Imported Diet Pills Threaten Health and Jobs

Wed. Jan 28, 2009

Americans who use illegal diet pills from South America are taking amphetamines without knowing it and seriously risking both their health and their jobs.

Although the US Food and Drug Administration (FDA) has banned the majority of amphetamine-based appetite suppressants, many are still prescribed in other parts of the world, including South America. The second most often prescribed amphetamine-based appetite suppressant worldwide is fenproporex. It is known to be addictive and is rapidly converted into amphetamine in the body. The international availability of fenproporex, combined with Internet sales and other illegal markets, have led to its availability in the US, despite an FDA ban.

Dr Pieter Cohen from the Department of Internal Medicine at the Cambridge Health Alliance says that patients visit their doctors with a variety of unexplained symptoms and do not mention they are taking these illegal drugs. Physicians are being asked to treat conditions which are actually the side effects of  fenproporex and benzodiazepines, selective serotonin reuptake inhibitors, diuretics, laxatives, thyroid hormones and other substances found in these drugs.

To illustrate the risks posed by taking these diet pills, Dr Cohen reviewed two case reports of patients taking appetite suppressants containing fenproporex, illegally imported from Brazil. In the first case, a 26 year-old woman suffered from intermittent chest pains, palpitations, headaches and insomnia for two years. She consulted her doctor numerous times over the two-year period for these unexplained symptoms. Her urine tested positive for amphetamines and benzodiazepines, and both fenproporex and chlordiazepoxide were present in her pills. Her symptoms disappeared after she stopped taking the imported pills.

In the second case, a 38 year-old man tested positive for amphetamines after an occupational urine screening test and was suspended from work. Both fenproporex and fluoxetine were detected in his imported pills. While he was taking the pills he also experienced insomnia and palpitations, symptoms which disappeared after he stopped taking the pills. In both cases, not all the substances detected in the pills matched the ingredients on the vial labels.

SOURCE: Journal of General Internal Medicine

More Liver Fat Burned By Low-Carbohydrate Diet than Low-Calorie Diet

Tue. Jan 20, 2009

People on low-carbohydrate diets are more dependent on the oxidation of fat in the liver for energy than those on a low-calorie diet, say researchers at UT Southwestern Medical Center.

These findings could have implications for treating obesity and related diseases such as diabetes, insulin resistance and nonalcoholic fatty liver disease, said Dr. Jeffrey Browning, the study's lead author.  "Instead of looking at drugs to combat obesity and the diseases that stem from it, maybe optimizing diet can not only manage and treat these diseases, but also prevent them," said Dr. Browning.

Glucose, a form of sugar, and fat are both sources of energy that are metabolized in the liver and used as energy in the body. Glucose can be formed from lactate, amino acids or glycerol.  

"We saw a dramatic change in where and how the liver was producing glucose, depending on diet," said Dr. Browning.

Researchers found that participants on a low-carbohydrate diet produced more glucose from lactate or amino acids than those on a low-calorie diet.

"Understanding how the liver makes glucose under different dietary conditions may help us better regulate metabolic disorders with diet," Dr. Browning said.

The different diets produced other differences in glucose metabolism. For example, people on a low-calorie diet got about 40 percent of their glucose from glycogen, which comes from ingested carbohydrates and is stored in the liver until the body needs it.

The low-carbohydrate dieters, however, got only 20 percent of their glucose from glycogen. Instead of dipping into their reserve of glycogen, these subjects burned liver fat for energy.

The findings are significant because the accumulation of excess fat in the liver - primarily a form of fat called triglycerides - can result in nonalcoholic fatty liver disease, or NAFLD. The condition is the most common form of liver disease in Western countries, and its incidence is growing. Dr. Browning has previously shown that NAFLD may affect as many as one-third of U.S. adults. The disease is associated with metabolic disorders such as insulin resistance, diabetes and obesity, and it can lead to liver inflammation, cirrhosis and liver cancer.

"Energy production is expensive for the liver," Dr. Browning said. "It appears that for the people on a low-carbohydrate diet, in order to meet that expense, their livers have to burn excess fat."

Results indicate that patients on the low-carbohydrate diet increased fat burning throughout the entire body.

SOURCE: Hepatology

Leptin sensitivity restored by approved drugs

Wed. Jan 07, 2009

The discovery more than a decade ago of leptin, an appetite-suppressing hormone secreted by fat tissue, generated headlines and great hopes for an effective treatment for obesity. But hopes dimmed when it was found that obese people are unresponsive to leptin due to development of leptin resistance in the brain.

Until recently, efforts to find drugs that act as leptin sensitizers have also failed. Now, researchers at Children's Hospital Boston report that two FDA-approved drugs might restore leptin sensitivity, offering a novel treatment for obesity.

