Obesity (Weight Loss) (cont.)
What about herbal fen/phen?
Since the withdrawal of fen/phen from the market, "herbal fen/phen"
has been proposed as an alternative in treating obesity. But the U.S. Food and Drug
Administration has issued a warning that "herbal fen/phen" has not been
shown to be a safe and effective treatment for obesity and may contain
ingredients that have been associated with injuries.
The main ingredients in most herbal fen/phen products are ephedrine and St.
John's wort. Ephedrine acts like amphetamines in stimulating the central nervous
system and the heart. Ephedrine promotes weight loss in part by an increase the
body's temperature, and when this happens, the body burns more calories.
Ephedrine use has been associated with high blood pressure, heart rhythm
irregularities, strokes, insomnia, seizures tremors, and nervousness. There have
been reports of deaths in young individuals taking ephedrine. St. John's wort
has been used in Europe to treat mild depression, but not obesity. The action,
effectiveness, and side effects of St. John's wort either alone or in
combination with other agents have not been adequately studied.
What about meal substitutes, artificial sweeteners, and OTC products?
Meal substitutes
When used as substitutes for regular meals, meal substitutes are a convenient
way to reduce calories as part of a low calorie diet plan. A typical meal
substitute available in powder and liquid form is Slim-Fast. Ensure is another
meal substitute available in both liquid and bars. Meal substitutes should
provide protein and be low in fat and calories. The label should include the
amount of calories per serving and the percentages of protein, carbohydrates,
and fat. The total number of calories per serving is predetermined so it is
easier to keep track of the daily consumption of calories.
Artificial sweeteners
Saccharin (Sweet 'N Low) and aspartame (Equal) are sugar substitutes that
provide little or no calories. They may be used as a substitute for table sugar.
Using saccharin instead of a teaspoonful of sugar eliminates 33 calories from
the diet. People with phenylketonuria (a serious genetic disease in which an
individual is unable to break-down and eliminate an amino acid, phenylalanine)
should not use aspartame because it contains phenylalanine.
Fructose, sorbitol, and xylitol may be used as alternatives to sugar, but they
provide more calories than saccharin and aspartame. Excessive use of sorbitol
also may cause diarrhea.
Over-the-Counter (OTC) weight-loss products
Despite claims by manufacturers, the use of OTC products alone does not cause
weight loss. Herbal weight loss products or preparations called "fat burners"
are even more misleading. These products may contain a combination of ma huang
(a botanical source of ephedrine), white willow (a source of salicin),
Hoodia gordonii, and/or
guarana or kola nut (a source of caffeine). These agents are stimulants, which
theoretically increase the metabolism and help the body break down fat.
Nevertheless, there is no evidence that they are effective for weight loss. In
addition, ma huang has been linked to serious side effects such as heart
attacks, seizures, and death. Chromium also is a popular ingredient in weight
loss products, but there is no evidence that chromium has any effect on weight
loss.
Weight loss teas contain strong botanical laxatives (Senna, cascara sagrada)
and diuretics (Rhamnus purshiana) that cause diarrhea and loss of water from the
body. Diarrhea and water loss lead to the depletion of sodium and potassium and can
lead to dehydration. Although an individual's weight may decrease, the loss is
fluid and is only temporary. Moreover, low sodium and potassium levels may cause
abnormal heart rhythms and can even lead to death.
Guar gum preparations have also been promoted as a weight loss agent. Guar
gum is thought to work by leading to a feeling of fullness early in the meal. It
has not been scientifically proven, and has been associated with abdominal pain,
gas, and diarrhea.
All of the OTC products discussed above are not considered drugs and are
therefore not regulated by the Food and Drug Administration. As a result,
there is little information on their effectiveness or safety.
Next: What is the role of surgery in the treatment of obesity? »
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