The quest for effective weight loss solutions has led many to explore various options, including Asian weight loss products. These products, often rooted in traditional practices, have gained popularity for their purported natural ingredients and holistic approach. However, their effectiveness and safety remain a subject of scrutiny. This article delves into the science behind some of these products, examining their potential benefits and risks, and providing a balanced perspective on their role in weight management.
Berberine: Nature's Ozempic?
Berberine, a dietary supplement found in plants like barberry, has recently surged in popularity, with some users touting it as "nature's Ozempic" due to its potential weight loss effects. Social media is buzzing with claims that berberine can curb appetite and improve blood sugar levels, leading to weight loss. This increased interest is partly driven by the demand for medications like Ozempic and Wegovy, which are known for their weight loss effects but are also expensive and require a doctor's prescription. Berberine, on the other hand, is widely available online and typically costs between $15 and $40 for a month's supply.
Dr. Pieter Cohen from Cambridge Health Alliance notes the appeal of berberine from an advertising perspective, citing its accessibility and lower cost. However, he cautions that its effectiveness and safety for weight loss are not fully established.
Limited Scientific Evidence
Many claims surrounding berberine have not been verified by large, peer-reviewed studies, and much of the existing research has been conducted on mice rather than humans. A meta-analysis of 49 studies published in Frontiers in Nutrition found that berberine may offer metabolic benefits, particularly for the heart, with only small potential benefits for weight loss.
Dr. Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital, points out that the weight loss observed in studies is not dramatic, ranging from a quarter to one BMI point, which is significantly less than what is typically seen with semaglutide (the drug found in Ozempic). She suggests that the optimal dose appears to be 1 gram per day.
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Safety Concerns and Lack of Regulation
Dr. Cohen emphasizes that dietary supplements like berberine are not reviewed or approved by the Food and Drug Administration (FDA), allowing them to be marketed with potentially unsubstantiated health claims. These supplements may also contain inaccurate amounts of the compound or other unlisted ingredients. He warns against taking an active pharmaceutical drug like berberine "willy-nilly."
Dr. Holly Lofton, the director of the weight management program at NYU Langone Health, clarifies that berberine is not the same as metformin, a medication used by people with diabetes to lower blood sugar levels, and she does not recommend it for weight loss.
Potential Side Effects
While medications derived from plants are not uncommon, with examples like aspirin and morphine, berberine has known side effects. In humans, these include nausea and vomiting. Animal studies have indicated potential enlargement of the liver and kidney, as well as a reduction in white blood cells. More extensive studies are needed to determine if there are serious side effects in humans.
Dr. Stanford advises consulting a doctor before incorporating berberine into a weight loss regimen, particularly for pregnant women. She stresses the lack of FDA approval and regulation, recommending guidance from a knowledgeable healthcare professional. If any side effects occur, discontinuing the medication is advised. Dr. Cohen concludes that the potential risks may outweigh the benefits, and any weight loss experienced while taking berberine should prompt immediate consultation with a doctor.
Traditional Chinese Medicines (TCMs) for Weight Loss
Traditional Chinese Medicines (TCMs) have been used for centuries in Asia and are gaining recognition worldwide for their potential in weight management. Increasing evidence suggests that TCMs may offer anti-obesity effects with fewer side effects and lower costs compared to Western medicines.
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A network meta-analysis (NMA) study reviewed the effects of various TCMs on weight loss, comparing them with different intervention durations. The study, which included 46 randomized controlled trials (RCTs) conducted among Chinese adults with overweight or obesity, found that TCMs, especially when the treatment duration was six months or less, were more effective in reducing both body weight and Body Mass Index (BMI) than non-pharmacological interventions and placebo/no treatment. Acupotomy was identified as the most effective TCM treatment for reducing both body weight and BMI.
Advantages of TCMs
TCMs offer potential advantages in weight loss, including fewer side effects and lower costs compared to Western medicines. They could be included in future clinical guidance as a standalone or supplementary treatment for obesity.
Limitations of Previous Studies
Previous review studies have primarily focused on a few commonly used TCM therapies like acupuncture and herbal medicines, limiting the understanding of the full range of available TCMs for treating obesity. Many studies have also used pairwise meta-analysis, which only allows direct comparison between two interventions. Network meta-analysis (NMA) is needed to compare multiple treatments simultaneously.
