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Pasdaran A, Hamedi A, Shiehzadeh S, Hamedi A. A review of citrus plants as functional foods and dietary supplements for human health, with an emphasis on meta-analyses, clinical trials, and their chemical composition. Clin Nutr ESPEN 2023; 54:311-336. [PMID: 36963879 DOI: 10.1016/j.clnesp.2023.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
Fruits, flowers, leaves, essential oils, hydrosols, and juices of citrus spp. Are utilized to prepare various forms of food products. Along with their nutritional values, in the health industry, different parts of the plants of the citrus genus have been used as supplements or remedies to prevent or control diseases. This review focused on reported meta-analyses and clinical trials on the health benefits of citrus plants as functional foods. Also, chemical compounds of various citrus species were reviewed. The following information sources were used for data collection: Google Scholar, the Web of Science, Scopus, and PubMed. Various keywords, including "citrus AND chemical compounds," "citrus AND phytochemicals," "citrus species," "citrus AND meta-analysis," "nutritional and therapeutical values of citrus spp.," "clinical trials AND citrus," "clinical trials AND Rutaceae," "health benefits of citrus spp.," "citrus edible or non-edible applications," and scientific names of the citrus plants were utilized to collect data for the review. The scientific name and common name of all twenty-eight citrus species, along with any of the above keywords, were also searched in the mentioned databases. Scientific papers and data sources were sought to review and discuss the citrus plant's nutritional and therapeutic importance. Several meta-analyses and clinical trials have reported beneficial effects of citrus spices on a variety of cancer risks, cardiovascular risk factors, neurologic disorders, urinary tract conditions, and gastrointestinal tract conditions. They have shown anxiolytic, antimicrobial, and pain-alleviating effects. Some of them can be helpful in managing obesity and cardiovascular risk factors.
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Affiliation(s)
- Ardalan Pasdaran
- Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmacognosy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azar Hamedi
- School of Agriculture, Shiraz University, Shiraz, Iran
| | - Sara Shiehzadeh
- Student Research Committee, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Hamedi
- Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmacognosy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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2
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The young fruit of Citrus aurantium L. or Citrus sinensis Osbeck as a natural health food: A deep insight into the scientific evidence of its health benefits. ARAB J CHEM 2023. [DOI: 10.1016/j.arabjc.2023.104681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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3
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The Safety and Efficacy of Citrus aurantium (Bitter Orange) Extracts and p-Synephrine: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14194019. [PMID: 36235672 PMCID: PMC9572433 DOI: 10.3390/nu14194019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Synephrine has been used to promote weight loss; however, its safety and efficacy have not been fully established. The goals of our study were to give an overview of the safety and efficacy of p-synephrine, to systematically evaluate its efficacy regarding weight loss and to assess its safety, focusing on its cardiovascular side effects in a meta-analysis. PubMed, the Cochrane Library, Web of Science and Embase were searched for relevant studies. Only placebo-controlled, human clinical trials with synephrine intervention were included in the meta-analysis. The meta-analysis was reported according to the PRISMA guidelines using the PICOS format and taking into account the CONSORT recommendations. Altogether, 18 articles were included in the meta-analysis. Both systolic and diastolic blood pressure (DBP) increased significantly after prolonged use (6.37 mmHg, 95% CI: 1.02–11.72, p = 0.02 and 4.33 mmHg, 95% CI: 0.48–8.18, p = 0.03, respectively). The weight loss in the synephrine group was non-significant after prolonged treatment, and it did not influence body composition parameters. Based on the analyzed clinical studies, synephrine tends to raise blood pressure and heart rate, and there is no evidence that synephrine can facilitate weight loss. Further studies are needed to confirm evidence of its safety and efficacy.
