Online Submissions: 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 of obesity. Attention to these natural compounds would Mohammad Abdol ahi, Faculty of Pharmacy, and Pharmaceutical open a new approach for novel therapeutic and more Sciences Research Centre, Tehran University of Medical Sciences, Tehran 1417614411, Iran effective agents.
Author contributions: Hasani-Ranjbar S completed the bibliography and drafted the paper; Nayebi N carried out the 2009 The WJG Press and Baishideng. Al 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
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; 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 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.
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, 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. Phar macologic 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, appropriate[2]. Unfortunately, drug treatment of obesity reviews, and letters to editors were excluded. Of the publications identified in the initial database, 915 despite short-term benefits, is often associated with results were identified and reviewed, and a total of rebound weight gain after the cessation of drug use, side 77 studies were included (19 human and 58 animal effects from the medication, and the potential for drug studies). Studies with Cissus quadrangularis (CQ), abuse[3]. 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 3074 ISSN 1007-9327 CN 14-1219/R World J Gastroenterol July 7, 2009 Volume 15 Number 25 loss including herbs, vitamins, nutritional supplements, 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 inclusion or exclusion. A total of 77 studies were Complementary and alternative therapies have included (19 human and 58 animal studies). Human long been used in the Eastern world but recently these studies included 17 randomized clinical trials (RCTs) therapies are being used increasingly worldwide[5]. When and two before-after clinical trials[8-26]. RCTs reported conventional medicine fails to treat chronic diseases random al ocation 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 genetical y or experimental y 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 al 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.
Change in human body weight

Al studies showed loss of body weight except one[21] 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 abstracts were reviewed. The main outcome measures sought at the end of treatments as anti-obesity effects, 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 Al 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 diseases such as diabetes were also reviewed and included Decreases in appetite or amount of food or energy if the appropriate outcomes were shown. In vitro studies, intake with a supplement containing ephedra and review articles, and letters to the editor were excluded. caffeine[20] and Caral uma fimbriata[19] were shown (not Unpublished data such as theses were also excluded. Two significant) but hydroxycitric acid (HCA-SX) with or reviewers independently examined the title, abstract and without Gymnema sylvestre[23] decreased the amount of references of each article meeting the inclusion criteria food intake efficiently. A natural compound containing and eliminated duplications and those showing exclusion capsicum and other lipotropic nutrients[10] did not significantly change energy intake.
Hasani-Ranjbar S et al . Herbal medicines used in the management of obesity 3075 Table 1 Human studies considering the anti-obesity effects of herbal medicines
Herbs (scientific name)
Main outcome
Other relevant effects
Slimax: extract of Sig. decrease in Modification of lipid et al[8] 2000 volunteers several plants: Hordeum body wt. & waist & vulgare, Polygonatum sig. effect on the accumulation & the Dimocarpus longan, release of lipid from Ligusticum sinense, Lilium brownie, and Boozer et al[9] Over wt. An herbal supplement: Sig. decrease in Greater reduction in (n = 35 ) (Ma Huang & Guarana) body wt. & total serum TG, potentially treatment-related greater reduction in dropouts (23%) in the hip & waist Cir.
active group and none in the placebo group. Dry mouth, insomnia A natural dietary Sig. decrease in et al[10] 1998 body fat percent, fat chromium picolinate, inulin, capsicum, L- no sig. difference in phenylalanine, and other body wt. BMI and lipotropic nutrients Hhyperlip- Terminalia arjuna Roxb Sig. improvement Sig. decrease in serum et al[11] 2004 total lipid levels. Sig. Reduction in body relief of palpitation, wt. in some cases dyspnea, chest & joint pain. Reduction in BP Obese non- A compound of Aralia Decrease in total Reduction in perilipin et al[12] 2006 mandshurica (A) and body wt. & fat wt. content in adipocytes Engelhardtia chrysolepis (E) extracts named Stimulate activity of hormone sensitive Herbal supplement Sig. decrease in No differences in lipid et al[13] 2004 containing caffeine levels, or BP were percentage of fat shown. No serious Hioki et al[14] No decrease in RMR. women with containing (Ephedrae (24 mg/ephedrine baseline the I group Sig. improvement IGT (n = 80) Herba, Glycyrrhizae lost significantly in insulin resistance Radix, Forsythiae Fructus, Schizonepetae abdominal visceral week 0. Loose bowel fat & the placebo movements resulted in three withdrawals no sig. change in abdominal visceral Oben et al[15] A combination of Cissus Sig. decrease in Sig. decrease in Chol quadrangularis (CQ) & body wt. & body & LDL of plasma and Irvingia gabonensis (IG) fat percent & waist fasting blood glucose size in both I groups but the combination resulted in larger A combination of Sig. decrease in Sig. improvement et al[16] 2008 Sambucus nigra (S) and mean of the wt.
