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gotu kola

What Is It?
Health Benefits

Forms

Dosage Information

Guidelines for Use

General Interaction

Possible Side Effects

Cautions
References
Evidence Based Rating Scale

What Is It?

Gotu kola (Centella asiatica) is a creeping perennial found growing in hot, swampy regions of India, Japan, Sri Lanka, Madagascar, Australia, South Africa, and China.  It is typically eaten by elephants and by humans who eat it cooked or as a salad green, and drink it in teas. In Thailand the juice of the leaves is sweetened and mixed with water as a drink. (26) Centuries ago, practitioners of ancient systems of healing such as Ayurveda and Traditional Chinese Medicine began using this plant therapeutically. It was the kidney-shaped leaves that were most useful for medicinal purposes, including the control of skin problems. Eventually, gotu kola's reputation for treating skin and other disorders spread throughout Asia to Europe. (1)

Due to the similarity in their names, gotu kola is sometimes confused with kola nut, a caffeine-containing stimulant used to produce cola beverages. In fact, gotu kola does not contain caffeine and is not related to kola nut. (2)

Health Benefits

The enduring popularity of gotu kola has been attributed to active ingredients known as triterpenes. One medicinal form, which is an extract of gotu kola, is sometimes referred to as TTFCA (total terpenoid fraction of Centella asiatica). These substances are believed to enhance the production of the tough, fibrous Protein known as Collagen, which is found in Cartilage, bones, and connective tissues. Triterpenes also help to keep blood vessels strong and assist in producing essential neurotransmitters, the brain's chemical messengers. (3-4)

When applied externally, gotu kola encourages the healing of burns, wounds, and various skin irritations. Some studies suggest that applying a gotu kola ointment directly to affected areas promotes healing. The various triterpenes of gotu kola have different actions in various stages of wound healing, including stimulating collagen synthesis and increasing collagen secretion. (5) In a study of patients with keloids, 227 patients were divided into two groups. One group took 60-150mg of gotu kola daily for 18 months while the second group took the same dose of gotu kola and had surgical scar revision. In the supplement only group, 82% showed relief of symptoms and disappearance of inflammation while 72% of patients in the second group showed improvement. (1) In addition, animal studies have shown topical application of Centella to sutured wounds increased the strength of the wound and suggest topical Centella could be part of a scar management program for surgical wounds. (11)

Taken internally, gotu kola is widely used to minimize varicose veins, boost memory, sharpen the mind in general, and stall memory loss related to Alzheimer's disease. (1-3, 6, 7) Clinical studies indicate gotu kola may be beneficial in treating scleroderma (an autoimmune disorder), while laboratory studies show promise in treating osteoarthritis due to gotu kola's ability to reinforce the structure of connective tissue. However, more studies are needed to determine any benefit for treatment of osteoarthritis. (1, 8-9)

Gotu kola has even been tested for reducing Inflammation and improving liver function in people with alcohol-induced cirrhosis and other conditions that involve scarring and hardening of tissues in this large organ. (1, 10) The herb may also have anticancer properties. Laboratory studies indicate the herb has activity against tumors in animals as well as in human breast cancer tumors. (3, 26)

Specifically, gotu kola may help to:

  • Improve skin health. When applied externally, gotu kola is believed to prevent or minimize scarring and accelerate the healing of burns, keloids (overgrown scar tissue), and wounds (including skin ulcerations and surgical incisions). (1-3) Gotu kola may be even more effective for burns when it's combined with echinacea, vitamins (A, C, E), and zinc. (11) In addition studies in rats indicate the anti-inflammatory properties of gotu kola may be beneficial in reducing dermatitis from exposure to radiation. (29) Gotu kola may also help to minimize stretch marks. In one study, a cream containing gotu kola, vitamin E, and collagen was used by pregnant women to prevent stretch marks. When compared to placebo, fewer women who had stretch marks in prior pregnancies developed them again. (25)

  • Heal duodenal and gastric ulcers. Studies in rats demonstrate inhibition of stress-induced gastric ulcers and more rapid healing of chemically induced duodenal ulcers. Human studies are needed. (27, 28)

