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Unfortunately, it just doesn’t work like that.
When to Treat a Sluggish Thyroid
By INGFEI CHEN
The symptoms are a laundry list of vague, common and easily overlooked complaints: tiredness, weight gain, ice-cold hands, thinning hair, constipation, depression and forgetfulness, to name a few. But for more than 10 million Americans, more often women than men, such woes are signs of something seriously wrong — a full-blown case of hypothyroidism, in which an underactive thyroid gland fails to crank out enough hormones.
By the Numbers
The deficiency is easily treated by replenishing the missing hormones with synthetic ones. The benefits can be stunning, almost instantly restoring some patients to their former selves and reversing the heart risks that can come with long-term unchecked hypothyroidism.
But despite the availability of a highly successful therapy for hypothyroidism, calibrating the correct drug dosage remains a challenge for patients and their doctors. And for certain patients with thyroids that are only slightly out of whack, determining whether treatment is warranted at all remains a subject of intense debate.
Roughly 20 percent of people on thyroid replacement therapy receive more hormone than they need. “It’s easy to inadvertently overtreat people with too much medication, which may have deleterious effects,” said Dr. David S. Cooper, director of the Johns Hopkins Thyroid Clinic in Baltimore.
Potential problems include irregular heart rhythms, especially for those over 60. Over-replacement may also weaken bones, with older patients and postmenopausal women at particular risk.
Undertreatment is also a worry — 20 percent of people on thyroid hormone don’t take enough medication. This can be particularly problematic in pregnant women, because an inadequate thyroid hormone supply raises the risk of miscarriage and premature birth and may harm brain development in the fetus. There is strong consensus that many pregnant women with hypothyroidism need an increase in their dose of thyroid medication. But that hazard has touched off a debate over whether every woman who is newly pregnant or contemplating pregnancy should be screened and treated for thyroid abnormalities.
Perhaps the most difficult issue in hypothyroidism is whether to treat one group of patients at all: those with a mildly lethargic thyroid, a condition known as subclinical hypothyroidism.
Some experts, and many patient advocates, urge that anyone with mild hypothyroidism be treated to relieve any symptoms and stave off overt thyroid failure and future cardiovascular trouble. Other clinicians think treatment is unwarranted, saying there is insufficient evidence that replacement therapy protects the heart in these patients, let alone makes them feel better.
Much of the controversy surrounds the question of what constitutes “normal” thyroid function.
The standard test for diagnosing hypothyroidism checks for blood levels of a hormone called thyroid-stimulating hormone, or T.S.H., that is secreted by the brain. Acceptable levels of the hormone, which does exactly what its name says, are considered to be roughly 0.5 to 4.1 milliunits per liter.
But some groups advocate lowering the upper limit of normal. The American Association of Clinical Endocrinologists, for instance, calls for dropping that value to 3.0 to identify otherwise undiagnosed cases — a controversial move that would more than double the count of all Americans considered to have abnormal thyroid function.
Complicating the picture is recent research suggesting that a normal T.S.H. level changes with age, and that the upper limit of normal may be much higher in the elderly.
Experts previously thought that subclinical hypothyroidism cropped up much more commonly in older people than in younger age groups, with roughly 15 percent of those 70 and above showing abnormal T.S.H. readings. A 2007 analysis, however, found that the upper limit of normal for an otherwise healthy person over 80 was 7.5, nearly double the current level.
The results imply that unless age-specific T.S.H. ranges are established, many people could be misclassified with hypothyroidism and receive unnecessary lifelong drug therapy.
Furthermore, it’s unclear whether treating subclinical hypothyroidism really helps head off heart trouble, particularly in the elderly. Though past studies have linked untreated mild hypothyroidism with an increased risk of cardiovascular problems and deaths, the research was mostly done in middle-age patients.
Newer studies hint that the elderly population is different. In an investigation of people 65 and older with mild hypothyroidism, Dr. Anne R. Cappola and colleagues at the University of Pennsylvania detected no adverse cardiovascular consequences in those who went untreated. Even more surprising, in 2004, investigators in the Netherlands reported that 85-year-olds with mild thyroid deficiency lived longer than those with normal thyroids.
Subclinical hypothyroidism “may be something bad for younger people and something that’s actually in some weird alternate universe way, good for older people,” Dr. Cooper said.
Garcinia (hydroxycitric acid)
Scientific Name(s): Garcinia cambogia (Gaertn.) Desr. Family: Clusiaceae (Guttiferae)
Common Name(s): Malabar tamarind , hydroxycitric acid ( HCA )
The medical literature primarily documents weight loss and lipid-lowering activity for the plant. However, trials supporting its use are limited.