of BP, physical and Asparagus officinalis (A) 370 mg flavonol, emotional well-being and quality of life 3076 ISSN 1007-9327 CN 14-1219/R World J Gastroenterol July 7, 2009 Volume 15 Number 25 Udani et al[17] Healthy Proprietary fractionated C: Placebo + wt. white bean extract decrease in body I: Extract + wt. wt. & waist size from baseline was sig. but no sig value Calcium hydroxycitrate Sig. decrease in in Garcinia atroviridis I: Diet + extract body wt. & greater et al[18] 2007 reduction in BMI. Sig. decrease in the triceps skin fold Caralluma fimbriata Sig. decrease in et al[19] 2007 waist Cir. & hunger decrease in body wt., BMI, hip Cir., body fat & energy intake but not sig. Sig. decrease in Sig. decline in serum et al[20] 2007 supplement containing body wt. decrease chol, TG, glucose, I: Multinutrient fasting insulin & leptin levels & minor adverse effects like dry mouth, insomnia, nervousness and palpitation were Proprietary extracts of No sig. wt. gain The I groups tended et al[21] 2006 Magnolia officinalis and to have lower levels of phellodendron amurense but sig. wt. gain cortisol in the evening Coffey et al[22] Human Product containing Additional wt. loss No difference in pulse, ephedrine, caffeine & (1/5 kg) & greater diastolic & systolic BP other ingredients.
reduction in BMI & adverse events difference in body percent was shown Preuss et al[23] Hydroxycitric acid (HCA 5%-6% decrease in Sig. decrease in serum -SX) and a combination lipids & leptin & of HCA-SX and niacin- I2 = GSE + NBC & sig. decrease in increase in HDL & excretion of urinary (NBC) and Gymnema fat metabolites in both sylvestre extract (GSE) I groups. There were mild adverse effects but not significant Udani et al[24] Decrease of body Reduction of TG three fractionated white bean times greater than (Phaseolus vulgaris) C. group. No adverse Bhatt et al[25] Guggulu (Medohar) patients > 90 kg lost wt. but 3 in C group did not lose wt.
Oben et al[26] Over wt. & Sig. decrease in Sig. decrease in serum lipids and glucose. Sig. increase in HDL-C 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.
Anti-hyperlipidemic, antihyperglycemic, and other No significant adverse effects compared to controls relevant anti-obesity effects of medicinal plants in were mentioned and no mortality was reported, except human studies are summarized in Table 1.
in studies with supplements containing ephedra and Hasani-Ranjbar S et al . Herbal medicines used in the management of obesity 3077 Table 2 Animal studies on the anti-obesity effects of herbal medicines
Herbs (scientific name) Dose/duration
Main outcome
Other relevant effects
Haidonghua powder: Sig. decrease in Did not influence the function et al[27] 2000 Laminaria japonica of thyroid gland & metabolism Aresch & Benincasa size of fat cells hispida (Thunb.) Cogn. Sig. suppression Lowered plasma TG et al[28] 2003 of body wt. gain and lower wt. of Hibiscus sabdariffa Sig. decrease in body No sig. change in TG & Chol obese (by MSG) + wt. gain in obese mice levels. Increase in ALT levels et al[29] 2007 & increased liquid was shown but was not sig. I: Same groups + intake in both groups Fructans extracted from Sig. decrease in body Lower serum glucose & Chol et al[30] 2008 Agave tequilana (TEQ) wt. gain & food intake. level but Sig. decrease in TG and Dasylirion spp The (TEQ) group had levels was shown in Raftilose the lowest value group. Higher concentration of GLP-1 & it's precursor & proglucagon mRNA in I groups Park et al[31] Sig. decrease in body Sig. decrease in plasma TG wt & subcutaneous & Chol concentrations, up- adipose tissue wt. & regulation of FABP mRNA adipocytes size in I expression induced by HFD Allium victorialis var. Considerable reduction Sig. decrease in hyperlipidemia et al[32] 2005 platyphyllum leaves of retroperitoneal, and increased lipid content in epididymal and total abdominal fat pad wt.
