Hydroxycitric acid (HCA)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
Bio-Max 3000, brindal berry, brindleberry, Citrilite®, CitriMax®, gambooge, Garcinia, Garcinia atroviridis, Garcinia cambogia, Garcinia indica, Garcinia-Max Diet System, Garcinia Trim-Plus®, gorikapuli, Hibiscus sabdariffa, (-)-hydroxycitrate (HCA), Malabar tamarind, PhytriMax®, Super Garcinia®, Super Prolean® mega fat burner, SuperCitrimax®.
Combination products: Avesil® (Super Citrimax, chromium, and green tea extract), Awe Slim® (aloe vera juice, hydrolyzed collagen, apple cider vinegar, conjugated linoleic acid, Garcinia cambogia extract, L-carnitine, L-arginine, L-lysine, and L-ornithine), Citri Chrome® (Garcinia cambogia and chromium picolinate), Citrin® (maltodextrin, Garcinia cambogia extract, microcrystalline cellulose, starch, magnesium stearate, chromium picolinate), Garcinia 1000® (chromium, picolinate, Garcinia berry extract, HCA), HCA with calcium/potassium salt (HCA-SX), Herbalife®'s "Snack Defense" tablets (Gymnema sylvestre, chromium polynicotinate, Garcinia cambogia), Hydroxycut® (Garcinia cambogia, chromium polynicotinate, and Gymnema sylvestre), Lite Bites™ (sugar, chromium picolinate, Garcinia cambogia), Metabolife® Ephedra-Free (green tea extract, Super Citrimax®, Garcinia cambogia extract, guarana extract, yerba mate extract).
Note: Hydroxycut® was withdrawn from the U.S. market on May 1, 2009 for causing liver injury.
(-)-Hydroxycitric acid (HCA) is a main component of the dried fruit rind of Garcinia cambogia, a native Southeast Asian plant commonly known as brindleberry or Malabar tamarind. HCA is present in high concentrations in Garcinia cambogia and is also found in the tropical plant Hibiscus sabdariffa. The dried rind of Garcinia cambogia has been used widely as a food preservative, a flavoring agent, and a carminative (prevents or relieves gas in the stomach and intestines). In Indian folk medicine, Garcinia cambogia is used to treat rheumatism (pain in the bones, muscles, joints, and tendons) and bowel complaints.
HCA is currently used in a number of over-the-counter weight loss products. HCA may also enhance exercise performance, but different studies have produced conflicting results. More high-quality clinical trials are needed.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
The effect of HCA on weight loss has been investigated. In some studies individuals lost weight after HCA treatment, and in others, did not. More high quality research is needed.
In some clinical studies, HCA caused a detectable increase in fat metabolism, which may increase exercise performance; however, other studies have not found such an increase. Additional study is required before firm conclusions can be made.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Bowel cramps, carminative (prevents or relieves intestinal gas), rheumatism (joint pain), stomach ulcers.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
For exercise performance, 250 milligrams has been taken by mouth daily for five days.
For weight loss, the following doses have been taken by mouth: 500 milligrams, three times daily for seven days; 4,667 milligrams, three times daily, five days weekly for 12 weeks; and 300 milligrams, three times daily for two weeks.
Children (under 18 years old)
There is no proven safe or effective dose for hydroxycitric acid in children.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Avoid in individuals with known allergy or hypersensitivity to hydroxycitric acid (HCA) or plants which contain HCA, such as those in the Garcinia group.
Side Effects and Warnings
HCA may cause zinc deficiency when taken as a free acid or lactone.
Chest pain has occurred with use of a product containing a number of herbs and supplements, including Garcinia cambogia.
Use cautiously in patients with a history of rhabdomyolysis (breakdown of muscle fibers and their export into the blood) or in patients taking cholesterol-lowering agents, due to an increased risk for rhabdomyolysis.
HCA may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or in those taking drugs, herbs, or supplements that may increase the risk of bleeding. Dosing adjustments may be necessary.
HCA may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
Use cautiously in males, as HCA use may have negative effects on the prostate and testicles.
Use cautiously in patients with liver disorders, Alzheimer's disease and other forms of dementia, or in patients with a history of gallstones.
Avoid use of Hydroxycut®. On May 1, 2009, the U.S. Food and Drug Administration (FDA) warned consumers to immediately stop using Hydroxycut® (Garcinia cambogia extract, chromium polynicotinate, and Gymnema sylvestre extract). The FDA has received reports of serious health problems including jaundice (a condition marked by yellowing of the skin), elevated liver enzymes (an indicator of potential liver injury), liver damage, and death from liver failure.
