Citrus Aurantium supplement extract, does this supplement help with weight loss? Does it have side effects or safety issues? by Ray Sahelian, M.D. Contains synephrine
March 28 2014


Citrus aurantium is commonly referred to as bitter orange. Zhi shi is the immature dried fruit of citrus aurantium. Zhi shi has bee used in Traditional Chinese Medicine to treat chest congestion and stimulate gastrointestinal functions. In recent years this supplement has been promoted for appetite control. If you would like a diet product without stimulants, consider Diet Rx, which works very well as an appetite suppressant. See below for details.

Benefit and review
Citrus aurantium extract may help control appetite, but caution is advised. Use the least amount possible and take breaks from use. Do not take it extract daily for many days or weeks without a break. Do not use citrus aurantium extract if you have heart disease or taking strong medicines.
At this point, itts safety is still being evaluated, and although it appears to be safer than ephedra, it still carries risks in high doses, particularly for those with heart disease, high blood pressure, or those who are elderly and frail.

Nature's Way buy Citrus Aurantium, Bitter Orange 450 mg
The immature bitter orange has been used for thousands of years in ancient Chinese medicine. Nature's Way Standardized Citrus Auranatium Extract provides high levels (6%) of the key compound, synephrine, which has been the focus of study for its thermogenic properties. High doses of can increase heart rate and increase metabolism. We suggest at first to only use half a capsule until you find out how this product works with your system. Use citrus aurantium by itself without other supplements or medicines the first couple of times you try it. Do not take these capsules if you have a heart condition or taking medicines for your heart or blood pressure.

Supplement Facts:
Bitter Orange 450 mg  - Citrus Aurantium dried extract (fruit)



Buy Citrus Aurantium supplement, available for sale and you will also find a FREE bottle of Diet Rx
 

Benefits of Diet Rx
If you would like to eat less, consider a product called Diet Rx. This natural appetite suppressant works without stimulants and it does not have citrus aurantium. Diet Rx has no added caffeine, ephedra, ephedrine alkaloids, synephrine, hormones, guarana, ginseng, or stimulating amino acids. When you eat less, there is a better likelihood that your cholesterol and blood sugar will be better managed.

All natural appetite suppressant, decreases appetite so you eat less
Helps you maintain healthy cholesterol and lipid levels
Provides a variety of antioxidant from two dozen herbs and nutrients
Provides healthy fiber
Improves mental concentration and focus
Improves will power and choice of food selection

Other Weight control options to consider
Green tea extract is a good option.
5-HTP is a nutrient that helps curb appetite in some individuals . 5-HTP, by converting into serotonin, can be used temporarily to improve will power and decrease the urge to eat until more established weight loss habits are in place.
Acetyl-l-Carnitine is another option. Some users have reported an all day decrease in appetite when this product was taken before breakfast.
Hoodia is a cactus plant extract from the Kalahari desert in South Africa that has been getting a lot of attention lately.
Ephedra was temporarily back on the market, but it has been removed again. I do not recommend the use of ephedra in high doses since it has many cardiac side effects.
Chitosan has not been found to be helpful.
Use stevia as a no calorie substitute for sugar.

Side effects, safety
Caution is advised in those who have heart disease. Citrus aurantium supplement use may increase the risk of heart irregularities and may increase blood pressure. Increased body temperature may occur as the dose is increased. Drink plenty of cold water. Discuss with your physician if you are taking medicines or have a chronic health condition. Long term effects or potential harm from high dose ingestion is still not fully understood. Diet Rx may be a safer approach as an appetite suppressant.

Food Chem Toxicol. 2013. Investigating herb-drug interactions: the effect of Citrus aurantium fruit extract on the pharmacokinetics of amiodarone in rats. Overall, after analysis of the pharmacokinetic data, it deserves to be highlighted the significant increase of the peak plasma concentration of amiodarone in rats pre-treated with C. aurantium extract, while the extent of systemic exposure was comparable between both groups. This paper reports, for the first time, data on the potential of herb-drug interaction between C. aurantium extract and amiodarone. However, specific clinical trials should be performed to confirm these results in humans.

