Comparación de suplemento dietético en fibras vs. Droga Pancreática en la pérdida de peso

(A comparison of a mixed fiber dietary supplement vs. a Pancreatic lipase inhibitor drug on weight loss Michael J. González, Jorge R. Miranda-Massari and Carlos M. Ricart)

Por: InBioMed Project
University of Puerto Rico, Medical Sciences Campus
Schools of Public Health and Pharmacy
PO Box 365067, San Juan PR 00936-5067
Dept. Biology, Cayey Campus, Cayey PR 00736

En: 1/14/2005

Abstract

A mixed fiber supplement (Fattaché ®) and a pancreatic inhibitor drug (Xenical ®) are compared on effectiveness and side effects. Both products proved effective for weight loss and improved lipid profile. The pancreatic lipase inhibitor was slightly more effective than the mixed fiber supplement, but presented some negative side effects especially of gastrointestinal origin. The mixed fiber supplement had no mayor side effects. We conclude that the mixed fiber supplement is a healthy alternative to attain weight loss.

Introduction

Obesity is a public health concern because it is related to increase risk of morbidity, mortality, psychological problems, and discrimination and reduces economic achievement (1). With a variable etiology and a very complex metabolic and physiologic nature, the treatment of obesity proves difficult. Obesity can be defined as an excessive adipose tissue (a body mass index 30) or the excessive accumulation of body fat (4). This accumulation of excessive fat is the primary culprit of obesity's harmful effects. Americans and Puerto Ricans consume about two times as much fat as considered appropriate (40% Vs 20%), in addition to consuming the wrong types of fat, mainly saturated, transfatty acids and excessive omega 6 fatty acids (5).

Many obese patients accomplish weight loss with diet, exercise and other lifestyle modifications. Others may require more aggressive therapy. Weight loss supplements and/or medications may be appropriate for the use of obese patients with comorbid conditions. Most medications for the obese are formulated to reduce energy intake, increase energy output or decrease absorption of fat. Nevertheless, they carry the burden of an array of secondary side effects. Of great interest is the use of supplements and nutritional products to help create a proper environment or provide a fine metabolic tuning that will facilitate weight/fat reduction goals with substantially less side effects. We will compare two effective weight loss products, the drug xenical Orlistat to a mix fiber supplement, (Fattaché) in terms of effectiveness and side effects.

Discussion

Xenical ® (Orlistat) is a weight loss agent with a novel mechanism of action that was approved by FDA for the treatment of Obesity. It inhibits gastric and pancreatic passes in the lumen of the gastrointestinal tract to decrease systemic absorption of dietary fat (6). In several trials lasting up to 2 years, Orlistat (120mg Td) was more effective than diet alone for weight reduction and maintenance of loss weight (6). Orlistat treatment also resulted in modest improvements in total cholesterol, LDL and fasting glucose (6). Orlistat is minimally absorbed and has no CNS effects (7,8). Because Orlistat decreases the absorption of fat-soluble vitamins, a multiple vitamin/mineral supplement is recommended daily during therapy (6). The major and most problematic adverse effects are gastrointestinal (8). Such as oily fecal spotting, abdominal pain, flatus with discharge and fatty oily stool (8). The potential for severe gastrointestinal discomfort and a modest degree of weight loss in some patients may limit the agent's clinical utility. Up to 40% of all patients experience gastrointestinal side effects (9).

There are two reported complaints associating Orlistat with hypertension (10) and subacute hepatic failure (11). In relation to Orlistat's effectiveness in reducing fat absorption, in three randomized controlled trails, Orlistat compared to placebo resulted in significant weight loss. Patients treated with Orlistat loss an average of 3.4kg more that patients taking placebo while on a hypocaloric diet. Orlistat inhibits pancreatic lipase and can block 30% of the triglyceride hydrolysis in subjects eating a 30 % fat diet (12). Orlistat reduces dietary fat absorption by approximately one-third (7). Orlistat has been reported to reduce coronary heart disease risk by reducing body weight, waist and hip circumferences, also reductions in blood pressure, improved serum lipid profile, improved fasting glucose and glycosylated hemoglobin have been reported (13).

Fattaché ® is a mixed fiber dietary supplement containing natural fibers, chitosan, apple pectin, gycomannan and psyllium. Its formula has been patented and is the only weight /fat reduction supplement with clinical studies (14, 15).

This supplement has a short-term study (open label) to assess efficacy and safety and to identify trends in body weight, fecal fat, serum lipids and blood pressure (14). Also published is a long term study (double blind, placebo controlled) to asses its clinical effectiveness (15).

Fattaché ® was effective in achieving weight loss, cholesterol reduction, LDL reduction, HDL increases and increase fecal fat content (15); interestingly it had no secondary side effects in the dose given (4 capsules, twice a day). In addition, patients followed their normal dietary habits. This weight reduction was attained even in the absence of a hypocaloric diet. Because the general potential to reduce overall absorption, a multivitamin/mineral supplement is recommended during the use of this supplement and taken three hours after the supplement or one (1) hour before. In addition the intake of 8-10 ounces glasses of water is recommended for the effectiveness of this mixed fiber weight reduction supplement. Patients treated with Fattaché ® had a weight loss average of 2.57 kg. This weight reduction was associated with a corresponding statistically significant increase in fecal fat content and decreasing total cholesterol, LDL and increase in HDL with no adverse side effects (16). Xenical may be the drug of choice of physicians to treat obesity patients that suffer GI side effects may benefit from the use of Fattaché as an alternative to Xenical.

Conclusions

Both products Xenical ® and Fattaché ® have demonstrated effectiveness attaining weight reduction (3.40 Vs 2.57kg, respectively) In addition to improving lipid profile, thus reducing cardiovascular disease risk. Nevertheless, the mixed fiber supplement had no adverse side effects while the drug presented gastrointestinal problems. Given that both products are effective as demonstrated by clinical studies, we conclude that the mixed fiber supplement is a safe alternative to attain healthy weight loss, especially on those patients that experience GI side effects when given the pancreatic light pace inhibitor.

References

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11. Montero JL, Muntane J, Fraga E, Delgado M, Costan G, Serrano M, Padillo J, de la Mata M and Mino G. Orlistat associated subacute hepatic failure. J Hepatol 2001, 34:173.

12. Bray GA. Drug treatment of obesity. Bailliers Best Pract Res Clin Endocrinol Metab 1999, 13:131-148

13. Lingarde F. The effect of Orlistat on body weight and coronary heart disease risk profile in disease patients: The Swedish multi-morbidity study. J Intern Med 2000, 248:245-254.

14. González MJ, Ricart CM, Nesbitt L and Claudio J. Short term effect of a high fiber dietary supplement on total body weight, fecal fat, lipid profile and blood pressure in human subjects. Biomedicina 1998,1:51-57.

15. Nesbitt L, Ricart CM, Miranda-Massari J and González MJ. Long term effect of a high fiber dietary supplement on total body weight, fecal fat, lipid profile and blood pressure in female human subjects. Biomedicina 1999, 2:59-512.

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