The Bottom Line on Weight Loss Supplements

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In the weight loss supplement debate, who is correct: proponents or opponents? Are any weight loss supplements beneficial? The answer is complicated.

The opponents of weight loss supplements have the bulk of research on their side for two primary reasons. Weight loss studies using dietary supplements have a lack of consistency in the form of the supplement used, the combination of nutrients in the supplements, and the methodology. That can include everything from the amount of the key ingredient being examined to the number of subjects in the study. The second reason is that some studies examining weight loss supplements on humans don’t control for confounding variables such as age, menopausal status, gender, and type of diet and exercise used to lose weight.

That doesn’t mean that opponents of weight loss supplements have evidence on their side—just the lack of consistent evidence. The problem is a lack of research that demonstrates a significant and permanent impact on body weight. In addition, some weight loss supplements may have potentially negative side effects, so the opponents have the advantage.

Another reason for the opponents’ advantage is the overselling of weight loss benefits based on marginal research. Remember what I began these memos with: “The fat will melt away!” I wish that were true, but there’s no supplement that directly does that. Even if we go back to a banned weight loss supplement, ephedra, it didn’t burn fat. It helped control appetite and may have increased metabolism slightly. There are no safe dietary supplements that do that to any significant degree. Small studies in rodents or even test-tube studies show the potential benefit of many types of herbs, but there are few human trials.

The problem for those selling weight loss supplements is that the type of research that would satisfy the opponents will never be done—it simply costs too much money. While the weight loss supplement industry is a multi-billion dollar industry in total, no single product comes close to generating that kind of revenue. With the type of clinical trials necessary to satisfy critics, there would be no profitability, especially when any other company could put out a competing product with the same ingredient in a different dose and say it’s just as good.

Bleak picture? It depends on how you look at it. Let me give you my perspective.

 

My Take on Weight Loss Supplements

I’ve spent a considerable amount of time checking out weight loss supplements. Is the research perfect? No. But if a nutrient or herb has at least some positive outcome helping people lose weight, I’m fine with that. If it’s mostly theory and animal research with poor human trials, I let it go until they prove something. With that in mind, I think there are some supplements that have consistently shown a benefit in helping people lose weight. The reason they work is not always what is purported to be the reason. The results will be different for different users based on their genetics, their microbiome, and their environment.

So here goes. In my opinion, the weight loss supplements that have shown the most benefit helping people lose weight when they eat less and move more are:

  • Chromium picolinate
  • Garcinia cambogia
  • Conjugated linoleic acid (CLA)
  • Green tea extract

Why do I think these will help? For one reason: they give people an edge in their effort. They positively affect carbohydrate and lipid metabolism, may help increase overall metabolism, and help control hunger. They will never help people lose weight without diet and exercise, but they will give those who are trying an edge in their efforts. To me, that’s worth the cost. That’s why I use most of them myself.

The opponents of weight loss supplements offer nothing other than an opinion. To me, that may be intellectually correct but it’s morally corrupt. With 70% of the population overweight, we don’t need naysayers and obstructionists. We need alternatives that work.

What are you prepared to do today?

Dr. Chet

 

Weight Loss Supplements: Pro vs. Con

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The proponents and opponents of weight loss supplements both cite research to support their opinions. For the opponents, the claim is that there’s a lack of adequate research that supports the benefits of weight loss supplements, and the research that has been done is marginal. The proponents often overstate the benefits of studies that have been done on some weight loss supplements. What gives?

In my opinion, there are several problems. The first problem is attempting to apply the randomized, placebo-controlled trial used in pharmaceutical studies. Trials haven’t included enough subject groups or anywhere near enough subjects per group. The obvious answer is to use people who want to lose weight as subjects: put them on a diet and exercise program while you give half the supplement and the other half the placebo. Reasonable but not good enough. There should be at least four more control groups: normal-weight people with the supplement or placebo, and overweight people who take the supplement or the placebo without a diet and exercise program. Without doing that, no one really knows how much the supplement helps.

