The effectiveness of popular, non-prescription weight loss supplements

Garry Egger, David Cameron-Smith and Rosemary Stanton

MJA 1999; 171: 604-608
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Abstract - Introduction - Methods - Results - Discussion - References - Authors' details
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Published evidence from peer-reviewed journals was considered primary, although the theoretical basis of claims from promoters and non-peer-reviewed publications was also evaluated. We used a structured format to review each substance, rating levels of evidence according to National Health and Medical Research Council guidelines (see Box).⁴ Evidence below level IV was discounted. Secondary sources of evidence and animal studies are excluded, but are available in a wider review that is available from the authors.

All weight loss is considered to be mediated through changes to energy intake and/or energy expenditure, and substances claiming effects without mediation through either or both of these mechanisms have been discounted.

Source: Rind of an exotic citrus fruit (Malabar tamarind). Active ingredient is hydroxycitric acid.

Products: "Slim Life", "Brindleslim", "Medislim", "Beer Belly Busters".

Proposed action: Reduces lipogenesis de novo; reduces appetite through glucostatic mechanisms.

Evidence: Conversion of carbohydrate into fat (lipogenesis de novo) is not the basis of most fat storage in humans.⁵ Similarly, the "glucostatic" model of appetite is now regarded as an oversimplification of the appetite process.⁶

Six peer-reviewed studies have examined hydroxycitric acid and weight loss in humans. Of these, five reported some positive results^7-12 (E3₁-E4), but all had experimental inadequacies (for a more detailed review see reference 12). Two were reported as abstracts only.^9,10 A recent randomised controlled study (E2) found no differences in weight loss between a group of obese individuals given 1500 mg of hydroxycitric acid daily and another group given placebo over a 12-week period.¹²

Conclusions: There is no strong support for the use of brindleberry in weight loss. The theoretical basis of claims made is also questionable.

Source: Major pungent ingredient of hot chillies and peppers.

Products: "Optislim 2000". Also found in spicy foods.

Proposed action: Increases metabolism; decreases appetite.

Evidence: Capsaicin activates neurons and neuropeptides thought to suppress appetite.¹³ It may also increase secretion of epinephrine, which stimulates gluconeogenesis and lipolysis.¹⁴ One recent study (E3₁) has shown that a spicy food entree containing capsaicin may reduce food intake by about 200 kcals.¹⁵ Two studies (E3₂) have not shown any changes in oxygen consumption, fat utilisation or body temperature.^16-17 However, different concentrations of capsaicin in various types of foods may affect research outcomes.¹⁸ There is no evidence that capsaicin exerts a thermogenic effect as a supplement.

Risks: Very spicy food can cause short-term pain.¹⁹

Conclusions: Capsaicin in low-fat, spicy foods may add variety to a low energy diet, with some possible benefits on energy balance. There is no support for taking the substance as a supplement.

Source: Caffeine is found in coffee, tea, cocoa and cola drinks and guarana, which is extracted from the leaf of a South American vine (Paullinia cupana).

Products: "Slim Life", "Beer Belly Busters", "Body Lean".

Proposed action: Increases alertness and decreases fatigue; may increase availability of free fatty acids for oxidation.

Evidence: The role of caffeine in increasing free fatty acids into the circulation and sparing glycogen in endurance events is well accepted.²⁰ Some studies (E3₁) have shown that the lipolytic effect of caffeine may be less in the elderly²¹ and in individuals needing to lose excess body fat.²² Caffeine has been shown in at least four studies (E2-E4) to stimulate the metabolic rate for up to 24 hours after ingestion.^22-25 It has also been shown (E31) to decrease the perception of work effort.²⁶

Several good quality studies^27-33 (E2-E3₂) have examined the effects of caffeine on weight loss in humans, but usually in combination with other substances. Only one has examined caffeine alone (200 mg daily) added to an energy-restricted diet in a placebo-controlled, double-blind trial.²⁷ In that study caffeine was no more effective than placebo in promoting weight loss. The remaining studies examined the effectiveness of caffeine in combination with ephedrine,^28-31 fibre or chromium.³² Caffeine-chromium-dietary fibre combinations have not been found to cause greater weight loss (E2).³² A caffeine-ephedrine combination has, but results in adverse side effects (tolerance and addiction).³³ Hence, there is a theoretical basis for caffeine in weight control, and good evidence for its lipolytic effect. However, controlled studies have not shown fat loss in overweight individuals using caffeine without an energy-restricted diet. No studies have reported on the effects of guarana on weight loss.

