This is a comprehensive, 100-hour continuing education program designed to strengthen physician associates'/assistants' knowledge and clinical decision-making across a broad range of common and complex conditions affecting adult health. The curriculum integrates evidence-based approaches to cardiovascular and metabolic disease, musculoskeletal and neurologic disorders, behavioral health, pain and substance-related concerns, and ethical and end-of-life care. Topics include heart failure, hypertension, diabetes, overweight and obesity, osteoporosis, back pain, Parkinson disease, behavioral addictions, opioid safety, anabolic steroid use, medical ethics, and counseling patients and families at the end of life. The program also addresses the evidence, safety considerations, and potential drug interactions associated with natural medicines and dietary supplements used for depression, anxiety, and weight loss. Emphasizing whole-person care, this program equips physician assistants to apply current evidence and clinical principles to the assessment, management, counseling, and ongoing care of diverse adult patients.
- 1. Part I— Treatment of Heart Failure: An Update — 10 CREDITS
- 2. Part II — Hypertension: Strategies to Improve Outcomes — 5 CREDITS
- 3. Part III — Low Back Pain — 15 CREDITS
- 4. Part IV — Alternative Therapies for Depression and Anxiety — 5 CREDITS
- 5. Part V — Medical and Illicit Use of Anabolic Steroids — 5 CREDITS
- 6. Part VI — Supplements for Weight Loss — 5 CREDITS
- 7. Part VII — Type 2 Diabetes: Treatment Strategies for Optimal Care — 5 CREDITS
- 8. Part VIII — Diagnosing and Treating Overweight and Obese Patients — 5 CREDITS
- 9. Part IX — Osteoporosis: Diagnosis and Management — 5 CREDITS
- 10. Part X — Behavioral Addictions — 15 CREDITS
- 11. Part XI — Parkinson Disease — 10 CREDITS
- 12. Part XII — Counseling Patients at the End of Life — 5 CREDITS
- 13. Part XIII — Medical Ethics for Physicians — 5 CREDITS
- 14. Part XIV — Opioid Safety: Balancing Benefits and Risks — 5 CREDITS
This course is designed for physician assistants and interested healthcare professionals.
Patricia Lea, RN, DNP, MSEd, CCRN, received a Bachelor of Science degree in Nursing in 1973 from Houston Baptist University in Houston, Texas. She returned to graduate school to complete a Master’s degree in Education, specifically Health Education, in 1996 from Baylor University in Waco, Texas, and a Doctorate in Nursing Practice in Executive Leadership in 2014 from American Sentinel University in Aurora, Colorado. Dr. Lea specializes in critical care nursing, with an emphasis on heart failure and sepsis. She started her career at the Houston Methodist Hospital in the cardiovascular ICU and opened an acute dialysis unit at what is now Baylor St. Luke’s Medical Center in the Houston Medical Center. Dr. Lea was a Cardiovascular Clinical Coordinator and Director of the Heart Failure Clinic at Hillcrest Baptist Medical Center in Waco, Texas. In 2004, Dr. Lea returned to Houston and was employed as a Senior Research Clinical Nurse Specialist at the Texas Heart Institute coordinating stem cell and cardiac stent trials. She is currently Associate Professor and Baccalaureate Program Director at the University of Texas Medical Branch School of Nursing in Galveston, Texas.
John J. Whyte, MD, MPH, is currently the Chief Medical Officer at WebMD. In this role, he leads efforts to develop and expand strategic partnerships that create meaningful change around important and timely public health issues. Previously, Dr. Whyte was the Director of Professional Affairs and Stakeholder Engagement at the FDA’s Center for Drug Evaluation and Research and the Chief Medical Expert and Vice President, Health and Medical Education at Discovery Channel, part of the media conglomerate Discovery Communications.
Prior to this, Dr. Whyte was in the Immediate Office of the Director at the Agency for Healthcare Research Quality. He served as Medical Advisor/Director of the Council on Private Sector Initiatives to Improve the Safety, Security, and Quality of Healthcare. Prior to this assignment, Dr. Whyte was the Acting Director, Division of Medical Items and Devices in the Coverage and Analysis Group in the Centers for Medicare & Medicaid Services (CMS). CMS is the federal agency responsible for administering the Medicare and Medicaid programs. In his role at CMS, Dr.Whyte made recommendations as to whether or not the Medicare program should pay for certain procedures, equipment, or services. His division was responsible for durable medical equipment, orthotics/prosthetics, drugs/biologics/therapeutics, medical items, laboratory tests, and non-implantable devices. As Division Director as well as Medical Officer/Senior Advisor, Dr. Whyte was responsible for more national coverage decisions than any other CMS staff.
