Alternative Medicine & OTC Weight Loss Pills: Should we prescribe them?

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Alternative Medicine OTC Weight Loss Pills
Should we prescribe them?

• By Dr. Samuel N. Grief, MDUIC Family Medicine
• July 23, 2003

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Outline

• 1. Scope of obesity epidemic
• 2. Treatment options
• 3. Dietary Supplements
• 4. Ephedra
• 5. Miracle Burn
• 6. Miracle Burn ingredients
• 7. Additional supplements
• 8. Dream Shape
• 9. Conclusion

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Obesity

• Growing health crisis in the U.S.
• 35 of Americans are overweight
• 27 of Americans are obese
• BMI 25-29 Overweight
• BMI gt29 Obesity
• Incidence of diabetes increased by 50 over the
  past decade, half attributable to obesity.

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Diet Weight Loss Pills

• Each year, over 17 million Americans buy diet
  pills
• In 1950s and 1960s, diet pills were mainly
  amphetamine derivatives (speed)
• 1973, FDA approved fenfluramine (Pondimin) for
  weight loss
• 1996, FDA approved dexfenfluramine (Redux)
• 1997, both withdrawn from market due to heart
  valve disease
• More recently, sibutramine and orlistat are
  available as Rx weight loss pills

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Medicinal Treatment Options for Obesity

• OTCs Diet pills, ephedra, metabolife, caffeine,
  chitosan, hydroxycitric acid, pyruvate, etc.
• Methylphenidate, dextroamphetamine, etc.
• Diuretics
• Growth hormone
• Testosterone
• Leptin
• Metformin
• Xenical
• Sibutramine

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Surgical Treatment Options for Obesity

• Last resort option for severely obese patients
• Choose patients carefully

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Dietary Supplements

• FDA estimates that at least 1,000 makers of
  dietary supplements sell in the U.S.
• Annual sales are in excess of 19 Billion.
• Up to half of Americans take some form of dietary
  supplement.
• 1994 DSHEA law exempts supplements from being
  scrutinized by FDAs safety board.
• Supplements are considered foods, not drugs.

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Dangers of Dietary Supplements

• All natural DOES NOT mean all safe!
• Some supplements inhibit blood clotting, others
  negate birth control pills or even cause
  seizures.
• Supplement manufacturers are not required to
  report adverse events to the FDA.

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Ephedra

• A.K.A. Ma Huang, Brigham Tea or Mormon Tea.
• Called the worlds oldest medicine, has been used
  in TCM for over 5,000 years.
• Early American settlers called ephedra Squaw
  Tea and took it mainly as an anti-syphilitic and
  blood purifier.

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Ephedra

• More recently used for asthma, bronchitis and
  colds.
• One of the most popular weight-loss supplements.
• Ephedra is known to raise blood pressure, cause
  arrythmias, and lead to seizures.
• Ephedra has been implicated in the death of a MLB
  pitcher following a spring training workout.
• In 2003, ephedra was banned from being sold in
  stores in the state of Illinois.

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Miracle Burn

• Manufactured by Urban Nutrition Inc., New York,
  NY

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Miracle BurnIngredients

• Proprietary blend of 16 different vitamins,
  minerals and herbal products
• No established RDA for ingredients
• Contains ephedra under the name Brigham Tea
• No scientific research done on this product

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Miracle BurnIngredients

• Sukday Root Konjac Root
• Brigham Tea Apple Cider Vinegar
• Fo-Ti Root Cascara Sagrada
• Bay-chi Root L-Carnitine
• Licorice Root Senna
• Lycii Berry Fruit Vitamin B6
• G.T.F. Chromium Spirulina Algea
• Icelandic Kelp Potassium Chloride

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Sukday Root

• Helps balance adrenals for increased strength and
  stamina.
• Helps strengthen kidneys and bladder.
• Found in numerous herbal supplements.
• Typical dose is 25 mg

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Fo-Ti Root

• AKA Polygonum Multiflorum, he-shou-wu
  (balck-haired mister)
• A plant native to China
• Known as a long life elixir (TCM)
• Usual dose is 4-8 grams per day in tea or capsule
  form two or three times per day
• Used in TCM to treat premature aging (darkens
  premature gray hair), weakness, vaginal
  discharges, numerous infectious diseases, angina
  pectoris, and ED.

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Fo-Ti Root

• Some research shows the whole root may lower
  cholesterol
• The unprocessed roots possess a mild laxative
  effect
• Chemical derivatives in Fo-Ti include
  anthraquinones such as rhein, emodin, and
  chysophanol, lecithin, tannins, and
  tetrahydroxystilbene glucoside (may help treat
  diabetes by potentiating insulin activity in fat
  cells).

