Vol.5 Issue 1
Obesity

I'm a nurse practitioner who works in a hypertension clinic.  Several of my patients are taking "ephedra-free" weight loss dietary supplements.  Are these supplements effective in promoting weight loss and are they safe?

It is not surprising to hear that several of your patients are taking “ephedra-free” dietary supplements. Dozens of ephedra-free weight loss products were developed and aggressively marketed after the Food and Drug Administration banned ephedra in 2003, following several highly publicized deaths (FDA, 2004).

Most ephedra-free products contain a combination of different herbs and dietary nutrients, raising several cautionary flags. First, it is difficult to establish the benefits and risks of combination products; little or no evidence is available on their safety and efficacy. Second, a number of combination products contain bitter orange and/or country mallow, which produce ephedra-like cardiovascular effects and are likely to be banned in the future (NMD, 2005). Other ingredients, such as phenteramine, inhibit the reuptake of serotonin, norepinephrine, and dopamine, and should be avoided by patients with hypertension and heart disease. Third, many ephedra-free products contain caffeine, often from “natural” or “disguised” sources such as extracts of guarana or tea, which may be contraindicated in hypertensive patients (NMD, 2005).

Several extensive reviews have examined the safety and efficacy of commonly used single-ingredient dietary supplements, including barley, bitter orange, chitosan, conjugated linoleic acid, chromium, garcinia, green tea, guarana, pyruvate, and St. John’s wort (Allison et al., 2001; Heber, 2003; Lenz & Hamilton, 2004; Pittler & Ernst, 2004; Saper, et al., 2004). All of the reviews concluded that there is insufficient evidence to support the use of dietary supplements for weight reduction.

Despite these findings, the number and use of ephedra-free dietary supplements is only expected to increase given:  a) the high prevalence of overweight and obesity in the U.S., with nearly two-thirds of adults classified as overweight or obese; b) the failure of conventional weight reduction approaches to sustain weight loss; c) the use of seductive marketing claims with promises of quick and natural weight loss; and d) the easy, over-the-counter accessibility of these products.

When working with your patients who are taking ephedra-free dietary supplements, it is important to assess the type of dietary supplement being used, advise them of potential risks, and closely monitor for adverse effects. A number of evidence-based resources are available for keeping up-to-date on the latest safety and efficacy information:
 
Aetna InteliHealth at http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.html  (free)

Consumer Labs at http://www.consumerlabs.com (user fee)

Medline Plus at http://www.nlm.nih.gov/medlineplus/herbalmedicine.html  (free)

Natural Medicines Comprehensive Database at http://www.naturaldatabase.com (user fee)

National Center for Complementary and Alternative Medicine at http://nccam.nih.gov/
(free)

National Standard at http://www.naturalstandard.com  (user fee)

Joyce Keithley, DNSc, RN, FAAN
Professor, Adult Health Nursing
Rush University College of Nursing

References

Allison, D.B., Fontaine, K.R., Heshka, S., Mentore, J.L., & Heymsfield, S.B. (2001). Alternative treatments for weight loss: A critical review. Critical Reviews in Food Science and Nutrition, 41(1), 1-28.

Heber, D. (2003). Herbal preparations for obesity: Are they useful? Primary Care; Clinics in Office Practice, 30(2), 441-463.

Lenz, T.L., & Hamilton, W.R. (2004). Supplemental products used for weight loss.
Journal of the American Pharmacists Association, 44(1), 59-68.

Natural Medicines Comprehensive Database, online version, accessed February 12, 2005.

Pittler, M.H., & Ernst, E. (2004). Dietary supplements for body-weight reduction: A systematic review. American Journal of Clinical Nutrition, 79, 529-536.

Saper, R.B., Eisenberg, D.M., & Phillips, R.S. (2004). Common dietary supplements for weight loss. American Family Physician, 70(9), 1731-1738.

U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition (2004). Dietary supplements: Ephedrine alkaloids. Retrieved from http://www.cfsan.fda.gov/~dms/ds-ephed.html