Dr. Whyte is a board-certified internist. He completed an internal medicine residency at Duke University Medical Center as well as earned a Master’s of Public Health (MPH) in Health Policy and Management at Harvard University School of Public Health. Prior to arriving in Washington, Dr. Whyte was a health services research fellow at Stanford and attending physician in the Department of Medicine. He has written extensively in the medical and lay press on health policy issues.
Mark Rose, BS, MA, LP, is a licensed psychologist in the State of Minnesota with a private consulting practice and a medical research analyst with a biomedical communications firm. Earlier healthcare technology assessment work led to medical device and pharmaceutical sector experience in new product development involving cancer ablative devices and pain therapeutics. Along with substantial experience in addiction research, Mr. Rose has contributed to the authorship of numerous papers on CNS, oncology, and other medical disorders. He is the lead author of papers published in peer-reviewed addiction, psychiatry, and pain medicine journals and has written books on prescription opioids and alcoholism published by the Hazelden Foundation. He also serves as an Expert Advisor and Expert Witness to law firms that represent disability claimants or criminal defendants on cases related to chronic pain, psychiatric/substance use disorders, and acute pharmacologic/toxicologic effects. Mr. Rose is on the Board of Directors of the Minneapolis-based International Institute of Anti-Aging Medicine and is a member of several professional organizations.
Chelsey McIntyre, PharmD, is a clinical pharmacist who specializes in drug information, literature analysis, and medical writing. She earned her Bachelor of Science degree in Genetics from the University of California, Davis. She then went on to complete her PharmD at Creighton University, followed by a clinical residency at the Children’s Hospital of Philadelphia (CHOP). Dr. McIntyre held the position of Drug Information and Policy Development Pharmacist at CHOP until her move to Washington state in 2017, after which she spent the next six years as a clinical editor for Natural Medicines, a clinical reference database focused on natural products and alternative therapies. She continues to create rigorous professional analysis and patient education materials for various publications while also practicing as a hospital pharmacist. Her professional interests include provider and patient education, as well as the application of evidence-based research to patient care.
Lisa Hutchison, LMHC, has more than 20 years of experience providing individual and group counseling with adults. She specifically focuses on teaching assertiveness, stress management, and boundary setting for empathic helpers. Ms. Hutchison graduated from the University of Massachusetts, Boston, with a Master’s degree in education for mental health counseling.
John M. Leonard, MD, Professor of Medicine Emeritus, Vanderbilt University School of Medicine, completed his post-graduate clinical training at the Yale and Vanderbilt University Medical Centers before joining the Vanderbilt faculty in 1974. He is a clinician-educator and for many years served as director of residency training and student educational programs for the Vanderbilt University Department of Medicine. Over a career span of 40 years, Dr. Leonard conducted an active practice of general internal medicine and an inpatient consulting practice of infectious diseases.
Contributing faculty, Patricia Lea, RN, DNP, MSEd, CCRN, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, John J. Whyte, MD, MPH, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Mark Rose, BS, MA, LP, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Chelsey McIntyre, PharmD, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Lisa Hutchison, LMHC, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, John M. Leonard, MD, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
John V. Jurica, MD, MPH
John M. Leonard, MD
The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.
Supported browsers for Windows include Microsoft Internet Explorer 9.0 and up, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Supported browsers for Macintosh include Safari, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Other operating systems and browsers that include complete implementations of ECMAScript edition 3 and CSS 2.0 may work, but are not supported. Supported browsers must utilize the TLS encryption protocol v1.1 or v1.2 in order to connect to pages that require a secured HTTPS connection. TLS v1.0 is not supported.
#41970: The Adult Patient: Evidence-Based Care for Mind and Body
Part 6 of 14 · Chapter 1 of 8
Table of Contents
The purpose of this course is to help healthcare professionals in all practice settings increase their understanding of supplements that are often used or are marketed for weight loss.
Upon completion of this course, you should be able to:
- Review the most common classes of dietary supplement ingredients used for weight loss.
