Natural practitioners can help lead the battle against obesity.
It should come as no surprise that of the forty-five percent of Americans who made New Year’s resolutions, the No. 1 in 2012 was to “lose weight,” according to the University of Scranton Journal of Clinical Psychology. Also not unexpected, the number of people who were successful in achieving their goal was just eight percent.By the time this magazine issue arrives at readers’ doors, more than 30 percent of 2013’s resolutions will be broken.
For practitioners, the challenge of helping patients stay motivated and achieve their weight-loss goals can be viewed as a driving force to aid in the battle of the bulge.
“With almost 70 percent of Americans either overweight or obese, natural health practitioners can play a leading role in weight management,” said Heather Hausenblas, PhD (health psychology, kinesiology), associate professor at Jacksonville University and adjunct faculty at the University of Florida. “The biggest issue facing natural health practitioners is whether they can lift their profile to be seen widely as providing the most effective solutions to the obesity epidemic.”
Natural approaches to weight management include lifestyle and following a healthy diet (including supplementation), exercising regularly and getting enough sleep, according to Dr. Hausenblas.
“A practitioner must consider the current health of his/her patient and the amount of weight that needs to be lost. Motivation is a key aspect for adherence to a weight-loss program. Unfortunately, adherence to conventional weight-loss interventions (e.g., regular exercise and a healthy diet) is low,” she said. “Nutritional supplements that are clinically proven to support weight loss may provide people with a simple and economical way to improve their health and weight.”
Dr. Michael Zemel, chief scientific officer with Tennessee-based manufacturer NuSirt Sciences, added that weight loss and gain is driven first and foremost by energy (calorie) balance; weight is gained when calories eaten exceed calories burned and lost when calories burned exceed calories eaten.“However, naturally occurring components of some foods can help this process by helping us to burn more calories,” he noted.
“A large number of food components have been proposed to contribute to weight management. These include conjugated linoleic acid, green tea, capsaicin, caffeine and many others, but the reported effect in the scientific literature for each of these is modest at best, with maximum effects in the 50 to 100 calorie range, and that support is limited to a small number of conflicting studies.”
The terms “overweight” and “obese” describe weight ranges that are above what is medically accepted as healthy. Being in either the overweight or obese weight ranges increases the likelihood of certain diseases and health problems. More than one-third of U.S. adults (~36 percent) are obese. For most people, body mass index (BMI) is a good estimate of body fatness; a BMI of 25 to 29.9 is considered overweight; a BMI of 30 or higher is considered obese.
“Many factors play a role in the development of obesity, making it a complex health issue to address,” said Dr. Hausenblas. “At the most basic level, it is the result of an Energy imbalance. Simply stated, we eat too much and exercise too little.”
Energy is another word for calories, she continued. “Whenever you eat or drink, energy (in the form of calories) is coming in. At the same time, your body is constantly working, so energy (in the form of calories) is going out.When you are in ‘energy balance,’ your energy (or calories) in equates to energy out. To maintain a healthy weight, your energy in and out does not have to balance exactly every day. It is the balance over time that helps you maintain a healthy weight.”
Other causes of weight gain (besides eating too much and exercising too little) include: not getting enough sleep, stress, obesogens, genetics, sitting for too long and age, noted Dr. Hausenblas.
A visit to weight-loss product shelves at any natural health food store is likely to make consumers feel overwhelmed.Which really work and which don’t? And are they safe?
“Natural supplementation has become one of the many components in a successful weight management program, with most adults believing that they are a key component in the success of that program,” said Dr. Hausenblas. “Many supplements target health at the cellular level—nourishing, defending and supporting the cell.”
That said, patients rely on natural practitioners to educate them and prescribe the highest quality products to improve and maintain their health, she added. “For an overweight person, it is not enough to say eat less and exercise more. Natural practitioners need to give their patients specific tools and support to help them maintain a healthy weight.”
Dr. Hausenblas noted that Americans spend billions of dollars annually on nutritional supplements, and a large number of dietary supplement products are promoted for weight loss purposes.1 “Unfortunately, most of the claims for weight-loss supplements have limited to no support from randomized clinical trials.2 This makes it daunting for people to know which nutritional weight-loss supplements are supported by clinical results.Natural health practitioners need to become educated on effective and clinically based weight-loss supplements.”
