Skip to main content
Top
Published in: Journal of General Internal Medicine 1/2012

01-01-2012

Use of a Pharmaceutically Adulterated Dietary Supplement, Pai You Guo, Among Brazilian-Born Women in the United States

Authors: Pieter A. Cohen, MD, Carly Benner, BA, Danny McCormick, MD, MPH

Published in: Journal of General Internal Medicine | Issue 1/2012

Login to get access

ABSTRACT

BACKGROUND

Pai You Guo is a weight loss supplement manufactured in China and adulterated with the banned pharmaceutical products sibutramine and phenolphthalein. The US Food and Drug Administration (FDA) announced a voluntary recall of Pai You Guo in 2009, yet clinicians have noted its continued use among Brazilian-born women in Massachusetts.

OBJECTIVE

To assess prevalence of Pai You Guo use, associated side effects, modes of acquisition, and impact of FDA regulatory action on these outcomes.

DESIGN

Cross-sectional study using an anonymous questionnaire.

PARTICIPANTS

Women ≤60 years of age, born in Brazil who attended one primary care clinic or one of six churches in Massachusetts.

MAIN MEASURES

Prevalence of use, how users first heard about the product, location of purchase, associated side effects, patterns of use before and after the FDA recall.

KEY RESULTS

Twenty-three percent (130/565) of respondents reported using Pai You Guo. In multivariate analysis, obesity (adj OR 3.7, p-value <0.001) and lack of insurance (adj OR 2.6, p-value 0.005) were associated with use. The majority of users (85%) reported at least one side effect. Dry mouth (59%), anxiety (29%), and insomnia (26%) were most commonly reported adverse effects. Nearly thirty-percent of users (38/130) purchased Pai You Guo from local stores and 9% (11/130) purchased it over the Internet. The majority of respondents (79/130; 61%) purchased Pai You Guo after the FDA recall. No respondent was aware of the FDA recall.

CONCLUSIONS

Use of this pharmaceutically adulterated supplement is common among Brazilian-born women in Massachusetts. The FDA alerts and recall did not appear to decrease its use.
Literature
1.
go back to reference Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.PubMedCrossRef Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.PubMedCrossRef
2.
go back to reference Pillitteri JL, Shiffman S, Rohay JM, Harkins AM, Burton SL, Wadden TA. Use of dietary supplements for weight loss in the United States: Results of a national survey. Obesity. 2008;16(4):790–96.PubMedCrossRef Pillitteri JL, Shiffman S, Rohay JM, Harkins AM, Burton SL, Wadden TA. Use of dietary supplements for weight loss in the United States: Results of a national survey. Obesity. 2008;16(4):790–96.PubMedCrossRef
3.
go back to reference Blanck HM, Serdula MK, Gillespie C, et al. Use of nonprescription dietary supplements for weight loss is common among Americans. J Am Diet Assoc. 2007;107(3):441–7.PubMedCrossRef Blanck HM, Serdula MK, Gillespie C, et al. Use of nonprescription dietary supplements for weight loss is common among Americans. J Am Diet Assoc. 2007;107(3):441–7.PubMedCrossRef
4.
go back to reference Cohen PA. American roulette—contaminated dietary supplements. N Engl J Med. 2009;361(16):1523–5.PubMedCrossRef Cohen PA. American roulette—contaminated dietary supplements. N Engl J Med. 2009;361(16):1523–5.PubMedCrossRef
5.
go back to reference Tang MH, Chen SP, Ng SW, Chan AY, Mak TW. Case series on a diversity of illicit weight-reducing agents: from the well known to the unexpected. Br J of Pharmacol. 2011;71(2):250–3.CrossRef Tang MH, Chen SP, Ng SW, Chan AY, Mak TW. Case series on a diversity of illicit weight-reducing agents: from the well known to the unexpected. Br J of Pharmacol. 2011;71(2):250–3.CrossRef
13.
go back to reference US Food and Drug Administration. Laxative Drug Products for Over-the-Counter Human Use; Proposed Amendment to the Tentative Final Monograph. Notice of proposed rulemaking. Fed Regist. 1997 62(169):46223–26. US Food and Drug Administration. Laxative Drug Products for Over-the-Counter Human Use; Proposed Amendment to the Tentative Final Monograph. Notice of proposed rulemaking. Fed Regist. 1997 62(169):46223–26.
14.
go back to reference (Forensic Chemistry Center, US Food and Drug Administration, Cincinnati, OH). Conversation with: Pieter Cohen (Department of Internal Medicine, Cambridge Health Alliance, Somerville, MA). 2011 Apr 8. (Forensic Chemistry Center, US Food and Drug Administration, Cincinnati, OH). Conversation with: Pieter Cohen (Department of Internal Medicine, Cambridge Health Alliance, Somerville, MA). 2011 Apr 8.
15.
go back to reference (Westenberger BJ, Division of Pharmaceutical Analysis, US Food and Drug Administration, St. Louis, Missouri). Conversation with: Pieter Cohen (Department of Internal Medicine, Cambridge Health Alliance, Somerville, MA). 2011 May 3. (Westenberger BJ, Division of Pharmaceutical Analysis, US Food and Drug Administration, St. Louis, Missouri). Conversation with: Pieter Cohen (Department of Internal Medicine, Cambridge Health Alliance, Somerville, MA). 2011 May 3.
18.
go back to reference Cohen PA, McCormick D, Casey C, Dawson GF, Hacker KA. Imported compounded diet pill use among Brazilian women immigrants in the United States. J Immigr Minor Health. 2009;11(3):229–36.PubMedCrossRef Cohen PA, McCormick D, Casey C, Dawson GF, Hacker KA. Imported compounded diet pill use among Brazilian women immigrants in the United States. J Immigr Minor Health. 2009;11(3):229–36.PubMedCrossRef
20.
go back to reference James WP, Caterson ID, Coutinho W, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363(10):905.PubMedCrossRef James WP, Caterson ID, Coutinho W, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363(10):905.PubMedCrossRef
21.
go back to reference Florentin M, Liberopoulos EN, Elisaf MS. Sibutramine-associated adverse effects: a practical guide for its safe use. Obes Rev. 2008;9(4):378–87.PubMedCrossRef Florentin M, Liberopoulos EN, Elisaf MS. Sibutramine-associated adverse effects: a practical guide for its safe use. Obes Rev. 2008;9(4):378–87.PubMedCrossRef
22.
go back to reference Nguyen MH, Ormiston T, Kurani S, Woo DK. Amphetamine lacing of an Internet-marketed neutraceutical. Mayo Clin Proc. 2006;81(12):1627–9.PubMedCrossRef Nguyen MH, Ormiston T, Kurani S, Woo DK. Amphetamine lacing of an Internet-marketed neutraceutical. Mayo Clin Proc. 2006;81(12):1627–9.PubMedCrossRef
23.
go back to reference Cohen PA. Imported fenproporex-based diet pills from Brazil: a report of two cases. J Gen Intern Med. 2009;24(3):430–3.PubMedCrossRef Cohen PA. Imported fenproporex-based diet pills from Brazil: a report of two cases. J Gen Intern Med. 2009;24(3):430–3.PubMedCrossRef
Metadata
Title
Use of a Pharmaceutically Adulterated Dietary Supplement, Pai You Guo, Among Brazilian-Born Women in the United States
Authors
Pieter A. Cohen, MD
Carly Benner, BA
Danny McCormick, MD, MPH
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 1/2012
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-011-1828-0

Other articles of this Issue 1/2012

Journal of General Internal Medicine 1/2012 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.