Phil Kaplan on the Magic Pills of 2006

So need I go on? Yes, because despite my assertions there are great minds and deep pockets at work and the "take a pill" messages will continue to invade your consciousness. If you have at least a few pounds you'd like to leave behind, you're a target, and the product marketers and creative advertisers have you in their sights.

On This Page
	Xenical (Orlistat) OTC A Weight Loss Supplement for Women? Hoodia - Does it Work?

A Drug You Can Pick Up Without a Prescription

The weight loss drug Xenical (generically named orlistat) is in all likelihood going to be released as an Over The Counter (OTC) product and it will no doubt set new records for weight loss product sales. Due to effectiveness? I'd predict moreso due to marketing spin.

GlaxoSmithKlein is a pharmaceutical company that also is a leader in selling OTC consumer health care products including recognizable names such as Nicorette, Aquafresh and Tums. Roche, the pharmaceutical giant, developed a co-promotional relationship with GlaxoSmithKlein in the 80's with the product Zantac. Now the two giants are connecting to release the pharmaceutical Xenical product sold as a prescription medication by Roche, as an OTC weight loss product. They'll certainly use the words "research has proven."

Before you get all excited that you can now buy what was once a "drug" without a prescription, I think there are some specifics that merit exploration to prevent excitement from overwhelming rational thought. In other words, the more you know the less likely you are to buy into something that may not bring the result you're hoping for. If you do opt to use a product, it's best to understand its mechanism of action, its potential value, and the potential risks.

Xenical is not an appetite suppressant. Its mechanism of action involves interfering with the enzyme Gastro Intestinal Lipase (GI lipase) in the digestive tract to limit the absorption of fat. This prevents some of the dietary fats in the stomach and small intestine from being converted from triglyceride form into free fatty acids and monoglycerides, the forms in which they're absorbed. The result? Some fat that might have been used as energy remains in the digestive tract until it is excreted.

I've looked at an abundance of research, and if you'd like to do your own exploration click here or scroll down for some studies you can begin to explore and interpret. The deeper you look, the more inconclusive you'll find the studies to be, at least in terms of my earlier proclamation, there aren't any weight loss drugs that in and of themselves deliver a lean, fit, healthy body. While some studies might indicate that those using Xenical lost more fat than those using placebo, and others demonstrate decreases in cholesterol absorption or increases in fat excretion, the abstracts might fail to report relevant issues such as that Xenical users often reduce their fat intake during the study due to unpleasant side effects.

What if they simply reduced fat intake and didn't use a drug? What if individuals in the study traded some of their saturated fat intake for EFAs? What if those in the study were given a placebo but walked an extra mile each day, performed 10 daily minutes of resistance exercise, and consumed 20% more protein? I could raise such questions with every study in which the conclusion expresses the demonstration of a benefit. I realize that researchers are attempting to answer a very specific question, but it's clear that our weight loss challenges are multi-factorial. The question that I believe must always be asked is, "can the outcome be clearly linked to the use of the drug, or could it have been achieved in a more pleasant and more beneficial manner by making other simple shifts in dietary habits and activity?"

If there were in fact a drug that we could take and be certain our health and body composition would improve, I assure you I'd be screaming its name from the rooftops. I haven't been a rooftop in awhile, so it's clear I haven't yet found that drug.

Because research is sophisticated, because research language is difficult for the layperson to interpret, and because elements of reseach can be extrapolated to place focus on a given outcome without revealing the entirety of the study's result, we have to be careful as a population blindly buying into the words "research has proven." There are always variables related to individual metabolism, activity level, caloric intake, micronutrient intake, and nutrient timing, that can skew translating the assessment of a specific result into an assertion that "it works." I believe if anyone tells you that research has proven this compound "works" as a weight loss aid, that person needs to continue to explore the available research.