  • Minimize varicose veins and hemorrhoids. Varicose veins are swollen veins that can be seen through the skin, usually appearing bluish in color. Hemorrhoids are varicose veins located in anal tissue. Gotu kola appears to enhance blood flow, increase the tone of the connective tissue sheath that surrounds the veins, and maintain the suppleness of the veins. (12,  13) Study results have been somewhat promising. In one study, topical application of Centella extract (TTFCA) three times daily was shown to improve vascular tone in hemorrhoidal vessels. (12) In a 1994 trial done in Italy, 87 people with varicose veins were randomized to take either gotu kola or a Placebo. At the end of two months, the participants taking the herb showed measurable improvements in the functioning of their veins, while those on the placebo did not experience any change in the tone or strength of their veins. More research in this area is needed, however. (14)

  • Improve edema due to venous insufficiency. Venous insufficiency, occurs when the valves in leg veins break down and the walls lose their elasticity. Blood cannot return back to the heart as easily and pools in the legs, sometimes causing edema, or swelling in the legs. Numerous studies show gotu kola improves circulation and reduces edema in an optimal dosage of 60mg taken three times per day. (15-20) Even with healthy veins, air travel predisposes compromises venous return from the legs due to the extended periods of immobility with pressure on the legs in the cramped sitting position. Preliminary studies suggest gotu kola improves circulation and reduces edema in patients during airplane flights longer than three hours. (21)

  • Alleviate symptoms of diabetic microangiopathy. Diabetes may eventually cause microangiopathy, or weakening of the small blood vessels and slowing of blood flow. In a study of 30 patients with type 2 diabetes who took 60mg of gotu kola two times a day, blood circulation improved and ankle edema decreased. (22)

  • Reduce the risk of stroke. Preliminary studies indicate taking gotu kola for twelve months may help to stabilize the plaques in blood vessels that can cause acute myocardial infarction (heart attack), pulmonary embolus, and stroke when they break off and move to other parts of the body. Increased plaque density in both the legs and in the carotid vessels of the neck was observed on ultrasound in subjects taking 60mg three times a day compared to controls. The increased density is believed to indicate that plaques are less likely to break off. However, no studies have yet assessed whether there is a change in the actual incidence of stroke. (23, 24)

  • Boost memory and counteract Alzheimer's disease. In China, gotu kola has been used for centuries to heighten mental function. Today, researchers are trying to determine if the herb has a role to play in improving memory, enhancing learning capabilities, and perhaps restoring some of the memory loss of Alzheimer's sufferers. Results of animal trials indicate the antioxidant properties of the herb may slow the neurodegenerative effects of Alzheimer's disease. (6, 7)

  • Relieve anxiety. In a 2000 study, 40 healthy patients received either gotu kola or placebo for two hours. The treatment group experienced decreased acoustic startle response, suggesting that gotu kola may have anti-anxiety properties. (1, 3)

Forms

  • Tincture
  • ointment
  • liquid
  • dried herb/tea
  • capsule

Dosage Information

Take 60mg standardized extract three times a day or 600mg of dried leaf or infusion three times a day. For topical use, apply ointment to affected area.

Guidelines for Use

Commercial gotu kola preparations are available in Europe and are sold under such names as Madecassol, Centelase and TECA.

General Interaction

Do not take with gotu kola with central nervous system (CNS) depressants such as anxiety medications and sedatives as there may be an additive effect or prior to surgery where it may interact with anesthetic agents. 

Hepatotoxicity (liver damage), has been reported after as little as 30 days use in a few patients taking gotu kola for weight loss. The dosages and specific products used were not reported. Caution should be used if taking with other drugs that can potentially cause liver damage. Check with your physician or pharmacist if you are uncertain about this potential in any drugs or other herbs you may be taking. (30)

Possible Side Effects

Neither topical nor oral gotu kola preparations are commonly associated with adverse reactions when taken in usual doses. In rare cases, headache, skin rash, and sensitivity to sunlight may develop. High doses may result in nausea. Lower your dose or stop taking the herb altogether if any of these reactions occur.