Evodiamine an alkaloid 0/02%, 0/03% Sig. decrease in Sig. decrease of lipid in liver et al[33] 2001 of a fruit: Evodia perirenal fat wt. & & serum FFAs. Sig. increase of decrease of epididymal lipolytic activity in perirenal fat tissue & specific GDP binding in brown adipose tissue mitochondria as the biological index of heat production Jin et al[34] Jiang-zhi jian-fei yao: No sig. increase in Prolongation of stomach the refined Rhubarb body wt. but reduction evacuation time and acceleration of intestinal Decreased size of abdominal adipose Kim et al[35] Juniperus chinensis Sig. decrease in body Sig. decrease in blood lipid, I: HFD + extract wt gain & visceral fat leptin & insulin levels. Sig. reversal of the down-regulation of genes implicated in adipogenesis & increased gene expressions & phosphorylations Shih et al[36] Momordica charantia Sig. decrease in Sig. improvement in blood I: Rosiglitazone/ epididymal white glucose, leptin, and FFA. adipose tissue wt. & Influenced PPARα/ visceral fat wt.
PPARγ expression Ilex paraguariensis Sig. decrease in body Sig. decrease in blood and et al[37] 2008 wt. of visceral fat-pad hepatic lipid, glucose, insulin and leptin levels. Reversed the down-regulation of genes implicated adipogenesis, thermogenesis & enhanced expression of uncoupling proteins in adipose tissue Sig. decrease in body In obese I group, sig. decrease et al[38] 2008 wt. of both I groups in hepatic steatosis was observed dose dependently. Liver enzymes decreased. 30%-41% and 22%-33% lower serum ALT and AST activities were shown, respectively 3078 ISSN 1007-9327 CN 14-1219/R World J Gastroenterol July 7, 2009 Volume 15 Number 25 Lee et al[39] A combination of Morus Sig. decrease in body Decreased serum levels of TG, alba, Melissa officinalis wt. gain & adipose Chol & inhibited hepatic lipid and Artemisia capillaries accumulation, and increased hepatic mRNA levels of enzymes responsible for FABO Choi et al[40] Cucurbita moschata Sig. suppression fat storage increase but amount of food Momordira charantia L. Sig. decrease in the Sig. decrease in enzymes of et al 2008[41] adipose tissue implicating adipocytes in both I reduction of insulin resistance thiazolidinedione groups. Sig. decrease in I group as compared to in adipose tissue mass in I1 group compared Cyperus rotundus Sig. decrease in wt. et al[42] 2007 gain without affecting Lei et al[43] Sig. decrease in body Sig. decrease in serum TG, wt. & energy intake Chol, glucose levels & Chol/ and adipose pad wt. HDL ratio, inhibition of percents in I. group. intestinal fat absorption Sig. decrease in appetite of obese mice Aoki et al[44] Licorice flavonoids Sig. decrease of Improvement of fatty degeneration of hepatocytes and adipose tissue & body changes in genes implicating wt. gain with 1% & 2% regulation of lipid metabolism LFO groups, decrease with 2% concentration of adipocyte size Garcinia cambogia Sig. decrease in Sig. decrease in TG pool of et al[45] 2007 seed (bitter cola) adipose tissue & liver but sig. increase of HDL & decreased Han et al[46] Sig. increase the fecal content & increases in body & fecal TG levels in day 3 parametrial adipose Zingiber officinale Sig. decrease in Sig. decrease in serum Chol, et al[47] 2006 TG, glucose, and insulin Salacia reticulata Sig. decrease in the Sig. decrease in plasma TG, et al[48] 2006 body wt. and visceral 4 h after ingestion; Sig. decrease fat mass increase in energy efficiency, plasma leptin and adiponectine levels Cornelian cherry 24% decrease in wt. Elevated insulin levels; Sig. et al[49] 2006 (cornus mas) (Purified 500 mg/kg (u) I: HFD + A/A gain in (A) group decrease of liver TG in A + u anthocyanins (A) & Arachis hypogaea Sig. decrease in body Increased fecal lipid excretion. et al[50] 2006 I: HFD + extract wt. gain and liver size Reduced TG content of liver and serum glucose and insulin Sig. decrease in body Sig. improvement of lipid et al[51] 2005 profile, FFA & insulin & TNF-α & hypoadinectinemia Zhao et al[52] Phillyrin (Fructose Sig. decrease in wet Decrease in jejunum microvillus wt. of fat & fat index & area, and serum levels of diameter of fat cells & Chen et al[53] Bitter melon (Momordica Reduced plasma glucose and efficiency and visceral hepatic TG but higher serum fat mass after 4 wk in FFA after 4 wk; Higher plasma catecholamine after 7 wk in I group; Sig. decrease in hepatic TG & steatosis and sig. increase of serum epinephrine & FFA in Hasani-Ranjbar S et al . Herbal medicines used in the management of obesity 3079 Han et al[54] Coleus forskohlii Reduced body wt.& food intake & fat Chikusetsu saponins Prevented body wt. Sig. increase of the fecal content isolated from Panax gain & increase of & TG level in day 3; reduction japonicus rhizomes parametrial adipose of plasma TG 2 h after oral lipid intake & inhibition of pancreatic lipase activity Han et al[56] Zingiber officinale Sig. decrease in body wt. gain at 2-8 wk with 3% & in final parametrial adipose tissue wt. with 1% Cha et al[57] HFD group of I had In HFD group of I, lower serum lower wt. gain but no LDL and restoration of liver TG difference in food at the same level as fed by LFD was shown; No alteration in Kim et al[58] Crude saponin of Reduced body wt., Reduction of hypothalamic Korean red ginseng food intake & fat NPY expression and serum content in HFD group leptin level in HFD group of I of I similar to those Yun et al[59] Sig. inhibition of Sig. inhibition of FBG, TG, and body wt. gain dose FFAs dose-dependently; insulin resistance improved Decrease of white & brown adipocytes Sig. decrease in body Reduction of fasting serum TG, et al[60] 2004 insulin & malondialdehyde Kim et al[61] Sig. decrease in body Increase of brown adipocytes (CoixLachrymajobi var. C2: HFD + saline wt. & food intake as compared to NLD group & epididymal and but not significant peritoneal fat & white adipose tissue size as compared to sham Kwon et al[62] Dioscorea nipponica Sig. decrease in body Suppression of time dependent wt. & adipose gain increase of serum TG level after Lu et al[63] Inspissation tea Stronger modulation Only fenfluramine showed sig. difference in small intestine quantity was shown in Salacia reticulata Suppression of body et al[64] 2002 wt. and periuterine fat storage increase in female rats but no effect on male rats Xie et al[65] C: Diabetic/lean Sig. decrease in body Sig. increase in glucose wt. as compared to day tolerance in diabetic mice but 0 in diabetic group of no sig. decrease of FBG in lean I: Same groups I. wt. loss in lean mice CT-Ⅱ, an extract from Sig. inhibition of Sig. inhibition of TG elevation et al[66] 2000 body wt. gain dose I: Same groups dependently without + HFD + plant affecting food intake in lean rats after 12 wk. Sig. decrease in body wt. gain in obese mice Han et al[67] No sig. difference Enhancement of noradrenalin in food intake but induced lipolysis & inhibition prevented obesity & of pancreatic lipase activity liver induced by a HFD 3080 ISSN 1007-9327 CN 14-1219/R World J Gastroenterol July 7, 2009 Volume 15 Number 25 Sig. decrease of body protein et al[68] 1998 (Phaseolus vulgaris) in lean I group. Sig. decrease in dependently lower plasma insulin levels in obese I group. Sig. pancreatic growth after long term feeding in all Sig. decrease in food Improvement in glucose et al[69] 1991 (Paenia suffruticosa) intake and Lee index tolerance. No sig. difference in Parasitic loranthus from Sig. decrease in body High inhibitory ability on FAS- et al[70] 2008 Loranthacea or Viscaceae wt. & food intake Loran thacea was nearly 400 fold stronger than that from Hu et al[71] Escins extracted Suppressed the increase of liver increase in body & TG content; increased TG in parametrial adipose feces after fat ingestion Nelumbo nucifera Sig. suppression of Exhibition of lipolytic activity et al[72] 2007 especially in visceral adipose tissue; β adrenergic receptor pathway was partly