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Supplements haven't been of value in treating obesity, but that doesn't stop them from being extensively advertised and sold.

Chitosan Small Benefit: Chitosan is a deacetylated chitin. In a review of the 14 best DB PC trials including a total of 1131 participants, chitosan resulted in a greater weight loss (mean difference 3.8 pounds; P < 0.00001), decrease in total cholesterol (-0.2 mmol/L; P < 0.00001), decrease in systolic (-5.9 mmHg; P < 0.0001) and diastolic (-3.4 mmHg; P < 0.00001) blood pressure compared with placebo. However, the quality of many studies was sub-optimal. Results obtained from high quality trials indicate that the effect of chitosan on body weight is minimal and unlikely to be of clinical significance. Chitosan for overweight or obesity. Ni MC, et al. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD003892

CortiSlim Bogus: A California supplement manufacturer approached Shawn Talbott, an adjunct prof in nutrition at the University of Utah to devise a weight loss product.  Since 2003, they have been making millions pushing CortiSlim, which Talbott initially claimed controlled cortisol, a hormone that he claims promotes weight gain. However, obese people don't have higher cortisol levels than lean people. Talbott never published any research supporting his claims. In fall, 2004, the FTC charged Talbott with consumer fraud for claiming that CortiSlim results in rapid, permanent weight loss of 10-50 pounds by lowering cortisol levels. CortiSlim has changed it's advertising which now promotes the "CortiSlim Lifestyle" of diet, exercise, stress management, and up to $5 a day of CortiSlim pills. CortiSlim contains a magnolia bark extract standardized for honokiol content (to "de-stress" you), chromium, green tea, banaba leaf, and vanadyl which supposedly stabilize blood sugar levels, and moderate insulin reaction and Citrus Aurauntium (bitter orange) standardized for synephrine, an "ephedra  cousin."

Honokiol Research: Honokiol is an extract from magnolia bark, which has been used in Chinese medicine, but does sound that popular in China. It has 102 studies on PubMed as of 6/9/05, which is a very small number (e.g. melatonin has over 15,000). Not one single study was on weight loss or was done with animals larger than rats. It seems to be mainly being studied as a possible anti-cancer agent. A few recent rat and lab studies are as follows: The natural product Honokiol induces caspase-dependent apoptosis in B-cell chronic lymphocytic leukemia (B-CLL) cells. Battle TE, et al. Harvard. Blood. 2005 Mar 31; Magnolol and honokiol enhance HL-60 human leukemia cell differentiation induced by 1,25-dihydroxyvitamin D3 and retinoic acid. Fong WF, et al. Hong Kong. Int J Biochem Cell Biol. 2005 Feb;37(2):427-41. Honokiol induces apoptosis through p53-independent pathway in human colorectal cell line RKO. Wang T, Chen F, et al. Cancer Institute, Second Hospital of Medicine, College of Zhejiang University, Hangzhou. World J Gastroenterol. 2004 Aug 1;10(15):2205-8. A couple studies have found an anxiolytic effect in rats in maze testing, however, nothing that could be extrapolated to human beings.

Melatonin Reduces Weight Gain in Rats with Diet-induced Obesity. Melatonin had no effect on plasma insulin level, but it decreased plasma glucose (13%), leptin (28%), and triglyceride (28%) levels. In pinealectomized high-fat diet rats, body weight gain and feed efficiency were increased 4 wk after surgery. Adipose tissue weight, insulinemia, and glycemia had a tendency to increase. Treatment with melatonin prevented in part these changes. Melatonin may act as a regulator of body weight in a model of obesity and may prevent some of the side effects on glucose homeostasis such as decreased insulin sensitivity. Prunet-Marcassus B, et al. Universitaire Paul Sabatier, Toulouse, France. Endocrinology. 2003 Dec;144(12):5347-52. 

Melatonin Reduces Olanzapine and Age Induced Fat Stores: The atypical antipsychotic drug olanzapine increases body weight and visceral adiposity in schizophrenia. In rats, aging-associated increased body weight and visceral adiposity are reversed by administration of the pineal hormone melatonin. Four groups (n=11/group) of female rats (240-250 g) were treated for 8 weeks with olanzapine, melatonin, olanzapine+melatonin, or vehicle alone. At week 8, olanzapine treatment reduced nocturnal plasma melatonin by 55% (p<0.001), which was restored to control levels by olanzapine+melatonin. Body weight increased 18% in rats treated with olanzapine alone, 10% with olanzapine+melatonin, 5% with melatonin alone, and 7% with vehicle control. Melatonin may be useful for the management of olanzapine-induced weight gain in humans. Olanzapine-Induced Weight Gain and Increased Visceral Adiposity is Blocked by Melatonin Replacement Therapy in Rats. Raskind MA, et al. University of Washington, Seattle. Neuropsychopharmacology 10 May 2006.

