MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

It hardly is a secret: we have a growing problem with obesity. Worldwide it is predicted to cause millions of premature deaths – unless, of course, we come up with a safe and effective treatment that patients find acceptable.

Many herbal remedies are being promoted as the solution to this serious problem. My team looked at the evidence for such treatments in much detail. Sadly the results were less than impressive.

But now, there seems to be new hope! Two recent studies of a specific herbal mixture report amazingly good results – or are they perhaps too good to be true?

Stern JS, Peerson J, Mishra AT, Sadasiva Rao MV and Rajeswari KP from the Department of Nutrition and the Department of Internal Medicine, University of California Davis, have just published an RCT in 60 subjects with body mass index (BMI) between 30 and 40 kg/square meter. Participants received either 400 mg herbal capsules with extracts from Sphaeranthus indicus and Garcinia mangostana or 400 mg placebo capsules twice daily. During the study period, participants consumed a standard diet (2,000 kcal per day) and walked 30 min 5 days per week.

After 8 weeks of this treatment, significant reductions in body weight (3.7 kg), BMI (1.6 kg/m2), and waist circumference (5.4 cm) were observed in the herbal group compared with placebo. Additionally, a significant increase in serum adiponectin concentration was found in the herbal group versus placebo. Adverse events were mild and were equally distributed between the two groups.

The authors’ conclusion leave no doubt: Supplementation with the herbal blend resulted in a greater degree of weight loss than placebo over 8 weeks.

As our own review had suggested that extracts of Garcinia cause small short-term weight reductions, the results did not come as a complete surprise to me. What did strike me as odd, however, was the fact that almost simultaneously another article was published. It was authored by Stern JS, Peerson J, Mishra AT, Mathukumalli VS and Konda PR from the Department of Nutrition, University of California-Davis, and it reported the pooled data from the above plus another, similarly designed trial.

The two studies together enrolled 100 patients who were treated either with the same herbal formula or with placebo. All subjects received 2000 kcal/day throughout the study and walked 5 days a week for 30 min. The primary outcome was the reduction in body weight. Secondary outcomes were reductions in BMI and in waist and hip circumference. Serum glycaemic, lipid, and adiponectin levels were also measured. Ninety-five subjects completed the trials, and the data from these two studies were pooled and analysed.

At study conclusion (8 weeks), statistically significant reductions in body weight (5.2 kg), BMI (2.2 kg/m2), as well as waist (11.9 cm) and hip circumferences (6.3 cm) were observed in the pooled herbal groups compared with placebo. A significant increase in serum adiponectin concentration was also found in the herbal groups versus placebo at study conclusion along with reductions in fasting blood glucose (12.2%), cholesterol (13.8%), and triglyceride (41.6%) concentrations. No changes were seen across organ function panels, multiple vital signs, and no major adverse events were reported. The minor adverse events were equally distributed between the two groups.

And what should be odd about that? Authors are entitled to pool the data of two of their own trials! Yes, of course, but what confuses me is the fact that the data from the second study of 40 patients cannot be found anywhere. I would have liked to see how it is possible that the results from just 40 more patients (actually just 35 seemed to have been included in the analysis) raise the average weight loss from 3.7 kg in the first RCT to a remarkable 5.2 kg in the two RCTs together. As a rough estimate, this means that, in the second trial, patients who took the herbal mixture must have lost about one kilo per week more than those who were on placebo. If true, this outcome is pretty sensational! It could signal the end of the obesity epidemic. It would also mean that the manufacturer of this herbal wonder mixture stands to earn billions.

Considering the potential importance of these findings, I would also like to know what precisely the Californian researchers’ involvement has been in these two studies. In the second article they state that: The two clinical trials were performed at Alluri Sitarama Raju Academy of Medical Sciences (ASRAM), Eluru, Andhra Pradesh, India from November 2009 to April 2010 (clinical trial registration number: ISRCTN45078827) and from March 2010 to July 2010 (clinical trial registration number: ISRCTN52261953). I find this puzzling.

Moreover, it would be interesting to learn what happened to the following co-authors of the first study: Sadasiva, Rao MV and Rajeswari KP. As authors of the largest of the two trials, I would have thought their names would have to be included in the article reporting the pooled data of the two studies.

Call me sceptical, perhaps even cynical, but I do wonder about trials which seem to beg so many intriguing questions. In case you want to know who funded these studies and who thus stands to make the above-named billions, the answer is provided in the second paper: This work was supported by an unrestricted grant from InterHealth Nutraceuticals Inc., Benicia, CA, to J.S.S.

So, do I think that we have finally identified a safe and effective treatment to combat the worldwide epidemic of obesity? Well….

6 Responses to Is a herbal mixture the solution to the obesity epidemic?

  • You don’t say what the weight/BMI changes were in the placebo arm. I’m assuming that 2000 kcal diet plus regular exercise meant some weight loss in both arms. Also, as any dieter will tell you, the first pounds (kg, sorry) are the easy ones particularly since body takes time to adjust metabolism to lower food intake/exercise increase I’d like to see whether over longer term there is any difference at all.

  • Perhaps I missed it, but you didn’t say in what journal these studies were published. Seems the authors only published in order to be able to cite “proven in studies” or some other such blurb, in their promotional materials. It’s a shame that any university would support such sloppy “research” and even worse that anyone would publish it.

    Isn’t there some mechanism to critique methodology BEFORE studies are approved?

    • the links take you to the journals.
      criticising research BEFORE it is published is not normally possible for the public [only the ethics committee might do that]; sometimes, the authors publish the protocol, in which case one might be able to do that.

      • I didn’t mean to imply that anything should be critiqued prior to publication. I meant to say that before research proposals are even approved, shouldn’t there be some way to reject studies that are sure to fall short of valid conclusions–like not having controls, for example?

        I realize that some studies are preliminary, and mean to establish the need for further work. In such a case, shouldn’t that be made clear?

        I will follow the links, and thank you–I should have realized! 🙂

  • So there’s a journal called OBESITY–who knew? How does a layperson know how to evaluate a journal that would publish a study that researches an herbal formula for which the authors pretty clearly have a financial interest:

    “This work was supported by an unrestricted grant from InterHealth Nutraceuticals Inc., Benicia, CA, to J.S.S.”

    One certainly cannot trust the media–even the NY Times, as they regularly do a pretty poor job reporting on “health”. The comments from the readership that are offered on these articles demonstrate a profound lack of basic science education. Thank goodness for books like yours (Trick or Treatment) and blogs like ScienceBasedMedicine, et al., but the readership is so much smaller!

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