The side effects regularly reported include loose and oily stools, fecal urgency, flatulence and incontinence. In addition, although the research indicates that with a dietary fat component approximating 30 - 35% of caloric intake, Xenical (a three-times per day 120mg dosage) "blocks" about 30% of dietary fat from being absorbed, there are going to be bioindividual variances and inhibiting fat transport can also inhibit the absorption of the fat soluble vitamins.

Here's where I believe the real danger lies. If people are capable of making better dietary choices without negative effects, and if the use of a drug is believed to prevent calories from being absorbed, a significant percentage of users will feel the drug allows for less dietary control. In other words, "I can have the extra cheese and sausage if I take my pill" is an inevitable attitudinal shortcoming in the impact this will have on our obese and overweight population. I believe as long as we continue to find "tricks" that make people feel as if the solution may lie in a pill, our overfat population moves farther away from taking responsibility.

By taking a product that was controlled at some level by a mandated need for prescription and making it an "off the shelf" product, we further rely on users to read and interpret warning labels and contraindications. A study in assessing the specifics of the new product release conducted by the FDA showed that more than 50% of populations at high risk of serious side effects with Xenical failed to adequately interpret the proposed warning labels. It should also be noted that OTC the product will contain a 60 mg. dosage with the intention of lessening the unpleasant side effects. I haven't seen any research to indicate that 60 mg. three-times-per-day brings the same outcomes as in research using twice the dosage.

GlaxoSmithKlein anticipates $1.5 billion in annual sales of the OTC orlistat product proposed to be released under the name Alli.

Is there a place for Xenical? Perhaps. If the words "obesity management" are adhered to with a reinforcement on the recommendation that Xenical is used, not as a solution, but as an addition to a program incorporating nutritional adjustments and controlled activity (exercise), we might see a more rapid reduction in some risk factors. That's a far cry from it being a drug that the population can rely on to treat and minimize their struggles with obesity.

I'm ready for the condemnation I'll receive. Before you send me a critical email referring to the science and condemning me for reporting based on opinion and anecdote, realize that my intention is not to be a scientific reporter or a research scientist, but rather a consumer advocate who has taken the responsibility of reviewing extensive research, speaking to thousands of prescribers and users, and maintaining a 20-year commitment to study, understand, and share the realities of physical improvement. This article is simply a brief summation of my educated opinion urging those who are tempted to believe a "magic pill" is soon to exist to study not only information put out by those who stand to benefit by consumer buy-in, but also by those who may be far less biased in seeing a product generate a financial windfall.

A Weight Loss Supplement for Women?

The next offering I'd like to examine uses two key words that weight loss product advertisers know summon up interest.

The word "Slim" was demonstrated to elicit a favorable response among weight loss wanters, and in market research it came up as more globally appealing than the words "Lean," "Trim," and "Thin."

Another word that drives the "I want it" bug to jump to the front of the human mind is "Quick." After all, our instant gratification society leads us to believe that even weight loss should take days at most.

In 2002 the FTC stopped a company, Bio Lab, from distributing a well-positioned (from a marketing standpoint) product named Quick Slim. Quick Slim was being sold deceptively with promises of quick and easy weight loss without need for diet or exercise.

If you wanted to drive a powerful campaign, and couldn't call a product Quick Slim, you could still start with two compelling words. All you'd have to do is reverse the order. Enter the new product marketed as "the world's first and most advanced fat burner designed specifically for the woman's body," Slim Quick. I'm not suggesting that the two companies have any connection other than the words of their product names, but I find it interesting how often "twists" are used to tap into proven consumer vulnerability.

Slim Quick is not a bad product, but I think it's important for consumers to understand its potential benefit beyond their marketing spin, "scientifically developed to overcome the physiological and hormonal barriers women face in losing fat." They have also adopted the line, "the world's first and most advanced fat burner designed specifically for the woman's body." (If they're first and they're new . . . isn't it a given they're the most advanced?)

