Home Health Diet Supplements: How Safe are They?

Diet Supplements: How Safe are They?


Text by Henrylito D. Tacio

Photo: US National Institute on Aging

A new enemy has emerged – and it is our appetites. With fast foods proliferating and “eat all you can” restaurants thriving here and there, gluttony has become a way of life, instead of an exception.

This must be the reason why obesity – the condition of a person having excessive weight for his/her height, build, and age – is no longer identified as a problem in industrialized nations but in developing countries as well.

And that includes the Philippines. In fact, a few years back, the Philippines was ranked third as having the “fattest people” in Asia – after Malaysia and Singapore. At that time, about 500,000 Filipinos were classified as obese.

For most people, the condition of being overweight is easy to recognize. But medically, a distinction is made between being overweight and being obese. The body mass index (BMI) is used to define these conditions. BMI is the weight (in kilograms) divided by height (in meters squared). Overweight is defined as a BMI of 25 to 29.9, and obesity is defined as a BMI of 30 or more.

“Body composition – the percentage of fat and muscle in the body – is also considered when obesity is defined,” says the Merck manual. “Women who have more than 30 percent body fat or men who have more than 25 percent body fat are considered obese.”

It was the Greeks who first recognized obesity as a medical disorder. Hippocrates wrote: “Corpulence is not only a disease itself, but the harbinger of others.” The Indian surgeon Sushruta (6th century BCE) related obesity to diabetes and heart disorders.

These days, obesity is now more of a life and death issue rather than just simply looking “bad.” As Dr. Nick Finer, an American endocrinologist, puts it: “Obesity must be considered as an important medical issue. A catalogue of diseases are caused and exacerbated by obesity.”

“Obesity results from consuming more calories than the body uses,” points out The Merck Manual of Medical Information. This simply means that if you consume more calories than your body can burn, you will gain weight.

The tricky part of the equation is that some people metabolize food differently from others. Why this happens is complex and not entirely clear to researchers, who continue to be surprised by each new finding. For instance, one recent study concluded that heavy people actually burn calories faster than underweight people because their metabolism speeds up as they put on pounds and slows if they try to take them off.

“For obese people, the average-sized meal really isn’t filling,” says The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. “Not only do these people have more fat cells sending out signals for food, but their faster metabolism burns more calories as well.”

According to the Philippine Obesity Control Surgery Team, obese people are at a much higher risk of developing type 2 diabetes (which is a result of a high blood sugar level). Also, obesity can triple the risk of heart disease. One-third of all deaths globally — about 17 million — are blamed on heart disease, stroke, and related cardiovascular problems.

“Certain cancers – of the breast, uterus, and ovaries in women and of the colon, rectum, and prostate in men – are more common among people who are obese than among those who are not,” the Merck manual reminds. “Menstrual disorders, osteoarthritis, gout, and gallbladder disease are also more common.”

Lack of sleep used to be seen as a disorder brought about by stress and environmental factors, but recent studies have shown that sleeping disorders like sleep apnea can also be caused by obesity. Sleep deprivation can lead one person to have a low energy level which deters them from doing physical activities during the day and ultimately gain more weight. This cycle traps an obese person even more.

There are several ways of losing weight. But some people want shortcuts and instant results. “This is why a lot of diet pills and weight loss supplements have become popular — they promise weight loss with minimum effort,” noted Dr. Karla Silverio-Fernando, an endocrinologist at the St. Luke’s Medical Center Global City, Manila Doctors Hospital, and Paranaque Doctors Hospital. “They also claim to have no side effects since most of them are ‘natural.’”

But don’t believe so much in those marketing promises, she warns. In an article she wrote for Health and Lifestyle, a magazine for health professionals, she looked at some of the common weight loss supplements available in the market today and provided some insights to separate myths from facts.

L-carnitine: Incorporated even in some drinks, it is being promoted for weight loss as the molecule “allows the cells to break down far and get energy from the stored fat reserves.” Studies show that it “does not seem to have a significant effect.” Side effects: some people who take L-carnitine may experience nausea or diarrhea.

Chromium: This essential trace element is often seen as part of supplements being promoted to help diabetes. “Some say that taking chromium picolinate for two to three months may also produce a small weight loss of about 1.1 kg, but most clinical studies show no significant effect,” Dr. Silverio-Fernando wrote.

Uncommon adverse effects of chromium include headache, insomnia, irritability, mood changes, and cognitive dysfunction.

Fiber: Fiber helps a person lose weight by making him feel full. “Although taking an appropriate amount of fiber can be good for you, taking too much can cause constipation and even gastrointestinal obstruction,” Dr. Silverio-Fernando noted.

Conjugated linoleic acid: This occurs naturally in small amounts in dairy products and red meat. It was proposed to be beneficial for obesity, diabetes, and cholesterol problems. “Based on the available data, the use of conjugated linoleic acid for the management of obesity or diabetes is not recommended,” the lady doctor reminded.

Green tea extract: Can decrease appetite while increasing calorie and fat metabolism. But “current evidence to support this is still lacking,” Dr. Silverio-Fernando pointed out. Adverse effects include dizziness, insomnia, agitation, nausea, vomiting, bloatedness, and diarrhea.

Meal replacements: These are sold in most pharmacies and health stores in the form of bars and shakes. “Several studies have shown equivalent or greater weight loss with structured meal replacement plans compared to low-calorie diet treatments,” Dr. Silverio-Fernando said.

As a successful weight loss and weight maintenance strategy, the American Dietetic Association recommends substituting one or two daily meals or snacks.

Bangkok pills: These pills contain bisacodyl (a laxative), furosemide (a diuretic), phentermine (raises levels of the hormone leptin, causing appetite suppression), and fenfluramine (an appetite suppressant that acts by increasing the blood levels of serotonin and catecholamine).

Adverse effects include increased heart rate, palpitation, irregular heart rhythm, chest pain, tremors, anxiety, insomnia, fatigue, drowsiness, dehydration, nausea, vomiting, seizures, stroke, or even death. In the United States, Bangkok pills have been banned since 1997.

Emagrece sim and Herbathin: These two supplements from Brazil have gained popularity, especially in the United States. However, these two “have been shown to contain prescription drugs such as Chlordiazepoxide (anti-anxiety), Fluoxetine (anti-depressant), and Fenproporex (a stimulant that is converted in the body to amphetamine, the family of shabu),” Dr. Silverio-Fernando reported.

Dr. Silverio-Fernando cautioned consumers to think twice before taking weight loss supplements.

“Most aren’t supported by good scientific evidence, and some may even be dangerous,” she cautioned. “Dietary supplements aren’t subject to the same rigorous standards as are prescription drugs. They can therefore be sold with limited proof of effectiveness or safety.”

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