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S22 © 2016 Archives of Pharmacy Practice | Published by Wolters Kluwer - Medknow
ABSTRACT
Aim: The aim of this study is to assess the uses of products containing Garcinia cambogia
to burn fat and suppressed the appetite.
Introduction: The availability and popularity of natural dietary supplements for the
treatment of obesity have risen dramatically in recent years. Investigation and analysis
on the efficacy and effectiveness of the G. cambogia are challenging. Furthermore,
consuming the products that claimed the anti‑obesity effect without a strong judgment
is not an appropriate way to losing weight. The overweight prevalence of 29.71% for the
Malaysian adults aged 18–59 years indicates that the overweight problem in Malaysia
is almost as serious as that for the developed countries.
Methodology: An electronic search of PubMed, CINAHL, ScienceDirect, Clinical Key for
studies, case report, trials and reviews using the following search criteria. Examining
the product registration in Pharmaceutical Division Services, Ministry of Health. The
Malaysian Advertisement Board was referred.
Results: Consumers in Malaysia most likely tend to have a fast method in losing the
weight. When the product is advertised inappropriately without any strong evidence
based, the Malaysian society is solely at risk in buying the product that does not have a
confirmed effectiveness and efficacy. The doubts in using G. cambogia are because the
marketed product is there is no single formulation that contains only G. Cambogia.
Evidence of Garcinia cambogia as a fat burning and
appetite suppressing agents
Wan Nur Asyiken Wan Ab Rahman1, Kah Seng Lee2, June Choon Wai Yee3, Manish Gupta3,
Long Chiau Ming1,4
1Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, 3School of Pharmacy, Monash University Malaysia, Bandar Sunway, 4Vector‑borne
Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia, 2School of
Pharmacy, Curtin University, Perth, Australia
Address for correspondence:
Wan Nur Asyiken Wan Ab Rahman,
Level 11, FF1 Building, Faculty of
Pharmacy, Universiti Teknologi MARA,
Puncak Alam, Selangor, Malaysia.
E‑mail: wannikinn@gmail.com
Access this article online
Quick Response Code: Website:
www.archivepp.com
DOI:
10.4103/2045-080X.183033
This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as the
author is credited and the new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com
How to cite this article: Ab Rahman WA, Lee KS, Yee JC, Gupta M,
Ming LC. Evidence of Garcinia cambogia as a fat burning and appetite
suppressing agents. Arch Pharma Pract 2016;7:S22-8.
Key words: Appetite, “Garcinia
cambogia”, “hydroxycitric acid”,
hypolipidemic effect, obesity
INTRODUCTION
Garcinia cambogia is cultivated in Southeast Asia, India,
and West and Central Africa and is used extensively for
culinary purposes in Asian countries. G. cambogia is also
included in the US Department of Agriculture inventory
of perennial edible fruits of the tropics. The extract of
G. cambogia has been widely marketed as a weight
loss supplement worldwide. Its weight loss effect has
mainly been attributed to its high (−)-hydroxycitric
acid (HCA) content. Several mechanisms of action have
been linked to the weight loss effect of HCA through
prior animal studies, including:
• Inhibition of lipogenesis through adenosine
triphosphate (ATP) citrate lyase inhibition, which
Product Review
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Archives of Pharmacy Practice Vol. 7 Supplement 1 2016 S23
prevents the conversion of carbohydrate to fat
• Suppression of appetite through increasing
glycogen storage thus stimulating the
glucoreceptors in the liver and inducing satiety
via vagus nerve
• Reduction of the hunger feeling by increasing the
level of serotonin and
• Improved glucose metabolism through regulation
of leptin and insulin plasma level.[1]
Several products of G. cambogia or its derivatives had
been patented and commercialized.
