Effect of Bitter Melon Extracts on Lipid Levels in Japanese Subjects: A Randomized Controlled Study

Abstract

Dyslipidemia is exemplified by high levels of low-density lipoprotein cholesterol (LDL-C) and represents a risk factor for cardiovascular diseases and requires therapeutic intervention. Several experimental studies suggest that bitter melon ( Momordica charantia ) improves lipid metabolism in animal models of dyslipidemia and diabetes. This study evaluated the effects of bitter melon extracts on lipid metabolism following a 30-day treatment period in Japanese adults. This randomized, double-blind, placebo-controlled trial included 43 adult volunteers who received either 100 mg of hot-water extracts of bitter melon ( n = 23) or a placebo ( n = 20) three times daily for 30 days. The body weight, blood pressure, and levels of LDL-C and other blood parameters of each subject were measured before and after the study period. The results showed that the intervention group exhibited significantly lower LDL-C levels ( P = 0.02) as compared with the control group, and there were no significant changes in either group in terms of body weight, body mass index, systolic pressure, diastolic pressure, total cholesterol, high-density lipoprotein cholesterol, triglycerides, or blood glucose. These results suggested that bitter melon extracts might effectively lower LDL-C levels in humans and exhibit potential therapeutic value for the management of dyslipidemic conditions.

Full text

Research Article
Effect of Bitter Melon Extracts on Lipid Levels in Japanese
Subjects: A Randomized Controlled Study
Hiroki Kinoshita 1,2 and Yasuyuki Ogata 2
1Department of Public Health, Graduate School of Medicine, e University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138654, Japan
2Imagine Global Care Corporation, 3-16-12 8th Fl. Roppongi Minato-ku, Tokyo 1060032, Japan
Correspondence should be addressed to Hiroki Kinoshita; hiroki.kinoshita@gmail.com
Received 9 May 2018; Revised 19 October 2018; Accepted 28 October 2018; Published 8 November 2018
A
c
ademicEditor:PratibhaV.Nerurkar
Copyright ©  Hiroki Kinoshita and Yasuyuki Ogata. is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Dyslipidemia is exemplied by high levels of low-density lipoprotein cholesterol (LDL-C) and represents a risk factor for
cardiovascular diseases and requires therapeutic intervention. Several experimental studies suggest that bitter melon (Momordica
charantia) improves lipid metabolism in animal models of dyslipidemia and diabetes. is study evaluated the eects of bitter melon
extracts on lipid metabolism following a -day treatment period in Japanese adults. is randomized, double-blind, placebo-
controlled trial included  adult volunteers who received either  mg of hot-water extracts of bitter melon (n=)oraplacebo
(n= ) three times daily for  days. e body weight, blood pressure, and levels of LDL-C and other blood parameters of each
subject were measured beforeand aer the study period. e results showed that the intervention group exhibited signicantly lower
LDL-C levels (P= .) as compared with the control group, and there were no signicant changes in either group in terms of body
weight, body mass index, systolic pressure, diastolic pressure, total cholesterol, high-density lipoprotein cholesterol, triglycerides,
or blood glucose. ese results suggested that bitter melon extracts might eectively lower LDL-C levels in humans and exhibit
potential therapeutic value for the management of dyslipidemic conditions.
1. Introduction
Cardiovascular diseases (CVDs) remain the leading global
cause of death, with the World Health Organization project-
ing that ,, people died due to ischemic heart disease
in  []. Various studies demonstrated that dyslipidemia
is a risk factor for CVD [], with low-density lipoprotein
cholesterol (LDL-C) having a greater eect than high-density
lipoprotein cholesterol (HDL-C) or triglycerides (TGs). e
US National Cholesterol Education Program Adult Treat-
ment Panel III guidelines found that high LDL-C levels
constitute a major risk factor for coronary heart disease and
require clinical intervention [].
Lipid-lowering drugs, such as statins, are used along
with lifestyle interventions to treat high LDL-C levels,
although the absence of clear symptoms is associated with
poor drug adherence []. Furthermore, many patients have
dyslipidemia and borderline dyslipidemia, which results in
large numbers of patients with inadequately managed high
LDL-C levels. Improvements in diet and exercise can be
enhanced by avoiding saturated fats and cholesterol, as well
as consuming greater proportions of plant stanols/sterols
and soluble ber []. Moreover, lower LDL-C levels can be
achieved by consuming greater prop ortions of oats, avocados,
nuts, soybeans, tomatoes, apples, and prunes [–].
Several studies report that bitter melon (Momordica
charantia)canimprovebloodglucoselevelsandlipid
metabolism in animal models of dyslipidemia and diabetes
[, ]. Bitter melon belongs to the Cucurbitaceae family
and is commonly eaten as a vegetable in Asia, Africa, and
Latin America. Additionally, it has been used as a traditional
herbal medicine for treating diabetes in India and China
for ages []. Studies using mouse models suggest that bitter
melon improves glucose and lipid metabolism by activating
the translocation of GLUT to cell membranes in mouse
L myotubes, T-L adipocytes, skeletal muscle tissue, and
the liver, as well as promoting AMP-activated protein kinase
(AMPK) function [–]. Moreover, bitter melon reduces
Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2018, Article ID 4915784, 6 pages
https://doi.org/10.1155/2018/4915784

