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AIII-Natural Health Products > L13-Weight Management > Flashcards

L13-Weight Management Flashcards

1
Q

BMI.
Describe.
List categories.

A

-Most common tool to determine weight status
-Categories of BMI:
1. under weight <18.5
2. normal 18.5-24.9
3. overweight 25-29.9
4 obesity >30

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2
Q

BMI.

Who can it not used for?

A
  • it applies to ages 20-65 (not outside)

- does not apply to infants, children, adolescents, preg, BF

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3
Q

How to reduce weight?

A
  • NRG intake < NRG expenditure
  • safe weight loss <2 lbs/wk
  • aerobic exercise 45 min= reducing cal intake by 40 kcal
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4
Q

Describe Brazil Food Guide.

A
  • golden rule: always prefer natural or minimimally processed foods and freshly made dishes and meals to ultra processed foods
  • want to use oils, fats, salt and sugar in small amounts; limit processed foods
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5
Q

over _____ CNDs try to lose weight via _____

A

1/4, dieting

F>M

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6
Q

Trade settlement w weight loss settlement in 2007.

WHAT IS IT?

A

they were making claims of effectiveness wo reliable scientific evidence

> since then: weight loss industry has tried to make some changes, but they have not been very successful (at least there are more studies being done)
-note: they can no longer claim HOW much weight loss a pill has (BUT they still make claims like mirable use, easy way to lose weight, sold out fast-> ppl see these claims and then beleive it!

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7
Q

OTC Products.
Are they recommended?
List some effects.

A

NO!

  • increase nrg expenditure
  • modulate CHO metab
  • incrase satiety
  • increase fat ox or reduce fat synthesis
  • block dietary fat absorption
  • increase water eliminaiton
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8
Q

OTC Products.

List types.

A
  1. Fat burners
  2. CHO burners
  3. Fat blockers
  4. Appetite sups
  5. Lose water
  6. Metabolism booster
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9
Q

FAT BURNERS:

claim, evidence, risks, examples

A
  • Claim: “Melt away fat” and increase muscle
  • Evidence: Insufficient
  • Risks: some products are not authorized for use
  • Examples: Conjugated linoleic acid, Vitamin B5
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10
Q

CHO BURNERS

claim, evidence, risks, examples

A

Claim: burns carbs
Evidence: lacking
Risks: potentially serious
Examples: chromium, ginseng

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11
Q

FAT BLOCKER

claim, evidence, risks, examples

A
  • Claim: absorption of fat decreased
  • Evidence: Weak, wnt work unless low calorie diet
  • Risk: some agents induce diarrhea and block vitamin absorption. AR risk for chitosan because contains shellfish
  • Examples: Chitosan, Hydroxycitric Acid*
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12
Q

APPETITE SUPPS

claim, evidence, risks, examples

A
  • Claim: feel full, so eat less
  • Evidence: Few studies done
  • Risk: unknown due to lack of studies
  • Examples: Guar gum, psyllium, hoodia gordonii, glucomannan
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13
Q

LOSE WATER

claim, evidence, risks, examples

A

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

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14
Q

METAB BOOSTER

claim, evidence, risks, examples

A

• Claim: burn more calories and fat
• Evidence: may help use more energy
• Risk: SIGNIFICANT as will increase hr and bp
• Examples: ephedra, bitter orange, DMAA, caffeine, green coffee, 7-Keto- DHEA, catechin, capsaicin, raspberry ketones
-> these are known as the thermogenic agents

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15
Q

METAB BOOSTER
Describe Ephedra.
____ is where the active compound is.

A
  • shrub native to china and mongolia
  • bitter orange and country mallow contain related chemicals
  • active cmpds in stem
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16
Q

METAB BOOSTER
Ephedra.
List some phenylalanine derived alkaloids.

A
  • Ephedrine
  • Pseudoephedrine
  • Phenylpropanolamine (norephedrine)
  • Cathine (norpseudoephedrine)
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17
Q

METAB BOOSTER

Ephedra results in wight loss because the muscles are burning more cals. Describe the specific effects on the body.

A
  1. alpha and beta aognist
    - alpha: PVR increases, bp increases; receptors on smooth muscle cells in bladder to increase resistance to outflow of urine
    - beta: stimuate rate and force of contraction; promotes bronchodilation in lung
  2. CNS stim
    - enhances release of NE from sympathetic neurons
    - act as anorectic by acting on satiety center
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18
Q

METAB BOOSTER
Ephedra - efficacious?
Recommend?

