Shape Up America! Newsletter-September 2002
All contents of this newsletter are copyright © Shape Up America! 2002 and may not be reproduced or distributed in any medium without written permission.
1. Weight Loss Magic - The Search for a Safe and Effective Substitute for Healthy Eating and Exercise
by Barbara J. Moore, PhD
Do you wish you could take a pill instead of eating right and exercising to control your weight? Why spend your time doing all of that work if you don't have to? If you feel burdened by healthy living, you are not alone. Lots of people are spending billions of dollars on weight loss supplements they hope will take off the pounds with no effort. But is there any evidence that any of these supplements actually work? As it turns out, there is very little information about the safety and efficacy of dietary supplements for weight loss, and most of the information we could find shows that believing in these supplements is like believing in magic. Because some of the supplements are dangerous, it is more like believing in black magic.
In June, 2002, we did some research to evaluate dozens of dietary supplements for their safety and effectiveness in producing true weight loss. True weight loss is really fat loss - after all, what you are really trying to do when you lose weight is lose body fat. As you lose fat, you want to avoid losing muscle or bone, and here's why. You need to maintain your muscle because you need your muscles to work and to play - besides, the more muscle you have, the more calories you will burn - even when you are at rest. Because muscle is a calorie burner, more muscle actually helps you keep your weight down. You don't want to lose bone because your bones will get thin and brittle and will break more easily. You need to be protective of your bones starting from childhood and throughout the rest of your life. If you wait until your bones are thin and brittle, it is too late. You don't even want to lose water when you lose weight because dehydration (water loss) can be dangerous. Your goal should be fat loss, period. So when we talk about true weight loss, what Shape Up America! really means is fat loss.
For the vast majority of supplements we studied, we were able to find no data at all - that is, no studies whatsoever of these supplements for the purpose of losing weight. Because of the complete lack of evidence that these compounds produce weight loss, we conclude there is no reason to purchase any of the following supplements in the hope that they will help you lose weight:
For a few supplements, some studies in humans had been conducted, but we found there were problems with the design of the studies that seriously interfered with our ability to draw conclusions. A poorly designed study is as bad as having no data at all. For some supplements, there are serious safety issues that we will tell you about. Finally, a few studies showed that the supplement was clearly INEFFECTIVE for weight loss.
Before getting into the specifics, our general comment is that none of the following supplements has been studied long enough. For the purpose of evaluating safety and weight loss effectiveness, we believe that a period of one year is the MINIMUM time required. Any prescription medication for weight loss must be evaluated for at least one year or even longer and we believe that dietary supplement products for weight loss should be held to the same standard. The studies of prescription medications must be conducted in a manner that makes it possible to clearly interpret the findings. Once the study is completed, there must be no question that the compound being tested is effective and additional testing is required to demonstrate that the compound is safe for extended use.
A company can choose to market dietary supplements for weight loss without undergoing any safety or effectiveness review process whatsoever. For prescription weight loss medications, that review process MUST be administered by the Food and Drug Administration (FDA) and must be properly designed to evaluate safety and effectiveness for weight loss. Since the FDA is not permitted to evaluate dietary supplements, there is, in effect, a double standard - one rigorous standard for demonstrating the safety and effectiveness of prescription medications and virtually no standard at all for dietary supplements.
If you are the CEO of a company that wants to market a product as a medication for weight loss that will be available by prescription only, then you MUST subject your product to FDA review. If you want to avoid FDA review of the safety and efficacy of your product, you can market the product as a dietary supplement for weight loss. To avoid FDA review, which is costly and time-consuming, many companies choose to market their products as dietary supplements. If you look at the hundreds of weight loss products for sale in your local stores, you will see they carry claims or statements that the product is effective for weight loss or for burning fat. If you read the product label carefully, you will see a statement that the FDA has not reviewed the product claims on the label about weight loss or fat burning or muscle building.
The "Fat Trapping" Products
You may have seen email or other advertisements about weight loss products that trap fat and eliminate it or prevent it from being absorbed by your body. These products usually carry a statement that they help you lose weight by removing fat from your body and washing it away. Some claim that this process takes place while you sleep and requires no effort on your part. Chitosan is one product that claims to work in this manner; Glucomannon is another. The Chitosan studies we found did not support the claim that Chitosan traps fat or eliminates fat. Nor do they support the claim that Chitosan helps you lose weight. We concluded that Chitosan is ineffective.1,2 The data we found on Glucomannon are inconclusive, in other words, the studies3,4,5,6 do not permit us to draw any meaningful conclusion.
