Dr. Fuhrman's colleague Dr. Steven Acocella, MS, D.C., DACBN, Board Certified Clinical Nutritionist, American College of Lifestyle Physicians, and a Diplomat of the American Clinical Board of Nutrition, discusses a popular supplement:
An herbal extract of the Hoodia gordonii cactus was found to be useful in quelling the thirst and hunger pangs of desert nomads during times of famine. The proposed mechanism, according to Dr. Richard Dixey, a spokesperson for Phytopharm Pharmaceuticals, who heads a research team efforting the synthesis of P57, the appetite suppressing component of the plant, explains how it works:
"There is a part of your brain, the hypothalamus. Within that mid-brain there are nerve cells that sense glucose sugar. When you eat, blood sugar goes up because of the food, these cells start firing and now you are full. What the Hoodia seems to contain is a molecule that is about 10,000 times as active as glucose. It goes to the mid-brain and actually makes those nerve cells fire as if you were full. But you have not eaten. Nor do you want to."Pretty impressive sounding stuff, but does it work? That depends on whom you ask. Naturally, any advertisement is filled with glowing endorsements. But there is only one published, peer-reviewed scientific evaluation of P57 and that was preformed on rats. This study concluded that there was evidence of drug-induced anorexia using the extract from Hoodia1. But before you run out to the health food store consider a few facts of this study. The study was conducted on rats whereby researchers injected huge dosages of P57 directly into the brains (hypothamus) of the animals and then observed their eating behaviors for several days (apologies to PETA). To date there are no credible published human trials. Basing the use of any product on a single animal trial and purely anecdotal information is risky.
Remember, the well known Leptoprin commercial, the "when is a diet pill worth 153 dollars a bottle�when it works" people? In it they state the effectiveness of their product is "backed by two major scientific clinical trials," what they don't tell you (and don't have to tell you) is that its effectiveness has also been debunked, refuted and disproved by 50 other clinical trials! It's up to us, the consumer, to do our own research.
Taking any substance that has not been thoroughly evaluated, or in which studies yield inconsistent or irreproducible results is a poor choice. Professionally I could never recommend, and personally I would never use, anything for which the credible scientific community has not reached a positive consensus. I don't experiment on my patients and I don't rely on social proof.
Smoke and Mirrors Weight Loss
The use of this substance as a weight loss aid really comes down to how you view health. The larger question we need to ask here transcends assessing if Hoodia is safe and effective, if it really works or is it is a scam. If we are desirous of losing weight and improving our health consider this:
Many of the Hoodia manufacturers boast that their product is safe because it is not a drug. And according to the Food and Drug Administration they're right; but relative to what Hoodia actually does in the body (if it really works) they're wrong. Hoodia is not a drug by FDA standards simply because it has not been approved by them (the FDA) to be "safe and effective in the treatment of aliments or conditions." Any substance that has been isolated, concentrated and ingested for the intent of producing a physiological response is a drug. I don't think anyone could have a problem with my definition here. With that said, during my pharmacology clerkship the first thing that my professor said is that every drug, no matter how trivial or potentially lifesaving has damaging negative side effects on the body that always accompany its intended beneficial use. There is always a 'health-tax' to pay with taking any substance. It's the nature of biochemistry and all drugs have negative side effects, no exceptions.
Okay, so let's say a thousand years of Hoodia use by the San tribesmen in the Kalahari Desert have got to give this stuff credibility, their Shaman can't be wrong, and it actually works well. Consider some potential negative side effects specific to taking Hoodia. Hoodia is said to suppress thirst as well as hunger. People taking it run the risk of dehydration which can lead to the development of kidney stones and other fluid related problems. More importantly, specific to weight loss, taking it over time it will do nothing to increase metabolism so you won't burn more calories at rest; as a good aerobic training regime will do for you. So, as soon as you stop taking it the body will go into a highly efficient fat-storage mode and store even more fat at an accelerated rate, the old diet rebound "yo-yo" syndrome. This phenomenon has been seen with every magic diet pill ever used. You've not changed any metabolic set points by taking Hoodia and your brain wants those stored calories back, big time. And, if you just continue taking it, it's possible that you'll begin to lose lean body mass and weight loss at that point can become deceptive and dangerous.
Also, what about those reduced calories you do take in? If you're on a reduced calorie diet style and in caloric deficit (the only way to lose weight) then you'll have to pay very close attention to what you eat to maintain excellent nutrition. A diet that does not contain the full complement of antioxidants, phytochemicals and other micronutrients and the right macronutrients (fat, carbohydrates and proteins) is disease promoting. If you've reduced your caloric intake 40% by using this substance then you'll have to get all of your nutrition from 60% of the amount of food you normally eat.
The problem is that the vast majority of Americans are already not getting nearly enough of the life-extending, health maintaining food elements eating 100% of their present calories to begin with! More food, or rather more higher quality food, not less low quality food is a much better way to get the appetite centers in the hypothalamus to cooperate and to lose weight. "Turning off" hunger can be achieved by not only the caloric component of food, but the bulk volume and nutrients present in the food as well. So, you can "suppress" (or better yet satisfy) your appetite with lower calorie, higher nutrient-dense foods and at the end of the day you've not only controlled your appetite, reduced your calories (and therefore weight) but you've also improved your nutritional status. Now we're talking!
Gee, what foods have all the following attributes at the same time?
A. High bulk, like lots of healthy fiber
B. Are extremely rich in nutrients
C. Are also much lower in calories
If you don't know the answer to this food trivia question we have a lot to talk about!
When it comes to Hoodia or any other quick fix medical breakthrough�flavor of the month diet pill�we just don't get something for nothing and there's always a price to pay. The arsenal in the war against being over fat and against obesity has got to include more than just weight loss; weight loss by itself does not necessarily equate to improved health. I regularly consult with patients that have lost large amounts of weight and are very unhealthy. What's the point of losing a bunch of weight only to develop some other diet-related morbid condition? Any change in body weight, up or down, should always result in an elevation of health and clearly this is not always the outcome of change, the scientific journals are full of such cases. I have seen several patients that have resorted to bariatic surgery (stomach stapling) and lost nearly 100 pounds each and are enduring tremendous nutrition-related health problems. And the damage I seen in victims of the Atkins weight loss scheme could fill volumes, but that's another article. A diet rich in Phen-Phen and Red-Bull can pretty much guarantee you rapid weight loss but it can be a bit hard on the system. Using some gimmick to fool the body to lose weight can result in the perfect body�corpse-weight! Write that down.
The smoke and mirror weight loss results you get from taking herbs and other diet drugs might win the battle short term but because it doesn't result in elevated health we still lose the war. Clearly Hoodia will not improve our nutrition and can further compromise our health over time. The only possible way it might be useful is if we were to learn how to eat healthfully while taking it, but if you learned how to do that you wouldn't need Hoodia anyway. Trust me; I see real weight loss success every day.
Allow me to leave you with the words of that pop-culture icon and high profile celebrity promoter of Hoodia, Anna Nicole Smith: "Hoodia works; it's the new miracle diet pill that aids in weight loss by suppressing appetite!"
Sorry Anna, we're not buying and neither should you. Now, how about you get with the program and go get a copy of Eat to Live by Dr. Fuhrman.
1. MacLean DB, Luo LG. 2004. Increased ATP content/production in the hypothalamus may be a signal for energy-sensing of satiety: studies of the anorectic mechanism of a plant steroidal glycoside. Brain Res. 1020 (1-2):1-11.