A 2005 study showed that it’s not the type of diet you choose that’s important, but how well you can stick to the regime.
iStockPhoto.com/ Roberto Adrian
Forget the Fountain of Youth. While many red-blooded Americans would like to look forever young, the majority would rather fit into a pair of size 6 jeans. Half of the population is overweight and another 27 percent is obese. “Globesity” has become an epidemic worldwide—even among children.
As it turns out, body weight does influence longevity. Ponce de Leon, the Spanish explorer who slogged around swampy Florida seeking the fabled Fountain, would have been fascinated by recent research from the New England Journal of Medicine showing that being even moderately overweight shortens life expectancy. Excess body fat also raises the risk of a host of maladies, including heart disease, atherosclerosis, high blood pressure, diabetes, osteoarthritis, depression and some cancers.
Most of us know the risks. So why do our girths keep expanding? Experts blame several factors: the abundance of high-calorie (and not necessarily nutritious) food; super-sized portions; too much time sitting in front of computers and television screens; too little time moving our bodies; and suburban sprawl, which fosters a reliance on automobiles.
It all comes down to energy balance: the ratio of calories consumed versus calories burned. The solution? Eat less and exercise more—a simple plan many find difficult to impossible to follow. The keys to success lie in identifying your personal tar pits and making those small-but-powerful lifestyle changes you can stick with.
To lose weight and keep it off, Brigitte Mars, a Boulder, Colorado-based herbalist and author of several books, including Rawsome! (Basic Health Publications, 2004), says you must first examine and resolve the reasons you overeat. She asks her clients such questions as, “What was going on in your life when your weight became excessive?” or, “Are you trying to armor or protect yourself from something?” She might also ask, “Are you using your weight as a way to bow out of social events and avoid intimate relationships?”
But reasons for overeating also can be more mundane, says Carrie Schroeder McConnell, R.D., who teaches nutrition at Metropolitan State College of Denver and has worked in an obesity clinic at the Children’s Hospital in Denver. “We eat because someone else paid for it, because it tastes good, because we’re encouraged by loved ones to eat, because we don’t want to be rude, because we worry that if we don’t eat that ice cream, someone else will,” she says.
Likening excess body baggage to unnecessary personal possessions, Mars urges her clients literally to clean house. “Lighten your load by letting go of stuff you don’t need,” she says. “What you do on the outside sets the tone for what you’re doing on the inside.”
While you’re cleaning your internal house, get rid of guilt. If you overindulge at a party, remain positive (but not delusional). Resolve to go for a longer hike the next day—then follow through and do it. Life is full of minor setbacks. Focus on long-term, slow, steady evolution. Documenting your progress will help you stay positive.
Get a Move On
Caloric restriction represents only half of the weight-loss equation. Successful weight loss requires exercise—the importance of this cannot be overstated. Whereas dieting can lower your metabolic rate (the rate at which your body burns calories), vigorous exercise increases it—for up to 12 hours afterward. Over time, physical exertion increases muscle tissue, which burns more calories than fat.
If you’re new to exercise, build up gradually. Several short bursts of moderate exercise over the day add up. Pass up that great parking place for a more distant one. Take the stairs rather than the elevator. Take up gardening, tap-dancing, any activity you enjoy. The more you like it, the more you’ll want to continue. McConnell recommends at least 30 to 60 minutes on most days of the week, noting that a survey by the National Weight Control Registry found that people who exercised 90 minutes a day were most likely to keep lost weight off. But don’t be discouraged by the high number—you don’t have to spend the whole time on a treadmill. Remember, all the forms of exercise you do throughout the day can add up to your 90 minutes.
My daughter, who worked in a bicycle store this summer, told me of a plump customer who exchanged her car for a new bike. She cycled everywhere—to work, to the store and just for fun. A few months later, she had lost 60 pounds!