Apart from the fact that these products don't work, from a safety standpoint, our concern about Chitosan is that it is derived from shellfish and many people with shellfish allergies may not be aware that the product is ineffective and has allergic potential. Glucomannon is a substance derived from underground stems or tubers of a plant called "konjac" and it may cause choking when taken in tablet form. It may be safe to take Glucomannon in a powder or capsule, but it appears to have only a laxative effect and has no demonstrated value in producing true weight loss.
The "Fat Burning" Products - Thermogenics and Fat Burning Stacks
There are a group of products that claim to increase your metabolic rate and waste calories as heat - causing you to lose weight without effort. These products claim they can cause your body to burn off or waste calories, especially fat or carbohydrate calories, while sparing protein calories for building muscle. The marketing appeal of these products is usually to body builders or body sculptors who take these products in the hopes of simultaneously building muscle and decreasing fat.
The "fat burning" products usually involve combinations of ingredients, or "stacks," which are claimed to work together to cause the desired effect. They are sometimes marketed as "thermogenics" which implies that they cause thermogenesis, which is a term that refers to a physiological process in which the body takes fuel sources and selectively burns them for the purpose of heat production. Since the process of thermogenesis takes place inside the cells of your body -- specifically inside tiny cellular "mitochondria" - some products claim that they can increase the number of mitochondria in your body. The argument is that the more mitochondria you have, the more heat production potential, and the more calories get wasted as heat - so you lose weight.
The fat burning products usually involve combinations or "stacks" of aspirin, caffeine and ephedra (also referred to as MaHuang). Some of the products include herbs that are used as substitutes for one of more of these ingredients. For example, Guarana, Cola Nut or Green Tea all contain caffeine so these compounds are sometimes used as a "natural" substitute for the caffeine in the stack. Willow Bark is sometimes substituted for the aspirin in the stack.
Marketers of dietary supplements want you to believe that if you use an herbal source of an ingredient, it is "natural," and if it is "natural," it must be safe. By this faulty reasoning, the fat burning stacks containing ephedra or MaHuang, which is an herb, are trusted, but this trust is misplaced. There is no doubt that some herbs are not safe and MaHuang is one of the many. It is a fact that many prescription drugs are derived from bioactive compounds found in herbs. Herbs can be the source of compounds that produce effects that are both desirable as well as dangerous.
MaHuang is the Chinese name of an herb - Ephedra sinica -- which contains a class of compounds that are referred to as the "ephedra alkaloids." These ephedra compounds have been associated with many dangerous side effects including high blood pressure, increased heart rate, heart palpitations, stroke (which is like a heart attack in the brain) and even sudden death. The ephedra alkaloids include: Ephedrine, Pseudoephedrine, and Phenylpropanolamine, all of which possess stimulant properties. An herb like MaHuang is just like any drug - it can have potent biological effects and should be treated with respect. Herbs may be "natural", but "natural" does not mean "safe."
In summary, some studies demonstrate that ephedra/MaHuang may actually work in combination with caffeine and aspirin to cause weight loss, but there are serious safety concerns that can not be ignored - like stroke, heart palpitations and sudden death. Shape Up America! does not recommend the use of dietary supplements containing MaHuang or ephedra because of the danger posed by these products.
-- Appetite Suppressants
Some dietary supplements claim to help you lose weight by suppressing your appetite. The marketers of these supplements encourage you to take appetite suppressants for extended periods time to reduce hunger, consume less food, and thereby lose weight. We have discussed above the potential danger of using the herb MaHuang or ephedra. A derivative of ephedra, phenylpropanolamine - also known as PPA -- has been sold as an over the counter appetite suppressant for many years. But the Food and Drug Administration (FDA) has taken steps to remove PPA from the market because it causes an increased risk of stroke.
Not surprisingly, Ephedra/MaHuang appears to have the capacity to suppress appetite. After all, the chemical structure of its bioactive ingredient - ephedrine -- resembles that of the addictive amphetamines which are also known to suppress appetite and which have many dangerous side effects besides their addictive potential.
The bottom line on MaHuang or ephedra: Studies show that chemically extracted or chemically synthesized ephedrine may have appetite suppressant ability, but it is not well studied, it is dangerous, and its herbal equivalent, MaHuang or ephedra, is also dangerous. For weight loss, Shape Up America! does not recommend and advises against the use of dietary supplements containing MaHuang or ephedra, or their bioactive components, phenylpropanolamine (PPA) or ephedrine or pseudoephedrine, because of the danger posed by these products.