Methodology of the NMA Study
The NMA study systematically evaluated and compared the efficacy of available TCM treatments for weight loss against regular care intervention (e.g., Western medicine, non-pharmacotherapy) or placebo/no treatment among adults with overweight or obesity. The study aimed to calculate and rank the effects of different TCMs in treating obesity and compare the effects of TCMs with different treatment durations on weight loss.
The study searched for studies published in English or Chinese prior to 1 March 2023, using databases such as PubMed, Embase, CNKI, WanFang Data, VIP Chinese Science Journals Database, and SinoMed. The search terms included combinations, truncations, and synonyms of TCMs/complementary treatment, obesity, Chinese adults, and effectiveness. Two reviewers independently screened titles and abstracts to identify studies that met the inclusion criteria.
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Eligible studies reported body weight (kg) and/or BMI (kg/m2) as weight change outcomes. The risk of bias in the eligible studies was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB2). Egger's test was used to evaluate the presence of publication bias, and funnel plots were generated for visual assessment.
Basic information about the reviewed studies, including author, year, sample size, participant demographics, intervention and control groups, and outcome measures, were extracted and summarized. A pairwise meta-analysis was performed to calculate the pooled effects of TCM therapies compared to no intervention or regular care intervention. The outcomes were reported as mean differences (MDs) in body weight and/or BMI after treatment and 95% confidence intervals (CIs).
Results of the NMA Study
The NMA study screened 1584 studies, with 46 meeting the inclusion criteria, encompassing 4397 patients with overweight or obesity in China. The participants' ages ranged from 18 to 70 years old. The study examined 10 types of TCM treatments, including acupuncture, electroacupuncture, auricular acupressure, catgut embedding, Chinese herbal medicine (CHM), tuina, tapping, cupping, moxibustion, and scraping, as well as their combinations.
The RoB2 assessment indicated that 63% of the studies had some concerns regarding the risk of bias, primarily due to the difficulty of blinding participants and/or operators. Funnel plots were used to assess the possibility of publication bias in the pairwise comparison between TCM and non-pharmacological interventions.
Overall, TCM therapies were more effective in weight reduction compared to placebo/no treatment and non-pharmacological interventions. However, they were not more effective in reducing body weight compared with Western medicine. In subgroup analysis by intervention duration, TCMs with 3-month and 3-to-6-month durations both yielded significantly more weight loss effects compared to placebo/no treatment, with the latter showing the largest advantage.
TCM therapies also yielded better BMI reduction results compared to placebo/no treatment and non-pharmacological interventions but were not more effective in reducing BMI compared to Western medicine. The subgroup analysis showed that TCMs with ⤠1-month and 3-to-6-month durations resulted in significantly greater BMI reductions compared to placebo/no treatment, with the former exhibiting more body weight improvement.
The pooled result of NMA showed that catgut embedding, combined TCM treatments, and acupotomy were more effective in weight loss than placebo/no treatment. Electroacupuncture, combined TCM treatments, and TCM treatments combined with non-pharmacological interventions were also shown to be more effective in weight loss than non-pharmacological interventions alone. Acupotomy was ranked as the most effective TCM treatment in reducing both body weight and BMI compared to other TCM treatments.
Ma-Xing-Gan-Shi-Tang (MXGST)
Ma-Xing-Gan-Shi-Tang (MXGST) is a Chinese medicine formula traditionally used to adjust lung qi stagnation, clear pathological heat, and reduce phlegm. TCM doctors often adjust prescriptions based on individual clinical symptoms and signs to achieve holistic effects. MXGST may play a role in treating obesity by improving the phlegm-dampness constitution through adjusting lung qi stagnation.
A cohort study explored the safety and effectiveness of CHM treatment with MXGST on weight control in comparison with liraglutide. The study used data from the Chang Gung Research Database (CGRD) and included patients diagnosed with obesity or metabolic syndrome between 2013 and 2018. The study assessed weight-loss efficacy and adverse effects over a 6-month treatment period.
