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Guide to Weight Loss
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About one-third of the U.S. population is overweight. Because excess body weight is implicated in many different diseases, including heart disease, diabetes, several cancers, and gallstones, it seems prudent to maintain a healthy body weight. Unfortunately, losing weight—and keeping it off—is very difficult for most people.

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Dietary changes that may be helpful:
Societies that eat very little fat have virtually no obesity. Reducing fat in the diet is an important component of weight loss efforts. Foods with a high proportion of calories from fat, which should be eliminated or limited in the diet, include red meat, poultry skins and dark meat, fried food, butter, margarine, cheese, milk (except skim milk), junk food, and most processed food. Vegetable oils should also be restricted. So should nuts, seeds, and avocados (although these foods are healthy for people who have no weight problem). Instead, the diet should be based on fruits, vegetables, whole grains, and non-fat dairy (and low-fat fish for non-vegetarians). Also see Pros and Cons of Fad Diets.
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Eating more fiber can be an important component to weight maintenance. Fiber fills people up, so they eat less; some studies find that soluble fibers work best. While soluble fiber can be found in beans and fruit, it is also available as a supplement. Glucomannan and psyllium contain soluble fiber and have been reported to help weight loss efforts in some studies. Some researchers add 10 or more grams per day to the diet.

Although the relationship between food sensitivities and body weight remains uncertain, according to one researcher, chronic food allergy may lead to overeating, resulting in obesity.2

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Watch out for yo-yo dieting:
People who go on and off diets frequently complain that the number of calories that result in weight gain gets less and less with each weight fluctuation. There is now clear evidence that the body gets stingier in its use of calories after each diet. This means it becomes easier to gain weight and harder to lose it the next time. Therefore, a person shouldn’t make changes until they are ready to stick with them. Otherwise, they’re better off not dieting in the first place.
 
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Lifestyle changes that may be helpful:
Although exercise alone may not result in significant weight loss, when combined with dietary approaches, it usually helps. It remains unclear whether exercise merely increases the burning of calories or whether the exerciser continues to burn more calories after the exercise is completed.
 
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Nutritional supplements that may be helpful:
When people diet, their caloric intake drops sharply. When this happens, it becomes increasingly difficult to eat the recommended amounts of many vitamins and minerals. Therefore, proponents of most weight-loss programs advocate taking a multiple vitamin/mineral supplement.
The mineral chromium plays an essential role in the metabolism of carbohydrates and fats as well as in the production of insulin. Chromium, in a form called chromium, has been studied for its potential role in altering body composition. Although preliminary research in and humans suggested that chromium increases fat loss and lean muscle tissue gain, follow-up research in people has not confirmed chromium to have a significant effect in altering body composition.
(-)Hydroxycitric acid (HCA), extracted from the fruit rind of the Garcinia cambogia fruit grown in Southeast Asia, has a similar chemical composition as citric acid (the primary acid in oranges and other citrus fruits). Preliminary research, based on laboratory experiments and animal research, suggests that HCA may be a useful weight loss aid. HCA has been demonstrated in the laboratory (but not yet in clinical trials with people) to reduce the conversion of carbohydrates into stored fat by inhibiting certain enzyme processes. Animal research indicates that HCA suppresses appetite and induces weight loss. One case report found that eating 1 gram of the fruit containing HCA before each meal resulted in the loss of 1 pound per day. However, much more research in human populations is needed to determine the effectiveness of HCA as a weight loss aid.
An altered form of the sugar molecule, pyruvate might aid weight loss efforts.18 A clinical trial found that pyruvate supplements, compared to placebo, enhance weight loss and also result in a greater reduction of body fat in overweight adults consuming a low-fat diet. Animal studies suggest that pyruvate leads to weight loss by increasing the resting metabolic rate.
Spirulina, or blue-green algae, is a rich source of protein, vitamins, minerals, and essential fatty acids. One double-blind trial of sixteen overweight individuals reports that 2.8 grams of spirulina taken three times per day for a four week period results in a small, but statistically significant weight loss.
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Are there any side effects or interactions?
(Refer to the individual supplement for complete information.) Supplemental intake (typically 50-300 mcg per day) of chromium has not been linked consistently with any toxicity in humans. One study suggested that chromium could cause mutagenic damage, based on very high doses of chromium in ovarian cells of hamsters. This risk, however, has not been demonstrated in humans. The potential side effects of HCA are not known; more research is needed in this area. High intakes of  pyruvate can trigger gastrointestinal upset, such as gas, bloating, and diarrhea.

There are no side effects reported with spirulina. However, since spirulina can accumulate heavy metals from contaminated water, consuming spirulina from such areas can increase the body’s load of lead, mercury, and cadmium. There are a few reports of allergic reactions to spirulina.

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Herbs that may be helpful:
The herb guaranį contains guaranine (which is nearly identical to caffeine) and the closely related alkaloids theobromine and theophylline; these compounds may curb appetite and increase weight loss. Caffeine’s effects (and hence those of guaranine) are well known and include stimulating the central nervous system, increasing metabolic rate, and producing a mild diuretic effect. Many doctors of natural medicine do not advocate using caffeine or caffeine-life substances to reduce weight.

Ephedra, commonly known as ma huang, is a diuretic and central nervous system stimulant. Studies show that ephedra, particularly when combined with caffeine, promotes weight loss. However, many nutritionally oriented doctors discourage the use of ephedra as a weight loss aid because of the many side effects that can occur with its use, especially since many of the side effects are intensified when ephedra is combined with caffeine.