A

there were very slight benefits from (couple pounds/ month) BUT severe AE

  • linked to serious AE (heart attack, arrythm, stroke, psychosis, seizure, death)
  • HC recalled all products marketed for weight loss w ephedra (only allowed for nasal decongestant)
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19
Q

METAB BOOSTER

Ephedra - list SE.

A
  • Hypertension
  • Cardiac arrhythmias
  • Insomnia
  • Tachyphylaxis (acute, sudden decrease in response to drug after its admission)
  • Anxiety and changes in mood
  • N/V

there were very slight benefits from (couple pounds/ month) BUT severe AE

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20
Q

METAB BOOSTER - Caffeine.

Describe.

A
  • alkaloid
  • occurs naturally in leaves, seeds and fruit of tea, coffee, cacae, kola trees, ect
  • Botanicals: guarana, yerba mate, kola nut, and green tea extract
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21
Q

METAB BOOSTER - Caffeine.
Described as “thermogenic”, what does that mean?
MOA?

A
  • inhibits degradation of cAMP thereby stims lipolysis by stimulating lipase;
  • antagonizing the neg modulatory effect of adenosine on increased noradrenalin release
  • reduced food intake after caffeine intake
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22
Q

METAB BOOSTER - Caffeine & Ephedra.

Safety?

A
  • ephedrine serious health risks (not recommended whether w or wo caffeine bc risks»> benefits)
  • caffeine probably safe but shows no long term efficacy
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23
Q

METAB BOOSTER - Caffeine.

Recommend?

A

NAH - safe but not LT efficacy.

-admin (3x200mg/d) for 24wks w nrg restricted diet showed no greater weight loss than placebo

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24
Q

METAB BOOSTER - Dimethylamylamine (DMAA).
T/F: HC has authorized use it for use.
Sources?
Recommend?

A

FALSE!

  • no good trials done (too short/small) but no benefits found
  • found in weight loss and pre-workout supps
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25
Q

METAB BOOSTER - Dimethylamylamine.
Safety?
AE?

A

-not allowed to be sold in canada
-potential AE:
>HTN, SOB, chest pain, stroke, psych disorders
-1 product containing DMAA linked to serious AE (csv, metabolic, NS, psych); acute hep/liver failure

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26
Q

METAB BOOSTER - Catechin.
Describe.
____ is the most abundant catechin in tea.

A

=green tea
• All types of tea (green, black, oolong) produced from Camellia sinensis plant using different methods.
• Epigallocatechin gallate (EGCG)

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27
Q

METAB BOOSTER - Catechin.

MOA?

A
  • thermogenic

- beleived to have role in increasing nrg metab, which may lead to weight loss

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28
Q

METAB BOOSTER - Catechin.

Safety?

A

SAFE IN MOD AMOUNTS

  • AE: insomnia, anxiety, irritability, upset stomach, n/d, freq urination; high doses increase bp, seizures, delirium or irregular heart rhythms
  • cases of hepatic failure/injury following consumption of green tea has been documented
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29
Q

METAB BOOSTER - Catechin.

DI?

A

Anticoags - makes them less effective b/c has Vit K

30
Q

METAB BOOSTER - Catechin.
Efficacy?
Recommend?

A

-causes small, statistically non-significant weight loss in overweight or obese adults
-no signift effect on the maintenance of weight loss.
-most adverse events were judged to be mild to moderate.
NO

31
Q

METAB BOOSTER - GREEN COFFEE.
AI?
Effect?

A

chlorogenic acid (from raw coffee beans before they are roasted)

Thought to:
1. help control glucose metabolism
>May decrease glucose conc & absorption in intestines after a meal
2. inhibit fat accumulation and alter and body fat distribution

32
Q

METAB BOOSTER - GREEN COFFEE.

AE?

A

-well tolerated w no signif se

some produts are decaf, others have caffeine

33
Q

METAB BOOSTER - Capsaicin.
Source?
MOA?

A

Red hot peppers

  • Thought:
    1. if you eat spicy foods you will eat smaller portions
    2. dose dependently enhancing catecholamine secretion from the adrenal medulla
  • likely based on beta-adrenergic stim
34
Q

METAB BOOSTER - Capsaicin.

