In our
society where almost nothing is impossible, scam is also present everywhere and
almost in every product there is a scam and there are scammers. The weight loss market has not escape from
the scammer and fake products. In fact according to the Press Release of
Federal Trade Commission posted in their website last January 7, 2014 about the
Crackdown on Deceptive Advertising, has charged Sensa, L’Occitane HCG Diet
Direct LeanSpa, LLC for used of deceptive advertising claims to peddle fad
weight- loss products, from food additives and skin cream to dietary
supplements.
- L’Occitane, which claimed that its skin cream would slim users’ bodies but had no science to back up that claim, and
- HCG Diet Direct, which marketed an unproven human hormone that has been touted by hucksters for more than half a century as a weight-loss treatment.
- Sensa, deceptively advertised that the powdered food additive Sensa enhances food’s smell and taste, making users feel full faster, so they eat less and lose weight, without dieting, and without changing their exercise regime. The defendants did not have competent and reliable scientific evidence to support these claims, according to the FTC’s complaint.
- LeanSpa LLC, was also charged for deceptively promoting their product through a fake news website that openly promote the benefits of the product.
The
four companies are just few of the many companies that have been charged for
deceptive advertising of weight loss product. The common denominator of
their charges was that, first, they have no scientific evidence of their claim about the effectiveness of
the product; second, in some instances consumers were compensated for their endorsement of the product; third,
they falsely cited clinical studies
to promote the product.
How
about Garcinia Cambogia Extract? It is a known weight loss product in the
market that started to pop-up in the market in the late 2012 and has 2.7
million monthly average searches according to Google for the last 12 months
since 2013 until June 2014.
Scroll
down the page and together let’s examine the validity of the claim about
Garcinia Cambogia and how effective it is for weight loss; and whether the
claim about it also falls on one of the three common denominator of false
advertising mention above.
We
will also examine how to spot deceptive and fake weight loss product.
Happy
Reading and Learning for a Safe and Effective Weight Loss.
What is in Garcinia Cambogia?
Garcinia
Cambogia is a scientific name of fruit tree that grows in the tropical countries
of the Southeast Asia, particularly in Indonesia, Malaysia, India and the
Philippines. The fruit of this tree looks like a small pumpkin and is green to
pale yellow in color. It has recently received significant media attention
because of its claimed effects on weight loss.
The
main component that is in Garcinia Cambogia Extract (GCE) is the Hydroxycitric
Acid (HCA), which becomes the centre of the claim that because of this natural
acid content, it makes weight loss fast and easy. Even without the need of diet
and exercise.
How did it all Started?
Garcinia
Cambogia Extract never had a significant history in the Google Trends until
September 2012. But in October 2012, the word Garcinia Cambogia has started to
pop up in the Google Trends and has made it to the top with an average of 2.7
million searches per month according to Google for the last 12 months prior to
July 2014.
It
all started with a TV Show, “The Dr Oz Show” hosted by Dr. Mehmet Oz.
Dr
Mehmet Oz is a known American cardiothoracic surgeon. He is an author of some
medical books and a TV personality with show such as “The Dr Oz Show”, “NY
Med”, “The Truth About Food”, “National Body Challenge” and “Your Life A to Z”.
Dr.
Oz is a respected medical practitioner having appeared in the popular TV shows
of Oprah Winfrey and Larry King.
In the
Oct 29, 2012 episode of his show, Dr Oz repeatedly and with flowery words touted
about the Holy Grail of weight loss, the GCE or the Garcinia Cambogia Extract. Who
doesn’t like it? No Exercise, No Diet and No Effort weight loss product.
What is
Hydroxycitric Acid?
HCA
is a derivative of citric acid and can be found in plants species native to
South Asia such as Garcinia Cambogia,
Garcinia Indica and Garcinia Atroviridis. HCA is usually
marketed as a weight loss supplement either alone or in combination with other
supplements.
HCA has been shown to be a competitive inhibitor of ATP-citrate
lyase, the enzyme catalysing the extramitochondrial cleavage of citrate to
oxaloacetate the acetyl-CoA. This enzyme is important in maintaining the
acetyl-CoA pool for fatty acid and cholesterol biosynthesis, particularly
during the hyperlipogenic nutritional state produced by high carbohydrates
feeding.
