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Guggul

Scientific Name(s): Commiphora mukul Hook. ex Stocks., Commiphora wightii (Arn.) Bhandari
Common Name(s): Guggal, Guggul, Guggulu, Gugulipid, Gum guggal, Gum guggulu, Indian bdellium, Indian myrrh

Medically reviewed by Drugs.com. Last updated on Jan 1, 2023.

Clinical Overview

Use

Guggul has been used in the traditional Ayurvedic medical system for centuries and has been studied extensively in India. Commercial products are promoted for use in hyperlipidemia; however, clinical studies do not substantiate this claim. Anti-inflammatory and cardiovascular effects are being evaluated, as well as use in cancer, obesity, and diabetes.

Dosing

Clinical trials are lacking to provide dosage guidelines; however, in a US clinical trial of hyperlipidemia, 75 to 150 mg of standardized guggulsterones were administered daily. In a study evaluating the anti-inflammatory effect of guggul, 500 mg of gum guggul was taken 3 times per day.

Contraindications

None identified. Caution may be warranted in patients previously experiencing adverse effects to statins.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Although generally accepted as relatively safe, case reports of adverse events exist. Moderate to severe generalized acute eczematous reactions to oral guggul have been reported, and caution may be warranted. A case report exists of rhabdomyolysis possibly caused by guggul consumption.

Toxicology

Research reveals little information regarding toxicology with the use of guggul.

Scientific Family

Botany

The guggul plant is widely distributed throughout India and adjacent dry regions. The tree is a small shrub with thorny branches. The gum, called "guggul" or "gum guggulu," is tapped from the stem of the plant, and the fragrant yellow latex solidifies as it oozes out. Excessive production of the gum eventually kills the plant. C. mukul is synonymous with Commiphora wightii and is in the same genus as Commiphora myrrha, the myrrh mentioned in the Bible.1, 2

History

The plant has been used in the traditional Ayurvedic medical system for centuries in the treatment of a variety of disorders, most notably arthritis, and as a weight-reducing agent in obesity. Other traditional uses have included liver dysfunction, tumors, ulcers and sores, urinary complaints, intestinal worms, edema, seizures, and as a cardiac tonic. In 1966, the first medical studies in animals were conducted, and in 1986, guggal was approved for marketing in India as a hypolipidemic drug. A commercial product, Guggulow, claiming cholesterol-lowering properties, is widely available on the internet.2, 3, 4

Chemistry

Guggul is the dry gum resin obtained from incisions in the bark of the Commiphora mukul tree as well as Commiphora molmol, Commiphora abyssinica, and Commiphora burseraceae.69 The gum contains minerals, resin, volatile oils, sterols, ferulates, flavones, sterones, and other chemical constituents.

Several pharmacologically active components have been identified in the plant, including guggulsterone (E- and Z-stereoisomers) and gugulipid, both found in the ethyl acetate extract of the plant. Studies have shown that the guggulsterones are antagonist ligands for the bile acid receptor farnesoid X receptor, which is activated by bile salts, thus reducing cholesterol. A triterpene, myrrhanol A, has been described to have potent anti-inflammatory effects. High-performance liquid chromatography and thin-layer chromatography methods for standardization have been described, and adulterants have been found in commercial preparations.2, 5, 6, 7, 8, 9, 10, 11, 12, 13

Uses and Pharmacology

Acne

One small study has shown guggulsterone to be as effective as tetracycline in the treatment of nodulocystic acne.(55) In vitro antibacterial effects have been described.(16)

Anti-inflammatory effects

Down-regulation of the expression of inflammatory mediators, including interleukins, transcription factors and cytokines, and hyaluronidase and collagenase enzymes have been demonstrated for extracts of C. mukul.(4, 14, 15, 16, 17, 18)

Animal data

Extracts of the plant have anti-inflammatory action and inhibit carrageenan-induced rat paw edema in animal models. Guggul was as effective as phenylbutazone and ibuprofen in an animal model of acute and chronic inflammation.(11, 19, 20, 21)

In mice with induced colitis, guggulsterone decreased the severity of the inflammatory disease.(16, 22) In rats with induced uveitis, guggulsterone demonstrated a protective effect against inflammatory mediators.(23)

Clinical data

A clinical study conducted in 30 elderly patients with osteoarthritis of the knee showed significant improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scores after taking 500 mg of C. mukul (guggulsterone 3.5%) 3 times daily with food. However, not all outcome measures showed improvement at the 2-month point.(24) Clinical studies in GI inflammatory disease are lacking.

Cancer

Animal data

In vitro studies have evaluated the effect of C. mukul extracts in a wide variety of cancer cell lines, including leukemia, myeloma, and head and neck, lung, breast, ovarian, prostate, skin, and bone cancers.(2, 25, 26, 27, 28, 29, 30, 31, 32, 33) Induction of apoptosis and inhibition of angiogenesis and cell signaling, as well as the down-regulation of transcription factors, have all been demonstrated.