AE

A

minor:

  • skin inflam
  • contact derm
  • skin blister
35
Q

METAB BOOSTER - Capsaicin.

Efficacy.

A

Human studies
• Short and long term fat oxidation
• Energy expenditure increases nearly 25% after meal including capsaicin (as chili)
• Satiety appears to be affected as well
• Effects are more pronounced with a high fat meal
• One long-term study: no improvement in weight maintenance or suppressed fat gain

36
Q

METAB BOOSTER - Raspberry ketones.

Describe.

A
  • compound that gives raspberries their odor

- structurally similar to capsaicin

37
Q

METAB BOOSTER - Raspberry ketones.
Claims to burn fat all over body - how?
(Based on shitty studies)

A
  • Increased production of adiponectin (hormone that is secreted by fat cells; said to regulate insulin sensitivity))
  • may inhibit fructose-associated accumulation and inhibition of fat absorption through reduction of pancreatic lipase activity
38
Q

METAB BOOSTER - Raspberry ketones.

AE.

A

-Antiandrogenic effect
high adiponectin levels associated w low bone density
-pt may need higher warfarin for maintainence of therapeutic INR
-reports of palps

39
Q

? - Forskolin.
Describe.
MOA?

A
  • part of the mint family
  • theorized MOA: activate cAMP –> triggers lipase resulting in release of fa from adipose tissue (but lack of evidence and conflicting results)
40
Q

? - Forskolin.

AE

A

-signif ae BUT
>tachycardia and arrhytm been reported
-avoid in pts w polycystic kidney disease
-IV formulation can cause flushing and hypotension

41
Q

? - Forskolin.

DIs

A 
Major: (Avoid combining with) 
• Calcium channel blockers
• Nitrates
Moderate: (Caution with combining) 
• Anticoagulants/antiplatelets
• Antihypertensives
• CYP P450 2C9 substrates
42
Q

CHO metabolism - CHROMIUM.

Which one is trivalent? Hexavalent?

A

Essential mineral
• Trivalent (chromium 3+)= is biologically active, in food
• Hexavalent (chromium 6+)= toxic, from industrial pollution
• Often as chromium picolinate

43
Q

CHO metabolism - CHROMIUM.

MOA?

A
  • Enhances action of insulin

- Involvement in CHO, fat and pro metab

44
Q

CHO metabolism - CHROMIUM.

Efficacy?

A
  • No effect in enhancing body fat reduction found

- statistically signif neg evidence (ie lack of evidence of benefit)

45
Q

CHO metabolism - CHROMIUM.

SE?

A
  • many supps are far over the adequate intake of 20-35mcg/d

- concerns of free radical damange; rhabdomyolysis; renal failure

46
Q

CHO metabolism - Ginseng.

Describe.

A
  • traditionally used to support overall health, boost IS

- also used for weight loss

47
Q

CHO metabolism - Ginseng.

Effect?

A
  1. Improving the health of people recovering from illness
  2. Increasing a sense of well-being and stamina, and improving both mental and physical performance
  3. Lowering blood glucose and controlling blood pressure
48
Q

CHO metabolism - Ginseng.

MOA?

A
  • Ginsenosides
  • CHOs are one of the main fuel sources for activity (stored in liver and skeletal muscle as glycogen)
  • Ginseng appears to mimic insulin
  • Improve glucose tolerance
  • Lowers blood glucose levels
  • Lack of evidence
49
Q

CHO metabolism - Ginseng.

SE?

A
  • ususally well tolerated but suggested to not be used for more than 3m
  • most common se: headache, GI, sleep
  • allergic reactions
  • caution in DM bc it mimics insulin
50
Q

APPETITE SUPPS - Psyllium

Describe

A
  • increase satiety
  • derived from seed husk of plantago psyllium, leafy plantain
  • e.g. found in Metamucil
  • soluble fiber
51
Q

APPETITE SUPPS - Psyllium

MOA

A
  • combines w water in stomach to form gel
  • provides sense of fullness
  • bulk-forming
52
Q

APPETITE SUPPS - Psyllium

Efficacy

A
  • most studies in obest show superiorty to diet alone; lowers chol
  • no effect on weight, just gives feeling of fullness
53
Q

APPETITE SUPPS - Psyllium

SE

A
  • Bloating
  • Allergy -> allergy from inhalation of powder
  • N/D/C (while it is a laxative, too much can cause constipation)
  • Dyspepsia
  • Flatulence
  • Abdominal Pain
54
Q

APPETITE SUPPS - Guar gum

Describe.