Risks: Large doses of caffeine can cause nervousness, anxiety, gastrointestinal discomfort, insomnia, heart arrhythmias and mild hallucinations, and may lead to dependence.³⁴

Conclusions: Caffeine, as part of a normal diet, may, at best, have some minor effects on energy balance. However, this has not been proven by research on caffeine alone. No studies are reported of the effects of guarana on weight loss.

Source: An amino acid found in meat and dairy products or made in the liver and kidney from the amino acids lysine and methionine.

Products: "Fat Metaboliser", "Pro-sport L-Carnitine" and "ProteCol".

Proposed action: Increases fat metabolism.

Evidence: Two studies (E3₁ and E3₂) have shown no changes in the rate of fat oxidation following L-carnitine supplementation.^35,36 Supplements can increase plasma carnitine concentrations, but have no effect on muscle carnitine levels.³⁵ The uptake of carnitine by muscle is a controlled process, with the concentration inside the cell 50-100 times greater than that circulating in the plasma, suggesting the involvement of a controlled, active transport mechanism and biological compensation.³⁷ No controlled studies examining the effects of L-carnitine on weight loss have been published.

Risks: Oral supplementation may cause diarrhoea, but no other major adverse effects have been noted.

Conclusions: There is no evidence that L-carnitine assists weight loss.

Source: Chitosan is an amino polysaccharide derived from the powdered shells of marine crustaceans such as prawns and crabs.

Products: "Chitorich", "Exofat", "Fatsorb", "Fat Breaker" and a number of other products labelled "Chitosan".

Proposed action: Binds to dietary fat, preventing digestion and storage.

Evidence: Most studies have been in animals. Some studies in humans (E3₂-E4) have shown lipid-lowering³⁸ as well as weight loss with chitosan,^39-41 although none have been published in peer-reviewed journals and all were limited by methodological flaws, including small numbers, high drop-out rate and lack of adherence to a high-fat diet. Trials (E3₂ and higher) have shown a weight-loss effect when chitosan was given with a hypocaloric diet for up to 4 weeks,^40,42-46 but a meta-analysis of these studies⁴⁷ shows discrepancies in the data, suggesting that the studies are flawed. In a recent randomised controlled trial, no effect of chitosan was found without a reduction in food intake.⁴⁸ However, this study involved only 17 people over one month. Malabsorption of fat in the digestive tract may theoretically affect energy uptake, but there is no long-term evidence showing the effectiveness of this strategy for weight loss with a substance such as chitosan.

Risks: Some malabsorption of essential nutrients is possible. If chitosan was effective, steatorrhoea could be a potential problem.

Conclusions: Malabsorption of fat in the digestive tract may have a limited effect on restricting energy uptake. However, in the absence of a low energy diet, the available evidence does not show that chitosan can assist in weight loss in humans.

Source: An organic derivative of chromium, an element required for normal carbohydrate and lipid metabolism.

Products: "Body Lean", "Chromaslim", "Medislim", "Beer Belly Busters" and "Protecol".

Proposed action: Increases satiety. Increases energy expenditure through thermogenesis.

Evidence: A number of double-blind, placebo-controlled studies (E2) have reported on the effects of chromium supplementation and exercise on body composition in non-obese individuals. Two showed a greater effect on fat loss with supplementation,^49-50 but have been criticised on methodological grounds.⁵¹ The remaining five, reviewed by Anderson,⁵² showed no effect. Two further studies of obese individuals randomised to either diet or diet plus exercise programs (E2 and E3₁) failed to show greater weight or fat loss with chromium supplementation.^32,53

Risks: Possible tissue accumulation and damage to DNA.⁵⁴ There have also been reports (E4) of renal damage following chronic ingestion of large doses of chromium picolinate.⁵⁵

Conclusions: There is no good-quality evidence to support any benefits of chromium picolinate in fat loss.

Source: Fucus vesiculosus is a seaweed.

Products: "Cellasene", "Medex", and "Bioslim" diet patches.

Proposed action: Iodine in Fucus vesiculosus increases thyroid response, leading to excess energy expenditure.

Evidence: There is only one, inconclusive published study (in French) on the effects of Fucus vesiculosis in obesity.⁵⁶

Risks: Possible hyperthyroidism if taken in excess.

Conclusions: Obesity can result from hypothyroidism, but it is a rare cause. The human thyroid gland can tolerate wide fluctuations in iodine levels and there is no evidence that increasing iodine intake in non-thyroid-deficient individuals has any effect on weight loss.