involved Kang et al[73] PM-F2-OB composed No sig. difference in Sig. decrease in serum Chol/ of Lycii Fructus, wt. change if STD LDL and total lipids; reduction Rehmanniae Radix, was used but in HFD of kidney fat wt./FFA/PL & Coicis Semen, group of I resulted in TG to levels equal or below the Carthami Flos, Hoelen, sig. decrease in body Angelicae Radix, wt. gain but showed Nelumbinis Semen, no sig. difference in Radix Dioscorea amount of food intake and Aurantii Mary et al[74] Sig. decrease in body Sig. increase in HDL after oral A herbal formulation administration and decrease in atherogenic index in oral administration; Sig. increase of the release of LPL enzyme and sig. hypolipidemic effect in Wu et al[75] Sig. decrease in Sig. decrease in plasma glucose; polysaccharide (APS) a improved insulin sensitivity component of Astragalus membranaceus roots Xie et al[76] Total, Ginsenosides in 100, 200 mg/kg Sig. decrease in Sig. decrease in FBG in Chinese ginseng (TG 200 mg/kg dose after injection CG), from leaves and the Sig. decrease in FBG in stem of Panax ginseng Palit et al[77] Galega officinalis 10% (w/w) of C: Diabetic/NL Sig. decrease in body Striking loss of body fat in both wt. in both I groups, groups; Sig. decrease in serum sig. wt. loss in normal glucose in both groups but Sig. mice independent of decrease in serum insulin in a reduction in food intake but in diabetic mice wt. loss was with reduced food intake Oi et al[78] Sig. decrease in Sig. decrease in plasma I: HFD + extract body wt. & perirenal TG levels; sig. decrease in adipose tissue wt. & mitochondrial protein and epididymal fat pad (UCP) in brown adipose tissue, and in urinary noradrenaline and adrenaline excretion Sig. decrease in body Sig. increase in GDP binding et al[79] 1995 wt. & retroperitoneal white adipose tissue wt. and no change in He et al[80] Body wt. decreased Decrease in TG/Chol/ LDL/FFA/FBG/insulin; improvement of glucose Hasani-Ranjbar S et al . Herbal medicines used in the management of obesity 3081 Jeong et al[81] Sig. decrease in food Sig. decrease in plasma leptin angjeehwan: Liriope intake & body wt. gain levels; decrease in circulating platyphylla F.T./Wang TG and inhibition of lipid & T. Tang (Liliaceae), accumulation in liver; increase Platycodongrandiflorum of mRNA of genes responsible A. DC. (Campanulaceae). Schisandrachinensis K. Koch (Magnoliaceae). Ephedra sinica Stapf Rat (obese by diet) Sig. decrease in wt. of Sig. decrease in fat cell number et al[82] 2005 body & adipose tissues & size in both I groups as in rats converted to compared to their state before NLD as compared to intervention; decrease of FABP expression in HFD group of I The wt. of WAT and Expression of UCP1 mRNA in et al[83] 2008 increase in size of WAT was found but not sig.
adipocytes inhibited Kim et al[84] Sig. decrease in Effectively suppressed the increase of postprandial blood glucose level by delaying absorption of diet Attele et al[85] Sig. loss of wt. with a Sig. improvement in glucose sig. reduction in food tolerance & sig. reduction in intake & a very sig. serum insulin levels & plasma increase in energy expenditure & body MSG: Monosodium glutamate; FABO: Fatty acid β oxidation; STD: Standard diet; LFD: Low fat diet; NLD: Normal diet; HFD: High fat diet; FABP: Fatty acid binding protein; FFM: Fat free mass; sig.: Significant; AST: Aspartate transaminase; ALT: Alanine transaminase; C: Control; I: Intervention; FAS: Fatty acid synthetase; UCP: Uncoupling protein; GDP: Guanosine 5' diphosphate; FAS: Fatty acid synthetase; TG: Triglyceride; HDL: High density lipoprotein; LDL: Low density lipoprotein; FBG: Fasting blood glucose; ip: Intraperitoneal; iv: Intravenous. Caps HT2 is a herbal formulation containing methanolic extract of selected parts of plants: commiphora mukul; Allium Sativum; Plumbago indica/some carpus anacardium/Hemidesmus indicus/Terminalia arjuna/Tinospora cordifolia/Withania somnifera ocimum sanctum.