Best Tips for Long-Term Success
Set reasonable goals. If you vow to shed 5 pounds in one week—just in time to squeeze into that little red dress you bought for Valentine’s Day—you will either miss the mark or quickly regain the weight. Only unhealthful maneuvers (starvation, taking diuretics and purging) yield rapid weight loss. That extra baggage didn’t appear overnight, and it will take time to lose—so give yourself plenty of time.
Don’t deprive yourself. Eating fewer calories doesn’t mean going hungry. Healthy foods are delicious and satisfying, Mars says. “If you’re satisfied, you don’t overeat.”
Furthermore, cold-turkeying your favorite, high-calorie foods may intensify cravings. If dinner isn’t complete without dessert, satisfy that sweet tooth with a bite—a morsel of chocolate (rather than the whole bar) or a spoonful of ice cream (not the whole pint). People often are surprised to find they enjoy the first bite most, anyway.
Steer clear of extreme diets. From a weight-loss standpoint, it doesn’t matter if you eat only bacon or grapefruit—as long as you limit your daily calorie intake. Your body stores extra calories as fat and doesn’t care whether they come from protein, carbohydrates or fat.
A 2005 study published in the Journal of the American Medical Association (JAMA) compared four diets: Atkins (low carbohydrate), Zone (balanced protein, carbs and fats), Weight Watchers (caloric restriction) and Ornish (lowfat). At the end of the year, dieters in all groups lost an average of 6 pounds. Individual success was determined not by the type of diet, but adherence to the particular regime.
Choose your carbohydrates wisely. “All carbohydrates provide four calories per gram,” McConnell says. “Regardless of whether your calories come from Gummy Bears or beans, you’ll lose weight if you take in less than you expend.” The difference is, the beans are more nutritious and high in fiber, which slows passage through the digestive tract and keeps you feeling full.
Good carbs come from whole grains, fruits and vegetables. And there is evidence that a plant-based diet does improve weight loss. In a 2005 study published in the American Medical Journal, 64 overweight, postmenopausal women embarked on a lowfat, vegan diet. Their results? The women lost an average of nearly 13 pounds in 14 weeks—without being advised to limit calories.
Fear not good fats. Fats help you feel satisfied and full. “Bad” fats are solid at room temperature: saturated fat (found mostly in meats and dairy) and “trans,” or hydrogenated, fats (found in many processed foods). “Good” fats are liquid at room temperature and include monounsaturated (olive oil) and polyunsaturated fats (most other vegetable oils and fish oils). Read labels. Be leery of products advertised as lowfat; they’re often loaded with refined carbohydrates, such as sugar and high-fructose corn syrup.
Eat slowly and with attention. If you munch while working, watching TV or driving, you may not even notice you ate all those tortilla chips until your hand hits the bottom of the bag. The brain lags 20 minutes behind the stomach in registering fullness. So savor every bite—pause and appreciate smells, textures and flavors. “Pay attention to those internal signals,” McConnell says, “and stop when you’re full.”
Don’t skip meals. If you do, you’ll be so famished the next time you sit at the dinner table you’ll bolt your food and have trouble pushing away. As McConnell puts it, “Healthy choices and portion control become extremely hard to practice when you’re starving.” Mars advises eating a good breakfast and making lunch your main meal. “We need more fuel in the daytime. In the evening, we usually eat dinner, then watch TV or read. Most of us just aren’t active at night.”
Plan ahead. On Sunday, McConnell plans her meals and shops for groceries for the entire week. “Healthy eating is more likely if it’s convenient,” she says. “Having good food on hand keeps you from snacking on junk food.” McConnell keeps prepackaged yogurt shakes and fruit on hand for rushed mornings. To get through her busy day, she packs lunch and snackable vegetables, such as baby carrots, sugar snap peas and grape tomatoes.
Don’t obsess on dieting. When I was a medical student, I was fascinated with eating disorders—an interest that no doubt stemmed from my years in mirrored ballet studios. My senior thesis examined factors that helped teens lose weight. The “successful losers” had developed an interest that took their minds off food. One joined a theater group. Another started dating. A third teen took up in-line skating.