Source: The leaves of the maidenhair tree (Ginkgo biloba).

Products: "Cellasene", "Cellusense" and related products.

Proposed action: Stress reduction, leading to reduced eating.

Evidence: Ginkgo has been associated with a reduction in adrenal peripheral benzodiazepine receptors⁵⁷ and hence may reduce the corticosteroid response to stress. Some stress-related medications have neural-mediation effects similar to those of appetite-suppressant drugs,⁵⁸ and in some cases there are indications of an effect on weight loss. However, their anxiolytic effects may be a contraindication in the treatment of people for whom stress reduction may actually increase eating.⁵⁹ Some well-controlled trials support the use of ginkgo as a mild anxiolytic,⁶⁰ but there are no studies showing it affects weight loss.

Risks: Possibility of "serotonin syndrome" if combined with antidepressant medications, or some non-prescription preparations.⁶¹

Conclusions: Gingko may have some effect on stress and therefore theoretically help in cases where obesity is due to stress-related overeating. However, there is no available evidence to support this, and gingko could be contraindicated in some cases.

Source: Soluble fibre extracted from fruit.

Products: "Zellulean", "Beer Belly Busters", "Exofat" and "Fatsorb".

Proposed action: Satiation and decreased energy density leading to decreased food intake.

Evidence: High-fibre foods containing pectin (among other fibres) can help lower cholesterol levels and are also promoted for people with diabetes.⁶² One study (E4) claimed that as little as 5 g of pectin could delay gastric emptying and increase satiety,⁶³ but the subjects were not overweight and no weight loss effect was shown. Another, uncontrolled study in Germany of eight overweight people over two weeks (E4) claimed success for a formula diet containing 3 g of apple pectin and 14.3 g of wheat bran.⁶⁴ Longer-term studies show no effects on weight loss from fibre supplements.⁶⁵

Risks: Low for most fibre, particularly soluble.

Conclusions: There is no long-term evidence of weight loss from fibre supplements. A diet high in fibre-rich foods, on the other hand, is known to be of benefit in weight loss.⁶⁶

Source: Grape seeds.

Products: "Cellasene".

Proposed action: Not specified.

Evidence: There is no rationale for weight loss presented in well-respected herbal texts and no published studies.

Risks: None known.

Conclusions: There is no evidence or rationale for grapeseed extract in weight loss.

Source: Phospholipid found in or soybeans, egg yolk and also made within the intestine.

Products: "ProteCol", "Cellasene", "Cellusense" and related products.

Proposed action: Prevents deposition of fat in fat cells.

Evidence: One two-year Swedish study (E3₁) looked at lecithin in protein powder with kelp and vitamin B₆. There were negligible benefits for 24 women who started on this diet, although the authors note that compliance was poor.⁶⁷

Risks: None known.

Conclusions: There is no support for the theory or practical use of lecithin in weight loss.

Source: Seed extract from horse chestnut.

Products: "Cellasene" and related products.

Proposed action: Aids circulation and prevents oedema.

Evidence: Nil.

Risks: None known.

Conclusions: Although reduced oedema may cause weight loss through loss of body fluid, this does not imply fat loss, so escin does not appear to be an effective treatment.

Source: Phytoestrogens from soybeans or sweet clover.

Products: "Cellasene" and related products.

Proposed action: Not specified.

Evidence: One study (E3₁) reported that women taking extra isoflavones had no change in body weight.⁶⁸

Risks: None known for adults.

Conclusions: There is no evidence to support the use of isoflavones in weight loss.

Source: St John's wort is a herb.

Products: "Beer Belly Busters".

Proposed mechanisms: Not specified, but an antidepressant effect may reduce depression eating.

Evidence: Extracts of St John's wort are recognised as a mild antidepressant.⁶⁹ However, there are no published studies showing any effects on weight loss.

Risks: Not known.

Conclusions: While St John's wort has been shown to have antidepressant effects, there is no evidence that it is effective in reducing weight.

More detailed future research may show advantages for these and other non-prescribed substances. The possible benefits of synergistic effects between ingredients can not be ruled out and need further study. Average long-term weight losses, even with proven prescribed medications, are poor and only exist while a drug is being taken. If non-prescribed substances are to be successful, lifetime use may be needed, as in other chronic disorders.

Lifestyle changes should be considered the basis of any weight loss initiative, even though counselling about such changes takes time and is difficult to achieve in the modern "obesogenic" environment.

