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DIETERS TEA | DIET GREEN TEA |
SENNA | Trim TX
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Trim Tx
(Hoodia
Gordonii, Green tea, and Bitter Orange Peel) is a popular brand.
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Dieters Tea
A cup of hot herbal tea may feel soothing
to the soul, but instead of soothing the body, some herbal teas can make
you sick.
This is especially true with so-called dieters teas, herbal teas
containing senna, aloe, buckthorn, and other plant-derived laxatives
that, when consumed in excessive amounts, can cause diarrhea, vomiting,
nausea, stomach cramps, chronic constipation, fainting, and perhaps
death. |
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In recent
years, FDA has received "adverse event" reports, including the deaths of
four young women, in which dieter's teas
may have been a contributing factor.
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As a result, FDA is advising consumers to
follow package directions carefully when using dieters teas and
other dietary supplements containing senna, aloe, and other stimulant
laxatives. Consumers should seek medical attention for persistent
diarrhea, abdominal cramps, and other bowel problems to prevent more
serious complications.
The agency may consider requiring manufacturers to place a warning about
the products' potential side effects on the products' labels. Some
manufacturers already are doing so voluntarily.
These products - bought in health food stores and through mail-order
catalogs, for example - often are used for weight loss based on some
consumers' belief that increased bowel movements will prevent absorption
of calories, thus preventing weight gain. However, a special committee
of FDA's Food Advisory Committee concluded in 1995 that studies show
that laxative-induced diarrhea does not significantly reduce absorption
of calories. This is because the laxatives do not work on the small
intestine, where calories are absorbed, but rather on the colon, the
lower end of the bowel.
Juice drinks and tablets also may contain stimulant laxatives. FDA
usually regulates these products as foods under the Federal Food, Drug,
and Cosmetic Act. If the products are represented as dietary
supplements, they are regulated under the Dietary Supplement Health and
Education Act of 1994.
Stimulant Laxatives
The stimulant laxative teas and dietary supplements FDA is most
concerned about contain one or more of the substances senna, aloe,
rhubarb root, buckthorn, cascara, and castor oil. These plant-derived
products have been used since ancient times for their ability to promote
bowel movements and relieve constipation. Several, such as cascara,
senna and castor oil, also are available as over-the-counter drug
laxatives and are regulated as drugs.
Some of these substances also are used in much smaller quantities as
natural flavorings in other foods. As such, they are regulated by FDA as
food additives or "generally recognized as safe" substances. FDA has not
received any information suggesting that these substances pose a hazard
when used in the amounts normally needed to provide flavoring.
Except when used solely as flavorings, the names of these plant
substances appear in the ingredient list on the label of these products.
Dieter's teas and similar products often list the substances at or near
the top because they often are the main ingredients. FDA proposed in
December 1995 to require manufacturers to declare dietary ingredients,
including proprietary blends, in descending order of predominance by
weight on product labels. In the proposed rule, the substance would have
to be given by its common or usual name: for example, Tinnevelly senna
followed by its Latin name, Cassia angustifolia.
Most consumers who use dieter's teas and similar products know that the
products have laxative properties, according to health professionals
familiar with the products, even though the product labeling does not
specifically state the term "laxative." Instead, the labeling may
promote the product as a natural bowel cleanser. Sometimes it may not
reflect the laxative qualities at all.
The product labels may not directly state that the products are for
weight loss, although some allude to it. For instance, some products use
the terms "dieter's," "diet," "trim," or "slim" in their names. Others
may carry information on weight-loss practices, mentioning consumption
of the product along with the weight-loss practices. Some of the teas
are labeled as "low-calorie." Unless sweetened, they provide essentially
no nutrients and no calories.
According to Ara DerMarderosian, Ph.D., professor of pharmacognosy
(study of medicinal products in their crude, or unprepared, form) and
medicinal chemistry at the Philadelphia College of Pharmacy and Science,
users favor the products because they believe that the products may cost
less and taste better than over-the-counter laxatives and because they
are easy to buy. In addition, he said, people with eating disorders,
such as bulimia and anorexia nervosa, may like the products because they
act quickly and produce loose, watery stools. Unfortunately, this
practice is not only useless for losing weight but can be dangerous for
people on severely restricted diets.
Writing in the January 1996 American Druggist, DerMarderosian and his
colleague Sharon Brudnicki, a registered pharmacist also with the
Philadelphia College of Pharmacy and Science, noted that some users like
dieter's tea and other stimulant laxatives for their purported "body
cleansing" ability.
DerMarderosian was a member of the FDA Food Advisory Committee's 1995
special task group on stimulant laxative substances in food.
Adverse Effects
Reports filed with FDA indicate that users tend to experience adverse
effects when they misuse the products by, for example, steeping the tea
longer than product labeling recommends or drinking more than the
recommended amount. The reports indicate three types of adverse events:
Short-term: stomach cramps, nausea, vomiting, and diarrhea lasting
several days. These symptoms are likely to occur in first-time users who
drink more than the recommended amount.
Chronic: chronic diarrhea, pain and constipation due to laxative
dependency, which causes a sluggish bowel. In one report to FDA, a
person who reported using herbal products with stimulant laxatives for
decades suffered severe pain and constipation from loss of colon
function and required surgery to remove the colon. People who develop
chronic problems usually have used these types of products for years.
Severe: fainting, dehydration and electrolyte disorders (for example,
low blood potassium, a condition that can cause paralysis, irregular
heartbeat, and possibly death). People who develop severe problems tend
to be those who are nutritionally compromised, partly as a result of
drastic reductions in food intake--for example, rigorous weight-loss
dieters and people with the eating disorders anorexia nervosa and
bulimia. Four deaths reported to FDA involved women with a history of
such medical problems. According to information presented at a 1995
meeting of FDA's Food Advisory Committee, these herbal stimulant
laxatives may have been a contributing factor in their deaths.
Label Warning
At the 1995 meeting, the advisory committee's task group agreed that
dietary supplements containing stimulant laxatives can have adverse
effects and that a label statement would be helpful in warning consumers
about the risks and reducing the incidence of these adverse effects. The
group proposed this label warning:
"NOTICE (or WARNING): Contains herbs (insert name of herbs) that can act
as stimulant laxatives. Prolonged steeping time can increase the risk of
adverse laxative effects, including: nausea, vomiting, abdominal cramps,
and diarrhea. Chronic use of laxatives can impair colon function. Use of
laxatives may be hazardous in the presence of abdominal pain, nausea,
vomiting, or rectal bleeding. Laxative-induced diarrhea does not
significantly reduce absorption of food calories. Acute or chronic
diarrhea may result in serious injury or death."
The full advisory committee concurred with the recommendations.
California has taken steps to require a similar warning label statement
on all food products containing stimulant laxatives sold in that state.
Some manufacturers have begun to carry the state's drafted warning
statement on their food products. FDA will monitor products sold
nationally to be sure that their labels carry information similar to
that required in California. |
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DIETERS TEA | DIET GREEN TEA |
SENNA
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