Patrick Holford has sent his latest email on weight-loss to our faithful reader, Precious Ramotswe. Mma Ramotswe has written to Holford Watch to ask for our advice.
Dear Holford Watch,
I am a traditionally-built lady, as you know. Most of the time, this is of great advantage to me (e.g., snakes know where I am and I can cast shade for small children), but I am subject to much advice on the topic of weight-loss. Patrick Holford has sent me an email about his eating programme. He exhorts me to “Be proud to be seen in [my] bikini this summer and switch to a low GL diet today”. I have looked through it but there is no mention of cake which makes me a little sad. However, it may be possible to put something together from oats and fruit, although that may make me sadder as it does not resemble cake.
He referred me to patrickholford.com and holforddiet.com to read more about the evidence for his diet. He seemed to be very excited about a Cochrane Review of diets. I am confused. It seemed to me that very recently he was saying that these Cochrane people produce stitch-ups and I wasn’t to trust them.
As part of his GL Diet Patrick Holford recommends that I should take some pills. Here in Botswana, we grow and sell the best-quality food, not like some other countries. Do you think that I need to take these pills?
Great Supplements to support weight loss
Eating a low-GL diet is a proven way to lose weight, but sometimes people welcome a little extra help. Slimming pills rarely work, and those that do often act like stimulants, speeding up your metabolism and giving you short-term weight loss – and potential long-term problems. But there are three nutrients that I’ve found to be extremely effective at supporting weight loss. They are an extract of the tamarind fruit, the amino acid 5-HTP and the mineral chromium.
1. Tamarind curbs your appetite
An extract from the dried rind of the tamarind fruit (Garcinia cambogia) – which you may know from Indian and other Eastern cuisine – can help you lose weight. Originally developed by the pharmaceutical giant Hoffman-LaRoche, it has been proved to slow down the production of fat and reduce appetite. It has been extensively tested and found to have no toxicity or safety concerns…
I recommend taking tamarind…available as a supplement in combination with the other recommended nutrients (see below).
2. 5-HTP helps you ‘think thin’
The two most powerful controllers of your appetite are your blood sugar level and your brain’s level of serotonin, the ‘happy’ neurotransmitter. Serotonin is often deficient, especially in those on weight-loss diets. A low level can lead to depression – and increased appetite (which is why many depressed people overeat).
If you are low in serotonin, one of the quickest ways to restore normal levels, and normal mood, is to supplement your diet with an amino acid called 5-hydroxytryptophan, or 5-HTP for short…
5-HTP, like tamarind and chromium (see below), is also available in a combination formula…
3. Chromium – the secret of balancing blood sugar
One mineral that helps you keep your blood sugar in balance is chromium. The older you are, the less likely you are to be getting enough of this essential mineral that helps stabilise blood sugar levels and, hence, weight. The average daily intake is below 50mcg, while an optimal intake – certainly for those with a weight and blood sugar problem – is around 225mcg…
[Y]ou can help balance your blood sugar and reduce sugar cravings more quickly by taking 75mcg three times a day for the first three months of a weight loss regime. Again, it’s also available in a combination formula with tamarind and 5-HTP.
I thought that it might be difficult to locate such things in Botswana but Patrick Holford has kindly put them into a convenient combination formula to meet my needs.
I look forward to your comments – Precious Ramotswe (Private Detective and Sole Proprietor of The No. 1 Ladies Detective Agency)
We are delighted to hear from you, Mma Ramotswe. Holford Watch can not give any advice on weight loss (as you know) but we can comment on some of the research behind the recommended supplements and maybe that will assist you in your decisions. As a private detective, you are very used to gathering the evidence and then weighing it before acting, so we hope that this will be helpful.
In general, there are very few, high-quality long-term studies that show any particular diet programme is more successful than others in losing body fat and then sustaining weight-loss, Mma. In 2007, researchers published a paper that looked at the long-term effects of both a high-GL and low-GL diet to promote weight loss. The researchers say that the outcome at the end of 6 months was equivalent and neither diet was better than the other. It did not seem to matter whether you ate foods with a high glycaemic load or a low one.
And, yes, Patrick Holford is very excited about the glycaemic load of diets or what he has so modestly named the Holford Diet. You are quite right, Mma Ramotswe when you recalled that he had recently been very dismissive of a Cochrane Review but that was a review that questioned the benefit of taking supplements and it may have made Holford very sad that people were advising against something that is such a good source of income for him. However, perhaps he agrees with this Cochrane review about the glycaemic load and index of diets because he is hopeful that it might persuade people to buy his diet books and related supplements. So, we hope that this is now clearer, Mma.
