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Garcinia cambogia and Glucomannan reduce weight, change body composition and ameliorate lipid and glucose blood profiles in overweight/obese patients


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Background Nowadays, overweight and obesity are worldwide epidemics associated with the development of diseases such as diabetes, dyslipidemias, hypertension and even cancer. Treatments for these conditions are not very successful and therefore looking for new strategies is imperative. Garcinia cambogia (GC) is used in Asia and Africa for hypolipidemic, antidiabetic and anti-obesity purposes while Glucomannan (GNN) is a diet supplement used to control weight in Japan and China. Here, the efficacy of GC and GNN in weight reduction and the impact on metabolic status of obese/overweight patients for 3 and 6 months was tested. Material and Methods This study was a pre-post test study. Adults> 18 years old (n = 136) with a body mass indexin excess of 25 were recruited for this study. These patients also suffered from diabetes mellitus type 2, dyslipidemias, hypertension and their combinations. They were treated with 1 g/day of both GC and GNN for 3 and 6 months Results The treatment reduced weight, visceral fat, fat mass, increased metabolic basal rate and was also effective reducing levels of triglycerides, glucose and cholesterol compared to baseline. There were not any adverse effects reported. Reduction in weight were independent of sex, age and previously reported condition. Conclusions It was concluded that treatment with GC and GNN is useful in the long term to reduce weight and improve the metabolic status of overweight/obese patients.
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Journal of Herbal Medicine 26 (2021) 100424
Available online 8 January 2021
2210-8033/© 2021 The Authors. Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license
Garcinia cambogia and Glucomannan reduce weight, change body
composition and ameliorate lipid and glucose blood proles in overweight/
obese patients
Andrea Maia-Landim
, Carolina Lancho
, María S. Poblador
, Jos´
e L. Lancho
Juan M. Ramírez
Department of Morphological Sciences, School of Medicine, University of C´
ordoba, Avenida de Men´
endez Pidal s/n, 14071, C´
ordoba, Spain
Centro de par´
alisis cerebral Aspace, camino de Illarra s/n CP:20018, Donostia/San Sebasti´
an, Guipúzcoa, Spain
Garcinia cambogia
Weight control
Lipid prole
Background: Nowadays, overweight and obesity are worldwide epidemics associated with the development of
diseases such as diabetes, dyslipidemias, hypertension and even cancer. Treatments for these conditions are not
very successful and therefore looking for new strategies is imperative. Garcinia cambogia (GC) is used in Asia and
Africa for hypolipidemic, antidiabetic and anti-obesity purposes while Glucomannan (GNN) is a diet supplement
used to control weight in Japan and China. Here, the efcacy of GC and GNN in weight reduction and the impact
on metabolic status of obese/overweight patients for 3 and 6 months was tested.
Material and methods: This study was a pre-post test study. Adults>18 years old (n =136) with a body mass
indexin excess of 25 were recruited for this study. These patients also suffered from diabetes mellitus type 2,
dyslipidemias, hypertension and their combinations. They were treated with 1 g/day of both GC and GNN for 3
and 6 months.
Results: The treatment reduced weight, visceral fat, fat mass, increased metabolic basal rate and was also effective
reducing levels of triglycerides, glucose and cholesterol compared to baseline. There were not any adverse effects
reported. Reduction in weight were independent of sex, age and previously reported condition.
Conclusions: It was concluded that treatment with GC and GNN is useful in the long term to reduce weight and
improve the metabolic status of overweight/obese patients.
1. Introduction
The number of people who are overweight or obese has reached
epidemic level not only in developed countries but across the world
(Caballero, 2007; James, 2008; OMS, 2012). The number of people
suffering from obesity has doubled since 1980 and it was estimated to be
around 1.4 billion in 2013 (Ng et al., 2014). In addition, some models
predict that half of the population in United States in 2030 will be obese
(Finkelstein et al., 2012).
These conditions have been associated with several metabolic dis-
orders such as diabetes, hypertension, dyslipidemias, cardiovascular
diseases, sleep apnea, osteoarthritis, osteoporosis and even increase the
risk of cancer (OMS, 2012; Pond, 1992; Tchernof and Despres, 2013).
Being overweight or obese reduces wellbeing, increases the risk of
mortality and reduces life expectancy (OMS, 2012). These conditions
show up when caloric intake exceeds caloric expenditure. This excess is
translated in an accumulation of fat in body fat deposit such as visceral
fat and changes in body composition (Pond, 1992). Different factors
such as peoples genetic background, bad nutritional habits, and
sedentary life style are related to overweight and obesity development
(Bowman et al., 2004; Kaur et al., 2017).
Obesity and being overweight are treated with a combination of
caloric restriction, a reduction in a 1540 % of calories per day is usually
recommended, and exercise (preferably aerobic) aimed at reducing fat
Abbreviations: GC, Garcinia cambogia; GNN, Glucomannan; BMR, Basal metabolic rate; BMI, Body mass index; AHC, Hidroxicitric acid; DM2, Diabetes mellitus
type II.
* Corresponding author.
E-mail addresses: (A. Maia-Landim), (C. Lancho), (M.S. Poblador),
(J.L. Lancho), (J.M. Ramírez).
Contents lists available at ScienceDirect
Journal of Herbal Medicine
journal homepage:
Received 9 November 2018; Received in revised form 21 March 2020; Accepted 6 January 2021
Journal of Herbal Medicine 26 (2021) 100424
accumulation and increasing energy expenditure (Iacobellis et al., 2008;
James, 2008; Kim et al., 2008; Kushner and Ryan, 2014). Cases of
morbid obesity are treated with bariatric surgery (Fried et al., 2014).