Another dietary supplement that is marketed as an appetite suppressant is 5HT or 5-hydroxy-tryptophan. The rationale behind this product is that when taken as a dietary supplement, it will be absorbed into your body and will travel, via the bloodstream to the brain where it will cross the blood-brain barrier. Then it will be taken up by brain cells and converted to serotonin - a compound which plays a role in appetite regulation and which is thought to reduce food intake. Could we find any studies that would support the claim that 5HT suppresses appetite and causes weight loss? We found only one study that was inconclusive Yohimbe is another dietary supplement that is thought to affect serotonin, but has not been studied for either safety or effectiveness.
-- Metabolism Accelerators -- Calorie Wasting Supplements
(Krebs Cycle, Mitochondriacs, Fat transporters, glucose transporters, thyroid hormone stimulators, etc.)
A number of dietary supplements claim to waste calories by speeding up your metabolism in a variety of different ways. Some claim to stimulate your thyroid gland and increase production of active thyroid hormones. An example is Tiratricol which is a substance the FDA considers dangerous and is taking steps to remove from the market. Other dietary supplements claim to have a stimulating effect on the selective uptake and burning of glucose by muscle which they claim helps weight control by wasting calories while building muscle. Garcinia Cambogia (also known as Brindleberry) and Chromium picolinate (and other chromium supplements) are examples of this type. Others, like Capsicum or Capsaicin, claim to have a specific effect on heat production, which is a calorie wasting process. Still others like Pyruvate and the Ephedra compounds discussed above claim to have a general effect as a metabolism accelerator or calorie waster. The general criticism of these compounds is that they are not well studied from the standpoint of either effectiveness or safety. As discussed above, the Ephedra compounds are clearly unsafe. There are also disturbing reports about the safety of chromium supplements suggesting they may have a damaging effect on the genetic material inside cells. Shape Up America! advises against the use of any of these compounds for weight loss or any other purpose.
-- The Muscle Builders
Although we are focusing on weight loss, some of the dietary supplements claim to help you build muscle and lose weight by stimulating the production of human Growth Hormone. The three most heavily marketed are unsafe and also have addictive properties. These are Gamma HydroxyButyrate (GHB), Gamma ButyroLactone (GBL) and Butanediol (BD). Another dietary supplement marketed as a muscle builder is Dehydroepiandrosterone (DHEA), which can alter androgen and estrogen levels. DHEA has not been studied for the purposes of weight loss and is thought to raise cancer risk, especially to cancers that are sensitive to estrogens. Shape Up America! recommends that these compounds be avoided entirely for the purpose of weight loss.
-- The Fractured Logic Behind Laxatives and Diuretics
What is the fractured logic or rationale behind the use of these dietary supplements for weight loss since almost none of them are based on any evidence that they actually work? In many instances, it is because there may be some laxative or diuretic effect of the compound. We hasten to point out that a laxative that helps to eliminate bodily waste is sometimes necessary, but should be used only when medically needed. Extended use causes mineral loss and dehydration. Laxative abuse is dangerous because it upsets salt and water balance that is needed for healthy heart function. It should be clear that elimination of wastes is not true weight loss - it will not help you lose fat. The use of a diuretic to cause water loss is another example of false weight loss. It can lead to dehydration and a loss of potassium and other salts that cause heart irregularities, muscle fatigue, dizziness and fainting. Both laxatives and diuretics (whether they are "natural" or not) can be extremely dangerous. Even products that are legitimately used for this purpose can cause mineral loss, metabolic and physiological derangements and other serious side effects. These products, like all herbal and non-herbal medicines, should be treated with caution and respect.
Only for the ephedra containing compounds were we able to find evidence of weight loss effectiveness, but we also found ample evidence that they are dangerous. None of the compounds we examined had been studied in properly designed weight loss clinical trials lasting one year or longer. Most experts consider one year to be the minimum period of time required to adequately demonstrate the effectiveness of a dietary supplement. Studies of safety take even longer. This means that the long term value of these supplements remains questionable for the purpose of true weight loss and the safety of usage for extended periods is unknown.
2. Quick Tips to Keep You On Track
You don't miss your water until your well runs dry and you don't miss your good health until you lose it. Shape Up America! is committed to the proposition that good health is worth working for and the achievement and maintenance of a healthy weight is an important way to preserve your health. As difficult as it is to manage your weight, there are some things you can do to make it a bit easier.
