William R. Hamilton

Supplemental products used for weight loss.

OBJECTIVE To review the scientific literature on several dietary supplements and herbal products commonly promoted for weight loss. DATA SOURCES Recently published articles and abstracts identified through PubMed (May 1987-May 2003), MEDLINE (January 1966-May 2003), International Pharmaceutical Abstracts (January 1970-May 2003), and Natural Medicines Comprehensive Database (January 1995-May 2003) using the search terms supplement, herbal, weight loss, obesity, overweight, conjugated linoleic acid, ephedra, ephedrine, chromium, Garcinia cambogia, hydroxycitric acid, chitosan, and pyruvate. STUDY SELECTION Performed manually by the authors. DATA EXTRACTION Performed manually by the authors. Only single-agent, randomized, blinded, controlled studies with sufficient scientific rigor in overweight or obese subjects were included. DATA SYNTHESIS Approximately 50 individual supplemental products and hundreds of combination products are promoted for weight loss. As a result, much confusion exists among health care professionals regarding the efficacy and safety of these products. Results for conjugated linoleic acid were positive in three clinical studies, with few adverse effects. Ephedra has been shown to be effective in promoting weight loss, especially when combined with caffeine, but it has a high adverse effect risk profile. The data regarding ephedra and ephedra combinations are conflicting, and many of the studies were poorly designed. Garcinia and chitosan have not shown much promise for weight loss, but little research has been done. Pyruvate has consistently shown positive weight loss effects. CONCLUSION Overall, herbal products and dietary supplements promoted for weight loss lack sufficient supporting efficacy and safety data. More research is needed to draw definitive conclusions. Conjugated linoleic acid and pyruvate have the best supporting evidence, but larger and better-controlled trials are needed before pharmacists should recommend these agents to patients seeking to lose weight.

An evidence-based review of fat modifying supplemental weight loss products.

Objective. To review the literature on fat modifying dietary supplements commonly used for weight loss. Methods. Recently published randomized, placebo-controlled trials were identified in PubMed, MEDLINE, International Pharmaceutical Abstracts, Cochrane Database, and Google Scholar using the search terms dietary supplement, herbal, weight loss, obesity, and individual supplement names. Discussion. Data for conjugated linoleic acid (CLA), Garcinia cambogia, chitosan, pyruvate, Irvingia gabonensis, and chia seed for weight loss were identified. CLA, chitosan, pyruvate, and Irvingia gabonensis appeared to be effective in weight loss via fat modifying mechanisms. However, the data on the use of these products is limited. Conclusion. Many obese people use dietary supplements for weight loss. To date, there is little clinical evidence to support their use. More data is necessary to determine the efficacy and safety of these supplements. Healthcare providers should assist patients in weighing the risks and benefits of dietary supplement use for weight loss.

Effect of omega-3 fatty acid supplementation on the arachidonic acid:eicosapentaenoic acid ratio.

Study Objectives. To determine the baseline arachidonic acid: eicosapentaenoic acid (AA:EPA) ratio in patients with coronary artery disease and healthy subjects, and whether supplementation of omega‐3 fatty acids, administered as fish oil capsules, affects this ratio.

Survey on unclaimed prescriptions in a community pharmacy.

OBJECTIVE To quantify the number of unclaimed prescriptions, document the reasons patients did not claim prescriptions, investigate the effect of telephone contact on the pickup rate, and document the types of medications involved and the frequency of this type of non-compliance. DESIGN A total of 549 unclaimed prescriptions were evaluated during a nine-month study. Pharmacy students contacted patients whose prescription orders had been dispensed but not claimed. Patients contacted by telephone were asked why they had not claimed their prescriptions. The types of medications involved were documented, and a follow-up check was made of the patients profile on the pharmacy computer system to determine whether the telephone contact affected the pickup rate. RESULTS Reasons given for not claiming the prescriptions included: transfer to another pharmacy, prescription was forgotten, the patient no longer wanted or needed the prescription because they had medication left over, or patient decided they did not need the medication. Telephone contact had minimal impact on the compliance rate of this patient group. The most common unclaimed medication categories were anti-infectives, cough and cold/allergy medications, and birth control/hormones. CONCLUSIONS Patients cited many reasons for not picking up their medication. Follow-up telephone calls did not increase the number of prescriptions picked up by patients in this study.