Melatonin Signals Fat Storage Release in Animals during Winterís Long Nights: Many animals show seasonal changes in adiposity that are triggered by changes in the photoperiod. In short "winterlike" days, the nocturnal duration of pineal melatonin (MEL) secretion increases resulting in body fat decreases. These decreases in body fat are mediated through increases in the sympathetic drive on white adipose tissue (WAT). The central nervous system (CNS) origins of the sympathetic outflow from brain to WATinclude the suprachiasmatic nucleus (SCN), an area necessary for the reception of season-encoded MELsignals in certain animals. The increased duration of MEL secretion in short days may increase MEL(1a)-receptor stimulation that, in turn, increases the sympathetic drive on WAT, thereby increasing lipolysis and decreasing adiposity. CNSsympathetic outflow neurons to white fat that express MEL receptors may mediate seasonal adiposity. Song CK, Bartness TJ. Georgia State University, Atlanta, GA.Am J Physiol Regul Integr Comp Physiol. 2001 Aug;281(2):R666-72.

Melatonin: Smaller Pineal Glands in Obese: This study found a lower pineal width and volume in overweight individuals. Other studies find less sleep associated with more obesity and less night time melatonin in the obsess. Morphometry of the pineal gland in overweight individuals. Torres K, Staskiewicz GJ, et al. Medical University of Lublin. Ann Univ Mariae Curie Sklodowska [Med]. 2003;58(2):270-5

Melatonin: Night Eaters Low in Nighttime Melatonin: Night-eating syndrome (NES) consists of morning anorexia, heavy evening eating, and insomnia. In a behavioral study, compared with 10 control subjects,10 night eaters had more eating episodes in the 24 hours (9.3 vs. 4.2; P<.001) and consumed significantly more of their daily energy intake at night than did controls (56% vs. 15%; P<.001). They averaged 3.6 awakenings per night compared with 0.3 by controls (P<.001). In night eaters, 52% of these awakenings were associated with food intake, with a mean intake per ingestion of 1134 calories. None of the controls ate during their awakenings. In the neuroendocrine study, compared with control subjects, night eaters had attenuation of the nocturnal rise in plasma melatonin and leptin levels (P<.001 for both) and higher circadian levels of plasma cortisol (P = .001). Behavioral and neuroendocrine characteristics of the night-eating syndrome. Birketvedt GS, Florholmen J, et al. University of Tromso, Norway. JAMA. 1999 Aug 18;282(7):657-63

Melatonin: TV Watching Decreases Melatonin in Children: Changes in magnetic field are associated with a decrease in nocturnal urinary melatonin excretion. Using 24-hour urines from 42 boys and 32 girls ages 6-13 after one week of watching TV and after another week of abstaining, exposure to a TV screen was associated with lower urinary melatonin concentrations, affecting particularly younger children at a pubertal stage. Researchers wonder whether exposure from TV might have an effect increasing obesity apart from any decreased activity and/or other lifestyle alterations. Age-dependent association of exposure to television screen with children's urinary melatonin excretion? Salti R, et al. University of Florence, Italy. Neuro Endocrin Lett 2006 Apr 25;27(1-2):73-80.

Enova Little Benefit: Archer Daniels Midland produces a diglyceride vegetable oil from canola and soybean oils, which are natural triglycerides. In the largest published study of DAG oil, 65 obese adults consumed 15% of their calories from Enova oil for 6 months, while 62 others used ordinary cooking oil. The Enova group lost an average of 2 more pounds with all of the weight loss in the first 2 months. Amer J Clin Nutr 76:1230, 2002. A Japanese study of 155 overweight or obese adults who just switched to Enova for one year lost an average of two pounds. (Nutrition Action 5/2005).

Tonalin CLA Little Value for Weight Loss and Troubling Lab Tests: In the best study, a 1-year DB PC trial of 93 overweight Norwegian adults, those on Tonalin CLA 3.4 grams/day lost five pounds of body fat vs. those on placebo gaining one pound.  However, the Tonalin groups had higher white blood cells counts, a sign of infection and well as higher levels of thrombocytes (blood clotting cells) and lipoprotein(a), a relative of LDL bad cholesterol which is associated with an increased risk of heart disease and stroke. J Nutrition 135:778, 2005.

Thomas E. Radecki, M.D., J.D.

modern-psychiatry.com

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