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 >29 = 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• 1973, FDA approved fenfluramine (Pondimin) for weight loss • 1996, FDA approved dexfenfluramine (Redux) • 1997, both withdrawn from market due to heart valve disease • More recently, sibutramine and orlistat are available as Rx weight loss pills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 FDA’s 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 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.

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 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

13. Miracle Burn:Ingredients • 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 Root:Side 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 (>10 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 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.

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 @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 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

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.), Cushing’s 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 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.

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