 Evidence-Based Complementary and Alternative Medicine
the mRNA levels of 𝛽-hydroxysteroid dehydrogenase type
(𝛽-HSD) in the mouse liver, which reduces its excessive
glucocorticoid activity and involvement in the development
of obesity and insulin resistance []. Furthermore, patients
with recently diagnosed diabetes and who consumed bitter
melon in herbal supplements exhibited decreased plasma
glycated hemoglobin levels and improved TG levels (vs.
baseline) along with a modest eect on hypoglycemia [].
erefore, the authors of that report concluded that bitter
melon helps ameliorate the diabetes-associated risk of CVD.
Several research groups evaluated the lipid-lowering
eect of bitter melon in mouse and rat models of obesity and
diabetes, providing evidence that its use can improve dyslipi-
demia (e.g., levels of TGs and LDL-C) and hyperglycemia [,
]. Additionally, bitter melon extract suppresses SREBPc
[], which is thought to play an important role in the
expression of lipid- constituting enzymes, synthesis of fatty
acids, and accumulation of TGs. Furthermore, pretreatment
of rats with a bitter melon polysaccharide extract reduced
the size of isoproterenol-induced myocardial infarction, as
well as serum levels of total cholesterol, TGs, and LDL-C.
However, this treatment increased the activity of superoxide
dismutase and catalase along with concomitant increases in
proinammatory cytokines and decreases in inammatory
markers, such as nitric oxide [, ]. ese observations
suggest that bitter melon might have a myocardial-protective
eect, although no human study has examined the eects
ofbittermelononhumanlipidmetabolism.erefore,the
present randomized controlled study examined the eect
of bitter melon extract on lipid metabolism in a group of
Japanese adults.
2. Materials and Methods
2.1. Materials. is study used capsules containing bitter
melon extract from Okinawa prefecture or placebo. e bitter
melons were subjected to hot-water extraction and ltration
along with the addition of starch hydrolysate as an excipient
before being autoclaved and dried. Based on our research,
the constituent (derived from bitter gourd) extracted with
this method is considered a type of pectin (a plant cell-wall
constituent). Because the extract has a unique appearance
andtaste,thestudydose(mgofextract,approximately
equivalent to  g of melon) was placed in white capsules that
also contained microcrystalline cellulose, calcium stearate,
and ne silicon dioxide as llers. e placebo capsules were
lled with starch hydrolysate.
2.2. Subjects. For this randomized controlled trial,  healthy
Japanese adults ( men and  women) were recruited
according to the method described by Ursoniu et al. [].
Subject recruitment was coordinated by Huma Corporation
(Minato Ward, Tokyo, Japan). e inclusion criteria were ()
age between  and  years and () willingness to provide
written informed consent to participate aer receiving a
sucient explanation regarding the purpose and procedures
of the study. e exclusion criteria were () receiving contin-
uous drug therapy (e.g., pranlukast hydrate, metformin, and
lipid-lowering drugs), () exhibiting an allergic response to
the study materials, () consuming supplements that might
aect the study parameters (based on the discretion of the
attending physician), () having had digestive organs surgi-
cally removed, () having had the presence or possibility of
pregnancy and/or breast feeding, and () having participated
in another clinical study within the previous  months.
2.3. Study Design and Parameters. e study protocol was
approved by the Ethics committee of Imagine Global Care
Corporation and was pre-registered in the University Hos-
pital Medical Information Network Clinical Trials Reg-
istry (UMIN). All participants provided written
informed consent, and the study was performed in accor-
dance with the  Declaration of Helsinki.
e subjects were randomly assigned. is was specif-
ically done by placing participants in either the control
group or the intervention group using a computer-generated
randomized number table. e subjects, study doctor, and
data analyzer were blinded to subject assignments. Starting
on day , the subjects consumed three capsules daily ( mg)
for  days, with each capsule containing either bitter melon
extract or placebo. Blood testing and measurements of weight
and blood pressure were performed on days  (the rst visit)
and  (the second visit).
Subjects were instructed to not consume sweet food or
drinks aer : on the night before blood testing. e
values of total cholesterol, HDL-C, LDL-C, TGs, glucose, and
glycated hemoglobin were also determined. All biochemical
tests were conducted by LSI Medience Corporation (Tokyo,
Japan) using Stacia, an automated clinical testing machine.
2.4. Statistical Analysis. Pearson's chi-square test was used
to compare the male: female ratios between the control and
intervention groups. An unpaired ttest was used to compare
baseline and post intervention body weight, blood pressure,
and biochemical parameters between the control and inter-
ventiongroupsaswellasthechangesinthesevaluesforeach
group. Confounding eects were evaluated using multiple
regression analysis (forced entry method), with the change
in LDL-C levels used as the dependent variable, and sex, age,
and baseline body mass index used as independent variables.
e Japan Atherosclerosis Society denes hypercholes-
terolemia as ≥ mg/dL LDL-C and borderline hypercholes-
terolemia as – mg/dL LDL-C. erefore, we addition-
ally analyzed subjects whose baseline LDL-C was equal to
or exceeded  mg/dL and determined the dierence in
changes in LDL-C between the control and intervention
subjects. Dierences were considered statistically signicant
at P<., and all analyses were performed using SPSS
soware (v.; SPSS, Inc., Chicago, IL, USA).
3. Results
Among the  recruited subjects, two were excluded because
they were receiving continuous drug therapy (pranlukast
hydrate and metformin), and two other were excluded aer
failing to attend the second visit. ere was no signicant
dierence in the male: female ratios of the control (n=)
and intervention (n= ) groups (Table ). Table  shows the

