Sympathomimetic activity of a Hoodia gordonii product: a possible mechanism of cardiovascular side effects

Concomitant medications, functional foods, and supplements: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of the body weight effects of concomitant medications (i.e., pharmacotherapies not specifically for the treatment of obesity) and functional foods, as well as adverse side effects of supplements sometimes used by patients with pre-obesity/obesity.

Methods

The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

This CPS outlines clinically relevant aspects of concomitant medications, functional foods, and many of the more common supplements as they relate to pre-obesity and obesity. Topics include a discussion of medications that may be associated with weight gain or loss, functional foods as they relate to obesity, and side effects of supplements (i.e., with a focus on supplements taken for weight loss). Special attention is given to the warnings and lack of regulation surrounding weight loss supplements.

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on concomitant medications, functional foods, and supplements is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity. Implementation of appropriate practices in these areas may improve the health of patients, especially those with adverse fat mass and adiposopathic metabolic consequences.

A Systematic Review of the European Rapid Alert System for Food and Feed: Tendencies in Illegal Food Supplements for Weight Loss

Background: Slimming products represent a dynamically growing group of food supplements worldwide. The efficacy of safely usable natural ingredients is usually below consumers' expectations. Certain manufacturers add unauthorized or prohibited ingredients to weight loss supplements in order to increase their efficacy. Hence, many of these products are adulterated and may pose a risk to the consumers' health. Aims: The aim of our work was to give an overview on natural ingredients used in slimming products, to summarize the frequently used synthetic adulterants and also to assess the trends of adulterated and illegal food supplements in the European Union based on the warnings of the Rapid Alert System for Food and Feed (RASFF) in the time period of 1988-2019. Methods: Reports between 1988-2019 were extracted from the RASFF portal on January 1, 2020. Each entry was individually reviewed. Results: 2,559 records of food supplements with quality problems were identified in the RASFF, several of which [319 (12,5%)] were marketed to facilitate weight loss. 202 (63,3%) contained unapproved, synthetic drug ingredients. The major adulterant (113 of 319, 35.4%) was DNP (2,4-dinitrophenol), whereas sibutramine was the second most frequent adulterant agent (69 products, 21,6%) between 1988 and 2019. Conclusion: The number of approved medicines for the indication of weight loss is relatively low and their efficacy (and also that of the natural ingredients) is limited. Therefore, a significant number of weight loss supplements is adulterated to satisfy patients' expectations. Hence, these products may cause serious adverse effects in sensitive patients.

Bioprospecting of South African Plants as a Unique Resource for Bioactive Endophytic Microbes

South Africa has a long history and strong belief in traditional herbal medicines. Using ethnobotanical knowledge as a lead, a large number of South African medicinal plants have been discovered to possess a wide spectrum of pharmacological properties. In this review, bioprospecting of endophytes is highlighted by following the advantages of the ethnomedicinal approach together with identifying unique medicinal plants where biological activity may be due to endophytes. This review focuses on the current status of South African medicinal plants to motivate the research community to harness the benefits of ethnobotanical knowledge to investigate the presence of endophytic microbes from the most potent South African medicinal plants. The potential chemical diversity and subsequent putative medicinal value of endophytes is deserving of further research. A timely and comprehensive review of literature on recently isolated endophytes and their metabolites was conducted. Worldwide literature from the last 2 years demonstrating the importance of ethnobotanical knowledge as a useful approach to discover endophytic microbes was documented. Information was obtained from scientific databases such as Pubmed, Scopus, Scirus, Google Scholar, Dictionary of Natural Products, Chemical Abstracts Services, official websites, and scientific databases on ethnomedicines. Primary sources such as books, reports, dissertations, and thesises were accessed where available. Recently published information on isolated endophytes with promising bioactivity and their bioactive natural products worldwide (2015-2017) was summarized. The potential value of South African medicinal plants as sources of endophytes is discussed. The insights provided through this study indicate that medicinal plants in South Africa are highly under-investigated sources of potentially useful endophytic microbes. New approaches may be used by medicinal plant scientists for further exploration of natural products from endophytic fungi and bacteria in southern Africa.

Ethnobotanical survey of medicinal plants used to manage High Blood Pressure and Type 2 Diabetes Mellitus in Bitterfontein, Western Cape Province, South Africa

ETHNOPHARMACOLOGICAL RELEVANCE

The aim of this study was to identify and document medicinal plants used to manage High Blood Pressure and Type 2 Diabetes Mellitus in Bitterfontein, Western Cape Province, South Africa.

METHODS

One hundred and twelve (112) respondents were interviewed between August 2014 and September 2015 through semi-structured surveys to gather data on the percentage of people who had been diagnosed with High Blood Pressure and/or Type 2 Diabetes Mellitus and to determine the frequency of medicinal plant and allopathic medicine use. Twelve (12) key respondents were subsequently selected, using a non-probability snowball sampling method. They were interviewed in-depth concerning their plant practices and assisted with plant collection.

RESULTS

Twenty-four plant (24) species belonging to 15 families were identified for the management of High Blood Pressure and Type 2 Diabetes Mellitus. The most frequently reported families were Asteraceae (20.8%), Lamiaceae (16.67%), Crassulaceae (8.33%) and Aizoaceae (8.33%). The remaining (45.54%) were evenly split over eleven families- Fabaceae, Amaryllidaceae, Anacardiaceae, Capparaceae, Geraniaceae, Apiaceae, Convolvulaceae, Apocynaceae, Rutaceae, Asphodelaceae and Thymelaeaceae. The most commonly used plant species overall was Lessertia frutescens (96.55%). The most frequently used plant parts included leaves (57.63%) roots/bulbs (15.25%) and stems (11.86%), mostly prepared as infusions or decoctions for oral administration.

