Can diet pills kill you?

Diet pills are big business but are you taking them at your own peril? How badly do you want to lose weight? Is it worth your life?Simply Slim is the latest slimming aid to come under media scrutiny after investigations revealed serious side effects in some users.

At the heart of the controversy lies the potentially harmful elements that diet pills contain; in the case of Simply Slim, allegations were made that the supplement had potential negative effects on heart health as well as hypertension.

So, where do overweight consumers, desperate to shed those kilos, stand when it comes to selecting an over-the-counter weight-loss pill?

Simply Slim was withdrawn from the South African market by the Medicines Control Council (MCC) on 27 January of this year. According to Fidel Hadebe, spokesman for the Department of Health, the MCC based its decision to suspend the sale of the productafter it was discovered that the product contained sibutramine, a schedule five substance. Medicines containing schedule five substances can only be sold on a prescription from a doctor, and need to be monitored.

“A number of complaints about the product were received by the MCC from the public. These included life-threatening adverse events such as psychological effects, kidney complications and cardiovascular events,” says Hadebe, who maintains that the risks associated with the use of Simply Slim by the public are greater than the benefits, and until this has been vetted by the MCC, sales have been prohibited.

Know where you stand

As a consumer, with a plethora of diet pills available over the counter (OTC) or via the click of a mouse, it’s important to understand the different types of diet pills – and what they contain.

Clinical dietician Claire Julsing explains that diet pills fall into two different categories:prescription medications and OTC slimming supplements. The second group is where most of the problems occur, Julsing points out: “Most of these diet pills are sold under the ‘supplement label’, but these are not regulated; do not undergo clinical trials; and are not expected to conform to the rules that apply to the pharmaceutical industry. As a result,‘quick-fix’ products are marketed and sold to the public at large, which, in many cases, act as the trial run to see if any side effects occur. “Once the product is on the market, the consumer is the guinea pig to decipher the side effects and dangers associated with the particular product,” says Julsing.

According to nutrition and lifestyle specialist, Melanie Papaioannou: “Slimming supplements in general contain substances that decrease the appetite while increasing the metabolism.” This explains why Sarah experienced increased energy levels and weight loss – and stands to reason why people often ignore the side effects.

Lured by the promise of ‘natural’ ingredients, users often underestimate the risks of slimming pills. She claims that often the ingredients you should be wary of are not listed on the label. It is therefore important that consumers practice caution and consult with a nutritional expert before popping a pill to lose weight.

Those to be cautious of include:

Bitter orange: This substance replaced ephedrine as an ingredient in many weight-loss supplements (including Simply Slim), when ephedrine was taken off the market because of adverse effects on blood pressure and heart rhythm. However, some studies show that bitter orange may have the same effect on the body as ephedrine.

Chromium: Promotes fat loss and increases lean body mass, but only small studies have indicated the benefits of this mineral.




Senna: This product is believed to induce diarrhoea and can cause low levels of potassium. “Three deaths have been reported from the use of this product,” cautions Julsing.

Dehydorepianrosterone (DHEA): is supposed to promote weight loss, however, adds Julsing, supplementation can cause insulin resistance, a reduction in good cholesterol and increase the risk for heart disease.

Fat blockers (like orlistate): remove fats via the intestine. “The reality is that, in the process, this product also prevents the absorption of the important fat-soluable vitamins A,D, E and K, as well as the essential fatty acids vital for overall health,” says Papaioannou. She adds that fat blockers can also cause uncomfortable cramping, gas and diarrhoea.

Sibutramine and appetite suppressants: These, by nature, stimulate the sympathetic nervous system, which can raise blood pressure and heart rate, explains Papaioannou. “These products increase the risk of heart attack and cardiac arrest, especially among those who already suffer from high blood pressure, irregular heartbeat or heart disease.

Slimming pill ingredients, positive and negative aspects

Slimming is a mega-billion dollar industry throughout the world and South Africa is no exception. Wherever you look, in newspapers, magazines, supermarkets, chemist and health shops, on TV and the radio, you will find adverts and products which promise you painless, effortless weight loss provided you take product X or swallow pill Y. So what do these ‘magic’ pills and drops really contain?