Evidence-Based Complementary and Alternative Medicine 
T:Numberandageofmaleandfemalesubjectsinthecontrolandinterventiongroups.
Control group Intervention group Overall
No. Age No. Age No. Age
Male  . ±.  . ±.  . ±.
Female  . ±.  . ±.  . ±.
Tot a l   . ±.      .  ±.      .  ±. 
T : Change in metabolic parameters aer intervention with bitter melon.
Control group (n = ) Intervention group (n = ) p-value
Body weight Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change -. ±. -. ±. .
Body mass index, kg/m2Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change -. ±. -. ±. .
Systolic pressure, mmHg Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change -. ±. -. ±. .
Diastolic pressure, mmHg Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change . ±.   .  ±. .
Total cholesterol, mg/dL Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change . ±. . ±. .
LDL-C, mg/dL Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change . ±. -. ±. .
HDL-C, mg/dL Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change . ±. -. ±. .
Triglycerides, mg/dL Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change . ±. . ±. .
Glucose, mg/dL Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change -. ±. . ±. .
Glycated hemoglobin, % Baseline . ±. . ±. .
Post intervention . ±. . ±. .
Change  ±.  ±. .
changes in metabolic parameters of the subjects from baseline
to post intervention. No signicant dierences were obser ved
between the control and intervention groups at baseline. e
intervention group showed signicantly decreased LDL-C
levels at the second visit (-. ±. mg/dL) as compared
with the control group (+ ±., P= .). ere was
no signicant dierence in changes in body weight, BMI,
blood pressure, total cholesterol, HDL-C, TGs, glucose, and
glycated hemoglobin between the control and intervention
groups. Multiple regression analysis revealed that the inter-
vention group had a signicantly increased likelihood of
lower LDL-C levels aer adjusting for sex, age, and baseline
body mass index (Table ). Baseline LDL-C ≥ mg/dL was
observed for  subjects in the control group and  subjects
in the intervention group compared with  subjects in each
group at the second visit. Furthermore, baseline LDL-C ≥
mg/dL was observed for  subjects in the control group
and  subjects in the intervention group compared with 
subjects in each group at the second visit. Among the subjects
with baseline LDL-C equal to or exceeding  mg/dL, the
mean changes were +. ±. mg/dL in the control group
and -. ±. mg/dL in the intervention group (P= .).
Figure  shows the changes in LDL-C levels in all subjects in
the control and intervention groups and those with baseline
LDL-C ≥ mg/dL.
4. Discussion
Bitter melon has been used in traditional Indian and Chinese
medicine since ancient times for the treatment of various