CONCLUSIONS

Medicinal plants are widely used by High Blood Pressure and Type 2 Diabetes Mellitus sufferers. They employ diverse plant species to manage both conditions. In addition, some sufferers often use prescribed allopathic medication, as well as medicinal plants, but at different intervals. Despite high usage the plants identified are not currently threatened (Red Data list status: least concern).

Bioactivity guided isolation of oxypregnane-oligoglycosides (calotroposides) from the root bark of Calotropis gigantea as potent anticancer agents

Bioactivity guided isolation of oxypregnane-oligoglycosides (calotroposides) from the ethanolic extract of root bark of Calotropis gigantea (L.) Dryand. with purple flowers has been performed and isolated pure compounds has been evaluated for anticancer activity.

Atrial Fibrillation Due to Over The Counter Stimulant Drugs in A Young Adult

The usage of over the counter stimulant drugs and energy drinks is increasing on a day to day basis for various purposes including work, sports and leisure among individuals in all age groups. Multiple formulations are available in the market including pills, liquid capsules and drinks in various flavours. Many of them contain excessively high doses of caffeine along with a variety of stimulant compounds that have multiple effects in different parts of the human body. The consumption of such high amounts of caffeine itself has shown to have caused cardiac arrhythmias in healthy individuals and when it is mixed with a number of stimulant compounds can be associated with a number of adverse effects in the human body. However, the awareness of such life threatening complications associated with these energy drinks does not exist among people who consume it on a day to day basis. We report a case of 25-year-old Caucasian male with no significant past medical history for cardiac diseases, no risk factors for atrial fibrillation, non smoker, occasional alcohol drinker who presents with new onset atrial fibrillation with rapid ventricular response due to the consumption of over the counter stimulant energy capsule which had high doses of caffeine.

Atrial Fibrillation Due to Over The Counter Stimulant Drugs in A Young Adult

The usage of over the counter stimulant drugs and energy drinks is increasing on a day to day basis for various purposes including work, sports and leisure among individuals in all age groups. Multiple formulations are available in the market including pills, liquid capsules and drinks in various flavours. Many of them contain excessively high doses of caffeine along with a variety of stimulant compounds that have multiple effects in different parts of the human body. The consumption of such high amounts of caffeine itself has shown to have caused cardiac arrhythmias in healthy individuals and when it is mixed with a number of stimulant compounds can be associated with a number of adverse effects in the human body. However, the awareness of such life threatening complications associated with these energy drinks does not exist among people who consume it on a day to day basis. We report a case of 25-year-old Caucasian male with no significant past medical history for cardiac diseases, no risk factors for atrial fibrillation, non smoker, occasional alcohol drinker who presents with new onset atrial fibrillation with rapid ventricular response due to the consumption of over the counter stimulant energy capsule which had high doses of caffeine.

Hoodia gordonii: to eat, or not to eat

ETHNOPHARMACOLOGICAL RELEVANCE

Hoodia gordonii (family Apocynaceae) has become known globally for its claimed effect of appetite suppression. Despite a relatively large body of evidence of the plant׳s chemical make-up, peer-reviewed studies to provide scientific information on physiological effects of Hoodia gordonii are relatively sparse. The role of the pregnane glycoside P57-commonly accepted to be responsible for appetite suppression-has been questioned recently. Furthermore, a variety of physiological side-effects associated with consumption of the plant in extracted form questions its suitability for consumption. Although adverse effects have been described before, the relative abundance of non-peer-reviewed data originating from patent documents and lay publication for advertising, which specifically only focus on beneficial outcomes, skews the view of the risk-benefit-balance. Here we provide a review of peer-reviewed studies on the plant׳s physiological effects. Novel data from an in vivo rodent study further elucidate the benefit-to-risk ratio associated with consumption.

CONCLUSIONS

we conclude that although Hoodia gordonii seems to have a desired effect on appetite and weight loss, this effect may at least in part be a secondary symptom of the serious adverse effects that are associated with consumption of the high doses required to achieve therapeutic clinical effect.

Hoodia gordonii extract targets both adipose and muscle tissue to achieve weight loss in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Hoodia gordonii (Masson) Sweet ex Decne (family Apocynaceae) is consumed globally as a natural appetite suppressant. While this effect-and its subsequent effect of weight loss-has been reported in the scientific literature, no information is available on the specific tissue types affected that accounts for the significant weight loss reported after consumption of the plant. Furthermore, most studies are performed on lean animals, so that the response of overweight or obese individuals to this plant supplement remains largely unknown.

MATERIALS AND METHODS

Twelve lean and twelve obese male Wistar rats were supplemented with different doses of Hoodia gordonii extract (80 or 160 mg/kg body mass twice daily) in a placebo-controlled study, for a period of 14 days.

RESULTS

All supplemented rats exhibited significant weight loss (P<0.001). This could be ascribed to decrease in both adipose cell size and skeletal muscle fibre size.

CONCLUSIONS

We conclude that the weight loss seen after consumption of Hoodia gordonii is due to loss of both adipose and muscle mass.