Adverse events of herbal food supplements for body weight reduction: systematic review*

Obesity Reviews - Tập 6 Số 2 - Trang 93-111 - 2005
Max H Pittler1, Katja Schmidt1, E. Ernst1
1Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, UK.

Tóm tắt

SummaryHerbal weight‐loss supplements are marketed with claims of effectiveness. Our earlier systematic review identified data from double‐blind, randomized controlled trials for a number of herbal supplements. The aim of this systematic review was to assess all clinical evidence of adverse events of herbal food supplements for body weight reduction for which effectiveness data from rigorous clinical trials exist. We assessed Ephedra sinica, Garcinia cambogia, Paullinia cupana, guar gum, Plantago psyllium, Ilex paraguariensis and Pausinystalia yohimbe. Literature searches were conducted on Medline, Embase, Amed and The Cochrane Library. Data were also requested from the spontaneous reporting scheme of the World Health Organization. We hand‐searched relevant medical journals and our own files. There were no restrictions regarding the language of publication. The results show that adverse events including hepatic injury and death have been reported with the use of some herbal food supplements. For herbal ephedra and ephedrine‐containing food supplements an increased risk of psychiatric, autonomic or gastrointestinal adverse events and heart palpitations has been reported. In conclusion, adverse events are reported for a number of herbal food supplements, which are used for reducing body weight. Although the quality of the data does not justify definitive attribution of causality in most cases, the reported risks are sufficient to shift the risk–benefit balance against the use of most of the reviewed herbal weight‐loss supplements. Exceptions are Garcinia cambogia and yerba maté, which merit further investigation.

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Tài liệu tham khảo

World Health Organization., 1998, Obesity: Preventing and Managing the Global Epidemic.

10.1001/archinte.160.7.898

10.1001/archinte.161.13.1581

10.1016/S0140-6736(02)09958-0

10.1056/NEJMoa020245

10.1001/jama.288.14.1723

National Audit Office., 2001, Tackling Obesity in England

10.1093/oxfordjournals.bmb.a011611

10.1016/S0002-9343(96)00456-1

10.1093/ajcn/79.4.529

Blumenthal M, 2000, Herbal Medicine.

10.1056/NEJM200012213432502

10.1212/01.WNL.0000042092.20411.5B

10.1001/jama.289.12.1537

10.3810/psm.2003.12.592

Schweinfurth J, 2003, Sudden hearing loss associated with ephedra use, Am J Health Syst Pharm, 60, 375, 10.1093/ajhp/60.4.375

Rezkalla SH, 2002, Myocardial infarction temporally related to ephedra – a possible role for the coronary microcirculation, WMJ, 101, 64

10.1067/mjd.2003.192

Chu Hwan R, 2003, Exertional heatstroke in an infantry soldier taking ephedra‐containing dietary supplements, Mil Med, 168, 429, 10.1093/milmed/168.6.429

10.1097/00042752-200305000-00010

Chu WW, 2001, Acute respiratory failure in a young woman taking herbal medications, J Crit Ill

10.1001/archsurg.138.8.852

10.1592/phco.23.3.380.32114

10.1136/bmj.326.7387.464/b

Wettach GE, 2002, A mysterious blood pressure increase in a drilling naval reservist, Mil Med, 167, 521, 10.1093/milmed/167.6.521

10.1046/j.1463-1326.2002.00235.x

Ryan CK, 2002, Ischemic colitis associated with herbal product use in a young women, J Am Board Fam Pract, 15, 309

10.1016/S0002-9394(02)01706-3

Verduin ML, 2002, Psychosis and delirium following metabolife use, Psychopharmacol Bull, 36, 42

10.1345/aph.1D408

10.1016/j.jns.2003.08.012

10.1023/A:1026105917735

Anonymous.Case Reports for Ephedra.World Health Organization ADR database (accessed 14 January 2004).

Anonymous.Case Reports for Garcinia cambogia.World Health Organization ADR database (accessed 14 January 2004).

10.1007/s100720070109

10.1300/J157v02n01_08

10.5694/j.1326-5377.2001.tb143404.x

Anonymous.Case Reports for Guarana.World Health Organization ADR database (accessed 14 January 2004).

Anonymous.Case Reports for Guar Gum.World Health Organization ADR database (accessed 14 January 2004).

10.1016/S0168-8278(00)80289-5

10.1111/j.1398-9995.1996.tb04604.x

Germán A, 1995, Shock anafiláctico tras la ingestión de un laxante, Med Clin (Barc), 104, 559

10.1157/13045198

Manbeck MA, 1996, Gastric bezoar formation in a patient with scleroderma: endoscopic removal using the gallstone mechanical lithotripter, Am J Gastroenterol, 91, 1285

10.1136/pgmj.71.835.305

Anonymous.Case Reports for Plantago Psyllium. World Health Organization ADR database (accessed 30 January 2004).

