A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity

Table 1 Human studies considering the anti-obesity effects of herbal medicines

Authors	Target	Herbs (scientific name)	Study	Dose/duration	Groups	Main outcome	Other relevant effects & complications
Ignjatovic et al[8] 2000	Healthy volunteers	Slimax: extract of several plants: Hordeum vulgare, Polygonatum multiflorum, Dimocarpus longan, Ligusticum sinense, Lilium brownie, and Zingiber officinale	RCT	6 wk	C: Placebo I: Compound	Sig. decrease in body wt. & waist & hip Cir. & BMI	Modification of lipid metabolism with sig. effect on the accumulation & the release of lipid from adipose tissue
Boozer et al[9] 2001	Over wt. (n = 35 )	An herbal supplement: (Ma Huang & Guarana)	RCT (double-blind)	72 mg (ephedra) 240 mg (caffeine)/8 wk	C: Placebo (n = 24) I: Compound (n = 24)	Sig. decrease in body wt. & total body fat & sig. greater reduction in hip & waist Cir.	Greater reduction in serum TG, potentially treatment-related dropouts (23%) in the active group and none in the placebo group. Dry mouth, insomnia & headache were reported
Hoeger et al[10] 1998	Healthy	A natural dietary compound of chromium picolinate, inulin, capsicum, L-phenylalanine, and other lipotropic nutrients	RCT (double-blind)	4 wk	C: wt. loss program (n = 67) I: wt. loss program + compound (n = 56)	Sig. decrease in body fat percent, fat mass & FFM, but no sig. difference in body wt. BMI and energy intake
Ziauddin et al[11] 2004	Hhyperlipidemic (n = 30)	Terminalia arjuna Roxb	Before-after CT			Sig. improvement in obesity. Reduction in body wt. in some cases	Sig. decrease in serum total lipid levels. Sig. relief of palpitation, dyspnea, chest & joint pain. Reduction in BP in some cases
Abidov et al[12] 2006	Obese non-diabetic women (n = 32)	A compound of Aralia mandshurica (A) and Engelhardtia chrysolepis (E) extracts named ARALOX	RCT	450 mg (A) & 450 mg (E)/d	C: Diet + placebo I: Diet + compound	Decrease in total body wt. & fat wt.	Reduction in perilipin content in adipocytes and plasma TG. Stimulate activity of hormone sensitive lipase
Greenway et al[13] 2004	Human (obese & over wt.) healthy	Herbal supplement containing caffeine and ephedra	RCT (double-blind)	210 mg (e) & 72 mg (c)/12 wk	C: Placebo I: Compound	Sig. decrease in body wt. & the percentage of fat	No differences in lipid levels, or BP were shown. No serious adverse effect
Hioki et al[14] 2004	Obese women with IGT (n = 80)	Bofu-tsusho-san containing (Ephedrae Herba, Glycyrrhizae Radix, Forsythiae Fructus, Schizonepetae Spica &…)	RCT (double-blind)	Equivalent of (24 mg/ephedrine & 280 mg caffeine/24 wk)	C: wt. loss program I: wt. loss program + compound	Compared to baseline the I group lost significantly more body wt. & abdominal visceral fat & the placebo group lost sig. body wt. & had no sig. change in abdominal visceral fat	No decrease in RMR. Sig. improvement in insulin resistance compared to week 0. Loose bowel movements resulted in three withdrawals
Oben et al[15] 2008	Human (obese & over wt.)	A combination of Cissus quadrangularis (CQ) & Irvingia gabonensis (IG)	RCT (double-blind)	300 mg (CQ) & 500 mg (IG) per day/10 wk	C: Placebo I: CQ CQ + IG	Sig. decrease in body wt. & body fat percent & waist size in both I groups but the combination group (CQ + IG) resulted in larger reductions	Sig. decrease in Chol & LDL of plasma and fasting blood glucose levels
Chrubasik et al[16] 2008	Healthy (n = 80)	A combination of Sambucus nigra (S) and Asparagus officinalis (A)	Before-after CT	(S): 1 mg anthocyanin, 370 mg flavonol, 150 mg hydroxycinnamate (A): 19 mg saponin per day	-	Sig. decrease in mean of the wt.	Sig. improvement of BP, physical and emotional well-being and quality of life
