Cissus by Core Nutritionals

POSSIBLY EFFECTIVE

• Obesity. Several small clinical studies suggest that oral Cissus quadrangularis extract, taken with or without other ingredients, can decrease body weight in those who are overweight or obese. Details: Two small clinical studies in adults with overweight or obesity shows that taking a specific Cissus quadrangularis extract standardized to 2.5% keto-steroids and 15% soluble plant fiber (CQR-300, Gateway Health Alliance) 300 mg daily for 6-8 weeks with a reduced calorie diet decreases body weight by around 4% to 11%, compared with a 0% to 3% reduction with reduced calorie dieting alone (15609,93637). Other small clinical studies in patients with overweight or obesity shows that taking 300 mg of this product daily for 8-10 weeks without following any specific diet decreases body weight by about 8% to 9%, compared with about 2% in those taking placebo (16457,99257). Taking this product also appears to reduce body fat by about 13%, compared with no decrease in those taking placebo (99257). However, most of these studies are of moderate to low quality, and all are short-term, limiting the reliability of the findings. Cissus quadrangularis has also been evaluated in combination with other ingredients. Several small clinical studies show that taking a specific combination product containing Cissus quadrangularis (standardized to 2.5% keto-steroids and 15% soluble plant fiber), green tea, soy, chromium, selenium, and B-vitamins (Cylaris, Iovate Health Sciences International) 1028 mg daily, taken in single or divided doses, for 8 weeks reduces weight by around 7% or 6.6 kg when used alone. When used with a reduced calorie diet, body weight is reduced by 8.5% or 8.1 kg (15608,15609,95921). It is unclear if these findings are due to Cissus quadrangularis, other ingredients, or the combination.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. Although there has been interest in using oral Cissus quadrangularis for asthma, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Cancer. Although there has been interest in using oral Cissus quadrangularis for cancer, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Diabetes. Although there has been interest in using oral Cissus quadrangularis for diabetes, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Epilepsy. Although there has been interest in using oral Cissus quadrangularis for epilepsy, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Fractures. Several small, low-quality clinical trials suggest that oral Cissus quadrangularis may accelerate the healing of various types of fractures and reduce pain and swelling. Details: Two small clinical studies in patients with jaw fractures in India show that taking powdered Cissus quadrangularis whole herb 500 mg three times daily for 6 weeks or a different Cissus quadrangularis preparation containing dried stem 600 mg twice daily for 8 weeks reduces pain, swelling, and healing time when compared with placebo (93634,95923). In patients with single, simple bone fractures, a small clinical study in India shows that taking an Ayurvedic preparation of crude, powdered Cissus quadrangularis (Asthishrunkhala churna), 10 grams divided into three doses daily for 30 days, accelerates bone healing and reduces analgesic requirements when compared with placebo (95921). Another small clinical trial in patients with distal radius fractures shows that taking the same Ayurvedic preparation orally, 3-4 grams twice daily for 6 weeks, with or without a topical preparation of Cissus quadrangularis, 15 grams applied once daily for 2 weeks, seems to decrease subjective measures of pain and swelling when compared to baseline (95922). The validity of this finding is limited by the lack of a comparator group. In patients with a fracture of the long bones of the leg, a very small clinical study in India shows that taking a specific Cissus quadrangularis extract (Calzbone, Verdure Sciences) 250 mg orally three times daily decreases the average fracture healing time from 16-20 weeks to 12-14 weeks (43216). Cissus quadrangularis has also been evaluated in combination with other ingredients. A small, open label trial in India among patients with jaw fractures shows that taking Cissus quadrangularis 500 mg and Dalbergia sissoo 400 mg twice daily for 4 weeks improves bite force restoration when compared with placebo, but not when compared with teriparatide. Improvements in pain, fracture site mobility, and bone healing were lacking in all groups (112139). The study may have been inadequately powered to detect differences between the groups, and it is unclear if these findings are due to Cissus quadrangularis, Dalbergia sissoo, or the combination.
• Gout. Although there has been interest in using oral Cissus quadrangularis for gout, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Hemorrhoids. Small clinical studies suggest that oral or topical Cissus quadrangularis extracts may not improve symptoms of hemorrhoids. Details: Several small clinical studies in patients with acute, symptomatic hemorrhoids show that taking Cissus quadrangularis extract as either 100 mg daily for 1 week, 180 mg daily for 2 weeks, or 1 gram three times daily for 3 days followed by 1 gram twice daily for 4 days, does not improve symptoms of hemorrhoids when compared with placebo (43204,95921). Using a topical preparation of Cissus quadrangularis extract three times daily for 1 week also seems to be no better than placebo (95921). Another small clinical study in this population shows that rectal administration of a suppository containing Cissus quadrangularis extract 1% and Amcella paniculata extract 1% twice daily for 7 days results in similar improvements in anal pain, bleeding, and prolapse size when compared with a commercial suppository containing hydrocortisone 5 mg and cinchocaine 5 mg (108548). It is unclear if these findings are due to Cissus quadrangularis, Amcella paniculate, or the combination.
• Hyperlipidemia. Although there has been interest in using oral Cissus quadrangularis for hyperlipidemia there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Joint pain. It is unclear if oral Cissus quadrangularis is beneficial in patients with joint pain. Details: A small clinical study in males with exercise-related chronic joint pain shows that taking two 800 mg capsules of a specific Cissus quadrangularis product (SuperCissus, USPlabs) twice daily for 8 weeks decreases pain by 31% and stiffness by 23% when compared to baseline (93633). The validity of these findings is limited by the lack of a comparator group.
• Metabolic syndrome. Although there has been interest in using oral Cissus quadrangularis for metabolic syndrome, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Muscle strength. Although there has been interest in using oral Cissus quadrangularis to improve muscle strength, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Osteopenia. It is unclear if oral Cissus quadrangularis is beneficial for osteopenia. Details: A moderate-sized clinical trial in Thailand among postmenopausal patients with osteopenia shows that taking Cissus quadrangularis 1200 or 1600 mg daily for 24 weeks does not improve bone mineral density (BMD) when compared with placebo. However, Cissus quadrangularis does seem to improve markers of bone turnover, suggesting that longer-term use might lead to improvements in BMD (112140). Also, a small clinical study in patients with low BMD shows that taking a combination of Cissus quadrangularis, ashwagandha, and holy basil once daily for 6 months seems to improve BMD, T-score, and Z-score when compared with placebo (43217). However, it is unclear if these findings are due to Cissus quadrangularis, other ingredients, or the combination.
• Osteoporosis. Although there has been interest in using oral Cissus quadrangularis for osteoporosis, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Peptic ulcers. Although there has been interest in using oral Cissus quadrangularis for peptic ulcers, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral Cissus quadrangularis for RA, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose.
• Wound healing. Although there has been interest in using topical Cissus quadrangularis for wound healing, there is insufficient reliable information about the clinical effects of Cissus quadrangularis for this purpose. More evidence is needed to rate Cissus quadrangularis for these uses.

