500–1,000 mg/day of standardized extract.
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Bergamot is a citrus fruit that grows almost exclusively in the Calabria region of southern Italy, where the essential oil from its peel has been used for centuries to flavor Earl Grey tea and as a folk remedy for digestion and the heart; the juice of the fruit, much less well known outside Italy, contains a unique mixture of polyphenols (brutieridin, melitidin, naringin, neohesperidin) with a lipid-lowering profile that in the last decade has drawn the attention of cardiologists and nutritionists for its efficacy comparable to mild statins.
Standardized bergamot extract (Bergamot Polyphenol Fraction, BPF) is the formulation that has been studied clinically, with defined concentrations of the active polyphenols that ensure reproducibility of effects; the commercial products with clinical backing are standardized to 38-44 percent total polyphenols and are the ones that have shown the published results on lipid profile and glucose metabolism.
The most robust evidence for bergamot concerns the lipid profile: several randomized trials have shown reductions of 15-20 percent in total cholesterol, 25-35 percent in LDL, and 20-30 percent in triglycerides, along with increases of 10-15 percent in HDL, at doses of 500-1,500 milligrams per day of standardized extract for 30-180 days; these effects are quantitatively close to those of low-potency statins and exceptional for a natural supplement.
The most plausible mechanism combines inhibition of HMG-CoA reductase (the target enzyme of statins) by brutieridin and melitidin, with additional effects on cellular LDL uptake and on PCSK9 activity; this multimodal profile explains why the lipid-lowering effect is greater than that of other citrus polyphenols and why it is maintained over time without loss of efficacy.
In metabolic syndrome and type 2 diabetes, several trials have shown significant improvements in fasting glucose, HbA1c, and markers of insulin resistance with prolonged use at doses of 500-1,300 milligrams per day for 12 to 24 weeks; the effect adds to the LDL reduction to offer a comprehensive cardiometabolic improvement in people with several simultaneous risk factors.
In non-alcoholic fatty liver disease, the data are promising, with improvements in transaminases and in markers of liver inflammation, although the studies are small and need to be confirmed in larger trials; the hepatoprotective profile seems related to direct antioxidant effects and to improved hepatic lipid metabolism, which probably underlies the effect on plasma triglycerides.
An interesting application of bergamot is its use in people who cannot tolerate high doses of statins (because of myalgia or other adverse effects) and who need to lower their LDL more than they achieve with low doses: the combination of a low-dose statin (10-20 mg of atorvastatin, for example) plus bergamot at 500-1,000 mg/day can offer an LDL reduction comparable to high-dose statin alone, with much better tolerability.
The doses studied range from 500 to 1,500 milligrams per day of extract standardized to 38-44 percent total polyphenols (BPF), ideally divided into one or two doses with meals for at least 30 days to assess the response in lipid profile; products without clear standardization (generic extracts or "bergamot oil") do not guarantee the clinical effects documented with the specific BPF used in the studies.
Generally very well tolerated; adverse effects are rare and mild (digestive discomfort, occasionally headache); people who take statins should exercise theoretical caution because of the additive effect on HMG-CoA reductase (although in clinical practice this combination is used precisely to improve tolerability), those who take anticoagulants should exercise caution because of the mild antiplatelet effect, and it is best avoided during pregnancy and breastfeeding because of limited data.
Information, not medical advice. Scientific evidence reflects the quality of the studies.