As of August 2012, a total of 66 patents that apply to G.
cambogia or HCA derived from Garcinia were led with
the US Patent and Trademark Ofce (USPTO) since
1976 (search of USPTO in the year 2012 using Google
patent search). These patents are on various aspects,
including HCA enrichment from Garcinia rind, HCA
and food products/dietary supplements prepared
therefrom, methods of production, and their use.[2]
EFFICACY AND SAFETY OF GARCINIA
PLUS
There are a few drugs in the market to ameliorate or
prevent obesity, but there are costs, efcacy, and side
effects to be considered. For example, the currently
available pharmacological agents, sibutramine,
rimonabant, orlistat, and phentermine which are
licensed for weight reduction therapy, appear to possess
some adverse effects.[3-5] Phentermine, for instance, has
been reported to cause dry mouth, insomnia, headache,
dizziness, fatigue, and palpitation.[4,5] In the year 2010,
Food and Drug Administration had announced the
market withdrawal of Meridia (sibutramine) due to
its risk of serious cardiovascular events.[4,5] Natural
products and plant-based dietary supplements have
been used by people for centuries. The evidence is
starting to emerge to shed light on the consumption of
herbs as an effective strategy for disease treatment and
health maintenance. Several ethnobotanical studies
have reported the bioprospecting surveys on the
positive application of herbs.[6]
Plant extracts have been used for many centuries in
the Eastern world. However, the use of these extracts
have recently become increasingly prevalent around
the world. Several chemical constituents isolated
from plants and crude extracts have been found to
prevent diet-induced obesity and signicantly reduce
body weight in the treatment of obesity. Due to the
prevalent use of plant extracts, evidence is required
to support claims of efcacy.[7] However, these studies
failed to show any effect of HCA on appetite variables
in the active treatment group compared with placebo.
It is also worth noting, that safety parameters were
not measured in the majority of these trials and the
percentage biochemical characterization of G. cambogia
extract was not described in any of the studies.
Overall, the evidence for G. cambogia in isolation is
not compelling. Several factors might contribute to
the controversial results of the efcacy of HCA in
human studies.[2]
HCA and G. cambogia exerted potential effects in
weight management, but clinical studies have yet to
prove optimum conditions for HCA to be effective.
For instance,[2] reported that hepatic lipid synthesis
was reduced only if HCA was administered before the
beginning of feeding, reaching optimum 30–60 min
before feeding. The reason for this remains unknown.[2]
We have previously reviewed and concluded that
Garcinia extract and HCA were generally safe to be
consumed. Collective results from 17 clinical studies
which involved 873 subjects demonstrated the safety
of HCA. These studies provided scientic evidence
that intake of alone did not produce adverse effects
and a dietary dosage of up to 2800 mg/day was
regarded as the “no observed adverse effect level”
of HCA in human based on these animal and human
safety data, HCA-also received self-afrmed generally
recognized as safe status in the USA by the Burdock
group in whereas taken together, the number of
patients reporting adverse events in the supplemented
groups was not signicantly different from the placebo
group.[2,3]
However, recent review of animal and human studies
established the safety prole of HCA (Chuah et al.,
2012). However, the weight loss efcacy of HCA in
the human study has shown equivocal ndings with
studies reporting both negative (Heymseld et al.,
1998) and positive results[2,4,8] and its uncertainty
required more trials with adequate sample size and
duration are still needed to conrm HCA’s weight
loss efciency.[1]
In spite of the vastly reported prominent role of HCA
in inducing satiety, reduced energy intake and weight
gain, and improved blood parameters and substrate
oxidation, controversial results regarding its efcacy
and safety as an antiobesity dietary supplement had
also been reported. Evidence from the in vitro, in vivo,
and clinical trials on the safety of Garcinia/HCA
as a dietary supplement for treating obesity had
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been extensively reviewed. However, the efcacy of
Garcinia/HCA remains the subject of debate. Despite
the previously stated issues, on conclusive evidence
for HCA’s efcacy in promoting weight loss and
suppressing food intake, the marketing of a plethora
of over-the-counter slimming aids containing HCA
has taken place.[2,3,9]
According to Chuah et al. and Mattes and Bormann
reported a lack of efcacy of HCA in suppressing
food intake in human subjects might be due to the low
doses of a relatively low-effective HCA preparation.