caffeine[9,20] which caused minor adverse effects such as dry mouth, insomnia, nervousness, palpitation and headache. Bofutsushosan[14] caused loose bowel In many studies[8-10,12-16,20-23,27,39,73,74,79-81,83], a combination of plants or compounds containing minerals and or chemical extracts of plants were investigated and the scientific names are summarized in Tables 1 and 2. Most of these studies showed anti-obesity effects such as de- Change in body weight and body fat
creasing body weight in humans or body weight gain in The majority of animal studies (41 out of 58) showed animals with or without changes in body fat. significant weight loss or inhibition of weight gain when Currently available anti-obesity medications attack supplemented with high fat diets containing extracts the body fat dilemma in three different ways. They can of plants, with or without an efficient decrease in fat stimulate metabolism, suppress appetite, affect serotonin, mass[27-85] (Table 2).
or they can impede digestion of fat. In this review, we can categorize the target effects of herbal medicines in the same way.
Clinical trials with Agave tequilana (TEQ) and Dasylirion spp Arachis hypogaea[50] decreased body weight gain, liver (DAS)[30], Pomegranate leaf[43], Korean red ginseng[58], Tree triglyceride content and liver size in association with peony[69], Gyeongshang angjeehwan containing a variety increased fecal lipid excretion, suggesting an inhibitory of plants including platycodongrandiflorum, Magnoliaceae mechanism on lipid absorption. Phillyrin[52], Allium and Ephedra[81], Parasitic loranthus[70], and Panax ginseng victorialis[32], Pomegranate leaf[43], Kochia scoparia[46], Panax berry[85] showed significant reductions in food intake japonicus[55], Oolong tea[67], and Aesculus turbinata Blume[71] or appetite. In studies with Cucurbita moschata[40], Cyperus also had the same effect.
rotundus[42], Nomame Herba[66], Acanthopanax senticosus[57] PM- A decrease in food intake as a result of a decrease F2-OB (a traditional herbal medicine used for the treatment in appetite and an influence on hormonal status was of obesity in Korea composed of Lyci Fructus), and observed with TEQ and DAS[30], Pomegranate leaf[43], several other plants[73], bofu-tsusho-san[79], Galega officinalis[77], Korean red ginseng[58], Tree peony[69], Gyeongshang and Oolong tea[67], no change in the amount of food intake angjeehwan containing a variety of plants including or appetite was observed.
platycodon grandiflorum and Magnoliaceae and 3082 ISSN 1007-9327 CN 14-1219/R World J Gastroenterol July 7, 2009 Volume 15 Number 25 ephedra[81], and Parasitic loranthus[70], refined Rhubarb[34], metabolic syndrome has recently attracted interest in Caralluma fimbriata[19] and Panax ginseng berry[85]. Possible other parts of the world, because of its milder adverse stimulation of metabolism has been reported as a effects comparing to ephedra. In this review, two studies mechanism of action for compounds such as Slimax[8], focused on this herb[15,26]. CQ in combination with supplements containing ephedra[9,13,14,20] and Terminalia IG[15] induced marked reductions in body weight and arjuna Roxb[11] which showed modification of lipid fat. In addition, a reduction in waist size of 1.0 cm in metabolism and a reduction in serum lipid levels.
the placebo group vs 21.9 cm in the CQ-IG group was Ephedra known as Ma Huang is a well known natural product with amphetamine-like stimulation As we focused on herbal medicines, all dietary effects. Although it's efficacy in weight loss need more interventions such as the consumption of fruits and investigations, its adverse effects are well established in vegetables, whole grains, different types of fibers, the literature. In this review, nine studies investigated the functional food components including omega three effects of ephedra as one of the major components in fatty acids or phytochemicals such as flavonoids were the combinations with caffeine[9,13,22] or with several other omitted. Lifestyle modification is still the safest and plants[14,20,79,81,83] 5 of which were human studies[9,13,14,20,22].
