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A Systematic Review of the Efficacy and Safety of Herbal Medicines Used in the Treatment of Obesity

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A Systematic Review of the Efficacy and Safety of Herbal Medicines Used in the Treatment of Obesity Online Submissions: wjg.wjgnet.com World J Gastroenterol 2009 July 7; 15(25): 3073-3085 [email protected] World Journal of Gastroenterology ISSN 1007-9327 doi:10.3748/wjg.15.3073 © 2009 The WJG Press and Baishideng. All rights reserved. EDITORIAL A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity Shirin Hasani-Ranjbar, Neda Nayebi, Bagher Larijani, Mohammad Abdollahi Shirin Hasani-Ranjbar, Neda Nayebi, Bagher Larijani, caffeine and Bofutsushosan. In conclusion, compounds Endocrinology and Metabolism Research Center, and Faculty containing ephedra, CQ, ginseng, bitter melon, and of Medicine, Tehran University of Medical Sciences, Tehran zingiber were found to be effective in the management 1411413137, Iran of obesity. Attention to these natural compounds would Mohammad Abdollahi, Faculty of Pharmacy, and Pharmaceutical open a new approach for novel therapeutic and more Sciences Research Centre, Tehran University of Medical effective agents. Sciences, Tehran 1417614411, Iran Author contributions: Hasani-Ranjbar S completed the bibliography and drafted the paper; Nayebi N carried out the © 2009 The WJG Press and Baishideng. All rights reserved. literature search and provided tables; Larijani B read the paper and commented; Abdollahi M supervised, reviewed and edited Key words: Animal; Herbal medicine; Human; Obesity the paper. Correspondence to: Mohammad Abdollahi, Professor, Peer reviewers: Cheng Ji, Professor of Research, Department Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, of Medicine, University of Southern California, 2011 Zonal Tehran University of Medical Sciences, Tehran 1417614411, Ave., HMR-101, Los Angeles, CA 90033, United States; Iran. [email protected] Anders E Lehmann, PhD, Associate Professor, Senior Principal Telephone: +98-21-66959104 Fax: +98-21-66959104 Scientist, Bioscience, AstraZeneca R&D Mölndal, Mölndal, Received: March 17, 2009 Revised: May 1, 2009 Sweden Accepted: May 8, 2009 Published online: July 7, 2009 Hasani-Ranjbar S, Nayebi N, Larijani B, Abdollahi M. A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity. World J Gastroenterol 2009; 15(25): 3073-3085 Available from: URL: http://www.wjgnet. Abstract com/1007-9327/15/3073.asp DOI: http://dx.doi.org/10.3748/ wjg.15.3073 This review focuses on the efficacy and safety of effective herbal medicines in the management of obesity in humans and animals. PubMed, Scopus, Google Scholar, Web of Science, and IranMedex databases were searched up to December 30, INTRODUCTION 2008. The search terms were “obesity” and (“herbal The prevalence of obesity is increasing worldwide[1] medicine” or “plant”, “plant medicinal” or “medicine resulting in an association with major health problems traditional”) without narrowing or limiting search such as type 2 diabetes, ischemic heart disease, stroke, elements. All of the human and animal studies on the and cancer. It is necessary to treat obese individuals by effects of herbs with the key outcome of change in both lifestyle interventions and/or pharmacological anthropometric measures such as body weight and therapy. Pharmacologic treatment and surgical waist-hip circumference, body fat, amount of food interventions used in some circumstances are not always intake, and appetite were included. In vitro studies, [2] appropriate . Unfortunately, drug treatment of obesity reviews, and letters to editors were excluded. Of the despite short-term benefits, is often associated with publications identified in the initial database, 915 results were identified and reviewed, and a total of rebound weight gain after the cessation of drug use, side effects from the medication, and the potential for drug 77 studies were included (19 human and 58 animal [3] studies). Studies with Cissus quadrangularis (CQ), abuse . Pharmacologic options include sibutramine, Sambucus nigra , Asparagus officinalis , Garcinia orlistat, phentermine, diethylpropion, and fluoxetine atroviridis , ephedra and caffeine, Slimax (extract or bupropion. Phentermine and diethylpropion have of several plants including Zingiber officinale and potential for abuse and are only approved for short- Bofutsushosan) showed a significant decrease in body term use. Approved medications for long term use in weight. In 41 animal studies, significant weight loss the treatment of obesity are sibutramine and orlistat, or inhibition of weight gain was found. No significant however, these agents should be used with caution in adverse effects or mortality were observed except patients with a history of cardiovascular disorders[4]. in studies with supplements containing