Spend less time staring at electronic screens. Several studies have shown a correlation between hours spent in front of the TV and weight gain. Go outside. Or exercise while you watch. If you sit at a computer terminal all day, take frequent breaks to get up and move around.
Sleep on it and stress less. Both sleep deprivation and stress overload contribute to weight gain. One study found that women who slept less than seven hours a night were more likely to gain weight. Conversely, getting sufficient sleep lowers the risk. Sleep deprivation decreases the hormone leptin and increases ghrelin, leading to slowed metabolism and a heightened appetite. Furthermore, insufficient sleep stresses the body. Any kind of stress elevates the hormone cortisol, which breaks down muscle protein, deposits fat in the belly and stimulates appetite. Plus, who feels like exercising when tired and stressed out? It all works together: Managing stress ensures good sleep, and exercise and proper nutrition relieve stress.
Drink unsweetened beverages. A can of soda a day (which contains 10 teaspoons of sugar) can tip the scales 15 pounds by year’s end, according to a 2004 study published in JAMA. Other beverages to minimize include juice and beverages sweetened with high-fructose corn syrup or sugar. Instead, drink water and unsweetened tea and coffee. A bit of lowfat milk or soy milk in your coffee is fine and will provide calcium. A tall glass of water before a meal will make your stomach feel full sooner and improve bowel function.
Reward yourself. Losing unwanted pounds is reward in itself. Bask in those compliments you’ll soon hear. Give yourself motivating treats: a membership at an athletic club at the start; a massage after 5 pounds; a new dress when you’re down 10 pounds; a spa weekend at 15 pounds. Try not to think of rich food as a reward.
What About Herbs?
In 2001, Americans spent an estimated $2 billion on weight-loss supplements. According to Robert Saper, M.D., assistant professor and director of integrative medicine at Boston University Medical Center, “Only about half the ingredients in weight-loss supplements have undergone studies in humans, and none of these supplements has a robust amount of evidence demonstrating efficacy and safety.” For that reason, he does not recommend them to his patients.
Max Pittler, M.D., and Edzard Ernst, M.D., two researchers from England’s Universities of Exeter and Plymouth, reviewed weight-loss supplements and concluded that their analyses, while “encouraging in some cases, provided little convincing evidence that any specific dietary supplement is effective in reducing body weight.” Further, supplements that do appear to be effective, such as ephedra, often carry the risk of serious side effects.
Eric Yarnell, a Seattle-area naturopathic physician and assistant professor at Bastyr University, recommends herbal supplements only to his patients who already are making serious attempts to exercise and improve their diets. “Weight-loss supplements are only crutches, not magical solutions,” he says. “If one doesn’t reduce one’s intake of calories and increase one’s use of calories, then no herb in the world is ultimately going to work for more than a short period of time and may cause a lot of problems in the meantime.”
Some herbs add fiber, rev up your metabolism, burn fat and suppress appetite (see the following examples). “Most of these herbs are safe used in reasonable doses for most basically healthy people,” Yarnell says. “They are only a problem when people start overdosing to be super athletes or if they believe they can melt off the fat with a pill.”
Herbs that Help You Feel Full
Plants high in soluble fiber absorb water, making you feel full. Provided you stop eating when you feel full, you will theoretically consumer fewer calories. Other benefits of soluble fiber in the diet include improved bowel regularity and reduced blood levels of cholesterol and glucose (sugar). These latter two actions reduce the risk of atherosclerosis and diabetes, respectively. Common foods rich in soluble fiber include legumes, oats, barley and fruits, such as apples and citrus.
While experts such as Yarnell and Mars say it’s better to get your fiber from whole foods, you will find plenty of fiber supplements on the market. These products typically contain glucomannan, which is derived from konjac root (Amorphophallus konjac), guar gum, a common thickening agent derived from the seeds of the Indian cluster bean (Cyamopsis tetragonoloba) or psyllium seed husks (Plantago spp.).