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Fo-Ti RootSide Effects

• GI upset (indigestion, diarrhea)
• Skin Rash
• Numbness and/or tingling of the extremities
• Avoid if pregnant or nursing

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Bay Chi

• AKA Astragalus
• Immune enhancer
• Touted as an antioxidant
• Promoted for lowering blood pressure, increasing
  stamina, controlling perspiration and in helping
  to control appetite.

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Licorice

• AKA Glycyrrhiza glabra, Gan Cao, the Great
  Harmonizer, Grandfather Herb, and Sweetwood.
• Alexander the Great gave his troops licorice to
  chew on when they went into battle.
• Used to treat respiratory ailments,
• stomach problems.
• Helps regulate low blood sugar and relieves
• menstrual cramps and pain from arthritis.
• Used as flavoring in cough drops, syrups, tonics,
  and laxatives.
• Its constituent Glycyrrhizin is 50 times sweeter
  than table sugar!

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Licorice

• Known to increase blood pressure and cause water
  retention (glycyrrhizin stimulates secretion of
  aldosterone)
• In clinical trials in Japan, glycyrrhizin
  prevented progression of HIV by inhibiting cell
  infection and inducing ifn activity
• Licorice extract has been shown to kill the SARS
  virus!
• Dose varies average range is 500-1000mg daily in
  two or three divided doses.

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Lycii Berry

• AKA Wolfberry, Matrimony Vine, Gou Qi Zi, lycium
  chinensis
• Contains zeaxanthin, a component of macular
  pigment.
• Zeaxanthin also known
• to be hepatoprotective.
• Used traditionally to rejuvenate the immune
  system and restore normal sexual function.
• Western studies show it may help regulate
  hyperglycemia.

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Spirulina Algea

• Single-celled, spiral-shaped blue-green algae
• Known as a superfood
• Contains a rich mixture of nutrients including
• complete proteins (all essential amino acids),
  omega-6 fatty acids (e.g. GLA, the precursor to
  prostaglandins, leukotrienes, and thromboxanes),
  CHOs, nucleic acids (purines), vitamins (beta
  carotene, vitamins B1, B2, B6, B12, Niacin,
  Folate, Pantothenate, Biotin, C), Minerals (Ca,
  P, Mg, Fe, Zn, Cu, Cr, Mn, Na, K)
• Interestingly, there is only a little Iodine in
  Spirulina.
• Toxic minerals (arsenic and Fluorine) have been
  found, depending on where the Spirulina was
  harvested.

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Spirulina Algea

• Thought to enhance the immune system
• Usual dose is 500-1000mg daily

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Senna

• AKA Cassia angustifolia
• Derived from the leaves and pods of Cassia a.
• Stimulates intestinal peristalsis
• Contains anthraquinone glycosides (sennosides,
  aloe-emodin, rhein) and many other chemical
  constituents
• Sennosides are irritating to the large intestinal
  lining
• Prolonged use may aggravate constipation and
  weaken the tone of the colon (gt10 days)
• Avoid in patients with IBD, abd. pain and
  obstruction
• Dose 150-300mg hs

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Cascara Sagrada

• Bark
• Helps stimulate intestinal peristalsis

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G.T.F. Chromium

• An essential trace mineral
• Co-factor for insulin (GTF stands for glucose
  tolerance factor)
• Animal and human research done showing possible
  weight loss enhancing effects
• Found in brewers yeast, grains and cereals,
  meats, poultry, fish, cheeses and beer!
• Adequate intake is 30-35mcg per day
• Recommended dose is often 200mcg per day
• Supplements come as picolinate, nicotinate,
  polynicotinate, and chloride.

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Icelandinc Kelp

• Kelp is seaweed (brown vs. green or red)
• 1750, Dr. Bernard Russell used dried kelp as a
  treatment for goiter
• 1862, Dr. Dupare used dried kelp as an aid to
  treat obesity
• The link?
• Kelp contains Iodine.
• Kelp also contains tntc minerals and most aas
• Yummy!!!

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Konjac Root

• AKA Konnyaku
• Active ingredient is glucomannan
• A pectin-like gel fiber composed of a
  polysaccharide chain of repeating units of
  glucose and mannose
• 1 tbsp. contains 6 grams of soluble fiber (found
  in oats, barley, beans, fruit, and some veggies)
• Reduces appetite, regulates insulin levels
• One study in 1983 of 20 pts. showed 5.5 lbs Wt.
  Loss over 8 weeks.
• Another more recent study showed lowering of
  total and LDL cholesterols.