The dosages of G. cambogia extract in clinical trials ranged from 1,500 to 4,667 mg/day (25 to 78 mg/kg/day). The equivalent hydroxycitric acid (HCA) dose in the trials ranged from 900 to 2,800 mg/day (15 to 47 mg/kg/day). G. cambogia is available in capsule or tablet form with a maximum dose of 1,500 mg/day.
Avoid use if there is a known allergy or hypersensitivity to any components of G. cambogia .
Information regarding safety and efficacy in pregnancy and lactation is lacking.
The herb has documented drug interactions.
At least 15 clinical studies involving approximately 900 patients document very mild adverse reactions. Most adverse reactions included headache, dizziness, dry mouth, and GI complaints such as nausea and diarrhea.
Toxicology studies resulted in no toxicity or deaths in animals at dosages of HCA 5,000 mg/kg, equivalent to 350 g or 233 times the maximum dosage of 1.5 g/day of HCA.
It does this by inhibiting the enzyme citric lyase.
In patients taking certain combination weight-loss supplements containing G. cambogia , severe or even fatal hepatotoxicity may occur.
The genus Garcinia is mainly distributed in tropical regions and includes approximately 200 species. G. cambogia belongs to the family Guttiferae and is found in India, Malaysia, and Africa. G. cambogia is commonly found in evergreen or semievergreen forests of southwest India, where 36 other species have been documented. 1 , 2 The plant species has variability in its branching pattern, fruit color, shape, and size. 1 The tree is small-to-medium in size with drooping branches. The leaves are dark green and glossy, oval-shaped with a narrow end, 5 to 12 cm in length, and 2 to 7 cm around. The tree is tolerant to drought and flowers during the hot season. The yellow, orange, or red fruit ripens during the rainy season and contains HCA. It is ovoid in shape, 5 centimeters around, has 6 to 8 seeds, and is listed in the US Department of Agriculture inventory of perennial edible fruits. 2
Dried fruit rinds have been used extensively for centuries throughout Southeast Asia for culinary purposes as a condiment and flavoring agent in place of tamarind or lemon. Additional culinary uses include the flavoring of curries, meat, and seafood. The fruit extract has been used as a flavoring agent for beverages and gourmet spices, as well as a carminative, thereby helping to prevent the formation of gas in the GI tract after a meal. HCA and other organic acids from the dried rind combined with salt help lower pH and provide a bacteriostatic effect used in curing fish. The herb is considered beneficial for overall health in the traditional Ayurvedic medical system. Rheumatism and bowel complaints are treated with a decoction of the fruit rind. A rinse is used from the herbal extract in veterinary medicine for some diseases of the mouth in cattle. HCA has also become popular as an ingredient for weight loss. 2 , 3 , 4
HCA is the primary medicinal component contained in the fruit rinds of G. cambogia . 5 HCA is present as up to 30% by weight in the pericarp of G. cambogia fruit. 6 Xanthones, xanthone derivatives, and polyisoprenylated benzophenones have been isolated. 6 , 7 Some salts used in commercial products are water soluble and bioavailable, and are a good source of calcium (495 mg) and potassium (720 mg). 8 Studies also document interest in production of HCA by using microorganisms. 9 , 10
Uses and Pharmacology
The medical literature primarily documents research on the weight loss and lipid-lowering activity of the plant.