However, diets and exercise sometimes are unable to achieve their ob-
jectives for genetic reasons (Corella et al., 2005; Phares et al., 2004), low
diet/exercise compliance or because patients trend to regain the lost
weight in a short time after the diet (MacLean et al., 2015).
Pharmacotherapy has emerged as an alternative when changes in
lifestyle do not reduce weight, or may be a tool to improve the results of
diet and exercise to control weight or if bariatric surgery is not an option
(Apovian et al., 2015). Different drugs with different mechanisms of
action are available in the armamentarium to ght obesity (Patel, 2015).
However, pharmacotherapy has some disadvantages such safety con-
cerns or side effects. Thus fenuramine and dexfelnuramine, subitr-
amine and rimonobant were retired from the market for producing
pulmonary hypertension, cardiovascular or psychiatric effects, respec-
tively (Kang and Park, 2012).
Among different alternatives to control weight, the use of some
herbal extracts is gaining acceptance in recent years. These compounds
come from natural sources, have a low cost, and sometime have been
used for a long time in some Asiatic and Indic cultures as dietary sup-
plements without having negative effects which makes a good candidate
to use as weight control agents (Mopuri and Islam, 2017). Two of the
most common agents are Garcinia cambogia (GC) and glucomannan
(GNN). GC is an extract from a south Asian plant that has been used as a
nutritional supplement to control weight (Astell et al., 2013; Hasa-
ni-Ranjbar et al., 2009; Mopuri and Islam, 2017; Semwal et al., 2015;
Tomar et al., 2019). GC has a high content of hydroxycitric acid (AHC)
that is involved in blocking lipogenesis. This action is mediated through
the inhibition of the ATP-citrate liase, an enzyme that is required for the
rst step in the lipogenesis process (Ohia et al., 2002). AHC also seems to
act on serotonin levels reducing food intake (Preuss et al., 2004). Be-
sides, other metabolic actions of AHC on lipid metabolism have been
reported such as increase of fatty acid oxidation and regulation of genes
involved in lipid metabolism (Han et al., 2016; Hayamizu et al., 2003;
Kovacs and Westerterp-Plantenga, 2006; Roy et al., 2007). On the other
hand, GNN is a natural ber formed by β 1,4-linked D mannose and
D-glucose monomers extracted from a tuber called Amorphophallus
konjac (Lyon and Reichert, 2010). Its mechanism of action to reduce
weight might be based on its capacity of absorbing 50 times its weight in
water volume, which would produce a delayed gastric emptying
together with a satiety feeling (Cairella and Marchini, 1995; Shima
et al., 1983). The principal mechanism of action of both agents are
summarized in Fig. 1.
In this study, the aim was to evaluate the effects of a combined
treatment of GC and GNN in a population of overweight and obese pa-
tients who also suffered from diabetes mellitus type 2, dyslipidemias and
hypertension, upon body composition (weight, visceral and fat mass)
and metabolic status (metabolic basal rate, triglycerides, cholesterol and
glucose levels) at 3 and 6 months since study onset.
2. Material and methods
This study was designed as a multicentric, non-randomized pro-
spective trial, evaluating differences between two dependent means (a
pre-post test study). Consort checklist is in supplementary Table 1. Pa-
tients were recruited after they signed an informed consent in Scientics
Aesthetics Clinics of the Body in C´
ordoba, Spain. The minimum number
of patients required for obtaining signicant results was estimated by
power analysis running the following parameters in G*power (V3.1.9.2)
software. These parameters were type I and II errors of 5 and 95 %
respectively, and an effect size of 0.25. The result of this analysis
resulted in a minimum of 130 patients.
Inclusion criteria were patients with an BMI >25 from both sexes (61
male and 75 female) and an age ranging from 18 to 59 years old. These
patients also suffered from dyslipidemias, hypertension, DM2 or their
combinations. The patientsmain characteristics are summarized in
Table 1. We conrmed that patients were under treatment for hyper-
tension, DM2 or dyslipidemias for a range of 2 months to 4 years before
study onset. The exclusion criteria are related to avoid possible in-
terferences in the outcome with other diseases, surgical interventions or
other conditions that might inuence the metabolic status of the pa-
tients. For this reason we excluded patients with pregnancy or lactation,
with gastroplasty or gastrointestinal weight-reducing surgery, cessation
Fig. 1. Main GC and GNN mechanism of action on overweight control. AHC: hidroxicitric acid; GNN: Glucomannan; GH: Garcinia cambogia.
A. Maia-Landim et al.
Journal of Herbal Medicine 26 (2021) 100424
of smoking during the past 6 months, kidney disease, history of recur-
rent kidney stones, liver dysfunction, untreated high blood pressure,
history or symptoms of gallstones, cancer, history of endocrine disorders
(particularly hypothyroidism), history of bulimia and/or laxative abuse,
mental disorders with impaired independence, history of alcohol or
other drug abuse. All of them were evaluated at the start of the study
(baseline), 3 and 6 months from study onset in Scientics Aesthetics
Clinics of the Body in C´
ordoba, Spain. All of them completed previously
to study onset, a form to evaluate their medical history. All patients were
informed and signed the proper informed consent. This work was in
accordance with Helsinki declaration and was approved by Ethical
Boards of Hospital Universitario Reina Soa de C´
ordoba (Spain).
2.1. Pharmacological treatment
Patients were advised to have a balanced diet (Mediterranean diet),
regular meals and drink plenty of water. This diet has been generally
recognized for its metabolic benets (Fit´
o and Konstantinidou, 2016)
and it was also recommended to patients to practice physical exercise,
avoid smoking, and control alcohol intake as it is usual in the manage-
ment of these kinds of patients (De Sousa and Norman, 2016; Myers
et al., 2019; Sherling et al., 2017). Standardized extracts of GC (52.4 %
HCA) and A. konjac (94.9 %, glucomannan) were administered in cap-
sules of 500 mg each of them. The patients were treated with GC (500
mg), twice a day, half an hour before lunch and dinner and GNN (500
mg), twice a day, half an hour before lunch and dinner.