The second is not including enough variables. Weight loss and fat loss are obvious and are always included. Some include blood indicators: hormones such as ghrelin, leptin, and cortisol. Too often they don’t do measures of hunger and satiety with simple 0-10 scales. For the guy who criticizes the Food Frequency Questionnaire as much as I do, do I really think a simple hunger scale could be important? I do. For one thing, I think it would be a good predictor of whether people will stick with the study, and by extension, with the program in real life.

The final problem is the expectation of the researchers. I believe that researchers on both sides go in with an expectation of success or failure. They’re supposed to begin a study anticipating both outcomes equally, but I think there’s an inherent investigator bias; they’re just people, after all.

Given the problems, and believe me, this list could include at least a dozen more problems, are all weight loss supplements suspect? No, and I’ll give you my list of real contenders on Saturday.

What are you prepared to do today?

Dr. Chet

 

Are Weight Loss Supplements Fact or Fiction?

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Last week I talked about fat—body fat—why it’s bad and what you can do about it, which raises a question about weight loss supplements. Will they give you a short-cut to getting rid of that fat, inside or outside? Can they help you or are they a waste of money? Worse yet, can they harm you? It depends on who’s doing the talking.

Traditional healthcare professionals such as physicians, nurses, and dieticians often say to save your money: there’s no good research that weight loss supplements will do anything but empty your wallet. They often cite the lack of adequate research on the supplements as the reason for their recommendations.

On the other hand, there are television and Internet physicians and health gurus who always seem to be promoting some type of supplement that will not only “melt away the fat” but do it “without diet or exercise!” They talk about research that proves how well these weight loss supplements work.

Who are we supposed to believe? We need some perspective here and that’s what I’m going to give you this week: what’s real, what’s imagined, and what you should expect.

What are you prepared to do today?

Dr. Chet

 

The Bottom Line on Belly Fat

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Our pretend daughter Jamie slow-cooked a roast for Memorial Day, and it was delicious, the best she’s ever done. She does them very well to begin with, so what made this one so good? Fat. It was a chuck roast. What made it so good was not the fat that you could see, it was the intramuscular fat you really can’t see when it’s cooked. The marbling you see before cooking? That’s more like what I mean, but some fat is so woven into the muscle you can’t see it even then. Why on earth am I talking about chuck roast? It’s because we humans are well marbled as we age, but in our case, it’s not a good thing.

I’ve told you about subcutaneous and visceral fat, but there’s one more type: intramuscular fat. Because we are so sedentary, we have plenty of it, and the more sedentary we are, the more intramuscular fat we have. While it could be a readily available supply of fuel, it’s a sign of muscle loss and sedentary living.

How can we tell whether our fat is located under our skin or around our organs? The only definitive way is with a CAT or PET scan. Dual energy x-ray absorptiometry (DEXA) can be used to determine body fat, but it’s not as precise on the location.

Let’s make it simple. Stand up. Contract your abdominal muscles as tight as you can. Now grab your belly fat, opening your hand as far as you have to get a good hold. If you seem to have more fat in your hands but there doesn’t seem to be much under the muscle, you most likely have more under the skin than under the muscle. If you can’t grab much fat in your hands but you still have a large waist, it’s mostly visceral fat.

While not exactly a scientific method, it can give you an idea of where you stand. And this doesn’t count the marbling effect. For me, it’s almost all subcutaneous fat I can grab.


The Bottom Line

How do you get rid of belly fat? Eat less. Eat better. Move more.

Yes, you’ve heard that before, but here’s why it’s the solution to this problem:

  • Eating less will help you lose fat from under the skin and under the muscle.
  • Eating better means you will be eating fewer refined carbohydrates, and that can benefit your visceral fat.
  • Exercise will help the intramuscular fat because you’ll use it as fuel. It will help the subcutaneous fat because you’ll be burning calories—and yes, do your crunches and leg lifts to strengthen your core. But the visceral fat will benefit the most from exercise because exercise can help use the hormones it produces and move your metabolic function more toward normal.