In vitro and animal data
In 2 experiments using the human hepatoma cell line HepG2, overnight exposure to G. cambogia extract caused an upregulation of low-density lipoprotein (LDL) receptor activity and an upregulation of the level of HMG-CoA reductase resulting in decreased cholesterol synthesis. 11 Flavonoids from the plant reduced lipid levels in normal and hypercholesterolemic rats. 7 Reductions were also documented in triglycerides, phospholipids, and free fatty acids. The mechanism of action for the flavonoids may involve: (1) reducing the rate of lipogenesis by reducing the activities of lipogenic enzymes, glucose-6-phosphate dehydrogenase, and isocitrate dehydrogenase; and (2) increasing the rate of degradation of cholesterol leading to higher levels of hepatic and fecal bile acids, as well as neutral sterols in rats treated with the herb. While dexamethasone typically elevates lipid profiles, G. cambogia extract maintained normal lipid levels in rats administered dexamethasone. 12
In a 4-week randomized, double-blind, placebo-controlled trial, 150 obese patients were treated with a dietary supplement ( G. cambogia extract 55 mg, chitosan 240 mg, and chrome 19 mg) together with a weight reduction regimen. Treatment groups administered the dietary supplement showed statistically significant dose-related reductions in weight, total and LDL cholesterol, and triglycerides, and improvement in high density lipoprotein cholesterol. 13
The suggested mechanism of action involves HCA-inhibiting lipogenesis, increasing lipid oxidation, and reducing food intake. 3 , 14
A study in obese rats found high doses of HCA-containing G. cambogia (154 mmol HCA/kg diet) effective in suppressing epididymal adipose tissue. This same study also found testicular atrophy and toxicity at dosages of 778 mg HCA/kg body weight/day (102 mmol HCA/kg diet) and higher. 4 Another study in rats administered a high-fat diet and a mixture of G. cambogia extract, soypeptide, and L-carnitine, led to a reduction in body weight and accumulation of visceral fat mass. 15 The mixture also improved blood and hepatic lipid concentrations or the induced dyslipidemia in the rats. Other combination products with G. cambogia are also effective in reducing weight gain and improving dyslipidemia, hyperinsulinemia, hyperleptinemia, and fatty liver in mice. 16 The antiobesity effect involves modulation of several genes associated with visceral adipogenesis. One study in adult, nonobese cats found no effect on fat-free mass or energy expenditure. 17
In an 8-week randomized clinical trial, 40 patients were given either placebo or G. cambogia extract (500 mg/capsule) by mouth before each meal. Patients administered the extract exhibited weight loss and improvement in cholesterol and triglycerides when compared with the placebo group. 2
In a 12-week, randomized, double-blind, placebo-controlled study, 40 obese patients were treated with a combination supplement containing G. cambogia 50 mg as well as a 1,200 calorie diet per day. Two tablets of the supplement were taken by mouth 3 times a day after meals. The treatment group attained a 3.5 kg weight loss versus 1.2 kg on placebo, and a more than 85% reduction in fat loss in body composition measurements. The majority of the active group participants did not follow the diet regimen. 18
In a 12-week, double-blind, placebo-controlled, parallel group trial, 89 mildly overweight women were treated with a 1,200 kcal diet along with 2 caplets of G. cambogia 400 mg or matched placebo 3 times a day before each meal.
The most common ones are ( 3, 9): However, some studies have indicated more serious side effects.
Possible Side Effects When you take garcinia cambogia, you might get: In 2009, the Food and Drug Administration warned everyone to stop using a weight-loss product that contained garcinia cambogia because some people taking it got serious liver problems.
At the end of the trial, both groups lost weight, but the treatment group achieved greater reduction in body weight. G. cambogia had no effect on appetitive variables. 14
Numerous studies document the safety profile of the calcium-potassium double salt of 60% HCA preparation (HCA-SX), as well as its bioavailability and efficacy in helping patients attain a healthy body weight. 3 , 19 , 20 , 21 , 22 , 23
An 8-week, randomized, placebo-controlled, double-blind study examined the efficacy of HCA-SX in 54 overweight patients. The treatment group was administered a combination supplement containing G. cambogia 500 mg 3 times a day while the control group received the placebo. All patients were asked to maintain a low-fat diet and drink 64 oz of water per day. The treatment group lost an average weight of 11.14 lb/person as compared with the control group, which lost an average of 4.2 lb/person. 19
Another 8-week, randomized, placebo-controlled, double-blind study examined the efficacy of HCA in 60 obese patients. The dosage regimen for HCA was 400 mg 3 times a day before each meal. All patients were on a low-fat diet and also instructed to exercise 3 times a week. Results indicated weight loss for the experimental group compared with the placebo group and that 87% of the weight loss in the HCA group was because of fat loss. Appetite scores were also reduced in the HCA-treated group. 19
Visceral, subcutaneous, and total fat accumulation were reduced in 39 patients over 16 weeks in a double-blind, randomized, placebo-controlled trial. The dosage regimen included HCA 1,000 mg/day versus placebo. At the end of the treatment, both groups were administered placebo for 4 weeks and no rebound effect was documented. 24