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Chen X, Man GCW, Hung SW, Zhang T, Fung LWY, Cheung CW, Chung JPW, Li TC, Wang CC. Therapeutic effects of green tea on endometriosis. Crit Rev Food Sci Nutr 2021:1-14. [PMID: 34620005 DOI: 10.1080/10408398.2021.1986465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Endometriosis is a chronic disorder characterized by the presence of endometrial glands and stroma outside the uterine cavity. It affects 8%-10% of women in their reproductive years, and represents a major clinical problem with deleterious social, sexual and reproductive consequences. Current treatment options include pain relief, hormonal intervention and surgical removal. However, these treatments are deemed unsatisfactory owing to varying success, significant side effects and high recurrence rates. Green tea and its major bioactive component, (-)-epigallocatechin gallate (EGCG), possess diverse biological properties, particularly anti-angiogenic, anti-proliferation, anti-metastasis, and apoptosis induction. In recent years, preclinical studies have proposed the use of green tea to inhibit the growth of endometriosis. Herein, the aim of this review is to summarize the potential therapeutic effects of green tea on molecular and cellular mechanism through inflammation, oxidative stress, invasion and adhesion, apoptosis and angiogenesis in endometriosis.
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Affiliation(s)
- Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, China.,Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Gene Chi Wai Man
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Sze Wan Hung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Tao Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Linda Wen Ying Fung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Chun Wai Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences; Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences; Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Description of Ventricular Arrhythmia after Taking Herbal Medicines in Middle-Aged Couples. Case Rep Cardiol 2020; 2020:6061958. [PMID: 33062339 PMCID: PMC7547334 DOI: 10.1155/2020/6061958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/01/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Abstract
Medicinal herbs and some derivatives have been used in the treatment of heart disease which is rarely responsible for ventricular arrhythmias and cardiac arrest. Ventricular tachycardia (VT) increases the risk of sudden cardiac death (SCD). However, only a few reports are available about the cardiac ventricular arrhythmia followed by taking herbal medicines. We present two patients (a couple) without a history of heart disease who referred to the hospital with ventricular arrhythmia.
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Gabr SA, Gabr NS, Elsaed WM. Aqueous Green Tea Extract and Prediction of Fibrosis in Lipopolysaccharide Intoxicated Rats. INT J PHARMACOL 2019. [DOI: 10.3923/ijp.2019.403.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Curran CP, Marczinski CA. Taurine, caffeine, and energy drinks: Reviewing the risks to the adolescent brain. Birth Defects Res 2017; 109:1640-1648. [PMID: 29251842 PMCID: PMC5737830 DOI: 10.1002/bdr2.1177] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/02/2017] [Indexed: 01/04/2023]
Abstract
Energy drinks are emerging as a major component of the beverage market with sales projected to top $60 billion globally in the next five years. Energy drinks contain a variety of ingredients, but many of the top-selling brands include high doses of caffeine and the amino acid taurine. Energy drink consumption by children has raised concerns, due to potential caffeine toxicity. An additional risk has been noted among college-aged consumers of energy drinks who appear at higher risk of over-consumption of alcohol when the two drinks are consumed together. The differential and combinatorial effects of caffeine and taurine on the developing brain are reviewed here with an emphasis on the adolescent brain, which is still maturing. Key data from animal studies are summarized to highlight both reported benefits and adverse effects reported following acute and chronic exposures. The data suggest that age is an important factor in both caffeine and taurine toxicity. Although the aged or diseased brain might benefit from taurine or caffeine supplementation, it appears that adolescents are not likely to benefit from supplementation and may, in fact, suffer ill effects from chronic ingestion of high doses. Additional work is needed though to address gaps in our understanding of how taurine affects females, since the majority of animal studies focused exclusively on male subjects.