We will write more about GL diets at another time, Mma, but, for now, the evidence is really not as clear cut as Holford presents it to be. E.g., that Cochrane review was not able to include the study that we mentioned above but probably will the next time that the writers update it (the reviewers have not included any studies published after July 2006). These results might change some of the present findings, Mma, because at present, the review only assesses 6 trials with a total of 202 participants. And, interestingly, the type of diet varies so much that none of them is that similar to the diet that is recommended to you by Holford.
If you are interested in reading further then this group of researchers has some useful information and a good publication list on these topics. We can not recommend the review of GL for weight loss written by Holford and some people who should have known better. We have still not recovered from as bad a case as the undistributed middle as we have ever had the misfortune to encounter:
High protein diets are no better at causing sustained weight loss when compared with a conventional low fat, low calorie diet. As shown earlier, low GL diets are superior to conventional low fat, low calorie diets. Therefore GL diets are superior to high protein diets.
They are referring to completely different trials, subjects groups and types of participants. At no point do they cite a direct head to head comparison of high protein v. low GL diets. The syllogism is so embarrassing that we can’t bring ourselves to comment on it.
Now for the supplements.
As for HCA, the tamarind fruit extract, there are several reviews that do not find that this is helpful for weight loss, Mma. Prof. Ernst and a colleague looked at a number of dietary supplements for body-weight reduction. They concluded that:
[o]verall, the evidence for G. cambogia is not compelling.
[a]lthough HCA appears to be well tolerated, the evidence for efficacy currently is contradictory.
Dr Saper (the lead doctor for the last paper, Mma) was interviewed for the New York Times for an article, Weight-Loss Drugs: Hoopla and Hype. He said: “Over-the-counter dietary supplements to treat obesity appeal to many patients who desire a magic bullet for weight loss”. He was sad to report that there is no such magic bullet.
5-HTP is sometimes promoted as a ‘natural anti-depressant’. You seem to be a naturally happy lady, Mma, especially since you married Mr J.L.B. Matekoni, and whenever you eat cake, so this might be treating you for a serotonin deficiency that you don’t have. I have looked for evidence as to why it might be useful in weight-loss but couldn’t find any on Entrez Pubmed. Although I did find people who intended to study whether or not a combination of 5-HTP with chromium and other substances would aid weight-loss but they do not seem to have reported the results of that study. Some older papers suggest that this substance might be helpful but there have not been long-term, high-quality investigations of the sort that you might expect. Under no circumstances in any sensible publication is there any indication that 5-HTP might help anyone to “think thin”, Mma.
We have already written about the fact that a review of the clinical evidence does not support the use of chromium to modify glucose metabolism in people without diabetes. You are not diabetic are you, Mma? Also, we can not find anything modern or scientific to support what Holford says about chromium helping to reduce sugar cravings. In fact, given that he claims that his Holford Diet also means that “[y]ou won’t suffer from food cravings”, you might wonder why he thinks that you need both.
Patrick Holford wrote:
Slimming pills rarely work, and those that do often act like stimulants, speeding up your metabolism and giving you short-term weight loss – and potential long-term problems.
All of the doctors and researchers that we have mentioned would agree that most “[s]limming pills rarely work” and, from what they have written, they seem to indicate that this would include the supplements like the ones that Patrick Holford recommends.
That is the evidence that we could find, Mma. As you say, Mma, there is good quality food in Botswana and you are careful to provide healthy food for yourself and your household. As Michael Pollan wrote, the best diet advice seems to be “Eat food. Not too much. Mostly plants“.
If we might express our own opinion, it does not seem as if it would be worth selling any cattle to fund the purchase of these supplements but we are sure that you will make up your own mind on this matter. Whatever you decide, we wish you well and hope to hear from you again.
 Thomas DE, Elliott EJ, Baur L. Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005105. Review. Full text html or pdf. PubMed link.
 Das, S., Gilhooly, C.H., Golden, J.K., Pittas, A.G., Fuss, P.J., Cheatam, R., Tyler, S., Tsay, M., Mccrory, M.A., Lichtenstein, A.H., Dallal, G., Dutta, C., Bhapkar, M.V., Delaney, J.P., Saltzman, E., Roberts, S. 2007. Long-term Effects of High and Low Glycemic Load Diets at Different Levels of Caloric Restriction on Dietary Adherence, Body Composition and Metabolism in CALERIE, a One Year Randomized Controlled Trial. American Journal of Clinical Nutrition. 85(4):1023-1030.
 Pittler MH, Ernst E. Dietary supplements for body-weight reduction: a systematic review. Am J Clin Nutr. 2004 Apr;79(4):529-36. Review.
 Saper RB, Eisenberg DM, Phillips RS. Common dietary supplements for weight loss. Am Fam Physician. 2004 Nov 1;70(9):1731-8. Review.
 Bell SJ, Goodrick GK. A functional food product for the management of weight. Crit Rev Food Sci Nutr. 2002 Mar;42(2):163-78. Review.