Another clinical study documented that treatment with HCA failed to produce weight change and fat mass change in patients. 25 However, the design of the clinical trial, the lack of bioavailability, and dosage of HCA used have been criticized. 2
Other pharmacologic activity
Some studies found that supplementation with G. cambogia can reduce oxidative damage. 26
The fruit contains xanthones, which inhibit pre-neoplastic lesions in mammary and colon cancer. The xanthones may also induce apoptosis in mouth, leukemia, breast, gastric, and lung cancer cell lines in vitro. 27
Glucose metabolism may be improved by lowering serum insulin levels in mice treated with G. cambogia . Leptin is a hormone associated with appetite control. G. cambogia may have leptin-like activity as mice treated with G. cambogia had decreased serum leptin levels and a reduced leptin/white adipose tissue ratio. 28 HCA treatment delayed and reduced intestinal glucose absorption in rats; the treatment causes delayed intestinal absorption of glucose rather than delayed gastric emptying. 29
HCA promoted lipid oxidation and reduced carbohydrate use in mice at rest and during running. 30 The utilization of respiratory gases was reduced for mice treated with HCA at rest and during exercise. Some studies on herbal coffee supplements with HCA showed an increase in resting energy expenditure to enhance metabolic rates and promote weight and fat loss. 31 , 32
Antiulcer activity was observed against induced gastric mucosal injury in rats with pretreatment of G. cambogia extract that decreased volume and acidity of gastric juice. 33 A similar study in rats found activity against indomethacin-induced gastric ulcers. 34 The anti-inflammatory activity of G. cambogia protected against induced colitis in rats. 35
Red blood cell count
A G. cambogia extract caused an increase in the red blood cell (RBC) count in rat tissue. The activity may be (1) associated with the iron in G. cambogia , as iron is an erythropoietic agent; (2) antioxidant activity and may decrease the rate of oxidant-induced hemolysis, which increases the life span of the RBC; or (3) the content of bioflavonoids in the plant, which may increase the level of peripheral testosterone, which can stimulate erythropoiesis in humans. 36
The dosages of G. cambogia extract in clinical trials ranged from 1,500 to 4,667 mg/day (25 to 78 mg/kg/day). The equivalent HCA dose in the trials ranged from 900 to 2,800 mg/day (15 to 47 mg/kg/day). 2 , 14 , 18 , 19 , 23 , 24 , 25 G. cambogia is available in capsule or tablet form with a maximum dose of 1,500 mg/day.
Due to lack of clinical and scientific information, use should be avoided during pregnancy and lactation. One animal study in rats documented decreased maternal body weight gain during gestation. 37
In patients taking medications for diabetes by mouth or insulin, G. cambogia may lower blood sugar levels. 28 , 29
G. cambogia contains iron and thus may have additive adverse reactions for patients taking medications for anemia. 36
Potassium and calcium supplements
Some commercial G. cambogia products contain adequate amounts of potassium and calcium. 8 Caution is advised for patients taking medications for heart disease, high blood pressure, or arrhythmia while supplementing with any product containing this herb.
A mouse study using a commercial polyherbal product containing G. cambogia found a potential serotonergic effect on food intake. Caution is advised for patients being treated for pain or taking medications for any psychiatric condition. 38
Singulair (or leukotriene receptor antagonists)
One case report documented fatal liver failure in a patient taking Singulair and 2 dietary supplements, one of which included G. cambogia and citrus derivatives. 39
A case report of rhabdomyolysisis is documented in a patient taking a combination herbal medicine containing G. cambogia . 40
In one case report, the international normalized ratio of a patient returned to normal after he stopped taking a combination herbal product containing G. cambogia . 41
A total of 15 clinical studies involving approximately 900 patients documented very mild adverse reactions. Most adverse reactions included headache, dizziness, dry mouth, and GI complaints such as nausea and diarrhea.
Then, we refined and summarized to give you the info you need.
2 , 42
Toxicology studies resulted in no toxicity or deaths in animals at HCA dosages of 5,000 mg/kg, equivalent to 350 g or 233 times the maximum dose of 1.5 g/day of HCA. 5 In patients taking certain combination weight-loss supplements containing G. cambogia , severe or even fatal hepatotoxicity may occur. 43 , 44 Some animal studies document testicular toxicity, 4 , 45 while other studies do not. 46 , 47
No unusual electrocardiographic effects (QTc interval or other electrocardiograph variables) were seen over 5 hours in patients taking half the recommended dose of a multicomponent weight loss supplement containing G. cambogia . 48 Patients receiving G. cambogia extract (1,667.3 mg/kg equivalent to 1,000 mg HCA/day) for 12 weeks exhibited no reproductive toxicity on serum testosterone, estrone, and estradiol levels. 49
2. Soni MG, Burdock GA, Preuss HG, Stohs SJ, Ohia SE, Bagchi D. Safety assessment of (-)-hydroxycitric acid and Super CitriMax, a novel calcium/potassium salt. Food Chem Toxicol . 2004;42(9):1513-1529.
