Diet Drugs and Supplements BREANNE BONILLA CARLIN COOMBS KIMBERLY WILLOW JANE JENSEN

History

Late 1800’s and Early 1900’s 2nd Century AD: Late 1800s: 1920’s: Soranus of Ephesus prescribes laxiatives and purgatives for obesity Late 1800s: The first diet pills based off of thyroid extract were marketed as "fat reducers“ Discontinued due to causing side effects such as hyperthyroidism 1920’s: Trend of using laxatives for weight loss. Gimmicky weight-loss products advertised.

Early-Mid 1900’s 1933: 1938: 1940’s: Dinitrophenol was introduced. It claimed that it prevented food energy from being turned into fat. 1938: Dinitrophenol was voluntarily withdrawn by manufacturers. Enactment of the Food, Drug, and Cosmetics Act. 1940’s: Appetite suppressant candy called Ayds was marketed

Mid 1900’s Late 1930s - 1950s: Doctors began prescribing amphetamines for its side effect of appetite suppression 1950’s: Tapeworm diet pills hit the news after opera singer Maria Callas was rumored to have ingested one for weight loss. Unverified if there were really tapeworms in the advertised pills. 1959: Phentermine approved by the FDA

Mid 1900’s 1960’s: "Rainbow pill" regimes were being used. They were a combination of multiple pills to help weight loss, such as amphetamines, diuretics, and laxatives. 1965: Appetite suppressant aminorex fumarate was developed as treatment for obesity. Withdrawn from the market two years later due to pulmonary hypertension side effects. 1970’s: Adderall was used as a diet drug, marketed under the name Obetrol.

Late 1900’s 1973: the Food and Drug Administration approved the drug fenfluramine FDA began the recall of diet drugs containing amphetamines. 1979: Fenfluramine and phetermine have been combined into Fen-Phen and gained popularity.

1990’s 1992: Fen-phen gained more popularity when a report stated that it caused a 10% weight loss. 1994 Dietary Supplement Health and Education Act is passed, which adds the "dietary supplement" category. Ephedra classified as a herb and use for weight loss increases. 1995 Dexfenfluramine (Redux) was developed as an alternative to fenfluramine with less side-effects.

1990’s 1997 Removal of fen-phen is called for by the FDA after reports linking fen-phen with heart valve problems. Redux removed from the market due to similar problems relating to cardiovascular health. 1998 Meridia is put on the market.

2000’s 2004: Ephedra removed from the US market from concerns with raising blood pressure which could lead to strokes and death. 2009 Hydroxycut diet supplements pulled off the market after reports of liver damage. Meridia (sibutramine) is removed from the US market from concerns that it could raise blood pressure and cause stroke or heart attack.

2000’s 2010 Orlistat (prescription as Xenical, over-the-counter as Alli) is available. Orlistat is taken to reduce the amount of dietary fat that is absorbed by the digestive tract.

Drug Pharmacodynamics

Prescription Drug Pharmacodynamics Orlistat (Xenical) Basic Function: Prevents the absorption of fats, reducing caloric intake Saturated version of Lipstatin Inhibits pancreatic lipases which break down fat molecules OTC version: Alli Half the dose of prescription Xenical Side Effects: Oily discharge/fatty stools Lower absorption of fat soluble vitamins

Prescription Drug Pharmacodynamics Sibutramine (Meridia) Phentermine Basic Function: Inhibits NT reuptake in brain Serotonin Norepinephrine Dopamine Enhances feeling of satiety Increased risk of heart attack and strokes Pulled from US market in October 2010 Still present in many counterfeit products Basic Function: Causes release of norepinephrine in hypothalamus Reduces feeling of hunger Similar structure to amphetamines Part of Fen-Phen combination drug

Prescription Drug Pharmacodynamics Metformin (Glucophage) Diabetes drug For people overweight and suffering from diabetes to aid in weight loss Basic function: Lowers glucose levels Increase insulin sensitivity Appetite suppressant

Common Side Effects for Prescription Drugs Nausea (minor or severe) Constipation/Diarrhea Dry mouth Headaches Insomnia Increased blood pressure and heart rate (minor or severe) Nervousness, confusion, and irritability

