Guggul

 

Guggul Clinical Report Summary

Written Exclusively for MyNutritionStore.com by Sarah Dzida 

 

Guggul contains bioactive compounds, which are used to lower low-density lipoproteins (LDL), triglycerides and high-density lipoproteins (HDL) levels, which affect heart health.  The majority of scientific evidence available supports guggul's effect upon the heart condition known as hyperlipidemia (1-4).  One trial carried out a preliminary study at seven sites in India, which showed guggul produced a significant reduction in total cholesterol by 22% during a 12-week study on 205 individuals (5).  The trial followed up with a second 12-week double-blind study and crossover of 125 subjects, which showed decreases in total cholesterol occurred by 13-15% (5).  Another randomized, controlled, double-blind study showed that 40 patients treated with purified guggul gum experienced a decreased in triglyceride levels by 21.75% (6).  While these results are compelling, experts admit that many prior studies on guggul have inherent flaws, which means that conclusions cannot be definitive.  Interestingly enough, in 2003, a well-designed randomized, double-blind, placebo controlled trial, actually found evidence that did not support guggul's effect on total cholesterol, HDL, triglycerides, or in lowering serum LDL levels (7).  However, this discrepancy between past scientific data and historical precedent may be due to the difference between American and Indian dietary habits as well as other regional and genetic factors. 

 

Guggul Overview

 

Guggul (Commifora mukul) is the source of guggulipid, an extract from the guggul tree's resin, which researchers believe may affect human lipid levels.  Studies hypothesize that guggulipid preparations effect lipid levels due to two components known as guggulsterones E and Z.  These plant sterols, researchers believe, function as farsenoid X receptor (FXR) and bile acid receptor (BAR) antagonists and check these nuclear hormones' affect on cholesterol metabolism and bile acid regulation (8, 9).  Historically, guggul's use in India can be traced back to 600 B.C. and was used for weight loss, heart conditions as well as other ailments.  In modern times, India approved guggul as a lipid-lowering agent in 1986, while Western medicine, through medical literature, was finally introduced to the plant in 1994 (1).  Despite recent reports as of 2003 that suggest guggul increases rather than decreases LDL levels, researchers believe, due to prior extensive research and historical evidence, more concrete data is necessary before definitive conclusions can be made about guggul's efficacy.

 

Safe Use of Guggul

 

There is no proven effective dosage for adults, but studies have used 500-1000 mg of guggulipid administered 2-3 times daily.  Experts do believe that guggul is most likely safe when taken in recommended doses for up to six months (1).  Persons with a known allergy or hypersensitivity to guggul or any of its constituents as well as pregnant or breast feeding women should avoid guggul products.  In most hypersensitive cases, skin reactions were noted, but resolved spontaneously after guggul therapy was discontinued (7).  Caution is recommended for patients with thyroid disorders due to guggul's possible stimulation of the thyroid, or in patients at risk for bleeding as guggul has been associated with increased fibrinolysis, but this is an unsubstantiated theory.

 

Clinical Reports of Guggul

 

 1. Guggul and Hyperlipidemia/Hypercholesterolemia

 

Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia.  Singh RB, Niaz MA, Ghosh S.

The effects of the administration of 50 mg of guggulipid or placebo capsules twice daily for 24 weeks were compared as adjuncts to a fruit- and vegetable-enriched prudent diet in the management of 61 patients with hypercholesterolemia (31 in the guggulipid group and 30 in the placebo group) in a randomized, double-blind fashion. Guggulipid decreased the total cholesterol level by 11.7%, the low density lipoprotein cholesterol (LDL) by 12.5%, triglycerides by 12.0%, and the total cholesterol/high density lipoprotein (HDL) cholesterol ratio by 11.1% from the postdiet levels, whereas the levels were unchanged in the placebo group. The HDL cholesterol level showed no changes in the two groups. The lipid peroxides, indicating oxidative stress, declined 33.3% in the guggulipid group without any decrease in the placebo group. The compliance of patients was greater than 96%. The combined effect of diet and guggulipid at 36 weeks was as great as the reported lipid-lowering effect of modern drugs. After a washout period of another 12 weeks, changes in blood lipoproteins were reversed in the guggulipid group without such changes in the placebo group. Side effects of guggulipid were headache, mild nausea, eructation, and hiccup in a few patients.

 

Guggul for hyperlipidemia: a review by the Natural Standard Research Collaboration.  Ulbricht C, et al. (10) 