3. Ohia SE, Opere CA, LeDay AM, Bagchi M, Bagchi D, Stohs SJ. Safety and mechanism of appetite suppression by a novel hydroxycitric acid extract (HCA-SX). Mol Cell Biochem . 2002;238(1-2):89-103.
4. Saito M, Ueno M, Ogino S, Kubo K, Nagata J, Takeuchi M. High dose of Garcinia cambogia is effective in suppressing fat accumulation in developing male Zucker obese rats, but highly toxic to the testis. Food Chem Toxicol . 2005;43(3):411-419.
5. Jena BS, Jayaprakasha GK, Singh RP, Sakariah KK. Chemistry and biochemistry of (-)-hydroxycitric acid from Garcinia . J Agric Food Chem . 2002;50(1):10-22.
6. Masullo M, Bassarello C, Suzuki H, Pizza C, Piacente S. Polyisoprenylated benzophenones and an unusual polyisoprenylated tetracyclic xanthone from the fruits of Garcinia cambogia . J Agric Food Chem . 2008;56(13):5205-5210.
7. Koshy AS, Anila L, Vijayalakshmi NR. Flavonoids from Garcinia cambogia lower lipid levels in hypercholesterolemic rats. Food Chem . 2001;72(3):289-294.
8. Downs BW, Bagchi M, Subbaraju GV, Shara MA, Preuss HG, Bagchi D. Bioefficacy of a novel calcium-potassium salt of (-)-hydroxycitric acid. Mutat Res . 2005;579(1-2):149-162.
9. Hida H, Yamada T, Yamada Y. Production of hydroxycitric acid by microorganisms. Biosci Biotechnol Biochem . 2005;69(8):1555-1561.
10. Yamada T, Hida H, Yamada Y. Chemistry, physiological properties, and microbial production of hydroxycitric acid. Appl Microbiol Biotechnol . 2007;75(5):977-982.
11. Berkhout TA, Havekes LM, Pearce NJ, Groot PH. The effect of (-)-hydroxycitrate on the activity of the low-density-lipoprotein receptor and 3-hydroxy-3-methylglutaryl-CoA reductase levels in the human hepatoma cell line Hep G2. Biochem J . 1990;272(1):181-186.
12. Mahendran P, Devi CS. Effect of Garcinia cambogia extract on lipids and lipoprotein composition in dexamethasone administered rats. Indian J Physiol Pharmacol . 2001;45(3):345-350.
13. Girola M, De Bernardi M, Contos S, et al. Dose effect in lipid-lowering activity of a new dietary integrator (chitosan), Garcinia combogia extract and chrome. Acta Toxicol Ther . 1996;17(1):25-40.
14. Mattes RD, Bormann L. Effects of (-)-hydroxycitric acid on appetitive variables. Physiol Behav . 2000;71(1-2):87-94.
15. Kim YJ, Kim KY, Kim MS, Lee JH, Lee KP, Park T. A mixture of the aqueous extract of Garcinia cambogia , soy peptide and L: -carnitine reduces the accumulation of visceral fat mass in rats rendered obese by a high fat diet. Genes Nutr . 2008;2(4):353-358.
16. Kim KY, Lee HN, Kim YJ, Park T. Garcinia cambogia extract ameliorates visceral adiposity in C57BL/6J mice fed on a high-fat diet. Biosci Biotechnol Biochem . 2008;72(7):1772-1780.
17. Leray V, Dumon H, Martin L, et al. No effect of conjugated linoleic acid or Garcinia cambogia on fat-free mass, and energy expenditure in normal cats. J Nutr . 2006;136(suppl 7):1982S-1984S.
18. Thom E. A randomized, double-blind, placebo-controlled trial of a new weight-reducing agent of natural origin. J Int Med Res . 2000;28(5):229-233.
19. Lau FC, Bagchi M, Sen C, Roy S, Bagchi D. Nutrigenomic analysis of diet-gene interactions on functional supplements for weight management. Curr Genomics . 2008;9(4):239-251.
20. Talpur N, Echard BW, Yasmin T, Bagchi D, Preuss HG. Effects of niacin-bound chromium, Maitake mushroom fraction SX and (-)-hydroxycitric acid on the metabolic syndrome in aged diabetic Zucker fatty rats. Mol Cell Biochem . 2003;252(1-2):369-377.
21. Bagchi D, Deshmukh NS, Soni MG, Bagchi M. Safety of a novel calcium/potassium salt of (-)-hydroxycitric acid: I. Two generation reproduction toxicity study. Toxicol Lett . 2007;172(suppl 1):S190.