Nevertheless, signicant suppression of food intake
was observed in the studies. There is another hypothesis
where Sprague–Dawley rats were supplemented with
HCA for 10 days after substantial, fasting-induced
weight loss. It seemed that HCA might be more
effective in regulating weight gain[10] than promoting
weight loss; thus, it was more useful for weight
maintenance after an initial loss. Hence, differences in
the experimental setups such as the difference in rat
strains could contribute to such discrepancy.[2]
However, there is a case report by Li and Bordelon
regarding acute kidney injury caused by an herbal
product containing HCA. HCA drug interactions
are unknown because HCA has not been studied in
combination with other drugs or adulterants used in
supplements. However, the effect of long-term use
is unclear because all studies were <12 weeks with
relatively small sample sizes (1000 subjects combined.)
A major concern is an herbal toxicity from numerous
factors: Excessive or prolonged ingestion, addition of
harmful adulterants or heavy metals, consumption
of toxic chemicals, and effects of combining herbs
with pharmacologic. A number of reports about the
toxicity of G. cambogia itself or G. cambogia - containing
supplements are available.[8,11] In agreement with
previous studies on soy and Garcinia cambogia extract
(GCE) supplements we used doses of 2 g/day, it was
beyond the scope of this study to determine whether
higher doses were more effective for promoting
weight loss and improving plasma lipid proles.
PHARMACOKINETICS HYDROXYCITRIC
ACID IN GARCINIA CAMBOGIA
HCA, up to 30% by weight is present in the pericarp or
the fruit rind[2] of the fruit of G. cambogia.[1,2,4] HCA can
exist as a free acid or in the lactone form. The former
form is considered to be biologically active. However,
the free acid is unstable and is usually converted to
its less active lactone form to attain higher stability.
To prevent the cyclization of HCA into its less potent
lactone, the acid has been combined with various
counter ions to form stable salts. Commercial HCA
is available in free acid form and as single, double,
or triple salts. Preparations with different counter
ions contribute to the different degree of solubility
as well as bioavailability. For example, Na+ salt of
HCA had been shown to be more effective than its
lactone in inhibiting lipogenesis. However, Na+ salt
is highly hygroscopic when bound to (−)-HCA,
which would deem unfavorable for the production
of pharmaceuticals for dry delivery.[2]
According to Chuah et al., observed that of the four
isomers of HCA ([−]-HCA, [+]- HCA, [−]-allo-HCA,
and [+]-allo-HCA), (−)-HCA, which is also known
as (2S, 3S)-HCA, was the only potent inhibitor
of ATP citrate lyase. (−)-HCA can be chemically
synthesized using citric acid as starting material.
Synthetic (−)-HCA offers several advantages including
higher purity and lactone stable as compared to
natural (−)-HCA. On the other hand, (−)-HCA is a
good starting material to synthesize other important
chiral synthons and compounds. On account of the
discovery of (−)-HCA as an effective compound in
weight management, market demand for the acid has
increased tremendously.
(−)-HCA is one of the important supplements for
antiobesity and weight management. Its effect
on weight management is mainly contributed by
giving the feeling of full and satisfaction. While the
antiobesity effect is by reduction of de novo lipogenesis
and acceleration of fat oxidation.[2]
ABSORPTION
No ndings in G. cambogia alone. The gure found
is varies, depending on which formulation is being
tested during the research. According to Kovacs
et al., a compound complexed with calcium and
potassium like the one used in this study is 100%
soluble and creates pH level that is favorable for
maximal gastrointestinal absorption. Whereas, study
done by Preuss et al., found that many HCA products
are <50% soluble in water and poorly absorbed. Thus,
more further study should be carried out to conrm
the actual absorption percentage for HCA.