Three nutritional supplements Dr. Hausenblas offered that have clinical support for weight loss are green coffee bean extract, saffron and high linoleic safflower oil, but noted that further research is needed to verify the weight-loss and health effects of these supplements in varying populations and study designs.
• Saffron—A recently published study found that Satiereal, a novel extract of the spice saffron, reduces snacking and enhances the experience of satiety potentially through its mood-enhancing effect.3 The randomized, placebo-controlled, double- blind study of 60 young, mildly overweight women evaluated body weight changes over an eight-week period. While caloric intake was left unrestricted during the study, participants consumed one capsule of Satiereal twice a day. The researchers found that the women who took the Satiereal saffron had a significant reduction in snacking frequency than women in the placebo group after eight weeks. In fact, snacking decreased by 55 Percent in the saffron group as compared to 28 percent in the placebo group.Women in the saffron group also lost significantly more weight (2.2 lbs.) Than women in the placebo group (0 lbs.) Of importance, the women achieved these results without changing either their diet or physical activity.
• Green Coffee Bean Extract—Green coffee beans are rich in chlorogenic acids, an antioxidant known for helping to lower blood pressure.4 Researchers have found that the same chlorogenic acids may also aid in weight loss.5 In a recent controlled clinical trial, overweight adults were randomized to either consume 400 mg a day of Svetol green coffee bean extract, with its specific ratio of chlorogenic acids, or a placebo-capsule for 60 days. Participants in both groups were also instructed to follow a bland low calorie diet. The researchers found that the adults who took the green coffee bean extract lost an average of almost 11 pounds compared to 5.4 pounds for the control group.
This study finding is supported by a recent meta-analysis of research examining the weight loss effects of green coffee bean extract.6 The review revealed that people who took green coffee bean extract had an average weight loss of 2.5 kg, suggesting that green coffee bean extract when used in conjunction with a lowcalorie diet can enhance weight loss.
• High Linoleic Safflower Oil—Another promising class of supplements target adipokine tissue and fat cell metabolism to reduce dangerous visceral fat found at the waistline. Researchers at the Ohio State University conducted a 16-week, double-blind, controlled study comparing high-linoleic safflower oil to conjugated linoleic acid in overweight women. They found that these diabetic and postmenopausal women lost significant amounts of visceral or belly fat (up to 9.4 percent) when taking the high-linoleic safflower oil.7 In fact, they lost six times more belly fat than did participants taking the conjugated linoleic acid. The researchers also found that adiponectin levels in the women taking the high-linoleic safflower oil increased by an average of 20 percent. Adiponectin is a protein hormone that modulates a number of metabolic processes, including glucose regulation and fatty acid oxidation. The women achieved these results without either diet restrictions or exercise.
In addition, Emily Gonzalez, ND, technical advisor with Washington-based BioGenesis Nutraceuticals, maker of the UltraLean Weight Management System, pointed out that many weight-loss products have evolved over the past few years based on available research recommending whey protein to support weight loss, better appetite control and improved insulin sensitivity. “The inclusion of phaseolamin, an alpha amylase inhibitor, and green tea leaf extract to support healthy metabolism and energy, assists patients to feel satisfied and helps with abdominal fat loss, making it more likely for patients to stay on a program supporting healthy weight loss,” said Dr. Gonzalez. “In the past two years, the variety of flavors and protein options has increased to cater to various dietary regimens and taste preferences.”
Launched in 2011, BioGenesis Nutraceuticals’ UltraLean Weight Management System incorporates UltraLean Body Composition powders, Ultra Low- Carb Bars, UltraLean Appetite Control supplement and a simple menu plan with structured meals and snacks. “In addition, guidelines for staying hydrated, incorporating appropriate exercise, getting adequate sleep and stress management strategies are detailed in the accompanying UltraLean patient handbook. They are free to health care professionals,” said Dr. Gonzalez.
UltraLean Body Composition powders help balance blood sugar and provide micronutrients to support insulin action. In addition, the 19 g of protein per serving, when combined with appropriate exercise, helps promote lean muscle mass synthesis and improved basal metabolic rate (BMR).UltraLean Appetite control is designed to support production of glucose tolerance factor and support healthy appetite regulation and reduced cravings through supporting balanced neurotransmitter levels. The Ultra Low- Carb Bars offer a low glycemic index and 10-13 g of protein per bar, and the Ultra Fiber Plus is a convenient way to increase dietary fiber intake, modulate glycemic response to meals and promote feelings of fullness.