efficacious method of inducing a persistent weight loss. In one study[13], efficient decreases in body weight In this review, some of the studies were carried out on and fat were observed with the administration of 210 mg subjects who simultaneously received diet and exercise caffeine and 72 mg ephedra per day for 12 wk with an programs (mentioned as weight loss programs in Tables). improvement in lipid metabolism and blood pressure These results demonstrated that specific phytochemical without serious adverse effects. In this study, the weight supplements increase the effectiveness of weight loss loss at 12-wk was -3.5 ± 0.6 kg with the test compound programs and additional significant anti-obesity effects which was significantly (P < 0.02) higher than that of the placebo. The percentage fat loss shown by DXA was Although few studies mentioned adverse effects, it -7.9% ± 2.9% and -1.9% ± 1.1%, respectively (P < 0.05). should be noted that many serious adverse events which In another study[20], ephedra at a dose of 40 mg/d and would have stopped a trial of a pharmaceutical agent caffeine at a dose of 100 mg/d for a longer time (9 mo) would likely not have been identified by the authors' was found to be more efficient than the previous study in search methods. Moreover, important safety issues lowering body fat and weight, improving lipid metabolism and blood pressure and had no serious adverse effects. including significant adverse events or supplement-drug The treatment group lost significantly more body weight interactions relevant to many clinical populations may (-7.18 kg) and body fat (-5.33 kg) than the control group not be fully addressed by the trials available for review. (-2.25 and -0.99 kg, respectively). The difference in data from these two studies possibly resulted from the different dosages and duration of interventions. In a human study[9], a significantly greater weight loss Compliance with conventional weight-management was observed (-4.0 ± 3.4 kg or 3.5% of baseline) in the programs, which often include increasing energy test group vs (-0.8 ± 2.4 kg or 0.09% of baseline) in the expenditure via physical activity, is low. It is not surprising placebo group. Changes were significantly greater for body to see the marketing of many new dietary slimming fat and percentage of body fat in the active group (-3.5 ± aids aimed at satisfying the need for palatable (as wel as 3.3 kg and -2.1% ± 3.0%) in comparison to the placebo safe, effective, and therapeutic) options. In accord with group (-0.7 ± 2.9 kg and -0.2% ± 2.3%). The tested prod- this approach there are numerous investigations on the uct also produced several untoward side effects, leading to effectiveness of medicinal plants as natural supplements some actively treated subjects withdrawing from the study. to reduce body weight. In this paper a variety of herbal Additional long-term studies are needed to elucidate the supplements had beneficial effects on obesity especial y effects of chronic treatment. Thus further examinations compounds containing ephedra, CQ, ginseng, bitter in healthy individuals using scientific combinations and melon (Momordica charantia), and zingiber. Most of the dose/duration adjustments are required.
introduced herbals (Tables 1 and 2) have also been shown Four studies[58,59,65,76] investigated different doses and to have antioxidant effects, and with regard to the role of types of ginseng which is a very popular Chinese herbal oxidative stress in the pathophysiology of some diseases medicine. Ginseng significantly decreased weight gain and conditions, their further positive effects may be very and efficiently improved glucose tolerance[59,76].
promising[86-95]. Attention to these natural compounds It has been reported[58] that hormonal influences and further work on the isolation and characterization of can reduce food intake and decrease serum leptin and their constituents is highly recommended.
neuropeptide Y in the brain hypothalamus although not significantly. Thus the anti-obesity effect of this plant requires further investigation.
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S- Editor Li LF L- Editor Webster JR E- Editor Zheng XM


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GUIDELINES FOR ANTIRETROVIRAL THERAPY IN GHANA National HIV/AIDS/ STI Control Programme Ministry of Health / Ghana Health Service ACKNOWLEDGEMENTS The National HIV/AIDS/STI Control Programme (NACP) wishes to express its extreme gratitude to and to acknowledge the valued input of those listed below whose efforts and contributions were essential in the preparation of this document. We wish to thank The World Health Organisation, Family Health International and the Ministry of Health for providing technical and financial support. We are grateful for the following group of individuals who aided the development of the first edition of the guidelines. Dr. George Amofa