"Most importantly, our study is the first success in sensitizing obese mice on a high-fat diet to leptin," said Umut Ozcan of Harvard Medical School. "If it works in humans, it could treat obesity."

Recent studies show that a condition known as endoplasmic reticulum (ER) stress in peripheral organs plays an important role in obesity-induced insulin resistance and type 2 diabetes. Ozcan describes ERs as protein factories within cells. Within those cellular components, molecular chaperones, which serve as the factory workers, facilitate the folding and transport of proteins. When the chaperones can't keep up, it triggers a stress response known as the unfolded protein response (UPR).

Ozcan suspected that ER stress and the UPR response might also lead to leptin resistance in the brain's hypothalamus. The hypothalamus is the primary brain region that responds to leptin, sending a signal that curbs appetite. Mice engineered to have reduced ER capacity or increased ER stress throughout their bodies do gain more weight on a high-fat diet, according to earlier studies.

Ozcan now reports that obese mice manipulated to have increased ER stress only in the hypothalamus show less response to leptin. The animals are not only more leptin resistant, but they also grow significantly more obese on a high-fat diet.

The question then became whether the animals could be resensitized by treating them with either of two pre-existing drugs (4-Phenyl Butyric Acid [PBA] and Tauroursodeoxycholic acid [TUDCA]) that act as ER stress reducers. And the answer, they report, is yes.

" It was very exciting," Ozcan said of the discovery. "Normal mice treated with the drugs dropped some weight and quickly rebounded, but the knockout mice [that were genetically predisposed to ER stress in the brain] continued to lose weight. It shows that ER stress relievers are leptin sensitizers."

That makes PBA and TUDCA the first leptin sensitizers, Ozcan emphasized.

" A leptin-sensitizing agent has not been previously described despite the long-standing efforts in both academia and industry," he wrote. "The results presented in this study provide evidence that chemical chaperones, particularly the PBA and TUDCA, can be used as leptin-sensitizing agents. When the high safety profiles of PBA, TUDCA, and leptin are taken into consideration, our results may define a novel treatment option for obesity."

SOURCE: Cell Metabolism

Obesity linked to elevated risk of ovarian cancer

Mon. Jan 05, 2009

A new study has found that among women who have never used menopausal hormone therapy, obese women are at an increased risk of developing ovarian cancer compared with women of normal weight. The research indicates that obesity may contribute to the development of ovarian cancer through a hormonal mechanism.

Ovarian cancer is the most fatal of gynecologic malignancies, and has a 5-year survival rate of only 37 percent. While studies have linked excess body weight to higher risks of certain cancers, little is known about the relationship between body mass index and ovarian cancer risk.

To investigate this issue, Dr. Michael F. Leitzmann of the National Cancer Institute and colleagues studied 94,525 U.S. women aged 50 to 71 years over a period of seven years. The researchers documented 303 ovarian cancer cases during this time and noted that among women who had never taken hormones after menopause, obesity was associated with an almost 80 percent higher risk of ovarian cancer. In contrast, no link between body weight and ovarian cancer was evident for women who had ever used menopausal hormone therapy.

According to Dr. Leitzmann, these findings support the hypothesis that obesity may enhance ovarian cancer risk in part through its hormonal effects. Excess body mass in postmenopausal women leads to an increased production of estrogen, which in turn may stimulate the growth of ovarian cells and play a role in the development of ovarian cancer.

Among women with no family history of ovarian cancer, obesity and increased ovarian cancer risk were also linked in this study. However, women that did have a positive family history of ovarian cancer showed no association between body mass and ovarian cancer risk.

These latest findings provide important additional information related to women's risks of developing ovarian cancer. "The observed relations between obesity and ovarian cancer risk have relevance for public health programs aimed at reducing obesity in the population," the authors wrote.

SOURCE: Cancer

FDA seeks recall on weight loss pills

Wed. Dec 24, 2008

The U.S. Food and Drug Administration has issued a nationwide alert warning people about more than 25 different over-the-counter weight loss products.  The warning comes after the FDA analyzed the products and found undeclared, active pharmaceutical ingredients at concentrations exceeding safe concentrations.

"These tainted weight loss products pose a great risk to public health because they contain undeclared ingredients and, in some cases, contain prescription drugs in amounts that greatly exceed their maximum recommended dosages," said Janet Woodcock, M.D., director, Center for Drug Evaluation and Research, FDA. "Consumers have no way of knowing that these products contain powerful drugs that could cause serious health consequences."

FDA analysis detected sibutramine (a controlled substance), rimonabant (a drug not approved for marketing in the United States), phenytoin (an anti-seizure medication), and phenolphthalein (a solution used in chemical experiments and a suspected cancer causing agent) in the weight loss products.  Some of the amounts of active pharmaceutical ingredients far exceeded the FDA-recommended levels.

