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Garcinia cambogia, Either Alone or in Combination With Green Tea, Causes Moderate to Severe Liver Injury

Published:August 13, 2021DOI:https://doi.org/10.1016/j.cgh.2021.08.015

      Background & Aims

      Garcinia cambogia, either alone or with green tea, is commonly promoted for weight loss. Sporadic cases of liver failure from G cambogia have been reported, but its role in liver injury is controversial.

      Methods

      Among 1418 patients enrolled in the Drug-Induced Liver Injury Network (DILIN) from 2004 to 2018, we identified 22 cases (adjudicated with high confidence) of liver injury from G cambogia either alone (n = 5) or in combination with green tea (n = 16) or Ashwagandha (n = 1). Control groups consisted of 57 patients with liver injury from herbal and dietary supplements (HDS) containing green tea without G cambogia and 103 patients from other HDS.

      Results

      Patients who took G cambogia were between 17 and 54 years, with liver injury arising 13–223 days (median = 51) after the start. One patient died, one required liver transplantation, and 91% were hospitalized. The liver injury was hepatocellular with jaundice. Although the peak values of aminotransferases were significantly higher (2001 ± 1386 U/L) in G cambogia group (P < .018), the median time for improvement in total bilirubin was significantly lower compared with the control groups (10 vs 17 and 13 days; P = .03). The presence of HLA-B∗35:01 allele was significantly higher in the G cambogia containing HDS (55%) compared with patients because of other HDS (19%) (P = .002) and those with acute liver injury from conventional drugs (12%) (P = 2.55 × 10–6).

      Conclusions

      The liver injury caused by G cambogia and green tea is clinically indistinguishable. The possible association with HLA-B∗35:01 allele suggests an immune-mediated mechanism of injury. Clinical Trials.gov number: NCT00345930.

      Graphical abstract

      Keywords

      Abbreviations used in this paper:

      ALT (alanine aminotransferase), AST (aspartate aminotransferase), DILIN (Drug-Induced Liver Injury Network), HCA (hydroxycitric acid), HDS (herbal and dietary supplements)
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      References

        • Collaboration N. C. D. R. F
        Rising rural body-mass index is the main driver of the global obesity epidemic in adults.
        Nature. 2019; 569: 260-264
        • Krishnaswami A.
        • et al.
        Real-world effectiveness of a medically supervised weight management program in a large integrated health care delivery system: five-year outcomes.
        Perm J. 2018; 22: 17-082
        • Myers V.H.
        • et al.
        Five-year medical and pharmacy costs after a medically supervised intensive treatment program for obesity.
        Am J Health Promot. 2014; 28: 364-371
        • Elangovan A.
        • Shah R.
        • Smith Z.L.
        Pharmacotherapy for obesity-trends using a population level national database.
        Obes Surg. 2021; 31: 1105-1112
        • Tak Y.J.
        • Lee S.Y.
        Anti-obesity drugs: long-term efficacy and safety—an updated review.
        World J Mens Health. 2020; 39: 208-221
        • Astell K.J.
        • Mathai M.L.
        • Su X.Q.
        Plant extracts with appetite suppressing properties for body weight control: a systematic review of double blind randomized controlled clinical trials.
        Complement Ther Med. 2013; 21: 407-416
        • Homoud M.K.
        The sale of weight-loss supplements on the Internet: a lurking health care crisis waiting to strike.
        Heart Rhythm. 2009; 6: 663-664
        • Rizvi R.F.
        • et al.
        Analyzing social media data to understand consumer information needs on dietary supplements.
        Stud Health Technol Inform. 2019; 264: 323-327
        • Sfodera F.
        • Mattiacci A.
        • Nosi C.
        • et al.
        Social networks feed the food supplements shadow market.
        British Food Journal. 2020; 122: 1531-1548
        • Xing S.
        • Sharp L.K.
        • Touchette D.R.
        Weight loss drugs and lifestyle modification: perceptions among a diverse adult sample.
        Patient Educ Couns. 2017; 100: 592-597
        • Pillitteri J.L.
        • et al.
        Use of dietary supplements for weight loss in the United States: results of a national survey.
        Obesity (Silver Spring). 2008; 16: 790-796
      1. Available at: https://www.nccih.nih.gov/health/garcinia-cambogia. Accessed June 27, 2021.

        • Ohia S.E.
        • et al.
        Safety and mechanism of appetite suppression by a novel hydroxycitric acid extract (HCA-SX).
        Mol Cell Biochem. 2002; 238: 89-103
        • Jena B.S.
        • Jayaprakasha G.K.
        • Singh R.P.
        • et al.
        Chemistry and biochemistry of (-)-hydroxycitric acid from Garcinia.
        J Agric Food Chem. 2002; 50: 10-22
        • Mattes R.D.
        • Bormann L.
        Effects of (-)-hydroxycitric acid on appetitive variables.
        Physiol Behav. 2000; 71: 87-94
        • Garcia-Cortes M.
        • Robles-Diaz M.
        • Ortega-Alonso A.
        • et al.
        Hepatotoxicity by dietary supplements: a tabular listing and clinical characteristics.
        Int J Mol Sci. 2016; 17: 537
      2. Payab M, et al. Effect of the herbal medicines in obesity and metabolic syndrome: a systematic review and meta-analysis of clinical trials. Phytother Res 202;34:526–545.

        • Hayamizu K.
        • et al.
        Effects of garcinia cambogia (hydroxycitric acid) on visceral fat accumulation: a double-blind, randomized, placebo-controlled trial.
        Curr Ther Res Clin Exp. 2003; 64: 551-567
        • Heymsfield S.B.
        • et al.
        Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomized controlled trial.
        JAMA. 1998; 280: 1596-1600
        • Opala T.
        • Rzymski P.
        • Pischel I.
        • et al.
        Efficacy of 12 weeks supplementation of a botanical extract-based weight loss formula on body weight, body composition and blood chemistry in healthy, overweight subjects: a randomised double-blind placebo-controlled clinical trial.
        Eur J Med Res. 2006; 11: 343-350
        • Preuss H.G.
        • et al.
        An overview of the safety and efficacy of a novel, natural(-)-hydroxycitric acid extract (HCA-SX) for weight management.
        J Med. 2004; 35: 33-48
        • Burdock G.
        • Soni M.
        • Bagchi M.
        • et al.
        Garcinia cambogia toxicity is misleading.
        Food Chem Toxicol. 2005; 43: 1683-1684
        • Crescioli G.
        • et al.
        Acute liver injury following Garcinia cambogia weight-loss supplementation: case series and literature review.
        Intern Emerg Med. 2018; 13: 857-872
        • Ferreira V.
        • Mathieu A.
        • Soucy G.
        • et al.
        Acute severe liver injury related to long-term garcinia cambogia intake.
        ACG Case Rep J. 2020; 7e00429
        • Yousaf M.N.
        • Chaudhary F.S.
        • Hodanazari S.M.
        • et al.
        Hepatotoxicity associated with Garcinia cambogia: a case report.
        World J Hepatol. 2019; 11: 735-742
        • Bessone F.
        • et al.
        Herbal and dietary supplements-induced liver injury in Latin America: experience from the Latindili Network.
        Clin Gastroenterol Hepatol. 2021; https://doi.org/10.1016/j.cgh.2021.01.011
        • Andueza N.
        • Giner R.M.
        • Portillo M.P.
        Risks associated with the use of garcinia as a nutritional complement to lose weight.
        Nutrients. 2021; 13https://doi.org/10.3390/nu13020450
        • Hoofnagle J.H.
        • et al.
        HLA-B∗35:01 and green tea induced liver injury.
        Hepatology. 2020; https://doi.org/10.1002/hep.31538
        • Chalasani N.
        • et al.
        Features and outcomes of 899 patients with drug-induced liver injury: the DILIN prospective study.
        Gastroenterology. 2015; 148: 1340-1352 e1347
      3. Available at: https://www.ncbi.nlm.nih.gov/books/NBK548241/. Accessed January 26, 2021.

        • Navarro V.J.
        • et al.
        Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network.
        Hepatology. 2014; 60: 1399-1408
        • Vuppalanchi R.
        • et al.
        Herbal dietary supplement associated hepatotoxicity: an upcoming workshop and need for research.
        Gastroenterology. 2015; 148: 480-482
        • Navarro V.
        • et al.
        The contents of herbal and dietary supplements implicated in liver injury in the United States are frequently mislabeled.
        Hepatol Commun. 2019; 3: 792-794
        • Sharma A.
        • et al.
        Acute hepatitis due to garcinia cambogia extract, an herbal weight loss supplement.
        Case Rep Gastrointest Med. 2018; 2018: 9606171
        • Kothadia J.P.
        • Kaminski M.
        • Samant H.
        • et al.
        Hepatotoxicity associated with use of the weight loss supplement garcinia cambogia: a case report and review of the literature.
        Case Reports Hepatol. 2018; 2018: 6483605
        • Corey R.
        • et al.
        Acute liver failure associated with Garcinia cambogia use.
        Ann Hepatol. 2016; 15: 123-126
        • Kim Y.J.
        • et al.
        Garcinia cambogia attenuates diet-induced adiposity but exacerbates hepatic collagen accumulation and inflammation.
        World J Gastroenterol. 2013; 19: 4689-4701
        • Li C.
        • et al.
        HLA-B∗35:01 allele is a potential biomarker for predicting polygonum multiflorum-induced liver injury in humans.
        Hepatology. 2019; 70: 346-357