The most valuable part of the SlimQuick offering is likely the "free diet and exercise program" that comes with your bottle. This is an age-old marketing technique. Sell a pill promising an outcome, but require that in order to achieve the outcome the users make shifts in their eating and exercising. A dose of common sense would raise the question, "if the regimen works, is the pill necessary?"

As many dietary product developers now do, in order to appear as if they've engineered some remarkable formulas, SlimQuick boasts "exclusive complexes." Six to be exact. Let's take a closer look.

The first is Cyclovite, a name they trademarked to brand a combination of micronutrients. For the sake of comparison, I'll compare this "exclusive formula" to the ingredients in the long selling OTC supplement, Centrum. Cyclovite has 200 iu of Vitamin D in two capsules. Centrum has 400 in one tablet. That would mean a single tablet of Centrum has four times as much Vitamin D. Cyclovite has 4 mg of B6 in two capsules, Centrum has 2 mg in one, which means they're equal. Cyclovite has 200 mcg of Folic Acid in two capsules, one tablet of Centrum has 400 mcg. Cyclovite has 12 mcg of Vitamin B12 in two capsules, Centrum has 6 mcg in one, again equal. Cyclovite has 150 mg of calcium in two capsules, Centrum has 162 in one tablet.

I'm not in any way holding Centrum up as superior, but rather using it as a standard to compare SlimQuick's proprietary Vitamin & Mineral formula to that which you can buy inexpensively in any convenience store and it appears SlimQuick has relatively low dosages of a very abbreviated vitamin and mineral list. Although calcim and the B vitamins certainly contribute to optimal metabolic function, I don't see any legitimacy in Cyclovite being purported to be any more supportive of fat burning in women than any mainstream multi-micronutrient formula aimed at the masses.

Next on the list of six exclusive formulas is the trademarked Nutratherm Thermogenic Complex. Here we have Green Tea extract, Caffeine in an undisclosed amount, cocoa bean extract, and yerba mate. These are all compounds that contain xanthines, caffeine and caffeine-like central nervous system stimulants. Most of the products sold as fat burners contain stimulants equal in dosage to OTC Stay Awake caffeine compounds. If these contribute to weight loss, their actions are combinations of stimulation (as amphetamines), appetite suppression, and water loss. While caffeine might increase fat release in individuals who have not developed a daily caffeine habit, I don't see anything here that customizes the formula for women or that differentiates it from any other "energy aid" or "weight loss supplement" reliant on caffeine.

The other "complexes" are Estrotrim, supposedly a hormone balancing complex with soy isoflavones and chasteberry, Cortifem, relying on some compounds in undisclosed dosages that can be found in most of the ineffective "cortisol control" weight loss formulas (phosphatidylserine and theanine), Aquaplex, a blend of diuretic herbs that can lead to deceptive and perhaps unsafe water loss, and Xtend which uses cellulose ethers and the fiber of the piper nigum fruit (the source of black pepper) to slow the absorption of the other compounds making it a slow release, or as the label says, "time release" complex.

Of all of the ingredients, the only one that actually has a suspected mechanism specific to women is chasteberry. This herb has been used since medieval times to "manage" the symptoms of PMS. It may play a role in lessening hormonally induced cravings for sweets and perhaps in that might play a small role in helping to manage appetite during select days of the month. The challenge lies in determining how much of the compound is included and whether it's significant to have any effect at all. If you want to try chasteberry, you can purchase a standardized herbal extract in any health food store.

Is this really the first fat burner for women? I've seen Hydroxycut, Xenadrine, Metabolife, and scores of other product marketed toward women. By putting the "designed for women" spin on their promotions and pumping millions into media, SlimQuick will likely generate a nice financial return. Does that mean "it works?" You decide.

Hoodia?

I explained Hoodia in an article where I discussed the selling power of TrimSpa, a heavily marketed product that adds Hoodia to its ingredient list.

Hoodia comes from a cactus that grows in the Kalahari desert and it's been marketed as "the weight loss secret of the Kalahari bushmen." Here's a question that remains unanswered . . .