Tex Heart Inst J. 2014 Feb. Acute Myocardial Infarction Associated with Dietary Supplements Containing 1,3-Dimethylamylamine and Citrus aurantium. We describe the case of a previously healthy 22-year-old man who presented with anginal chest pain and was diagnosed with a non-ST-elevation myocardial infarction. For 3 weeks, he had been ingesting the dietary supplements Jack3d® (principal ingredient, 1,3-dimethylamylamine) and Phenorex™ (principal ingredient, Citrus aurantium) daily, before undertaking physical activity. Coronary angiograms revealed a proximal left anterior descending coronary artery thrombus with distal embolization. A combined medical regimen led to resolution of the thrombus. Three months later, the patient was asymptomatic with no evidence of ischemia. The primary ingredients in the sympathomimetic supplements taken by our patient are controversial in the medical community and have been individually associated with adverse cardiac events. There are no safety data on their simultaneous use. We discuss other reports of adverse effects associated with these supplements and recommend that the relevant safety guidelines be revised.

Possible association of acute lateral-wall myocardial infarction and bitter orange supplement.
Ann Pharmacother. 2004.
To report a possible incidence of acute lateral-wall myocardial infarction (MI) coinciding with the use of a Citrus aurantium containing dietary supplement in a patient with undetected coronary vascular disease. A 55-year-old white woman presented to the emergency department with symptoms of dull aching shoulder and chest pain. A review of medications during cardiac rehabilitation revealed the patient had ingested a multicomponent dietary supplement for weight loss containing 300 mg of Citrus aurantium (Edita's Skinny Pill) for the past year. Although the patient's past medical history did not include hypertension, coronary disease, or hyperlipidemia, an arteriogram revealed a lesion in the left main coronary artery. She did have a smoking history. She was diagnosed with acute lateral-wall MI and hospitalized for 4 days. Consumers generally consider dietary supplements safe. However, some supplements taken for weight loss contain ingredients that have been associated with cardiovascular events. Although consumers are becoming more aware of the serious adverse effects secondary to products containing ingredients such as Ma huang and ephedra, reports involving other ingredients are increasing. Citrus aurantium or synephrine, found in citrus aurantium, has been associated with adverse cardiovascular reactions. Based on the Naranjo probability scale, citrus aurantium is possibly associated with this cardiovascular event. The use of Citrus aurantium containing supplements may present as a risk for cardiovascular toxicity; however, additional studies/case reports are needed to validate this conclusion.

Bitter orange raises red flags -- Ephedra substitute is causing reactions, and alarm
By Shari Roan, Los Angeles Times. July, 2004

Only months after the herb ephedra was pulled from the market, government regulators and scientists have become increasingly alarmed about a new generation of herbal weight-loss products — specifically those containing bitter orange. The herb, also called sour orange, Seville orange or zhi shi, has a long history of use in Chinese medicine but only came to the attention of American consumers as fears over ephedra grew. Extracts from the peel of the bitter orange contain a chemical called synephrine, a substance similar to ephedra and pseudoephedrine. Like ephedra, bitter orange may contribute to weight loss by increasing metabolism. But while ephedra raises heart rate, respiratory rate and blood pressure, it is unclear whether bitter orange acts similarly. Some animal studies suggest similar effects, which could make the herb particularly risky for people with arrhythmias and high blood pressure.

Compounds in the plant
Extracts from citrus aurantium contain a rare combination of five adrenergic amines: synephrine, N-methyltyramine, hordenine, octopamine, and tyramine.