 Evidence-Based Complementary and Alternative Medicine
T : Multiple linear regression analysis of factors related to changes in LDL-C.
𝐵SE 𝛽𝑃
Sex (male = ; female = ) –. . –. .
Age –. . –. .
Group (control = ; intervention = ) –. . –. 0.006
Body mass index –. . –. .
R2= .. Bold values represent signicant dierences.
𝛽: standardized regression coecient; B: unstandardized regression coecient; LDL-C: low-density lipoprotein cholesterol; SE: standard error.
All subjects
20
10
0
1
−10
−20
Baseline LDL‐C ≥ 120
20
10
0
1
−10
−20
F : Changes in LDL-C. p=. for both all subjects and those with baseline LDC-C ≥.
ailments, including gastrointestinal complaints, constipation,
dermatitis, cough, and diabetes []. However, several clinical
studies have failed to show clear pharmacological eects.
Our research revealed that the component extracted from
bitter melon in this study was one form of pectin. It has long
been known that soluble ber, including pectin, eectively
lowers LDL-C. Brown et al. conducted a meta-analysis of
four types of soluble ber (pectin, oat bran, guar gum, and
psyllium) and found that all reduce LDL-C to the same extent
[]. Namely, intake of  g of soluble ber per day reduced
LDL-C by roughly  mg/dL. ough soluble ber also lowers
HDL-C,thedecreaseisextremelyslight,andthereisnoeect
on TGs. is study was consistent with the results of previous
research on soluble ber, demonstrating that although bitter
melon extract reduced LDL-C, there was no eect on HDL-
C or TGs. e daily dose of bitter melon extract used in
the present study was  mg—a small amount compared
with that in most previous studies, in which quantities were
in grams—suggesting that soluble ber from bitter melon
extract is eective at reducing LDL-C even at a lower dose.
ere are several possible mechanisms involved in the
reductioninHDL-Cbysolubleber.First,thetheorythat
ber promotes bile acid excretion, thereby reducing choles-
terol, has been advocated for years []. e idea is that
because blood cholesterol is used in the synthesis of bile
acid, highly viscous soluble ber adheres to and helps excrete
bile acid enveloping cholesterol. However, some scholars
argue that the amount of bile acid excretion is insucient
to explain the reduction in cholesterol []. It was further
reported that soluble ber increases the number of apo B/E
receptors, which bind to LDL-C and accelerate the LDL-
C metabolic turnover rate [, ]. Eects from improved
insulin sensitivity [] and inhibition of cholesterol synthesis
in the liver due to the formation of short-chain fatty acids
through fermentation of ber in the large intestine have also
been indicated [, ]. Although we observed signicant
decrease in LDL-C levels in the present study, there was no
change in blood glucose levels, suggesting that reduced LDL-
C levels might not be mediated by insulin resistance.
Previous studies evaluated the eects of bitter melon on
dyslipidemia using rats. Bitter melon treatment of diabetic
rats normalized the increase in nonesteried cholesterol,
TGs, LDL, and phospholipids [, , ]. Additionally,
increased mitochondrial biogenesis could be a pathway
associated with increased lipid metabolism and utilization,
with several genes, including PPAR𝛾,involvedinthereg-
ulation of this process [, ]. Bitter melon treatment of
rats increased the expression of PPAR𝛾coactivator (PGC𝛼)
and fatty acid-binding protein , and in this context, PGC
family members inuence hepatic metabolism by stimulating
mitochondrial biogenesis and respiration in several types
of cells while also altering biological pathways involved in
oxidative metabolism []. In rat-based studies, test animals
that received a high-fat diet and bitter melon extract displayed
reduced levels of plasma TGs, cholesterol, and free fatty acids
[]. ese results suggest that bitter melon extract might
improve dyslipidemia in humans.
is study had several limitations. First, the small sample
size of the study suggests that caution is needed in gener-
alizing the applicability of the study results. Using puried

Evidence-Based Complementary and Alternative Medicine 
samples of bitter melon extract might improve the interest
of volunteers in enrolling in follow-up studies. Second, the
dose of  mg per day used in this study may be too low
compared with that in previous studies, in which several
grams were administered daily. In addition, the administered
dose in this study was not adjusted for individual body weight
and was unrelated to the dose used in tradomedical use of
bitter melon. Previous studies used doses of ∼ mg/kg []
and between  mg/kg and , mg/kg [, ].
erefore, it is important to perform additional studies
to determine the mechanisms through which bitter melon
lowers LDL-C levels, as well as its eects on other indices
related to the lipid prole.
5. Conclusion
e water-soluble extract of bitter melon signicantly
decreased LDL-C levels as compared with the control
(placebo) group in humans. erefore, bitter melon might be
useful in reducing the risks of cholesterol-mediated diseases,
including CVDs.
Data Availability
e data used to support the ndings of this study are
included within the article.
Disclosure
Editage provided editorial support in the form of medical
writing, assembling tables, creating high-resolution images
based on the authors’ detailed directions, collating author
comments, copyediting, fact checking, and referencing.
Conflicts of Interest
Hiroki Kinoshita is a board member of Imagine Global Care
Corporation, and Yasuyuki Ogata is an employee of the
company.
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