DISTRIBUTION
Ingestion of a single dose of HCA (4.4 g) resulted in
maximal plasma HCA concentration after 60–90 min (0.12
mmol/L - 1.4% of the administered HCA, assuming 4.5 L
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blood and an hematocrit of 45%. HCA remained present
at least for 3 h. It believed the low concentration of HCA
continuously present in plasma. Furthermore, HCA
can act directly on adipocytes, causing lipid droplet
dispersion, and altering transcription. Other bioactive
components of G. cambogia including benzophenone
are reported to reduce oxidative stress levels based on
in vitro experiments in human plasma, hence G. cambogia
may protect against diseases associated with oxidative
stress.[5]
METABOLISM
Increased blood ketones and hepatic or muscle glycogen
levels have been posited as potential mechanisms for the
satiety effect of HCA. The fat-degradation or fat-oxidation
ability of HCA was evaluated based on the excretion of
urinary fat metabolites. Enhanced beta-oxidation of fat
may be the prime sources of these four fat metabolites.
Enhanced excretion of malondialdehyde (MDA) was
observed during increased oxidative stress. In the same
study, radiolabelled MDA administered to rats was
found to be extensively metabolized to acetate and
carbon dioxide.[10]
EXCRETION
Metabolism of glycerol to fatty acid has been reported
in rat liver microsomes and is a result of the metabolism
of triglycerides by adipose tissue and other tissues that
possess the enzyme that activates glycerol, namely
glycerol kinase. High glycerol kinase levels are found
in liver and brown tissues.[3] Although, a previous
report suggest higher doses may be futile, as oral
administration of higher doses of G. cambogia extract
to normal subjects leads to increased urinary excretion
of (−)-HCA, attributed to limitations in (−)-HCA
absorption efciency.[12]
METHODOLOGY
An electronic search of PubMed, CINAHL,
ScienceDirect, Clinical Key for studies, case report,
trials and reviews using the following search criteria.
RESULTS
The prevalence of overweight among the Malaysian
adults has increased almost 2-fold from 16.6% to 29.7%.
Overweight was highest among the Indians (31.01%),
and affects the minority ethnic groups too, for example,
15.06% among the Orang Asli of Peninsular Malaysia,
28.07% in the Bumiputera Sarawak and 23.73% for
the Bumiputera Sabah. In fact, the prevalence of
overweight among the Bumiputera Sarawak women
was high at 31.68%.
The overweight prevalence of 29.71% for the Malaysian
adults aged 18–59 years indicates that the overweight
problem in Malaysia is almost as serious as that for
the developed countries reported in the 1999–2002
National Health and Nutrition Examination Survey
and WHO (2006). Overall, overweight increased
with age and household income. This pattern of
increase was also observed among the men.[6,13] This
nding is not consistent with other population-based
studies, which reported that females had a higher
rate of obesity than males.[2,13,14] Sociodemographic,
psychosocial factors, and working hours were found
to contribute to obesity in this sample of adults.[14] The
analyses showed a signicant relationship between
education status and body mass index (BMI) and
waist circumference (WC) in this sample of subjects.
There were signicant differences in mean BMI and
mean WC between the subjects who had secondary
or less education and those with preuniversity and
matriculation and diploma education. Hence, this
finding suggests that lower education status is
associated with a higher BMI and WC.