- Compare and contrast the evidence for different fibers that are used to increase satiety.
- Outline the use of various fruit supplements for potential weight loss.
- Provide counseling points for the safe use of caffeine and caffeine-containing products.
- Discuss the cardiovascular risks associated with most thermogenic agents.
- List the dietary supplements with the greatest risk for drug interactions.
Dieting has become so common in the United States that some people call it the national pastime. Each year, approximately 50% of adults younger than 50 years of age report following a diet, with the majority of people pursuing that diet in an effort to either lose weight or improve overall health.
Many adults who are trying to lose weight, or even maintain weight, also report using weight-loss supplements. In 2020, the global weight-loss market was valued at $33.4 billion, with a projected annual growth rate of 16.6% from 2021 to 2028 [1]. While this market value indicates a high rate of use, actual statistics on consumer use are limited. In one survey conducted in 2008, 65.8% of survey participants reporting making a serious weight-loss attempt. Of those respondents, one-third reported using a dietary supplement for weight loss [2].
Weight-loss supplements are often marketed as a method to reduce the amount of effort necessary to lose weight. Although the U.S. Food and Drug Administration (FDA) does not proactively review the safety or efficacy of these products, many consumers are under the false impression that dietary supplements have been approved as safe and effective. Additionally, many consumers believe that any relevant side effects caused by these products will be prominently displayed on the label, which is not the case. Thus, patients often turn to weight-loss supplements due to the incorrect belief that they are safe and potentially effective options for enhancing weight loss [2].
Unfortunately, many products which are marketed for weight loss have not been adequately studied to determine whether they are actually effective. Additionally, while some ingredients are generally safe, others can cause serious adverse effects and should be avoided. Finally, some natural products marketed for weight loss can cause serious interactions with drugs or medical conditions.
This course will cover the major classes of dietary supplements that are marketed for (and used for) weight loss, including digestion inhibitors, appetite suppressants, and thermogenic agents. The course will also cover some common dietary ingredients, such as fruits and fibers, that are also often promoted for weight loss.
1. Grand View Research. Weight Loss Supplements Market Size, Share & Trends Analysis Report By End User (18-40 Years, Under 18 Years), By Distribution Channel (Offline, Online), By Type (Powders, Pills), By Ingredient, And Segment Forecasts, 2021 - 2028. Available at https://www.grandviewresearch.com/industry-analysis/weight-loss-supplements-market-report. Last accessed November 8, 2024.
2. Pillitteri JL, Shiffman S, Rohay JM, Harkins AM, Burton SL, Wadden TA. Use of dietary supplements for weight loss in the United States: results of a national survey. Obes Silver Spring Md. 2008;16(4):790-796.
3. Bhattacharya SK, Chakrabarti A, Chatterjee SS. Activity profiles of two hyperforin-containing hypericum extracts in behavioral models. Pharmacopsychiatry. 1998;31 Suppl 1:22-29.
4. Hohmann N, Maus A, Carls A, Haefeli WE, Mikus G. St. John's wort treatment in women bears risks beyond pharmacokinetic drug interactions. Arch Toxicol. 2016;90(4):1013-1015.
5. Chrubasik-Hausmann S, Vlachojannis J, McLachlan AJ. Understanding drug interactions with St. John's wort (Hypericum perforatum L.): impact of hyperforin content. J Pharm Pharmacol. 2019;71(1):129-138.
6. Ceci F, Cangiano C, Cairella M, et al. The effects of oral 5-hydroxytryptophan administration on feeding behavior in obese adult female subjects. J Neural Transm. 1989;76(2):109-117.
7. Cangiano C, Ceci F, Cascino A, et al. Eating behavior and adherence to dietary prescriptions in obese adult subjects treated with 5-hydroxytryptophan. Am J Clin Nutr. 1992;56(5):863-867.
8. Cangiano C, Laviano A, Del Ben M, et al. Effects of oral 5-hydroxy-tryptophan on energy intake and macronutrient selection in non-insulin dependent diabetic patients. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1998;22(7):648-654.
9. Roza O, Lovász N, Zupkó I, Hohmann J, Csupor D. Sympathomimetic activity of a Hoodia gordonii product: a possible mechanism of cardiovascular side effects. BioMed Res Int. 2013;2013:171059.