Consumer protection demands that weight loss claims should be based on evidence. Manufacturers of weight loss supplements should prove the effectiveness of their products through impartial, well-controlled trials. Lack of positive evidence, while not necessarily disqualifying sale of a particular product (provided safety issues are satisfied), should certainly disqualify the use of unverified claims relating to these products.

1. Popkin BM, Doak CM. The obesity epidemic is a worldwide phenomenon. Nutr Rev 1998; 56: 106-114.
2. Australian Bureau of Statistics. National Nutrition Survey. Canberra: ABS, 1998. (Catalogue No 4805.0.)
3. Egger G, Swinburn B. An ecological approach to the obesity pandemic. BMJ 1997; 315: 477-480.
4. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1999.
5. Flatt J-P. Body fat content and balance between fat and alcohol oxidation and consumption. In: Dalton S, editor. Overweight and weight management. Gaithersburg, Md: Aspen Publications, 1997: 224-253.
6. Vasselli JR, Maggio CA. Mechanisms of appetite control and body weight regulation. In: Dalton S, editor. Overweight and weight management. Gaithersburg, Md: Aspen Publications, 1997: 187-208.
7. Badmaev V, Majeed M. Open field, physician controlled, clinical evaluation of botanical weight loss formula citrin. Paper presented to Nutracon 1995, Nutriceutical, Dietary Supplements and Functional Foods, and reported in Heymsfield SB, Allison DB, Vasselli JR, et al. Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomised controlled trial. JAMA 1998; 11: 280: 1596-1600.
8. Conte AA. A non-prescription alternative on weight reduction therapy. Am J Bariat Med, Summer 1993: 17-19.
9. Thom E. Hydroxycitrate (HCA) in the treatment of obesity [abstract]. Paper presented to the European Conference on Obesity, Barcelona, 1996. Int J Obes 1996; 20: 111.
10. Rothacker DQ, Waitman BE. Effectiveness of a Garcinia cambogia and natural caffeine combination in weight loss: a double-blind placebo-controlled pilot study [abstract]. Int J Obes 1997; 21 Suppl 2: 53.
11. Girola M, De Bernardi M, Conti S, et al. Dose effect in lipid lowering activity of a new dietary integrator (chitosan, Garcinia cambogia extract, and chrome). Acta Toxicol Ther 1996; 17: 25-40.
12. Heymsfield SB, Allison DB, Vasselli JR, et al. Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomised controlled trial. JAMA 1998; 280: 1596-1600.
13. Buck SH, Burks TF. The neuropharmacology of capsaicin: review of some recent observations. Pharmacol Rev 1986; 38: 179-226.
14. MacLean DB. Abrogation of peripheral cholecystokinin-satiety in the capsaicin treated rat. Regul Pept 1985; 11: 321-333.
15. Tremblay A. Obesity and health: what can we learn from intervention studies? [abstract]. Paper presented to the Australasian Society for the Study of Obesity, 8th Annual Meeting, Sydney 1999. ASSO Proceedings. Melbourne: ASSO, 1999: 38.
16. Henry CJ, Emery B. Effect of spiced food on metabolic rate. Hum Nutr Clin Nutr 1986; 40: 165-168.
17. Edwards SJ, Montgomery IM, Colquhoun EQ, et al. Spicy meal disturbs sleep: an effect of thermoregulation? Int J Psychophysiol 1992; 13: 97-100.
18. Colquhoun E. Possible new pharmacological approaches to the management of obesity [abstract]. Paper presented to the Australian Society for the Study of Obesity, 2nd Annual Meeting, Melbourne, 1993. ASSO Proceedings. Melbourne: ASSO, 1983: 35.
19. Williams SR, Clark RF, Dunford JV. Contact dermatitis associated with capsaicin: human hand syndrome. Ann Emerg Med 1995; 25: 713-715.
20. Dodd SL, Herb RA, Powers SK. Caffeine and exercise performance. Sports Med 1993; 15: 14-23.
21. Arciero PJ, Gardner AW, Calles-Escandon J, et al. Effects of caffeine ingestion on NE kinetics, fat oxidation, and energy expenditure in younger and older men. Am J Physiol 1995; 268(6 Pt 1): E1192-E1198.
