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" Where Health and Wellness Begin"

There has been a growing trend for people to increasingly turn to complementary and alternative medicines for weight loss. Becasuse many of these are available without medical supervision, our Medical Director has commented on the most current ones available.

Many of these aids are not appropriate to utilize with our program. Please let us know about any additional supplements that you are taking. Again, be careful of the products. Not all supplements are equal. For more information on criteria, see the criteria page.

The herbal remedy ephedra, or ma huang, is currently being used in many commercially available weight loss preparations such as Herbal Phen Fen (ephedra and St Johns wort), Metabolife (ma huang and caffeine), and Herbal Ecstacy (ephedra, kola nut, guarana, and green tea).

Ma huang is derived from evergreen plants of the Ephedra genus. It contains naturally occurring alkaloids, primarily ephedrine and pseudoephedrine. Ephedrine has been used as a bronchodilator, and pseudoephedrine in many over-the-counter decongestants, and cold and allergy products.

It has been suggested that ephedrine, a sympathomimetic agent, has thermogenic and anti-obesity properties. In clinical studies, ephedrine has been shown to decrease body fat in obese individuals by suppression of appetite and stimulation of energy expenditure. This thermogenic effect of ephedrine can be further enhanced by the addition of methylxanthines such as caffeine and theophylline or aspirin. Daly and colleagues found that a mixture of ephedrine (75 mg to 150 mg), caffeine (150 mg), and aspirin (330 mg) in divided pre-meal doses was well-tolerated and supported modest, sustained weight loss in healthy obese subjects. These clinical studies are based on a known dosage of the drug ephedrine, and extrapolation to the herbal remedy ephedra would be difficult.
Ephedrine's toxic effects primarily involve the cardiovascular and central nervous systems. Side effects include insomnia, motor restlessness, irritability , headache, nausea, vomiting, urinary disturbances, and tachycardia. In higher closes, hypertension, dysrhythmias, and myocardial infarction can occur. During September 1993 through September 1995, the Bureau of Food and Drug Safety, Texas Department of Health, received over 500 reports of adverse events, including at least 8 deaths, in persons taking dietary supplements containing ephedrine or its associated alkaloids. Moreover, Powell and associates found that ephedrine can induce nephrolithiasis (kidney stones); and Nadir and colleagues reported acute hepatitis due to the use of ephedrine. NOT RECOMMENDED

Chromium is an essential element required for normal carbohydrate and lipid metabolism. Chromium appears to help with insulin sensitivity by binding insulin to receptor tissues. Chromium deficiency can lead to insulin resistance with dysfunctions in carbohydrate and lipid metabolism. Chromium has also been reported to increase lean body mass and decrease percentage of body fat, which may lead to weight loss. Although some studies have found that daily supplementation with 200 mcg to 400 mcg of chromium picolinate resulted in a significant increase in lean body mass and decrease in percentage of body fat, others found no beneficial effects on body fat loss. Trivalent chromium, the form found in foods and dietary Supplements, is considered one of the least toxic nutrients, but adverse effects could include headaches, sleep disturbances, mood changes, and changes in cognitive, motor, and perceptual processes. QUESTIONABLE, USE WITH CAUTION

Citrin is the trademark name for the herbal extract from the fruit of the Garcinia cambogia plant. It is purported to inhibit the synthesis of lipids, leading to weight loss and reduced body fat. However, in a randomized controlled trial done by Heymsfield and associates,12 subjects given 3000 mg of G cambogia per day (50ydroxycitric acid) in three divided doses before meals failed to demonstrate significant loss of weight or fat mass. However, the number of adverse events was not significantly different between the placebo and treatment group. BENEFITS DOUBTFUL

Cola nut is derived from the seeds of evergreen trees from the various Cola species. It contains the active ingredients caffeine, theobromine, tannins, phlobaphene, and an anthocyanin. It stimulates the central nervous system and has been used to treat depression, headaches, and migraines. Because of its stimulatory effect, it is used in some over-the-counter remedies as an appetite suppressant. The recommended dosage is 2 g to 6 g of cola nut daily. Side effects include sleep disorders, over excitability, nervous restlessness, and gastric irritation. Cola nut is contraindicated in those suffering from gastric or duodenal ulcers, high blood pressure, or palpitations. No data were found to support the use of cola nut for weight reduction. NOT RECOMMENDED FOR WEIGHT LOSS

Guarana is derived from the seeds of Paullinia cupana. It contains the chief alkaloid caffeine in addition to small amounts of theophylline and theobromine. It also contains tannins, cyanolipides, saponins, starch, and proteins. Guarana has a stimulating effect with a positive inotropic and positive chronotropic effect on the heart. It relaxes the vascular muscles (with the exception of the cerebral vessels) and the bronchial tube. Because of the presence of caffeine, guarana has a stimulatory effect and works as a mild diuretic, increases gastric secretion, increases the release of catecholamines, and has been observed to inhibit platelet aggregation. It is used in many commercial products as an appetite suppressant. Quantities corresponding to 400 mg of caffeine (7 g to 11 g of drug), spread out during the day, were not found to be harmful in healthy adults habituated to caffeine. No clinical data were found with regard to the use of guarana as a weight loss aid. QUESTIONABLE

