Dear DOCTOR Owen:

I read constantly about this or that product to help lose weight. I see people giving testimonials all night on TV. I really want to believe the promotions, but am skeptical to use the products. Do you have any information on some of these products? While I do take nutritional supplements, I like to be informed.

Herb

Dear “Herb”:

Unfortunately, there are few good scientific studies available on many of these products. In addition, the production standards are different for each one. Therefore, the level of the herb in the blood may vary considerably from brand to brand—even from dose to dose.

At the November 1999 convention of the North American Association for the Study of Obesity (NAASO), this topic was covered and the available research reviewed. The products covered included chromium picolinate; Garcinia cambogia; chitosan; linoleic acid; and Ma Haung; as well as Ma Haung in combination with willow bark, guarana, and/or St. John’s Wort.

The only compound with significant results in all the studies compared to placebo was Ma Haung, which has Ephedra as its active ingredient. In the mid-20th century, Ephedra was used to treat asthma. Ephedra, which is the base compound of most stimulant appetite suppressants, causes adrenaline production to be increased and may have some mild appetite-suppressing effects. It certainly would need to be taken forever if a good response was seen in your individual case.

The other herbs did not hold up under placebo comparisons.

Placebo comparisons are important when testing a drug or herb that can cause behaviors to change. Investigators must be blinded as to subjects who are taking the real drug or herb or the fake pill. Even the researcher’s facial expressions can influence a subject to act differently. Good double-blinded research is costly and requires a team of experts to make sure the quality of work is high. Most herb distributors and manufacturers do not have the capital needed to perform such research. Therefore, many products are released for use by the public without good research.

My opinion is that sweeping statements are useful for the general public, but individual cases may have remarkable responses. Therefore, it is good to keep an open mind about these herbs if they appear to be safe. At high doses, Ephedra can cause cardiac arrhythmias, even death. Like any drug, compliance with recommended doses is important. More is not better—especially with herbal drugs.

Remember: Most of the drugs used in medicine today are derivatives of a plant or animal product. Modern physicians are really nothing but highly educated, board-certified “herb” doctors. The difference between the licensed medical doctor and the “quack” is that the M.D. knows precisely what is in a product as well as its mechanisms of action. The products that physicians prescribe are rigidly manufactured to standards. We physicians have tests available to follow blood levels for many products. I believe that this is the standard that most people would expect of medical professionals.

I really “go ballistic” is when I see a patient who spends hundreds of dollars on herbs, yet refuses to consider mainline testing or treatment because it is too expensive. Keep up with your reading and continue to ask good questions. I’ll keep looking for quality answers.