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Apple Cider Vinegar

• Vinegar comes from the Latin word vinum (wine)
  and acer (sour).
• 5000 B.C. Babylonians fermented dates to make
  date vinegar
• Ancient Egyptians first to recognize the medical
  benefits of ACV _at_3000 B.C.
• Romans made vinegar from grapes, figs, dates, and
  rye
• Hippocrates recommended vinegar for ill patients
• Vinegar is mentioned in the bible in both Old and
  New testaments

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ACV

• ACV is an acidic solution produced by
  fermentation of apples.
• Promotes
• 1. Weight loss
• 2. Lowering blood pressure
• 3. Reducing cholesterol
• 4. Fighting arthritis pain
• 5. Relief of sore throat

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ACV Recipes

• 1 oz ACV
• 1 tsp honey
• 1-4 oz glass of warm water
• OR
• 2 tbsp Bran
• 2 tsp ACV
• Porridge, Yogurt, or Fruit

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ACV

• Caution Do not take ACV if you suffer from
  gastritis, ulcers, or have GERD.

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L-Carnitine

• Made in the body from the essential amino acids
  lysine and methionine (found in brewers yeast,
  legumes, dairy, fish, meat)
• Transports long chain fatty acids to the
  mitochondria
• Claims are made that L-Carnitine
• supplements help increase energy,
• burn fat, treat angina, and reduce hunger!
• Typical dose 1-4 grams daily

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Potassium Chloride

• Prescribed for low potassium conditions
• Potassium usually lost through kidneys or
  intestines
• Hypokalemia occurs in diabetic ketoacidosis,
  diuretic use, laxative abuse, vomiting, NG tube,
  VIPoma, hyperaldosteronism (excess licorice,
  e.g.), Cushings Syndrome, type 1 Renal Tubular
  Acidosis, drugs (digoxin, amphotericin B),
  insulin.
• Non-medicinal uses in photography and as a
  fertilizer

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KCL

• Side effects are typically gastrointestinal
  (nausea, vomiting, diarrhea)
• Excess potassium can lead to cardiac arrest
  and/or renal failure possible GI poisoning.
• Caution in patients on ACEI, potassium sparing
  diuretics

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Vitamin B6

• Is a water-soluble vitamin
• In 3 forms pyridoxine, pyridoxal, and
  pyridoxamine
• Needed for over 100 enzymes involved in protein
  metabolism
• Essential for RBC metabolism
• Also involved in nervous and immune systems
• Found in a variety of foods fortified cereals,
  beans, meat, poultry, fish, some fruits and
  veggies
• RDA is no more than 2 mg per day
• Often Rxed along with INH
• Not proven to be of clinical benefit in PMS

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Garcinia

• Full name is Garcinia Cambogia
• Plant found in Southeastern Asia
• Produces a small, pumpkin-shaped fruit, of which
  the rind is rich in Hydroxycitric acid (HCA)
• HCA inhibits ATP-citrate lyase, an enzyme in the
  Krebs cycle needed to convert excess glucose into
  acetyl-coenzyme A and oxaloacetic acid,
  precursors to fatty acids, thus promoting an
  increase in the formation of stored energy as
  glycogen.
• Theoretically, this reduces appetite and lessens
  fat production.

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Guarana

• An evergreen vine indigenous to the
• Amazon basin. (mostly Brazil)
• Traditionally used by natives
• (Maue Indians) to treat diarrhea, fatigue,
  arthritis, menstrual cramps and to reduce hunger.
• Contains caffeine and the closely related
  alkaloids theobromine and theophylline.
• One cup of guarana contains about 50mg caffeine.
• Side effects similar to caffeine.

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Relora

• Contains extracts of magnolia officinalis and
  phellodendron amurense (active chemicals are
  honokiol and berberine, respectively)
• Thought to help relax people by binding to CNS
  receptors implicated in anxiety.
• In theory, decrease stress leads to decrease
  levels of cortisol leading to less cravings for
  high-fat, high-sugar foods!
• Take a valium instead!! Better yet, exercise!!!

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Pyruvate

• Created during CHO and prot. Metabolism
• Four different trials demonstrated enhancement of
  weight loss.
• May increase resting metabolic rate.
• Present in foods like red apples, cheese, dark
  beer, and red wine.

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7-Keto

• 3-acetyl-7-oxo-dehydroepiandrosterone
• Breakdown product of DHEA
• In one double bind study, participants were given
  either 7-keto or placebo for 8 weeks along with
  1800 kcal diet and exercise 3x/week for 45
  minutes.
• Result 6.34 pounds lost vs. 2.13
• Increased weight loss associated with higher
  levels of T3
• Dose 100mg bid

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5-Hydroxytryptophan

• 5-HTP is the precursor to serotonin.
• Made from L-tryptophan, a natural amino acid
  found in most dietary proteins
• Also found in seeds of Griffonia simplicifolia, a
  West African plant
• Three studies done show appetite reduction and
  weight loss (avg. 11 lbs. In 12 weeks)
• Dose 600-900 mg daily

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Cayenne

• Used as a food and spice
• Related to bell peppers,
• jalapenos, paprika
• Contains active ingredient capsaicin
• Japanese studies found that cayenne reduced
  appetite and increased metabolism

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Green Tea

• AKA epigallocatechin gallate (EGCG)
• Derived from the plant camellia sinensis
• Contains volatile oils, vitamins, minerals, and
  caffeine
• Primary constituent is polyphenols (EGCG)
• Antioxidant properties
• Prevents iron absorption
• Need to drink about 10 cups per day to derive
  health benefits.

