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Overweight diabetes patients often look for answers in their drugstores' weight-loss aisles, where so-called natural products are available OTC. Not all these products are safe, and many patients don't realize it.
During my public health rotation, I performed MTM at various brown-bag events, where I noticed that a few of my diabetic patients were on the heavier side. When I asked about their diet and exercise regimens, I received sheepish replies such as “Yeah, it’s just hard.” These patients were well aware of the need for exercise and healthy eating; what they wanted to know was whether they really could get a boost from products like Hydroxycut or Alli.
Numerous products offering quick pound-shaving results line the shelves of pharmacies nationwide. But do consumers know how these products work? And how do these products affect the diabetic population that struggles to lose weight?
Is this safe?
Popular weight-loss supplements such as Hydroxycut, Zantrex-3, and Cortislim are promoted as offering “natural” alternatives to similar products. These “natural” formulations rely on a proprietary blend of herbal, root, and/or fruit extracts. Key ingredients include green tea, caffeine, guarana, and/or ginseng, which are used to stimulate the body’s metabolism, in order to burn more fat.
Green tea has no harmful effects, and a systematic review has indicated that caffeine actually decreases the risk of type 2 diabetes. However, other ingredients that are included in these blends make them potentially dangerous.
For example, in the case of diabetic patients with other cardiovascular co-morbidities requiring them to take warfarin, ginseng can decrease its blood-thinning effects, resulting in a greater risk for blood clots.
FDA has discouraged the use of Hydroxycut after receiving reports of liver damage and rhabdomylosis, a condition that damages the muscles and leads to kidney injury; this is particularly hazardous for patients with diabetes who already have a heightened risk of kidney injury.
In February 2013 FDA recalled Maxiloss Weight Advanced Softgels, found to contain a hidden drug known as sibutramine, a substance that elevates blood pressure and increases risk of heart disease. Diabetic patients who are overweight or obese are already at a greater risk than the general population for cardiovascular diseases such as heart failure or stroke.
Because these products have not been tested for long-term safety and efficacy, one never knows when the next “blended solution” will be recalled.
Then there is Alli. Alli is the only medication approved by FDA for long-term use in weight reduction. It works by inhibiting the absorption of dietary fat. On the other hand, this proven product comes with a price: a whole slew of side effects, including abdominal discomfort, flatulence with discharge, fecal urgency, and oily stool. Despite those setbacks, this drug does not [VERB?] renal adjustment if the patient’s kidneys are bad, and it has almost no drug-drug interactions.
In addition, a number of clinical trials have shown Alli to be effective in supporting weight reduction in obese patients with type 2 diabetes, especially when it was used as an adjunct to healthy lifestyle changes.
The weight-loss product niche is a marketing gold mine. Every year we will see something new come out to take advantage of the huge demographic of potential users.
It is our duty as pharmacists to stay on top of these trending drugs to better inform and protect the public. Providing education is one of our key roles. Since we are easily accessible healthcare providers, we are able to respond to doubts and answer queries about these weight-loss products and ultimately empower patients to take charge of their conditions.
Amy Ng is a 2014 PharmD candidate at Touro University College of Pharmacy in Vallejo, Calif. Contact her at firstname.lastname@example.org.