Spirulina is a microalgae. It is very nutrient dense, containing 3-linolenic acid, linoleic and arachidonic acids, vitamin B12, iron, protein, essential amino acids, nucleic acids RNA and DNA, chlorophyll, and phycocyanin. Spirulina allegedly aids in protecting the immune system, reducing cholesterol, and in enhancing mineral absorption. It has been suggested that spirulina also causes appetite suppression, and it may be beneficial in stabilizing blood sugar levels in those with hypoglycemia. Supplement should be taken between meals as directed on the manufacturer's label. No clinical data were found to support its usefulness with weight reduction. UNKNOWN BENEFIT

Glucomannan is a dietary fiber obtained from the tubers of Amorphophallus konjac. Studies have shown that a high-fiber diet with glucomannan as a supplement has beneficial effects on serum lipid and glucose levels. Glucomannan is also thought to suppress appetite as it expands to 60 times its own weight when ingested. However, no evidence was found that this product helps with weight reduction. Caution: Sufficient fluid consumption is needed when taking glucomannan in the capsule or pill form; capsules can lodge in the throat and expand, causing respiratory distress. UNKNOWN BENEFIT

Psyllium is derived from the seeds of Plantago isphagula, a source of dietary fiber. It is most often used for chronic constipation, diarrhea, and irritable bowel syndrome. Psyllium may also help reduce serum cholesterol levels and reduce postprandial hyperglycemia. It is thought to help with weight loss by producing a sense of satiety, but there was no evidence found regarding the usefulness of this product for weight reduction. The recommended dose is 12 g/d to 40 g/d. Sufficient fluids must be taken with psyllium. It is contraindicated in those with narrowing in the gastrointestinal tract, bowel obstruction, or difficulty in regulating diabetes mellitus. Psyllium may also delay the absorption of other medications. QUESTIONABLE

Fennel seed is derived from Foeniculum vulgare. The active compounds are transanethole, fenchon, and estragole. Fennel seed promotes gastric motility and, in higher concentrations, acts as an antispasmodic. It has also been used to treat cough and bronchitis. Like the other dietary fibers, it is thought to help with weight loss by producing a sense of fullness, but there is no clinical evidence to support this hypothesis. The recommended daily dosage of fennel seed is 5 g/d to 7 g/d. Fennel seeds can be crushed or ground for teas or other tea-like products. No health risks or adverse events have been reported with administration of the recommended dosage. QUESTIONABLE

Chitosan, promoted as an oral remedy to reduce fat absorption, is currently being used in many over-the-counter weight loss supplements. It is a cationic poly-saccharide derived from the exoskeleton of various arthropods and crustacea including insects, crabs, and shrimp. Chitosan behaves as a weak anion exchange resin with viscosity properties similar to certain dietary fibers. This agent does appear to depress intestinal absorption of lipids with potency equivalent to cholestyramine, arousing interest in the potential use of Chitosan as a hypolipidemic agent. Several studies have suggested that supplementation with oral chitosan might help to reduce body weight when given in addition to a hypocaloric diet for 4 weeks. However, using a randomized, placebo-controlled, double-blind trial with 34 overweight volunteers, Pittler and colleagues found that without dietary alteration, chitosan, in its recommended dosage of 2 g/d to 3 g/d, did not reduce body weight in overweight subjects. There were no serious adverse effects of chitosan reported. The effectiveness of chitosan as an anti-obesity agent remains controversial. QUESTIONABLE

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Hypnosis is defined as the induction of a passive, trance-like state that resembles normal sleep. In this state, perception and memory are altered, which results in increased responsiveness to suggestion.

The condition is induced by the monotonous repetition of words and gestures while the subject is completely relaxed. The American Medical Association and other medical associations have formally recognized hypnosis as a viable medical treatment for certain conditions. Scientific literature on hypnosis spans the past 100 years; in fact, each year there are about 150 articles on hypnosis in mainstream medical and scientific journals. However, exaggerated claims by lay hypnotists have obscured the technique's proven benefits. Hypnosis for the management of diet was first reported in 1847 when Dr J. W. Robbins used aversive suggestions, such as ""you will be nauseated after taking a small quantity of tea ". Although popular lay literature may report the effectiveness of hypnosis for weight loss, the research literature is sparse. In 1996, Kirsch performed a third meta-analysis of six studies from 1980 to 1989 using hypnotic therapy. He compared cognitive-behavioral weight reduction treatments with and without the enhancement of hypnosis. Kirsch reported a mean weight loss of 6.03 pounds (2.74 kg) without hypnosis and 14.88 pounds with hypnosis. Hypnosis provided an increase in treatment efficacy of 147126703700ver the conventional methods.
Johnson and Karkut described the methods used during hypnosis for weight loss. After the use of standard relaxation techniques, the patient is given direct suggestion regarding the negative effects of consuming problem foods or excessive amounts of food and drinks. Positive suggestions were given regarding personal attractiveness, health, self-esteem, confidence, control, and weight loss goals. During the second treatment, the patients were taught self-hypnosis. They were encouraged to use it often, especially before meals and whenever around food and drink.