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Guggul

• Yellowish resin produced by the
• stem of the mukul myrrh tree
• found in India
• In Ayurvedic medicine, thought to be useful for
  treating many conditions, including obesity
• One study showed a slight tendency to weight loss
  when given along with HCA and tyrosine.

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Xenadrine

• Contains ma huang (ephedra), guarana (equivalent
  of 200mg caffeine per serving), L-tyrosine,
  L-Carnitine, and more.
• Implicated in the death of Baltimore Orioles
  pitcher Steve Bechler (Xenadrine RFA-1)
• Lawsuit calls Xenadrine a poisonous cocktail
• Now theres Xenadrine EFX (ephedra free!)
• Contains proprietary blend of many substances.
• Side effects include anxiety, shakiness, feeling
  faint, increased heart rate, diaphoresis, GI
  upset.

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Chitosan

• Made from chitin, the main component of
  crustacean shells (e.g. shrimp, crab)
• Sold as a dietary supplement for
• weight loss
• No scientific data confirming its effects as a
  fat blocker or fat binder or in promoting
  weight loss

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Dietary Supplements for Weight Loss

• Power Thin contains folic acid, vit. B12, mg,
  chromium, potassium citrate, and proprietary
  blend of ma huang(ephedrine), kola nut
  (caffeine), fo-ti root, licorice, spirulina
  algea, guarana seed, gotu kola, ginseng (2
  types), gingko biloba, and much more
• Dose 1 capsule 3-4x/day

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Dietary Supplements for Weight Loss

• Thermadrene XP the next generation of
  Fat-Burning Thermogenics
• Works by firing up your brown adipose tissue
• Contains muscle activators
• Contents green tea extract, theobroma cocoa
  extract, guarana seed extract, caffeine (100mg
  per serving), and more
• 2 capsules 2x/day

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Dietary Supplements for Weight Loss

• Lean System 7 a new frontier in nutritional
  sciences
• Penetrates and attacks fat cells
• Contains Yerba Mate, guarana, 7-Keto, and more.
• 3 capsules 2x/day

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Dietary Supplements for Weight Loss

• Super Grapefruit Trim
• Primary ingredient is Konjac Root
• Contains grapefruit extract - assists in the
  digestion of food and helps the digestive tract
  use sugar
• Also has Vitamin B6, Kelp, ACV and more.
• 1 tablet with each meal

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Dietary Supplements for Weight Loss

• Thermo Edge
• A powerful fat burner that will melt off
  unwanted pounds fast
• Contains guarana extract, bitter orange extract
  (contains synephrine which may promote fat
  burning), Konjac root, cocoa powder, spirulina,
  gotu kola, and more
• 1-2 capsules 2-3x/day

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Dietary Supplements for Weight Loss

• Energy Slim
• The perfect blend of science and nature in a
  bottle
• Contains Guarana extract (40mg caffeine), Ma
  Huang extract (ephedrine), gotu kola, licorice
  root, spirulina, echinacea, ginger, dandelion,
  chromium (125mcg), and more!
• Dose 1-2 capsules bid

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Dietary Supplements for Weight Loss

• Start losing fat while you sleep!
• Dream Shape
• Contains GABA
• GABA is an amino acid discovered in 1883
• Is an inhibitory neurotransmitter
• Product claims
• 1. GABA increases anterior pituitary release of
  human growth hormone
• 2. Decreased levels of GH cause excess body fat
• 3. Effective dose is about 5 grams per dose at
  night (sleep naturally signals release of GH)

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Dream Shape

• Recent research on macaque monkeys show that
  aging decreases amount of GABA in the brain,
  leading to decreased memory ability
• BDZs, alcohol, other sedatives potentiate GABAs
  effects
• Higher GH levels associated with less body fat
  and increased lean tissue mass (muscle)
• Other effects of GABA may include mild facial
  tingling, tachycardia (both transient per the
  manufacturer)

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Conclusion

• Obesity is a growing epidemic
• Discuss ALL weight loss options with patients
• The best weight loss method is . . .
• Regular exercise and a well-balanced diet!

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Have a great day!

• Thank you very much!