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Natural Products > 13 - NP for Weight Loss > Flashcards

13 - NP for Weight Loss Flashcards

1
Q

Are any weight loss supplements effective?

A

NO WAY JOSE

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2
Q

Why do people turn to natural supplements for weight loss even if there is limited evidence?

A

easy, promised a quick fix

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3
Q

What is the most commonly used criteria to determine weight status?

A

BMI (kg/m2)

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4
Q

List the weights and BMI relationships

A

Underweight < 18.5
Normal 18.5 - 24.9
Overweight 25 - 29.9
Obesity > 30

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5
Q

What age is BMI indicated for?

A

20-65

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6
Q

Who is BMI not indicated for?

A

Does not apply to infants, children, adolescents, pregnancy, or breastfeeding

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7
Q

Simple concept for weight reduction

A

energy intake < energy expenditure

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8
Q

What is considered safe weight loss?

A

<2 lbs/week

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9
Q

Does HC actually promote any OTC products for weight loss?

A

NO - drugs or natural product therapy cannot replace lifestyle changes for effective, maintained weight loss

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10
Q

List 3 reasons why overweight patients seek dietary supplements for weight loss

A
  • Social stigma of obesity
  • Health benefits of weight loss
  • Less demanding than accepted lifestyle changes, such as exercise and diet
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11
Q

List the potential affects of supplements

A
  • Increase energy expenditure
  • Modulate carb metabolism
  • Increase satiety (fullness)
  • Increase fat oxidation or reduce fat synthesis
  • Block dietary fat absorption
  • Increase water elimination
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12
Q

Describe Fat Burners

A

Claim: “Melt away fat” and increase muscle
Evidence: insufficient
Risks: some products are not authorized for use

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13
Q

List examples of Fat Burners

A

conjugated linoleic acid, vitamin B5

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14
Q

Describe Carb Burners

A

Claim: burns carbs
Evidence: lacking
Risks: potentially serious

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15
Q

List examples of Carb Burners

A

chromium, ginseng

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16
Q

Describe Fat Blockers

A

Claim: absorption of fat decreased
Evidence: weak, will not work unless on a low calorie diet
Risk: some agents induce diarrhea and block vitamin absorption. Allergic reaction risk for chitosan, because contains shellfish

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17
Q

List examples of Fat Blockers

A

Chitosan, Hydroxycut (Hydrocitric Acid)

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18
Q

Describe appetite suppressants

A

Claim: feel full, so eat less
Evidence: few studies done
Risk: unknown due to lack of studies

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19
Q

List examples of appetite suppressants

A

guar gum
psyllium
hoodia gordonii
glucomannan

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20
Q

Describe NHP Diuretics

A

Claim: increased water elimination
Evidence: weak
Risks: dehydration, diarrhea, allergy

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21
Q

List an example of a NHP diuretic

A

dandelion

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22
Q

Describe metabolism boosters

A

Claim: burn more calories and fat
Evidence: may hep use more energy
Risk: SIGNIFICANT as will increase heart rate and blood pressure

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23
Q

List examples of metabolism boosters

A 
ephedra
bitter orange
DMAA
caffeine
green coffee
7-Keto-DHEA
catechin
capsaicin
raspberry ketones
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24
Q

Agents that increase energy expenditure are thought to ?

A

burn energy as you sit there

“thermogenic agents”

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25
Q

Mechanisms of ephedra

A

1) A and B adrenergic agonist

A adrenergic agonists cause:

  • Peripheral vascular resistance to increase and BP is elevated
  • Receptors on smooth muscle cells in the bladder to increase the resistance to outflow of urine

B adrenergic agonists cause:

  • Stimulate rate and force of cardiac contraction
  • Promotes bronchodilator in the lung

2) CNS Stimulant
3) Enhances release of NE from sympathetic neurons
4) Act as an anorectic by acting on the satiety centre - makes you think you are full

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26
Q

SE of Ephedra

A 
Hypertension
Cardiac arrhythmias
Insomnia
Tachyphylaxis
Anxiety and changes in mood
Nausea
Vomiting
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27
Q

Is ephedra effective?