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Affiliation(s)
- Christine Perdan Curran
- Department of Biological Sciences, Northern Kentucky University, Highland Heights, KY, USA 41099
| | - Cecile A. Marczinski
- Department of Psychological Science, Northern Kentucky University, Highland Heights, KY, USA 41099
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Ratamess NA, Bush JA, Stohs SJ, Ellis NL, Vought IT, O'Grady EA, Kuper JD, Hasan SB, Kang J, Faigenbaum AD. Acute cardiovascular effects of bitter orange extract (p-synephrine) consumed alone and in combination with caffeine in human subjects: A placebo-controlled, double-blind study. Phytother Res 2017; 32:94-102. [PMID: 29047215 DOI: 10.1002/ptr.5953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/07/2017] [Accepted: 09/21/2017] [Indexed: 01/09/2023]
Abstract
The purpose was to examine cardiovascular responses to supplementation with p-synephrine alone and in combination with caffeine during quiet sitting. Sixteen subjects were given (in double-blind manner) either 103 mg of p-synephrine (S), 233 mg of caffeine +104 mg of p-synephrine (LC + S), 240 mg of caffeine (LC), 337 mg of caffeine +46 mg of p-synephrine (HC + S), 325 mg of caffeine (HC), or a placebo. The subjects sat quietly for 3 hr while heart rate (HR) and blood pressure were measured. Only HC + S and HC significantly increased mean systolic blood pressure (SBP) during the second hour and tended to increase mean SBP during the third hour. Mean diastolic blood pressure in S was significantly lower than the other trials during the first and second hours, and mean arterial pressure was significantly lower in S compared to the LC, LC + S, HC, and HC + S trials. No differences were observed in HR. Consumption of p-synephrine may acutely reduce diastolic blood pressure and mean arterial pressure and not affect SBP or HR during quiet sitting. The addition of p-synephrine to caffeine did not augment SBP or HR indicating that consumption of up to 104 mg of p-synephrine does not induce cardiovascular stress during quiet sitting.
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Affiliation(s)
- Nicholas A Ratamess
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Jill A Bush
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Sidney J Stohs
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE, 68178, USA
| | - Nicole L Ellis
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Ira T Vought
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Elizabeth A O'Grady
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Jeremy D Kuper
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Saif B Hasan
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Jie Kang
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Avery D Faigenbaum
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628, USA
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9
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Brown AC. Heart Toxicity Related to Herbs and Dietary Supplements: Online Table of Case Reports. Part 4 of 5. J Diet Suppl 2017; 15:516-555. [PMID: 28981338 DOI: 10.1080/19390211.2017.1356418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The purpose of this review was to create an online research summary table of heart toxicity case reports related to dietary supplements (DS; includes herbs). METHODS Documented PubMed case reports of DS appearing to contribute to heart-related problems were used to create a "Toxic Table" that summarized the research (1966 to April, 2016, and cross-referencing). Keywords included "herb," "dietary supplement," and cardiac terms. Case reports were excluded if they were herb combinations (some exceptions), Chinese herb mixtures, teas of mixed herb contents, mushrooms, poisonous plants, self-harm (e.g. suicide), excess dose (except vitamins/minerals), drugs or illegal drugs, drug-herbal interactions, and confounders of drugs or diseases. The spectrum of heart toxicities included hypertension, hypotension, hypokalemia, bradycardia, tachycardia, arrhythmia, ventricular fibrillation, heart attack, cardiac arrest, heart failure, and death. RESULTS Heart related problems were associated with approximately seven herbs: Four traditional Chinese medicine herbs - Don quai (Angelica sinensis), Jin bu huan (Lycopodium serratum), Thundergod vine or lei gong teng (Tripterygium wilfordii Hook F), and Ting kung teng (Erycibe henryi prain); one an Ayruvedic herb - Aswagandha, (Withania somnifera); and two North American herbs - blue cohosh (Caulophyllum thalictroides), and Yohimbe (Pausinystalia johimbe). Aconitum and Ephedra species are no longer sold in the United States. The DS included, but are not limited to five DS - bitter orange, caffeine, certain energy drinks, nitric oxide products, and a calming product. Six additional DS are no longer sold. Licorice was the food related to heart problems. CONCLUSION The online "Toxic Table" forewarns clinicians, consumers and the DS industry by listing DS with case reports related to heart toxicity. It may also contribute to Phase IV post marketing surveillance to diminish adverse events that Government officials use to regulate DS.
