living gotu kola herb

The Problem With Gotu Kola For Loose Skin Tightening and Cellulite

[toc]Commercials for prescription medications are required by law to list their side effects. Unfortunately, marketing for surgery doesn’t carry that same requirement!

Those gastric bypass and lap band surgery commercials love showing you the before and after photos, yet they fail to tell you about the side effect of saggy and loose skin, which is almost guaranteed to happen with major weight loss.

Even if you didn’t lose 50 or 100 pounds, it still can happen. Depending on your body size and age, that extra 20 or 30 pounds you shed might be enough to cause saggy skin.

With or without weight loss, this problem is compounded by age.

process of woman agingOnce women and men enter their 40’s and beyond, skin elasticity goes downhill big time. Cellulite can happen at any age, but as you get older you’re more prone to develop it. Likewise for stretch marks.

When it comes to combating flabby or sagging skin, even excellent genetics are no match against the law of gravity which takes its toll over the years. Of course the face is the most obvious location, but our whole body experiences the same thing.

Whether from losing weight or normal aging, whatever the cause, you want a magic bullet to combat these skin care issues. Gotu kola benefits are being peddled as a solution by many. Creams and supplements say it works, but does it really? And is it truly even safe? Let’s take a look at what the science actually says…

What is gotu kola?

Also known as Indian pennywort, gotu kola (Centella asiatica) is a low-growing green leafy herb which can be found natively throughout wetlands in Southeast Asia, India, and down south in the United States. It is used for both traditional herbal medicinal remedies as well as culinary purposes.

nam bai bua bok drink
The nam bai bua bok is an herbal tea served over ice. The recipe is simply the water, leaves, and a little sugar. You can also make it using dry powder extract.

As a food, it is particularly popular in Sri Lankan cuisine, where it is finely chopped and sprinkled on top of rice and curries. One salad recipe uses it in lieu of lettuce. In Thailand, the ground powder is used to make a cold herbal tea called nam bai bua bok. It is widely used throughout India in various dishes.

It should not be confused with the kola nut, which is a caffeine-containing fruit that cola was originally made from. Even though it is sometimes touted as a brain stimulant, it’s not a good coffee alternative. The gotu kola caffeine content is actually zero!

The herb has played an important role in Ayurvedic medicine, which is the practice of herbal medicine in India dating back thousands of years. The Chinese have also used it for centuries where it is reportedly known as one of the “miracle elixirs of life” (1). Even today, it remains one of the top-selling herbal medicines in these regions (2).

As a purported herbal remedy, it is true that gotu kola has been used for skin care including leprosy, psoriasis, eczema, varicose veins, and lupus. Additionally, some in these cultures believe it can boost memory, improve cognition, and help with anxiety.

Gotu kola side effects

According to the University of Maryland Medical Center, gotu kola side effects are rare but when ingested may include:

  • Nausea
  • Upset stomach
  • Headache
  • Dizziness
  • Drowsiness

Those are all for internal uses such as supplements, teas, and foods. It was noted that these reactions tended to occur with high doses, but they do not specify how much that is.

Possible drug interactions include statins (cholesterol-lowering medications), diabetes medications, sedatives (since it can have a sedating side effect on its own in some people), diuretics, and drugs that affect the liver.

With external use such as skin care, a sensation of burning or other skin allergy symptoms can occur.

Even though it is an herbal supplement you can buy without a prescription, you should still consult your doctor before using it. (3)

Does gotu kola tighten loose skin?

Let’s zero in on the purported skin care benefits. Does the science actually support the claims being made?

PubMed is the U.S. National Institutes of Health’s database of references and abstracts that have appeared in scientific journal literature.

A search for the “centella asiatica” (the scientific name for pennywort) yields 577 results and adding the word “skin” onto that query produces 67. If we further filter those results to just clinical trials, we get 6 results (4). From newest to oldest, those are:

  • Efficacy observation on acupuncture & moxibustion combined with hot compress of TCM herbs for scleroderma (2013) (5)
  • Comparative study of the efficacy and tolerability of a unique topical scar product vs white petrolatum following shave biopsies (2013) (6)
  • Clinical, biometric and structural evaluation of the long-term effects of a topical treatment with ascorbic acid and madecassoside in photoaged human skin (2008) (7)
  • A randomized, double-blind, vehicle-controlled, half-side comparison with a herbal ointment containing Mahonia aquifolium, Viola tricolor and Centella asiatica for the treatment of mild-to-moderate atopic dermatitis (2007) (8)
  • Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: a clinical prospective randomized trial with a microcirculatory model (2001) (9)
  • The microcirculatory activity of Centella asiatica in venous insufficiency. A double-blind study (1994) (10)

diagram of normal skin vs. celluliteNone are clinical trials for the most hyped benefits, such as the ability to tighten your skin or improve cellulite on legs.

However for the oldest study on venous insufficiency, that is a disease which is often caused by varicose veins and deep vein thrombosis. But is there evidence that gotu kola helps varicose or spider veins?

In that study, there were 87 patients who took either a placebo or supplements of 30 mg or 60 mg, twice daily, for a total of 60 days.

Those receiving the herb experienced a “significant” response that appeared to correlate with dosage. People on both doses experienced improvement, but the higher dosage group had the most benefit for symptoms like edema, heaviness, and discomfort. The herb was reportedly “well tolerated” with no adverse side effects.

Digging deeper…

Okay so far the results are disappointing, as we’re seeing only one study which suggests there may be benefits for varicose veins.