Much like the marketing of Hunza Bread, Coral Calcium found only in Okinawa, and the Himalayan Secret Formula, Hoodia is sold as a "secret" of a population that never experienced the problem our population is attempting to resolve. Hoodia may have appetite suppressing properties, thus it may be used by nomadic tribesmen to stave off hunger, but appetite suppression is not an obesity cure.

As with many dietary product releases, Hoodia is sold with the premise of "research" validating its worth. Supposedly it caused rats to lose lots of weight. A bit of continued exploration would reveal that the research was in fact done with a compound found within the Hoodia cactus, a compound named P57. It was injected directly into the brains of rats and yes, those rats lost weight. If you're ready to deem yourself the biological equivalent of a rat, and you're prepared to inject a component of the Hoodia cactus into your brain, sure, maybe you'll shed a few pounds, but if you're hoping that swallowing a handful of Hoodia pills will give you the body of your dreams you'll likely continue your search for the magic pill for many years to come.

As a final note regarding Hoodia and P57, Pfizer was working to attempt to create a pharmaceutical appetite suppressant compound using P57 but they have since abandoned the quest.

So what works?

Synergy works. The combination of the Right Nutrition, Moderate Aerobic Exercise, and a Concern For Muscle. I've been saying that unequivocally for over twenty years and I continue without reservation.

If you decide to attempt to incorporate any of the compounds mentioned in this article into a weight loss regimen, please let me know the outcome.

Xenical References:

Zhi J, Melia AT, Guerciolini R, et al. Retrospective population-based analysis of the dose-response (fecal fat excretion) relationship of orlistat in normal and obese volunteers. Clin Pharmacol Ther 1994;56:82-5.

Sjostrom L, Rissanen A, Andersen T, Boldrin M, Golay A, Koppeschaar HPF, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet 1998;352: 167-73.

Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat. JAMA 1999;281:235-42.

Vidgren HM, Agren JJ, Valve RS, Karhunen LJ, Rissanen AM, Uusitupa MI. The effect of orlistat on the fatty acid composition of serum lipid fractions in obese subjects. Clin Pharmacol Ther 1999;66:315-22.

Davidson MH, Hauptman J, DiGirolamo M, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA 1999;281:235-42.

Rossner S, Sjoström L, Noack R, Meinders AE, Noseda G. Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. European Orlistat Obesity Study Group. Obes Res 2000;8:49-61.

Heymsfield SB, Segal KR, Hauptman J, et al. Effects of weight loss with orlistat on glucose tolerance and progression to type 2 diabetes in obese adults. Arch Intern Med 2000;160:1321-6.

Trouillot TE, Pace DG, McKinley C, et al. Orlistat maintains biliary lipid composition and hepatobiliary function in obese subjects undergoing moderate weight loss. Am J Gastroenterol 2001;96:1888-94.

Muls E, Kolanowski J, Scheen A, Van Gaal L. The effects of orlistat on weight and on serum lipids in obese patients with hypercholesterolemia: a randomized, double-blind, placebo-controlled, multicentre study. Int J Obes Relat Metab Disord 2001;25:1713-21.

Mittendorfer B, Ostlund RE Jr, Patterson BW, Klein S. Orlistat inhibits dietary cholesterol absorption. Obes Res 2001;9:599-604.

Doucet E, St-Pierre S, Almeras N, et al. Reduction of visceral adipose tissue during weight loss. Eur J Clin Nutr 2002;56:297-304.

Rivellese AA, De Natale C, Lilli S. Type of dietary fat and insulin resistance. Ann N Y Acad Sci 2002;967:329-35.

Weight Loss by Pill or Capsule Ingestion?

Has Research Proven it's Possible?

by Phil Kaplan

A Drug You Can Pick Up Without a Prescription

A Weight Loss Supplement for Women?

Hoodia?

So what works?

Xenical References:

Now Available Wherever You Live: