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

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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.

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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

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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?

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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.

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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

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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.

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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

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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

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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

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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,

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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
  

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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.

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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

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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.

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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.

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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.

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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,

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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

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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.

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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

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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

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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.

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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!

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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.

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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.

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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

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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.
  

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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

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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.

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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.

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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.

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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!

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Evaluate a Supplement

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

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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