10. Citó MCO, Silva MIG, Santos LKX, et al. Antidepressant-like effect of Hoodia gordonii in a forced swimming test in mice: evidence for involvement of the monoaminergic system. Braz J Med Biol Res Rev Bras Pesqui Medicas E Biol. 2015;48(1):57-64.
11. Zhang S, Ma Y, Li J, Ma J, Yu B, Xie X. Molecular matchmaking between the popular weight-loss herb Hoodia gordonii and GPR119, a potential drug target for metabolic disorder. Proc Natl Acad Sci U S A. 2014;111(40):14571-14576.
12. Blom WAM, Abrahamse SL, Bradford R, et al. Effects of 15-d repeated consumption of Hoodia gordonii purified extract on safety, ad libitum energy intake, and body weight in healthy, overweight women: a randomized controlled trial. Am J Clin Nutr. 2011;94(5):1171-1181.
13. Castro-Guerrero NA, Isidra-Arellano MC, Mendoza-Cozatl DG, Valdés-López O. Common bean: a legume model on the rise for unraveling responses and adaptations to iron, zinc, and phosphate deficiencies. Front Plant Sci. 2016;7:600.
14. Celleno L, Tolaini MV, D'Amore A, Perricone NV, Preuss HG. A Dietary supplement containing standardized Phaseolus vulgaris extract influences body composition of overweight men and women. Int J Med Sci. 2007;4(1):45-52.
15. Spadafranca A, Rinelli S, Riva A, et al.. Phaseolus vulgaris extract affects glycometabolic and appetite control in healthy human subjects. Br J Nutr. 2013;109(10):1789-1795.
16. Nchanji EB, Ageyo OC. Do common beans (Phaseolus vulgaris L.) promote good health in humans? A systematic review and meta-analysis of clinical and randomized controlled trials. Nutrients. 2021;13(11):3701.
17. Wang S, Chen L, Yang H, Gu J, Wang J, Ren F. Regular intake of white kidney beans extract (Phaseolus vulgaris L.) induces weight loss compared to placebo in obese human subjects. Food Sci Nutr. 2020;8(3):1315-1324.
18. Valentine R, Athanasiadis T, Moratti S, Hanton L, Robinson S, Wormald PJ. The efficacy of a novel chitosan gel on hemostasis and wound healing after endoscopic sinus surgery. Am J Rhinol Allergy. 2010;24(1):70-75.
19. Gades MD, Stern JS. Chitosan supplementation and fat absorption in men and women. J Am Diet Assoc. 2005;105(1):72-77.
20. Moraru C, Mincea MM, Frandes M, Timar B, Ostafe V. A meta-analysis on randomised controlled clinical trials evaluating the effect of the dietary supplement chitosan on weight loss, lipid parameters and blood pressure. Med Kaunas Lith. 2018;54(6):109.
21. Jull AB, Ni Mhurchu C, Bennett DA, Dunshea-Mooij CA, Rodgers A. Chitosan for overweight or obesity. Cochrane Database Syst Rev. 2008;(3):CD003892.
23. Al-Tamimi FA, Hegazi AEM. A case of castor bean poisoning. Sultan Qaboos Univ Med J. 2008;8(1):83-87.
24. Müller-Lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and misconceptions about chronic constipation. Am J Gastroenterol. 2005;100(1):232-242.
25. U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025. 9th Edition. Available at http://www.dietaryguidelines.gov. Last accessed November 8, 2024.
26. U.S. Food and Drug Administration. Questions and Answers on Dietary Fiber. Available at https://www.fda.gov/food/food-labeling-nutrition/questions-and-answers-dietary-fiber. Last accessed November 8, 2024.
27. Noureddin S, Mohsen J, Payman A. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: a randomized trial in patients with type 2 diabetes and chronic constipation. Complement Ther Med. 2018;40:1-7.
28. Clark MJ, Slavin JL. The effect of fiber on satiety and food intake: a systematic review. J Am Coll Nutr. 2013;32(3):200-211.
29. Rahmani J, Miri A, Černevičiūtė R, et al. Effects of cereal beta-glucan consumption on body weight, body mass index, waist circumference and total energy intake: a meta-analysis of randomized controlled trials. Complement Ther Med. 2019;43:131-139.
30. Hodgson JM, Lee YP, Puddey IB, et al. Effects of increasing dietary protein and fibre intake with lupin on body weight and composition and blood lipids in overweight men and women. Int J Obes. 2010;34(6):1086-1094.