The GC and GNN compounds were obtained by patients by medical
prescription in pharmacies authorized by RD175/2001 for the formu-
lation of medical products. The RD175/2001 rule, is the Spanish law
that regulates the preparation of in situ drugs in pharmacies thus the
compounds prepared meet the highest quality and safety criteria.
This kind of treatment is based on the ranges reported by previous
studies that produced a safe reduction in weight although in short pe-
riods of time (Biancardi et al., 1989a; Birketvedt et al., 2005b; Cairella
and Marchini, 1995; Girola et al., 1996; Preuss et al., 2005; Sood et al.,
2008a; Thom, 2000; Toromanyan et al., 2007; Vasques et al., 2008; Vido
et al., 1993; Walsh et al., 1984).
2.2. Anthropometric measurements and estimation of body composition
Anthropometric measurements and body composition: Body mass
was measured on a digital balance (HD-305 TanitaTM) to the nearest 0.1
kg. Height was taken with a Seca Bodymeter 206 to the nearest 0.1 cm.
These data were used to calculate body mass (BM) and (BM) index (BMI)
Bioelectrical impedance was performed with a BioScan Spectrum
operating at 50 KHz, measuring fat mass (Wid´
en et al., 1995). Briey,
two-compartment body composition, percentage fat mass (%FM) and
free fat mass (FFM) were measured by tetrapolar bioelectrical
impedance analysis in 12 h fasted subjects on a restricted
physical-activity schedule. FFM was assessed using the following equa-
tion (Deurenberg et al., 1991): FFM (kg) =0.340 (h
/R) +0.1534 (h)
+0.273 (BM) -0.127 (age) +4.56 (sex) -12.44 where: h is the height
(cm), R is the resistance (ohm) and female =0, male =1.
Basal Metabolic rate (BMR) was assessed by indirect calorimetry,
using a TEEM 100® (INBRASPORT) calorimeter: 12 h fasted subjects on
a restricted exercise schedule lay comfortably on their backs in a silent
room at a mean temperature of 24 ±1 C, and VO2 and VCO2 were
recorded over a 15 min period; data obtained over the last 10 min were
used to calculate BMR. BMR estimation was based on Weir equation
(Weir, 1949): BMR (kcal/min) =[3.9(VO2) +1.1(VCO2)]. The value
obtained was multiplied by 1440 in order to estimate BMR for 24 h
(kcal/day). BMR was also calculated from the relationship with BM or
FFM (kcal/kg/24 h). Additionally, mean values for the respiratory
quotient (RQ), VO2 (L/min) and metabolic equivalent (MET) were also
obtained, taking 1 MET to be equal to an expenditure of 3.5 mL
2.2.1. Blood analysis
Blood extraction was performed using a clinical routine laboratory
protocol after 12 h of patients fasting. Patients were advised to restrain
from performing exercise or consuming alcohol 24 h prior the test. Pa-
tients consumed food with lipid composition similar to that ingested
during the months the study took place. Glucose concentrations,
cholesterol and triglycerides levels were measured using a colorimetric
enzyme assay method (CEPA® kits MBiolog Diagn´
osticos Ltda.) as
previously described (Vasques et al., 2008).
2.2.2. Statistic
Results are presented as mean ±SEM. SPSS© r22 was used to
perform an analysis of covariance to nd out if there were signicant
differences among measurements and the possible inuence of different
variables such as sex. Pearson correlation test was used to discard
possible inuence of age (that is a continuous variable) in the outcome.
A posteriori Tukey test was run to analyze differences as considered
appropriate. A p <0.05 was considered a as signicant.
3. Results
3.1. GC and GNN administration reduces weight and affects positively
body composition
The rst goal was to test if GC and GNN combined treatment was able
to reduce weight. The result conrmed that administration of GC and
GNN signicantly (p <0.01) reduced weight at 3 and 6 months since
study onset (Fig. 2A). Notably, there was a signicant (p <0.01)
reduction in weight at 6 months compared with 3 months (Fig. 3A).
Moreover, this reduction was effective in weight reduction indepen-
dently of sex or age by the patients as conrmed by analysis of covari-
ance for sex (p =0.62) and Pearson correlation for age at 3 months (p =
0.71; R
<0.001) and 6 months (p =0.47; R
<0.01) (Fig. 2BD). Next,
analysis was carried out to see if visceral and fat mass were reduced
accordingly to weight loss. Indeed, both fat mass and visceral fat were
signicantly decreased at three months (p <0.01) and this reduction
was even higher (p <0.01) at 6 months compared with the previous
measurement (Fig. 3A, B). the authors also wanted to discover if BMR
was affected by GC and GNN administration. Indeed, BMR was increased
at 3 and 6 months p <0.05 and p <0.01 respectively vs study onset,
although in this case there was not a signicant difference between 3
and 6 months (Fig. 3C).
3.2. Treatment with GC and GNN improves metabolic status
In agreement with previous results (Vasques et al., 2008), it was
found that glucose, triglycerides and cholesterol levels were reduced in
Table 1
Patients description.
Variable Number (%)
Age 37.8 ±11.5
Male 61 (44.8)
Female 75 (55.2)
Hypertension (H) 27 (19.85)
Dyslipidemia (D) 28 (20.58)
Diabetes mellitus II (DM) 10 (7.35)
H+D 31 (22.80)
H+D+DM 40 (29.41)
Age (mean ±SD); H +D: Hypertension and Dyslipidemia;
H+D+M: hypertension and Dyslipidemia and Diabetes mellitus
type II.
