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What do Natural Weight Loss Aids and Diet Pills Really Offer?



Ephedra Alternative

The natural weight loss aid ephedra worked weight-loss wonders for thousands, helping them control their appetites and drop pounds easily. That's what we heard in testimonials, at least.

Of course, we only heard those testimonials from the survivors. So many people died in connection with their ephedra and diet pill use that the substance, derived from the ma huang plant, was banned from U.S. markets in 2004.

It didn't take long for supplement manufacturers to rush to market with more natural weight loss alternatives to the banned substance. But like ephedra supplements, few if any of these natural weight loss replacements had been subjected to any kind of legitimate clinical testing to determine their safety or effectiveness. Yet manufacturers make the same grand claims, complete with similarly delighted testimonials. The packaging has changed to reflect the new formulas, but not much else has.

So patients sometimes come in asking about bitter orange and other so-called thermogenic enhancers. They see advertisements for supplements with savvy product branding like Metabolife and Xenadrine, names that sound vaguely healthy or medical, and they want to know if there's any validity to the claim that these thermogenics will increase their metabolism and help them lose weight.

The answer is that there is still no reliable evidence for their effectiveness, but there have been studies that show that the most popular of these, an herb called bitter orange, will cause some of the same effects as ephedra, though they probably aren't the effects consumers are looking for. Bitter orange can cause increases in both blood pressure and heart rate.

So, for some people, that means taking any such supplement could be taking their life in their hands.

What's in there?

Bitter orange contains synephrine, a substance related to ephedrine, the active ingredient in ephedra. At the molecular level, synephrine is structurally similar to the epinephrine our bodies produce when we're having an "adrenalin rush." Bitter orange contains one to six percent synephrine. Most products containing bitter orange provide between 10 to 40 mg. of synephrine per dose.

Another common replacement for ephedra has been extracts of country mallow, which is also known as heartleaf. It contains about one to two percent synephrine. But some extracts boost this amount to six to ten percent or more. Most products containing country mallow provide between 10 to 30 mg. synephrine per dose.

Most weight-loss supplements that include these ingredients also include caffeine, which can amplify the stimulant effects of synephrine.

The study that found bitter orange to have similar effects to the banned ephedra tested both bitter orange on its own, and in combination with caffeine. The subjects were all tested on both supplements, as well as a placebo, after overnight stays in the hospital and a supervised fast. Their heart rate and blood pressure were tested at baseline and again one, two and six hours after taking the supplements or placebo. They were also asked to give their own subjective scores of factors like feeling lethargic or nauseated, and sweating, flushing and experiencing heart pounding.

Double-blind, triple cross-over results

What the research showed was that the bitter orange on its own didn't raise blood pressure significantly, but in combination with the caffeine, it did cause a marked increase.

Heart rate, on the other hand, was significantly raised by both the bitter orange alone and the bitter orange/caffeine combo. The participants also subjectively rated themselves as feeling less lethargic on the combination product at two hours out than they did on the bitter orange alone, but no other subjective differences were noted.

Obviously, anyone who has difficulty with heart disease or high blood pressure would want to avoid the use of these supplements. But it's really not enough to say that. Overweight people-the folks who typically buy weight-loss supplements-very often have health problems they are not even aware of.

This research was conducted with only healthy subjects as participants. The actual likely consumers of these compounds could be expected to be at higher risk for having poor reactions to these supplements.

That was sometimes the case with ephedra, when it was still available. Someone would die after using an ephedra supplement, and an autopsy would later show they were already medically compromised in a way they didn't even know about.

Since ephedra was banned, marketers crow about their products not having ephedra just as much as they promoted its inclusion, prior to the ban. "Dexatrim Natural-Ephedrine Free Formula" contains the synephrine of bitter orange instead of the ephedrine that was previously used in Dexatrim Natural with ephedra.

But for practical purposes, in terms of health effects, there is little difference. And touting the ephedrine-free angle this way is like a food manufacturer claiming a treat is sugar-free just because it's been sweetened with corn syrup instead of cane sugar. Consumers have to see through the smoke screens.

Unnatural, and maybe unhealthy

Finally, if you want to lose weight totally "naturally," that would mean simply eating better, exercising more and not taking any pill at all.

There's nothing natural about consuming a substance that artificially raises your heart rate and blood pressure, makes you feel hyper and jittery, and suppresses your appetite by making you feel sick to your stomach.

And sure, many prescription drugs can cause those same side effects in some people. Whether the substance is compounded from various chemicals in a pharmaceutical lab or ground up from various plants in a foreign factory, the fact is that you're consuming something that will affect the way your body usually functions.

The chief difference is that if you go online or even to a store and buy a supplement in response to some ad, no one is looking out for you, or even looking at you. There's no one between you and those potentially dangerous side effects. You won't get an exam to find out if your body is hiding a secret that could blow up dangerously when mixed with that supplement.

And while I believe they can be helpful for some patients, I'm not necessarily a huge proponent of prescription weight-loss medications either. After the debacle with the weight-loss drug Phen-Fen, and the various high-profile recalls of other approved medications like Vioxx, we know there are problems with pharmaceutical products and procedures, too.

But there is no denying that the oversight and safeguards in the regulated pharmaceutical industry, fallible as they may be, are vastly superior to having no safeguards at all. Dietary supplements are subject to less regulation than tire-pressure gauges.

I have found again and again that with the appropriate education and guidance, and the right dietary schedule and composition, people are able to lose weight without any prescription at all, and without the risks-or the agonizing cravings most drugs and supplements are designed to combat in the first place.  

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