Former Visiting Professor Patrick Holford may be Head of Science and Education at Biocare but he is not above blogging some very amusing doublethink[a] about weightloss pills for our enjoyment: Why I’m not a fan of slimming pills. Holford criticises starch blockers, fat blockers, appetite suppressants and slimming pills. He advises his readers to “[a]void them at all costs”. This is fairly unexceptional and would be worth little more than a scratch and a yawn were it not for the justifications that Holford offers for the reader’s merriment and if it were not that he has effectively re-issued a post that we had previously written up and that Holford subsequently withdrew.[b] We had assumed that Holford and his assistants had recognised the parlous blind spot concerning Holford’s own weight-loss products and recommendations but it seems not (which is a little sad as it vividly illustrates that the Holford-formulated Brain Food pack can’t be that effective).
Both the Big Pharma and Big Supplements weightloss market can be sectioned into 6 mechanisms of action:
- increase water elimination
- increase the metabolic rate and therefore energy expenditure
- regulate carbohydrate metabolism
- increase satiety or suppress appetite
- increase fat oxidation or reduce fat synthesis
- block absorption of dietary elements such as fat or carbohydrate.
Holford singles out the ‘fat blockers’ chitosan, NeOpuntia® and Orlistat[c] for his especial derision. The reasons that he gives are as follows:
three studies have found no significant differences in either weight or cholesterol levels in people taking chitosan or a placebo…
While some studies do show that [NeOpuntia®] binds to fat, and also lowers cholesterol, I’ve not been able to find any evidence to date that it causes weight loss…
[Orlistat] appears to work by reducing fat absorption. However, a recent study found that the drug versus placebo had no beneficial effect on weight loss or liver function in patients with fatty liver disease.
Now, while our own position is that weight-loss supplements rarely have any high-quality trials to support their marketing claims and the usefulness of Orlistat is limited, we would remind you that this is Holford making these criticisms.
Patrick Holford has yet to rescind his recommendations for the ‘treatment’ of autism. His recommended supplement package is based on the leaky gut theory which is grounded in Dr Andrew Wakefield’s work. Wakefield’s work in this area depends upon a small number of papers for which the status is dubious following both prolonged criticism and recent revelations.
We could easily find a number of papers that argue that cinnamon and chromium have no clinically validated impact on weightloss for non-diabetic people. However, whereas highlighting 3 papers is sufficient to condemn chitosan, somehow that logic doesn’t hold for chromium or cinammon, far less the lack of any specific studies on Holford’s own formulation – Cinnachrome.
Oddly enough, there is a Cochrane Review of Chitosan for overweight or obesity (2008) and it scrutinises and assesses the relevant literature (RCTs involving overweight or obese people and of more than 4 weeks duration).
There is some evidence that chitosan is more effective than placebo in the short-term treatment of overweight and obesity. However, many trials to date have been of poor quality and results have been variable. Results obtained from high quality trials indicate that the effect of chitosan on body weight is minimal and unlikely to be of clinical significance.
It is not infeasible that Holford would normally offer similarly lacklustre findings as clinical vindication for his own preferred supplements. You might also recall that Holford once offered his own anecdata of 2 people as a counter-argument to the findings of a Cochrane Review of anti-oxidants that involved more than 230,000 participants.
Holford disdains NeOpuntia® because there isn’t as yet any evidence that it produces weightloss, although there is some indication that it binds fat etc. in bench evaluation. Careful readers may recollect that Holford is normally keen to recommend a supplement on the back of in vitro studies or studies that are conducted on other species. At random, 9 June 2008, Holford sent around a newsletter with the exciting title, Can you improve your genes with vitamins? One could sense the excitement as he reported:
As billions of dollars goes into researching how to change defective genes, a breakthrough study has found that common genetic defects can be changed with something as simple as a B vitamin…
[T]he critical question this research set out to examine was whether giving extra folate, the B vitamin rich in greens and beans, could restore the defective enzymes to normal function.
Of the five gene mutations they found in their volunteers, four could be restored to normal functionality by increasing intracellular levels of folate.
That all sounded tremendously exciting but not only did Holford fail to link to the paper, he neglected to mention that the study tested the function of human gene variants by transplanting them into yeast cells – no actual humans were involved in the way that his summary suggested. There was no actual evidence, as yet, to support specific supplement recommendations. Not that that usually prevents Holford from making such.
There are many well-justified criticisms one might make of Orlistat, however, the best Holford could do is to shift the goal posts. Oddly enough, even in Holford’s flights of fancy about chromium, cinnamon and the Holford Low GL diet, HolfordWatch does not recall claims that they have any “beneficial effect on weight loss or liver function in patients with fatty liver disease”.
Holford concludes this exercise in doublethink with a recommendation that readers abjure slimming pills that are stimulants, that suppress appetite or ‘wire you up’.
Even if it sounds ‘natural’, avoid any herb or supplement whose active ingredient is caffeine – and that includes guarana.
As we have pointed out previously, Holford is not quite so reticent in his support for the alleged appetite-suppressing properties of Hoodia.
What do you think is the implied function of Holford’s formulation, APPESTOP (known, more prosaically, in the UK as GL Support)? Would you imagine that its 3 ingredients might, oh for argument’s sake, suppress appetite? Or are appetite suppressants inappropriate when stimulant based but not when based on Garcinia Cambogia (tamarind fruit), 5-HTP (5-Hydroxytryptophan) and Chromium? If you are generally interested in the less than impressive corpus of evidence that supports any role for those in weight loss then please consult Saper et al’s Common Dietary Supplements for Weight Loss.
In general, no pill, supplement or intervention for weightloss should be recommended in the absence of lifestyle modifications: such interventions can only ever be part of a strategy, not a stand-alone solution. Derek Lowe provides an elegant summary in Another Obesity Drug? Not Likely:
There are several lines of evidence that make [the serotonin-receptor based drug] a plausible way to affect appetite – well, as plausible as any of the appetite-based obesity targets are. I’ve long been wary of these, since we’ve found (over and over) that human feeding behavior is protected by multiple, overlapping redundant pathways. We are the descendants of a long line of creatures that have made eating and reproducing their absolute priorities in life, and neither of those behaviors are going to be altered lightly. The animals that can be convinced to voluntarily eat so little that they actually lose weight, just through modifying a single biochemical pathway, are all dead. Our ancestors were the other guys. [Emphasis added.]
However, the main thrust of Holford’s argument seems to be that the reader should disdain weight-loss aids or supplements that are not explicitly endorsed by Holford or are presented in bottles that lack his smiling face because, otherwise, he doesn’t get any money. We hope that we have clarified Holford’s criteria for selecting a weight-loss pill: the selection doesn’t seem to depend upon the state of the clinical evidence.
[a] Orwell, George (1949). Nineteen Eighty-Four. Martin Secker & Warburg Ltd, London, pp. 220.
The power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them….To tell deliberate lies while genuinely believing in them, to forget any fact that has become inconvenient, and then, when it becomes necessary again, to draw it back from oblivion for just so long as it is needed, to deny the existence of objective reality and all the while to take account of the reality which one denies — all this is indispensably necessary. Even in using the word doublethink it is necessary to exercise doublethink. For by using the word one admits that one is tampering with reality; by a fresh act of doublethink one erases this knowledge; and so on indefinitely, with the lie always one leap ahead of the truth.
[b] On reflection, we now realise that it is an amended version of the original post but there are really no improvements and just as much purblindness.
[c] HolfordWatch was initially puzzled as to why Holford had included Orlistat but, like the other supplements that he names, Orlistat is now available over the counter to the general consumer, without a prescription which may make it a potential rival to Holford’s market share and products.