31. Yari Z, Rahimlou M, Poustchi H, Hekmatdoost A. Flaxseed supplementation improves anthropometric measurements, metabolic, and inflammatory biomarkers in overweight and obese adults. Int J Vitam Nutr Res Int Z Vitam- Ernahrungsforschung J Int Vitaminol Nutr. 2022;92(3-4):161-168.
32. Mohammadi-Sartang M, Mazloom Z, Raeisi-Dehkordi H, Barati-Boldaji R, Bellissimo N, Totosy de Zepetnek JO. The effect of flaxseed supplementation on body weight and body composition: a systematic review and meta-analysis of 45 randomized placebo-controlled trials. Obes Rev Off J Int Assoc Study Obes.
33. Bongartz U, Hochmann U, Grube B, et al. Flaxseed mucilage (IQP-LU-104) reduces body weight in overweight and moderately obese individuals in a 12-week, three-arm, double-blind, randomized, and placebo-controlled clinical study. Obes Facts. 2022;15(3):395-404.
34. Kaats GR, Bagchi D, Preuss HG. Konjac glucomannan dietary supplementation causes significant fat loss in compliant overweight adults. J Am Coll Nutr. 2015:1-7.
35. Lyon MR, Reichert RG. The effect of a novel viscous polysaccharide along with lifestyle changes on short-term weight loss and associated risk factors in overweight and obese adults: an observational retrospective clinical program analysis. Altern Med Rev J Clin Ther. 2010;15(1):68-75.
36. Rodriguez J, Neyrinck AM, Van Kerckhoven M, et al. Physical activity enhances the improvement of body mass index and metabolism by inulin: a multicenter randomized placebo-controlled trial performed in obese individuals. BMC Med. 2022;20(1):110.
37. Health Canada. Health Canada Advises Canadians That Natural Health Products Containing Glucomannan May Cause Serious Choking If Used With Insufficient Fluid. Available at https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2010/13439a-eng.php. Last accessed November 8, 2024.
38. Basu A, Betts NM, Nguyen A, Newman ED, Fu D, Lyons TJ. Freeze-dried strawberries lower serum cholesterol and lipid peroxidation in adults with abdominal adiposity and elevated serum lipids. J Nutr. 2014;144(6):830-837.
39. Moazen S, Amani R, Homayouni Rad A, Shahbazian H, Ahmadi K, Taha Jalali M. Effects of freeze-dried strawberry supplementation on metabolic biomarkers of atherosclerosis in subjects with type 2 diabetes: a randomized double-blind controlled trial. Ann Nutr Metab. 2013;63(3):256-264.
40. Conceição de Oliveira M, Sichieri R, Sanchez Moura A. Weight loss associated with a daily intake of three apples or three pears among overweight women. Nutr Burbank Los Angel Cty Calif. 2003;19(3):253-256.
41. Habanova M, Holovicova M, Scepankova H, et al. Modulation of lipid profile and lipoprotein subfractions in overweight/obese women at risk of cardiovascular diseases through the consumption of apple/berry juice. Antioxid Basel Switz. 2022;11(11):2239.
42. Khezri SS, Saidpour A, Hosseinzadeh N, Amiri Z. Beneficial effects of apple cider vinegar on weight management, visceral adiposity index and lipid profile in overweight or obese subjects receiving restricted calorie diet: a randomized clinical trial. J Funct Foods. 2018;43:95-102.
43. Cobb KM, Chavez DA, Kenyon JD, Hutelin Z, Webster MJ. Acetic acid supplementation: effect on resting and exercise energy expenditure and substrate utilization. Int J Exerc Sci. 2021;14(2):222-229.
44. Heskey C, Oda K, Sabaté J. Avocado intake, and longitudinal weight and body mass index changes in an adult cohort. Nutrients. 2019;11(3):691.
45. Wien M, Haddad E, Oda K, Sabaté J. A randomized 3×3 crossover study to evaluate the effect of Hass avocado intake on post-ingestive satiety, glucose and insulin levels, and subsequent energy intake in overweight adults. Nutr J. 2013;12:155.
46. González-Ortiz M, Martínez-Abundis E, Espinel-Bermúdez MC, Pérez-Rubio KG. Effect of pomegranate juice on insulin secretion and sensitivity in patients with obesity. Ann Nutr Metab. 2011;58(3):220-223.