The weight loss products, some of which are marketed as "dietary supplements," are promoted and sold on various Web sites and in some retail stores. Some of the products claim to be "natural" or to contain only "herbal" ingredients, but actually contain potentially harmful ingredients not listed on the product labels or in promotional advertisements. These products have not been approved by the FDA, are illegal and may be potentially harmful to unsuspecting consumers. 

The FDA is seeking a recall on the following weight loss products:

• 2 Day Diet
• 3x Slimming Power
• 5x Imelda Perfect Slimming
• 3 Day Diet
• 7 Day Herbal Slim
• 8 Factor Diet
• 7 Diet Day/Night Formula
• 999 Fitness Essence
• Extrim Plus
• Fatloss Slimming
• GMP
• Imelda Perfect Slim
• Japan Lingzhi 24 Hours Diet
• Lida DaiDaihua
• Miaozi Slim Capsules
• Perfect Slim
• Perfect Slim 5x
• Phyto Shape
• ProSlim Plus
• Royal Slimming Formula
• Slim 3 in 1
• Slim Express 360
• Slimtech
• Somotrim
• Superslim
• TripleSlim
• Zhen de Shou
• Venom Hyperdrive 3.0

SOURCE: U.S. Food and Drug Administration

Europeans move to control useless health food products

Fri. Dec 12, 2008

In an attempt to control their weight, overweight and obese people in the United States spend billions of dollars on totally ineffective products.  Spending on unproven products for weight loss or other health benefits is reported at more than $35 billion annually. Similar spending in Europe has prompted the European Union (EU) to take action.   

Professor Lean from the University of Glasgow applauds a new Directive on Unfair Commercial Practices adopted this year by the EU.  He hopes it will afford some protection to vulnerable consumers tricked into to buying useless food products or supplements in attempts to combat their disease. However he is still concerned that people are being fooled into parting with large amounts of money for products that cannot help with weight control.

While unsubstantiated claims regarding the health and weight loss benefits of commercial products is illegal, misleading marketing, indirectly stated benefits, and claims of pseudo scientific validation of effectiveness continue to be made. Unlike medicines, food products marketed for health reasons are not subject to the same stringent research trials and control, and consumers are often misled.

The "commercial exploitation of vulnerable patients with quack medicines" will hopefully be brought to an end with the introduction of the new EU directive, say Lean. However, the laws need to be enforced proactively to enable doctors and consumers to move towards managing diseases confidently with evidence based treatment and diet programs.

He points out that, of all the hundreds of products currently on sale to help people lose weight, only energy-restricted diets and exercise, the drugs orlistat and sibutramine, and in some cases bariatric surgery, are safe, effective and cost-effective. The remainder, he says, are either not effective or not safe.

SOURCE: BMJ

Calorie cutting makes it harder to fight flu

Mon. Dec 08, 2008

Forget the old axiom "feed a cold, starve a fever;" conventional wisdom says staving off the effects of illness depends on maintaining adequate levels of nutrients and perhaps even a little extra in the tank to help deal with loss of appetite during illness.  However, people on calorie controlled diets may find combating flu more difficult says immunology professor Elizabeth Gardner from Michigan State University.

In a study published in the November issue of the Journal of Nutrition, Gardner showed that mice with a calorie-restricted diet were hit harder by infection than mice with a normal diet even though they were receiving adequate amounts of vitamins and minerals.

"If you are exposed to a new strain of influenza, to which your body has not made adequate antibodies to protect you from infection, your body must rely on cells that will kill the virus," Gardner said. "The natural killer cells are important in controlling the early stages of virus infection, because they act quickly once they encounter virus-infected cells. Calorically restricted mice have increased susceptibility to influenza and their bodies are not prepared to produce the amount of natural killer cells needed to combat the stress of fighting an infection."

"Our research shows that having a body ready to fight a virus will lead to a faster recovery and less-severe effects than if it is calorically restricted," Gardner said. "Adults can calorically restrict their diet eight months out for the year, but during the four months of flu season they need to bump it up to be ready. You need the reserves so your body is ready for any additional stress, including fighting a virus."

Calorically restricted diets in general have been shown to increase lifespan in everything from yeast to primates, according to Gardner. But the model used in Gardner's research can be extended to more vulnerable groups including children and the elderly, who don't eat as much but often take vitamin supplements.

Flu shots can't guarantee protection, in any case, since they are formulated months in advance and only can target a small handful of the many flu virus strains that might infect the population.

"If the strain of flu a person is infected with is different from the strain included in the flu vaccination, then your body sees this as a primary infection and must produce the antibodies to fight it off. A calorically restricted body is not as well prepared to do this and cannot control early infection, which impedes recovery," Gardner added.

SOURCE: Journal of Nutrition

Obesity may be a matter of taste

Wed. Dec 03, 2008

Penn State researchers are searching for a link between taste and body weight to find out if an abnormal craving for sugary food is linked to a reduced sensitivity for sweet tastes in some people.