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Affiliation(s)
- Amy C Brown
- a Complementary and Alternative Medicine, John A. Burns School of Medicine , University of Hawaii at Manoa , Honolulu , HI , USA
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10
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Effects of Lemon and Seville Orange Juices on the Pharmacokinetic Properties of Sildenafil in Healthy Subjects. Drugs R D 2017; 16:271-278. [PMID: 27550653 PMCID: PMC5045831 DOI: 10.1007/s40268-016-0140-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Several severe drug interactions have been reported when sildenafil, a potent drug for the treatment of erectile dysfunction, is co-administered with drugs or herbal remedies that inhibit cytochrome P450 (CYP) 3A4. This study evaluates the effects of two citrus fruit juices, lemon and Seville orange, on the pharmacokinetics of sildenafil in male healthy subjects following a single oral dose. METHODS We conducted an open-label, three-way crossover study in nine healthy male volunteers. Participants received a single oral dose of sildenafil (50 mg) after pretreatment with 250 mL of either water (control), undiluted lemon juice, or Seville orange juice for 3 consecutive days. All subjects were monitored for adverse effects during the study period. Plasma samples were collected for 12 h after dosing and analyzed for sildenafil concentration. RESULTS Compared with pretreatment with water, Seville orange juice significantly increased the area under the plasma concentration-time curve from time zero to infinity and the peak plasma concentration of sildenafil by 44 % (90 % confidence interval [CI] 30-60) and 18 % (90 % CI 108-129), respectively, without affecting the time to reach peak plasma concentration. Additionally, Seville orange juice significantly reduced the apparent oral clearance of sildenafil by 30 % (90 % CI 63-75) without affecting its elimination half-life. In contrast, lemon juice did not cause any significant alterations in the pharmacokinetics of sildenafil. There was no significant treatment-related adverse effects reported during the study. CONCLUSIONS Although it is considered as a moderate CYP3A4 inhibitor, Seville orange only caused a mild increase in exposure to sildenafil after a single oral dose, without manifestation of any adverse effects. The enhanced bioavailability of sildenafil by Seville orange may be attributed to inhibition of its intestinal first-pass effect (CYP3A4 and or p-glycoprotein). Lemon juice, in contrast, had no effects on the pharmacokinetics of sildenafil.
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Bakhiya N, Ziegenhagen R, Hirsch-Ernst KI, Dusemund B, Richter K, Schultrich K, Pevny S, Schäfer B, Lampen A. Phytochemical compounds in sport nutrition: Synephrine and hydroxycitric acid (HCA) as examples for evaluation of possible health risks. Mol Nutr Food Res 2017; 61. [DOI: 10.1002/mnfr.201601020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Nadiya Bakhiya
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
| | - Rainer Ziegenhagen
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
| | - Karen I. Hirsch-Ernst
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
| | - Birgit Dusemund
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
| | - Klaus Richter
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
| | - Katharina Schultrich
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
| | - Sophie Pevny
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
| | - Bernd Schäfer
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
| | - Alfonso Lampen
- Department of Food Safety; Federal Institute for Risk Assessment (BfR); Berlin Germany
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Gesundheitliche Risiken von Synephrin in Nahrungsergänzungsmitteln. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:323-331. [DOI: 10.1007/s00103-016-2506-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Jung YP, Earnest CP, Koozehchian M, Cho M, Barringer N, Walker D, Rasmussen C, Greenwood M, Murano PS, Kreider RB. Effects of ingesting a pre-workout dietary supplement with and without synephrine for 8 weeks on training adaptations in resistance-trained males. J Int Soc Sports Nutr 2017; 14:1. [PMID: 28096757 PMCID: PMC5234097 DOI: 10.1186/s12970-016-0158-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine whether ingesting a pre-workout dietary supplement (PWS) with and without synephrine (S) during training affects training responses in resistance-trained males. METHODS Resistance-trained males (N = 80) were randomly assigned to supplement their diet in a double-blind manner with either a flavored placebo (PLA); a PWS containing beta-alanine (3 g), creatine nitrate as a salt (2 g), arginine alpha-ketoglutarate (2 g), N-Acetyl-L-Tyrosine (300 mg), caffeine (284 mg), Mucuna pruiriens extract standardized for 15% L-Dopa (15 mg), Vitamin C as Ascorbic Acid (500 mg), niacin (60 mg), folate as folic acid (50 mg), and Vitamin B12 as Methylcobalamin (70 mg); or, the PWS supplement with Citrus aurantium extract containing 20 mg of synephrine (PWS + S) once per day for 8-weeks during training. Participants donated a fasting blood sample and had body composition (DXA), resting heart rate and blood pressure, cognitive function (Stroop Test), readiness to perform, bench and leg press 1 RM, and Wingate anaerobic capacity assessments determined a 0, 4, and 8-weeks of standardized training. Data were analyzed by MANOVA with repeated measures. Performance and cognitive function data were analyzed using baseline values as covariates as well as mean changes from baseline with 95% confidence intervals (CI). Blood chemistry data were also analyzed using Chi-square analysis. RESULTS Although significant time effects were seen, no statistically significant overall MANOVA Wilks' Lambda interactions were observed among groups for body composition, resting heart and blood pressure, readiness to perform questions, 1RM strength, anaerobic sprint capacity, or blood chemistry panels. MANOVA univariate analysis and analysis of changes from baseline with 95% CI revealed some evidence that cognitive function and 1RM strength were increased to a greater degree in the PWS and/or PWS + S groups after 4- and/or 8-weeks compared to PLA responses. However, there was no evidence that PWS + S promoted greater overall training adaptations compared to the PWS group. Dietary supplementation of PWS and PWS + S did not increase the incidence of reported side effects or significantly affect the number of blood values above clinical norms compared to PLA. CONCLUSION Results provide some evidence that 4-weeks of PWS and/or PWS + S supplementation can improve some indices of cognitive function and exercise performance during resistance-training without significant side effects in apparently health males. However, these effects were similar to PLA responses after 8-weeks of supplementation and inclusion of synephrine did not promote additive benefits. TRIAL REGISTRATION This trial (NCT02999581) was retrospectively registered on December 16th 2016.
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Affiliation(s)
- Y. Peter Jung
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243 USA
| | - Conrad P. Earnest
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243 USA
- Nutrabolt, Bryan, TX 77807 USA
| | - Majid Koozehchian
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243 USA
| | - Minye Cho
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243 USA
| | - Nick Barringer
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243 USA
| | - Dillon Walker
- Department of Health & Kinesiology, Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, TX 77843-4243 USA
| | - Christopher Rasmussen
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243 USA
| | - Mike Greenwood
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243 USA
| | - Peter S. Murano
- Department of Nutrition and Food Sciences, Institute for Obesity Research & Program Evaluation, Texas A&M University, College Station, TX 77843 USA
| | - Richard B. Kreider
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243 USA
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Ratamess NA, Bush JA, Kang J, Kraemer WJ, Stohs SJ, Nocera VG, Leise MD, Diamond KB, Campbell SC, Miller HB, Faigenbaum AD. The Effects of Supplementation withp-Synephrine Alone and in Combination with Caffeine on Metabolic, Lipolytic, and Cardiovascular Responses during Resistance Exercise. J Am Coll Nutr 2016; 35:657-669. [DOI: 10.1080/07315724.2016.1150223] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Gutiérrez-Hellín J, Del Coso J. Acute p-synephrine ingestion increases fat oxidation rate during exercise. Br J Clin Pharmacol 2016; 82:362-8. [PMID: 27038225 DOI: 10.1111/bcp.12952] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/26/2016] [Accepted: 03/23/2016] [Indexed: 12/30/2022] Open
Abstract
AIMS p-Synephrine is a protoalkaloid widely used in dietary supplements for weight management because of its purported thermogenic effects. However, there is a lack of scientific information about its effectiveness to increase fat metabolism during exercise. The purpose of this investigation was to determine the effects of an acute ingestion of p-synephrine on fat oxidation at rest and during exercise. METHODS In a double-blind, randomized and counterbalanced experimental design, 18 healthy subjects performed two acute experimental trials after the ingestion of p-synephrine (3 mg kg(-1) ) or after the ingestion of a placebo (cellulose). Energy expenditure and fat oxidation rates were measured by indirect calorimetry at rest and during a cycle ergometer ramp exercise test (increases of 25 W every 3 min) until volitional fatigue. RESULTS In comparison with the placebo, the ingestion of p-synephrine did not change energy consumption (1.6 ± 0.3 vs. 1.6 ± 0.3 kcal min(-1) ; P = 0.69) or fat oxidation rate at rest (0.08 ± 0.02 vs. 0.10 ± 0.04 g min(-1) ; P = 0.15). However, the intake of p-synephrine moved the fat oxidation-exercise intensity curve upwards during the incremental exercise (P < 0.05) without affecting energy expenditure. Moreover, p-synephrine increased maximal fat oxidation rate (0.29 ± 0.15 vs. 0.40 ± 0.18 g min(-1) ; P = 0.01) during exercise although it did not affect the intensity at which maximal fat oxidation was achieved (55.8 ± 7.7 vs. 56.7 ± 8.2% VO2peak ; P = 0.51). CONCLUSIONS The acute ingestion of p-synephrine increased the fat oxidation rate while it reduced the carbohydrate oxidation rate when exercising at low-to-moderate exercise intensities.
