extract: rabbit prenatal developmental toxicity study. Food Chem Toxicol. 2012;50(suppl 1):S26-S33.22410261
21. Mohlapo TD, Ng'ambi JW, Norris D, Malatje MM. Effect of Hoodia gordonii meal supplementation at finisher stage on productivity and carcass characteristics of Ross 308 broiler chickens. Trop Anim Health Prod. 2009;41(7):1591-1596.19396624
22. Blom WA, Abrahamse SL, Bradford R, et al. Effects of 15-d repeated consumption of Hoodia gordonii purified extract on safety, ad libitum energy intake, and body weight in healthy, overweight women: a randomized controlled trial. Am J Clin Nutr. 2011;94(5):1171-81.21993434
23. Smith C, Krygsman A. Hoodia gordonii: to eat, or not to eat. J Ethnopharmacol. 2014;155(2):987-991.24955559
24. Roza O, Lovász N, Zupkó I, Hohmann J, Csupor D. Sympathomimetic activity of a Hoodia gordonii product: a possible mechanism of cardiovascular side effects. Biomed Res Int. 2013;2013:171059.24307991
25. Robb-Nicholson C. By the way, doctor. I've seen a lot of Internet ads for Hoodia, a natural supplement that suppresses your appetite. What do you know about it? Does it work, is it safe? Harv Womens Health Watch. 2008;15(12):8.19115502
26. Dent MP, Wolterbeek AP, Russell PJ, Bradford R. Safety profile of Hoodia gordonii extract: mouse prenatal developmental toxicity study. Food Chem Toxicol. 2012;50(suppl 1):S20-S25.22410260
27. Posadzki P, Watson LK, Ernst E. Adverse effects of herbal medicines: an overview of systematic reviews. Clin Med. 2013;13(1):7-12.23472485
28. Scott AD, Orsi A, Ward C, Bradford R. Genotoxicity testing of a Hoodia gordonii extract. Food Chem Toxicol. 2012;50(suppl 1):S34-S40.21315789
29. Navarro VJ, Barnhart H, Bonkovsky HL, et al. Liver injury from herbals and dietary supplements in the U.S. drug-induced liver injury network. Hepatology. 2014;60(4):1399-1408.25043597

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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