Stephen Holt MD

The timely withdrawal of high dosage Ephedra (Ma Huang), used in dietary supplements as an adjunct to weight control, has left a large void in the supplement industry. Any stimulant nutraceutical that is strong enough to suppress appetite is powerful enough to raise blood pressure and promote cardiovascular or stroke risk. Obesity or being overweight is not just a cosmetic issue, and this commentary is not relevant to “squeezing into a bathing suit”. The dietary supplement industry has not focused enough attention on the risk of obesity related disease. Obesity has become the most common preventable cause of premature death and disability in Western society.

There are as many as 70 million US citizens with the metabolic Syndrome X, where obesity is variably associated with high blood pressure and abnormal blood lipids, linked by underlying insulin resistance. This constellation of problems causes much obesity related disease and disability and the modern approach to managing obesity must address metabolic Syndrome X.1 Using positive lifestyle changes and a variety of nutritional factors, in dietary supplements or functional food to combat Syndrome X must be a priority.2

Consumers are fed up with promises of a quick fix for weight control and there is not a diet known in the history of medical practice that has resulted in sustained weight control.3,4 This circumstance resulted in the fizzle of low carbohydrate diets which are known to be effective only in the short term.4 Low carbohydrate diets are valuable in the management of Syndrome X and the important concepts proposed by Robert Atkins MD were misinterpreted by marketing predators.3,4

Weight control has to be seen to be a function of a balanced, calorie-controlled diet that targets global health initiatives, together with behavior modification and exercise. 3,4 Dietary supplements play an adjunctive role in weight control and they should not be sold with “stand-alone treatment claims” for obesity. Failure to comply with this latter objective has resulted in sanctions by regulatory agencies.

Some segments of the dietary supplement industry will not acknowledge the laws of thermodynamics, where fat storage in the body is a function of the amount of energy intake in the diet (calories). In other words, people who eat too much will tend to get fat. A priority for Western society is to control calorie intake by overcoming distorted impressions of required food portions. In my writings and public presentations, I have uncovered a lack of clear evidence to support stand-alone weight loss claims for dietary supplements.1-4

Hoodia gordonii has emerged as the most attractive supplement used for weight control, but it is beleaguered by controversies.3 The industry is faced with one of the most important ethnobotanical discoveries of the 20th century, in the form of Hoodia gordonii. If early observations of the effectiveness of authentic Hoodia gordonii, as a non-stimulant appetite suppressant, are confirmed in controlled clinical studies, the secrets of this botanical may prove to be one of the most valuable options for the management of excessive weight, obesity and the metabolic Syndrome X.3

Evidence has emerged that not all brands of Hoodia gordonii are of authentic South African origin and many may not contain molecules that are associated with demonstrated biological activity of this botanical.3 The occurrence of intentional adulteration of certain supplements or misbranding of some supplements by the making of illegal treatment claims has haunted the dietary supplement industry. Can certain segments of the dietary supplement industry stop “shooting itself in the foot”? These issues may plague the use of Hoodia gordonii in the future.3

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