ephedra, The general public uses many other methods for weight www.wjgnet.com 3074 ISSN 1007-9327 CN 14-1219/R World J Gastroenterol July 7, 2009 Volume 15 Number 25 loss including herbs, vitamins, nutritional supplements, FINDINGS and meal replacement preparations. Rigorous scientific studies have not been carried out on these products, Of the publications identified from the initial database and in many cases safety and efficacy take a back seat to search, 915 results were identified and reviewed for marketing. inclusion or exclusion. A total of 77 studies were Complementary and alternative therapies have included (19 human and 58 animal studies). Human studies included 17 randomized clinical trials (RCTs) long been used in the Eastern world but recently these [8-26] therapies are being used increasingly worldwide[5]. When and two before-after clinical trials . RCTs reported conventional medicine fails to treat chronic diseases random allocation of humans to herbal medicines vs and conditions such as obesity efficaciously and without (placebo/another plant/combination of plants) with or adverse events, many people seek unconventional without specific dietary and exercise programs outlined in therapies including herbal medicine[6]. Although the Tables 1 and 2 as weight loss programs. Human subjects number of randomized trials on complementary therapies were healthy overweight, obese or with impaired glucose has doubled every 5 years and the Cochrane library tolerance test volunteers. Animal studies included healthy, included 100 systematic reviews of unconventional genetically or experimentally obese or diabetic mice, rats interventions[7], none of these studies specifically and other rodents. The route of administration of herbs mentioned herbal therapy in obesity. in almost all studies was oral intake with the exception of This review aimed to evaluate the current science some animal studies as indicated in Table 2. on the efficacy and safety of herbal medicines in the management of obesity. HUMAN STUDIES Change in human body weight DATA SOURCES AND STUDY All studies showed loss of body weight except one[21] SELECTIONS which seemed to have problems with the study design, and one other study[10] which showed a significant PubMed, Scopus, Google Scholar, Web of Science, and decrease only in body fat. Studies with Cissus quadrangularis IranMedex databases were searched up to December 30, (CQ)[26] or combined with Irvingia gabonensis (IG)[15], a 2008 for all human and animal studies investigating the combination of Sambucus nigra and Asparagus officinalis[16], effects (both harmful and beneficial) of treating obesity calcium hydroxycitrate in Garcinia atroviridis[18], supplements with herbal medicines. The search terms were “obesity” containing ephedra and caffeine[9,13,20], and Slimax as an and (“herbal medicine” or “plant”, “plant medicinal” or extract of several plants including Zingiber officinale[8] and “medicine traditional”) without narrowing or limiting Bofutsushosan[14] showed significant decreases in body search elements. Only publications with available weight. abstracts were reviewed. The main outcome measures sought at the end of treatments as anti-obesity effects, Body fat were body weight, body fat including fat mass/fat weight A significant decrease in body fat was shown with CQ[26], or fat percentage/visceral adipose tissue weight, triceps supplements containing ephedra and caffeine[9,13], a natural skin fold thickness, waist or hip circumference, and compound containing capsicum and some lipotropic appetite or amount of food intake. nutrients[10], Bofutsushosan[14], and calcium hydroxycitrate Herbal medicines are defined in this review as raw or in Garcinia atroviridis[18]. These phytopharmaceuticals refined products derived from plants or parts of plants showed a significant decrease in triceps skin fold thickness (e.g. leaves, stems, buds, flowers, roots, or tubers) used indicating significant loss of fat. for the treatment of diseases. The synonyms of herbal medicines are herbal remedies, herbal medications, Waist and hip circumference herbal products, herbal preparations, medicinal herbs, Efficient decreases in both waist and hip circumferences and phytopharmaceuticals, etc. in trials with a supplement containing ephedra and All of the abstracts from human and animal studies caffeine[9] and Slimax (extract of several plants including with the main outcome of change in anthropometric Zingiber officinale[8] were shown whereas Caralluma measures such as body weight and waist-hip circumference, fimbriata[19] and CQ with or without IG[15] significantly body fat (weight or mass of visceral adipose tissue, fat decreased waist size. mass or percent), amount of food intake, and appetite in participants were included. Even studies on other relevant Food intake diseases such as
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