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Guggul (generic name)

treats Obesity, Rheumatoid arthritis, Osteoarthritis, Acne, and Hypercholesterolemia
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Alternate Title

Commifora mukul

Category

Herbs & Supplements

Synonyms

African myrrh, Arabian myrrh, Commifora mukul, Commiphora myrrha, guggal, guggulu, guggulsterone (4,17(20)-pregnadiene-3,16-dione), gum guggul, gum guggulu, guggulsterone, gugulimax, guggulipid C+, guglip, gum myrrh, fraction A, myrrha, Somali myrrh, yemen myrhh.

Background

Guggul (gum guggul) is a resin produced by the mukul mirth tree. Guggulipid is extracted from guggul, and contains plant sterols (guggulsterones E and Z), which are believed to be its bioactive compounds.

Prior to 2003, the majority of 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). Although recent evidence provides preliminary evidence against the efficacy of guggul for hypercholesterolemia, and thus, further study is necessary before a definitive conclusion can be reached.

Initial research reports that guggulsterones are antagonists of the farsenoid X receptor (FXR) and the bile acid receptor (BAR), nuclear hormones that are involved with cholesterol metabolism and bile acid regulation.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Hypercholesterolemia: Prior to 2003, the majority of 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). However, recent evidence provides preliminary evidence against the efficacy of guggul for hypercholesterolemia. Due to the precedent of prior research and historical use, further study is necessary before a definitive conclusion can be reached.
Grade: C

Acne: Guggulipid has been found to possess anti-inflammatory properties, and has been suggested as an oral therapy for nodulocystic acne vulgaris. Preliminary data suggest possible short-term improvements in the number of acne lesions. However, further evidence is warranted before a therapeutic recommendation can be made.
Grade: C

Obesity: There is insufficient evidence to support the use of guggul or guggul derivatives for the management of obesity.
Grade: C

Rheumatoid arthritis: There is insufficient evidence to support the use of guggul or guggul derivatives for the management of rheumatoid arthritis.
Grade: C

Osteoarthritis: There is insufficient evidence to support the use of guggul or guggul derivatives for the management of osteoarthritis.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Asthma, bleeding, colitis, diabetes, gingivitis, hemorrhoids, leprosy, leucorrhoea, menstrual disorders, mouth infections, neuralgia, obesity, pain, psoriasis, rhinitis, sores, sore throat, tumors, weight loss, wound healing.

Dosing

Adults (18 years and older):

There is no proven effective dose for guggul in adults. For hyperlipidemia, 500-1,000 milligrams of guggulipid (standardized to 2.5% guggulsterones) taken 2-3 times daily has been used. An equivalent dose of commercially prepared guggulsterone is 25 milligrams three times daily or 50 milligrams twice daily by mouth. A higher dose has been studied (2,000 milligrams three times daily, standardized to 2.5% guggulsterones), although this dose may be associated with a greater risk of hypersensitivity skin reactions. For nodulocystic acne, dose of guggulipid equivalent to 25 milligrams guggulsterone per day has been used.

Children (younger than 18 years):

There is no proven effective dose for guggul in children.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies:

Avoid in individuals with a known allergy or hypersensitivity to guggul or any of its constituents. Hypersensitivity skin reactions have been noted, in most cases within 48 hours of starting therapy, and resolving spontaneously within one week of therapy discontinuation.

Side Effects and Warnings:

Standardized gugulipid is generally regarded as safe in healthy adults at recommended doses for up to six months. Gastrointestinal upset is the most common adverse effect, as well as diarrhea, nausea, vomiting, burping, and hiccough. Headache, restlessness, and anxiety have been noted in studies. Allergic skin rash (especially at higher doses) has been reported.

Gugulipid has been associated with inhibition of platelets and increased fibrinolysis (blood clot breakdown), and in theory the risk of bleeding may increase.

Although not well studied in humans, weight loss and stimulation of thyroid function may occur.

