Toxicological screening and DNA sequencing detects contamination and adulteration in regulated herbal medicines and supplements for diet, weight loss and cardiovascular health

Background: Obesity represents the second preventable mortality cause worldwide, and is very often associated with type 2 Diabetes Mellitus (T2DM). The first line treatment is lifestyle modification to weight-loss, but for those who fail to achieve the goal or have difficulty in maintaining achieved results, pharmacological treatment is needed. Few drugs are available today, because of their side effects. Objective: We aim to review actual pharmacological management of obese patients, highlighting differences between Food and Drug Administration - and European Medicine Agency-approved molecules, and pointing out self-medications readily obtainable and widely distributed. Methods: Papers on obesity, weight loss, pharmacotherapy, self- medication and diet-aid products were selected using Medline. Research articles, systematic reviews, clinical trials and meta-analyses were screened. Results: Anti-obesity drugs with central mechanisms, such as phentermine and lorcaserin, are available in USA, but not in Europe. Phentermine/topiramate and naltrexone/bupropion combinations are now available, even though the former is still under investigation from EMA. Orlistat, with peripheral mechanisms, represents the only drug approved for weight reduction in adolescents. Liraglutide has been approved at higher dose for obesity. Anti-obesity drugs, readily obtainable from the internet, include crude-drug products and supplements for which there is often a lack of compliance to national regulatory standards. Conclusion: Mechanisms of weight loss drugs include the reduction of energy intake or the increase in energy expenditure and sense of satiety as well as the decrease of hunger or the reduction in calories absorption. Few drugs are approved, and differences exist between USA and Europe. Moreover, herbal medicines and supplements often sold on the internet and widely used by obese patients, present a risk of adverse effects.

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Translating Weight Loss and Physical Activity Programs Into the Community to Preserve Mobility in Older, Obese Adults in Poor Cardiovascular Health

Archives of Internal Medicine ◽

10.1001/archinternmed.2010.522 ◽

2011 ◽

Vol 171 (10) ◽

Cited By ~ 100

Author(s):

W. Jack Rejeski ◽

Peter H. Brubaker ◽

David C. Goff ◽

Lucille B. Bearon ◽

Jacquelyn W. McClelland ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Cardiovascular Health ◽

Obese Adults ◽

Physical Activity Programs

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Abstract 3610: Comparative Effects of 3 Popular Diets on Lipids, Endothelial Function and Biomarkers of Atherothrombosis in the Absence of Weight Loss

Circulation ◽

10.1161/circ.116.suppl_16.ii_819 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Michael Miller ◽

Valerie Beach ◽

Charles Mangano ◽

Jeffrey Rhyne ◽

Christina Dobmeier ◽

...

Keyword(s):

Weight Loss ◽

Endothelial Function ◽

Cardiovascular Health ◽

Dietary Intervention ◽

Saturated Fat ◽

Inverse Correlation ◽

Monounsaturated Fat ◽

The South ◽

Atkins Diet ◽

Total Fat

Background : While the effect of popular diets on weight loss has been extensively studied, less is known in the absence of weight loss. We hypothesized that a diet high in total and saturated fat would be associated with adverse effects on LDL-C, endothelial function and biomarkers of atherothrombosis compared to lower fat diets. Methods : We tested 3 popular diets, including Atkins (50% fat), South Beach (30% fat) and Ornish (10% fat) in a randomized and counterbalanced, crossover study. Subjects completed each of the three 4-week dietary intervention phases followed by a 4-week washout period. They were weighed weekly and caloric adjustments made if weight change exceeded 1 kg. At the completion of each dietary phase, 3-day food records were analyzed, fasting blood was sampled and brachial artery reactivity testing (BART) performed. Results : Eighteen of 26 adults (mean age: 30.6 ± 9.6 yrs, 50% female) completed all 3 dietary phases. There were no changes in weight at the conclusion of each phase. However, non-significant increases in LDL-C occurred during the Atkins phase (pre: 96.5, post: 112.9 mg/dL; P=0.12 ), whereas LDL-C was reduced during the Ornish (pre: 110.1, post: 84.6 mg/dL; P=0.006 ) and South Beach phases (pre: 101.7, post: 91.5 mg/dL; P=0.01 ). BART testing revealed a significant inverse correlation between flow-mediated vasodilation and intake of total fat (r 2 =−0.29; P=0.03 ), saturated fat (r 2 =−0.31; P=0.02 ) and monounsaturated fat (r 2 =−0.35; P=0.01 ). Microarray analysis demonstrated increased expression of several leukocyte biomarkers including, ICAM2 (37%; P=0.002 ), SELL (26%; P=0.007 ) and SOD1 (42%; P=0.04 ) at the completion of the Atkins diet compared to baseline. In contrast, expression of atherothrombotic biomarkers was not increased after the South Beach or Ornish phase. Conclusions: In the absence of weight loss, the high fat Atkins diet is associated with increased LDL-C, reduced endothelial vasoreactivity and increased expression of biomarkers of atherothrombosis. As such, these data suggest that isocaloric conversion to the Atkins diet may negatively impact cardiovascular health as compared to the South Beach or Ornish Diet.