A. Maia-Landim et al.
Journal of Herbal Medicine 26 (2021) 100424
obese patients under GC and GNN therapy. Cholesterol was reduced
signicantly (p <0.01) at 3 and 6 months since study onset (Fig. 4A)
without differences between 3 and 6 months. Triglycerides levels were
only found to be signicantly (p <0.05) reduced at 6 months (Fig. 4B),
in accordance with glucose levels which were signicantly reduced (p <
0.05) at 6 months since study onset (Fig. 4C). All the patients in this
study were evaluated periodically by their physician and they did not
report any adverse effects. Means and standard errors of each gure are
summarized in Table 2.
4. Discussion
It has been widely reported in the literature that GC and GNN
administration has a positive effect in weight and lipids control. How-
ever, many of these reports were hampered by a reduced number of
patients or follow-up (M´
arquez et al., 2012), which creates doubts about
the long-term effects of these treatments. Thus, Ramos and co-workers
reported that treatment with 1.5 g of GC daily for 8 weeks together
with caloric restriction reduce signicantly the weight in obese patients
(Ramos et al., 1995a). Accordingly Mates and Bormann in a study with
overweight patients (n =256) under caloric restriction and treated with
2.4 g of GC per day for 12 weeks also found a reduction in weight
(Mattes and Bormann, 2000). Other studies treated obese/overweight
patients with GC in combination with other plant extracts such as Chi-
tosan, Phaseolus vulgaris, Gymnema silvestra, Matricaria chamomilla,
Rosa damascena, Lavandula ofcinalis and Cananga odorata reporting
similar results. These studies included data no longer than 12 weeks and
Fig. 2. GC and GNN treatment effects in weight. A) GC and GNN reduce weight
in overweight/obese patients. B) Linear regression indicates that weight
reduction is independent of patients sex. C) Correlation test showing that there
is not association between age distribution and weight at 3 months. D) Corre-
lation test showing that there is not association between age distribution and
weight at 6 months. **p <0.01 vs study onset (0 months);
p <0.05 vs
3 months.
Fig. 3. GC and GNN treatment ameliorate and body composition. A) and B) Fat
mass (%) and visceral mass (%) were reduced at 3 and 6 months. C) Increase in
BMR upon treatment with GC and GNN. *p <0.05 and **p <0.01 vs study
onset (0 months);
p <0.01 vs 3 months.
A. Maia-Landim et al.
Journal of Herbal Medicine 26 (2021) 100424
with doses ranging from 0.055 g to 2.8 g per day (Girola et al., 1996;
Preuss et al., 2005; Thom, 2000; Toromanyan et al., 2007). On the other
hand, the benecial action of GNN treatment on weight control has also
been extensively reported. GNN treatment with doses from (1.24 to 3 g
per day) alone or with caloric restriction was able to reduce weight in
obese adult and children patients (Biancardi et al., 1989b; Birketvedt
et al., 2005a; Cairella and Marchini, 1995; Sood et al., 2008a; Vido et al.,
1993; Walsh et al., 1984). In addition, treatment with GC and GNN has
been reported to change lipid proles in overweight/obese patients.
Thus GC and GNN alone or in combination with another other plant
extract or with caloric restriction reduce the levels of cholesterol, tri-
glycerides and low density lipoproteins (Girola et al., 1996; Ramos et al.,
1995b; Sood et al., 2008b; Vuksan et al., 2000; Wardle et al., 2008;
Yoshida et al., 2006). On the other hand, the authors have recently re-
ported that the presence of different polymorphism in overweight/obese
patients may affect the effectiveness of GC and GNN treatment
(Maia-Landim et al., 2018).
In this study, the authors have included a large number of patients
and which have been followed up for 6 months. It was found that in
agreement with previously mentioned studies, this treatment was able to
reduce weight and this reduction was parallel to visceral fat and fat mass
and accordingly increased BMR. Besides, this treatment has a positive
effect on the lipid prole of patients, reducing cholesterol triglycerides
and glucose levels. Previously, it has been reported that combined
treatment of GC and GNN was able to reduce the levels of cholesterol but
without having any signicant effect upon weight, metabolic basal rate,
triglycerides and glucose. In this study, that was a double blind ran-
domized study (n =25 patients in control group and n =32 in study
group) that lasted for 12 weeks, the doses of GC was 2.5 g/day and GNN
1.5 g/day (Vasques et al., 2008). Here, the authors have increased the
number of patients up to 136 and the follow-up to 6 months reducing the
doses of each plant extract to a 1 g/day with the mentioned results.
Differences in the results between two studies might be related to the
number of patients recruited that regarding the present study increase
the possibility of nding signicant differences. Of note, signicant
differences in the lipid prole were only found when the results from 6
months to baseline were compared. These results can be attributable to a
decrease in administered doses and therefore more time is needed to
reduce triglycerides and glucose levels. It is true that our population is
heterogeneous regarding sex and age, which might be interpreted as a
limitation because factors such as hormonal levels are not controlled. It
was recognized that it should be addressed in further studies through
randomized controlled trials. However, it was necessary to test if our
combined treatment might work in different age ranges and in both
sexes as in fact the results would seem to demonstrate.
Others studies have failed to nd differences in weight or changes in
lipid prole in treated patients with GC and GNN (Onakpoya et al.,
2014, 2011; Ríos-Hoyo and Guti´
an, 2016; Semwal et al.,
2015; Zalewski et al., 2015). It is important to keep in mind that GC and
GNN are used in different concentrations and the quality of nal
extracted product sometimes is uncertain and vary among studies. Be-
sides, they are often used in combination with other plant extract which
make difcult to disclose the putative effects of both extracts.
