According to the Centers for Disease Control and Prevention,1 71.6 percent of adult Americans are overweight or obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death.2 Clearly, as a nation, its citizens would do well to reduce their collective body weight—even though it’s not that simple.

Despite marketing promises to the contrary, the magic bullet for weight loss doesn’t exist. The bottom line is that losing weight and keeping it off takes work. It takes a change in diet, commitment to regular exercise as well as the right mindset. Even so, the majority of persons who lose weight regain the weight within one to five years.3 The reasons for more than 80 percent recidivism rate in gaining back weight previously lost are multifactoral, and include metabolic mechanisms.4 Consequently, a multifaceted approach to losing weight and keeping it of is required. Since the role of diet and exercise are already well-established in promoting successful weight loss, this article will address some of the key metabolic mechanisms.

Metabolic Control

In order to gain the metabolic control necessary to promote successful weight loss, it is vital to address the following metabolic issues:

• Cortisol levels—Research has shown an association between stress and abdominal fat distribution. Cortisol, the stress hormone, is implicated.5 In fact, increase stress and cortisol response is implicated in the desire to binge eat. Reducing cortisol levels can help reduce binge eating.6

• Glucose control—Failure to maintain healthy glucose levels and healthy insulin response results in weight gain.7,8

• Serum lipid control—It’s a bit of a chicken/egg story. High triglycerides contribute toward weight gain, and weight gain can result in higher triglyceride and cholesterol levels.

• Testosterone balance—For men especially, but also for women, a drop in testosterone levels can make it difficult to lose weight and maintain muscle mass while keeping energy levels up.

• Appetite control—Adverse changes in ghrelin and leptin levels can make appetite control difficult.

• Adiponectin levels—Adiponectin is a protein secreted from adipose tissue. It helps actively convert glucose into energy instead of storing it as body fat. Low production of adiponectin correlates with the development of insulin resistance and type 2 diabetes, while increasing the availability of adiponectin might help reverse insulin resistance. Adiponectin is low in obese individuals. Also, increasing adiponectin activates AMPk.

• AMPk activation—AMP-activated protein kinase (AMPk) plays a critical role in helping to burn fat and rev up our metabolism. Its activity helps determine our body fat composition and the amount of visceral fat we maintain in our abdomen (i.e. “belly fat”). Furthermore, we have more AMPk when we are young and more active, and less as we age—which contributes toward more visceral fat accumulation and loss of muscle mass.

A combination of bergamot (Citrus bergamia) and tonkat ali (Eurycoma longifolia) extracts may help address these issues. Specifically, I’m referencing a branded material called CitruSlim (HP Ingredients), which is a combination of two component branded materials, Bergamonte BPE-Complex and LJ100 E. longifolia—both of which I have written about in previous issues of Vitamin Retailer (January 2019 and June 2018, respectively).

Bergamot

Bergamot is a small citrus plant that grows along the southern coast of the Calabria region of Italy. It has a traditional history of use for treating fatty arteries and heart problems.9 This is consistent with scientific research10-12 showing that the citrus flavonoid polyphenols present in bergamot fruits influence lipid and sugar metabolism at the molecular level, helping to lower cholesterol and triglyceride levels.13,14

Additionally, Bergamot (Bergamonte BPE-Complex) has been shown to positively impact leptin and ghrelin. Leptin is the “satiety hormone” whose main role is regulating how many calories we eat and burn, as well as how much fat we carry on our bodies. Leptin resistance is believed to be a main biological abnormality in obesity. Obese people have very high levels of leptin, but the leptin signal isn’t working, and it erroneously thinks that the body is starving, even though it has more than enough energy stored. Ghrelin, the “hunger hormone,” plays a key role in weight gain because it signals your brain to eat. Its levels increase during a diet and intensify hunger, making it hard to lose weight.

In any case, a 120-day clinical study demonstrated that supplementation with Bergamonte BPE-Complex resulted in a reduction in leptin by 12.3 percent (650 mg) and 21.36 percent (1,300 mg), a reduction of ghrelin by 6.89 percent (650 mg) and 14.90 percent (1,300 mg), and an increase in adiponectin by 18.65 percent (650 mg) and 21.76 percent (1,300 mg). These changes were also accompanied by a reduction of body weight by -10.04 percent (650 mg) and -14.91 percent (1,300 mg), as well as reduction of BMI (body mass index) by -10.12 percent (650 mg) and -15.85 percent (1,300 mg) respectively.