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POSSIBLY SAFE ...when used orally and appropriately, short-term. Preparations of Cissus quadrangularis dried herb have been used with apparent safety in doses up to 1600 mg for 24 weeks (93634,95923,112140). An Ayurvedic preparation of the dried herb has been used with apparent safety in doses of 6-10 grams daily for 4-6 weeks (95921,95922). Some research shows that a specific Cissus quadrangularis product (SuperCissus, USPlabs) can be used safely in a dose of 3.2 grams daily for up to 8 weeks (93633). Other research shows that another specific Cissus quadrangularis extract (CQR-300; Gateway Health Alliance) has been used with apparent safety in a dose of 300 mg daily for up to 10 weeks (15609,16457,93637,99257).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Cissus quadrangularis might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Small clinical studies suggest that Cissus quadrangularis might reduce fasting blood glucose in individuals with overweight or obesity (16457,99257).

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General ...Orally, Cissus quadrangularis seems to be well tolerated.

Gastrointestinal ...Orally, Cissus quadrangularis has been reported to cause flatulence (15608,16457), diarrhea (15608,112140), gastritis (43204), and dry mouth (15608). However, the rates of these adverse effects are similar to or lower than that observed with placebo (15608,16457,43204,112140).

Neurologic/CNS ...Orally, Cissus quadrangularis has been reported to cause headache and insomnia. However, the rates of these adverse effects are similar to or lower than that observed with placebo (15608,16457).

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