Pregnancy and Breastfeeding:

Guggul is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

Co-administration of guggulipid to humans has been reported to decrease the bioavailability of the beta-blocker propranolol and the calcium channel blocker diltiazem.

Gugulipid has been associated with inhibition of platelets and increased blood clot breakdown. In theory, guggul may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

The effect of guggul on serum lipids remains controversial. Guggul may affect serum lipid levels (decreasing cholesterol, triglycerides, and low-density lipoproteins; increasing high-density lipoproteins), and may thus increase the effects of lipid-lowering drugs such as statins.

Animal studies suggest that the guggul constituent Z-guggulsterone may stimulate thyroid function. Therefore, additional effects may occur in patients taking thyroid drugs and guggul together.

Interactions with Herbs and Dietary Supplements:

The effect of guggul on serum lipids remains controversial. Guggul may affect serum lipid levels (decreasing cholesterol, triglycerides, and low-density lipoproteins; increasing high-density lipoproteins), and may thus increase the lipid-lowering effects of lipid-lowering agents such as niacin, garlic, or fish oil (omega-3 fatty acids).

Gugulipid has been associated with inhibition of platelets and increased blood clot breakdown. In theory, guggul may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic or saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Attribution

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Serguei Axentsev MD, PhD, Dr.Sci (Natural Standard Research Collaboration); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Heather Boon B.Sc.Phm, PhD (University of Toronto); Levi Garraway, MD, PhD (Harvard Medical School); Paul Hammerness, MD (Harvard Medical School); David Kroll, PhD (Duke University); Philippe Szapary, MD (University of Pennsylvania); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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;84:626-634.

Antonio J, Colker CM, Torina GC, et al. Effects of a standardized guggulsterone phosphate supplement on body composition in overweight adults: A pilot study. Curr Ther Res 1999;60:220-227.

Dalvi SS, Nayak VK, Pohujani SM, et al. Effect of gugulipid on bioavailability of diltiazem and propranolol. J Assoc Physicians India 1994;42(6):454-455.

Dogra J, Aneja N, Saxena VN. Oral gugulipid in acne vulgaris management. Ind J Dermatol Venereol Leprol 1990;56(1):381-383.

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;12:65-69.

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):200-202.

Kesava RG, Dhar SC. Effect of a new non-steroidal anti-inflammatory agent on lysosomal stability in adjuvant induced arthritis. Ital J Biochem 1987;36(4):205-217.

Kotiyal JP, Singh DS, Bisht DB. Gum guggulu (Commiphora mukul) fraction 'A' in obesity -- a double-blind clinical trial. J Res Ayur and Siddha 1985;6(1,3,4):20-35.

Malhotra SC, Ahuja MM, Sundaram KR. Long term clinical studies on the hypolipidaemic effect of Commiphora mukul (Guggulu) and clofibrate. Indian J Med Res 1977;65(3):390-395.

Mester L, Mester M, Nityanand S. Inhibition of platelet aggregation by "guggulu" steroids. Planta Med 1979;37(4):367-369.

Nies LK, Cymbala AA, Kasten SL, et al. Complementary and alternative therapies for the management of dyslipidemia. Ann Pharmacother. 2006 Nov;40(11):1984-92.

Nityanand S, Srivastava JS, Asthana OP. Clinical trials with gugulipid. A new hypolipidaemic agent. J Assoc Physicians India 1989;37(5):323-328.

Singh BB, Mishra L, Aquilina N, et al. Usefulness of guggul (Commiphora mukul) for osteoarthritis of the knee: An experimental case study. Altern Ther Health Med 2001;7(2):120, 112-114.

Szapary PO, Wolfe ML, Bloedon LT, et al. Guggulipid for the treatment of hypercholesterolemia: a randomized controlled trial. JAMA 2003;290(6):765-772.

Ulbricht C, Basch E, Szapary P, et al. Guggul for hyperlipidemia: a review by the Natural Standard Research Collaboration. Complement Ther Med. 2005 Dec;13(4):279-90.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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