Clown Car Supplements II – Hydroxycut Edition
The FDA warning and Hydroxycut recall are all over the news now, and the major retailers appear to have pulled the products from their inventories. While the reports of liver injury are limited (23 so far), they’re still not easy to dismiss. Nor is it a good idea to do so, especially since there are some “take home” lessons from the current situation.
One of them is a point that Paul and I have stressed in earlier posts: “natural” does NOT mean safe or wholesome. The Hydroxycut products are “natural” all right: they contain a slew of herbal extracts. For example, “Hydroxycut Max” contains Pausinystalia yohimbe bark extract, Juniper powder, Aralia mandschurica powder, Angelica keiskei powder, Cissus quadrangularis extract and so on. Some of these are undoubtedly harmless – at least taken solo. Likewise, some are almost certainly “label decoration” – that is, added in amounts too small to be helpful… or harmful, for that matter.
Trouble is, which is which? While herbs are used extensively in traditional medical systems, this does not make them 100% safe. Leaves, roots, seeds, etc. are biologically complex and contain a range of bioactive components. Needless to state, many haven’t even been identified, let alone studied. Thus, it’s not surprising, perhaps, to see adverse reactions when a lot of them are crammed together in a single supplement.
And “crammed” is actually a pretty good description – which is why I call supps like these “clown car supplements“. Hydroxycut Hardcore contains 14 separate active ingredients; there are 23 in Hydroxycut Max. That’s ridiculous…and it brings us to the next point: There’s very little genuine science behind these (overlong) lists of ingredients.
This may seem counter-intuitive to certain folks who conflate “complexity” with “science.” The confusion is understandable, I guess, since…well, science is HARD. Scientists use a lot of specialized technical terminology that sounds like Greek to a lot of people. Unfortunately, while science IS complex, complexity doesn’t automatically mean that that scientific methods were used to achieve it, even if scientific terminology is used.
The reality is that – even in science – the K.I.S.S. principle* applies. When conducting an experiment, a researcher looks at ALL of the variables that could influence the outcome, and holds those constant…except for the one that’s being tested. This “test one thing at a time” approach is what makes it difficult – if not impossible – to optimize a complicated supplement formula: there are too many damn variables to manipulate. There’s not only the individual ingredients, but also the potential interactions between them to consider. Two or more ingredients might work synergistically…or they might be antagonistic. How the hell do you test different amounts and combinations of 15 – 20 ingredients to find the arrangement that’s most effective?
The answer is that you can’t. The process would be hideously expensive and time consuming. This is why prescription and OTC drugs contain very few active ingredients: it makes the science a heck of a lot more manageable. To even have a chance at being “scientific”, a formula should be no more complex than it needs to be to get the job done. Weight loss supps are no exception. For the record, one of the most effective weight loss “stacks” ever devised has only two ingredients: ephedrine and caffeine (EC).
But we’ve been down this road before – the only difference is the brand. Unfortunately, there are a number of individual case reports of hepatotoxicity associated with a range of dietary supplements, and figuring out the reason(s) can be like trying to nail Jello to a tree. This is yet another issue with “clown car supplements” – as the greater the complexity, the greater the potential for unanticipated problems…and the harder the task of figuring out which ingredients/conditions are causing it.
The difficulty of the task is spelled out in this overview of hepatotoxicity assessments for dietary supplements. To summarize, hepatotoxic reactions can be classified as either predictable or unpredictable. The former are “high incidence”/”dose related”, and are typically caused by the presence of identifiable hepatotoxic agents. A good example of this would be pyrrolizidine alkaloids, which are found in a wide variety of plants, including medicinal herbs like comfrey.
It’s the unpredictable reactions that are difficult to investigate, as individual variables (pre-existing conditions, co-ingested medications/supplements/dietary factors, immune hypersensitivity; genetic polymorphisms in liver enzymes, etc.) come into play.
To take one example, one of the issues I discussed earlier with Paul concerns the potential for problems with “Phase I” (cytochrome P-450) drug metabolizing enzymes. It’s already well-known that certain dietary factors – such as the furanocoumarins in grapefruit – can inhibit an enzyme called “CYP3A4”, which, in turn, reduces the clearance of certain drugs from the body and thus, increases their toxicity.
Could certain herbal extracts used in Hydroxycut products also affect Phase I enzymes? If so, the metabolism of co-ingested drugs could be affected. For that matter, the metabolism of other components in Hydroxycut products could be affected, too.
Then there’s the potential for variability within various herbal extracts, not to mention the presence of potentially toxic contaminants. Many herbs and nutraceuticals come from China, and…well, maybe the less said about that, the better.
It’s a pretty messy situation, overall, and I don’t envy the folks trying to make sense of it all.
So what can we conclude from the current recall/investigation? While this may surprise you, my answer isn’t “stop taking supplements”. I certainly haven’t, and don’t intend to. Rather, I’m going to reiterate three guidelines from a different, but related post.
- buy supps that clearly list the amounts of each component on the label (Labrada SuperCharge Xtreme NO is a good example) – avoid “proprietary blends”.
- choose supp formulas with a limited number of well-chosen ingredients backed by solid human and/or animal studies.
- support companies that do basic safety and efficacy testing, and put their data front and center (Gaspari Novedex XT is a good example).
Short of total abstinence, following the above recommendations should serve to reduce your risk – however small – of serious, health-threatening side effects from commercial dietary supplement formulas.
*”Keep It Simple, Stupid!”
