**3.8. Hydroxycitric acid (HCA,** *Garcinia cambogia***)**

*Garcinia cambogia* is a plant native to Southeast Asia which yields a small purple fruit used in weight loss products for its hydroxycitric acid (HCA) content [27, 244]. The anorectic activity of HCA is due to the inhibition of the adenosine triphosphate-citrate (pro-3S)-lyase, which catalyzes the formation of acetyl-CoA, resulting in decreased fatty acid synthesis and lipo‐ genesis [245]. The evidence for HCA as an effective weight loss agent is contradictory. One randomized controlled trial reported a 5-6% reduction in weight and BMI following approx‐ imately a 4.5 gram daily dose of HCA, while two other studies reported no significant weight loss or effect on appetite at lower doses of 1.5 – 2.4 gram daily HCA doses [246-248]. There are a minimal number of reported interactions with *Garcinia* or HCA. Antilipemic agents such as HMG-CoA reductase inhibitors should be avoided due to an increased risk of rhabdomyolysis. In one case report a healthy 54 year old female patient reported chest pain following ingestion of an herbal product containing ephedra, guarana, chitosan, *Gymnena sylvestre*, *Garcinia cambogia* (50% HCA), and chromium. Lab results indicated elevated serum creatine kinase (1028 IU/mL), which declined following cessation of the supplement [249]. Although the exact interaction was not determined, cautionary use of HCA-containing products in patients at risk of rhabdomyolysis is warranted.