Likewise, a very recent double-blind, placebo-controlled, randomized trial15 published in the June 2019 issue of the journal Nutrients, evaluated the effect of two dose of Bergamonte BPE-Complex (650 and 1,300 mg daily) and a placebo on several metabolic syndrome parameters in 45 obese patients with high triglycerides and cholesterol and mildly high glucose levels. The results were that Bergamonte BPE-Complex significantly reduced fasting glucose by 18.1 percent, triglycerides by 32 percent and cholesterol parameters by up to 41.4 percent in the high dose group. In addition, insulin resistance and insulin levels were also improved. Moreover, Bergamonte BPE-Complex decreased body weight by 14.8 percent and body mass index by 15.9 percent in high dose group. This correlated with a significant reduction of circulating hormones balancing caloric intake, including leptin, ghrelin and upregulation of adiponectin.

Additionally, Bergamonte BPE-Complex activates AMPk, which helps improve metabolic rate, and in turn helps burn off more fat over time. The fact is, we have more AMPk when we are young and more active, and less as we age—which contributes toward more visceral fat accumulation and loss of muscle mass. Therefore activation of AMPk is especially important as we age.

Tongkat Ali

Eurycoma longifolia Jack is an herbal medicinal plant of southeast Asian origin (Malaysia, Thailand, and Indonesia), commonly known as tongkat ali (meaning ali’s walking stick). The plant parts have been traditionally used for its antimalarial, antidiabetic, antimicrobial, antipyretic activities, as well as its aphrodisiac/sexual stimulant properties for which it has been widely used and recognized.16-19 Human clinical research on LJ100, a specific extract of tongkat ali (known in Europe as Physta) is the basis for many of the modern, science-based claims for this herb.

Multiple human studies20-25 have demonstrated the efficacy of LJ100 in significantly increasing testosterone levels using doses ranging from 100 to 400 mg. A randomized, double-blind, placebo-controlled study26 also showed that, compared to placebo, LJ100 improved various parameters of quality-of-life and sexual health/wellbeing, significant improved physical functioning (P = 0.028), and significantly improved in fat loss (P = 0.008). Other LJ100 studies27-29 showed a reduction in cortisol levels ranging between 16 to 32 percent.

CitruSlim

Good results were also obtained when Bergamonte BPE-Complex and LJ100 where combined as CitruSlim. One 12-week study examined the effects of a lifestyle program incorporating moderate exercise (five d/wk including aerobic & strength training), nutrition (1,500-1,800 calories/day) and 200 mg of CitruSlim/day on weight-loss and metabolic parameters in 29 subjects (21 women and eight men). The results showed that the overall lifestyle program led to significant changes in body weight, body fat, salivary testosterone, total cholesterol, LDL cholesterol and global mood state (p<0.05):

• Body fat loss of ½ pound per week (2 percent drop in BF percent)
• Cortisol/Testosterone = -15 percent
• Testosterone = +14 percent
• Cholesterol = -16 percent / LDL = -20 percent
• Stress = -14 percent / Global Mood State = +22 percent
• Tension = -27 percent
• Depression = -52 percent
• Anger = -42 percent
• Vigor = +27 percent
• Fatigue = -48 percent
• Confusion = -14 percent

In a second six-week study, 50 moderately overweight men and women exercised for 30 minute daily for five days/week, and followed a diet plan of 1,500-1,800 calories/day. Forty of the subjects received 200 mg CitruSlim/day, while 10 received a placebo. Results were that CitruSlim promoted an anabolic state, prevented binge eating, promoted higher energy level, reduced fatigue, and better mood. CitruSlim also reduced cholesterol levels, body weight and body fat:

A third double-blind, randomized placebo-controlled CitruSlim study with 90 overweight and obese subjects is underway and is estimated to be completed in December of 2019.