A
  • Lots of studies with no conclusions

- Ephedrine is not licensed to be sold for weight loss, only as a decongestant

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28
Q

Ephedra has bene linked to many serious side effects such as ?

A
  • heart attack
  • arrhythmia
  • stroke
  • psychosis
  • seizures
  • death
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29
Q

Describe caffeine

A
  • stimulant
  • alkaloid
  • occurs naturally in the leaves, seeds and fruit of tea, coffee, cocoa, kola trees and more than 60 other plants
  • botanicals such as guarani, yerba mate, kola nut and green tea extract
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30
Q

List some mechanisms of caffeine

A
  • Thermogenic agent (thought to burn energy while you sit)
  • Inhibits phosphodiesterase-induced degradation of intracellular cyclic AMP (cAMP)
  • Stimulates lipolysis by stimulating lipase
  • Stimulates uncoupled respiration
  • Antagonizing the negative modulatory effect of adenosine on increased noradrenalin release
  • Reduced food intake after caffeine intake
31
Q

There is a HC warning against what combo of weight loss products ?

A

ephedra and caffeine

32
Q

Describe DMAA (dimethylamylamine)

A
  • HC has not authorized use
  • Found in weight loss and pre-workout supplements (body building and increasing athletic performance)
  • One small study suggested increased calorie expenditure and potentially lipolysis
  • No evidence long term
33
Q

Is DMAA safe?

A

No - lots of adverse effects:

  • High BP
  • SOB
  • chest pain
  • stroke
  • psychiatric disorders
34
Q

Mechanism of catechin in green tea?

A
  • Thermogenic agent
  • Believed to have a role in increasing energy metabolism, which may lead to weight loss
  • Said to increase a person’s energy output
35
Q

SE of green tea (from the caffeine)

A
  • insomnia, anxiety, irritability, upset stomach, nausea, diarrhea or frequent urination
  • green tea contains small amounts of vitamin K, which can make anticoagulant drugs, such as warfarin, less effective
36
Q

What is the active ingredient in green coffee?

A

chlorogenic acid from raw coffee beans before they are roasted

37
Q

MOA of green coffee

A

Thought to help control glucose metabolism

  • may decrease glucose concentration after a meal
  • may decrease glucose absorption in intestines

Also chlorogenic acid thought to inhibit fat accumulation and may alter adipokine levels and body fat distribution

38
Q

Adverse effects of green coffee

A
  • Appears well tolerated with no significant side effects reported
  • Some products decaffeinated, others may contain as much caffeine as regular coffee
  • Studies are preliminary and of poor quality, therefore too early to recommend
39
Q

_______ is a major pungent principle in red hot peppers

A

Capsaicin

40
Q

Mechanism of capsaicin ?

A
  • Dose dependently enhancing catecholamine secretion from the adrenal medulla
  • Likely based upon B-adrenergic stimulation
41
Q

SE of capsaicin ?

A
  • skin inflammation
  • contact dermatitis
  • skin blister
42
Q

Raspberry ketone is structurally similar to ?

A

capsaicin and synephrine (from citrus plants)

43
Q

What are the potential actions of raspberry ketones?

A

inhibits fat accumulation and inhibition of fat absorption

44
Q

Raspberry ketones may have a negative effect on what other disease ?

A

Osteoporosis:

May have a negative effect on bone by stimulating the RANKL pathway

45
Q

raspberry ketones can also decrease the effectiveness of _____

A

warfarin

46
Q

Forskolin is part of the _____ family

A

mint

47
Q

Proposed MOA of Forskolin

A

-Theorized to activate cAMP thereby triggering lipase resulting in a release of fatty acids from adipose tissue

48
Q

List some Drug interactions with Forskolin

A

Major:
CCB
Nitrates

Moderate (caution combo):
Anticoagulants
Antihypertensives
CYP P450 2C9 substrates

49
Q

Adverse effects with forskolin?