Objective: To evaluate the scientific evidence on guggul for hyperlipidemia including expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing. Methods: Electronic searches were conducted in nine databases, 20 additional journals (not indexed in common databases), and bibliographies from 50 selected secondary references. No restrictions were placed on language or quality of publications. All literature collected pertained to efficacy in humans, dosing, precautions, adverse effects, use in pregnancy/lactation, interactions, alteration of laboratory assays, and mechanism of action. Standardized inclusion/exclusion criteria were utilized for selection. Results: Before 2003, most scientific evidence suggested that guggulipid elicits significant reductions in serum total cholesterol, low-density lipoprotein (LDL), and triglycerides, as well as elevations in high-density lipoprotein (HDL) [Kotiyal JP, Bisht DB, Singh DS. Double blind cross-over trial of gum guggulu (Commiphora mukul) Fraction A in hypercholesterolemia. J Res Indian Med Yoga Hom 1979;14(2):11-6; Kotiyal JP, Singh DS, Bisht DB. Gum guggulu (Commiphora mukul) fraction 'A' in obesity-a double-blind clinical trial. J Res Ayur Siddha 1985;6(1, 3, 4):20-35; Gaur SP, Garg RK, Kar AM, et al. Gugulipid, a new hypolipidaemic agent, in patients of acute ischaemic stroke: effect on clinical outcome, platelet function and serum lipids. Asia Pacif J Pharm 1997;12:65-9; Urizar NL, Liverman AB, Dodds DT, et al. A natural product that lowers cholesterol as an antagonist ligand for the FXR. Science 3 May 2002 [Science Express Reports]; Nityanand S, Srivastava JS, Asthana OP. Clinical trials with gugulipid. A new hypolipidaemic agent. J Assoc Physicians India 1989;37(5):323-8; Kuppurajan K, Rajagopalan SS, Rao TK, et al. Effect of guggulu (Commiphora mukul-Engl.) on serum lipids in obese, hypercholesterolemic and hyperlipemic cases. J Assoc Physicians India 1978;26(5):367-73; Gopal K, Saran RK, Nityanand S, et al. Clinical trial of ethyl acetate extract of gum gugulu (gugulipid) in primary hyperlipidemia. J Assoc Physicians India 1986;34(4):249-51; Agarwal RC, Singh SP, Saran RK, et al. Clinical trial of gugulipid-a new hypolipidemic agent of plant origin in primary hyperlipidemia. Indian J Med Res 1986;84:626-34; Verma SK, Bordia A. Effect of Commiphora mukul (gum guggulu) in patients of hyperlipidemia with special reference to HDL-cholesterol. Indian J Med Res 1988;87:356-60; Singh RB, Niaz MA, Ghosh S. Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia. Cardiovasc Drugs Ther 1994;8(4):659-64; Ghorai M, Mandal SC, Pal M, et al. A comparative study on hypocholesterolaemic effect of allicin, whole germinated seeds of bengal gram and guggulipid of gum gugglu. Phytother Res 2000;14(3):200-02]. However, most published studies were small and methodologically flawed. In August 2003, a well-designed trial reported small significant increases in serum LDL levels associated with the use of guggul compared to placebo [Szapary PO, Wolfe ML, Bloedon LT, et al. Guggulipid for the treatment of hypercholesterolemia: a randomized controlled trial. JAMA 2003;290(6):765-72]. No significant changes in total cholesterol, high-density lipoprotein (HDL), or triglycerides were measured. These results are consistent with two prior published case reports [Das Gupta R. Gugulipid: pro-lipaemic effect. J Assoc Physicians India 1990;38(12):346]. Conclusion: The effects of guggulipid in patients with high cholesterol are not clear, with some studies finding cholesterol-lowering effects, and other research suggesting no benefits. At this time, there is not enough scientific evidence to support the use of guggul for any medical condition. Guggul may cause stomach discomfort or allergic rash as well as other serious side effects and interactions. It should be avoided in pregnant or breast-feeding women and in children. Safety of use beyond 4 months has not been well studied.

 

Guggul References

 

1. Singh RB, Niaz MA, Ghosh S. Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia. Cardiovasc Drugs Ther 1994;8(4):659-664.
2. Kotiyal JP, Bisht DB, Singh DS. Double blind cross-over trial of gum guggulu (Commiphora mukul) Fraction A in hypercholesterolemia. J Res Indian Med Yoga Hom 1979;14(2):11-16.
3. Agarwal RC, Singh SP, Saran RK, et al. Clinical trial of guggulipid--a new hypolipidemic agent of plant origin in primary hyperlipidemia. Indian J Med Res 1986;84:626-634.
4. Gopal K, Saran RK, Nityanand S, et al. Clinical trial of ethyl acetate extract of gum gugulu (guggulipid) in primary hyperlipidemia. J Assoc Physicians India 1986;34(4):249-251.
5. Nityanand S, Srivastava JS, Asthana OP. Clinical trials with guggulipid. A new hypolipidaemic agent. J Assoc Physicians India 1989;37(5):323-328.
6. Verma SK, Bordia A. Effect of Commiphora mukul (gum guggulu) in patients of hyperlipidemia with special reference to HDL-cholesterol. Indian J Med Res 1988;87:356-360.
7. Szapary PO, Wolfe ML, Bloedon LT, et al. Guggulipid for the treatment of hypercholesterolemia: a randomized controlled trial. JAMA 2003;290(6):765-772.
8. Nityanand S, Kapoor NK. Hypocholesterolemic effect of Commiphora mukul resin (guggal). Indian J Exp Biol 1971;9(3):376-377.
9. Singh V, Kaul S, Chander R, et al. Stimulation of low density lipoprotein receptor activity in liver membrane of guggulsterone treated rats. Pharmacol Res 1990;22(1):37-44.
10. Ulbricht C, Basch E, Szapary P, Hammerness P, Axentsev S, Boon H, Kroll D, Garraway L, Vora M, Woods J; Natural Standard Research Collaboration. Guggul for hyperlipidemia: a review by the Natural Standard Research Collaboration. Complement Ther Med. 2005 Dec;13(4):279-90. Epub 2005 Sep 23.