The popularity of weight loss drugs and supplements are on the rise, but according to the first federal guidelines for the treatment for weight loss and obesity, about 55 percent of adult Americans, or 97 million people, are either overweight or obese. Quick-fix diets, pharmaceuticals, and even "natural" weight loss formulations don�t promote good eating habits because they are not a life-long plan. "When you talk to me, we�re talking the 90-year plan," says Houston-based nutritionist Anne Dubner, R.D., L.D." You need to establish eating patterns that work long-term, and incorporate foods that allow you to lose, and then maintain, body weight."
Do Weight Loss Drugs Work?
Dubner, whose specialty is weight loss, found that her clients didn�t want to learn anything about diet, they just wanted to take a pill and lose weight. But when they went off the drug they gained the weight back. "I do not recommend weight loss drugs. I�m sure they work, but they are temporary." Dubner believes that if weight loss drugs are used they should be a part of a multi-disciplinary approach. "See a dietician, psychiatrist, or psychologist, if necessary." Weight loss drugs can serve as a jump start for an individual who is significantly overweight, or someone who has to lose weight before undergoing surgery.
Both Fen-phen and Redux were found to cause damage to heart valves and were taken off the market in 1997. The newly hyped weight loss drug, Meridia, released last April, acts on serotonin and norepinephrine, another brain chemical to make users feel full, like Fen-Phen and Redux, but not in the same way. Researchers at Knoll Pharmaceutical, who produce Meridia (sibutramine), say Meridia works on two neurotransmitters instead of just on serotonin.
What's coming down the road in the way of weight loss drugs? Orlistat, which will be marketed as Xenical, received FDA advisory committee approval in May of 1997, but Hoffmann-La Roche, its manufacturer, has decided to do more analysis before releasing it for final approval. Orlistat is a lipase inhibitor, which means it works on lipase, an intestinal enzyme that breaks down fat. Xenical cuts fat absorption in the intestine by about 30 percent.
None of the weight loss drugs on the market now, or any that might be available in the future, are going to solve the problem of excess weight. And serious health effects were found with the drugs that have been removed from the market.
Searching for a Natural Solution
Each year Americans spend billions of dollars in the hopes of finding the magic pill(s) for weight loss. In fact, according to the National Council Against Health Fraud, a whopping $8.9 million are spent annually on vitamins and dietary supplements alone. And, because vitamins, herbs and other supplements are not officially regulated by the Food and Drug Administration, consumers are often unaware of the proper dosage amounts, efficacy and product safety. Then, add to that the fact that an incredible amount of diet supplements are introduced each year, making it virtually impossible for government officials to keep up.
Herbal Phen-Fens
According to many health food store operators, herbal phen-fens in all forms-from teas to pills-are by far the biggest sellers of herbal weight-loss products. And, store operators and experts agree, the reason for their popularity is probably due in part to slick marketing tactics by manufacturers that compare their products to the banned fen-phen prescription drug. The big difference, according to herbal phen-fen marketers, is that unlike the prescription drug, their herbal phen-fens are completely safe because they use "natural" ingredients.
"Some of the most potent toxins are �natural�...even poison is natural...the word �natural� does not guarantee safety," says Dr. Kathy Kapica, PhD, RD, associate professor of nutrition and dietetics at Chicago Medical School. And, according to Dr. Kapica, another major problem is that due to the lack of government standards for botanicals and herbs, consumers can�t always be sure that the products they are getting are pure, or even contain what the labels say. "It�s very scary to think that consumers invest in products that they think will help them when they�ll actually be lucky if they don�t harm them," adds Dr. Kapica.
Most herbal phen-fens contain a mixture of herbs which often include ephedra, St. John�s wort, chromium picolinate and others. Some ingredients like ephedra, which is addressed below, can be dangerous when abused, while others, such as St. John�s wort and chromium picolinate, show no clinical evidence of being beneficial for weight loss.