Avoid in individuals with known allergy or hypersensitivity to HCA or plants which contain HCA, such as those in the Garcinia group.
Avoid in pregnant or breastfeeding women.
Pregnancy and Breastfeeding
Avoid use of HCA in pregnant or breastfeeding women, due to a lack of sufficient evidence.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
HCA may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
HCA may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
HCA may also interact with agents that cause dilation of the bronchial tubes, antiarrhythmic agents, antibiotics, anticancer drugs, antifungals, anti-inflammatory drugs, cholesterol-lowering agents, exercise performance enhancers, and weight loss drugs.
Interactions with Herbs and Dietary Supplements
HCA may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
HCA may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
HCA may also interact with antiarrhythmics, antibacterials, anticancer herbs and supplements, antifungals, anti-inflammatory herbs and supplements, antioxidants, cholesterol-lowering herbs and supplements, exercise performance enhancers, Gymnema sylvestre, herbs and supplements that cause dilation of the bronchial tubes, lipogenic diet (high carbohydrate diet), niacin-bound chromium, and weight loss herbs and supplements.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Heymsfield SB, Allison D, Vasselli JR, et al. Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomized controlled trial. JAMA 1998;280(18):1596-1600. View Abstract
Kovacs EM, Westerterp-Plantenga MS. Effects of (-)-hydroxycitrate on net fat synthesis as de novo lipogenesis. Physiol Behav 2006;88(4-5):371-381. View Abstract
Lim K, Ryu S, Nho HS, et al. (-)-Hydroxycitric acid ingestion increases fat utilization during exercise in untrained women. J Nutr Sci Vitaminol (Tokyo) 2003;49(3):163-167. View Abstract
Lim K, Ryu S, Ohishi Y, et al. Short-term (-)-hydroxycitrate ingestion increases fat oxidation during exercise in athletes. J Nutr Sci Vitaminol (Tokyo) 2002;48(2):128-133. View Abstract
Mansi IA, Huang J. Rhabdomyolysis in response to weight-loss herbal medicine. Am J Med Sci 2004;327(6):356-357. View Abstract
Mattes RD, Bormann L. Effects of (-)-hydroxycitric acid on appetitive variables. Physiol Behav 2000;71(1-2):87-94. View Abstract
Michno A, Skibowska A, Raszeja-Specht A, et al. The role of adenosine triphosphate citrate lyase in the metabolism of acetyl coenzyme a and function of blood platelets in diabetes mellitus. Metabolism 2004;53(1):66-72. View Abstract
Ohia, SE, Opere, CA, LeDay, AM, et al. Safety and mechanism of appetite suppression by a novel hydroxycitric acid extract (HCA-SX). Mol. Cell Biochem. 2002;238(1-2):89-103. View Abstract
Peal A, D'Altilio M, Simms C, et al. Therapeutic efficacy and safety of undenatured type-II collagen (UC-II) alone or in combination with (-)-hydroxycitric acid and chromemate in arthritic dogs. J Vet Pharmacol Ther 2007;30(3):275-8. View Abstract
Preuss HG, Garis RI, Bramble JD, et al. Efficacy of a novel calcium/potassium salt of (-)-hydroxycitric acid in weight control. Int J Clin Pharmacol Res 2005;25(3):133-144. View Abstract
Roongpisuthipong C, Kantawan R, Roongpisuthipong W. Reduction of adipose tissue and body weight: effect of water soluble calcium hydroxycitrate in Garcinia atroviridis on the short term treatment of obese women in Thailand. Asia Pac J Clin Nutr 2007;16(1):25-9. View Abstract
Tomita K, Okuhara Y, Shigematsu N, et al. (-)-hydroxycitrate ingestion increases fat oxidation during moderate intensity exercise in untrained men. Biosci.Biotechnol.Biochem. 2003;67(9):1999-2001. View Abstract
van Loon LJ, van Rooijen JJ, Niesen B, et al. Effects of acute (-)-hydroxycitrate supplementation on substrate metabolism at rest and during exercise in humans. Am J Clin Nutr 2000;72(6):1445-1450. View Abstract
Westerterp-Plantenga MS, Kovacs EM. The effect of (-)-hydroxycitrate on energy intake and satiety in overweight humans. Int J Obes Relat Metab Disord 2002;26(6):870-872. View Abstract
Yamada T, Hida H, Yamada Y. Chemistry, physiological properties, and microbial production of hydroxycitric acid. Appl Microbiol Biotechnol 2007;75(5):977-82. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017