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Are there any side effects or interactions?
(Refer to the individual herb for complete information.) As with any caffeinated product, G uaranį may cause insomnia, trembling, anxiety, palpitations, urinary frequency, and hyperactivity. Guaranį should be avoided during pregnancy and lactation. Long-term use may cause decreased fertility, cardiovascular disease, and several forms of cancer according to epidemiological studies of caffeine use.

 

Ephedra has a long history of safe use at the recommended amount. However, abuse of the drug—especially for weight loss—can lead to amphetamine-like side effects including elevated blood pressure, muscle disturbances, insomnia, dry mouth, heart palpitations, nervousness, and even death due to heart failure.
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Anyone with high blood pressure, heart conditions, diabetes, glaucoma, and thyroid disease and those taking MAO-inhibiting antidepressants should consult with a physician before using any type of product with ephedra. Ephedra-based products should be avoided during pregnancy and lactation and used with caution in children under the age of six years.

References
Biancardi G, Palmiero L, Ghirardi PE. Glucomannan in the treatment of overweight patients with osteoarthritis. Curr Ther Res 1989;46:908-12.
• Randolph TG. Masked food allergy as a factor in the development and persistence of obesity. J Lab Clin Med 1947;32:1547.
• Muls E, Kempen K, Vansant G, et al. Is weight cycling detrimental to health? A review of the literature in humans. Int J Obes 1995;19(3):S46-S50.
• Horton TJ, Geissler CA. Effect of habitual exercise on daily energy expenditure and metabolic rate during standardized activity. Am J Clin Nutr 1994;59:13-9.
• Page TG, Ward TL, and Southern LL. Effect of chromium picolinate on growth and carcass characteristics of growing-finishing pigs. J Animal Sci 1991;69:356.
• Lefavi R, Anderson R, Keith R, et al. Efficacy of chromium supplementation in athletes: Emphasis on anabolism. Int J Sport Nutr 1992;2:111-22.
• McCarty MF. The case for supplemental chromium and a survey of clinical studies with chromium picolinate. J Appl Nutr 1991;43:59-66.
• Hallmark MA, Reynolds TH, DeSouza CA, et al. Effects of chromium and resistive training on muscle strength and body composition. Med Sci Sports Exercise 1996; 28:139-44.
• Lowenstein JM. Effect of (-)-hydroxycitrate on fatty acid synthesis by rat liver in vivo. J Biol Chem 1971;246(3):629-32.
• Triscari J and Sullivan AC. Comparative effects of (-)-hydroxycitrate and (=)-allo-hydroxycitrate on acetyl CoA carboxylase and fatty acid and cholesterol synthesis in vivo. Lipids 1977;12(4):357-63.
• Cheema-Dhadli S, Harlperin ML, Leznoff CC. Inhibition of enzymes which interact with citrate by (-)hydroxycitrate and 1,2,3,-tricarboxybenzene. Eur J Biochem 1973;38:98-102.
• Sullivan AC, Hamilton JG, Miller ON, et al. Inhibition of lipogenesis in rat liver by (-)-hydroxycitrate. Arch Biochem Biophys 1972;150:183-90.
• Greenwood MRC, Cleary MP, Gruen R, et al. Effect of (-)-hydroxycitrate on development of obesity in the Zucker obese rat. Am J Phys 1981;240:E72-8.
• Sullivan AC and Triscari J. Metabolic regulation as a control for lipid disorcers. Am J Clin Nutr 1977;30:767-76.
• Sullivan AC, Triscari J, Hamilton JG, et al. Effect of (-)-hydroxycitrate upon the accumulation of lipid in the rat: I. Lipogenesis. Lipids 1974;9:121-128.
• Sullivan AC, Triscari J, Hamilton JG, et al. Effect of (-)-hydroxycitrate upon the accumulation of lipid in the rat: II. Appetite. Lipids 1974;9(2):129-34.
• Sergio W. A natural food, malabar tamarind, may be effective in the treatment of obesity. Medi Hyp 1988;27:40.
• Stanko RT, Tietze DL, and 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):630-5.
• Stanko RT, Reynolds HR, Hoyson R, et al. Pyruvate supplementation of a low-cholesterol, low-fat diety: Effects on plasma lipid concentration and body composition in hyperlipidemic patients. Am J Clin Nutr 1994;59:423-7.
• Ivy JL, Cortez MY, Chandler RM, et al. Effects of pyruvate on the metabolism and insulin resistance of obese Zucker rats. Am J Clin Nutr 1994;59:331-7.
• Becher EW, Jakober B, Luft D, et al. Clinical and biochemical evaluations of the alga spirulina with regard to its application in the treatment of obesity. A double-blind cross-over study. Nutr Rep Intl 1986;33(4):565-573.
• Sterns DM, Belbruno JJ, Wetterhahn KE. A prediction of chromium (III) accumulation in humans from chromium dietary supplements. FASEB J 1995;9:1650-7.
• Sterns DM, Wise JP, Patierno SR, Wetterhahn KE. Chromium (III) picolinate produces chromosome damage in Chinese hamster ovary cells. FASEB J 1995;9:1643-9.
• Johnson PE,  Shubert LE. Accumulation of mercury and other elements by spirulina (cyanophyceae). Nutr Rep Intl 1986;34(6):1063-1071.
• Leung A, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2d ed. New York: John Wiley & Sons, 1996, 293-4.
• Breum L, Pedersen JK, Ahlstrom F, et al. Comparison of an ephedrine/caffeine combination and dexfenfluramine in the treatment of obesity. A double-blind multi-centre trial in general practice. Int J Obes Rel Met Dis 1994;18(2):99-103.
• Toubro S, Astrup A, Breum L, et al. The acute and chronic effects of ephedrine/caffeine mixtures on energy expenditure and glucose metabolism in humans. Int J Obes Rel Met Dis 1993;17(suppl 3):73-7.

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