Billings Clinic
Especially For:

Complementary Medicine - Cam

Bitter Orange

Bitter Orange

Uses

Common names:
Seville Orange, Zhi Shi
Botanical names:
Citrus X Aurantium

Parts Used & Where Grown

The dried outer peel of the fruit of bitter orange, with the white pulp layer removed, is used medicinally. The leaves are also commonly used in many folk traditions. The bitter orange tree is indigenous to eastern Africa, Arabia, and Syria, and cultivated in Spain, Italy, and North America.

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

This supplement has been used in connection with the following health conditions:

Used for Why
2 Stars
Indigestion, Heartburn, and Low Stomach Acidity
3 cups of tea daily, prepared with 1 to 2 grams of dried peel
Bitter orange has traditionally been used as a digestive aid.

Bitter herbs are thought to stimulate digestive function by increasing saliva production and promoting both stomach acid and digestive enzyme production.8 As a result, they are particularly used when there is low stomach acid but not in heartburn (where too much stomach acid could initially exacerbate the situation). These herbs literally taste bitter. Some examples of bitter herbs include greater celandine , wormwood , gentian, dandelion , blessed thistle , yarrow , devil’s claw , bitter orange, bitter melon , juniper , andrographis , prickly ash , and centaury .9. Bitters are generally taken either by mixing 1–3 ml tincture into water and sipping slowly 10–30 minutes before eating, or by making tea, which is also sipped slowly before eating.

Very little published research is available on the traditional uses of bitter orange as a digestive aid and sedative. The German Commission E has approved the use of bitter orange for loss of appetite and dyspeptic ailments.10 One test tube study showed bitter orange to potently inhibit rotavirus (a cause of diarrhea in infants and young children).11 Bitter orange, in an herbal combination formula, reportedly normalized stool function and completely eased intestinal pain in 24 people with non-specific colitis and, again in an herbal combination formula, normalized stool function in another 32 people with constipation.12 , 13

1 Star
Insomnia
Refer to label instructions
Bitter orange has a history of use as a calming agent and to counteract insomnia.

Bitter orange has a history of use as a calming agent and to counteract insomnia. There is no clinical trial data to support its efficacy in this regard. The usual amount of tincture used is 2 to 3 ml at bedtime.14 , 15

1 Star
Obesity
Refer to label instructions
Bitter orange contains synephrine, which might promote weight loss.
Although historically used to stimulate appetite, bitter orange is frequently found in modern weight-loss formulas because synephrine is similar to the compound ephedrine, which is known to promote weight loss. In one study of 23 overweight adults, participants taking a daily intake of bitter orange (975 mg) combined with caffeine (525 mg) and St. John’s wort (Hypericum perforatum, 900 mg) for six weeks lost significantly more body weight and fat than the control group.16 No adverse effects on heart rate or blood pressure were found. Bitter orange standardized to contain 4 to 6% synephrine had an anti-obesity effect in rats. However, the amount used to achieve this effect was accompanied by cardiovascular toxicity and mortality.17

Traditional Use (May Not Be Supported by Scientific Studies)

Bitter orange is used similarly in a wide variety of traditions. In Mexico and South America the leaf is used as a tonic, as a laxative, as a sedative for insomnia, and to calm frazzled nerves.1 , 2 The peel of the fruit is used for stomach aches and high blood pressure.3 , 4 The Basque people in Europe use the leaves for stomach aches, insomnia, and palpitations and the bitter orange peel as an anti-spasmodic.5 In traditional Chinese medicine, the peel of the immature fruit is used for indigestion, abdominal pain, constipation, and dysenteric diarrhea. Where the patient is weak, the milder, mature fruit is used similarly.6 Bitter orange continues to be widely used for insomnia and indigestion in many parts of the world.7

How It Works

Common names:
Seville Orange, Zhi Shi
Botanical names:
Citrus X Aurantium

How It Works

Bitter orange has a complex chemical makeup, though it is perhaps most known for the volatile oil in the peel. The familiar oily residue that appears after peeling citrus fruit, including bitter orange, is this volatile oil. It gives bitter orange its strong odor and flavor, and accounts for many of its medicinal effects. Besides the volatile oil, the peel contains flavones, the alkaloids synephrine, octopamine, and N-methyltyramine, and carotenoids.18 , 19

How to Use It

Usually 1 to 2 grams of dried peel is simmered for 10 to 15 minutes in a cup of water; three cups are drunk daily. As a tincture, 2 to 3 ml (with a weight-to-volume ratio ranging from 1:1 to 1:5) is often recommended for use three times per day. 20 The purified volatile oil is generally avoided for reasons discussed in the side effects section.

Interactions

Common names:
Seville Orange, Zhi Shi
Botanical names:
Citrus X Aurantium

Interactions with Supplements, Foods, & Other Compounds

Decoctions of bitter orange substantially increased blood levels of cyclosporine in pigs, causing toxicity.21 Bitter orange also inhibited human cytochrome P450 3A (CYP3A) in the test tube.22 This is an enzyme that helps the liver get rid of numerous toxins, and strongly affects metabolism of certain drugs. Bitter orange might, therefore, interact with drugs that are metabolized by CYP3A. To be on the safe side, bitter orange should not be combined with prescription medications, unless someone is under the care of an experienced natural medicine clinician.