A
  • increase satiety

- several studies, but does not help w weight loss

55
Q

APPETITE SUPPS - Glucomannan

Describe.

A
  • increase satiety
  • fibrous polysacch from konjac plant
  • more research needed
56
Q

APPETITE SUPPS - Hoodia

Describe.

A

-increase satiety
>appetite supp through P57, an oxypregnane steroidal glycoside
-NON-stimulating appetite suppressant

57
Q

APPETITE SUPPS - Hoodia

SE

A

allergy

58
Q

FAT BLOCKER- hydroyxcitic acid/ garcinia

Describe.

A
  • Increase fat oxidation or reduce fat synthesis
  • plant from india
  • efficacy: contradictory evidence
59
Q

FAT BLOCKER- hydroyxcitic acid/ garcinia

MOA.

A
  • increase hepatic glycogen synthesis, inhibiting lipogenesis, increased lipid oxidation
  • decreased food intake, decrease weight gain
60
Q

FAT BLOCKER- hydroyxcitic acid/ garcinia

SE

A
  • well tolerated

- headache, GI

61
Q

FAT BURNER - conjugated linoleic acid

Describe

A

-Increase fat oxidation or reduce fat synthesis, induce apoptosis of fat cells
• Mix of isomers of linoleic acid
• Marketed alone or in combo with triacyglycerol or FFA
• NS: mostly in beef and dairy

62
Q

FAT BURNER - conjugated linoleic acid

Efficacy

A

-seems to signif decrease body fat & might increase lean body mass
BUT doesnt seem to reduce total body weight or BMI
-seems to reduce hunger and improve satiety and feeling of fullness, but does not lower nrg intake or improved body weight maintenance

63
Q

FAT BURNER - conjugated linoleic acid

SE

A

-GI: nausea, dyspepsia, loose stools

64
Q

FAT BURNER - conjugated linoleic acid

caution if:

A

person already has HIGHER glc

-can increase hyperproinsulinemia & insulin resistance in pts w abdominal obesity

65
Q

FAT BLOCKER - Chitosan

Describe

A
  • block dietary fat absorption (binds to fats to reduce their absorption… similar to orlistat)
  • Deacetylated chitin- chitin is a polysaccharide found in the exoskeleton of shellfish (shrimp, lobster and/or crabs)
  • Cationic mucopolysaccharide of glucosamine and N-acetyglucosamine
66
Q

FAT BLOCKER - Chitosan

MOA

A
  • Plausible BUT probably ineffective at reasonable doses (in effective for weight loss)
  • May block fat soluble vits
67
Q

FAT BLOCKER - Chitosan

SE

A
  • safe, except for indivs allergic to shellfish

- constipation, flatulence

68
Q

LOSE WATER - Dandelion

Describe.

A

-increase water eliminiaton
-Tx: liver & kidney diseases & spleen problems
>root=hepatic stimulant; leaves=diuretic & choleretic action
>less common: digestive probs & skin conds
-Monitor for: minor digestive problems

69
Q

LOSE WATER - Dandelion

MOA?

A

Contains: potassium & theophylline
• Inhibits reabsorption of Na+ and increases glomerular filtration rate
• Only modest effects-> NOT comparable to an Rx diuretic

70
Q

LOSE WATER - Dandelion
Safety?
SE?

A
  • safe
  • SE: upset stomach/ diarrhea; some allergic (rare)
  • Avoid in: ppl w inflamed or infected gallbladder or blocked bile ducts
71
Q

the 7 gut check claims for products you are unsure of:

A

1) causes weight loss of 2lbs+/ wk for a month or more wo diet/exercise
2) causes substantial weght loss no matter what/how much you eat
3) causes permanent weight loss even after stpping product
4) blocks absorption of fat/cals to enable loss of substantial weight
5) safely enables consumers to lose more than 3+lb/wks for more than 4wks
6) causes substantial weight loss for all uses
7) causes substantial weight loss by wearing product on body or rubbing it in

AIII-Natural Health Products (19 decks)

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