Transcript Alternative Weight Loss Pills: Should we prescribe them?

Alternative Medicine & OTC
Weight Loss Pills:
Should we prescribe them?
By: Dr. Samuel N. Grief, MD
UIC Family Medicine
July 23, 2003
Outline
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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
Obesity
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Growing health crisis in the U.S.
35% of Americans are overweight
27% of Americans are obese
BMI 25-29 = Overweight
BMI >29 = Obesity
Incidence of diabetes increased by 50%
over the past decade, half attributable to
obesity.
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• 1997, both withdrawn from market due to heart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
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
Surgical Treatment Options for
Obesity
• Last resort option for severely obese
patients
• Choose patients carefully
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 FDA’s safety board.
• Supplements are considered foods, not drugs.
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.
Ephedra
• A.K.A. Ma Huang, Brigham Tea or Mormon Tea.
• Called the world’s 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.
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.
Miracle Burn
Manufactured by Urban Nutrition Inc., New York, NY
Miracle Burn:
Ingredients
• 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
Miracle Burn:
Ingredients
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Sukday Root
Brigham Tea
Fo-Ti Root
Bay-chi Root
Licorice Root
Lycii Berry Fruit
G.T.F. Chromium
Icelandic Kelp
Konjac Root
Apple Cider Vinegar
Cascara Sagrada
L-Carnitine
Senna
Vitamin B6
Spirulina Algea
Potassium Chloride
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
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.
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).
Fo-Ti Root:
Side Effects
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GI upset (indigestion, diarrhea)
Skin Rash
Numbness and/or tingling of the extremities
Avoid if pregnant or nursing
Bay Chi
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AKA Astragalus
Immune enhancer
Touted as an antioxidant
Promoted for lowering blood pressure,
increasing stamina, controlling perspiration
and in helping to control appetite.
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!
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.
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.
Spirulina Algea
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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.
Spirulina Algea
• Thought to enhance the immune system
• Usual dose is 500-1000mg daily
Senna
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AKA Cassia angustifolia
Derived from the leaves and pods of Cassia a.
Stimulates intestinal peristalsis
Contains anthraquinone glycosides (sennosides, aloeemodin, 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 (>10 days)
Avoid in patients with IBD, abd. pain and obstruction
Dose: 150-300mg hs
Cascara Sagrada
• Bark
• Helps stimulate intestinal peristalsis
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 brewer’s 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.
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!!!
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.
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 @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
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
ACV Recipes
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1 oz ACV
1 tsp honey
1-4 oz glass of warm water
OR
2 tbsp Bran
2 tsp ACV
Porridge, Yogurt, or Fruit
ACV
• Caution: Do not take ACV if you suffer
from gastritis, ulcers, or have GERD.
L-Carnitine
• Made in the body from the essential amino acids
lysine and methionine (found in brewer’s 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
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.), Cushing’s Syndrome, type 1 Renal Tubular
Acidosis, drugs (digoxin, amphotericin B), insulin.
• Non-medicinal uses in photography and as a
fertilizer
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
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
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
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.
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!!!
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.
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
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
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
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.
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.
Xenadrine
• Contains ma huang (ephedra), guarana (equivalent
of 200mg caffeine per serving), L-tyrosine, LCarnitine, and more.
• Implicated in the death of Baltimore Orioles
pitcher Steve Bechler (Xenadrine RFA-1)
• Lawsuit calls Xenadrine a “poisonous cocktail”
• Now there’s Xenadrine EFX (ephedra free!)
• Contains proprietary blend of many substances.
• Side effects include: anxiety, shakiness, feeling
faint, increased heart rate, diaphoresis, GI upset.
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
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
Dietary Supplements for Weight
Loss
• Thermadrene XP: the next generation of “FatBurning” 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
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
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
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
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
Dietary Supplements for Weight
Loss
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“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)
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 GABA’s 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)
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!
Have a great day!
• Thank you very much!