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Adulterants and Contaminants in Psychotropic Herbal Medicines Detected with Mass Spectrometry and Next-Generation DNA Sequencing

Pharmaceutical Medicine ◽

10.1007/s40290-018-0252-8 ◽

2018 ◽

Vol 32 (6) ◽

pp. 429-444 ◽

Cited By ~ 4

Author(s):

Claire L. Hoban ◽

Ian F. Musgrave ◽

Megan L. Coghlan ◽

Matthew W. P. Power ◽

Roger W. Byard ◽

...

Keyword(s):

Mass Spectrometry ◽

Dna Sequencing ◽

Herbal Medicines ◽

Next Generation ◽

Next Generation Dna Sequencing

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Abstract P055: Six-Month Changes in Ideal Health and Cardiovascular Risk Scores Among Young Adults Enrolled in a Weight Loss Intervention

Circulation ◽

10.1161/circ.131.suppl_1.p055 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Bethany Barone Gibbs ◽

Wendy C King ◽

John M Jakicic

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Young Adults ◽

Cardiovascular Health ◽

Lifestyle Changes ◽

Risk Scores ◽

Rank Test ◽

Weight Loss Intervention ◽

Spearman's Rho ◽

Spearman’S Rho

The Framingham 10-year (FRS-10) and lifetime (FRS-LIFE) risk scores use clinical CVD risk factors to predict coronary heart disease (CHD) and CVD outcomes, respectively. In contrast, the AHA’s Ideal Cardiovascular Health (IDEAL) paradigm encourages a 7-component, healthy phenotype that additionally includes healthy diet, body mass index (BMI), and physical activity behaviors that are also associated with the avoidance of developing cardiovascular disease (CVD). Objective: To compare changes in IDEAL, FRS-10, and FRS-LIFE over 6 months in young adults enrolled in a behavioral weight loss intervention Methods: FRS-10 and FRS-LIFE were calculated using published equations at baseline and 6 months in young adults who were overweight or obese at study entry but otherwise healthy. IDEAL was calculated on a 14-point scale where, for each component, 0, 1, or 2 points were given for ‘poor’, ‘moderate’, or ‘ideal’ classification, respectively. Descriptive statistics are reported as % or median [IQR]. McNemar’s test, test of symmetry, and Wilcoxon signed rank test were employed to evaluate pre- to post-intervention changes. Spearman’s correlations evaluate associations. Results: In 335 young adults, age 31 [27, 34] yrs, BMI 31 [28, 34] kg/m 2 , and 32% male, the intervention achieved significant 6-month decreases in BMI: -3.0 [-4.3, -1.5] kg/m 2 . Out of a possible 14 points (higher is better), IDEAL was 9 [8, 10] at baseline and 11 [10, 12] at 6 months, with 73% improving and 9% worsening (net improvement 64%) (p<.0001). Though<1% ever had IDEAL diet, a net improvement in diet was observed in 19%, with specific improvements in sugar-sweetened beverage and sodium components (p<0.001). Significant net improvements were also observed in IDEAL classification for BMI (49%), physical activity (39%), total cholesterol (14%), blood pressure (14%) and glucose (11%) components (all p<.0001). FRS-10 was negligible (<1%) for 88% of the cohort at baseline and 94% at 6 months. Across predicted FRS-10 scores, 7% improved and 2% worsened (net improvement 5%) over the 6 months (p<.0001). Improved FRS-10 and IDEAL were correlated (Spearman’s rho = -0.49, p<0.001). IDEAL had a stronger correlation with change in weight compared to FRS-10 (Spearman’s rho = -0.49 vs. 0.30; both p<0.001). FRS-LIFE indicated lifetime risk was high for 35% of the cohort at baseline and 22% at 6 months (p<.0001). FRS-LIFE as a 5-category scale improved in 38% and worsened in 13% (net improvement 26%) (p<.0001). Conclusions: In a cohort of overweight or obese, but otherwise healthy, young adults enrolled in a weight loss intervention, IDEAL was able to measure positive lifestyle changes in a majority of participants while the FRS-10 and FRS-LIFE did not. These results suggest that IDEAL may be particularly sensitive and appropriate to detect positive cardiovascular health changes in the growing population of overweight and obese young adults.

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