Prescription Drug Results Very minimal results without diet and exercise Most show loss of about 8-12 lbs/year Lifestyle changes needed for more serious results All have serious side effects  should only be used in more serious cases (risk vs. reward?) Many people abuse (OD, use of non-diet prescription drugs)

OTC Supplement Pharmacodynamics Ephedra/Ephedrine Ephedra: plant with 2 active constituents: Ephedrine Pseudoephedrine Ephedrine is normally paired with caffeine in OTC diet supplements Basic function of Ephedrine: Appetite suppressant Acts on adrenergic receptors Side Effects: High blood pressure Heart attacks, strokes (can be fatal) Tremors/seizures Insomnia Banned by FDA Drugs now contain “legal ephedra” Epehdra without ephedrine

OTC Supplement Pharmacodynamics Ephedra Replacements Bitter orange Essential oil from an type of orange Similar health concerns as ephedrine Lack of evidence about effectiveness Hoodia gordonii South African spiny succulent plant Increases hypothalamic ATP No published scientific evidence demonstrating use as appetite suppressant

Celebrity Endorsements

Celebrity Sponsors Marketed products claim weight loss through celebrity endorsements Much of the popularity of diet drugs is due to clever marketing and ad campaigns… such as TrimSpa

Anna Nicole Smith “LIKE MY BODY” Lost 69 lbs. In 2005, TrimSpa was sued for Anna's erratic behavior at a concert- associated with slurred speech and behavior http://www.youtube.com/watch?v=A4GsS5ua4MEht

TrimSpa Baby! Potential TrimSpa Side Effects and Concerns Original TrimSpa formula contained the stimulant herb ephedra Expensive (>$48/month) No longer individually lists the ingredients Side effects may include anxiety and insomnia (rec. amount of 4 pills/day = two 8-ounce coffee) May trigger migraines (tyramine) Shouldn’t be taken with Monoamine Oxidase Inhibitor(MAOI) antidepressant drugs What’s good about TrimSpa? Contains glucomannan, a water-soluble dietary fiber derived from konjac root

Keeping Up With the Kardashians “How HOT Can You Be?” Kim claims to have lost 15 lbs, Khloe 25 lbs(some of which she gained back) Advertises “to help burn calories, support energy levels, and supercharge workouts” (getquicktrim.com) Pressures women receive: Temptation of getting that bikini body Kim and Khloe Kardashian use sex to sell their QuickTrim diet pills  http://www.youtube.com/watch?v=Q69Igo7xcGA

QuickTrim “This product isn’t intended to be a complete replacement for having a reasonably healthy diet and lifestyle” (kardashiansquicktrim.com) Dangers of Kardashian-Endorsed QuickTrim 4 QuickTrim products Sculpting gel for cellulite 14-day "burn and cleanse“ 48-hour cleanse 8-hour weight loss formula that burns calories 300% x faster All of which are advertising fast weight loss. Most experts recommend effective weight loss to be gradual and just 2 lbs/week for safe and long-term weight loss, even with the help of diet drugs.

QuickTrim Weight Loss Supplement Burn & Cleanse 14-Day Diet System- burns calories by day and cleanses by night Daytime pills are mostly caffeine: contains thermogenic complex, black pepper, white willow bark Nighttime supplements are laxatives: contains stimulant laxatives (senna, cascara, rhubarb) and bulk laxatives (fig extracts, oat fiber) May get diarrhea, loss of nutrients, dehydration Iso-Flush- taken along with Burn & Cleanse Herbal diuretics to shed water from body: contains horsetail extract, juniper berry If taken for long periods can be toxic. Can reduce kidney function & may suffer from severe dehydration.

Lose it on the QT! Fast Cleanse- “48-hour Super Diet Detox” to drop a dress size Fiber-rich drink 4x/day b/w meals Primarily a digestion-resistant polysaccharides Extreme Burn- supposed to be used long term after finishing 14-day plan Contains a lot of caffeine and herbs to boost potency Powerful stimulants, laxatives, and diuretics. At best, these diet pills will produce short-term weight loss because they stimulate or speed up metabolism and act as diuretics Since under "supplements" instead of “medications”, they are NOT required to undergo rigorous FDA testing to ensure they are safe and do what their manufacturers claim they do

