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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, MD UIC Family Medicine July 23, 2003 Outline 1. Scope of obesity ... – PowerPoint PPT presentation

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


1
Alternative Medicine OTC Weight Loss Pills
Should we prescribe them?
  • By Dr. Samuel N. Grief, MDUIC Family Medicine
  • July 23, 2003

2
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

3
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.

4
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  • 1997, both withdrawn from market due to heart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

5
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

6
Surgical Treatment Options for Obesity
  • Last resort option for severely obese patients
  • Choose patients carefully

7
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.

8
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.

9
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.

10
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.

11
Miracle Burn
  • Manufactured by Urban Nutrition Inc., New York,
    NY

12
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

13
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

14
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

15
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.

16
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).

17
Fo-Ti RootSide Effects
  • GI upset (indigestion, diarrhea)
  • Skin Rash
  • Numbness and/or tingling of the extremities
  • Avoid if pregnant or nursing

18
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.

19
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!

20
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.

21
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.

22
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.

23
Spirulina Algea
  • Thought to enhance the immune system
  • Usual dose is 500-1000mg daily

24
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

25
Cascara Sagrada
  • Bark
  • Helps stimulate intestinal peristalsis

26
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.

27
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!!!

28
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.

29
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

30
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

31
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

32
ACV
  • Caution Do not take ACV if you suffer from
    gastritis, ulcers, or have GERD.

33
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

34
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

35
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

36
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

37
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.

38
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.

39
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!!!

40
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.

41
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

42
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

43
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

44
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.

45
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.

46
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.

47
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

48
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

49
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

50
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

51
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

52
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

53
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

54
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)

55
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)

56
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!

57
Have a great day!
  • Thank you very much!
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