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Affiliation(s)
- Jorge Gutiérrez-Hellín
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
| | - Juan Del Coso
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
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Shara M, Stohs SJ, Mukattash TL. Cardiovascular Safety of Oralp-Synephrine (Bitter Orange) in Healthy Subjects: A Randomized Placebo-Controlled Cross-over Clinical Trial. Phytother Res 2016; 30:842-7. [DOI: 10.1002/ptr.5590] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/21/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Mohd Shara
- Faculty of Pharmacy; Jordan University of Science and Technology; Irbid Jordan
| | - Sidney J. Stohs
- Dean Emeritus; Creighton University Medical Center; Omaha NE 68178 USA
| | - Tareq L. Mukattash
- Faculty of Pharmacy; Jordan University of Science and Technology; Irbid Jordan
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Gutiérrez-Hellín J, Salinero JJ, Abían-Vicen J, Areces F, Lara B, Gallo C, Puente C, Del Coso J. Acute consumption of p-synephrine does not enhance performance in sprint athletes. Appl Physiol Nutr Metab 2016; 41:63-9. [DOI: 10.1139/apnm-2015-0299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
P-Synephrine is a protoalkaloid widely used as an ergogenic aid in sports. This substance has been included in the World Anti-Doping Agency monitoring program, although scientific information about its effects on performance and athletes’ well-being is scarce. The purpose of this investigation was to determine the effectiveness of p-synephrine to increase performance in sprint athletes. In a randomized and counterbalanced order, 13 experienced sprinters performed 2 acute experimental trials after the ingestion of p-synephrine (3 mg·kg−1) or after the ingestion of a placebo (control trial). Forty-five minutes after the ingestion of the substances, the sprinters performed a squat jump, a countermovement jump, a 15-s repeated jump test, and subsequently performed 60-m and 100-m simulated sprint competitions. Self-reported questionnaires were used to assess side-effect prevalence. In comparison with the control trial, the ingestion of p-synephrine did not change countermovement jump height (37.4 ± 4.2 vs 36.7 ± 3.3 cm, respectively; P = 0.52), squat jump height (34.4 ± 3.6 vs 33.9 ± 3.7 cm; P = 0.34), or average 15-s repeated jumps height (31.8 ± 4.1 vs 32.2 ± 3.6 cm; P = 0.18). P-Synephrine did not modify maximal running speed during the 60-m (9.0 ± 0.5 vs 9.0 ± 0.4 m·s−1, respectively; P = 0.55) and 100-m sprint competitions (8.8 ± 0.5 vs 8.8 ± 0.5 m·s−1, respectively; P = 0.92). The ingestion of p-synephrine did not alter the prevalence of headache, gastrointestinal discomforts, muscle pain, or insomnia during the hours following the tests. Acute consumption of 3 mg·kg−1 of p-synephrine was ineffective to increase performance in competitive sprint athletes. Moreover, p-synephrine did not increase the occurrence of side effects after the competition.