A
  • Significant adverse effect not found in tow small clinical trials
  • Tachycardia and arrhythmias have been reported
  • Avoid in patients with polycystic kidney disease
  • IV formulation: flushing and hypotension
50
Q

List 2 things that modulate carb metabolism

A
  • Chromium

- Ginseng

51
Q

Which forms of Chromium are active and toxic?

A

Trivalent - biologically active and found in food

Hexavalent - a toxic form that results from industrial pollution

52
Q

What is the mechanism of Chromium ?

A
  • Enhances the action of insulin, the so called “glucose tolerance factor”
  • Involvement in carb, fat, and protein metabolism
53
Q

Is Chromium effective for weight loss?

A

No LOL - none of these products are

54
Q

SE of Chromium ?

A

> 1000 mag daily can cause rhabdomyolysis and renal failure

55
Q

Mechanism of ginseng?

A
  • Ginsenosides
  • Carbs are one of the main fuel sources for activity
  • Stored in the liver and skeletal muscle as glycogen
  • Ginseng appears to mimic insulin
  • Improve glucose tolerance
  • Lowers blood glucose levels
  • Lack of evidence
56
Q

SE of ginseng

A
  • Usually well tolerated
  • Suggested that use be limited to 3 months
  • Most common SE are headaches, GI, and sleep
  • Caution in ppl with DM
57
Q

Which NHPs increase satiety?

A
  • Psyllium
  • Hoodia
  • Guar Gum
  • Glucomannan
58
Q

What is Pysllium

A

Soluble fibre

59
Q

Mechanism behind Psyllium and weight loss?

A
  • Combines with water in the stomach to form a gel

- Provides a sense of fullness

60
Q

SE of Psyllium

A 
Bloating
Allergy
Nausea
Dyspepsia
Flatulence
Abdominal Pain
Diarrhea
Constipation
61
Q

Which agents increase fat oxidation or reduce fat synthesis

A
  • Hydroxycitric acid or garcinia

- Conjugated linoleic acid

62
Q

Mechanism of hydroxycitric acid ?

A
  • Increase hepatic glycogen synthesis, inhibiting lipogenesis, increased lipid oxidation
  • Decrease food intake
  • Decrease weight gain
63
Q

SE of hydroxycitric acid?

A
  • well tolerated
  • headache
  • gastrointestinal complaints
64
Q

How do conjugated linoleic acid work?

A

promoted to induce apoptosis of fat cells

65
Q

SE of conjugated linoleic acid ?

A
  • Nausea
  • Dyspepsia
  • Loose stools
66
Q

What do isolated isomers increase?

A

hyperproinsulinemia and insulin resistance in patients with abdominal obesity

67
Q

MOA of Chitosan

A

block dietary fat absorption

“fat blocker”

68
Q

What does Chitosan affect since it’s a fat blocker?

A

Absorption of fat-soluble vitamins (ADEK)

69
Q

SE of Chitosan

A
  • Safe, except for individuals allergic to shellfish
  • Constipation
  • Flatulence
70
Q

What is Dandelion

A

NHP diuretic - increase water elimination

71
Q

MOA of Dandelion

A
  • Contains sesquiterpenes, such as eudesmanolides and germacranolides, as well as phenolic compounds
  • Contains potassium
  • Contains theophylline
  • Inhibits reabsorption of Na+ and increases glomerular filtration rate
  • Only modest effects
72
Q

SE of dandelion

A
  • Generally considered safe
  • Rare reports of upset stomach and diarrhea and some people are allergic to the plant
  • People with an inflamed or infected gallbladder or blocked bile ducts, should avoid using dandelion
  • Could cause similar effects as conventional diuretics (i.e. dehydration)
73
Q

What are the 7 Gut Check Claims ?

A

1) Causes weight loss of 2 lbs or more a week for a month or more without dieting or exercise
2) Causes substantial weight loss no matter what or how much the consumer eats
3) Causes permanent weight loss even after the consumer stops using product
4) Blocks absorption of fat or calories to enable consumers to lose substantial weight
5) Safety enables consumers to lose more than 3 lbs per week for more than 4 weeks
6) Causes substantial weight loss for all users
7) Causes substantial weight loss by wearing a product on the body or rubbing it into the skin

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