Problems with Diet Drugs

Diet Pill Makers Misleading Consumers Federal Trade Commission says some diet companies make false advertising claims ranging from rapid weight loss to reducing risk of cancer, Alzheimer’s, osteoporosis FTC challenges marketing of claims -> required to back up claims with the science Fines levied against 4 over-the-counter non-prescription diet pills: Xenadrine, One a Day Weight Smart, CortiSlim, TrimSpa A combined $25 million Receive money back when consumers have been deceived Ex: Bayer Corp. paid $3.2 million civil penalty to settle claims and agreed to stop ads that say “multivitamins can increase metabolism”

Trying to lose weight? Don’t turn to pills! FTC claims there are NO scientific evidence that diet pills cause weight loss Testimonials from individuals are not a substitute for science FTC also said that customers using the products and providing testimonials were paid as much as $20,000 for their “endorsements.” The media and women’s magazine have been “urged” to refuse or remove these type of ads from their magazines, or investigate the claims being made. But doesn’t because they want the revenues!

Counterfeit Diet Pills Booming trade in counterfeit slimming pills Medicines and Healthcare Regulatory Agency(MHRA) sited 2 prescription-only anti-obesity pills: Xenical, Reductil Very commonly counterfeited in UK Through illegal pharmacies and illegal websites where demand is high and maximum profits are made Fake prescription obesity pills contain little active ingredient, some may cause harm Made in substandard conditions, contain impurities No true regulation (no prescription necessary)

Problems There is NO medical or other supervision of any kind May be easily abused. Ex: In fact, teenage girls are some of the heaviest users of retail diet pills, because they’re easily accessible.

Advertisements for Male Audiences “A SKINNY MAN HASN’T A CHANCE” POP SOME PILLS AND WATCH THE FAT MELT AWAY -- THAT’S NOT FAR FROM THE TRUTH

Apolo Ohno and 8 Zone Apolo Ohno Founder/owner of 8 Zone Pills for each 8-hour segment of day

Apolo Ohno and 8 Zone Step 1: Aggressive (Red Zone) For the most active part of your day (during work) For healthy, sustained energy And for thermogenic fat-burning Step 2: Subtle (White Zone) To keep you going after work For wholesome nutritional replenishment To promote anti-aging and combat oxidative stress Step 3: Downtime (Blue Zone) For full rest and recovery For great sleep For muscle recuperation

Some of the Disclaimers Apolo Ohno and 8 Zone Some of the Disclaimers 22.4 - We do not guarantee that You will have any specific or particular result or benefit from the Product, or that your experience will match those of others who use the Product(s). Individual results will vary from person to person. Apolo Ohno is a professionally trained athlete and 8zone makes no guarantee or warranty that taking 8zone alone will produce the same results as a professionally trained athlete like Apolo Ohno. 22.5 - Any and all testimonials and/or statements from users of the Product(s) are those of the respective user. 8zone does not endorse any such statement and/or warrant that any such statement is true or accurate. 8zone likewise does not investigate the accuracy of any testimonial.

Xenadrine Since Ronnie has started, his GTL routine is now XGTL-Xenadrine. Gym. Tan. Laundry.

Xenadrine Xenadrine ULTRA, “these ingredients have not been evaluated by the FDA.  These products are not intended to diagnose, cure or prevent any disease” Sold at GNC where various diet supplements are sold. 1990’s, Xenadrine EFX contained ephedrine and synephrine (similar to amphetamines) Now, Xenadrine ULTRA contains yerba mate, guarana, 1,3,7-trimethylxanthine Contain 200 milligrams of caffeine Excite body functions, result in short-term weight loss Vitamins in Xenadrine don’t impact weight loss

Xenadrine From Ronnie’s Facebook page (linked from Xenadrine website): “You heard? I got a new workout partner: Xenadrine. Gives me the energy I need. Love that I'm endorsing something that really works!” A response to Ronnie’s Post: CSP- I truly use Xenadrine cuz of ONLY one reason and that reason Ronnie.thank You Ronnie for be their Spokes Man cuz of You and Xenadrine I`am finally lossing the weight I want.so thank You Ronnie and Xenadrine We are sure that Ronnie is happy CSP is “lossing” the weight with Xenadrine.

