Potential for toxicity with use of bitter orange extract and guarana for weight loss

Hypertension in an Adolescent Secondary to Performance-Enhancement Supplement Use

Objective: To describe the effects of performance-enhancing supplements and caffeine on the blood pressure (BP) of an adolescent male. Case Summary: An adolescent male presented to his primary care provider for a preseason athletic physical. On physical exam, his BP was 162/90, exceeding the 99th percentile for his age. It had been elevated during the previous 2 yearly physicals. He was referred to the Pediatric Preventive Cardiology Clinic for follow-up. Illegal substance use and renal trauma were ruled out. During the evaluation, the patient acknowledged using energy drinks and performance-enhancing supplements, the majority of which were caffeine-based. His intention was to continue the use of supplements, so lisinopril was initiated. On follow-up, however, the patient reported supplement discontinuation, intermittent medication adherence, and lower home-based BP readings. He was subsequently lost to follow-up. An objective causality assessment revealed that the adverse drug event was probable. Discussion: When working with adolescent patients, it is particularly important to conduct an in-depth interview reflecting lifestyle choices. Use of performance-enhancing supplements and caffeine for adolescent athletes has been well reported in the literature. Adolescent use of supplements may be driven by misguided beliefs and lack of knowledge about potentially detrimental health effects, such as altered heart rate and elevated BP. Little evidence-based research is available to provide treatment guidance for clinicians regarding potential effects. Conclusions: A thorough patient history, including specific questions probing for any recent or chronic use of nutritional supplements, including energy drinks, will help identify substances that may contribute to BP variations. Even mild BP elevations in adolescents should lead clinicians to further investigate supplement use and include specific questions on any product use within the past 24 hours, several days, or longer. Adolescents may not consider the potential for adverse health effects when ingesting performance-enhancing supplements or energy drinks.

Food components with anti-obesity effect

Although many food components are reportedly beneficial to body-weight management, lack of understanding of molecular mechanisms and their function in overall adiposity under physiological conditions hinders successful and safe development of antiobesity functional foods. A positive energy balance resulting from an increase in food intake, a reduced energy expenditure, and/or dysfunction of adipose biology is associated with the development of obesity. This article provides an overview of the components involved in energy balance and adipose development and function. There is evidence that numerous ingredients found in foods can modulate energy balance and adipose biology, thereby potentially lowering adiposity.

Assessment of herbal weight loss supplement counseling provided to patients by pharmacists and nonpharmacists in community settings

OBJECTIVE

To assess the extent of appropriate counseling provided to patients by pharmacists and nonpharmacists in retail settings regarding herbal dietary supplements for weight loss.

DESIGN

Descriptive, exploratory, nonexperimental study.

SETTING

Phoenix, AZ, metropolitan area, from June 2008 to January 2009.

PARTICIPANTS

Pharmacists and nonpharmacists (e.g., cashiers, sales clerks, pharmacy technicians) working in retail locations selling herbal dietary supplements (e.g., grocery stores, health food stores, pharmacies).

INTERVENTION

Investigators posing as patients sought herbal weight loss supplement product recommendations and counseling on potential safety, drug interaction, and adverse effect issues from pharmacists or nonpharmacists.

MAIN OUTCOME MEASURES

Level of knowledge regarding safety and efficacy of herbal dietary supplements for weight loss.

RESULTS

52 sites were visited, and 27 unique product recommendations were given. In general, counseling provided to investigators/patients by pharmacists versus nonpharmacists varied significantly (P < 0.05) except when participants were asked about expected weight loss (P = 0.39) or use of herbal supplements during pregnancy (P = 0.07) and breast-feeding (P = 0.48). Pharmacists were more reluctant to recommend herbal products for weight loss than nonpharmacists and tended to question the safety and/or efficacy of these products or refer the patient to an alternate health care provider.

CONCLUSION

The counseling that investigators/patients received regarding herbal products for weight loss in various retail settings from both pharmacists and non-pharmacists varied greatly. Efforts are needed from the medical and herbal communities to ensure that patients are adequately informed about herbal products at the point of purchase.

Energy drinks: a review of use and safety for athletes

Energy drinks have increased in popularity in adolescents and young adults; however, concerns have been raised regarding the ingredients in energy drinks and their potential negative effects on health. Caffeine, the most physiologically active ingredient in energy drinks, is generally considered safe by the US Food and Drug Administration (FDA), although adverse effects can occur at varying amounts. Guarana, which contains caffeine in addition to small amounts of theobromine, theophylline, and tannins, is also recognized as safe by the FDA, although it may lead to caffeine toxicity when combined with caffeine. The amount of ginseng in energy drinks is typically far below the amount used as a dietary supplement, and is generally considered safe. Taurine, an intracellular amino acid, has been reported to have positive inotropic effects; however, this claim is not supported by research. Most energy drinks also contain sugar in an amount that exceeds the maximum recommended daily amount. Young athletes are increasingly using energy drinks because of the ergogenic effects of caffeine and the other ingredients found in these beverages. Energy drinks combined with alcohol are also gaining popularity in young adults, which poses significant concerns about health risks. Other health concerns related to consumption of energy drinks include case reports of seizures and cardiac arrest following energy drink consumption and dental enamel erosion resulting from the acidity of energy drinks.

Herbal drugs of abuse: an emerging problem

Some herbal products are emerging as popular drugs for recreational abuse. Plant and herbal supplements used recreationally can have a wide spectrum of clinical effects ranging from euphoric and stimulant effects to hallucinogenic experiences. Despite the potential for abuse, addiction, and serious adverse effects, there may be a false perception that these products are all safe, legal, and organic. These perceptions and the ease of accessibility to herbal products could result in greater potential for recreational abuse and subsequent complications presenting to emergency departments. Health care professionals must be cognizant of this emerging problem as increased media coverage and marketing have made these products accessible and recognizable to many young adults and teenagers.

Availability of weight-loss supplements: Results of an audit of retail outlets in a southeastern city

The sale of nonprescription weight-loss products accounts for millions of dollars spent by Americans trying to lose weight, yet there is little evidence for effectiveness and there are multiple safety concerns. The purpose of this study was to determine what products, and ingredients within products, were available at retail outlets in a metropolitan area. A purposive sampling strategy identified 73 retail outlets. An audit form was used to collect information from product labels. The audit identified 402 products containing 4,053 separate ingredients. The mean number of ingredients per product was 9.9+/-8.96 (range = 1 to 96). A database search was conducted regarding evidence for effectiveness, safety precautions, and side effects for the 10 ingredients that appeared most often across products. Modest evidence of effectiveness exists for green tea (Camellia sinensis), chromium picolinate, and ma huang (Ephedra major). For the remaining seven (ginger root [Zingiber officinale], guarana [Paullinia cupana], hydroxycitric acid [Garcinia cambogia], white willow [Salix alba], Siberian ginseng [Eleutherococcus senticosus], cayenne [Capsicum annuum], and bitter orange/zhi shi [Citrus aurantium]), inadequate or negative evidence exists. Although precautions and contraindications were found for all 10 ingredients, the strongest concerns in the literature appear for ma huang, bitter orange, and guarana. Our audit revealed numerous weight-loss products available to consumers, yet there is little evidence to support the effectiveness of the top 10 ingredients identified and many potential adverse reactions; therefore, food and nutrition professionals should discuss dietary supplement use with their clients.