These fiber supplements generally are safe, although effectiveness varies. Four small trials suggest glucomannan may help, whereas the other two fiber forms haven’t proven successful. Saper speculates that glucomannon may have specific characteristics that differ from soluble fiber in common foods. Study doses of glucomannan average 3 to 4 grams a day, divided into three doses and taken with a tall glass of water an hour before each meal. To avoid bothersome symptoms, such as flatulence, bloating, indigestion and nausea, start with a low dose and gradually increase.
Thermogenesis means generating heat. The body heats itself by expending energy and burning calories. Thermogenic substances favor the conversion of food into heat rather than fat. Examples of such substances include plants that contain stimulant alkaloids, such as caffeine, ephedrine and synephrine. The latter two chemicals also may reduce food intake. Coffee, black and green tea (Camellia sinensis), guarana (Paullinia cupana) and yerba maté (Ilex paraguariensis) all contain caffeine. Ephedra, also known as ma huang (Ephedra sinica), contains alkaloids, such as ephedrine and pseudoephedrine. Bitter orange (Citrus ×aurantium) contains synephrine and octopamine. Cinnamon (Cinnamomum verum), ginger (Zingiber officinale), garlic (Allium sativum) and cayenne (Capsicum annuum) improve circulation and safely warm the body, Mars says.
While research suggests that these alkaloids can improve weight loss, they also stimulate the cardiovascular, respiratory and nervous systems. In excess, they can cause jitteriness, insomnia, upset stomach, palpitations, rapid heart rate and elevated blood pressure. As in the case of ephedra, they can even trigger heart attacks, seizures and strokes. Such adverse events caused the FDA to remove ephedra from the market in 2004. For centuries, Asian healers have safely used this herb in low dosages in herbal blends to treat respiratory ailments. “Used judiciously,” Yarnell says, “it is a wonderful herb for allergies and cold symptoms.”
Adverse effects cropped up when Westerners, zealous for weight loss and physical endurance, began consuming ephedra in higher doses and in combination with other stimulants, such as caffeine, and decongestants, such as pseudoephedrine. Although ephedra alkaloids can augment weight loss, misuse can cause serious problems. As Mars puts it, “Ephedra works. The problem came in using it as a pharmaceutical.”
Lately, bitter orange has taken ephedra’s place in popular weight-loss supplements. Also known as Seville orange, the fruit of this spiny evergreen tree is used to make marmalade, the liqueurs Triple Sec and curaçao, and orange flower water. It yields neroli and bergamot, essential oils prized by aromatherapists and perfumers. Traditional Chinese Medicine practitioners call it zhi shi and use it for gastrointestinal ailments.
Bitter orange contains synephrine and optopamine, weaker chemical cousins to ephedrine and adrenaline (also known as epinephrine) and norepinephrine, which are manufactured by the body. A pharmaceutical derivation of synephrine, phenylephrine (Neosynephrine) is used to treat nasal congestion and low blood pressure.
A recent review of the research on bitter orange extracts for weight loss, published in Obesity Reviews in 2006, labeled the preliminary evidence “promising” and called for further investigation. Of the four studies demonstrating significant weight loss, all were of short duration (two to six weeks) and used small numbers of volunteers (nine to 30 people). None tested bitter orange alone. Rather, bitter orange extract was variously combined with caffeine, guarana, ginkgo (Ginkgo biloba), St. John’s wort (Hypericum perforatum) and ephedra. Effects of these products on heart rate and blood pressure were mixed.
The safety of bitter orange is not clear-cut. The herb’s active ingredients, synephrine and octopamine, are not well absorbed from the digestive tract and are weaker than ephedrine. Studies have used synephrine alkaloids in daily doses as low as 5 mg (in combination with caffeine and ephedrine) and up to 120 mg (used alone). Christine Haller, M.D., an assistant professor in the department of medicine at the University of California, San Francisco, notes, “It is unusual to find a commercial product that only contains bitter orange.” Usually the herb is mixed with caffeine, a combination her research demonstrates can raise blood pressure.