3. Taking a Stand
A piece of legislation is being introduced in the Senate - the "Improved Nutrition and Physical Activity (IMPACT) Act" Here is why it is important to your health and to weight management.
Is your neighborhood safe for little children and for elderly folks to walk in? Are there sidewalks available for children to walk to school? Can you walk or bike to visit friends or shops in your community? Do you have a park or green space to play in? Is your community growing in a way that is pedestrian friendly? Bike friendly? If you answered "no" to any of these questions, you may be interested in the following ..
Twenty-five years ago, type 2 diabetes - which is caused by obesity and inactivity -- was considered a disease that afflicted only adults. Today, type 2 diabetes is the most common form of diabetes in children. But type 2 diabetes is preventable in both children and adults by avoiding obesity and inactivity. In some communities, childhood obesity is growing at an alarming rate and one out of four overweight children is developing diabetes. You can do something to stop this dreaded disease that is the leading cause of blindness, kidney failure, and amputations.
In June 2002, Senators Frist, Bingaman and Dodd introduced a bill in the Senate to address the growing epidemic of obesity in America. The bill is called "Improved Nutrition and Physical Activity (IMPACT) Act". IMPACT addresses obesity in America as a serious public health problem that is raising the prevalence of many related serious chronic diseases. The passage of IMPACT would provide funding for the following:
Shape Up America! supports IMPACT, but we know the bill will not be passed if you don't take action. Please think about the needs of your community and its children. Let your US Senator and Representative know what your needs are and why you want the IMPACT legislation to be passed and fully funded. Take the time to write today to express your support of IMPACT.
4. Toxic Trends
By the year 2010, or perhaps sooner, more than half of every food dollar in America will be spent OUTSIDE THE HOME. That means more eating out in restaurants, fast food places, and more take out meals. This trend will make it even harder for you and your children to manage your weight because portion sizes are steadily growing. More food, bigger sodas, bigger dinner plates, bigger glasses of wine, and more calories - all add up to more weight gain.
A study by one of our favorite scientists, Dr. Barbara Rolls, at Penn State, shows that if you place lots of food in front of a 3 year old, it does not influence the child's food intake. But in a slighter older child, the results are different. If you place an abundance of food in front of a 5 year old, the child will indeed eat more calories. So the trend toward ever increasing portion sizes is toxic because it does promote overeating and leads to obesity.
Wouldn't you like to learn about portion control? Do you have any questions you would like to ask the Shape Up America! weight management experts about weight control? Become a member and let us help you learn how to navigate through all of the temptation that surrounds you.
For more information, visit Shape Up America!
5. Book Review - Tiny Bites by Sandra Beauchamp-Parke
Reviewed by Barbara J. Moore, PhD
More than five million Americans have a BMI of 40 or higher and are classified clinically as "morbidly obese." Many of these people are considering gastric surgery as a treatment for their obesity. If you are contemplating this type of surgery, there is a great deal you will need to know and many decisions to make:
If you are contemplating gastric surgery, we have found an excellent little book called "Tiny Bites" written by a critical care nurse who skillfully and compellingly presents the patient's point of view. Through her excellent book, Sandra Beauchamp-Parke shares a number of enlightening stories about people who have been through the experience and she helps you feel the pain as well as the joy in a remarkably engaging manner. The book is written clearly and it will help you learn what to expect and what questions you should be asking. The book was published in 2002 by Jessica Kingsley Publishers (www.jkp.com). If you are considering surgery or if you are a health care professional seeking a better understanding of the world in which your morbidly obese patients live, and the challenges and decisions they face, reading this book is a must.
We noted that the book's references include the work of Dr. Patricia Choban, a scientific advisor to Shape Up America! since 1996. Dr. Choban was chair of the committee that developed Guidance for Treatment of Adult Obesity - an excellent resource for health care professionals that covers all forms of treatment from lifestyle change to pharmacotherapy to surgery.
If you are a health care professional interested in membership in Shape Up America!, you will receive a copy of Guidance for Treatment of Adult Obesity upon becoming a member. If you are a layperson seeking information about all forms of treatment of adult obesity (including surgery), join Shape Up America! and receive a copy of Healthy Weight, Healthy Living as a benefit of membership.
For more information about membership in Shape Up America!, visit www.shapeup.org.