22. Asghar M, Monjok E, Kouamou G, Ohia SE, Bagchi D, Lokhandwala MF. Super CitriMax (HCA-SX) attenuates increases in oxidative stress, inflammation, insulin resistance, and body weight in developing obese Zucker rats. Mol Cell Biochem . 2007;304(1-2):93-99.
23. Preuss HG, Rao CV, Garis R, et al. An overview of the safety and efficacy of a novel, natural(-)-hydroxycitric acid extract (HCA-SX) for weight management. J Med . 2004;35(1-6):33-48.
24. Hayamizu K, Ishii Y, Kaneko I, et al. Effects of Garcinia cambogia (hydroxycitric acid) on visceral fat accumulation: A double-blind, randomized, placebo-controlled trial. CurrTher Res Clin Exp . 2003;64(8):551-567.
25. Heymsfield SB, Allison DB, Vasselli JR, Pietrobelli A, Greenfield D, Nunez C. Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomized controlled trial. JAMA . 1998;280(18):1596-1600.
26. Yonei Y, Takahashi Y, Hibino S, Watanabe M, Yoshioka T. Effects on the human body of a dietary supplement containing L-carnitine and Garcinia cambogia extract: a study using double-blind tests. J Clin Biochem Nutr . 2008;42(2):89-103.
27. Mazzio EA, Soliman KF. In vitro screening for the tumoricidal properties of international medicinal herbs. Phytother Res . 2009;23(3):385-398.
28. Hayamizu K, Hirakawa H, Oikawa D, et al.
Cell-Food® quindi realizza in una sola fase una azione triplice: fornisce minerali, enzimi e aminoacidi elimina l'aciditа e i radicali liberi ossigena le cellule fornendo energia lа dove serve e fornisce Sette Benefici Fondamentali qui riassunti: 2.
Effect of Garcinia cambogia extract on serum leptin and insulin in mice. Fitoterapia . 2003;74(3):267-273.
29. Wielinga PY, Wachters-Hagedoorn RE, Bouter B, et al. Hydroxycitric acid delays intestinal glucose absorption in rats. Am J Physiol Gastrointest Liver Physiol . 2005;288(6):G1144-G1149.
30. Ishihara K, Oyaizu S, Onuki K, Lim K, Fushiki T. Chronic (-)-hydroxycitrate administration spares carbohydrate utilization and promotes lipid oxidation during exercise in mice. J Nutr . 2000;130(12):2990-2995.
31. Hoffman JR, Kang J, Ratamess NA, Jennings PF, Mangine G, Faigenbaum AD. Thermogenic effect from nutritionally enriched coffee consumption. J Int Soc Sports Nutr . 2006;3:35-41.
32. Taylor LW, Wilborn CD, Harvey T, Wismann J, Willoughby DS. Acute effects of ingesting Java Fittrade mark energy extreme functional coffee on resting energy expenditure and hemodynamic responses in male and female coffee drinkers. J Int Soc Sports Nutr . 2007;4:10.
33. Mahendran P, Sabitha KE, Devi CS. Prevention of HCl-ethanol induced gastric mucosal injury in rats by Garcinia cambogia extract and its possible mechanism of action. Indian J Exp Biol . 2002;40(1):58-62.
34. Mahendran P, Vanisree AJ, Shyamala Devi CS. The antiulcer activity of Garcinia cambogia extract against indomethacin-induced gastric ulcer in rats. Phytother Res . 2002;16(1):80-83.
35. dos Reis SB, de Oliveira CC, Acedo SC, et al. Attenuation of colitis injury in rats using Garcinia cambogia extract. Phytother Res . 2009;23(3):324-329.
36. Oluyemi KA, Omotuyi IO, Jimoh OR, Adesanya OA, Saalu CL, Josiah SJ. Erythropoietic and anti-obesity effects of Garcinia cambogia (bitter kola) in Wistar rats. Biotechnol Appl Biochem . 2007;46(pt 1):69-72.
37. Deshmukh NS, Bagchi M, Yasmin T, Bagchi D. Safety of a novel calcium/potassium salt of (-) hydroxycitric acid (HCA-SX): II. Developmental toxicity study in rats. Toxicol Mech Methods . 2008;18(5):443-451.
38. Kaur G, Kulkarni SK. Investigations on possible serotonergic involvement in effects of OB-200G (polyherbal preparation) on food intake in female mice. Eur J Nutr . 2001;40(3):127-133.