In one study, published in 2005 in The American Journal of Medicine, Haller and colleagues compared the effects of two bitter orange-containing supplements: Advantra Z, which contains only bitter orange, and Xenadrine EFX, which contains many ingredients, including bitter orange, green tea extract, yerba maté and cocoa extract. While bitter orange did not raise blood pressure in healthy volunteers, the product combining a relatively low dose of bitter orange with caffeine-containing herbs did.
What does this mean? Haller responds, “We can only say that, to date, there appear to be far fewer adverse health effects from bitter orange than with ephedra-containing products. Large-scale controlled studies are needed to determine safety.” In the meantime, Haller advises people with high blood pressure, heart disease and glaucoma to talk to their doctors before taking these weight-loss supplements.
Important note: Even if you think you’re healthy, discontinue a weight-loss product if you notice insomnia, jitteriness, racing heart rate or palpitations. And please don’t combine such products with decongestant-containing cold preparations or stimulants to treat attention deficit disorder. If you’re pregnant or nursing, avoid all strong herbs and drugs.
However, a 2005 study published in the British Journal of Nutrition found that adding green tea extract (providing 1,125 mg tea catechins and 225 mg caffeine a day) to a low-calorie diet didn’t augment long-term weight loss in a group of women, though it did counteract the dip in energy expenditure that comes with restricting calories. At this point, there isn’t enough research to judge green tea’s weight-loss power.
A plant-derived supplement called hydroxycitric acid (HCA) alters fat metabolism by both inhibiting fat production and promoting its breakdown; it also reduces appetite. HCA is extracted from the rind of a pumpkin-shaped fruit native to Indonesia known as garcinia (Garcinia cambogia), also called brindleberry or Malabar tamarind. In a review of herb safety, Pittler and Ernst found garcinia was one of the few supplements—with preliminary scientific support—that appeared to be safe. While one study failed to find benefit, three studies demonstrated weight loss, although one of them didn’t find that HCA curbed appetite. Another study failed to confirm that HCA significantly altered energy expenditure or fat metabolism.
Two of the positive trials used a product said to be more bioavailable called HCA-SX, providing 2,800 to 4,667 mg a day of HCA, divided into three doses and taken 30 minutes before mealtime. This product is marketed as Super CitriMax, with a manufacturer’s recommended dosage of 900 mg 30 to 60 minutes before breakfast, lunch and dinner. This supplement is not a ground-up herb but rather a chemical extracted from a plant.
Herbal Appetite Suppressants
Ephedrine from ephedra and synephrine from bitter orange both suppress appetite, but the new kid on the block is hoodia (Hoodia gordonii). Making a big media splash, this herb has been featured on Today, 60 Minutes and in Oprah’s O Magazine. This rare succulent from the Kalahari Desert of South Africa has helped the Bushmen endure lean times and contains steroidal glycosides that trick the brain into thinking the stomach’s full, thereby suppressing appetite—but without stimulating the cardiovascular and nervous systems. A substance isolated from hoodia called P57 has shown to suppress appetite and stimulate weight loss in laboratory animals.
In an unpublished study funded by the product’s manufacturer, PhytoPharm, 19 obese adults took either a placebo or a hoodia extract without changing diet or activity levels. After 15 days, the hoodia group had reduced their food intake by 1,000 calories a day—a big drop when you consider the average American needs around 2,200 calories per day.
According to the website www.researchhoodia.info, not all products that claim to contain hoodia really do. The website offers guidelines for making sure you have the real deal. Until the plant is mass cultivated, hoodia pills and liquid extracts will remain rare and expensive.
Reaching Your Own Bottom Line
What does this all mean for the average person trying to shed flab? Eat fewer calories and make sure those calories are nutrient- and fiber-rich. Exercise every day. And hold off on weight-loss supplements until there’s enough research to prove they’re both effective and safe. As Ponce de Leon learned long ago, there is no magic potion.
Linda B. White, M.D., teaches botanical medicine and other courses at Metropolitan State College of Denver. A plant-based diet and daily rambles with her dog help keep her lean.
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