GC and GNN safety have been screened and several studies have
reported that there is no increase in toxicity, side effects or mortality
associated with their use (Keithley et al., 2013; M´
arquez et al., 2012;
Ohia et al., 2002; Wells and Fewtrell, 2005). However, some concerns
have arisen regarding the treatment of GC and hepatic and pancreatic
toxicity (Crescioli et al., 2018; Iqbal et al., 2019; Lunsford et al., 2016).
These side effects might be related to previous pathologies of the pa-
tients, an uncontrolled dosage of the agent, other agents in the prepa-
ration or even that sometimes the preparations might be contaminated
with other substances with unpredictable results (Jamila et al., 2016).
Fig. 4. GC and GNN treatment ameliorate lipid and glucose blood levels. A)
Cholesterol levels at 3 and 6 months of treatment. B) Triglycerides levels at 3
and 6 months of treatment. C) Glucose levels at 3 and 6 months of treatment. *p
<0.05 and **p <0.01 vs study onset (0 months).
Table 2
Data from the graphics.
Parameter Time
Baseline (0) 3 months 6 months
Weight 85.96 ±
72.28 ±
69.84 ±0.68**
Fat mass (%) 31.06 ±
38.52 ±
26.04 ±0.31**
Visceral fat (%) 22.14 ±
20.10 ±0.24 18.26 ±0.26
Basal Metabolic rate (Kcal/
1647 ±
1684 ±
1714 ±29.80**
Cholesterol (mg/dL) 229.1 ±
209.4 ±
198.7 ±2.85**
Tryglicerides (mg/dL) 159.8 ±4.9 148.3 ±3.7 142.9 ±2.9*
Glucose (mg/dL) 95.6 ±1.3 93.8 ±1 91.9 ±0.9*
Data are mean ±standard error of mean. (n =136). *p <0.05 and **p <0.01 vs
study onset (0 months);
p <0.05 and
p <0.01 vs 3 months.
A. Maia-Landim et al.
Journal of Herbal Medicine 26 (2021) 100424
For these reasons, it is of utmost importance to follow up and control the
preparation of the agents and the status of the patients. In this case, a
close follow up of the patients was performed certifying that all were in a
healthy situation given their comorbidities.
Looking at the results, one might think that it is also possible that the
co-treatment with GNN might counteract some of the adverse effects of
GC in these patients. However, to conrm this hypothesis, a new
experimental design must be explored in which a detailed study of liver,
renal and pancreatic function would be carried out.
The authors are aware that to extend the use of this kind of therapy to
treat obesity it is necessary to design more double-blinded randomized
trials, improving the characterization of the different extracts and using
homogenous doses to treat the patients. However, it is also mandatory to
expand our knowledge in the possible long-term effects of the supple-
mentation in obese patients. In this regard, in our study none of the
patients reported any side or adverse effects in the duration of the
treatment supporting the safety of this therapy. Another limitation of
this study is the difculty of differentiating the effects of the Mediter-
ranean diet from the effect of the administration of treatment. For this
reason, new studies would be necessary in which a population that did
not follow this type of diet was included to nd out if the effects of both
extracts are independent of the diet.
The authors consider that one important nding of this study is that
combined treatment was successful independent of age, sex, and pre-
vious associated comorbidity such hypertension, diabetes and dyslipi-
demias supporting that this treatment might be used in a wide variety of
5. Conclusions
This study demonstrated that combined treatment of GC and GNN on
overweight/obese patients, in the long-term reduced weight related to
decreasing visceral fat and fat mass and increasing BMR. This treatment
was also effective in ameliorating the lipid prole of these patients.
These effects were also independent of sex, age or suffering from hy-
pertension, diabetes mellitus type 2 or dyslipidemias. Even though it is
necessary to conduct further research with randomised controlled trials
to assess the long-term effects of these plant extracts, the authors
conclude that the combined treatment with GC and GNN might be a
good candidate to control weight in overweight/obese patients.
Transparency document
The Transparency document associated with this article can be found
in the online version.
CRediT authorship contribution statement
Andrea Maia-Landim: Methodology, Data curation, Writing - orig-
inal draft, Investigation. Carolina Lancho: . María S. Poblador: Su-
pervision, Validation, Writing - review & editing. Jos´
e L. Lancho:
Conceptualization, Supervision, Validation, Writing - review & editing.
Juan M. Ramírez: Conceptualization, Methodology, Investigation.
Declaration of Competing Interest
None to declare.
Non Applicable.
Appendix A. Supplementary data
Supplementary data associated with this article can be found, in the
online version, at
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... After a one week adaptation period, the mice were randomly divided into five groups and received a normal diet (NCD, n = 9, 10 kcal% fat, cat #D10012G, Research Diets, Inc., New Brunswick, NJ, USA), HFD (n = 11, 45 kcal% fat, cat #D12451, Research Diets, Inc.), HFD with oral administration of PW at 100 mg/kg body weight (PW100, n = 10), HFD with PW at 300 mg/kg body weight (PW300, n = 10), or HFD with garcinia cambogia (GC) at 200 mg/kg body weight (GC200, n = 8, Shinwon, Anyang, Korea) for 12 weeks. GC is used a dietary supplement to reduce body fat and has major active ingredients, such as hydroxycitric acid [59]. Mice were provided experimental diet and tap water ad libitum. ...
