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HerbsSupplements and other weight loss aids

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Title: HerbsSupplements and other weight loss aids


1
Herbs/Supplements and other weight loss aids
  • Class 7
  • Samantha Rubin, MS, RD, CDE
  • Exercise, Diet, and Weight Management

2
Weight Loss Supplements
  • One of the, if not the fastest, growing segment
    of the weight loss industry,
  • Increased sales from 10 to 20 annually from
    1997 to 2001
  • Expect sales to continue to grow.

3
FDA
  • Regulates food label
  • Dec 2002 issued a new guidance document updating
    its policy on health claims on labels for dietary
    supplements.
  • A health claim is one that relates a substance or
    a nutrient to a disease or a health related
    condition, to be considered a health claim, both
    a substance and a disease would be mentioned or
    inferred, for example, this cereal contains
    fiber, which has been shown to reduce the risk of
    certain types of cancer.

4
FTC
  • Regulates advertising-including ads for food and
    dietary supplements- to ensure it is not
    deceptive or misleading,
  • 1) there must be a representation, omission or
    practice that is likely to mislead the consumer,
  • 2) the FTC examines the practice from the
    perspective of the consumer,
  • 3) the representation, omission or practice must
    be material, that without the deception, the
    consumer would have chosen a different product
  • Exercise in a bottle-sued by the FTC

5
Issues Regarding Supplements
  • Effectiveness
  • Do they do what they say they do?
  • Quality Assurance
  • Are they what they say they are?
  • Adverse Effects
  • Are they safe?
  • Drug interactions
  • Can they be taken with other medications?

6
Dietary Supplement Health and Education Act 1994
  • Not required to prove safety or efficacy before
    marketing
  • Considered safe, unless proven unsafe by the FDA
  • Not required to demonstrate bioequivalence
  • No regulation of manufacturing process.

7
CGMP
  • Current Good Manufacturing Practice, proposed by
    the FDA in March 2003,
  • Proposed rule would establish CGMP and would
    ensure that manufacturers produce supplements
    that are not adulterated or mislabeled,
  • Manufacturers would have to evaluate the
    identity, purity, quality, strength and
    composition of their ingredients

8
Ephedra/Ma Huang
  • A plant the contains six ephedrine alkaloids
    where ephedrine is predominant.
  • 1999 12 million Americans using ephedra
  • FDA is seeking to ban Ephedra,
  • Study looked at 46 studies involving Ephedra and
    weight loss, subjects on ephedra lost on average
    2 pounds per months compared to placebo, and the
    weight loss was enhanced with the pill also
    contained caffeine.

9
Ephedra Continued
  • Study looked at 16,000 adverse events reported
    after taking Ephedra
  • 20 sentinel events including heart attack,
    stroke and death that occurred without
    contributing factors.
  • Ephedra as currently marketed may be associated
    with unreasonable safety risks.

10
Ephedra
  • FDA had stated not to exceed 8 mg of ephedra per
    day,
  • Products with ephedra include
  • Metabolife, Herbalife, Natures Nutrition Formula
    One, Ripped Fuel, Diet Fuel, Dexatrim
    Natural,Slim Up one, Hydroxycut
  • some of these products have changed their
    formulas so they are Ephedra free now

11
Aristolochic Acid
  • Found in botanical products, sold as traditional
    medicines or as ingredients in dietary
    supplements,
  • FDA these products have been associated with
    permanent kidney damage resulting in kidney
    dialysis or kidney transplants, and some people
    have developed certain types of cancers

12
Aristolochic Acid
  • FDA advises consumers to stop using any product
    that may contain this, look also for the words
    aristolochia, bragantia or asarum on the
    label,
  • Product BioSlim Doctors Natural Weight Loss
    System Slim Tone Formula

13
Dieters Tea
  • Often labeled for weight loss and as a natural
    bowel cleanser because of their laxative effect,
    labeled for weight loss,
  • Often contains senna, caster oil, cascara, aloe
    and other stimulant laxatives,
  • Sometimes have diuretics,
  • Weight loss is due to diarrhea, fluid loss, can
    be dangerous because of electrolytes loss,

