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Take It Slow on the Seasonal Run for Supplements


From the minute those leftover Halloween candies hit the shelves, it's a non-stop onslaught of sweets, treats, desserts and indulgences. So a lot of consumers decide to call in reinforcements, and head for the supplement section of their drug or discount store to find them.

If you're going to use dietary supplements as a component of your weight-control effort, you need to know what you're up against. There are always new products appearing in the supplement market, so let's have a quick overview.

Thermogenic Agents

Thermogenic agents are so-called fat-burning drugs that increase energy expenditure. In the United States, there are no approved thermogenic medications for obesity, but that doesn't keep manufacturers of unregulated supplements from throwing the term around.

Hence, many of my patients come in asking about "natural" thermogenic enhancers. They see advertisements for supplements that offer "increased fat-burning" with enticing names that evoke healthy images: metabo- this and thermo-that.

But you don't want to be fooled by these fancy names and marketing ploys. These products are often wolves in sheep's clothing.

While the really dangerous products containing ephedrine--from the plants known as ma huang or ephedra -- were banned from the U.S. last year, many of the remaining products are simply sources of related compounds, such as synephrine. The fact that they're ephedra-free is often proudly emblazoned across the label.

This is not unlike a food manufacturer claiming a food product is sugar-free, because it's been sweetened with corn syrup instead of cane sugar. Consumers have to see through the smoke screens.

Like ephedrine, synephrine increases release of norephinephrine in the brain, which could decrease appetite. When mixed with caffeine, the combination can produce an slightly increased thermogenic effect, but it also increases heart rate and blood pressure, which led to so many of the tragic deaths and health crises caused by ephedra-based products.

Watch for products containing extracts of bitter orange or country mallow, which is also known as heartleaf, both related to the banned ephedra.

And remember that these "natural" products can interact with your prescription medications or other supplements in some surprising, even dangerous, ways. Always check with your doctor or pharmacist for interactions.

Digestion inhibitors

Some people are using supplements of psyllium and other fibers like barley and guar gum for weight loss. Like some pharmaceuticals, they can prevent fats from being absorbed.

But instead of inhibiting enzymatic breakdown of fats as drugs like Orlistat do, these fibers prevent absorption by binding to fats in the gut. This lets some portion of fats pass right through the body as harmless passengers on the fiber.

That's why increasing fiber intake decreases blood lipid levels. But there is a little evidence that these fibers alone actually help decrease weight in heavy patients. Guar gum has been studied the most, but on its own, it does not seem to be working for weight loss.

The best weight-loss or weight-control effect to be drawn from fiber comes from simply consuming more of your daily calories from dietary fiber sources.

If you're looking for that fat-blocking function, try eating almonds in moderation. They're high in fiber and good monounsaturated fatty acids, and while almonds are no miracle munchie, recent research shows that the cellular walls in almonds also have a lipase-blocking property, preventing some absorption of fats in the gut.

Other enticing promises

Some patients also ask me about trying dietary supplements that affect serotonin levels in the brain, in particular, St. John's wort and 5-HTP. With respect to the appetite suppressant effects of supplements that act on the serotonin function, St. John's wort has a long and solid history as an herbal anti-depressant.

It's true that St. John's wort can inhibit serotonin reuptake, and because of this, it is prescribed as an anti-depressant in some European countries. But there is no reliable evidence it helps reduce weight in obese patients, and it doesn't consistently produce weight loss in patients who take it for depression.

A huge number of other supplements are being tried for obesity. One of the hottest is conjugated linoleic acid (CLA). CLA refers to isomers of the fatty acid linoleic acid, which is primarily found in dairy products and beef. Researchers theorize that CLA might shrink adipose tissue by inducing apoptosis (programmed cell death) of fat cells.

There's preliminary evidence that three to four grams of CLA per day might reduce the proportional level of body fat mass, but not actual weight or body mass index. These findings are interesting, and I think it's too soon to put much store in them since these supplements are pretty expensive for this minor effect.

Chromium is being used to address obesity-related conditions like hyperlipidemia, diabetes, and obesity. The theory is that American diets are deficient in chromium, which can lead to diabetes, overweight and other metabolic abnormalities. There is some evidence that chromium can help reduce lipid and glucose levels in people with diabetes. But chromium doesn't seem to help for actual weight loss.

Garcinia cambogia fruit and rind extracts contain up to 50 percent hydroxycitric acid, which manufacturers claim inhibits the body's production of lipids. This ingredient appears in tons of supplements promoted for weight loss. But a study published in the Journal of the American Medical Association shows that it has no significant effect on weight. Don't bother.

Through Thick and Thin

When it comes to supplements, consumers need to carefully sort through the marketing blitz. A few supplements show some promise, but there's not enough evidence to recommend them. Especially try to avoid potentially dangerous products that contain country mallow, or bitter orange that provide ephedrine-like drugs.


Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center, her Naples, FL private practice, you can also get more information about Dr Cederquist and her weight management plan by visiting www.bistromd.com.

She is the author of Helping Your Overweight Child - A Family Guide, which is available at, DrCederquist.com and Amazon.com.


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last update: December 2010



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