- Hydroxycitric acid
For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
How It Works
Garcinia gummi-gutta and one of its active compounds, hydroxycitric acid (HCA), have been promoted for weight loss or body building, but evidence is insufficient and mixed.
Garcinia gummi-gutta, better known by its older name Garcinia cambogia, is a plant native to Southeast Asia. The fruit rinds are used as a flavoring agent and in traditional medicine. The extract and its active compound, HCA, can be found in many products promoted for weight loss or body building.
Preclinical animal studies suggest some benefits on weight and feed intake. However, human studies are limited and generally did not find effects on appetite, calorie intake, or weight loss.
G. cambogia and HCA supplements may cause liver toxicity. Patients who have cancer, diabetes, depression, or other chronic diseases should use garcinia with caution as it may interact with medications.
Humans studies are limited and did not find decreases in calorie intake or appetite.
Obesity, weight loss
Controlled trials are mixed, but showed no benefit over placebo for weight loss.
Although garcinia has been used in traditional medicine, studies on its effects for digestive problems have not been conducted.
Do Not Take If
- You are having lab tests to measure cholesterol or blood sugar levels: Taking garcinia may cause results to be inaccurate.
- You are taking antidepressants: Several case reports have described manias and potential interactions with antidepressants.
- You have liver problems: A number of case reports have associated G. cambogia and HCA supplements with liver toxicity and injury.
- You are pregnant: G. cambogia has not been tested in pregnant women.
- You have diabetes: G. cambogia can decrease insulin levels and affect blood sugar levels.
- You are taking CYP2B6 substrate drugs: Lab studies suggest potential interactions with drugs metabolized by this enzyme and garcinia. A number of drug classes may be affected, including antitumor drugs (cyclophosphamide, ifosphamide, and sorafenib), antimalarials (artemisinin), antidepressants (bupropion, selegiline), antivirals (efavirenz), analgesics (methadone, meperidine), and anticonvulsants (valproic acid).
Common: Nausea, headache, GI discomfort
Rare: Itching around the mouth, upper respiratory tract symptoms
Acute hepatitis, livery injury/toxicity: Multiple cases
Liver failure requiring transplant: In a 52-year-old woman and a 34-year old man, both associated with the use of G. cambogia.
Mania, psychosis: Several cases, both with and without psychiatric histories
Skeletal muscle damage: In an 18-year-old man, possibly associated with the ingestion of an herbal supplement that contained HCA in addition to his increased exercise regimen.
Acute kidney injury: In a 38-year-old obese woman after long-term use of an HCA-containing supplement.
Serotonin toxicity: Suspected in a 35-year-old woman taking serotonin reuptake inhibitors (SSRIs) along with a nutritional supplement containing G. cambogia and HCA.
Cardiovascular toxicity: In a previously healthy 48-year-old woman taking G. cambogia extract.
Diabetic complications, pancreatic inflammation, and severe heart muscle weakness: In a 56-year-old woman with a complex medical history and whose outpatient medication had not been adjusted in the last 3 years. These events occurred after several weeks of G. cambogia consumption and sudden weight loss, and was therefore felt to be possibly related.
Acute pancreatitis: Possibly associated with garcinia, in an 82-year-old man with history of obesity and prior gallbladder removal.
Decreased vision and ocular pain: In an obese patient who took garcinia extract at a higher than recommended dose.
For Healthcare Professionals
Garcinia gummi-gutta, better known by its older name Garcinia cambogia, is a plant native to Southeast Asia. The fruit rinds have antioxidant and anticholinesterase activities (1), and are used as a flavoring agent and in traditional medicine to treat gastrointestinal ailments. The extract, rich in hydroxycitric acid (HCA), can be found in many products promoted for weight loss or body building.
In animal studies, G. cambogia increased satiety, fatty acid oxidation, and weight loss (3) (4) and seemed to protect against high-fat and high-sugar diets (5) (6). An ethanol extract of garcinia also showed erythropoietic effects (7).
In humans, clinical trials are limited. HCA did not decrease caloric intake, promote satiety, or affect fat oxidation (8) (9) (10), but improved glycogen synthesis and insulin sensitivity in a small study (10). Other preliminary data suggest garcinia may improve HDL levels, but have minimal effects on other plasma lipids (8). Results from RCTs are mixed, but show no significant effect of G. cambogia extract over placebo for weight reduction (12) (13). A combination of G. cambogia with orlistat had more effects on cardiometabolic profiles and visceral adiposity index than orlistat alone in obese patients (14).
G. cambogia and HCA supplements have been associated with liver toxicity, mania, and herb-drug interactions. Patients who have cancer, diabetes, depression, or other chronic diseases, or women who are pregnant should use G. cambogia with caution.
G. cambogia should not be confused with Garcinia mangostana (Mangosteen).
Mechanism of Action
The negative isomer of hydroxycitric acid ((-)-HCA), may be the most active chemical compound of G. cambogia fruit rind. HCA is theorized to affect weight loss via decreased fatty acid synthesis, appetite suppression, and increased fatty acid metabolism. It competitively inhibits ATP-citrate lyase, the enzyme that catalyzes the conversion of citrate to substrates for fatty acid synthesis (3). Increased citrates in the cytoplasm may reduce glycolysis and increase glycogen synthesis. ATP-citrate lyase is also upregulated in cancer cells with high levels of aerobic glycolysis (18).
An animal study observed decreases in leptin and insulin levels in obese mice treated with HCA, which may suggest alterations in glucose metabolism (4). The iron contents in G. cambogia may contribute to the erythropoietic effect observed in animals (7).
Skeletal muscle damage: In an 18-year-old man, possibly associated with the ingestion of a supplement containing HCA in addition to his increased exercise regimen (27).
Nephropathy: In a 38-year-old obese woman after long-term use of an HCA-containing supplement (28).
Suspected serotonin toxicity: In a 35-year-old woman taking SSRIs along with a supplement containing G. cambogia and HCA, who presented with stuttering, profuse sweating, hypertension, and tachycardia. Although a direct cause could not be proven, she had already used escitalopram without incident for over 1 year and developed serotonin toxicity only after the addition of G. cambogia (29).
Myocarditis: In a previously healthy 48-year-old woman taking G.cambogia extract (30).
Diabetic ketoacidosis, pancreatitis, and stress cardiomyopathy: In a 56-year-old woman with a complex medical history and whose outpatient medications had not been adjusted in the last 3 years. These events transpired after several weeks of G. cambogia consumption and sudden weight loss, and was therefore felt to be possibly related (31).
Acute pancreatitis: Possibly associated with garcinia, in an 82-year-old man with history of obesity and prior cholecystectomy (43).
Decreased vision and ocular pain: In an obese patient who took garcinia extract at a higher than recommended dose (44).
Leukotriene receptor antagonists: A case report noted fatal liver failure when G. cambogia extract and another weight loss supplement was used along with the leukotriene receptor antagonist montelukast, but it is unclear if liver failure was due to G. cambogia (36).
CYP2B6 substrate drugs: In vitro studies suggest G. cambogia extract could modulate the pharmacokinetics of these drugs, potentially causing interactions (37). A number of drug classes may be affected, including antitumor drugs (cyclophosphamide, ifosphamide, and sorafenib), antimalarials (artemisinin), antidepressants (bupropion, selegiline), antivirals (efavirenz) analgesics (methadone, meperidine), and anticonvulsants (valproic acid). However, HCA did not exhibit significant effects on CYP450.