39. Actis GC, Bugianesi E, Ottobrelli A, Rizzetto M. Fatal liver failure following food supplements during chronic treatment with montelukast. Dig Liver Dis . 2007;39(10):953-955.
40. Mansi IA, Huang J. Rhabdomyolysis in response to weight-loss herbal medicine. [Published correction appears in: Am J Med Sci . 2004;328(2):129.] Am J Med Sci . 2004;327(6):356-357.
41. Ferris DJ. Interaction between warfarin and Garcinia cambogia (Fat Burner); a case report. ASHP Midyear Clinical Meeting . 38(DEC): p P-404(D). 2003.
42. Pittler MH, Schmidt K, Ernst E. Adverse events of herbal food supplements for body weight reduction: systematic review. Obes Rev . 2005;6(2):93-111.
43. Shim M, Saab S. Severe hepatotoxicity due to Hydroxycut: a case report. Dig Dis Sci . 2009;54(2):406-408.
44. Lobb A. Hepatoxicity associated with weight-loss supplements: a case for better post-marketing surveillance. World J Gastroenterol . 2009;15(14):1786-1787.
45. Anno T, Oono H, Tamura K. Improvement of testicular toxicity in F/344DuCrj male rats fed Ca-type Garcinia cambogia extract by zinc supplemented diets. Nippon Shokuhin Kagaku Gakkaishi . 2005;12(3):121-127.
46. Shara M, Ohia SE, Yasmin T, et al. Dose- and time-dependent effects of a novel (-)-hydroxycitric acid extract on body weight, hepatic and testicular lipid peroxidation, DNA fragmentation and histopathological data over a period of 90 days. Mol Cell Biochem . 2003;254(1-2):339-346.
47. Burdock G, Soni M, Bagchi M, Bagchi D. Garcinia cambogia toxicity is misleading. [Published correction appears in: Food Chem Toxicol . 2007;45(3):515.] Food Chem Toxicol . 2005;43(11):1683-1684; author reply 1685-1686.
48. Min B, McBride BF, Kardas MJ, et al. Electrocardiographic effects of an ephedra-free, multicomponent weight-loss supplement in healthy volunteers. Pharmacotherapy . 2005;25(5):654-659.
49. Hayamizu K, Tomi H, Kaneko I, Shen M, Soni MG, Yoshino G. Effects of Garcinia cambogia extract on serum sex hormones in overweight subjects. Fitoterapia . 2008;79(4):255-261.
Copyright © 2009 Wolters Kluwer Health
8 Tips for Losing Weight After Pregnancy
Load Up on 'Super Foods', Find Time to Exercise, Consider Breastfeeding to Help Shed Excess Pounds
WebMD archives content after 2 years to ensure our readers can easily find the most timely content.
">From the WebMD Archives
Now that your new baby is here, you have a lot to think about: when to feed her, what to do if she cries -- and how to get rid of those extra pounds you packed on during your pregnancy.
If you started out at a normal weight and gained the 25-35 pounds your doctor probably recommended, it shouldn't take you more than a couple of months to get back to your pre-pregnancy weight if you watch what you eat and exercise.
If, on the other hand, you were overweight before your pregnancy or you put on more weight than your doctor advised, it could take much longer -- up to a year -- to get the weight off. Any baby weight you don't take off could stick with you for a long time.
"It's very critical that you do get the weight off, because if you don't it has been associated with overweight and obesity 15 to 20 years later in life," says Debra Krummel, PhD, RD, endowed professor in the University of Cincinnati department of nutrition.
And although every new mom is eager to look like her old self again, one of the most important things to remember is to be patient with yourself. Your favorite celebrity might have gone straight from the delivery room into her size 0 jeans, but she may not have done it in a way that was good for her body.
"All the magazines ask, 'How did she do it?' The more important question is, 'Why did she do it?'" says Melinda Johnson, MS, RD, registered dietitian and spokeswoman for the American Dietetic Association (ADA). "They do this with very, very strict diets, and a lot of them do it by getting back into activity before their body is really ready for it."
Johnson advocates a more gradual approach to weight loss.
Consumers want to see how a business took care of business.
"The number one thing new mothers have to have is a certain amount of patience with their body," she says. "It took nine months to get there. It should take at least that long to get back to their fighting weight."
With that in mind, here are some tips to help you lose weight after pregnancy and fit back into your old jeans -- whatever their size.
It may sound strange, but going on an official "diet" could derail your post-pregnancy weight loss goals. Feeling deprived of your favorite foods while you're already stressed out by your new role as mom could actually cause you to gain weight, Johnson says.
"If you go back to eating healthy and eating for your hunger, most women find that the weight comes off pretty naturally," she says.
Instead of dieting, she recommends eating a well-balanced variety of foods. Keep different snacks in the house to keep you from feeling hungry and give you energy throughout the day. Apple slices, carrot sticks, and wheat crackers are all good for noshing.
No matter how much you want to lose weight, try not to dip below 1,800 calories a day, particularly if you are breastfeeding. The U.S. Department of Agriculture's MyPyramid site can help you design a personalized eating plan based on your age, activity level, and weight loss goals. The site even has a special section for breastfeeding moms.
Load up on "super foods."
When you're a new mother, your body needs maximum nutrition, especially if you're nursing. Choose foods that are heavy in the nutrients you need and light in calories and fat.
Fish is one of these "super foods" because it's packed with DHA, an essential omega-3 fatty acid that helps your newborn develop a healthy brain and nervous system. The best sources of DHA are cold-water fish such as salmon, sardines, and tuna (stick to canned light tuna because albacore tends to be high in mercury).
Milk and yogurt are also super foods because they're high in the calcium you need to keep your bones strong. And don't forget the protein. Lean meat, chicken, and beans are low in fat and high in protein and fiber. They're good for you, and they'll keep you feeling full for longer.
Whether breastfeeding can actually help you lose weight is still up in the air -- some studies find that breastfeeding exclusively can help you return to your pre-baby weight faster, while others find no difference in weight loss between women who breastfeed and those who bottle feed.
What is for sure is that breastfeeding is good for your baby, boosting immunity and providing a number of other important health benefits. And nursing exclusively lets you add about an extra 300 calories a day to your diet (you can add slightly more calories if you have a really big eater or twins). Just make sure that if you do breastfeed, you don't use it as an excuse to eat whatever you want.
Drinking plenty of water throughout the day prevents you from getting dehydrated. It also fills you up so that you don't eat as much, and some research has found that it may speed up your metabolism.
Whether you need the often-recommended eight glasses a day isn't certain, so Johnson recommends using the color of your urine and how often you need to go to the bathroom as guides. If you're drinking enough fluids, your urine should be relatively clear, and you should be going to the bathroom about every three to four hours.
Diet is important, but it's only one part of your post-pregnancy weight loss plan. You also need to incorporate aerobic and strength training exercises after pregnancy to burn calories and keep your muscles and bones strong. "Exercise, beyond helping you lose weight, provides so many benefits to a new mom," Johnson says. "It helps with depression, it helps with the sleep issue . it helps in relieving stress -- and having a new baby in the house can definitely be stressful."
You don't have to hit the gym to get back in shape after pregnancy -- taking a brisk walk with your baby in the stroller is enough to get your heart pumping and muscles working. "You want to shoot for at least 150 minutes a week," says James M. Pivarnik, PhD, FACSM, professor of kinesiology and epidemiology at Michigan State University and president-elect of the American College of Sports Medicine. With a new baby, finding 30 minutes in a row might be impossible, so Pivarnik suggests breaking up the time into 10-minute increments. Then try to work your way up to 20- or 30-minute sessions.
Lugging around a baby all day is itself a workout, but you still need to add some strength training. Use light weights -- or even a couple of soup cans -- as resistance. Many health clubs and community centers offer "mommy and me" classes that will let you incorporate your baby into your workout routine. But before you start any exercise program, get your doctor's approval, especially if you had a C-section.
Get some sleep.
It may seem impossible to get a full eight hours of sleep when you have a baby summoning you like clockwork throughout the night, but being sleep deprived could make it harder for you to shed the baby weight. In one study, new moms who slept five hours or less a night were more likely to hold onto their extra pregnancy weight than women who slept seven hours. When you're tired, your body releases cortisol and other stress hormones that can promote weight gain. "Also when you're exhausted, you don't feel like taking good care of yourself," Johnson says. "You're less likely to choose healthy food. You're more likely to grab something through a drive-through. You're also less likely to get physical activity."
Your friends or family members may have told you to "sleep when your baby sleeps," and that's good advice. Catch as many naps as you can during the day and go to bed early -- at least until your baby starts sleeping through the night.
Ask for help.
If you're struggling to lose the weight, enlist the help of your doctor and a dietitian. The dietitian can help you design an eating plan that will let you lose weight safely and effectively, while the doctor can guide you on how much weight you need to lose and when you can start exercising.
Melinda Johnson, MS, RD, spokeswoman, American Dietetic Association.