Herbal Remedies for Weight Loss?

I. Introduction

• Herbal remedies are being used extensively today.
• Herbal remedies can be extremely costly, yielding little or no clinical effect.
• Some herbal preparations can interact with other herbals as well as interact with conventional medications.
• Many herbal products are contaminated.
• Many herbal remedies have multiple names and can be very difficult to identify.
• There are wide variations in quality among the herbal remedies.
• Most herbal preparations are sold by people who have limited clinical knowledge. They are therefore unable to alert the public about the potential hazards and/or how these may affect you or the medicines you are taking.

II. Herbal remedies commonly used for weight loss

Aloe (aloe vera, aloe barbadensis, aloe capensis):

• This is usually used as a topical product for wound healing.
• Oral forms of aloe are added to herbal weight-loss products. Oral aloe produces a strong cathartic response (producing bowel movements). Many aloe weight-loss products are marketed as "internal cleansers."
• Aloe or products containing aloe should not be taken orally. Use of this agent orally has lead to side effects such as abdominal cramping, diarrhea, electrolyte disturbances, and decreases in potassium. In addition, due to the side effect profile, some significant drug interactions can occur with medications such as digoxin (Lanoxin) and diuretics [i.e. furosemide (Lasix), hydrochlorothiazide (Esidrix, Hydro-D, HydroDIURIL) and others].
• The use of aloe internally has yielded inconsistent therapeutic effects, and has not been shown to be effective for permanent weight loss.

Cascara (Rhamnus purshiana, Cascara sagrada, bitter bark, chittem bark):

• This is a strong stimulant laxative.
• It is a common ingredient in herbal weight loss products.
• It should not be taken if you are pregnant or lactating (passed to milk).
• Misuse has caused disturbances in electrolytes (such as potassium, sodium).
• It might interact with medications such as digoxin and diuretics (i.e. furosemide, hydrochlorothiazide, etc.).

Dandelion (Taraxacum officinale, lion's tooth):

• This is a natural diuretic.
• It might produce a significant weight loss by decreasing body water.
• It has been known to cause allergic reactions. There have also been some reports of potential carcinogenic (cancer-causing) activity.

Ephedra (Ma-huang, sea grape, yellow horse, yellow astringent)

• This has a long history of producing stimulant effects.
• It is used primarily to relieve cold symptoms in many herbal preparations.
• It has not been shown to be safe and effective for weight loss, although it is the principle ingredient in many weight-loss products.
• Misuse has caused deaths. Ephedra can cause high blood pressure and central nervous system stimulation (nervousness, insomnia, palpitations). In addition, ephedra can cause significant fluctuations in blood sugar levels. Therefore, diabetic patients should not take any preparations containing this ingredient.
• Ephedra products or products containing ephedra should not be taken. The benefit does not outweigh the risk. It is too dangerous.

Glucomannan (Amorphophallus konjac, Konjac mannan):

• This is used as a weight-loss aid. It delays the absorption of glucose (sugar) from the intestines.
• Some studies have shown glucomannan to significantly reduce fasting blood glucose. Small, limited studies have shown glucomannan to be effective in decreasing body weight. This effect is believed to be due to a "feeling of fullness," which might be due to the swelling of the glucomannan in the gut once it has been exposed to liquids.
• Precautions: Esophageal obstruction has been reported in several patients ingesting glucomannan. Glucomannan and products containing glucomannan have been banned in several countries due to the high incidence of gastrointestinal obstruction.
• Glucomannan should not be used in diabetic patients or in patients with a previous history of obstruction.

Guarana (Paullina cupana, guarana paste or gum, Brazilian cocoa, Zoom):

• This is commonly known as Zoom.
• It contains caffeine 2.5 percent to 5 percent.
• This is an effective central nervous system stimulant. It is used as a weight loss product due to its stimulant and diuretic effects.
• Precautions: Guarana might cause high blood pressure. Some of the extracts have been known to inhibit platelet aggregation, known to prolong bleeding and interact with anticoagulants [i.e. warfarin (Coumadin)].
• Many advertisements state guarana is free from side effects. This statement is not true.

Guar Gum (Cyamopsis tetragonolobus, guar, guar flour, Jaguar gum)

• Guar gum is a dietary fiber obtained from the Indian cluster bean.
• Guar gum has been used extensively as a thickening agent for foods and pharmaceuticals.
• Guar gum has been studied for decreasing cholesterol, management of diabetes, and weight loss. As a weight loss product, guar gum has been used to promote normal gastrointestinal motility and maintain fecal bulk. It has been noted to decrease appetite by providing a "feeling of fullness."
• Precautions: Guar gum and guar gum preparations have been implicated in esophageal obstruction. The water-retaining capacity of the gum permits it to swell to 10 to 20 fold and has led to gastrointestinal obstructions. Guar gum has also been known to cause significant fluctuations in blood glucose (sugar) levels, thus diabetic patients should not use these preparations.