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The purpose of the present study was to determine whether an anti-obesity effect of a Polygonum multiflorum Thunb. hot water extract (PW) was involved in the lipid metabolism of white adipose tissue (WAT) and brown adipose tissue (BAT) in high-fat diet (HFD)-induced C57BL/6N obese mice. Mice freely received a normal diet (NCD) or an HFD for 12 weeks; HFD-fed mice were orally given PW (100 or 300 mg/kg) or garcinia cambogia (GC, 200 mg/kg) once a day. After 12 weeks, PW (300 mg/kg) or GC significantly alleviated adiposity by reducing body weight, WAT weights, and food efficiency ratio. PW (300 mg/kg) improved hyperinsulinemia and enhanced insulin sensitivity. In addition, PW (300 mg/kg) significantly down-regulated expression of carbohydrate-responsive element-binding protein (ChREBP) and diacylglycerol O-acyltransferase 2 (DGAT2) genes in WAT compared with the untreated HFD group. HFD increased BAT gene levels such as adrenoceptor beta 3 (ADRB3), peroxisome proliferator-activated receptor γ (PPARγ), hormone-sensitive lipase (HSL), cluster of differentiation 36 (CD36), fatty acid-binding protein 4 (FABP4), PPARγ coactivator 1-α (PGC-1α), PPARα, and carnitine palmitoyltransferase 1B (CPT1B) compared with the NCD group; however, PW or GC effectively reversed those levels. These findings suggest that the anti-obesity activity of PW was mediated via suppression of lipogenesis in WAT, leading to the normalization of lipid metabolism in BAT.
... One of these agents is GC, an extract from an Asian plant that has been used as a nutritional supplement to control weight. 3,4 Considering the numerous benefits of GC and the importance of diabetes: the aim of this study was to perform a mini review about GC consumption and its relationship with DM condition in humans. ...
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Medicinal plants, particularly edible plants have long been used as traditional knowledge to treat and prevent obesity, especially in Asian countries, because various bioactive compounds from both herbs and fruits have been found useful for anti-obesity drug discovery and development processes. Obesity is an important problem for normal growth in children, with both primary and secondary health risks such as high blood pressure, insulin resistance, hypertension, cardiovascular diseases, and different cancers. The different mechanisms which medicinal plants may affect weight loss consist of increasing levels of leptin, hypolipidemic and hypoglycemic effects, reducing fat absorption, influencing fat metabolism, enhancing metabolism, decreasing appetite, and preventing carbohydrate intake. The most important medicinal plants which are common in traditional medicinal sciences of different countries due to their anti-obesity activities are Acosmium dasycarpum (Vog.) Yakovlev, Allium cepa L., Aloe barbadensis Miller, Amorphophallus konjac K. Koch., Artemisiasphaerocephala Krasch, Betula utilis, Bupleuri Radix, Butea monosperma, Caralluma fimbriata, Corchorus olitorius L., Cuminum cyminum L., Carum carvi L., Cyclopia spp., Cynara scolymus L., Cynometra cauliflora Linn., Cynomorium songaricum Rupr., Echium angustifolium Mill., Echium angustifolium Mill., Garcinia cambogia, Gnidia glauca (Fres.) Glig, Ganodermalucidum sensu strict, Gnidia glauca (Fres.) Glig., Hibiscus sabdariffa L., Ilex paraguariensis, Justicia carnea Lindl., Juniperus communis L., Ligustrum robustum Blume, Lobelia chinensis lour, Macrotyloma uniflorum (Lam.) Verdc., Mangifera indica Linn., Melissa officinalis L., Memecylon umbellatum Burm. f., Moringa oleifera Lam., Moringa peregrine (Forssk.) Fiori., Morus alba L., Nigella sativa L., Oroxylum indicum Kurz, Passiflora edulis Sims, Pilosocereusgounellei (F.A.C. Weber) Byles & G.D.Rowley, Piper nigrum L., Populus balsamifera L., Psidium guajava L., Raphanus sativus L., Salacia chinensis L., Salvia hispanica L., Salviaofficinalis L., Smilax china L., Smilax glabra Roxb., Solenostemma argel Hayne, TabebuiaavellanedaeLorentz ex Griseb, Tinospora cordifolia (Thunb.) Miers.,Urtica dioica L., Vaccinium arctostaphylos L., and Withania somnifera (L.) Dunal. Three main types of hepatitis are known as hepatitis A, B, and C, and two other types are D and E. Each is caused by a different virus, and all three types can be acute, lasting for 6 months or less, and types B and C can be chronic, lasting for longer. The most important herbs which use to prevent and treatment of different kinds of hepatitis are cordyceps (Cordyceps sinensis), milk thistle (Silybum marianum), licorice root (Glycyrrhiza glabra), and reishi mushroom (Ganoderma lucidum). Chinese medicine uses nutrition, acupuncture, heat therapies (such as moxibustion), exercise, massage, meditation, and herbal medicine to treat people infected by hepatitis C virus. The review has shown some traditional Chinese medicinal herbs and plants may have positive influence on treatment of hepatitis, but may few of them associated with side effects.
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Overweight and obesity have become global epidemics, especially during the lockdown due to the COVID-19 pandemic. The potential of medicinal plants as a better and safe option in treating obesity and overweight has gained attention in recent years. Obesity and overweight has become a major public health concern, and its incidence rising at an alarming rate. Obesity is one of the major types of metabolic syndrome, resulting in various types of problems such as hyperten-sion, diabetes, dyslipidemia, and excess fat accumulation. The current searching was done by the keywords in main indexing systems including Scopus, PubMed/MEDLINE, the search engine of Google Scholar, and Institute for Scientific Web of Science. The keywords were traditional medicine , health benefits, pharmaceutical science, pomegranate, punicalin, punicalagin, and ellagitan-nins. Google Scholar was searched manually for possible missing manuscripts, and there was no language restriction in the search. This review was carried out to highlight the importance of medicinal plants which are common in traditional medicinal sciences of different countries, especially Asia to prevent and treatment of obesity and overweight during the global pandemic and the post-COVID-19 era.
