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To the Editor: Dr Szapary and colleagues¹ reported that 8 weeks of treatment with guggulipid did not appear to improve levels of serum cholesterol among adults with hypercholesterolemia. They also found that guggulipid was associated with higher levels of low-density lipoprotein cholesterol (LDL-C). We are concerned that preparations of guggulsterones may contain many other substances that can inhibit the absorption and biodisposability of active substances. The gum resin of Commiphora mukul, from which guggulipid is derived, has been found to contain a complex mixture of compounds.^2-3

Furthermore, like other gum resins, guggulsterones may decrease the absorption of cholesterol in the bowel. Guggulsterone inhibits the secretion of bile acid from hepatocytes and activates the farnesoid X receptor, which inhibits bile acid synthesis in the liver. Decreased conversion of cholesterol and decreased excretion of bile acid may lead to an increase in hepatic cholesterol and a decrease in intestinal cholesterol . . . [Full Text of this Article]

Fabio Firenzuoli, MD; Luigi Gori, MD
Clinical Center of Natural Medicine
San Giuseppe Hospital
Empoli, Italy

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