Perhaps the reason we’re not seeing anything is because the word “skin” was not used in the abstract, and hence, only 6 results were produced?

To find out if that was happening, we removed “skin” and reviewed all 41 clinical trials for the herb. With this, we saw more relevant research. In addition to several related to varicose veins, we saw:

Evaluation of an onion extract, Centella asiatica, and hyaluronic acid cream in the appearance of striae rubra [stretch marks] (2010) (11)

In this study, women used a cream which consisted of onion extract, gotu kola, and hyaluronic acid (that’s the stuff used in Restylane and Juvederm). Since it wasn’t straight up gotu kola extract, it’s not the ideal review, though better than nothing.

The results? The side that was treated (which was randomized on each woman) showed a “statistically significant difference” with the stretch marks for all four of those characteristics.

As far as the other trials, around two-thirds related directly or indirectly to dermatological problems. We say “indirectly” because many are addressing the benefit that it improves circulation, which does affect skin care.

  • wound healing in diabetic patients (12) (13)
  • atopic dermatitis (14)
  • diabetic microangiopathy, which is where the blood vessels shrink and is a major cause for diabetic neuropathy (15)
  • circulation problems from extended flying (16)

There are very few studies for topics different than those listed above. The outliers were anxiety disorder (17) ADHD (18), mood, and cognition (19).

The vast majority were related in some way to venous insufficiency, but again, there was nothing about tightening skin or improving saggy skin after weight loss.

Research outside of clinical trials

When we remove the clinical trial filter and broaden it to all types of research, we find much more promising information. There were several dozen papers linking gotu kola to scar and wound healing.

For the topics we’re interested in, there wasn’t a great deal of research published. Here are a few examples of what we did find…

Harvard Women’s Health Watch mentioned it in a 1999 article titled “Another cellulite remedy” (20). Since it’s nearly 20 years old and no longer available online, we can’t access it to find out what they said about pennywort.

pregnancy stretch marksCochrane Database did an analysis of a study involving 100 women, which was published in a paper titled “Creams for preventing stretch marks in pregnancy” (21). The conclusion was that “one particular cream” appears to help stretch marks and that was the one containing gotu kola, alpha tocopherol (vitamin E), and collagen-elastin hydrolysates.

Compared to placebo, it was linked to less stretch marks forming but only for women who previously experienced the problem during pregnancy (which makes sense, because if you’re not prone to getting stretch marks, obviously there’s nothing to help).

Poznan University of Medical Sciences (Poland) published a piece in 2013 titled “Centella asiatica in cosmetology” where they review the scientific mechanisms of how and why it reportedly works  (22). In it, this sentence caught our eye: “The positive effects of the treatment of cellulite with the C. asiatica extract were confirmed by a few clinical studies that used different methodologies.”

This means there are clinical trials out there, but they are not on PubMed, likely because they don’t meet the qualifications (e.g. being published in a peer reviewed journal). We’re guessing they must be in foreign languages without English translations published.

And finally… skin tightening!

computer model of fat over muscleAfter poring over research papers for many hours, believing we would never find anything about using gotu kola for loose skin, we finally came across something. In fact, it was on the last page of results.

It is actually a double-blind clinical trial, but apparently not one that meets PubMed’s requirements for being categorized as such, which is why it didn’t show up in their search for that category.

Taking place in 2000 at an Italian University, the researchers tested a placebo against what’s known as a gotu kola firming cream, which also contained boswellia and milk thistle extracts (23).

Being that younger participants were used (20 to 25 years old) and that the cream contained other active ingredients, it’s far from being an ideal. There were also only 20 people, which is a small sample. However being that it’s a clinical and double-blind trial, it’s better than nothing.

“A very significant improvement in the biomechanical properties (extensibility and firmness) of the skin” was the finding.

There was one other study which looked at skin viscoelastic properties, but the cream contained 10 different herbs, so it’s too unrelated to even hint if gotu kola stretch mark treatments work (24).

Excess skin after weight loss?

measuring waistClinical studies or not, we were unable to locate any reputable research which evaluated using centella asiatica to tighten up skin.

Yet there are many stories and customer reviews of people using gotu kola cream and powder for skin tightening. Does it actually work?

In theory it might be possible, given the body of research related to how this ingredient reportedly affects circulation in skin care. However since it’s never been formally studied for this problem, there’s no medical evidence to back this claim.

Charles Poliquin, a respected trainer of athletes, had recommended in a podcast a couple years back to take  “2 pills, 3 times daily for 6 months” to help eliminate stretch marks. He did not mention the dosage of those capsules, only the quantity and how often to take them.

He’s not considered a snake oil salesman, which is why this advice from him piqued our interest. We have read product reviews and comments from people. Some claim they see results after a month or two, others do not.

As far as the dosage, many supplements we see for sale are between 350 and 450 mg per capsule. If  and we stress the “if” part  that was what he had in mind, then it would mean per day anywhere from 2,100 mg (6 capsules at 350 mg each) to 2,700 mg (6 at 450 mg).

Ultimately, anyone using pennywort for this purpose is experimenting, so please be aware of that when you see see products making claims.

Supplements vs. creams?

We hear of some people using both; taking the capsules daily along with applying the cream directly to the affected area.

While not necessarily a reflection of efficacy, here are products we have read good things about:

Nature’s Way Gotu Kola – 180 Capsules/475 mg certified

Mederma Stretch Marks Therapy 5.29 oz – contains Cepalin (onion extract), Centella asiatica, and hyaluronic acid

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.