Conclusion

CitruSlim and its component ingredients, Bergamonte BPE-Complex and LJ100, may help overweight and obese individuals gain the metabolic control necessary to promote successful weight loss—this includes an increase in energy levels and a suppression in hunger hormones. To be clear, when combined with diet and exercise, it can modulate biochemical parameters sufficiently to change metabolic outcomes, resulting in successful weight loss. VR

References:

1 Centers for Disease Control and Prevention. Obesity and Overweight. Last reviewed: June 13, 2016. Retrieved June 29, 2019 from www.cdc.gov/nchs/fastats/obesity-overweight.htm.

2 Centers for Disease Control and Prevention. Adult Obesity Facts. Last reviewed: August 13, 2018. Retrieved June 29, 2019 from www.cdc.gov/obesity/data/adult.html.
3 Wysoker A. A Conceptual Model of Weight Loss and Weight Regain: An Intervention for Change J Am Psychiatr Nurses Assoc. 2002; 8(5):168-173.

4 Rosenbaum M, Leibel RL. Adaptive thermogenesis in humans. Int J Obes (Lond). 2010;34 Suppl 1:S47-55.

5 Moyer AE, Rodin J, Grilo CM, Cummings N, Larson LM, Rebuffé-Scrive M. Stress-induced cortisol response and fat distribution in women. Obes Res. 1994 May;2(3):255-62.

6 Rosenberg N, Bloch M, Ben Avi I, Rouach V, Schreiber S, Stern N, Greenman Y. Cortisol response and desire to binge following psychological stress: comparison between obese subjects with and without binge eating disorder. Psychiatry Res. 2013 Jul 30;208(2):156-61.

7 Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes—causes, effects and coping strategies. Diabetes Obes Metab. 2007 Nov;9(6):799-812.

8 Laville M, Andreelli F. [Mechanisms for weight gain during blood glucose normalization]. Diabetes Metab. 2000 Jun;26 Suppl 3:42-5. [Article in French]

9 Walker R, Janda E, Mollace V. Chapter 84: The Use of Bergamot-derived Polyphenol Fraction in Cardiometabolic Risk Prevention and its Possible Mechanisms of Action. In Watson RR, Preedy VR, Zibadi S. Polyphenols in Human Health and Disease. Volume 2. 2014:1087-110.

10 Jandaa E, Lascalaa A, Martinoa C, Ragusab S, Nuceraa S, Walkera R, Gratteria S, Mollacea V. Molecular mechanisms of lipid- and glucose-lowering activities of bergamot flavonoids. PharmaNutrition. 2016; 4S:S8–S18.

11 Cappello AR, Dolce V, Iacopetta D, Martello M, Fiorillo M, Curcio R, Muto L, Dhanyalayam D. Bergamot (Citrus bergamia Risso) Flavonoids and Their Potential Benefits in Human Hyperlipidemia and atherosclerosis: an Overview. Mini Rev Med Chem. 2016;16(8):619-29.

12 Mollace V, Sacco I, Janda E, Malara C, Ventrice D, Colica C, Visalli V, Muscoli S, Ragusa S, Muscoli C, Rotiroti D, Romeo F. Hypolipemic and hypoglycaemic activity of bergamot polyphenols: from animal models to human studies. Fitoterapia. 2011 Apr;82(3):309-16.

13 Cai Y, Xing G, Shen T, Zhang S, Rao J, Shi R. Effects of 12-week supplementation of Citrus bergamia extracts-based formulation CitriCholess on cholesterol and body weight in older adults with dyslipidemia: a randomized, double-blind, placebo-controlled trial. Lipids Health Dis. 2017 Dec 22;16(1):251.

14 Gliozzi M, Walker R, Muscoli S, Vitale C, Gratteri S, Carresi C, Musolino V, Russo V, Janda E, Ragusa S, Aloe A, Palma E, Muscoli C, Romeo F, Mollace V. Bergamot polyphenolic fraction enhances rosuvastatin-induced effect on LDL-cholesterol, LOX-1 expression and protein kinase B phosphorylation in patients with hyperlipidemia. Int J Cardiol. 2013 Dec 10;170(2):140-5.