Cautions

Avoid taking gotu kola orally if you are pregnant, breast-feeding, or trying to conceive.

References 

1. Centella asiatica. Altern Med Rev. 2007 Mar;12(1):69-72.
2. http://www.charakayurveda.com/Article/GotuKola.pdf. Accessed December 11, 2009
3. Zheng CJ, Qin LP. Chemical components of Centella asiatica and their bioactivities. J Chin Integr Med / Zhong Xi Yi Jie He Xue Bao. 2007; 5(3): 348-351.
4. James JT, Dubery IA. Pentacyclic triterpenoids from the medicinal herb, Centella asiatica (L.) Urban. Molecules. 2009 Oct 9;14(10):3922-41.
5. Widgerow AD, Chait LA, Stals R, Stals PJ. New innovations in scar management. Aesthetic Plast Surg. 2000 May-Jun;24(3):227-34.
6. Dhanasekaran M, Holcomb LA, Hitt AR, Tharakan B, Porter JW, Young KA, Manyam BV. Centella asiatica extract selectively decreases amyloid beta levels in hippocampus of Alzheimer's disease animal model. Phytother Res. 2009 Jan;23(1):14-9.
7. Subathra M, Shila S, Devi MA, Panneerselvam C. Emerging role of Centella asiatica in improving age-related neurological antioxidant status. Exp Gerontol. 2005 Aug-Sep;40(8-9):707-15.
8. Hong SS, Kim JH, Li H, Shim CK. Advanced formulation and pharmacological activity of hydrogel of the titrated extract of C. asiatica. Arch Pharm Res. 2005 Apr;28(4):502-8.
9. Hartog A, Smit HF, van der Kraan PM, Hoijer MA, Garssen J. In vitro and in vivo modulation of cartilage degradation by a standardized Centella asiatica fraction. Exp Biol Med (Maywood). 2009 Jun;234(6):617-23.
10. Guo JS, Cheng CL, Koo MW. Inhibitory effects of Centella asiatica water extract and asiaticoside on inducible nitric oxide synthase during gastric ulcer healing in rats. Planta Med. 2004 Dec;70(12):1150-4.
11. MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev. 2003 Nov;8(4):359-77.
12. MacKay D. Hemorrhoids and varicose veins: a review of treatment options. Altern Med Rev. 2001 Apr;6(2):126-40.
13. Arpaia MR, Ferrone R, Amitrano M, Nappo C, Leonardo G, del Guercio R. Effects of Centella asiatica extract on mucopolysaccharide metabolism in subjects with varicose veins. Int J Clin Pharmacol Res. 1990;10(4):229-33.
14. Cesarone MR, Laurora G, De Sanctis MT, Incandela L, Grimaldi R, Marelli C, Belcaro G. The microcirculatory activity of Centella asiatica in venous insufficiency. A double-blind study. Minerva Cardioangiol. 1994 Jun;42(6):299-304. [Article in Italian]
15. Brinkhaus B, Lindner M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomedicine. 2000 Oct;7(5):427-48.
16. Cesarone MR, Belcaro G, De Sanctis MT, Incandela L, Cacchio M, Bavera P, Ippolito E, Bucci M, Griffin M, Geroulakos G, Dugall M, Buccella S, Kleyweght S, Cacchio M. Effects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy: a prospective, placebo-controlled, randomized trial. Angiology. 2001 Oct;52 Suppl 2:S15-18.
17. Cesarone MR, Belcaro G, Rulo A, Griffin M, Ricci A, Ippolito E, De Sanctis MT, Incandela L, Bavera P, Cacchio M, Bucci M. Microcirculatory effects of total triterpenic fraction of Centella asiatica in chronic venous hypertension: measurement by laser Doppler, TcPO2-CO2, and leg volumetry. Angiology.2001 Oct;52 Suppl 2:S45-8.
18. De Sanctis MT, Belcaro G, Incandela L, Cesarone MR, Griffin M, Ippolito E, Cacchio M. Treatment of edema and increased capillary filtration in venous hypertension with total triterpenic fraction of Centella asiatica: a clinical, prospective, placebo-controlled, randomized, dose-ranging trial. Angiology. 2001 Oct;52 Suppl 2:S55-9.