Find a way to eat less, eat better, and move more that suits your lifestyle. It may be completely different from what works for your best friend or your Aunt Mary, but it will work for you. For many people, my Optimal Performance Program is helping them achieve results they haven’t gotten any other way. But whatever approach you use, you must do something; when I say the guy in the photo has a killer belly, I mean it literally. The answer isn’t a pill or a special food; it’s the effort you put into it.

What are you prepared to do today?

Dr. Chet

 

The Dangers of Undercover Fat

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What’s lurking under your abdominal muscles, in and around your liver and other internal organs? Undercover fat, actually called intra-abdominal or visceral fat. It’s dangerous because visceral fat is more metabolically active and increases the risk of heart disease and type 2 diabetes among other diseases.

What does “metabolically active” mean? Primarily, this fat makes more chemicals that can impact other organs in a negative way: protein, fat, and cholesterol-based hormones such as cortisol, insulin, and estrogen. These chemicals are critical to our health but in excess amounts can result in insulin resistance, fatty liver, and excess estrogen in women and men.

How do you know what type of fat predominates in your body? Better yet, is there anything you can do about it? We’ll finish this up on Saturday.

What are you prepared to do today?

Dr. Chet

 

“Sit-Ups Make You Fatter”

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When I spot a headline like that, I have to click on it to see what they’re talking about. And I usually end up disappointed because it’s about some product to help you lose belly fat. What about the sit-up claim? They say doing crunches or sit-ups or leg lifts will make the muscle under the fat bigger, thereby pushing the fat out farther, and giving you the appearance of being fatter.

Baloney. Sit-ups won’t make you fatter and those products they’re pitching won’t help you lose belly fat. But it does merit a look at the types of fat, where it’s stored, and what you can do about it.

The most obvious fat is the type you can see and pinch: subcutaneous fat. Literally, that means it’s right under the skin. We can see the rolls and bulges. It doesn’t make us happy and, in fact, can make us feel bad about ourselves. I can’t tell you to stop feeling that way because I feel the same way at times.

But there are two things that are important about it. First, it’s a form of protection against famine; not that famine is likely on this continent, but it’s a reserve energy supply. Second, it’s not as metabolically active as intra-abdominal fat, which is found underneath the abdominal muscle. I’ll talk more about that on Thursday.

What are you prepared to do today?

Dr. Chet

 

The Microbiome of Your Lungs

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When we think of the microbiome, it’s logical to think only of the digestive system and our skin. In reality, the microbiome includes every microbe in and on our entire body, including our lungs. At one time, the lungs were thought to be microbe free; that certainly seemed to be the case for newborns. As babies are exposed to various bacteria and other microbes, a microbiome develops in the lungs much as it does throughout the body. It seems to have the same balance of good and bad microbes, although not as extensive as the gut.

Research has shown that in serious lung conditions such as cystic fibrosis as well as chronic lung conditions such as asthma and allergies there’s a dysbiosis of the lung microbiome. In other words, the lung microbiome is out of balance.

What can be done to restore the balance? Nothing other than traditional treatments for now, but this is an area of great research interest. I believe that focusing on eating foods with probiotics as well as prebiotics can help our entire microbiome, not just our gut.

Vegetables, beans, yogurt, fermented foods, and fruit should still be the foundation of our diet. Whether it helps the lung microbiome is not known, but it will help the gut microbiome. As we know, what helps the gut microbiome can influence other parts of the body; it’s reasonable to believe that it just may help the lung microbiome as well.

What are you prepared to do today?

Dr. Chet
References:
1. JAMA. 2017;317(17):1713-1714. doi:10.1001/jama.2017.3023
2. http://www.news-medical.net/life-sciences/Lung-microbiome.aspx

 

Potatoes and Your Microbiome

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A Cherokee legend talks of two wolves inside us, one good and one evil. Which one will win? The one you feed. It applies to our microbiome as well. We have good and bad microbes within us at all times. Which ones dominate? It depends on how we feed them.

In a recent study, researchers tested a prebiotic made up of a harder-to-metabolize starch extracted from potatoes. The subjects were a group of elderly and middle aged men and women. The objective was to compare the types of bacteria that responded positively to the prebiotic.