15 Capomolla AS, Janda E, Paone S, Parafati M, Sawicki T, Mollace R, Ragusa S, Mollace V. Atherogenic Index Reduction and Weight Loss in Metabolic Syndrome Patients Treated with A Novel Pectin-Enriched Formulation of Bergamot Polyphenols. Nutrients. 2019 Jun 4;11(6). pii: E1271.

16 Bhat, R. and Karim, A.A. Tongkat Ali (Eurycoma longifolia Jack): A review on its ethnobotany and pharmacological importance. Fitoterapia 2010;81:669–679.

17 Handa, S.S., Rakesh, D.D., and Vasisht, K. 2006. Compendium of Medicinal and Aromatic Plants—Volume II: Asia. Trieste, Italy: ICS-UNIDO.

18 Ramawat, K.G. (ed.). 2009. Herbal Drugs: Ethnomedicine to Modern Medicine. Heidelberg, Germany: Springer-Verlag.

19 Singh, R., Singh, S., Jeyabalan, G., and Ali, A. An overview on traditional medicinal plants as aphrodisiac agent. J Pharmacogn Phytochem 2012;1:43–56.

20 Tambi, M.I.M. and Saad, J.M. Water-soluble extract of Eurycoma longifolia Jack soluble extract as a potential natural energizer for healthy aging men. Unpublished. Specialist Reproductive Research Center, National Population & Family Development Board, Ministry of Women & Family Development, Malaysia. 2000:9pp.

21 Unpublished. n.d. LJ100 Saliva Testosterone Test. HP Ingredients. Bandenton, PL. www.hpingredients.com/lj100_human_clinical_research.htm (accessed August 24, 2012).
22 Talbott, S., Talbott, J., Negrete, J., Jones, M., Nichols, M., and Roza, J. Poster 32: Effect of Eurycoma longifolia extract on anabolic balance during endurance exercise. JISSN 2006;3:S32.

23 Tambi, M.I. Nutrients and botanicals for optimizing men’s health. Examining the evidence for Eurycoma longifolia longjack, the Malaysian Ginseng in Men’s Health. Asian J Androl 2009;11:37–38.

24 Tambi MI, Imran MK, Henkel RR. Standardised water-soluble extract of Eurycoma longifolia, Tongkat ali, as testosterone booster for managing men with late-onset hypogonadism? Andrologia. 2012 May;44 Suppl 1:226-30.

25 Henkel, R.R., Wang, R., Bassett, S.H., Chen T., Liu, N., Zhu, Y., and Tambi, M.I. Tongkat ali as a potential herbal supplement for physically active male and female seniors—A pilot study. Phytother Res 2014;28:544–550.

26 Ismail, S.B., Mohammad, W.M.Z.W., George, A., Hussain, N.H.N., Kamal, Z.M.M., and Liske, E. Randomized clinical trial on the use of PHYSTA freeze-dried water extract of Eurycoma longifolia for the improvement of quality of life and sexual well-being in men. Evid Based Complement Alternat Med 2012; Article ID 429268:10pp.

27 Talbott, S., Talbott, J., Negrete, J., Jones, M., Nichols, M., and Roza, J. Poster 32: Effect of Eurycoma longifolia extract on anabolic balance during endurance exercise. JISSN 2006;3:S32.

28 Tambi, M.I. Nutrients and botanicals for optimizing men’s health. Examining the evidence for Eurycoma longifolia longjack, the Malaysian Ginseng in men’s health. Asian J Androl 2009;11:37–38.

29 Talbott, S.M., Talbott, J.A., George, A., and Pugh, M. Effect of Tongkat Ali on stress hormones and psychological mood state in moderately stressed subjects. JISSN 2013;10:28.

Gene Bruno, MS, MHS, the dean of academics for Huntington University of Health Sciences, is a nutritionist, herbalist, writer and educator. For more than 30 years he has educated and trained natural product retailers and health care professionals, has researched and formulated natural products for dozens of dietary supplement companies, and has written articles on nutrition, herbal medicine, nutraceuticals and integrative health issues for trade, consumer magazines and peer-reviewed publications. He can be reached at gbruno@hchs.edu.