14
FDA Advisement for Dieters Tea
  • Stop using the product if diarrhea, loose stools,
    or stomach pain develops,
  • See a doctor if frequent diarrhea develops,
  • See a doctor before using the product if the user
    is pregnant, nursing, taking medication or has a
    medical condition
  • Can cause N/V, diarrhea, edema, bone
    deterioration, cardiac arrhythmia, dehydration,
    fainting, loss of K

15
Tiratricol
  • FDA has forced the recall of products marketed as
    dietary supplements for weight loss that contain
    tiratricol, as known as triiodothyroacetic acid
    or TRIAC, a potent thyroid hormone that may cause
    serious health consequences including heart
    attacks and strokes.
  • FDA advises all individuals to stop taking
    immediately and consult their health provider if
    having any health problems.

16
Tiratricol
  • Products include Triax Metabolic Accelerator by
    Syntrax,
  • Tricana Metabolic Hormone, Tria-cutz Thyroid
    Stimulator by Gentech,
  • Sci-Fi-Tri-cuts dietary supplement by ATF Fitness
    products,
  • BioPharm, T-cuts

17
Chromium
  • Mineral, preferred form for absorption is
    chromium picolinate
  • 200-600 micrograms/day
  • Excess intake may be toxic, may cause sterility,
    tissue damage, mild GI distress,
  • Essential trace element involved in potentiating
    the action of insulin.

18
Chitosan
  • Sold as fat trappers or fat magnets, supposedly
    block fat absorption and cause weight loss
    without food restriction,
  • Study gave chitosan and measured fecal fat,
    showed no difference in fecal fat in those who
    took chitosan and those who did not.
  • Another study combined chitosan and psyllium
    husk, there was more fat in stool, suspect due to
    psyllium not chitosan.

19
Chromium
  • Lots of false claims, wont burn fat
  • Some studies have shown people with diabetes who
    take chromium improve their glucose levels,
  • In 3 different studies, chromium given compared
    to placebo, the people taking the chromium had
    greater amounts of weight loss and when measured
    by underwater weighing and DEXA showed more fat
    was lost and more lean body mass preserved, ex
    2.88kg compared to 1.81kg taking 400 micrograms
    of chromium.

20
Calcium
  • Several studies have shown that increased calcium
    intakes are associated with greater weight loss
    compared to placebos
  • 2,000 mg of calcium, people lost 10
  • 1500 mg of calcium from food and supplements,
    lost more weight
  • One study compared 800 calories without calcium,
    1500 calories with calcium, 1200 calories with
    calcium, showed those with calcium lost more
    weight
  • Influences the rate of fat being used by the body
    for energy,

21
Calcium
  • Melanson et al, International Journal of Obesity,
    2003, Relation between calcium intake and fat
    oxidation in adult humans,
  • Higher acute intakes of Ca was associated with
    higher rates of whole body fat oxidation, during
    light activity, daily activities, and during
    sleep.
  • 300 mg increase in Calcium results in 5 pounds
    weight loss. 8 oz300 mg of Ca

22
Calcium
  • Study in girls between age of 9 to 14 who
    consumed more calcium on a regular basis weighed
    less and had less body fat than theirs peers who
    consumed less calcium.
  • Study in adults who consumed yogurt lost more
    weight than group who ate the same amount of
    calories without yogurt, yogurt group ate 3 per
    day, 1,100 mg of calcium, the other group
    averaged 500 mg of calcium per day.
  • Those eating yogurt lost 81 more fat in the
    stomach.

23
Green Tea Extract
  • Contains caffeine, and the extract of green tea
  • 10 volunteers took green tea and caffeine
    compared to a hot beverage with just caffeine
  • Measured 24 hour energy expenditure and the RQ
  • Those who drink the green tea had a lower RQ and
    4 increase in energy expenditure

24
Green Tea
  • Epigallocatechin gallate seems to inhibit the
    degrading of norepinephrine and so it influences
    fat metabolism
  • A 4 increase in metabolism could equate to 75
    calories, over a year this is 8 pounds

25
5-Hydroxythrptophan
  • One study gave obese individuals 300 mg of 5-HTP
    3 times per day 30 minutes before meals for a 6
    week period.
  • Significant weight loss occurred in the group
    receiving 5 HTP but not in the controlled group,
  • Maybe the amino acid by conversion of tryptophan
    to 5-HTP makes serotonin becomes available,
    serotonin influence energy balance and the
    circadian patterns of eating, 3 times per day,
    and may decrease appetite and curb carbohydrate
    intake.