Within the past two years, NuSirt Sciences developed NuShape, an all-natural supplement containing the amino acid leucine and vitamin B6 formulated at precise levels demonstrated to burn an additional 300 calories of fat daily in a randomized, placebo-controlled, double-blind, clinical trial of overweight and obese individuals.8 The impact of this increased fat oxidation on body weight and composition was then demonstrated in a six-month placebocontrolled, double-blind, randomized, clinical trial of NuShape in obese subjects with mild caloric restriction. The NuShape group lost 82 percent more weight and more than twice as much body fat as the placebo group at three months, and 55 percent more weight and 66 percent more body fat at six months. In a similar study with no calorie restriction, NuShape still promoted a fourpound loss of body fat, while the placebo had no effect.
Another example can be found in resveratrol, a plant polyphenol that exerts beneficial effects on glucose metabolism and protects against metabolic disease, including diabetes. “Unfortunately, most of these effects are only achieved at high doses (2,000-6,000 mg/day), which are difficult to obtain in humans; consequently, promising results from cellular studies with high concentrations are not readily translated to human outcomes,” Dr. Zemel said.
However, the nutraceutical combination, NuControl, has recently been developed to amplify the effects of resveratrol, reducing the amount required to produce significant metabolic benefits to 100 mg/day.9 “Although this level of resveratrol produced no independent beneficial effect, when combined with other nutrients to leverage it’s effects on key metabolic pathways it produced marked improvements in insulin sensitivity and glucose control,” he explained.
Developed in Germany over eight years, and launched in the United States about a year ago, the theory behind the PRECURSOR Diet is to limit the total number of calories while maintaining a healthy level of vitamins, minerals, fiber and fatty acids. “This is achieved through the use of the PRECURSOR Concentrate and following a low carbohydrate diet with low fat foods and lots of fresh vegetables,” said Brad Shewmaker, managing director of Floridabased Precursor Diet LLC.
“We recommend using the PRECURSOR Concentrate for the majority of dietary needs. A diet of protein with vegetables is also recommended to maintain a healthy level of nutrients. One could also supplement the diet with omega-3 supplements and fiber supplements if the patient is not eating enough vegetables.”
There are no “new” ingredients in the product, but rather amounts of common metabolic substrates used in conjunction with a low-carb, low-fat diet to maintain a healthy weight. The basis of the diet is knowing that calorie restriction is the most effective means for weight management, according to Shewmaker. “Following a calorie restriction protocol can be difficult and unhealthy because reducing calories usually results in depriving the body of nutrients.The PRECURSOR Diet is formulated to only take away the calories, and keep the nutrition,” he said.
The main ingredient of the PRECURSOR Concentrate is glycerol, a naturally occurring metabolic substrate, Shewmaker explained. “The glycerol is converted into glucose in the liver via gluconeogenesis and used by the brain.The brain is given the energy It needs for the day, thus eliminating hypoglycemic cravings.”
Weight-loss product safety and efficacy standards are in the hands of manufacturers, and the category continues to suffer from overstated promises, inadequate data support for claims and overly aggressive marketing, noted Dr. Zemel. “These make it difficult for consumers to distinguish between legitimate products with adequate scientific validation and products with little or no validation,” he said. “Although most consumers are intellectually skeptical of such exaggerated claims, body image issues often breed irrational behavior, and hope springs eternal that perhaps the next product really will work. If the industry fails to rein in these excesses, legitimate products will have a more difficult time seeing the light of day.”
1 Pittler, M. H., & Ernst, E. (2005).Complementary therapies for reducing body weight: A systematic review. International Journal of Obesity. 29, 1030-38.
2 Bray, G. A. (2008). Are non-prescription medications needed for weight control? Obesity.16, 509-14.
3 Gout, B., Bourges, C., & Paineau-Dubreuil,S. (2010). Satiereal, a Crocus sativus L extract, reduces snacking and increases satiety in a randomized placebo-controlled study of mildly overweight, healthy women. Nutrition Research.30, 305–13.