The results showed that CHM users tended to be younger and more often female than WM users. WM users had a higher prevalence of hypertension, dyslipidemia, and diabetes mellitus (DM) and a higher Charlson Comorbidity Index (CCI). There were prominent differences in mean arterial pressure (MAP), body weight, BMI, and lipid profiles, which were higher in the WM group.
Ephedra (Ma Huang) and Ephedrine
Ephedra sinica, also called ma huang, is a plant native to Asia that has been used in Chinese medicine for thousands of years. The major effects of ephedra are likely caused by the molecule ephedrine, which increases metabolic rate and fat burning. Ephedrine has been studied for its ability to reduce body weight and body fat and gained popularity in weight loss supplements in the past. However, due to safety concerns, supplements containing ephedrine alkaloids have been banned in several countries, including the United States.
Effects on Weight Loss
Studies have shown that ephedrine increases resting metabolic rate and boosts the fat-burning process in your body. One study found that the number of calories burned over 24 hours was 3.6% greater when healthy adults took ephedrine compared to when they took a placebo. Another study observed that when obese individuals went on a very-low-calorie diet, their metabolic rate dropped, but this was partially prevented by taking ephedrine.
Ephedrine can also promote weight and fat loss over longer time periods. In five studies of ephedrine compared to a placebo, ephedrine led to weight loss of 3 pounds (1.3 kg) per month more than a placebo for up to four months.
Ephedrine and Caffeine Combination
The combination of ephedrine and caffeine appears to exert greater effects on your body than either ingredient alone. Some research has even reported that caffeine and ephedrine individually had no effects on weight loss, while the combination of the two did produce weight loss.
Over 12 weeks, ingesting a combination of ephedra and caffeine three times per day led to a reduction of 7.9% of body fat as compared to only 1.9% with a placebo. Another 6-month study in 167 overweight and obese people compared a supplement containing ephedrine and caffeine to a placebo during a weight loss program. The group taking ephedrine lost 9.5 pounds (4.3 kg) of fat compared to the placebo group, which only lost 5.9 pounds (2.7 kg) of fat.
Safety Concerns and Legal Status
While some individual studies did not demonstrate serious side effects of ephedra or ephedrine consumption, mild to highly concerning side effects became apparent upon examination of all available research. One analysis of 52 different clinical trials found no serious adverse events such as death or heart attack in studies on ephedrine, with or without caffeine. Yet, the same analysis found these products were associated with a two- to threefold increased risk of nausea, vomiting, heart palpitations, and psychiatric problems.
Based on the evidence, potential safety concerns were significant enough to prompt legal action in the United States and elsewhere. Due to safety concerns, the Food and Drug Administration (FDA) banned products containing ephedrine in 2004. Some ephedrine-containing medications are still available over the counter, though regulations on the purchase of these products can vary by state.
RAND Corporation's Review of Ephedra
The Department of Health and Human Services called for a review of all the evidence on ephedra, turning to the Southern California Evidence-Based Practice Center (SCEPC), based at RAND. The SCEPC conducted an exhaustive search and review of the medical research literature, including 52 clinical trials that measured the effects of ephedra or ephedrine on weight loss and athletic performance.
The review found that over the short term (four to six months), ephedrine, ephedrine plus caffeine, and supplements containing ephedra or ephedra plus caffeine promoted modest increases in weight loss, about two pounds per month more than the weight loss of persons taking the placebo. Products containing caffeine seemed to promote slightly more weight loss than those containing only ephedrine.
The review also found that one-time use of ephedrine-containing products seems to enhance immediate physical performance, but only when taken in combination with caffeine. However, the use of ephedra or ephedrine does cause an increase in jitteriness, mood changes, palpitations, nausea, and vomiting.
The existing evidence is insufficient to link these products conclusively with death and other serious health problems, but the federal government quickly moved to propose stricter labeling of ephedra products and solicited public comment on whether the safety evidence thus far warrants further restrictions.
Queen Slimming and Sibutramine
A case study reported psychosis in a 46-year-old woman who had taken an herbal appetite suppressant bought online from China (âQueen Slimmingâ). The product had reports of containing sibutramine, a substance known to induce psychiatric symptoms. The US Food and Drug Administration had advised against using âQueen Slimming Soft Gelâ products specifically because they contained sibutramine.
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