10.1016/S0735-6757(99)90139-0

10.1038/sj.ijo.0802061

10.1067/mcp.2002.124523

10.1001/jama.291.2.216

Girola M, 1996, Dose effect in lipid‐lowering activity of a new dietary integrator (Chitosan, Garcinia cambogia extract and chrome), Acta Toxicol Ther, 17, 25

10.1001/jama.280.18.1596

10.1177/147323000002800505

Rothacker DQ, 1997, Effectiveness of a Garcinia cambogia and natural caffeine combination in weight loss – a double‐blind, placebo‐controlled pilot study, Int J Obes, 21, 53

10.1016/S0011-393X(00)88517-3

10.1016/j.curtheres.2003.08.006

Román Ramos R, 1995, Extracto de Garcinia cambogia en el control de la obesidad, Investigatión Médica Internacional, 22, 97

10.1111/j.1472-8206.1997.tb00179.x

10.1590/S1516-31801996000100003

10.2337/diacare.18.4.584

Blake DE, 1997, Wheat bread supplemented with depolymerized guar gum reduces the plasma cholesterol concentration in hypercholesterolemic human subjects, Am J Clin Nutr, 65, 107, 10.1093/ajcn/65.1.107

10.1016/S0002-9149(96)00672-8

10.1016/S0749-3797(99)00039-2

Tai ES, 1999, A study to assess the effect of dietary supplementation with soluble fibre (Minolest®) on lipid levels in normal subjects with hypercholesterolaemia, Ann Acad Med Singapore, 28, 209

10.1034/j.1600-0412.2000.079004260.x

10.1038/sj.ijo.0801546

10.1046/j.1365-2362.1998.00282.x

Vajifdar BU, 2000, Is dietary fiber beneficial in chronic ischemic heart disease?, J Assoc Physicians India, 48, 871

10.1136/bmj.310.6972.95

10.1016/S0002-8223(98)00210-7

10.1016/S0271-5317(99)00029-9

10.1016/S0261-5614(98)80006-X

Anderson JW, 2000, Long‐tern cholesterol‐lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia, Am J Clin Nutr, 71, 1433, 10.1093/ajcn/71.6.1433

10.1093/ajcn/70.4.466

Chicouri MJ, 2001, Clinical study of psyllium husk combined to microencapsulated paraffin in intestinal primary constipation therapy, Rev Bras Med, 58, 672

10.1016/S0140-6736(00)02813-0

10.1111/j.1572-0241.1999.872_a.x

Weingand KW, 1997, Effects of psyllium on cholesterol and low‐density lipoprotein metabolism in subjects with hypercholesterolemia, Endocrinol Metab, 4, 141

10.1185/03007999809113363

Davidson MH, 1998, Long‐term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia, Am J Clin Nutr, 67, 367, 10.1093/ajcn/67.3.367

10.1007/BF02237246

Oliver SD, 2000, The long‐term safety and tolerability of ispaghula husk, J R Soc Med, 120, 107

10.1016/S1056-8727(98)00003-8

10.1038/sj.ejcn.1601398

Wahington N, 1998, Moderation of lactulose‐induced diarrhea by psyllium: effect on motility and fermentation, Am J Clin Nutr, 67, 317, 10.1093/ajcn/67.2.237

10.1007/BF02238940

10.1046/j.1365-2036.1997.00250.x

Barroso Aranda J, 2002, Efficacy of a novel chitosan formulation on fecal fat excretion: a double‐blind, crossover, placebo‐controlled study, J Med, 33, 209

10.5737/1181912x10396100

10.1097/00043798-199806000-00005

Brock FE, 2001, Psyllium is an effective and safe drug in the treatment of hypercholesterinemia, Pharm Pharmacol Lett, 2, 68

10.1080/07315724.1998.10718809

10.1111/j.1365-2354.1995.tb00046.x

10.7326/0003-4819-123-7-199510010-00003

Davidson MH, 1996, A psyllium‐enriched cereal for the treatment of hypercholesterolemia in children: a controlled, double‐blind, crossover study, Am J Clin Nutr, 63, 96, 10.1093/ajcn/63.1.96

10.1007/978-3-642-55528-2

10.1016/S0002-9343(01)00702-1

10.1046/j.1365-277X.2001.00290.x

10.1002/1097-0215(20001115)88:4<658::AID-IJC22>3.0.CO;2-T

ErnstE PittlerMH.Yohimbine for erectile dysfunction: a systematic review and meta‐analysis of randomized clinical trials.J Urol1998 433–436.

10.1136/bmj.309.6959.958

10.1016/S0895-7061(01)02172-0

Ernst E, 2000, UK and German media differ over complementary medicine, BMJ, 321, 707

10.1046/j.1365-2125.1998.00715.x

10.1001/jama.290.11.1519

Blumenthal M, 2002, Market report, Herbalgram, 55, 60

10.1046/j.1468-2982.2002.00376.x

10.1006/pmed.2002.1057

Ernst E, 2001, The Desktop Guide to Complementary and Alternative Medicine.