Ephedra
Ephedra, also known as ma huang, is a strong stimulant found in popular herbal phen-fen diet aids. While the efficacy has been well researched and substantiated for relieving nasal congestion and some allergic disorders, Varro E. Tyler, an authority of the medicinal use of herbs, states in his book, The Honest Herbal, that "there is no substantial clinical evidence that [ephedra] is either a safe or effective promoter of weight loss in obese patients." And, ephedra can be very damaging to the body, especially when abused. Its active ingredient is ephedrine, a stimulant that works in the body much the way that adrenaline does in what is known as the "fight or flight" response. The danger is that when taken regularly, your body stays in an unnatural high gear and there is risk for heart palpitations, heart attacks, and strokes; particularly for those with a history of heart disease, hypertension, diabetes, or thyroid disease.
To date the FDA and Centers for Disease Control Prevention have received more than 900 complaints about products containing ephedrine, including 17 deaths. The FDA has plans to regulate ephedrine levels in dietary supplements in the future.
St. John's wort
Many herbal phen-fen combinations with ephedra contain St. John�s wort as well. Manufacturers of diet supplements containing St. John�s wort claim it may increase the production of the brain chemical serotonin, possibly having a positive influence on mental wellness, which could help suppress overeating that may be linked to depression.
St. John's wort has been one of the most scientifically researched medicinal herbs in history. Many clinical trials using standardized St. John�s wort preparations have confirmed its safety and effectiveness in treating depression. However, there is no clinical evidence to substantiate that St. John�s wort has weight loss benefits.
Chromium picolinate
Chromium picolinate, another popular ingredient in many diet supplements and teas, is sometimes paired up with ephedra and St. John�s wort, but is also sold as a dietary supplement on its own. Chromium picolinate is a synthetic compound that contains chromium, a nutrient necessary for regulating blood sugar. Chromium can be found naturally in vegetables like potatoes, broccoli, and mushrooms. In his book, Chromium picolinate-Everything you need to know, Dr. Gary Stevens says that, "Chromium picolinate plays a vital role in any program for fat reduction because it keeps insulin working properly."
While its true chromium is an essential trace mineral that aids a number of body functions, it is only required in small amounts. And while countless proponents claim it does everything from help you control blood glucose to burn fat and build muscle, none of these claims has been substantiated clinically. "While chromium shows promise in the treatment of adult-onset diabetes, I have not seen any good evidence that it can help people lose weight. Although it has been marketed for weight loss, the evidence is simply not there," says Veggie Life Nutrition Editor John Westerdahl, MPH, RD, CNS.
Garcinia
Garcinia is a supplement made from a dried Indian fruit. Its active ingredient, hydroxycitric acid (HCA), is the main ingredient found in many diet and energy supplements on the market, despite its limited research.
Marketers of weight-loss products containing HCA claim it suppresses appetite and makes calories easier to burn by preventing carbohydrates from being stored as fat.
Studies in animals have shown HCA to be effective in preventing weight gain, which experts say more than likely has to do with its effect on appetite. But to date, there is no scientific evidence indicating that Garcinia is effective for weight loss in humans. Although there are no known dangers associated with taking Garcinia, consumers should be cautious due to the lack of research substantiating its safety when used at levels recommended for weight loss. "There is no reliable scientific evidence to demonstrate its effectiveness for weight loss in humans. At this point, claims that say it can help you lose weight are unjustified," says Westerdahl.
Calorad
Another hot seller for weight loss is Calorad. Calorad's ingredients include collagen, aloe vera, glycerin, potassium sorbate and methyl paraben (preservatives), natural flavor, and demineralized water. But, while most experts concur that these ingredients just don�t add up to weight loss, marketers of Calorad say this collagen protein formula supports lean body tissues and assists the body in burning sugars and fats more efficiently. Also, they claim Calorad will help you "lose inches and build lean muscle while you sleep."