47. Gheflati A, Mohammadi M, Ramezani-Jolfaie N, Heidari Z, Salehi-Abargouei A, Nadjarzadeh A. Does pomegranate consumption affect weight and body composition? A systematic review and meta-analysis of randomized controlled clinical trials. Phytother Res PTR. 2019;33(5):1277-1288.
48. Larsson SC, Woolf B, Gill D. Appraisal of the causal effect of plasma caffeine on adiposity, type 2 diabetes, and cardiovascular disease: two sample mendelian randomisation study. BMJ Med. 2023;2(1):1-8.
49. Gavrieli A, Karfopoulou E, Kardatou E, et al. Effect of different amounts of coffee on dietary intake and appetite of normal-weight and overweight/obese individuals. Obes Silver Spring Md. 2013;21(6):1127-1132.
50. Wikoff D, Welsh BT, Henderson R, et al. Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children. Food Chem Toxicol Int J Publ Br Ind Biol Res Assoc. 2017;109(Pt 1):585-648.
51. Carrillo JA, Benitez J. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinet. 2000;39(2):127-153.
52. Jagim AR, Harty PS, Fischer KM, Kerksick CM, Erickson JL. Adverse events reported to the united states food and drug administration related to caffeine-containing products. Mayo Clin Proc. 2020;95(8):1594-1603.
53. U.S. Food and Drug Administration. FDA Takes Step to Protect Consumers Against Dietary Supplements Containing Dangerously High Levels of Extremely Concentrated or Pure Caffeine. Available at https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm604485.htm. Last accessed November 8, 2024.
54. Zheng G, Sayama K, Okubo T, Juneja LR, Oguni I. Anti-obesity effects of three major components of green tea, catechins, caffeine and theanine, in mice. Vivo Athens Greece. 2004;18(1):55-62.
55. Lin Y, Shi D, Su B, et al. The effect of green tea supplementation on obesity: a systematic review and dose-response meta-analysis of randomized controlled trials. Phytother Res PTR. 2020;34(10):2459-2470.
56. Yates AA, Erdman JW, Shao A, Dolan LC, Griffiths JC. Bioactive nutrients: time for tolerable upper intake levels to address safety. Regul Toxicol Pharmacol RTP. 2017;84:94-101.
57. Oketch-Rabah HA, Roe AL, Rider CV, et al. United States Pharmacopeia (USP) comprehensive review of the hepatotoxicity of green tea extracts. Toxicol Rep. 2020;7:386-402.
58. Kalman DS, Antonio J, Kreider RB. The relative safety of ephedra compared with other herbal products. Ann Intern Med. 2003;138(12):1006; author reply 1006-1007.
59. U.S. Food and Drug Administration. Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk. Fed Regist. 2004;69(28):6787-6854.
60. Gutiérrez-Hellín J, Ruiz-Moreno C, Del Coso J. Acute p-synephrine ingestion increases whole-body fat oxidation during 1-h of cycling at Fatmax. Eur J Nutr. 2020;59(7):3341-3345.
61. Koncz D, Tóth B, Bahar MA, Roza O, Csupor D. The safety and efficacy of Citrus aurantium (bitter orange) extracts and p-synephrine: a systematic review and meta-analysis. Nutrients. 2022;14(19):4019.
62. Zhao J, Wang M, Avula B, Khan IA. Detection and quantification of phenethylamines in sports dietary supplements by NMR approach. J Pharm Biomed Anal. 2018;151:347-355.
63. Carpéné C, Galitzky J, Fontana E, Atgié C, Lafontan M, Berlan M. Selective activation of beta3-adrenoceptors by octopamine: comparative studies in mammalian fat cells. Naunyn Schmiedebergs Arch Pharmacol. 1999;359(4):310-321.
64. Smith TB, Staub BA, Natarajan GM, Lasorda DM, Poornima IG. Acute myocardial infarction associated with dietary supplements containing 1,3-dimethylamylamine and Citrus aurantium. Tex Heart Inst J. 2014;41(1):70-72.
65. Smedema JP, Müller GJ. Coronary spasm and thrombosis in a bodybuilder using a nutritional supplement containing synephrine, octopamine, tyramine and caffeine. South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 2008;98(5):372-373.