A random survey of some of the most popular over-the-counter slimming products sold in South Africa, showed that most of these diet pills contain the following ingredients in varying concentrations and combinations:

Acetic acid

Example Effects Side-effects/Caution
Apple cider vinegar – common product of apple fermentation No scientific proof that using vinegar made from apples, differs from any other vinegar
(acetic acid) used for cooking. No proven slimming effect.
Non-toxic. Probably harmless if taken in moderate quantities.

Amino acids

1) BCAA

Example Effects Side-effects/Caution
BCAA (branched-chain amino acids) – valine, isoleucine, and leucine – essential amino acids found in all animal protein foods Muscle metabolism;
Prevent tiredness duriong exercise
Probably non-toxic because of small quantities included in slimming products – much larger quantities are ingested daily from protein foods

2) L-Glutamine

Example Effects Side effects/Caution
L-glutamine – conditionally essential amino acid – found in practically every food Neurotransmitter; Muscle metabolism; Prevents protein catabolism (breakdown) during stress and exercise Probably non-toxic because of small quantities included in slimming products – much larger quantities are ingested daily from protein foods

3) L-Glycine

Example Effects Side effects/Caution
L-Glycine – non-essential amino acid, produced in the human body Neurotransmitter; Muscle metabolism; Improves muscle contraction Probably non-toxic because of small quantities included in slimming products – much larger quantities are ingested daily from protein foods. Excessive intakes can cause fluid and electrolyte imbalances

4) Taurine

Example Effects Side effects/Caution
Taurine – non-essential amino acid, produced in the human body, found in animal protein foods Neurotransmitter; Muscle metabolism; Conjugates bile acids and may lower blood cholesterol levels Probably non-toxic because of small quantities included in slimming products – much larger quantities are ingested daily from protein foods. Excessive intakes may cause overstimulation of the nervous system

5) L-Tyrosine

Example Effects Side effects/Caution
L-tyrosine – non-essential amino acid, produced in the human body Converted to neurotransmitters, norepinephrine, epinephrine and dopamine which suppress appetite and prevent tiredness, produces a ‘high’. Tyrosine combines with iodine to form thyroid hormones Probably non-toxic because of small quantities included in slimming products – much larger quantities are ingested daily from protein foods.
See side-effects, contra-indications and warnings for epinephrine below.

;

6) DL-Phenylalanine

Example Effects Side effects/Caution
DL-phenylalanine – essential amino acid, found in protein foods Triggers release of cholyccystokinine (CCK) which increases satiety. Converts norepinephrine which suppresses appetite, increases energy, lifts the mood, poroduces a ‘high’. Converted to tyrosine (see 5 above) Probably non-toxic because of small quantities included in slimming products – much larger quantities are ingested daily from protein foods.
Excessive intakes may produce epinephrine side-effects (see belwo). Harmful to patients with phenylketonuria.

Warning: Harmful to patients with phenylketonuria

L-Carnitine

Example Effects Side effects/Caution
L-Carnitine – biological compound, produced in the human body, found in protein foods Transports long-chain fatty acids into the mitochondria of the cell to serve as fuel during exercise; improves cardiovascular function and muscle strength; decreases fatigue; may decrease body fat if combined with a strenuous exercise programme No evidence that it removes fat from fat depots especially at the low levels included in slimming products. No evidence that L-carnitine deficiency is common.

Conjugate Linoleic Acid (CLA)

Example Effects Side effects/Caution
Conjugated Linoleic Acid (CLA) – essential omega-6 fatty acid, found in protein foods ( beef, turkey, dairy products) Antioxidant; may increase lean body mass and reduce body fat No conclusive evidence that it lowers body fat in humans -additional research required. Excessive intake may interfere with omega-3 uptake.