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Affiliation(s)
- Jorge Gutiérrez-Hellín
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
| | - Juan José Salinero
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
| | - Javier Abían-Vicen
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
| | - Francisco Areces
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
| | - Beatriz Lara
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
| | - Cesar Gallo
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
| | - Carlos Puente
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
| | - Juan Del Coso
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
- Exercise Physiology Laboratory, Sport Science Institute, Camilo José Cela University, Madrid, Spain
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19
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Gurley BJ, Steelman SC, Thomas SL. Multi-ingredient, Caffeine-containing Dietary Supplements: History, Safety, and Efficacy. Clin Ther 2015; 37:275-301. [DOI: 10.1016/j.clinthera.2014.08.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/19/2014] [Accepted: 08/23/2014] [Indexed: 02/07/2023]
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20
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Ulbricht C, Costa D, Giese N, Isaac R, Liu A, Liu Y, Osho O, Poon L, Rusie E, Stock T, Weissner W, Windsor RC. An evidence-based systematic review of bitter orange (Citrus aurantium) by the Natural Standard Research Collaboration. J Diet Suppl 2014; 10:391-431. [PMID: 24237193 DOI: 10.3109/19390211.2013.830821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
An evidence-based systematic review of bitter orange (Citrus aurantium) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
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Milton RM, Kelly-Rehm M, Brahm N, Fox MD. Hypertension in an Adolescent Secondary to Performance-Enhancement Supplement Use. J Pharm Technol 2014; 30:81-86. [PMID: 34860875 DOI: 10.1177/8755122513503790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: To describe the effects of performance-enhancing supplements and caffeine on the blood pressure (BP) of an adolescent male. Case Summary: An adolescent male presented to his primary care provider for a preseason athletic physical. On physical exam, his BP was 162/90, exceeding the 99th percentile for his age. It had been elevated during the previous 2 yearly physicals. He was referred to the Pediatric Preventive Cardiology Clinic for follow-up. Illegal substance use and renal trauma were ruled out. During the evaluation, the patient acknowledged using energy drinks and performance-enhancing supplements, the majority of which were caffeine-based. His intention was to continue the use of supplements, so lisinopril was initiated. On follow-up, however, the patient reported supplement discontinuation, intermittent medication adherence, and lower home-based BP readings. He was subsequently lost to follow-up. An objective causality assessment revealed that the adverse drug event was probable. Discussion: When working with adolescent patients, it is particularly important to conduct an in-depth interview reflecting lifestyle choices. Use of performance-enhancing supplements and caffeine for adolescent athletes has been well reported in the literature. Adolescent use of supplements may be driven by misguided beliefs and lack of knowledge about potentially detrimental health effects, such as altered heart rate and elevated BP. Little evidence-based research is available to provide treatment guidance for clinicians regarding potential effects. Conclusions: A thorough patient history, including specific questions probing for any recent or chronic use of nutritional supplements, including energy drinks, will help identify substances that may contribute to BP variations. Even mild BP elevations in adolescents should lead clinicians to further investigate supplement use and include specific questions on any product use within the past 24 hours, several days, or longer. Adolescents may not consider the potential for adverse health effects when ingesting performance-enhancing supplements or energy drinks.
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Affiliation(s)
| | | | | | - Mark D Fox
- The University of Oklahoma, Tulsa, OK, USA
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22
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Questionable conclusions in the article "Cardiovascular toxicity of Citrus aurantium in exercised rats". Cardiovasc Toxicol 2013; 13:180-1. [PMID: 23568750 DOI: 10.1007/s12012-013-9210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Multiple Dosing of Ephedra-Free Dietary Supplements: Hemodynamic, Electrocardiographic, and Bacterial Contamination Effects. Clin Pharmacol Ther 2012; 93:267-74. [DOI: 10.1038/clpt.2012.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Stohs SJ, Preuss HG, Shara M. A review of the human clinical studies involving Citrus aurantium (bitter orange) extract and its primary protoalkaloid p-synephrine. Int J Med Sci 2012; 9:527-38. [PMID: 22991491 PMCID: PMC3444973 DOI: 10.7150/ijms.4446] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/09/2012] [Indexed: 11/29/2022] Open
Abstract
This review summarizes the published as well as unpublished human studies involving Citrus aurantium (bitter orange) extract and its primary protoalkaloid p-synephrine, providing information and an assessment of the safety and efficacy of these widely used products. The results of over 20 studies involving a total of approximately 360 subjects that consumed p-synephrine alone or in combination with other ingredients are reviewed and critiqued. Over 50 % of the subjects involved in these studies were overweight/obese, and approximately two-thirds of these overweight/obese subjects consumed caffeine (132-528 mg/day) in conjunction with p-synephrine (10-53 mg/day). Bitter orange/p-synephrine containing products were consumed for up to 12 weeks. Approximately 44 % of the subjects consumed a bitter orange/p-synephrine only product, while the remainder consumed a complex product that contained multiple ingredients in addition to p-synephrine. In general, bitter orange extract alone (p-synephrine) or in combination with other herbal ingredients did not produce significant adverse events as an increase in heart rate or blood pressure, or alter electrocardiographic data, serum chemistry, blood cell counts or urinalysis. p-Synephrine alone as well as in combination products were shown to increase resting metabolic rate and energy expenditure, and modest increases in weight loss were observed with bitter orange extract/p-synephrine-containing products when given for six to 12 weeks. Longer term studies are needed to further assess the efficacy of these products and affirm their safety under these conditions.