As obesity has reached epidemic proportions, the
management of this global disease is of clinical
importance. The availability and popularity of
natural dietary supplements for the treatment of
obesity has risen dramatically in recent years.[7] Due
to the difculty in maintaining sustained lifestyle
changes, potential complications of surgery and
accompaniment of serious adverse effects associated
with pharmacotherapy, it is not surprising that the
general public frequently turn to easily obtainable
over the counter proprietary weight loss products
such as herbal products, nutritional supplements, and
meal replacements.[7]
The ndings of a multi-state survey conducted in the US
revealed that 7% of adults used nonprescription/over
the counter weight loss supplements, with a greater
proportion of use among young obese women.[1] In
Search strategies
Keywords used
“Garcinia cambogia,”
“hydroxycitric acid,”
appetite, obesity,
hypolipidemic effect
Years searched
All
Total no. of articles reviewed
46
Relevant full text articles reviewed
16
Relevant abstracts reviewed 16
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Rahman, et al.: Review on Garcinia cambogia
S26 Archives of Pharmacy Practice Vol. 7 Supplement 1 2016
addition, retail sales of weight loss supplements were
estimated to be >$1.3 billion in 2001.[3] Plant extracts
possessing appetite suppressing properties for obesity
treatment.
According to the ndings from this systematic review,
the evidence is not considerable in demonstrating
that most dietary supplements used as appetite
suppressants for weight loss in the treatment of
obesity are effective and safe. A balance between
conclusive findings by double blind randomized
controlled trials (RCTs) and advertisement is required
to avoid safety concerns and dissatisfaction from
consumers.[5,7,10,11]
Although the use of internet continues to grow rapidly,
its impact on health care is unclear. The advantages
of the internet as a source of health information
include convenient access to a massive volume of
information, ease of updating information, and the
potential for interactive format that promotes better
understanding. However, health information on the
internet maybe misleading or misinterpreted.
Malaysia is a developing country with growing
internet usage. Current data showed that there were
15.355 million internet users in 2009 compared with
5.700 million in 2002. Addictive use of the internet
can lead to physical or familial problems, as well as
academic and occupational deciency. Thus, there is a
need to validate a scale to measure internet addiction
in the Malaysian population for clinical practice and
research purposes.[15]
In information technology literature, attitudes
inuence a person’s adoption of computer technologies
and adaptation of purchasing behavior. The attitude
toward intention to use information technology is
multidimensional, involving perceived usefulness,
accessibility, and quality.
Consumers in Malaysia most likely tend to have a
fast method in losing the weight. When the product
is advertised inappropriately without any strong
evidence based, the Malaysian society is solely at risk
in buying the product that does not have a conrmed
effectiveness and efcacy.
RECOMMENDATION AND CONCLUSION
Studies show that Indians have the highest prevalence
of abdominal obesity and diabetes while Malays are
at greater risk of developing hypertension. These
ndings also identied women as the group with
the highest risk to such diseases.[16] It is reasonable
because individuals with a higher education status
tend to adopt healthier lifestyle behaviors. Such as
a higher consumption of fruit and vegetables, less
dietary fat intake, and engagement in exercise as
most of them have a higher awareness of weight
control.[14] Overweight employees are assumed to
lack self-discipline, be lazy, less conscientious, less
competent, sloppy, disagreeable, and emotionally
unstable. Obese employees are also believed to think
slower, have poorer attendance records, and be poor
role models.[17,19]
Chronic energy imbalance due to excess energy
intake that exceeds energy expenditure is the reason
behind weight gain in humans. The multiple health
complications of obesity, poor response to medical
treatment and its economic costs justies the need for
effective prevention strategies.[18]
The pressure to eat subscale evaluates parental child
feeding practices by assessing the extent to which a
parent encourages the child to eat by insisting that
the child nishes all the food on the plate. The scores
range from 1 to 5 indicating low to high levels of
pressure on the child. In this study, the mean score
was signicantly higher in the normal body weight
group (4.0 ± 0.6) compared to the overweight/obese
group (3.5 ± 0.9) (P < 0.001). This meant that parents
of overweight/obese children seemed to exert less
pressure on their children.[18] Wan Abdul Manan
et al. 2012 showed that parental feeding attitudes and
practices were correlated with childhood obesity.