Herbal Diuretics: (see table list below)

• These are very commonly found in over-the-counter (OTC) weight loss products, as well as herbal weight loss preparations.
• Most of the diuretics used OTC are derived from xanthine alkaloids (i.e. caffeine or theobromine). Avoid preparations that contain juniper seeds (capable of causing renal damage), equistine (neurotoxic--causing brain damage), horse tail or shave grass (several toxic compounds leading to convulsions or hyperactivity).
• Most of the herbal diuretics are not toxic but have been known to interact with medications (i.e. lithium, digoxin, or conventional diuretics such as furosemide or hydrochlorothiazide).
• Most of the herbal diuretics do not provide enough of a diuresis (water loss) to be considered effective.

There are many more herbal diuretics. Always check the ingredients prior to ingestion.

Herbal Phen-Fen (active ingredients: Ma-Huang, Ephedra, and St. John's Wort):

• This is being promoted for weight loss after the market withdrawal of fenfluramine (Pondimin) and dexfenfluramine (Redux).
• There are no clinical studies showing effectiveness or potential long-term effects.
• The combination of the two products is of theoretical benefit.
• the side effect profile is similar to that of ephedra (Ma-Huang) and St. John's Wort. These include central nervous system hyperstimulation, changes in blood glucose, high blood pressure, and a potential for serotonin syndrome (characterized by confusion, shivering, agitation, fever, diaphoresis, diarrhea, tremor, etc.).
• Avoid medications such as fluoxetine (Prozac), sertraline (Zoloft ), paroxetine (Paxil), venlafaxine (Effexor), trazodone (Desyrel), mirtazapine (Remeron), nefazodone (Serzone), meperidine (Demerol), buspirone (BuSpar), dextromethorphan (contained in various OTC cold remedies), and OTC nasal decongestants (pseudoephedrine, phenylpropanolamine, etc.).
• The combination of ephedra and St. John's Wort has been classified as dangerous by the Food and Drug Administration (FDA) and should not be taken.

St. John's Wort (Hypercium perforatum, goatweed, klamath weed, amber, touch and heal, rosin rose):

• This is primarily used as an antidepressant due to its effects on serotonin (increases). Most of the studies conducted have been very small and have not been for weight loss. These studies have been to assess the efficacy of this agent in the management of depression.
• One of the primary ingredients in herbal phen-fen.
• Avoid foods containing tyramine (i.e. aged meats, cheese, wines, etc).
• Avoid medications such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), venlafaxine (Effexor), trazodone (Desyrel), mirtazapine (Remeron), nefazodone (Serzone), meperidine (Demerol), buspirone (Buspar), and dextromethorphan (contained in various OTC cold remedies).
• The use of St. John's Wort for weight loss is theoretical and potentially very dangerous. Avoid using this herbal remedy.

Yerba Mate (IIex paraguariensis, mate, Paraguay tea):

• This is a strong central nervous system stimulant. (The doses typically used mimic that of 100 to 200 milligrams of caffeine.)
• Some case reports of poisoning (leading to hospitalization) with this agent have been reported.
• The principle side effects reported are excessive stimulation and high blood pressure.
• Excessive use has been linked to esophageal cancer.

III. Common sense advice for the public regarding herbal medicines

If ill, see a doctor or consult with a health care professional.

• Do not take herbs if pregnant or attempting to become pregnant.
• Do not take herbs if you are nursing.
• Do not give herbs to a baby.
• Do not take large quantities of any one herbal preparation.
• Do not take any herb on a daily basis.
• Buy only preparations in which the plants are listed on the packet (Note: There is no guarantee attached to any product.)
• Do not take herbal remedies if you are on a chronic therapy (i.e. high blood pressure medications, antidepressants, etc.) If you are unsure, consult with a health care provider prior to taking any herbal preparation.
• Do not take herbal remedies if you are taking medications that have a narrow margin for safety such as warfarin (Coumadin), digoxin, phenytoin (Dilantin), lithium (Lithobid, Eskalith), theophylline (Theo-Dur, Theo-24, others) etc. If you are unsure, consult with a health care provider prior to taking any herbal preparation.
• Always advise your health care provider of any herbal remedy or alternative medicine you are taking.

IV. Summary

• Most herbal weight loss products provide some weight loss by: (1) enhancing urine and/or fecal discharge, (2) stimulating the central nervous system, (3) increasing serotonin or (4) creating a "feeling of fullness." Herbal preparations will not provide a permanent weight loss.
• There are multiple ingredients in herbal weight loss preparations, some of which have serious side effects and can lead to dangerous toxicities.
• Most herbal preparations are sold by people who have limited clinical knowledge. They are, therefore, unable to alert the public about the potential hazards and/or how these products might affect you or the medicines you are taking.
• Many herbal manufacturers make "false claims" regarding the effectiveness of these preparations. Beware.
• The use of herbal remedies to lose weight is discouraged due to the high risk of toxicities and lack of clinical effectiveness.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/5/2002