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Affiliation(s)
- Sidney J. Stohs
- 1. Dean Emeritus, Creighton University Medical Center, Omaha, NE 68078, USA
| | - Harry G. Preuss
- 2. Departments of Biochemistry, Medicine and Pathology, Georgetown University Medical Center, Washington, DC 22039, USA
| | - Mohd Shara
- 3. Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
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Stohs SJ, Shara M, Preuss HG. Issues Associated With the Case Report Entitled “Hypertensive Urgency Associated With Xenadrine EFX Use”. J Pharm Pract 2011; 24:577-9; author reply 580. [DOI: 10.1177/0897190011422606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sidney J. Stohs
- Dean Emeritus, School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
| | - Mohd Shara
- Vice Dean, Jordan University of Science and Technology, Irbid, Jordan
| | - Harry G. Preuss
- Professor of Biochemistry, Medicine and Pathology, Georgetown University Medical Center, Washington, DC, USA
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Onakpoya I, Davies L, Ernst E. Efficacy of herbal supplements containing Citrus aurantium and synephrine alkaloids for the management of overweight and obesity: a systematic review. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.2042-7166.2011.01115.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stohs SJ, Preuss HG, Shara M. A review of the receptor-binding properties of p-synephrine as related to its pharmacological effects. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2011; 2011:482973. [PMID: 21904645 PMCID: PMC3166186 DOI: 10.1155/2011/482973] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 06/07/2011] [Indexed: 11/21/2022]
Abstract
Bitter orange (Citrus aurantium) extract and its primary protoalkaloid p-synephrine are used widely in weight loss/weight management and sports performance products. Because of structural similarities, the pharmacological effects of p-synephrine are widely assumed to be similar to those of ephedrine, m-synephrine (phenylephrine), and endogenous amine neurotransmitters as norepinephrine and epinephrine. However, small structural changes result in the receptor binding characteristics of these amines that are markedly different, providing a plausible explanation for the paucity of adverse effects associated with the wide-spread consumption of p-synephrine in the form of dietary supplements as well as in various Citrus foods and juices. This paper summarizes the adrenoreceptor binding characteristics of p-synephrine relative to m-synephrine, norepinephrine, and other amines as related to the observed pharmacological effects.
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Affiliation(s)
- Sidney J Stohs
- School of Pharmacy and Health Professions, Creighton University Medical Center, Omaha, NE 68178, USA.
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Stohs SJ, Preuss HG, Shara M. The safety of Citrus aurantium (bitter orange) and its primary protoalkaloid p-synephrine. Phytother Res 2011; 25:1421-8. [PMID: 21480414 DOI: 10.1002/ptr.3490] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 03/04/2011] [Accepted: 03/08/2011] [Indexed: 11/07/2022]
Abstract
Citrus aurantium (bitter orange) extract and its principal protoalkaloidal constituent p-synephrine are widely used in weight loss and weight management as well as in sports performance products. However, questions are raised frequently regarding the safety of these ingredients. The potential inherent dangers associated with the use of products containing C. aurantium extract are frequently touted, while conversely, millions of doses of dietary supplements have been consumed by possibly millions of individuals in recent years. Furthermore, millions of people consume on a daily basis various juices and food products from Citrus species that contain p-synephrine. This review summarizes current information regarding the safety of C. aurantium (bitter orange) extract and p-synephrine based on human, animal and in vitro assessments as well as receptor binding and mechanistic studies. The data indicate that based on current knowledge, the use of bitter orange extract and p-synephrine appears to be exceedingly safe with no serious adverse effects being directly attributable to these ingredients.
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Affiliation(s)
- Sidney J Stohs
- School of Pharmacy and Health Professions, Creighton University Medical Center, Omaha, NE 68178, USA.
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