66. Nasir JM, Durning SJ, Ferguson M, Barold HS, Haigney MC. Exercise-induced syncope associated with QT prolongation and ephedra-free Xenadrine. Mayo Clin Proc. 2004;79(8):1059-1062.
67. Asbaghi O, Ghanbari N, Shekari M, et al. The effect of berberine supplementation on obesity parameters, inflammation and liver function enzymes: a systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN. 2020;38:43-49.
68. Guo Y, Chen Y, Tan ZR, Klaassen CD, Zhou HH. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol. 2012;68(2):213-217.
69. Xin HW, Wu XC, Li Q, Yu AR, Zhong MY, Liu YY. The effects of berberine on the pharmacokinetics of cyclosporin A in healthy volunteers. Methods Find Exp Clin Pharmacol. 2006;28(1):25-29.
70. Hou Q, Han W, Fu X. Pharmacokinetic interaction between tacrolimus and berberine in a child with idiopathic nephrotic syndrome. Eur J Clin Pharmacol. 2013;69(10):1861-1862.
71. Clark KL, Sebastianelli W, Flechsenhar KR, et al. 24-week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain. Curr Med Res Opin. 2008;24(5):1485-1496.
72. Tak YJ, Kim YJ, Lee JG, et al. Effect of oral ingestion of low-molecular collagen peptides derived from skate (Raja kenojei) skin on body fat in overweight adults: a randomized, double-blind, placebo-controlled trial. Mar Drugs. 2019;17(3):157.
73. Liang CW, Cheng HY, Lee YH, Liou TH, Liao CD, Huang SW. Effects of conjugated linoleic acid and exercise on body composition and obesity: a systematic review and meta-analysis. Nutr Rev. 2023;81(4):397-415.
74. Golzarand M, Omidian M, Toolabi K. Effect of Garcinia cambogia supplement on obesity indices: a systematic review and dose-response meta-analysis. Complement Ther Med. 2020;52:102451.
75. Vuppalanchi R, Bonkovsky HL, Ahmad J, et al. Garcinia cambogia, either alone or in combination with green tea, causes moderate to severe liver injury. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2022;20(6):e1416-e1425.
76. Lopez AM, Kornegay J, Hendrickson RG. Serotonin toxicity associated with Garcinia cambogia over-the-counter supplement. J Med Toxicol Off J Am Coll Med Toxicol. 2014;10(4):399-401.
77. Turner S, Diako C, Kruger R, et al. The effect of a 14-day Gymnema sylvestre intervention to reduce sugar cravings in adults. Nutrients. 2022;14(24):5287.
78. Turner S, Diako C, Kruger R, et al. Consuming Gymnema sylvestre reduces the desire for high-sugar sweet foods. Nutrients. 2020;12(4):1046.
79. Zuñiga LY, González-Ortiz M, Martínez-Abundis E. Effect of Gymnema sylvestre administration on metabolic syndrome, insulin sensitivity, and insulin secretion. J Med Food. 2017;20(8):750-754.
80. Gaytán Martínez LA, Sánchez-Ruiz LA, Zuñiga LY, González-Ortiz M, Martínez-Abundis E. Effect of Gymnema sylvestre administration on glycemic control, insulin secretion, and insulin sensitivity in patients with impaired glucose tolerance. J Med Food. 2021;24(1):28-32.
81. Stanko RT, Tietze DL, Arch JE. Body composition, energy utilization, and nitrogen metabolism with a 4.25-MJ/d low-energy diet supplemented with pyruvate. Am J Clin Nutr. 1992;56(4):630-635.
82. Onakpoya I, Hunt K, Wider B, Ernst E. Pyruvate supplementation for weight loss: a systematic review and meta-analysis of randomized clinical trials. Crit Rev Food Sci Nutr. 2014;54(1):17-23.
83. Kalman D, Colker CM, Wilets I, Roufs JB, Antonio J. The effects of pyruvate supplementation on body composition in overweight individuals. Nutr Burbank Los Angel Cty Calif. 1999;15(5):337-340.
84. U.S. Food and Drug Administration. Questions and Answers about FDA's Initiative Against Contaminated Weight Loss Products. Available at https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/questions-and-answers-about-fdas-initiative-against-contaminated-weight-loss-products. Last accessed November 8, 2024.
Part 6 of 14 · Chapter 1 of 8
Mention of commercial products does not indicate endorsement.