Interactions with Medicines

As of the last update, we found no reported interactions between this supplement and medicines. It is possible that unknown interactions exist. If you take medication, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

Side Effects

Common names:
Seville Orange, Zhi Shi
Botanical names:
Citrus X Aurantium

Side Effects

Bitter orange oil may possibly cause light sensitivity (photosensitivity), especially in fair-skinned individuals.23 Generally this occurs only if the oil is applied directly to the skin and then exposed to bright light; in rare cases it has also been known to occur in people who have taken bitter orange internally. The oil should not be applied topically and anyone who uses it internally should avoid bright light, including tanning booths.

Internal use of the volatile oil of bitter orange is also potentially unsafe and should not be undertaken without expert guidance. Large amounts of orange peel have caused intestinal colic, convulsions, and death in children.24 The amounts recommended above for internal use should not be exceeded.

One text on Chinese medicine cautions against the use of bitter orange in pregnancy.25 This concern is not raised in any other reference, and the American Herbal Products Association classifies the herb as "class 1," an herb that can be safely consumed during pregnancy when used appropriately.26

References

1. Martinez M. Las Plantas Medicinales de Mexico. Mexico City: Libreria y Ediciones Botas, 1991.

2. Gonzalez-Ferrara MM. Plantas medicinales del noreste de Mexico. Monterey, Mexico: Grupo Vitro, 1998.

3. Gonzalez-Ferrara MM. Plantas medicinales del noreste de Mexico. Monterey, Mexico: Grupo Vitro, 1998.

4. Bejar E, Bussmann R, Roa C, Sharon D. Herbs of Southern Ecuador: A Field Guide to the Medicinal Plants of Vilcabamba. Spring Valley, CA: LH Press, 2001.

5. Molina GV: Plantas Medicinales en el Pais Vasco. San Sebastian, Spain: Editorial Txertoa, 1999.

6. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine: Materia Medica, rev. ed. Seattle: Eastland Press, Inc., 1993.

7. Hernandez L, Munoz RA, Miro G, et al. Use of medicinal plants by ambulatory patients in Puerto Rico. Am J Hosp Pharm 1984;41:2060-4.

8. Schulz V, Hänsel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. 3rd ed, Berlin: Springer, 1998, 168-73.

9. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 425-6.

10. Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs.Newton, MA: Integrative Medicine Communications, 1999.

11. Kim DH, Song MJ, Bae EA, Han MJ. Inhibitory effect of herbal medicines on rotavirus infectivity. Biol Pharm Bull 2000; 23:356-8.

12. Chakurski I, Matev M, Koichev A, et al. [Treatment of chronic colitis with an herbal combination of Taraxacum officinale, Hipericum perforatum, Melissa officinaliss, Calendula officinalis and Foeniculum vulgare.] Vutr Boles 1981;20:51-4 [in Bulgarian].

13. Matev M, Chakurski I, Stefanov G, et al. [Use of an herbal combination with laxative action on duodenal peptic ulcer and gastroduodenitis patients with a concomitant obstipation syndrome.] Vutr Boles 1981;20:48-51 [in Bulgarian].

14. Martinez M. Las Plantas Medicinales de Mexico. Mexico City: Libreria y Ediciones Botas, 1991.

15. Gonzalez-Ferrara MM. Plantas medicinales del noreste de Mexico. Monterey, Mexico: Grupo Vitro, 1998.

16. Colker CM, Kalman DS, Torina GC, et al. Effects of Citrus aurantium extract, caffeine, and St. John's wort on body fat, lipid levels, and mood states in overweight adults. Curr Ther Res 1999;60:145-53.

17. Calapai G, Firenzuoli F, Saitta A, et al. Antiobesity and cardiovascular toxic effects of Citrus aurantium extracts in the rat: A preliminary report. Fitoterapia 1999;70:586-92.

18. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications, 1999.

19. Dr. Duke's Phytochemical and Ethnobotanical Databases. Cited 2003 Jul 11. Available from URL: www.ars-grin.gov, 2002.

20. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications, 1999.

21. Hou YC, Hsiu SL, Tsao CW, et al. Acute intoxication of cyclosporine caused by coadministration of decoctions of the fruits of Citrus aurantium and the pericarps of Citrus grandis. Planta Med 2000;66:653-5.

22. Guo LQ, Taniguchi M, Chen QY, et al. Inhibitory potential of herbal medicines on human cytochrome P450-mediated oxidation: Properties of umbelliferous or citrus crude drugs and their relative prescriptions. Jpn J Pharmacol 2001;85:399-408.

23. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications, 1999.

24. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, 1998.

25. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine: Materia Medica, rev ed. Seattle: Eastland Press, Inc., 1993.

26. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, 1998.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

Print This Page
Email to a Friend
Home | Contact | Site Map | Site Privacy Policy | Terms & Conditions | Patient Privacy Policy | Medical Records | Fast Command
2800 10th Ave. North | P.O. Box 37000 | Billings, Montana 59107 | 406.238.2500
© Copyright 2014 Billings Clinic. All Rights Reserved.