You want to lose some weight. You hear about this stuff at the drugstore that melts pounds away. What's the harm? Ellen Ruppel Shell investigates the current crop of diet pills that are so tempting, and so potentially deadly.

Baltimore Orioles pitching prospect Steve Bechler knew he had to drop a few pounds if he was going to break into the major leagues. So when he cracked open the bottle of Xenadrine RFA-1, swallowed three pills, and reported for spring training at Fort Lauderdale Stadium last February, he figured he was doing the right thing, just taking care of business.

Twenty-four hours later, Bechler was dead. He left behind a pregnant wife, a slew of grieving fans, and a raging controversy over an herbal supplement taken by millions of Americans.

Bechler never stood a chance. Desperate to lose weight quickly, he was precisely the sort of person supplement-makers target. Plagued with high blood pressure and abnormal liver function, the 23-year-old athlete was also precisely the sort of person most endangered by their wares.

Diet Supplements 101
Xenadrine RFA-1's advertising campaigns brag of "clinical studies" that "prove" it significantly alters the ratio of fat to muscle, "which results in significant improvements to the body's metabolism." The boasts are backed by testimonials and snazzy before-and-after shots of happy customers, but no explanation of how these metabolic improvements might occur, or what they might be. It's unlikely Bechler knew that Xenadrine RFA-1 is not approved for weight loss, or anything else, by the Food and Drug Administration. Nor is it likely he was aware that Congress has for years debated a ban on its active ingredient, the herb ephedra.

Ephedra can be found in more than 200 weight-loss aids and energy boosters. Among these is Metabolife 356, the country's best-selling over-the-counter diet preparation. Metabolife 356 contains a particularly potent combination of ephedra and caffeine, which the maker claimed for years had no serious side effects. Under threat of a federal investigation and criminal charges, Metabolife president David Brown finally admitted last year that between 1997 and September 2001 his company received roughly 13,000 reports of "certain health-related issues" linked to the supplement, among them heart attacks, strokes, seizures and death. A subsequent analysis added high blood pressure, palpitations, psychosis and other serious problems. Indeed, while ephedra makes up less than one percent of herbal supplement sales, it accounts for 64 percent of all reported side-effects from herbs. And for every one of these incidents, the FDA estimates, nearly 100 go unreported.

Looking back, it's almost incredible that anyone would consider ephedra a safe method for weight loss. The herb contains ephedrine, which in its synthetic form is a staple on crash carts, the hospital emergency room trolleys filled with drugs and devices used to shock the near dead back to life. Because its effect on the central nervous system is similar to that of amphetamines, it is sometimes called "poor man's speed." The idea of shedding pounds without extra effort has great appeal, of course, and drug companies have for decades searched for a weight-loss elixir that would uncouple the burning of calories from the performance of work. Unfortunately, ephedra and other amphetamine-like substances do not divorce these functions. In fact, it is their side-effects—the nervous jitters, pounding heart, thumping blood pressure—that speed the metabolic rate. In many of the most popular weight loss preparations, this effect is enhanced by caffeine. Together, these can make for a deadly combination.

Since Bechler's death, Congress has stepped up its investigation of ephedra, and the supplement industry has scrambled to remove it from diet formulations.

Diet Supplements 101
History is littered with frightening tales of snake-oil salesmen peddling elixirs and tonics—most of them ineffective and many dangerous—to unwitting citizens. In 1958, Congress attempted to curb this abuse by giving the FDA power to regulate supplements as it would food or drugs. But in 1994, the agency's authority was revoked with the passage of the Dietary Supplement Health and Education Act, a piece of legislation cosponsored by Iowa senator Tom Harkin and Utah senator Orrin Hatch (whose son, Scott Hatch, is a lobbyist for the supplement industry). The new law stipulated that makers of dietary supplements do not have to seek approval from the FDA and do not have to prove their products safe and effective. No surprise, then, that the act helped launch supplements into a $17.7 billion industry. In order to ban a supplement today, the FDA must prove it is dangerous—an arduous and expensive process.

In the summer of 2000, the Department of Health and Human Services held a public meeting on ephedra-based products, where it was noted that the FDA had received more than one thousand reports of adverse effects—including death—of ephedra. But George Bray, M.D., a professor of medicine at Louisiana State University and former executive director of the Pennington Biomedical Research Center, and an esteemed, widely published scientist, did not believe this was reason to ban the drug. Rather, he told the panel members that over-the-counter preparations of ephedra and caffeine are safe when used correctly. Indeed, Bray endorsed the use of ephedra. A former president of the International Association for the Study of Obesity who had devoted his career to researching and treating the clinically overweight, Bray had great credibility and influence with the committee. Although he stated up front that his appearance was being supported by Metabolife, the fact that he himself had licensed a thigh-shrinking ointment to three companies (including one, Herbalife, which sold ephedra products) did not come up in his testimony.

Diet Supplements 101
Nonprescription diet aids proliferate so quickly—the names of the products and their makers changing so frequently—that no oversight agency, no matter how efficient, can keep track of them. The Internet has made their sale all the easier (a quick search for any diet supplement on the Web pops up scores of vendors eager to dole out bottles of the stuff at the click of a mouse). As a result, consumers are left largely on their own. But understanding a few basic principles helps:  
  • Virtually all weight-loss supplements, even moderately effective ones, contain either amphetamine-like herbs or laxatives.
  • Amphetamines speed the heart and nervous system, tend to aggravate rather than mitigate high blood pressure and other side effects of being overweight, and can be addictive.
  • Laxatives—potentially dehydrating, particularly in children—can also be addictive.
  • Both amphetamines and laxatives tend to lose their power over time, forcing users to raise the dose, often to dangerous levels.
Controlling appetite is a complicated process, one that has yet to be fully understood by scientists. The labyrinth of genes, proteins and hormones regulating our eating behavior is dense, byzantine and extremely difficult to fool or manipulate. Knocking out one or two components of this system with supplements—or even prescription drugs—is unlikely to work for long because other components rush in to take their place. At best, the prescription weight-loss drugs that are currently available, as well as those in the pipeline, are considered a stopgap measure, a crutch to support patients as they develop healthier life strategies.

Before purchasing a diet supplement, consider this: Were the scores of over-the-counter weight-loss remedies safe and effective, they wouldn't rely for sales on Sunday morning infomercials and endorsements from trumped-up diet experts. Given that obesity and overweight are among the most common 21st-century ills, any product that actually helped people to get thin quickly, safely and with minimum effort would sell itself. Thanks to the tragic loss of a young ballplayer, Congress is finally stepping up to the plate in an effort to regulate diet supplements. But for now, prudence and common sense are our best protection: Rather than throw your money away on worthless and possibly dangerous over-the-counter diet aids, consider sending a note to your congressperson demanding their regulation.  

Diet Supplements 101


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