Cardiac effects

Animal data

In rats with isoproterenol-induced ischemia, a hydroalcoholic extract of C. mukul improved cardiac function and prevented myocardial ischemic impairment.(34) Guggulsterone also exerts a protective effect on cardiac enzymes against drug-induced myocardial necrosis.(35)

Clinical data

In an older trial, C. mukul in combination with Inula racemosa (another Ayurvedic botanical) was studied in 200 patients with ischemic heart disease and found to improve electrocardiogram readings and decrease episodes of dyspnea and chest pain.(36) Gum guggul fraction increased fibrinolytic activity and decreased platelet adhesiveness.(37) However, there were no adverse effects on hemodynamic parameters in a safety study.(2)

Dementia

Animal data

Positive effects on neuroinflammation, memory impairment, and dementia-related memory deficit in animal models suggest potential benefits in Alzheimer disease dementia. Effects appear to result from disruption in amyloid protein processing via cholesterol synthesis pathways.(69)

Diabetes

Animal data

In mice with induced diabetes, administration of C. mukul extracts improved glucose tolerance, decreased plasma insulin levels, reduced weight gain, and improved the lipid profile.(38, 39)

Clinical data

Research reveals no clinical trials regarding the use of guggul for diabetes. However, a small trial with 58 adult obese patients demonstrated that diet and guggulu taken over 30 days increased weight loss in patients who weighed more than 90 kg.(40)

Endocrine effects

Animal data

In mice with induced hypothyroidism, coadministration of C. mukul extracts reversed the hypothyroid state and increased triiodothyronine levels in euthyroid animals.(41, 42) In vitro laboratory experiments have shown that guggulsterone is able to bind to mineralocorticoid, glucocorticoid, androgen, and progesterone receptors with either antagonist or agonist action.(43, 44)

Hemorrhoids

A guggul-based kshar sutra ligation was more effective in healing but was less favored than rubber band ligation of hemorrhoids.(56)

Hyperlipidemia

Animal data

Rabbits with induced hyperlipidemia showed decreases of high-density lipoprotein (HDL) and triglycerides after 14 weeks of receiving C. mukul extracts.(45) Studies have shown that the guggulsterones are antagonist ligands for the bile acid receptor farnesoid X receptor, which is activated by bile salts, thus reducing cholesterol.(2, 46)

Clinical data

Limited quality clinical trials have been conducted, with the majority of studies in eastern Indian populations. Reviews of these studies have been published. In most studies, total cholesterol and HDL were reduced. However, in a study conducted in a US population, increases in low-density lipoprotein (LDL) were observed, and case reports of increased LDL with guggul consumption exist. Systematic reviews conducted on herbal medicines used for treatment of cardiovascular conditions, including hyperlipidemia reported the same data for guggul noting reductions as well as increases observed in total and LDL cholesterol, significant decreases in triglycerides, and minor adverse effects.(67, 68) Until larger, long-term quality trials have been conducted and the incidence of adverse events clarified, C. mukul extracts cannot be routinely recommended for the management of hyperlipidemia.(4, 47, 48, 49, 50, 51, 52, 53, 54)

Urinary stones

Studies have demonstrated the ability of C. wightii extracts (synonymous with C. mukul) to inhibit the growth of struvite crystals associated with the development of urinary stone/calculi.(57, 58)

Dosing

Clinical trials are lacking to provide dosage guidelines; however, in a US clinical trial in hyperlipidemia, 75 mg to 150 mg of standardized guggulsterones were administered daily.51 1,000 mg capsules containing 21 mg of guggulsterones were used in this study. In a study evaluating the anti-inflammatory effect of guggul, 500 mg of gum guggul was used 3 times daily.24

Various formulations (eg, tablets, capsules, powders) of guggul are available. Guggul and gugulipid are typically standardized to provide a fixed amount, normally 2.5% or 3.5%, of guggulsterones. However, liquid chromatography has shown commercial over-the-counter products contain less or none of claimed guggulsterone content.6, 7, 13 Standardization of herbal products is warranted.

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

Diltiazem: Guggul may decrease the serum concentration of diltiazem. Monitor therapy.(60)

Propranolol: Guggul may decrease the serum concentration of propranolol. Monitor therapy.(60)

Adverse Reactions

While the human safety profile of the extract has not been well described for children, pregnant or breast-feeding women, or patients with severe hepatic or renal disease, little to no adverse events have been reported in clinical studies; the adverse effects were primarily GI-related (diarrhea, nausea) as well as cases of hypersensitivity, possible thyroid problems, headache, hiccough, and rash.2, 4, 48, 52, 61, 67

In a study evaluating the effect of oral guggulipid on hyperlipidemia, moderate to severe generalized cutaneous reactions were noted in 9% of participants, leading to dropouts from the study.62 Case reports exist of acute eczematous reactions to guggul-containing creams.63, 64

A case report exists of rhabdomyolysis in a patient taking an extract of C. mukul 300 mg 3 times daily who was previously sensitized (increased creatine kinase) to lipid-lowering statins.59 A similar case report of increased transaminases exists for a combination preparation containing guggulsterol and red yeast rice extract; however, fungal metabolites found in the red yeast rice extract were suspected to be responsible for the adverse effect because the metabolites are structurally similar to lovastatin. The patient had previously experienced hepatotoxicity while taking lovastatin.65 A case report of hepatotoxicity exists for a combination product (fat burner) that included guggul.66

Toxicology

Research reveals little information regarding toxicology with the use of guggul. In rats, dogs, and monkeys, no acute, subacute, or chronic toxicity has been reported. No mutagenesis or teratogenicity has been described for gum guggul.2

Index Terms

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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