Creatine

Example Effects Side effects/Caution
Creatine Monohydrate – found in most animal protein foods Improves exercise performance over short distances and brief periods (<30 seconds) by enhancing body pool of creatine phosphate, may prevent fatigue; best used with intensive exercise programme Recommended doses must not be exceeded. Can cause weight gain. Long-term use may have negative effects – additional research required – “more is not necessarily better”

Epinephrine
1) Pharmacological products

Example Effects Side effects/Caution
Epinephrine, norepinephrine, norpseudoepinephrine, also called adrenalin or nor-adrenalin Suppresses appetite, increases energy, lifts the mood, produces a ‘high’ Nausea, vomiting, dry mouth, thirst, thirst, problems with urination, hypertension, rapid, irregular heartbeat, cardiac arrhythmias, angina pain, palpitations, heart arrest, fear, anxiety, restlessness, insomnia, dizziness, faintness, flushing, tremor, muscle weakness, headache, irritability, psychotic states, altered metabolism

Contraindications: Should not be used in pregnancy, breastfeeding, high blood pressure or hypertension, hyperthyroidism, diabetes, closed-angle glaucoma, heart disease, prostate enlargement. Should not be used by children and teenagers.

Special warning: Can become addictive. Can be abused. Effects wears off over time, requiring larger doses.

Ephedrine is a banned substance in sport

2) Herbal products

Example Effects Side effects/Caution
Citrus aurantium, Bitter orange extract contains synephrine Suppresses appetite, increases energy, lifts the mood, produces a ‘high’ Nausea, vomiting, dry mouth, thirst, thirst, problems with urination, hypertension, rapid, irregular heartbeat, cardiac arrhythmias, angina pain, palpitations, heart arrest, fear, anxiety, restlessness, insomnia, dizziness, faintness, flushing, tremor, muscle weakness, headache, irritability, psychotic states, altered metabolism

Contraindications: Should not be used in pregnancy, breatfeeding, high blood pressure or hypertension, hyperthyroidism, diabetes, closed-angle glaucoma, heart disease, prostate enlargement, children and teenagers.

Special warning: Can become addictive. Can be abused. Effects wears off over time, requiring larger doses.

Ephedrine in any form is a banned substance in sport.

 

Fibre and Gums

Example Effects Side effects/Caution
Guar gum, pectin derived from apples, citrus fruit, psyllium, methylcellulose, bran derived from cereals Fibre swells when mixed with liquid in the digetsive tract, thus causing a feeling of satiety (fullness) and stimulating peristalsis, thus reducing the length of time that food is present in the digestive tract. Fibre lowers blood cholestrol levels. Small amounts used in slimming products may not be sufficient to produce satiety. Dietary fibre in standard foods is just as, if not better, for producing satiety and increasing peristalsis. Excessive intakes of fibre, esp. psyllium and methylcellulose can cause diarrhoea, bloating, cramps and interfere with mineral uptake. Dietary fibre in standard foods lowers the energy content of foods.

Herbal extracts




1) Guarana

Example Effects Side effects/Caution
Guarana contains caffeine Stimulant, suppresses appetite, increases energy, lifts the mood, produces a ‘high’, diuretic Headache, nausea, insomnia, restlessness, excitement, muscle tremor and gastric ulcers. Excessive intake can casue dehydration.

Contra-indidcations : Should not be used during pregnancy or breatsfeeding, or by children and teenagers.

Special warning: Can become addictive. Can be abused. Effects wears off over time, requiring larger doses.

Caffeine in large doses More than 12 ug/ml of urine) is a banned substance in sport.

2) Cayenne

Example Effects Side effects/Caution
Cayenne Improves circulation. May counteract ulcers. Probably non-toxic because of small quantities included in slimming products. Benefit not proven scientifically.

3) Dandelion

Example Effects Side effects/Caution
Dandelion root or extract – taraxacum Laxative Probably non-toxic because of small quantities included in slimming products. If taken in excess, it may cause diarrhoea, upset the fluid and electrolyte balance and prevent absorption of vital nutrients leading to deficiencies.

4) Ginseng

Example Effects Side effects/Caution
Ginseng (American, Chinese, Siberian or Korean) Can increase energy, counteract fatigue, repair damage due to stress, aids recovery after exercise, may lower blood sugar levels. Appetite stimulant! Products may vary in strength and quality because of the high cost of the original ginseng root. May cause insomnia, asthma, hypertension, fever, fibrocystic breasts, emphysema, hypoglycaemia, irregular heartbeat, palpitations and blood clotting problems.