Overt aversive techniques also can be used. Overt aversive techniques used in weight loss studies have ranged from subjects holding their breath, breathing cigarette smoke, snapping a rubber band, reading a ""fat" sheet, responding to electric shock, or noxious odors. Johnson and Karkut had patients bring five of their desired foods to the session, which were then soaked in white vinegar and mouthwash. Subjects placed a spoonful of food, or a sip of drink, on the tongue and were told to shout to themselves mentally, ""Make it horrible. Make it disgusting. See it turn into fat!" They sampled each food at least three times. The clinician then suggested disgusting images from the subjects' aversion history . Subjects were shocked 7 to 11 times while listening to the aversive imagery. After each trial, the subjects were shocked and directed to expel the sample into the wastebasket. Johnson and Karkut also studied 172 adult overweight women who were assigned to either hypnosis only or overt aversion and hypnosis treatment protocol. In addition, they were instructed on a 1200- to 1500-calorie low-fat diet. Both groups lost a significant amount of weight ( 11.1 pounds), although there was not a significant difference between the groups. The lack of randomization, control group, experimental, and comparative studies makes any conclusions tentative.

In summary, the Better Business Bureau describes the use of hypnosis this way: "excellent for many uses, BUT OF NO USE IN WEIGHT CONTROL." There are no known medical risks with hypnotherapy, except that highly suggestible people might absorb false information. BENEFITS DOUBTFUL

Acupuncture
USE WITH CAUTION, UNDER THE SUPERVISION OF A CERTIFIED ACUPUNCTURIST

Millions of Americans have chosen acupuncture either in addition or as an alternative to conventional medical treatment. The NIH Consensus Development Panel on Acupuncture has found that sufficient evidence of acupuncture's value exists to expand its use into conventional medicine. Acupuncture assumes that disease is the result of disruptions in the patterns of energy flow coursing through the human body .

Acupuncture at designated points close to the skin corrects these disruptions and restores health. The most well known form of acupuncture involves penetration of the skin by thin, solid, metallic needles to stimulate the acupuncture points. Studies have confirmed that acupuncture stimulates the release of opioid peptides, whereas administration of opioid antagonists reverses this effect. This link partially explains the treatment's analgesic effect.

The use of auricular acupuncture for weight loss is based on the theory that stimulation of certain parts of the ear can reduce appetite by activating the satiety center within the hypothalamus or control stress and depression via endorphin and dopamine production. Richards and Marley reported significant mean weight loss in Australian patients using the AcuSlim product in their double-blind, randomized study .

Sixty overweight patients were randomly assigned to an active treatment or a control group. The active treatment group attached the AcuSlim to specific acupuncture points on the ear. The control group attached the device to the thumb, where there are no acupuncture points. The device noninvasively delivered transcutaneaous electric nerve stimulation. In the active treatment group, 95reported appetite suppression, 93126703700st weight, and as a group, lost significantly more weight (mean, 2.98 kg). Allison and colleagues studied 96 adults at the New York Obesity Research Center. A randomized, placebo-controlled trial studied the efficacy of an auricular acupressure device. Although the device appeared to be safe, it did not promote significantly greater weight loss. Although scientific evidence may support the use of acupuncture for pain and nausea, its use for weight loss is not substantiated. However, the NIH notes that an advantage of acupuncture is that the incidence of adverse effects is substantially lower than that of many medications. Since 1965, there have been only 10 cases of organs damaged by needle sticks. The risk of infection from poorly sterilized needles has been reported and can be reduced by the use of disposable needles. According to the NIH, acupuncture may have a role in the treatment of addictions, along with a comprehensive management program. Addiction to and abuse of food may be a cause of obesity , and perhaps acupuncture may be a viable treatment for certain patients. USE WITH CAUTION, UNDER THE SUPERVISION OF A CERTIFIED ACUPUNCTURIST

Retail costs listed on this page are for comparison purposes only. Discounted prices available on most products.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

The information presented on these pages is based on scientifically based research and current medical knowledge. Many of the supplements mentioned on these pages have been used to treat diseases for hundreds or thousands of years. The medical community is just beginning to research natural treatments. As new information develops, the information on these pages will be updated. Whenever possible, several sources for each supplement will be listed. The manufacturers mentioned within, have presented evidence that they have independent studies demonstrating standardization of potency, purity, and activity for that product. Some of the products presented are processed by Pharmanex.

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