22. Bracco D, Ferrarra J-M, Arnaud MJ, et al. Effects of caffeine on energy metabolism in lean and obese women. Am J Physiol 1995; 269: E671-E678.
23. Astrup A, Toubro S, Cannon S, et al. Caffeine: a double-blind, placebo-controlled study of its thermogenic, metabolic, and cardiovascular effects in healthy volunteers. Am J Clin Nutr 1990; 51: 759-767.
24. Horton TJ, Geissler CA. Post-prandial thermogenesis with ephedrine, caffeine and aspirin in lean, pre-disposed obese and obese women. Int J Obes 1996; 20: 91-97.
25. Graham TE, Rush JWE, van Soeren MH. Caffeine and exercise: metabolism and performance. Can J Appl Physiol 1994: 19; 111-138.
26. Cole KJ, Costill DL, Starling RD, et al. Effect of caffeine ingestion on perception of effort and subsequent work production. Int J Sports Nutr 1996; 6: 14-23.
27. Astrup A, Breum L, Toubro S, et al. The effect and safety of an ephedrine/caffeine compound compared with ephedrine, caffeine and placebo in obese subjects on an energy restricted diet. A double blind trial. Int J Obes 1992; 16: 269-277.
28. Astrup A, Buemann B, Christensen NJ, et al. The effect of ephedrine/caffeine mixture on energy expenditure and body composition in obese women. Metabolism 1992; 41: 686-688.
29. Breum L, Pedersen JK, Ahlstrom F, Frimodt-Moller J. Comparison of an ephedrine/caffeine combination and dexfenfluramine in the treatment of obesity. A double-blind multi-centre trial in general practice. Int J Obes 1994; 18: 99-103.
30. Buemann B, Marckmann P, Christensen NJ, Astrup A. The effect of ephedrine plus caffeine on plasma lipids and lipoproteins during a 4.2 MJ/day diet. Int J Obes 1994; 18: 329-332.
31. Daly PA, Krieger DR, Dulloo AG, et al. Ephedrine, caffeine and aspirin: safety and efficacy for treatment of human obesity. Int J Obes 1993; 17 Suppl 1: S73-S78.
32. Pasman WJ, Westerterp-Plantenga MS, Saris WH. The effectiveness of long-term supplementation of carbohydrate, chromium, fibre and caffeine on weight maintenance. Int J Obes 1997; 21: 1143-1151.
33. Toubro S, Astrup AV, Breum L, Quaade F. Safety and efficacy of long-term treatment with ephedrine, caffeine and an ephedrine/caffeine mixture Int J Obes 1993; 17 Suppl 1: S69-S72.
34. International Life Sciences Institute. Caffeine: a scientific review. Food Technol Aust 1988, January Suppl.
35. Vukovich MD, Costill DL, Fink WJ. Carnitine supplementation: effect on muscle carnitine and glycogen content during exercise. Med Sci Sports Exerc 1994; 26: 1122-1129.
36. Sulkers EJ, Lafeber HN, Degenhart HJ, et al. Effects of high carnitine supplementation on substrate utilization in low-birth-weight infants receiving total parenteral nutrition. Am J Clin Nutr 1990; 52: 889-894.
37. Heinonen OJ. Carnitine and physical activity. Sports Med 1996; 22: 109-114.
38. Ventura P. Lipid lowering activity of chitosan, a new dietary integrator. In: Muzzarelli RAA, editor. Chitin enzymology, Vol. 2. Ancona, Italy: Atec Edizioni, 1996: 55-62.
39. Maezaki Y, Tsuji K, Nakawa, et al. Hypocholesterolaemic effect of chitosan in adult males. Biosc Biochem Biotech 1993; 57: 1439-1444.
40. Veneroni G, Veneroni F, Contos S, et al. Effect of a new chitosan on hyperlipidaemia and overweight in obese patients. In: Muzzarelli RAA, editor. Chitin enzymology, Vol. 2. Ancona, Italy: Atec Edizioni, 1996: 63-67.
41. Abelin J, Lassus AL. 112 Bipolymer - Fat [binder] as a weight reducer in patients with moderate obesity. Medical research report. A study performed at Ars Medicina, Helsinki, August-October, 1994.
42. Columbo P, Sciutto AM. Nutritional aspects of chitosan employment in hypocaloric diet. Acta Toxicol Ther 1996; 17: 278-302.
43. Veneroni G, Veneroni F, Contos S, et al. Effect of a new chitosan dietary integrator and hypocaloric diet on hyperlipidemia and overweight in obese patients. Acta Toxicol Therap 1996; 17: 53-70.