Xenadrine Studies published on website all have reduced calorie diet… Mentions that Xenadrine is best combined with diet and exercise! Promotes the unachievable body Promotes weight management with minimal effort Study showed placebos more effective than Xenadrine

Children and Teens

Advertisements Obesity drug ads misleading teens “Xenical” Ads aired during popular show, Australian Idol. Controversial The Australian National Drugs and Poisons Schedule Committee banned OTC commercials as they were targeted to average weight people

Effects in Society Questioned UCSF study that 80% of fourth-grade girls were dieting At a school in Illinois (1986) 75% of 9 year old girls said they weighed too much and afraid boys wouldn’t like them if they got fat Results have not changed much

TV Shows and Media Icons 90210 stars although labeled by magazines ‘too skinny’ still very popular show Dr Aric Sigman’s article in The Biologist The media is a causal risk factor for body dissatisfaction Studied female reactions to TV shows with thin characters around the world

Cost/Common Statistics US weight loss market 1992 $30 billion Now estimated $40-60 billion Prescription and over-the-counter diet drugs altogether took in $381.5 million in 2009, according to data from IMS Health.

Diet Pill for Dogs… Substitute for exercise and food reduction Slentrol is the first FDA-approved diet pill for dogs

Final Thoughts Rule: Do NO harm Question: Do benefits outweigh the risks? No Quick fix Not for people who want to lose 5-10 lbs For morbidly obese Must include lifestyle change; diet and exercise!!!!!!

Works Cited - History "Diet Pills - Overview." Encyclopedia of Drugs and Addictive Substances. Ed. Barbara C. Bigelow. Gale Cengage, 2006. eNotes.com. 2006. 9 Mar, 2011 <http://www.enotes.com/drugs-substances-encyclopedia/diet-pills/overview>   Whittemore, Frank. (January 18, 2010). The History of Diet Pills. In Livestrong.com. Retrieved March 2011, from http://www.livestrong.com/article/74336-history-diet-pills/. Grabianowski, Ed.  "Have people ever really eaten tapeworms for weight loss?"  16 December 2008.  HowStuffWorks.com. <http://health.howstuffworks.com/wellness/diet-fitness/weight-loss/tapeworm-weight-loss.htm>  09 March 2011. Jones, A. R. (2002). FDA vs. Ephedra: Dietary Supplement Regulation Under DSHEA, pp. 2. Citation. (2011, March). In Wikipedia, The Free Encyclopedia. Retrieved from http://en.wikipedia.org/wiki/Anti-obesity_medication

Works Cited - Pharmacodynamics Zhi, J., Melia, A. T., Eggers , H., & Joly, R. (1995). Review of limited systemic absorption of orlistat, a lipase inhibitor, in healthy human volunteers. Journal of Clinical Pharmacology, Retrieved from http://jcp.sagepub.com/content/35/11/1103.long Morris, J. (2006). Little research behind claims that hoodia is safe, effective for losing weight. The Seattle Times, Retrieved from http://seattletimes.nwsource.com/html/health/2002850423_healthhoodia08.html Haller, C. A., & Benowitz, N. L. (2000). Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. The New England Journal of Medicine, 343. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJM200012213432502#t=articleTop Gurley, B. J., Wang, P., & Gardner, S. F. (2000). Ephedrine-type alkaloid content of nutritional supplements containing ephedra sinica (ma-huang) as determined by high performance liquid chromatography. Journal of Pharmaceutical Sciences, 87(12), Retrieved from http://onlinelibrary.wiley.com/doi/10.1021/js9801844/pdf The pharmacokinetics of phentermine and chlorphentermine in chronically treated rats. (1973). Journal of Pharmaceutical Pharmacology, 25(3), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/4146324 Guerciolini, R. (1997). Mode of action of orlistat. Int J Obes Relat Metab Disord. , 21(3), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9225172 Bray, G. A. (1999). Sibutramine produces dose-related weight loss. Pennington Biomedical Research Center, 7(2), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10102256 James, Philip. (2000). Effect of sibutramine on weight maintenance after weight loss: a randomised trial. The Lancet, 356(9248), Retrieved from http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T1B-4221FXX-9-6&_cdi=4886&_user=4429&_pii=S0140673600034917&_origin=gateway&_coverDate=12%2F30%2F2000&_sk=996430751&view=c&wchp=dGLzVzz-zSkWA&md5=c8f66276ed614b035e95c691f53b50b8&ie=/sdarticle.pdf Duenwald, M. (2005). Bitter orange under scrutiny as new ephedra. The New York Times, Retrieved from http://www.nytimes.com/2005/10/11/health/policy/11cons.html?_r=1 Shekelle, P. G., & Hardy, M. L. (2003). Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance. JAMA, 289(12), Retrieved from http://jama.ama-assn.org/content/289/12/1537.full.pdf+html Gokcel, A., & Gumurdulu, Y. (2002). Evaluation of the safety and efficacy of sibutramine, orlistat and metformin in the treatment of obesity. Diabetes, Obesity and Metabolism, 4(1), Retrieved from http://onlinelibrary.wiley.com/doi/10.1046/j.1463-1326.2002.00181.x/pdf Lee, A., & Morley, J. E. (1998). Metformin decreases food consumption and induces weight loss in subjects with obesity with type ii non-insulin-dependent diabetes. Obesity Research, 6(1), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9526970