Parents should be more responsible toward their
children by practicing appropriate child feeding
strategies without exerting force during feeding so
as to avoid unwanted circumstances such as weight
problems and eating disorders.[18]
There are a variety of effective options for weight
loss in the treatment of overweight and obesity
which include dietary therapies, altering physical
activity, behavioral techniques, pharmacotherapy,
surgery and a combination of these strategies. The
rst-line of therapy for the management of obesity
has the least risk which consists of lifestyle changes
including diet, exercise and behavioral modication.
The second line of therapy for obesity treatment is
pharmacotherapy,[19] which is often recommended
when lifestyle modication is ineffective in producing
sufcient weight loss. The last approach in extreme
cases of morbid obesity is through surgical therapy.
Surgical treatment is an option for a limited
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Archives of Pharmacy Practice Vol. 7 Supplement 1 2016 S27
number of patients with clinically severe or morbid
obesity (BMI >40 or >35 with comorbid conditions)
and is reserved for those who are suffering from the
complications associated with extreme obesity or are
unresponsive to nonsurgical treatment.[7]
Studies have found that the availability and accessibility
of exercise equipment and facilities in the workplace
environment, such as sports centers, jogging track,
swimming pool, and tennis court correlated with
higher physical activity in the workers, resulting in
better control of weight. The large amount of sitting
time spent in sedentary activities such as working at
a desk and using computers has played a role in the
development of the current overweight and obesity.[3,14]
As a conclusion, consuming the products that claimed
the antiobesity effect without a strong judgment is
not an appropriate way in losing weight. Treatment
obesity requires a two-divided reducing energy intake
as well as increasing energy expenditure.[1]
Weight control programs are required in order to
increase physical activity and promote healthier
eating in the workplace. Several approaches are
suggested for weight control intervention, such
as counseling, skills training, writing materials,
partnerships, and local projects.[14] Other than that,
pharmacotherapy using antiobesity Current available
drug treatments for obesity, for example, appetite
suppressant (e.g., phentermine and topiramate) or
lipase inhibitor (orlistat), focus primarily on reducing
caloric intake, while IQP-GC-101, investigated in this
study, offers the possibility of increasing thermogenesis
and metabolism in supporting weight loss.[1] Under
the physician consultation is highly suggested.
According to Chong et al., 55% reduction in the risk
of diabetes and other cardiovascular disease can be
achieved if the obese manage to lose about 5 kg over
time).[1] The doubts in using G. cambogia is because the
marketed product is there is no single formulation
that contains only G. cambogia as the active ingredient.
Most of the preparation is a combination of more
than one active ingredient. It is found quite difcult
to carry an investigation and analysis on the efcacy
and effectiveness of the G. Cambogia. For example,
the study indicated that the use of herbal extracts
combination in IQP-GC-101 results in better weight
loss effect in comparison to products containing only
G. cambogia extract used in the other studies.[1]
Thus, scientific surveys on the probable health
stimulating effects of herbal preparations as diet
supplement are requirements for new discoveries
of alternative therapies.[2] In addition, the difference
in mean weight loss observed in the current study is
higher than the net mean effect of 0.88 kg reported in
a meta-analysis of RCTs of G. cambogia extracts with
daily dose of HCA ranging from 1.0 to 2.8 g. Most
of the undesirable reports have been related to cases
where multi-ingredient preparations were consumed
and the effect could not be accredited to a specic
ingredient. However, as G. cambogia may increase the
levels of serotonin, it is especially crucial to investigate
a possible interaction between medicines that increase
serotonin levels such as selective serotonin reuptake
inhibitors and G. cambogia.[8]
Financial support and sponsorship
This work was supported by Academic and Research
Assimilation grants: 600 RMI/DANA5/3/ARAS
(46/2015). The authors would like to express their
gratitude to Ministry of Higher Education and
Universiti Teknologi MARA (UiTM), Malaysia for
nancial support for this research.
Conicts of interest
There are no conicts of interest.
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