26
Guarana, Cola nut
  • Caffeine-rich extract of seeds from and Amazonian
    vine,
  • One study with overweight subjects who took a
    supplement that combined guarana with a second
    potent caffiene source lost more weight than
    those taking a placebo
  • One woman died after drinking a guarana drink
    that contained 17 times the amount of caffeine as
    one cup of coffee
  • Be careful of your caffeine intake!

27
Yohimbe
  • Claim to lose weight, increase muscle size and
    strength
  • Used a lot for the treatment of ED
  • Should not be taken with high blood pressure,
    angina, kidney disease, liver disease, diabetes,
    cardiovascular disease,
  • Should avoid red wine, cheese, liver, sausage due
    to increase in BP.
  • Does not help with weight loss.

28
DHEA
  • A natural hormone that may decrease as we age,
  • Can cause increased facial hair, scalp hair loss,
    mood swings, aggressiveness, irritability,
    increased risk of heart disease,
  • No studies show aids in weight loss.

29
Pyruvate
  • Study gave subjects pyruvate or a placebo, gave
    22-44 gm of pyruvate, and equal calorie placebo,
  • After 6 weeks, the subjects who got pyruvate had
    lost more weight and more fat than the placebo
    group, p value , 0.05
  • May help to increase metabolism

30
HCA
  • Hydroxycitric acid- a chemical in the garcinia
    cambogia fruit
  • 1998 study, overweight men and women who took HCA
    for 12 weeks did not lose more weight than those
    taking a placebo
  • Not enough research, does not appear to help in
    weight loss.

31
Bitter Orange
  • Extract of the immature Seville orange, used to
    make marmalade
  • The extracts active compound, synephrine, is
    chemically similar to ephedra, It raises
    metabolism and suppresses appetite.
  • An industry-sponsored study in 1999 showed a
    modest effect on weight loss,
  • We dont know if is side effects are less or
    worse than ephedra.
  • May make you sensitive to light and does increase
    blood pressure

32
CLA
  • Conjugated linoleic acid, found primarily in meat
    and dairy products, in supplements is from
    sunflower oil or safflower oil.
  • Claim that it burns fat, increases metabolism,
  • Some studies have shown great weight loss in
    animals, but not as good in humans. Some studies
    show more fat loss, but others have shown no
    change.
  • Dose is 3-5 gram per day of CLA,
  • Non stimulating method for slightly increasing
    metabolism, green tea is better.

33
LipoKinetix
  • FDA wrote a letter to the company, stating the
    product has been implicated in a number of
    serious adverse reactions, specifically serious
    liver injuries,
  • FDA urged the company to remove the product from
    the market and to alert consumers to stop taking
    the product.
  • FDA released a consumer warning alert.

34
Oxygenated Water
  • Claim O2 water delivers extra oxygen to the body
    to enhance metabolism and improve endurance,
  • Products are sold as containing extra oxygen in
    different amounts, but ..
  • These products are sold in plastic, and plastic
    is permeable or porous and allows oxygen to
    diffuse out of the bottle and the oxygen is lost
    to the air.

35
Extra O2 Water
  • Studies have shown when consumed there was not
    change in oxygen saturation of the blood,
  • Doubtful that there is oxygen in the water,
  • The intestinal tract does not absorb the oxygen
  • Bottom line Marketing for money, save yours!

36
Evaluate a Supplement
  • Look for a diuretic,
  • Fiber source
  • Caffeine, cola nut, guarana,
  • Ephedra

37
Choosing a Supplement
  • Carry USP United States Pharmacopeia, on the
    label- passed test for how well it dissolves,
    potency, purity and the product passes for
    uniformity, purity and content potency,
  • Made by nationally known food and drug
    manufacturers-companies that follow strict
    quality control procedures,
  • Supported by research peer reviewed
  • Accurate and appropriate claims, if it sounds too
    good to be true, be wary
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