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Both observational and interventional studies suggest an important role for physical activity and higher fitness in mitigating the metabolic syndrome. Each component of the metabolic syndrome is, to a certain extent, favorably influenced by interventions that include physical activity. Given that the prevalence of the metabolic syndrome and its individual components (particularly obesity and insulin resistance) has increased significantly in recent decades, guidelines from various professional organizations have called for greater efforts to reduce the incidence of this condition and its components. While physical activity interventions that lead to improved fitness cannot be expected to normalize insulin resistance, lipid disorders, or obesity, the combined effect of increasing activity on these risk markers, an improvement in fitness, or both, has been shown to have a major impact on health outcomes related to the metabolic syndrome. Exercise therapy is a cost-effective intervention to both prevent and mitigate the impact of the metabolic syndrome, but it remains underutilized. In the current article, an overview of the effects of physical activity and higher fitness on the metabolic syndrome is provided, along with a discussion of the mechanisms underlying the benefits of being more fit or more physically active in the prevention and treatment of the metabolic syndrome.
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Hydroxycitric acid (HCA), a major active ingredient of Garcinia cambogia extracts, is known to suppress body weight gain and fat synthesis in animals and humans. But the underlying mechanism of HCA action is not fully understood. Clinical study on 100 obese individuals for a period of 3 months was performed followed by a computational study aimed to investigate the effects of HCA treatment on human subjects at anthropometric and plasma lipid profile levels. A detailed hepatic metabolic model was used to incorporate the effect of HCA at the metabolic pathway level. Perturbation analysis of ATP citrate lyase activity in the metabolic pathway was performed to simulate the net effect of HCA. Significant reductions in body weight, triceps, subscapular, and mid axillary measurements as well as in serum triglyceride, cholesterol, HDL and LDL levels were observed following HCA dosage. During the study, half of the subjects experienced a decline in body weight and the remainder experienced an increase in body weight. However, analysis of fat mass with the help of empirical correlations clearly showed significant reduction in the mean values due to HCA dosage in both cases. An extra increase in fat free mass was responsible for offsetting the decrease in fat mass for the subjects who experienced an increase in body weight during the trials. Perturbation analysis showed a net reduction in fatty acid, triglyceride and cholesterol synthesis along with urea cycle fluxes under lipogenetic conditions. Moreover, protein synthesis fluxes increased under these conditions. These results indicate that HCA treatment can reduce body weight gain and fat accumulation in obese subjects along with improving their anthropometric parameters and metabolic state.
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Herbal weight-loss supplements are sold as self-medication products, and are often used under the misconception that their natural origin guarantees their safety. Food supplements are not required to provide any benefit/risk profile evaluation before marketing; however, possible risks associated with use of herbal extracts in food supplements are becoming more and more documented in the literature. Some herbs are listed as the leading cause of herb-induced liver injury, with a severe or potentially lethal clinical course, and unpredictable herb–drug interactions. Garcinia cambogia (GC) extract and GC-containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we present four cases of acute liver failure in women taking GC extract for weight loss, and a literature review of clinical evidences about hepatic toxicity in patients taking dietary supplements containing GC extract.
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Background: Overweight and obesity are considered major health problems that contribute to increase mortality and quality of life. Both conditions have a high prevalence across the world reaching epidemic numbers. Our aim was to evaluate the effects of the administration of Garcinia cambogia (GC) and Glucomannan (GNN) on long-term weight loss in people with overweight or obesity. Methods: Prospective, not-randomized controlled intervention trial was conducted. We treated 214 subjects with overweight or obesity with GC and GNN (500 mg twice a day, each) for 6 months evaluating weight, fat mass, visceral fat, basal metabolic rate, and lipid and glucose blood profiles comparing them with basal values. Some patients were carriers of polymorphisms PLIN4 -11482G > A-, fat mass and obesity-associated (FTO) -rs9939609 A/T- and β-adrenergic receptor 3 (ADRB3) -Trp64Arg. Results: Treatment produced weight loss, reducing fat mass, visceral fat, lipid and blood glucose profiles while increasing basal metabolic rate. Results were independent of sex, age or suffering from hypertension, diabetes mellitus type 2 or dyslipidemia and were attenuated in carriers of PLIN4, FTO, Trp64Arg polymorphisms. Conclusions: Administration of GC and GNN reduce weight and improve lipid and glucose blood profiles in people with overweight or obesity, although the presence of polymorphisms PLIN4, FTO and ADRB3 might hinder in some degree these effects. ISRCTN78807585, 19 September 2017, retrospective study.