Mechanism of action
The amines in citrus aurantium stimulate beta-3 cell receptors with less of an effect on other alpha and beta receptors.
Stimulation of these beta-3 receptors elicits the breakdown of fat. Simultaneously, this stimulation causes an increase in the metabolic rate – thermogenesis – which burns calories. It may also act as an appetite suppressant.

Citrus aurantium extract potencies
This natural product is sold by raw material suppliers in various extracts, including 4 percent , 6 percent , 8 percent, 10 percent and 30 percent synepherine.

Citrus Aurantium Research studies
A botanical used in some weight-loss products as a substitute for now-banned ephedra may possibly pose health risks of its own. The ingredient is an extract of the Seville orange, known scientifically as Citrus aurantium. According to the authors of the new report, there is no reliable evidence that the herb works, but there is evidence that it could raise blood pressure or interact with certain medications. Citrus aurantium contains a compound called synephrine that, like ephedra, stimulates the central nervous system and may boost metabolism. There have yet to be any reports of serious side effects, but scientists know that synephrine can raise blood pressure and has the potential to raise the risk of cardiovascular complications.

Citrus aurantium, an ingredient of dietary supplements marketed for weight loss: current status of clinical and basic research.
Exp Biol Med. 2004.
Seville orange extracts are being marketed as a safe alternative to ephedra in herbal weight-loss products, but it may also have the potential to cause adverse health effects. Citrus aurantium contains synephrine (oxedrine), which is structurally similar to epinephrine. Although no adverse events have been associated with ingestion of Citrus aurantium products thus far, synephrine increases blood pressure in humans and other species, and has the potential to increase cardiovascular events. Additionally, Citrus aurantium contains 6',7'-dihydroxybergamottin and bergapten, both of which inhibit cytochrome P450-3A, and would be expected to increase serum levels of many drugs. There is little evidence that products containing citrus aurantium are an effective aid to weight loss. Synephrine has lipolytic effects in human fat cells only at high doses, and octopamine does not have lipolytic effects in human adipocytes.

Citrus aurantium as a thermogenic, weight-reduction replacement for ephedra: an overview.
Preuss HG. Georgetown University Medical Center, Washington, DC, USA. J Med. 2002.
The inability of many individuals to keep their weight in check by diet and exercise has created a need for additional therapeutic means to combat obesity. Despite great effort, the pharmaceutical industry has not come up with the solution; because most weight-loss drugs to date have serious adverse effects to health and well-being. The theory that beta agonists, especially beta 3 agonists, can affect body weight and fat mass is well accepted. Ephedrine has proven time and time again that it is an effective weight loss agent through its ability to increase thermogenesis and quench appetite. However, the publicity concerning adverse reactions has led to its withdrawal from use by many despite the perceived consequences of obesity. Many companies are now substituting Citrus aurantium for ephedra in their formulations. Citrus aurantium, an agent containing beta agonists, has been reported to aid in weight loss in two studies and increase thermogenesis, at least to some extent, in three studies. Colker et al. (1999) reported that in a double-blind, placebo-controlled, randomized study the subjects receiving a combination of Citrus aurantium, caffeine and St John's Wort, lost significant amounts of total body weight while on a strict diet and exercise. Those in the placebo and control groups who also were on the same restricted diet did not. However, intergroup analysis showed no statistical significance among the weight changes in the three groups. In contrast, the loss of fat mass in the test group was significantly greater compared to the placebo and control groups. Jones describes an open labeled study performed on 9 women. The subjects showed a mean of 0.94 kg lost during the first week when no product was given and 2.40 kg during the second week when a Citrus aurantium product was taken. Body weight losses were statistically greater during the second week compared to the first week. Since most clinicians would agree that the most weight loss should occur initially coinciding with a greater fluid loss during the first week, these differences are even more remarkable. Three studies reported increased metabolic rates when ingesting Citrus aurantium products, however, at least two of these studies were acute. At present, Citrus aurantium may be the best thermogenic substitute for ephedra. However, more studies are needed to establish this definitively.