Sibutramine-Induced Nonischemic Cardiomyopathy

Isolation and identification of a novel bisacodyl analogue, bisacodyl dicycloproyl carboxylate, as a potential illegal additive in a dried plum product advertised for weight loss

In the process of a routine illegal adulterant inspection of food products sold online, a suspicious compound was detected in a dried plum food product, which claimed to have a natural weight loss effect. After mass spectrometric analysis the similarity between MS/MS peaks of this compound and that of bisacodyl, it was hypothesized to be a bisacodyl derivative. The chemical structure of the unknown compound was characterized by ultra-HPLC with quadrupole time-of-flight tandem mass spectrometry (UHPLC/Q-TOF MS), HPLC-diode array detection (HPLC-DAD) and nuclear magnetic resonance (NMR) methods. Based on these results, it was confirmed that the unknown compound had the substitution of two acetyl groups in bisacodyl by two cyclopropanecarbonyl groups, respectively. This distinctive compound has been termed as bisacodyl dicycloproyl carboxylate. The new compound has not been reported yet, and therefore the detection of bisacodyl analogue should be included in routine inspection of diet foods and health products.

Label Accuracy and Quality of Select Weight-Loss Dietary Supplements Sold on or near US Military Bases

Background/Objectives: Sixty-eight percent of service members are living with overweight or obesity, some who may not consult a healthcare provider when they decide to lose weight. Instead, they often turn to weight-loss dietary supplements for self-care solutions. The purpose of this case series study was to examine the label accuracy and quality of select weight-loss dietary supplements sold on or near US military bases across the country. Methods: Weight-loss dietary supplements (n = 44) were selected and purchased in GNCs, Exchanges, and Shoppettes across 12 military installations from March 2023 to January 2024. Liquid chromatography-mass spectrometry was used to verify the label accuracy according to the Supplement Facts listed ingredients and whether they contained any ingredients prohibited for use in the military. Product label claims were analyzed using the Operation Supplement Safety (OPSS) Risk Assessment Scorecard. Results: Thirty-six products (82%) had inaccurate labels. Twenty-seven (61%) had ingredients listed on the label not detected through analysis. Sixteen products (36%) contained hidden ingredients. The four products purchased within one mile from the base listed multiple prohibited ingredients on the labels, with all detected. Forty (91%) products scored a "no-go" according to the OPSS Scorecard and none contained a third-party certification seal on the label. Multiple stimulants were included in products such that the product safety was unknown. Conclusions: The majority of weight-loss dietary supplements analyzed in this case series study had inaccurate labels and were considered a "no-go" according to the Scorecard. Service members should only have access to safe, high-quality dietary supplement products. OPSS is collaborating with the Department of Defense stakeholders to determine the most effective ways for service members to have access to third-party certified products on all military establishments.

Cardiogenic shock in a 28-year-old woman associated with sibutramine use

A 28-year-old woman collapsed in her home, and her companion rushed to call emergency services. Upon arrival, a physician performed CPR and endotracheal intubation, successfully restoring her voluntary heart rhythm. However, while en route to the hospital, ventricular fibrillation recurred. Despite the restoration of her voluntary rhythm through electrical defibrillation, she remained in a comatose state, which eventually led to multiple organ failures. Family members revealed that she had a 2-month history of taking diet pills. Histological examination revealed cardiomyocyte necrosis, contraction band necrosis, interstitial hemorrhage, collagen deposition, interstitial fiber proliferation, and myofiber remodeling. Analysis of blood and urine using GC-MS and LC-MS detected sibutramine and its primary metabolites, M1 and M2, which were consistent with the composition of the medication she was taking. The deceased was in good health with no underlying heart disease. The above information confirmed that the cause of her death was sibutramine.