Studies have suggested that obese persons are less sensitive to sweet taste and crave sweet foods more than lean people.

"When you have a reduced sensitivity to palatable foods, you tend to consume it in higher amounts," said Andras Hajnal, associate professor of neural and behavioral sciences at Penn State College of Medicine. "It is a vicious circle."

"When you have excess body weight, the brain is supposed to tell you not to eat more, or not choose high caloric meals" said Hajnal. "But this control apparently fails and thus the obesity epidemic is rising, and we want to find out how the sense of taste drives up food intake."

Using rats bred specifically for their obesity traits, the researchers found that the number of neurons activated in the brains of obese rats was far fewer than that of lean rats when eating foods of the same sweetness.

"If you sense sweetness less, you may be inclined to eat sweeter foods" said Hajnal.

Increased consumption of sweet foods over time could be influencing the brain's reward center by relaying progressively weaker nerve signals, which affects the perception of taste of the meals. Based on their studies, the researchers believe that larger meals and increased tendency toward sweet food may be the result of fewer feelings of reward when consuming smaller, less sweet meals

The findings linking taste responses and obesity could hold an important message for a condition that affects more than 60 percent of adult Americans.

For instance, Hajnal points to an ever-increasing amount of fat and sugar in processed foods. The enhanced taste of these foods, he says, stimulates our taste and food reward neurons on a chronic basis, making them less sensitive over time. And what do we do when this happens?

"Instead of eating less, we seek out higher palatability," Hajnal explained. "We simply start putting an extra spoonful of sugar in our coffee."

SOURCE: Journal of Neurophysiology

Care Needed with OTC Diet Pills

Thu. Nov 06, 2008

Over-the-counter weight-loss pills are no quick fix to melt away extra pounds. Many local drugstores sell diet pills, and even more choices are available on the Internet. But most diet pills haven't been proved safe or effective, and some are downright dangerous, according to a special report in the November issue of Mayo Clinic Women's HealthSource.

The report looks at popular weight-loss diets, eating plans and strategies, including diet pills.

Pills containing ephedra are touted to decrease appetite. But they can cause dangerous side effects, including heart attacks, seizures, strokes and sudden death. Ephedra, although banned by the U.S. Food and Drug Administration (FDA), can be purchased online. Herbal supplements that contain the plant-derived chemical ephedrine also are available online and can cause similar health problems.

Other weight-loss pills can contain a cocktail of ingredients, including herbs, botanicals, vitamins, minerals, caffeine or laxatives. It's too often unknown how these ingredients, individually or in combination, could affect individuals. The risk of adverse reactions increases when diet pills are taken with other medications.
The FDA has approved the weight-loss drug Alli, a reduced-strength version of the prescription drug orlistat (Xenical). Alli is taken with meals and promotes weight loss by decreasing absorption of fat by the intestines. It's intended for use as part of a reduced-calorie, low-fat diet. When individuals don't reduce fat in the diet, diarrhea and gas with oily spotting can be significant side effects.

While diet pill claims may be tempting, weight loss only happens when more calories are burned than consumed.

SOURCE: Mayo Clinic

Immunize against weight gain

Thu. Oct 30, 2008

Far fetched as it may sound, scientists at Scripps Research are working on immunizing against weight gain.

The theory behind the research is that antibodies working against the hormone ghrelin could provide an effective method for suppressing appetite and modifying how the body uses energy.

Grehlin, the hormone released by the body in response to calorie restriction, promotes eating and fat storage. Higher levels of ghrelin are produced before meals and fall away after eating.  During weight loss, higher levels of ghrelin are produced in an attempt to stimulate hunger and end food deprivation.

Immunizing with anti-ghrelin antibodies, such as GHR-11E11, could decrease levels of ghrelin and reduce its effect on appetite and fat storage role.

"The reason we looked at passive immunopharmacotherapy to treat obesity was because agonist/antagonist types of drugs have been remarkably unsuccessful," says Ely J Callaway, a Professor of Chemistry at the Skaggs Institute for Chemical Biology. "They are effective only while treatment is maintained and when treatment stops, weight returns. For obesity treatments to work, they must affect food intake and energy expenditure or storage - which is what this new catalytic antibody does by degrading ghrelin. Some people have the idea that because ghrelin is an endogenous hormone there might be too many adverse side effects if you eliminate it, but there is new evidence that the body itself produces antibodies against ghrelin."

Because obesity is such a complex disease, any antibody-based treatment would be just one part of a comprehensive treatment plan including nutrition, exercise, and lifestyle modification.  However, with focused research and development of more effective grehlin antibodies, weight control could be just an injection away.

SOURCE: Proceedings of the National Academy of Sciences