19. Belcaro GV, Rulo A, Grimaldi R. Capillary filtration and ankle edema in patients with venous hypertension treated with TTFCA. Angiology. 1990 Jan;41(1):12-8.
20. Incandela L, Belcaro G, De Sanctis MT, Cesarone MR, Griffin M, Ippolito E, Bucci M, Cacchio M. Total triterpenic fraction of Centella asiatica in the treatment of venous hypertension: a clinical, prospective, randomized trial using a combined microcirculatory model. Angiology. 2001 Oct;52 Suppl 2:S61-7.
21. Cesarone MR, Incandela L, De Sanctis MT, Belcaro G, Geroulakos G, Griffin M, Lennox A, Di Renzo AD, Cacchio M, Bucci M. Flight microangiopathy in medium- to long-distance flights: prevention of edema and microcirculation alterations with total triterpenic fraction of Centella asiatica. Angiology. 2001 Oct;52 Suppl 2:S33-7.
22. Cesarone MR, Incandela L, De Sanctis MT, Belcaro G, Bavera P, Bucci M, Ippolito E. Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: a clinical prospective randomized trial with a microcirculatory model. Angiology. 2001 Oct;52 Suppl 2:S49-54.
23. Incandela L, Belcaro G, Nicolaides AN, Cesarone MR, De Sanctis MT, Corsi M, Bavera P, Ippolito E, Griffin M, Geroulakos G, Sabetai M, Ramaswami G, Veller M. Modification of the echogenicity of femoral plaques after treatment with total triterpenic fraction of Centella asiatica: a prospective, randomized, placebo-controlled trial. Angiology. 2001 Oct;52 Suppl 2:S69-73.
24. Cesarone MR, Belcaro G, Nicolaides AN, Geroulakos G, Bucci M, Dugall M, De Sanctis MT, Incandela L, Griffin M, Sabetai M. Increase in echogenicity of echolucent carotid plaques after treatment with total triterpenic fraction of Centella asiatica: a prospective, placebo-controlled, randomized trial. Angiology. 2001 Oct;52 Suppl 2:S19-25.
25. Young GL, Jewell D. Creams for preventing stretch marks in pregnancy. Cochrane Database Syst Rev. 2000;(2):CD000066.
26. Fugh-Berman, A. The 5-Minute Herb & Dietary Supplement Consult. Lippincott Williams & Wilkins, Philadelphia, 2003.
27. Guo JS, Cheng CL, Koo MW. Inhibitory effects of Centella asiatica water extract and asiaticoside on inducible nitric oxide synthase during gastric ulcer healing in rats. Planta Med. 2004 Dec;70(12):1150-4.
28. Sairam K, Rao CV, Goel RK. Effect of Centella asiatica Linn on physical and chemical factors induced gastric ulceration and secretion in rats. Indian J Exp Biol. 2001 Feb;39(2):137-42.
29. Chen YJ, Dai YS, Chen BF, Chang A, Chen HC, Lin YC, Chang KH, Lai YL, Chung CH, Lai YJ. The effect of tetrandrine and extracts of Centella asiatica on acute radiation dermatitis in rats. Biol Pharm Bull. 1999 Jul;22(7):703-6.
30. Jorge OA, Jorge AD. Hepatotoxicity associated with the ingestion of Centella asiatica. Rev Esp Enferm Dig 2005;97:115-24.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

Condition

Rating

Explanation

 

Acid Related Stomach Disorders-Ulcers & GERD

   

Animal studies show benefit. Human studies are needed. (27, 28)

 Alzheimer’s  
Animal studies indicate antioxidant properties may slow the neurodegenerative effects of Alzheimer's. Human studies are needed. (6, 7)
 Diabetes   Date Published: 04/18/2005
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