So, while experts say collagen offers no weight-loss mechanism, manufacturers of Calorad say their extraction process makes their product different from other collagen products on the market. But, according to the experts in a recent issue of Environmental Nutrition, "Extracted or not, collagen is not a weight-loss aid in our book."
Another interesting thing to note is that manufacturers suggest taking the product on an empty stomach just before bedtime, after withholding food for three hours. They say it�s because Calorad works more effectively that way...but it sounds like pretty good advice for anyone trying to lose weight, since most of us know that late-night snacking often leads to weight gain.
Chitosan
Marketers of this popular diet supplement tout its ability to "trap" and get rid of dietary fat and cholesterol. The theory is that when taken regularly, chitosan-a non-digestible dietary fiber-will decrease the absorption of fats and carry them, along with their calories, right out of the body. While there have been some promising studies that show chitosan to have a cholesterol-lowering effect in animals, there has been no such evidence in humans.
"There is absolutely no research indicating that chitosan is effective for weight loss," says Dr. Kapica. "It has never been tested for weight loss, or in humans at all." In fact, Dr. Kapica says that Chitosan has the potential to be harmful due to the fact that it binds fat soluble vitamins, which could result in deficiencies and set in motion other harmful effects. And, while limited research has shown chitosan may help lower cholesterol in animals, Dr. Kapica says Chitosan isn�t even at a point where it can be recommended for that.
The bottomline is that we just don�t know enough about chitosan and the potential dangers from taking it. Therefore, she says, consumers would be wise to stay away.
Conjugated Linoleic Acid (CLA)
CLA is a term which refers to a group of derivatives of the essential fatty acid, linoleic acid. These polyunsaturated fatty acids are found naturally in certain foods, especially meats and dairy products. Marketers of CLA claim that due to the healthy eating patterns of today�s health-conscious consumers, lower intakes of meat and dairy products has lead to lower levels of CLA in our diets. A problem, they say, because CLA may be an important nutrient for optimal body composition, possibly helping to reduce body fat and increase muscle. Marketers claim the need for this nutrient is evidenced by the fact that "Americans seem to be getting fatter, even as we eat less fatty foods."
While some studies have shown CLA to play a role in reducing body fat and increasing body protein (muscle) in animals, there have been no clinical trials indicating that the same results are applicable to humans, and many scientists are skeptical. "Many of the references for research sited by marketers actually have nothing to do with research that is related to what the company is hawking as the benefit of their product," says Rosemarie Szostak, PhD, a professor in the Department of Chemistry at Clark Atlanta University.
Diet Teas
Flavorful combinations of teas have entered the weight-loss industry with a splash. But, don�t plan on sipping your way to weight loss. According to Mark S. Meskin, PhD, RD, of California State Polytechnic University in Pomona in the July 1998 issue of Environmental Nutrition, "They�re a gimmick...and an inappropriate way to lose weight." Plus, Meskin and many other health professionals have concerns about some of the ingredients used. Ephedra and chromium picolinate are popular ingredients used in teas as mentioned above. And according to Environmental Nutrition experts, other popular "diet tea" ingredients like Senna and Cascara have laxative effects, which are not only an unhealthy method of weight loss, but prolonged use can have damaging effects on bowel tone.
WORDS TO THE WISE
When checking out weight loss supplements, read the claims and literature carefully. One product manufacturer, after touting its product�s effectiveness, also encouraged users to exercise for 20 to 60 minutes five to seven days a week; eat three low-fat, balanced meals and two snacks every day; eat at least two servings of fruit and three servings of vegetable each day; drink six to eight glasses of water every day; limit or stop drinking alcohol; stop eating two to three hours before bedtime; reach for the walking shoes before reaching for the refrigerator...etc. This sounds very much like the US Department of Agriculture�s Dietary Guidelines for Americans for Healthy Living, which remarkably when followed, generally result in a healthy weight and best of all, here they are for free.
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