Works Cited – Celebrity Endorsements and Problems with Diet Drugs Ashton, J. (2010, September 16). CBS News Health Watch. New Diet Drugs Await Approval. Retrieved from http://www.cbsnews.com/video/watch/?id=6871953n Blatner , D., & Bauer, J. (2007, October 5). Weight Loss Drugs: How Much Do Diet Pills Help? . American Dietetic Association, Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=56559&page=2 Bowdler, N. (2010, July 7). BBC News Health. The booming market in counterfeit slimming pills. Retrieved from http://www.bbc.co.uk/news/10258849 Diet and Nutrition. (2007, January 4). Diet pill makers fined millions for false claims . Retrieved from http://www.msnbc.msn.com/id/16467558/ns/health-diet_and_nutrition/ Diet Pills Report & Review [The Use of Retail (non-prescription) Diet Pills & Appetite Suppressants]. (2010). Retrieved from http://www.bestdietforme.com/dietpills.htm Kardashians QuickTrim Resource [Online forum post]. (2010). Retrieved from kardashiansquicktrim.com Kotz, D. (2010, January 19). The Dangers of Kardashian-Endorsed QuickTrim. U.S. News & World Report of Health on Women, Retrieved from http://health.usnews.com/health-news/blogs/on-women/2010/01/19/the-dangers-of-kardashian-endorsed-quicktrim QuickTrim. (n.d.). Retrieved March 6, 2011, from getquicktrim.com Wong, C. (2007, September 19). Does Trimspa Work? Trimspa Review. Retrieved March 6, 2011, from http://altmedicine.about.com/od/popularhealthdiets/a/Trimspa_Review_2.htm

Works Cited – Ads for Male Audiences and Children and Teens Zaslow, Jeffrey.  (2009).  Girls and Dieting, Then and Now.  Wall Street Journal online.  http://online.wsj.com/article/SB10001424052970204731804574386822245731710.html Beauty and Body Image in the Media (n.d.)  Media Awareness Network, CA. http://www.media-awareness.ca/english/issues/stereotyping/women_and_girls/women_beauty.cfm?RenderForPrint=1 Erfurt, Barbara.  (2010).  How Does Xenadrine work?  Livestrong.com http://www.livestrong.com/article/74416-xenadrine-work/#ixzz1G30vDgcD A Skinny Man hasn't a chance.  Picture from http://farm4.static.flickr.com/3167/3009875959_b3273af86f_o.jpg Ronnie Magro facebook http://www.facebook.com/pages/Ronnie-Magro/114953338537646 Wall Street Journal.  Picture from http://www.wasauna.com/wallstreet.html 90210 Stars:  Too thin for TV? (2008) http://justjared.buzznet.com/2008/09/17/90210-stars-too-thin/ Marris, Sid. (2007).  Ban on Weight Loss Drug Ads.  The Australian online. http://www.theaustralian.com.au/news/nation/ban-on-weight-loss-drug-ads/story-e6frg6nf-1111114303350 Xenadrine information: http://www.xenadrine.com/ 8 Zone information: http://8zone.com/about.php Extreme Weight Loss Techniques.  Askmen.com http://www.askmen.com/sports/health_150/154b_mens_health.html