Udani et al[17] 2007	Healthy (n = 25)	Proprietary fractionated white bean extract	RCT (double-blind)	2000 mg/14 wk	C: Placebo + wt. loss program I: Extract + wt. loss program	In both groups, decrease in body wt. & waist size from baseline was sig. but no sig value between groups	There were no adverse effect
Roongpisuthipong et al[18] 2007	Obese women	Calcium hydroxycitrate in Garcinia atroviridis	RCT	2 mo	C: Diet I: Diet + extract	Sig. decrease in body wt. & greater reduction in BMI. Sig. decrease in the triceps skin fold thickness
Kuriyan et al[19] 2007	Over wt. (n = 50)	Caralluma fimbriata	RCT	1 g/60 d	C: wt. loss program I: wt. loss program + extract	Sig. decrease in waist Cir. & hunger levels. Greater decrease in body wt., BMI, hip Cir., body fat & energy intake but not sig.
Hackman et al[20] 2007	Obese & over wt. women (n = 41)	Multinutrient supplement containing ephedra (e) and caffeine (c)	RCT (double-blind)	40 mg (e) and 100 mg (c)/9 mo	C: Control supplement I: Multinutrient supplement	Sig. decrease in body wt. decrease in appetite	Sig. decline in serum chol, TG, glucose, fasting insulin & leptin levels & minor adverse effects like dry mouth, insomnia, ervousness and palpitation were reported
Garrison et al[21] 2006	Over wt. women	Proprietary extracts of Magnolia officinalis and phellodendron amurense	RCT	750 mg/6 wk	C: Placebo I: Extract	No sig. wt. gain for the I group but sig. wt. gain in C. groups	The I groups tended to have lower levels of cortisol in the evening
Coffey et al[22] 2004	Human (over wt. & obese) (n = 102)	Product containing ephedrine, caffeine & other ingredients.	RCT (double-blind)	12 wk	C: Placebo I: Compound	Additional wt. loss (1/5 kg) & greater reduction in BMI & waist Cir. No difference in body fat & fat mass percent was shown	No difference in pulse, diastolic & systolic BP & adverse events
Preuss et al[23] 2004	Obese (n = 60)	Hydroxycitric acid (HCA -SX) and a combination of HCA-SX and niacin-bound chromium (NBC) and Gymnema sylvestre extract (GSE)	RCT (double-blind)	HCA-SX: 4667 mg GSE: 400 mg NBC: 4 mg/8 wk	C: Placebo I1 = HCA-SX I2 = GSE + NBC + HCA-SX All groups had wt. loss program	5%-6% decrease in body wt. & BMI & sig. decrease in food intake in both I groups	Sig. decrease in serum lipids & leptin & increase in HDL & excretion of urinary fat metabolites in both I groups. There were mild adverse effects but not significant between groups
Udani et al[24] 2004	Obese (n = 24)	A proprietary fractionated white bean (Phaseolus vulgaris)	RCT (double-blind)	3000 mg/8 wk	C: Placebo I: Extract	Decrease of body wt. with 129% difference	Reduction of TG three times greater than C. group. No adverse effect was shown
Bhatt et al[25] 1995	Healthy (n = 58)	Guggulu (Medohar)	RCT	1/5, 3 g/30 d	C: wt. loss program I: wt. loss program + extract	Higher mean wt. reduction in I group. In I group, all patients > 90 kg lost wt. but 3 in C group did not lose wt.
Oben et al[26] 2007	Over wt. & obese	Cissus quadrangularis	RCT (double-blind)	300, 1028 mg	C: Placebo I: Two extract formulation: CQR-300, CORE	Sig. decrease in body wt & body fat	Sig. decrease in serum lipids and glucose. Sig. increase in HDL-C plasma 5-HT and creatinine levels

Cir: Circumference; BP: Blood pressure; BMI: Body mass index; sig.: Significant; C: Control; I: Intervention; RCT: Randomized control trial; CT: Clinical trial; TG: Triglyceride; HDL: High density lipoprotein; LDL: Low density lipoprotein; Chol: Cholesterol; IGT: Impaired glucose tolerance.