44. Macchi G. A new approach to the treatment of obesity: chitosan's effects on body weight reduction and plasma cholesterol levels. Acta Toxicol Ther 1996; 17: 303-320.
45. Giustina A, Ventura P. Weight-reducing regimens in obese subjects: effects of a new dietary fibre integrator. Acta Toxicol Ther 1995; 16: 199-214.
46. Sciutto AM, Columbo P. Lipid-lowering effect of chitosan dietary integrator and hypocaloric diet in obese patients. Acta Toxicol Ther 1995; 16: 215-230.
47. Ernst E, Pittler MH. A meta-analysis of chitosan for body weight reduction. Perfusion 1998; 11: 461-465.
48. Pittler MH, Abbot NC, Harkness EF, Ernst E. Randomized, double-blind trial of chitosan for body weight reduction. Eur J Clin Nutr 1999; 53: 379-381.
49. Evans GW. The effect of chromium picolinate on insulin controlled parameters in humans. Int J Biosoc Med Res 1989; 11: 163-180.
50. Kaats GR, Fischer JA, Blum K. The effects of chromium picolinate supplementation on body composition in different age groups [abstract]. Am Aging Assoc Abstr 1991; 21: 138.
51. Anderson RA, Polansky MM, Bryden NA, et al. Chromium supplementation of human subjects: effects on glucose, insulin, and lipid variables. Metabolism 1983; 32: 894-899.
52. Anderson RA. Effects of chromium on body composition and body weight. Nutr Rev 1998; 56: 266-270.
53. Grant KE, Chandler RM, Castle AL, Ivy JL. Chromium and exercise training: effect on obese women. Med Sci Sports Exerc 1997; 29: 992-998.
54. Stearns DM, Belbruno JJ, Wetterhahn KE. A prediction of chromium (III) accumulation in humans from chromium dietary supplements. FASEB J 1995; 9: 1650-1657.
55. Cerulli J, Grabe DW, Gauthier I, et al. Chromium picolinate toxicity. Ann Pharmacother 1998; 32: 428-431.
56. Gaigi S, Elati J, Ben Osman A, Beji C (Experimental study of the effects of seaweed in the treament of obesity) (Article in French). Tunis Med 1996; 74: 241-243.
57. Marceilhac A, Drakine N, Bourhim N, et al. Effect of chronic administration of Ginkgo biloba extract or ginkgolide on the hypothalamic-pituitary-adrenal axis in the rat. Life Sci 1998; 62: 2329-2340.
58. White HL, Scates PW, Cooper BR. Extracts of Ginkgo biloba leaves inhibit monoamine oxidase. Life Sci 1996; 58: 1315-1321.
59. Striegel-Moore R, Rodin J. The influence of psychological variables in obesity. In: Brownell KD, Foreyt JP, editors. Handbook of eating disorders. NewYork: Basic Books, 1986: 99-121.
60. Rapin JR, Lamproglou I, Drieu K, DeFeudis FV. Demonstration of the "anti-stress" activity of an extract of Ginkgo biloba (EGb761) using a discrimination learning task. Gen Pharmacol 1994; 25: 1009-1016.
61. Chan BSH, Graudins A, Whyte IM, et al. Serotonin syndrome resulting from drug interactions. Med J Aust 1998; 169: 523-525.
62. Nuttall FQ. Dietary fiber in the management of diabetes. Diabetes 1993; 42: 503-508.
63. Tiwary CM, Ward JA, Jackson BA. Effect of pectin on satiety in healthy US Army adults. J Am Coll Nutr 1997; 16: 423-428.
64. Matzkies F, Budelski I, Webs B. Effect of a fiber-containing dietary formula on metabolism. Fortschr Med 1982; 100: 917-920.
65. Pasman WJ, Westerterp-Plantenga MS, Muls E, et al. The effectiveness of long-term fibre supplementation on weight maintenance in weight-reduced women. Int J Obes 1997; 21: 548-555.
66. Livesey G. Fibre as energy in man. In: Kretchevsky D, Bonfield C, editors. Dietary fibre in health and disease. Eagan, Minnesota: Eagan Press, 1995: 46-57.
67. Bjorvell H, Rossner, S. Long-term effects of commonly available weight reducing programmes in Sweden. Int J Obes 1987; 11: 67-71.
68. Baird DD, Umbach DM, Lansdell L, et al. Dietary intervention study to assess estrogenicity of dietary soy among postmenopausal women. J Clin Endocrinol Metab 1995; 80:1685-1690.
69. Linde K, Ramirez G, Mulrow CD, et al. St John's wort for depression -- an overview and meta-analysis of randomised clinical trials. BMJ 1996; 313: 253-258.

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