Safe Usage Guidelines for Bitter Kola (Garcinia kola)
If you are planning surgery, consider holding bitter kola (kola nut) for 2 weeks preoperatively, and at minimum, patients should taper their intake due to its caffeine content (2-3%) and theobromine (1-2%) which may interfere with diabetes control. 1
Perioperative Management
The Society for Perioperative Assessment and Quality Improvement (SPAQI) provides specific guidance on kola nut supplementation:
- Preoperative discontinuation: Hold for 2 weeks before surgery 1
- Rationale: The caffeine and theobromine content produces effects parallel to equivalent doses of caffeine, which may inhibit platelet aggregation and interfere with glycemic control 1
- Minimum requirement: If complete discontinuation is not feasible, patients must taper intake gradually to avoid withdrawal symptoms 1
Key Safety Concerns
Diabetes management: Bitter kola may interfere with blood glucose control, requiring closer monitoring in diabetic patients 1
Cardiovascular effects: The stimulant properties from caffeine and theobromine can affect heart rate and blood pressure 1
General Usage Considerations
While bitter kola is widely used in West African traditional medicine for various conditions including cough, bacterial infections, and as a stimulant, there is currently no established safe dosage for therapeutic use in humans based on clinical trials 2, 3.
Evidence Limitations
- Most pharmacological studies demonstrating anti-inflammatory, antimalarial, hepatoprotective, and antidiabetic effects have only been confirmed in animal models 4, 2
- Human clinical trials are lacking to verify safe and effective dosing 4, 2
- One study showed oral ingestion of 100 mg/kg body weight lowered intraocular pressure by 21% in healthy young adults, but long-term safety data is absent 5
Potential Toxicity Concerns
Clastogenic effects: Bitter kola alone induced micronucleus formation in animal studies, indicating potential DNA damage, though it paradoxically protected against carcinogen-induced toxicity when combined with other substances 6
Practical Recommendations
For patients with diabetes: Avoid or use with extreme caution due to glucose metabolism interference 1
For patients on anticoagulants or antiplatelet agents: Exercise caution due to potential aspirin-like effects on platelet aggregation from the caffeine content 1
For patients with liver disease: Monitor closely, as bitter kola contains compounds that affect hepatic function, though some studies suggest hepatoprotective effects 2
For pregnant women: Avoid use due to lack of safety data and caffeine content 2
Common Pitfalls to Avoid
- Do not assume traditional use equals safety—the lack of standardized dosing and clinical trial data means therapeutic windows are unknown 4, 2
- Do not combine with other stimulants or caffeine-containing products without medical supervision 1
- Do not use as a substitute for evidence-based treatments for serious conditions like glaucoma, despite the IOP-lowering effect observed in one small study 5