At baseline, the elderly subjects had higher amounts of the bad microbes, proteobacteria such as E. coli, compared to middle-aged subjects. After three months of using the prebiotic, there was a decrease in the bad microbes in the elderly subjects while both groups experienced in increase in bifidobacteria, the good microbes. The conclusion was that the prebiotic helped create a better microbiome balance.

While this was a small study that focused on one type of prebiotic, there’s a lesson. If you have a diet that includes vegetables, beans, and some starchy root vegetables such as potatoes, you will get a variety of prebiotics including the type used in this study. They will help you feed the good microbes to create the right balance in your digestive system. Which microbes will win? Your diet determines which ones dominate.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI: http://dx.doi.org/10.1016/j.clnu.2017.03.025

 

Fiber and Your Microbiome

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Researchers used gnotobiotic mice in a recent study to test the importance of fiber; gnotobiotic mice are born with no bacteria of any type. Researchers used a synthetic human microbiome to introduce a bacteria colony into the mice. Once the colony was established, they withheld fiber from the diet of the mice. Then it gets scary: the mice’s microbiome used the naturally occurring mucus layer of the digestive system as food, which led to exposure of the underlying cells. The mice were exposed to a pathogen similar in effect to strains of E. coli in humans, and the mice that were deprived of fiber became ill as a result of the bacteria and died.

This mucus barrier is the same in our digestive system. The fiber we eat feeds our microbiome; if we don’t get adequate fiber in our diet, the possibility exists that a similar destruction of the mucus can take place.

The solution seems simple: eat vegetables, beans, and other fiber-containing foods to strengthen your microbiome and use a fiber supplement as insurance.

What are you prepared to do today?

Dr. Chet
Reference: http://dx.doi.org/10.1016/j.cell.2016.10.043

 

How to Limit Your Processed Food

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There are two strategies that you can use to control your intake of processed foods.

The first is the simplest yet the most difficult, especially if it’s something you really love to eat: Don’t buy it. If it’s not in the house, you can’t eat it. Whenever I tell that to someone, the next words out of their mouth are usually something like “That’s not going to happen!”

I understand completely, but for me, it’s the only way I can reduce my intake of chips and peanuts. If they’re in the house, I will eat them and I won’t stop. Some types of nuts such as almonds or walnuts are easier to control. I have yet to find something to substitute for any type of chip. You can put salt on carrots and celery, but it isn’t the same. You can dip broccoli or cauliflower in olive oil or balsamic vinegar and it doesn’t come close. It’s the combination of processing combined with the fat and salt that makes these foods difficult to resist for me.

Can you walk away from the pantry as you let one square of chocolate dissolve in your mouth? Can you eat two Oreos and put the package away? We all have our Achilles heel of foods; Paula almost finished a box of deluxe ice cream sandwiches the day we bought them, so we never bought them again. For you, it may be bread or donuts or chocolate or jelly beans. If you can’t walk away, just don’t buy it.

The second approach, and one that may be more reasonable for some, is to portion out a serving and don’t eat any more. In my opinion, there are no foods that you can never eat as long as you control the amount and the frequency. If you can control your portions, that works just fine. If you can’t, you have no alternative other than to not purchase them.

Here is a bonus third way: Eat your vegetables first. Research shows that vegetables contribute to satiety. If you eat them first, it may be easier to control the processed foods you desire. Drinking a glass of tomato juice instead of a milkshake may not be as rewarding emotionally, but it may satisfy you physically.

This is something to work on at home with your children. Based on recent changes to the guidelines for school lunches, the upper levels of sodium may be suspended for school districts that request it. It seems innocent enough but in effect, your kids probably will be exposed to high levels of salt, learning to become dependent on the same nutritionally deficient foods we have problems with today. Schools can also opt out of the whole-grain requirement, so expect to see cheaper white bread. Best bet is to fix healthy lunches for your children every day and teach the kids to fix them, too.

I hope this helps. For me, it’s a never-ending battle and I know it is for others as well. Find which strategy works best for you—abstinence or control—and stick to it.

What are you prepared to do today?

Dr. Chet