4 Watanabe T, Arai Y, Mitsui Y, Kusaura T, Okawa W, Kajihara Y, Saito I. The blood pressure- lowering effect and safety of chlorogenic acid from green coffee bean extract in essential hypertension. Clin Exp Hypertens. 2006 Jul;28(5):439-49.
5 Vinson, J. A., Burnham, B. R., & Nagendran,M. V. (2012). Randomized, double-blind, placebo- controlled, linear dose, crossover study to evaluate the efficacy and safety of a green coffee bean extract in overweight subjects. Diabetes, Metabolic Syndrome, and Obesity. 5, 21–7.
6 Onakpova, I., Terry, R., & Ernst, E. (2011).The use of green coffee extract as a weight loss supplement: a systematic review and metaanalysis of randomized clinical trials.Gastroenterology Research and Practice, Epub.
7 Norris, L. E., Collene, A. L., et al. (2009).Comparison of dietary conjugated linoleic acid with safflower oil on body composition in obese postmenopausal women with type 2 diabetes mellitus. The American Journal of Clinical Nutrition. 90, 468–76.
8 Zemel M, Bruckbauer A. Effects of a leucine and pyridoxine-containing nutraceutical on fat oxidation, and oxidative and inflammatory stress in overweight and obese subjects. Nutrients.2012; 4:529-541.
9 Bruckbauer, Zemel, et al. Synergistic effects of leucine and resveratrol on insulin sensitivity and fat metabolism in adipocytes and mice.Nutriton & Metabolism. 2012; 9:77.
Healthy Take Aways
The biggest issue facing natural health practitioners is whether they can lift their profile to be seen widely as providing the most effective solutions to the obesity epidemic.
Food components such as conjugated linoleic acid, green tea, capsaicin, caffeine and many others, have been proposed to contribute to weight management. But the reported effect in the scientific literature for each of these is modest at best, and that support is limited to a small number of conflicting studies.
Nutritional ingredients that have clinical support for weight loss include green coffee bean extract, saffron and high linoleic safflower oil.
Staying hydrated, incorporating appropriate exercise, getting adequate sleep and stress management strategies aid in weight loss.
FOR MORE INFORMATION:
BioGenesis Nutraceuticals, (866) 272-0500, www.bio-genesis.com
Centers for Disease Control and Prevention, www.cdc.gov/obesity/
NuSirt Sciences, (800) 634-4610, www.nusirt.com
Precursor Diet, (305) 908-7602, www.precursordiet.com
Weight-Loss Product Check
Key issues to be addressed by practitioners when making recommendations are those that ensure that the products they recommend to patients are safe, effective tools to help manage body weight, body fat and metabolic risk. NuSirt Sciences’ Dr. Zemel supplied key questions and criteria that can be used to see whether a product measures up:
• Are the claims made based upon sound science, using widely accepted approaches and published in reputable scientific publications?
• Is there a clear understanding of how the product works? Is there a well-understood mechanism of action?
• What populations has the product been tested in? (“Cellular testing is important, but is not sufficient—the scientific literature has many examples of promising approaches from cellular studies that don’t work when tested in people,” he said.)
• Has the product been shown to effectively enhance or support weight management/ weight loss in overweight and obese individuals? And is this demonstration in the form of scientific publication, or only testimonials and personal examples?
• Is the dose marketed in the product the same as the dose tested in scientific studies? “The scientific literature has multiple examples of natural products that appear to be effective in the prevention or management of chronic diseases using doses that are difficult or impossible to obtain. Unfortunately, many companies then go ahead and market much lower doses for practical reasons, with claims of ‘scientific validation’ actually referring to the impossibly high doses rather than the levels marketed,” said Dr. Zemel.
“For example, resveratrol, a supplement derived from grapes, is widely consumed based on promising results from cellular studies, animal studies and studies of impractically high doses (2,000-6,000 mg/day) in humans,” he continued. “When recently studied at more practical doses (75 mg/day), consistent with levels in many supplements, no measurable benefits were found.”1
1 Yoshino J, Conte C, Fontana L, Mittendorfer B, Imai S-I, Schechtman KB, Gu C, Kunz I, Fanelli FP, Patterson BW, Klein S. Resveratrol supplementation does not improve metabolic function in non-obese women with normal glucose tolerance. Cell Metabolism 2012; 16:1-7.
Natural practitioners can help lead the battle against obesity.