5) Uva ursi

Example Effects Side effects/Caution
Uva ursi (bearberry leaves, busselrole) Diuretic Probably non-toxic because of small quantities included in slimming products. If taken in excess, it may cause dehydration and upset the fluid and electrolyte balance.

6) Bitter orange extract or citrus aurantium
(See above – herbal products that contain epinephrine – note side-effects, contraindications and warnings!)

7) Ginger root

 

Example Effects Side effects/Caution
Ginger root (gengibre, ingwer) Prevents nausea and motion sickness Probably non-toxic because of small quantities included in slimming products. May be added to counteract side-effects of other ingredients!

8) White willow bark

Example Effects Side effects/Caution
White Willow Bark contains salicin, the same chemical aspirin is derived from! Prevents pain. Prostaglandin inhibitor. Nausea, vomiting, bleeding ulcers, severe reactions in asthmatics, kidney damage, dissiness, anaemia, skin eruptions, bronchospasm, breathlessness, prevents blood clotting. reye’s syndrome in children.

Contraindications: pregnancy and lactation, young children, patients with peptic ulcers, anaemia, haemophilia, kidney disease, and those taking anticoagulant therapy.

 

Hydroxycitrine (HCA)

Example Effects Side effects/Caution
Hydroxycitrine or-citrate (HCA) or Garcinia cambogia May stimulate the Krebs Cycle or inhibit the ensyme citrine lyase which may inhibit fat deposition Probably non-toxic because of small quantities included in slimming products. Slimming effects not proven – additional research required.

Kelp and seaweed extracts

Example Effects Side effects/Caution
Kelp, seaweed extracts, ascophyllum nodosum, agar Contains iodine and other trace minerals that may stimulate metabolsim. Agar may produce a feeling of satiety. Iodine supplementation not required in South Africa as table salt is iodated by law. Excessive intake of iodine may cause thyroid problems.

Phenolphthalein

Example Effects Side effects/Caution
Phenolphthalein Laxative Allergis reactions including skin eruptions, rashes, cramps, colic, cardiac and respiratory distress, diarrhoea which may cause dehydration, fluid and electrolyte imbalance and deficiencies, and lead to colon malfunction.

Contraindications: Pregnancy, patients with sensitivity to this compound.




Pyruvate

Example Effects Side effects/Caution
Pyruvate, pyruvic acid Acts as a substrate in the Krebs Cycle releasing energy when oxidised Probably non-toxic. Slimming effects of pyruvate taken orally are not proven. Additional research required

Trace elements

1) Chromium

Example Effects Side effects/Caution
Chromium picolinate or polynicotate Regulates blood glucose levels and promotes weight loss. The optimum dose is 200 microgram per day. this does should not be exceeded. Excessive intakes of chromium and other trace elements can cause toxicity. “More is not better!”

2) Boron

Example Effects Side effects/Caution
Boron salts Influences calcium and magnesium metabolism. May increase testosterone levels in the body, thus promoting lean muscle development. Doses should not exceed 50 mg/day as Boron may be toxic.  “More is not better!”.

2) Selenium

Example Effects Side effects/Caution
Selenium salts Involved in fat metabolism, vitamin E and antioxidant functions RDA is 70 ug for men, 55 ug for women per day. Excessive intakes may be toxic. “More is not better!”

Many slimming pills and products contain added vitamins, particularly of the water-soluble B complex group – thiamine (B1), riboflavin (B2), niacin (nicotinamide), pyridoxine (B6), folate ( folic acid), cobalamin (B12) pantothenic acid, biotin and vitamin C. These vitamins play important roles in most chemical reactions in the human body and are, therefore, capable of stimulating metabolsim. Vitamin C is also an important antioxidant, but does not have any slimming properties. Unless water-soluble vitamins are present in excessive amounts exceeding their RDA’s they should not have adverse effects.

Fat-soluble vitamins such as vitamins A, and D, should not be taken in amounts exceeding their RDAs of 5000 IU and 400 IU respectively per day.




Credits: https://www.timeslive.co.za/sunday-times/lifestyle/2010-08-05-can-diet-pills-kill-you/

https://www.health24.com/Diet-and-nutrition/Weight-loss/Slimming-pills-and-drops-20120721

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