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,
1. Sources and Composition of Garcinia Cambogia
1.1. Sources
Garcinia
Cambogia (of the
family Guttiferae), sometimes also referred to as Pazham Puzhi[4], Malabar tamarind,[5] or Bitter Kola[6] is a plant that bears small fruits (5cm
diameter) and has traditionally been used as a food additive to both enhance
the flavor of food products and to enhance satiety following consumption.[5] Very limited traditional medicine usage
extends to gastrointestinal complications.[5]
1.2. Composition
The
fruits of Garcinia Cambogia tend to contain:
- Citric Acids (causative of taste and flavor) at 10-30% dry weight, of which a large segment consists of hydroxycitric acids (HCAs);[7] HCAs come in four isomers, (-)-Hydroxycitric acid, (+)-Hydroxycitric acid, (-)-Allo-HCA, and (+)-Allo-HCA[5]
- Guttiferone I-K[8][9] and M-N[8]
- The polyisoprenylated benzophenones Garcinol[9] and Isogarcinol[10]
- Xanthochymol (highly variable between 113.66+/-0.75ng/mL fruit and undetectable) and Isoxamthochymol (23.26ng/mL or lower); about 2.52-2.56ng/mL of both in the leaves[11][12]
- Cambogin, an isomer of isoxanthochymol[10] and Camboginol[13] (88.2mg/g of the fruit methanolic extract; undetectable in aqueous extracts, seeds, or stems)[10]
- Isoxanthochymol (16.6mg/g methanolic extract; none in aqueous extract of the stems/seeds)[10]
It should
be noted that currently marketed (-)-Hydroxycitric Acid supplements tend to be
calcium/potassium salts of (-)-HCA containing about 60% (-)-HCA by weight.[5]
2. Pharmacology of Garcinia Cambogia
2.1. Serum
2g of
(-)-HCA salts given to 4 human participants on an empty stomach resulting in
plasma levels of 0.8μg/mL within 30 minutes leading up to plasma levels of
8.4μg/mL at two hours with a variable peak between 4.7 and 8.4μg/mL.[14] The authors hypothesized that if
absorption was complete and evenly distributed, it would have resulted in a
serum peak of 46μg/mL (based on the participant's body weight and 25% body
fat), a preliminary guess at the bioavailbility of (-)-Hydroxycitric acid
following oral administration would be 10-18%.[14]
The bioactive has been
demonstrated to appear in the blood following oral administration, and may have
bioactivity
3. Neurology and Garcinia Cambogia
3.1. Appetite
In
freshly prepare rat brain slices, (-)-Hydroxycitric acid (salt form; 60% HCA by
weight) was able to inhibit serotonin reuptake into rat corticol slices by 20%
(300uM concentration), which was outperformed by fluoxetine (100uM) plus
clomipramine (10uM) which inhibited 30% of uptake; oddly, no inhibition was
noted with 1000uM (1mM) of (-)-Hydroxycitric acid.[15] The increased bioavailability of
serotonin is thought to be related to appetite suppressing effects of
supplemental (-)-Hydroxycitric acid.[15]
Another
possible mechanism is the thought to be leptin related. One rat study (that
failed to find reductions in food intake or weight after 4 weeks of 3.3%
(-)-Hydroxycitric acid) noted that serum levels of insulin and leptin
decreased, which was thought to be in response to leptin-mimetic actions (not
established).[16]
May inhibit the reuptake of
serotonin (not yet confirmed in a living model)
In rats
who have had the reductions in feed intake quantified, it has been reported to
be reduce by 13.7% (0.2% feed intake), 26.7% (2% feed intake) and 25.6% (5%
feed intake) in male rats with similar reductions in female rats, with
significant reductions of feed intake in this study only occurring 46 days
after consumption (earliest) or 74 days (all tested doses).[17]
In rats, appears to suppress food
intake
3.2. Neuroprotection
Garcinia
Cambogia has once
been associated with reduced brain oxidation and pathology of
neurodegeneration, but was said to be working vicariously through reduced food
intake and body weight (with the study concluding that the state of obesity and
a high fat diet impairs neural function).[18]
4. Cardiovascular Health and Garcinia Cambogia
4.1. Lipoproteins and Cholesterol
A study
in rates using 200-400mg/kg Garcinia Cambogia seeds (ethanolic extract)
noted slight but statistically significant increases in LDL-C (the 'bad'
cholesterol) with decreases in HDL-C, vLDL-C, and triglycerides.[6]
In obese
humans given 2g of Garcinia Cambogia (60% Hydroxycitric acid) for 10
weeks, there were no significant alterations in ApoA1, ApoB, Phospholipids,
Free Fatty acids, or the Artherogenic Index.[19]
4.2. Blood
One study
on blood lipids also noted a small but significant increase in red blood cell
count, indicative of erythropoeisis.[6] One review[5] suggests this may be due to the iron
content of the seeds, or perhaps an increase in testosterone from the
polyphenolic component.
5. Interactions with Fat Mass of Garcinia Cambogia
5.1. Mechanisms
(-)-Hydroxycitric
acid appears to be a competitive inhibitor of the enzyme adenosine
triphosphate-citrate (pro-3S)-lyase (a shorter designation is ATP
Citrate Lysase),[20] which is an enzyme in the biosynthetic
pathway of fatty acids (de novo lipogenesis) and its inhibition results
in suppressed formation of Acetyl-CoA from Citrate and less substrate for fatty
acid synthesis in vitro.[21] The (+)- isomer of Hydroxycitric acid
does not have this same inhibitory potential, and is instead a substrate of the
enzyme.
Can inhibit an enzyme in the de
novo lipogenesis pathway that mediates fatty acid synthesis from non-fat
sources, thought to inhibit the synthesis and deposition of fatty acids via
this mechanism
The
relevance of this pathway to humans may be in question, as human capacity for de
novo lipogenesis does exist but tends to be less than that of rodents that
are commonly used in research.[22]
In regards to this mechanism of
action, there may be species-related differences
5.2. Adipokines
2g of Garcinia
Carmbogia for 10 weeks was associated with a reduction in the adipokine
Adipsin (19%) without significantly influencing Adiponectin or Leptin.[19]
5.3. Weight Regain
There
have been a few studies assessing weight regain. One in rats who were
semi-starved (less than 10g of food daily for 10 days) who were subsequently
randomized to receive normal diets of standard chow, sucrose loaded chow,
glucose loaded chow or a high glucose fat diet with half of each group
recieving 3% (-)-Hydroxycitric acid (85mmol/kg) and then followed for 10 days
(so overall, 8 groups of which 4 had HCA supplementation).[23]
This study noted that the inevitable
weight regain in these rats was attenuated with HCA supplementation in all
groups except normal chow, and only reached significance with glucose and
glucose+fat diet groups; this was in part due to less food intake, and appeared
to decrease the food efficiency ratio with all groups except standard chow.[23] This trial style was replicated with
the glucose group, and it was noted that food intake was suppressed for a short
time, and although there was indication that de novo lipogenesis may
have been inhibited there was no significant suppressive effect on body weight
regain.[24]
Two rat studies suggesting that
Garcinia can reduce the amount of weight regained during a period of
overfeeding after a period of low caloric intake
5.4. Weight Gain
A rat
trial in which rats were fed an obesogenic diet for 15 days with 2% added
(-)-Hydroxycitric acid (as trisodium conjugate) noted that the food efficiency
ratio decreased to 60% of control, and that body weight gain was suppressed to
approximately half (49%) of control; food intake also decreased 17%, which
would have contributed to the observed reduction in weight.[25]
One rat study suggesting that
Garcinia can attenuate the rate of weight gain
5.5. Weight Loss
A study
in human subjects using 2g Garcinia cambogia (60% Hydroxycitric acid)
for 10 weeks in 86 overweight adults failed to find significant differences in
weight loss or food intake.[19] One study using 2400mg of Garcinia
cambogia daily divided before meals noted that while active treatment lost
more weight from a low calorie diet than placebo over a period of 12 weeks
(3.7+/-3.1kg weight loss rather than 2.4+/-2.9kg) that there were no reported
differences in appetite.[26]
One of
the larger and better controlled studies on the matter noted that, 1000mg of Garcinia
Camboga (50% HCA by weight) taken before the three main meals of a low
calorie diet given to overweight but otherwise healthy adults (of which placebo
was also placed on) and then followed for 12 weeks failed to find any
significant differences in dropout rates, weight loss, or adverse effects
relative to placebo.[27]
Studies done in humans using
isolated Garcinia Cambogia have mixed results on fat loss, with the one
study reporting benefit showing relatively low magnitude of benefit (1.3kg more
than placebo over 3 months, with very high variability)
In 40
persons with a BMI between 27.5-39 (mostly obese) given 100mg Garcinia
Cambogia (confounded with inclusion of 400mg Inulin and 200mg White Kidney bean extract) before each of the
three major meals for a period of 12 weeks, with both placebo and supplemental
group being advised to diet (1200kcal), noted that weight loss in the diet and
supplement group was greater (4% body weight over 12 weeks) than the diet and
placebo group (not statistically significance).[1] Dropouts from the study were also
greater in placebo (6) than supplement (1) groups.[1] One other study that uses Garcinia
Cambogia but is highly confounded with other nutrients also noted
beneficial effects on weight loss.[3]
The studies that are associated
with both weight loss and Garcinia Camboga are confounded with many
ingredients, and the observed effects on fat loss cannot be attributed to
Garcinia itself.
Several
reviews on the efficacy of Garcinia Cambogia suggest no significant
benefit for weight loss in human interventions.[28][29][30][31][32] The rather frequent inclusion of Garcinia
Cambogia in review articles relative to the lack of interventions may be
related to the popularity of the supplement.
Numerous review articles
assessing the evidence of Garcinia Cambogia conclude that there is no
significant benefit of this compound in humans
6. Interactions with Glucose Metabolism of Garcinia Cambogia
6.1. Glycogen
When
500mg (-)-Hydroxycitric acid is consumed alongside 2g/kg carbohydrate post
exercise in humans, a slight increase in the rate of glycogen resynthesis
occurs.[33]
7. Interactions with Hormones of Garcinia Cambogia
7.1. Testosterone
1667.3mg
of Garcinia Cambogia for 12 weeks (1000mg (-)-Hydroxycitric acid) failed
to find significant influences on serum testosterone.[34]
7.2. Estrogen
1667.3mg
of Garcinia Cambogia for 12 weeks (1000mg (-)-Hydroxycitric acid) failed
to find significant influences on serum estrogens (estrone and estradiol).[34]
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8. Interactions with Organ Systems of Garcinia Cambogia
8.1. Kidney and Bladder
While
ingestion of a high-fat or high-sucrose diet is able to increase serum levels
of urea and creatinine (thought to be indicative of kidney impairment),
coingestion of Garcinia Cambogia at 50mg/kg is able to effectively normalize
the increases in creatinine and urea.[35]
Oral
ingestion of the leaves from Garcinia Cambogia at 100-200mg/kg of either
the water extract or ethanolic extract was able to increase urine output in the
range of 36-72% (ethanolic) or 17-39% (aqueous), both of which underperformed
to 20mg/kg injections of the reference drug furosemide.[36]
The leaves of Garcinia may have
weak diuretic properties
8.2. Testes
One study
noted that oral consumption of 778-1244mg/kg bodyweight of (-)-Hydroxycitric
acid to rats for up to 93 days was associated with testicular toxiciy with
lower doses not associated with testicular toxicity.[37] This study has been critiqued,[38] where the lack of assurance on the
salt form was questioned and the fact that the No Obervable Adverse Effect
Limit (NOAEL) of 389mg/kg in rats is still 10-16 fold higher than the typical
recommended serving for humans.[38]
A lone report on testicular
toxicity with high dose (-)-Hydroxycitric acid consumption; may not be relevant
to human supplementation doses
,
9. Safety and Toxicology of Garcinia Cambogia
9.1. General
Acute (14
day) administration of 5000mg/kg bodyweight (-)-Hydroxycitric Acid to albino
rats of both genders (small sample size of 10) was not associated with any
mortality or clinical signs of toxicology.[15]
Studies
that do not inhernetly design themselves to assess toxicology but nevertheless
use (-)-Hydroxycitric acid supplementation have also failed to find any
toxicity associated with 3% of the rat diet for 5 days[24] or 10 days,[23] or up to 5% of the feed for 90 days.[39]
Currently,
the human trials cited in Examine do not report any adverse effects that occur
in the treatment groups (using Garcinia Camboga) to a greater degree
than placebo.
No observable toxicity in rats or
humans following oral ingestion at this moment in time.
9.2. Mutagenicity
A
preliminary study assessing the mutagenicity of (-)-Hydroxycitric acid on five
strains of Salmonella typhimurium (TA98, TA100, TA102, TA1535, and
TA1537) up to 5000mcg/plate failed to find evidence of DNA damage or
mutagenicity associated with (-)-Hydroxycitric Acid[40] and a lack of genotoxicity was
repeatedly demonstrated elsewhere with the Ames test;[40][41] this latter study noted that (-)-HCA
increased the amount of micronucleated polychromatic erythrocytes (MNPCEs)
after intravenous administration, which is though to be genotoxic.[41] The conclusion of this has been
criticized for being suggestive of genotoxicity while the study had some design
flaws (used DSMO alongside (-)-HCA while control got water, DMSO not being
recommended for this test[42]) and no LD50 test of the
method of administration prior to genotoxicity testing.[43]
In rats
given up to 5% (-)-Hydroxycitric acid in feed intake for a period of 90 days,
there does not appear to be any significant DNA fragmentation in the liver or
testicles.[17]
There does not appear to be any
influence of the bioactive (-)-Hydroxycitric acid on DNA fragmentation or genomic
damage; unlikely to be carcinogenic
9.3. Case Studies
There are
numerous case reports of hepatoxicity associated with a supplement known as
'Hydroxycut' which touts Garcinia Cambogia as the main active
ingredient,[44][45] although it has been argued that there
is no evidence to suggest a link to (-)-Hydroxycitric acid due to inclusion of
many ingredients.[46]
In a
patient on chronic Monteluskat treatment who then consumed two supplements,
fatality occurred; it was thought that Montelukast interacted advesely with one
of the many compounds consumed but causative could not be linked.[47]
One
reported case of Rhabdoyolysis associated with a dietary supplement of which
contained Garcinia Cambogia has been noted, although Ma Huang
(plant source of Ephedrine) is a large confound alongside Chromium
and Guarana.[48]
Due to the usage of Garcinia in
fat burners, there have been reported connections between Garcinia and adverse
effects; there is currently no evidence to assume a direct link between the
compounds