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Commercial dietary supplements are marketed as a panacea for the morbidly obese seeking sustainable weight-loss. Unfortunately, many claims cited by supplements are unsupported and inadequately regulated. Most concerning, however, are the associated harmful side effects, often unrecognized by consumers. Garcinia cambogia extract and Garcinia cambogia containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we report the first known case of fulminant hepatic failure associated with this dietary supplement. One active ingredient in this supplement is hydroxycitric acid, an active ingredient also found in weight-loss supplements banned by the Food and Drug Administration in 2009 for hepatotoxicity. Heightened awareness of the dangers of dietary supplements such as Garcinia cambogia is imperative to prevent hepatoxicity and potential fulminant hepatic failure in additional patients. © The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
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Species of genus Garcinia are rich sources of bioactive constituents with antimicrobial, anticancer, anti-inflammatory, hepatoprotective and anti-HIV activities. Commercial products of Garcinia cambogia are used as anti-obesity drugs with increasing market demand. Because of the high price of its products, it could be adulterated with similar lower-priced species. This study was designed to develop and validate an accurate and efficient method for the detection of any adulteration (G. indica) in G. cambogia products. For this purpose, high performance liquid chromatography (HPLC) was used to analyze the ethanolic fruit rind extracts of G. cambogia, G. indica, their formulations of 0.5, 1, 2, 5, 10, 20, 30, 40, 50, 60, 70, 80, 90 and 95% G. indica with G. cambogia, and eleven G. cambogia commercial products. The analytical methods were validated by quality assurance parameters of linearity, sensitivity, precision and accuracy. Two marker peaks were detected in G. indica fruit extract, whereas G. cambogia did not show these peaks. The detected peaks were identified as anthocyanins; cyanidin-3-O-sambubioside and cyanidin-3-O-glucoside. In the study to determine the effect of pH and temperature on the stability of its anthocyanins content, HPLC analysis of G. indica extract showed the highest content at pH 1 and 50 °C. Using two different mobile phases, the limits of detection (LOD) for cyanidin-3-O-sambubioside and cyanidin-3-O-glucoside were 0.036 and 0.059, and 0.022 and 0.033 mg/kg, respectively. Furthermore, the inter-day precision (< 3.2%) confirmed that the applied analytical method fulfils the required criteria of Association of Official Analytical Chemists (AOAC). From this study, it was found that the HPLC method used for the detection of adulteration in G. cambogia products is rapid and accurate.
Due to the global epidemic of obesity, weight loss and appetite suppressant herbal products are quite popular. As these medications are not United States Food and Drug Administration-approved and are regulated as dietary supplements, little evidence exists regarding their safety. This case discusses an 82-year-old man with the past medical history of obesity who presented to the emergency department with abdominal pain in the epigastric region. His serum lipase was elevated, and an abdominal computed tomography revealed acute pancreatitis (AP). He reported two episodes of AP in the past. He denied any alcohol use and reported no recent changes in his medications. He reported taking Garcinia cambogia (GC) recently as an appetite suppressant. Due to prior cholecystectomy, no alcohol abuse, no recent changes in medications and recent use of GC, a likely etiology of AP was thought to be secondary to the use of GC. He was treated with bowel rest and intravenous fluid hydration with significant improvement in his symptoms. He was advised to avoid GC in the future. Clinicians should be vigilant in evaluating their patients with AP and should get a meticulous history regarding their use of over-the-counter medications and herbal products.
Abstract Human mortality has been significantly increased in last few decades due to the increased prevalence of obesity and associated chronic disorders such as type 2 diabetes, non-alcoholic fatty liver disease, coronary heart disease and atherosclerosis. Apart from genetic and medicine or drug related side effects, nearly 90–95% people became obese due to the imbalanced calorie intake and lack of nutritional knowledge. The anti-obesogenic drugs, Orlistat and Sibutramine, which have been duly approved by Food and Drug Administration (FDA), USA, work very well on diet-induced obesity however they are not getting popular to the people with overweight/obesity due to the higher cost and severe side effects. In contrast, plant based drugs have been considered as a better alternative due to their lower cost and negligible side effects. A number of medicinal plants and their bioactive constituents have received attention from scientists not only for their anti-obesity activity in vitro and in vivo but also in clinical trials. However, there is no systematic review of data available in the scientific domain in order to guide researchers to conduct further in depth research. In our present review, we differentiated the anti-obesogenic effects of various medicinal plant extracts, fractions and their bioactive compounds at in vitro, in vivo and clinical conditions. During our review, we could also identify the most effective plants with strong anti-obesogenic effects at in vitro or in vivo studies with lack of clinical trials when no one tried to isolate pure bioactive compounds from these plants. Hence, scientific community, government agencies/pharmaceutical industries should work together not only to isolate pure bioactive compounds but also to conduct clinical trials including toxicity to develop better alternative anti-obesity drugs.
Syndromic monogenic obesity typically follows Mendelian patterns of inheritance and involves the co-presentation of other characteristics, such as mental retardation, dysmorphic features and organ-specific abnormalities. Previous reviews on obesity have reported 20 to 30 syndromes but no systematic review has yet been conducted on syndromic obesity. We searched seven databases using terms such as 'obesity', 'syndrome' and 'gene' to conduct a systematic review of literature on syndromic obesity. Our literature search identified 13,719 references. After abstract and full-text review, 119 relevant papers were eligible, and 42 papers were identified through additional searches. Our analysis of these 161 papers found that 79 obesity syndromes have been reported in literature. Of the 79 syndromes, 19 have been fully genetically elucidated, 11 have been partially elucidated, 27 have been mapped to a chromosomal region and for the remaining 22, neither the gene(s) nor the chromosomal location(s) have yet been identified. Interestingly, 54.4% of the syndromes have not been assigned a name, whereas 13.9% have more than one name. We report on organizational inconsistencies (e.g. naming discrepancies and syndrome classification) and provide suggestions for improvements. Overall, this review illustrates the need for increased clinical and genetic research on syndromes with obesity.
The United States is experiencing its greatest life expectancy ever. Nonetheless, the general health of the US population is far from at an all-time high. An important contributor to the pandemic of cardiovascular disease is that overweight and obesity are also the major determinants of metabolic syndrome, an all too common and all too serious clinical and public health challenge. Clinicians have traditionally evaluated each of the major risk factors contributing to metabolic syndrome on an individual basis. There is evidence, however, that the risk factors are more than additive. The overlap of these factors in each disease state, resulting in increased atherogenic risks, is worth examining as a broader entity rather than separately. While therapeutic lifestyle changes (TLCs) should be strongly recommended, clinicians should not let the perfect be the enemy of the possible. Evidence-based doses of statins, aspirin and angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers should be prescribed as adjuncts, not alternatives, to TLCs. In fact, there is cogent evidence that the benefits of these pharmacologic therapies may also be at least additive.