By: Ilma Hasan , Nabeela Khan
April 24 2024
A fractured leg in 2018 led IT professional Sumeet Pallav’s 66-year-old father to gain weight to over 90 kilograms. An active Facebook user, he came across an advertisement of a supplement claiming to “burn fat” and made his first online purchase in late 2023.
By mid-December, four days after he first started consuming the “Sky Herbal Life” powder manufactured by “Vihan Herbal & Food Ingredients,” the Delhi-based IT professional claims his father lost his appetite.
“He was instructed to have the powder mixed in a glass of water on an empty stomach. After the fourth day, he stopped eating anything and complained of severe pain,” Pallav told Logically Facts. “When we sought medical help, the doctor told us he has DILI — drug-induced liver injury,” he said.
Pallav’s father died a month later on January 18.
Regrettably, Pallav’s situation is far from unique. Other accounts online echo the same narrative, highlighting how these ‘herbal’ medications are easily available and are potentially harmful. The powder, consumed by Pallav’s father, claimed to be a “natural weight control powder” and had about 18 ingredients listed on its packaging, including garcinia cambogia, green tree extract, and coffee bean extract — commonly found in similar fat-burning pills.
Image taken from Pallav’s post on LinkedIn. (Source: Sumeet Pallav/LinkedIn)
Alluding to this incident, Dr. Abby Phillips, popularly known LiverDoc on X (formerly Twitter), wrote on the platform, “Green tea extracts (not green tea) and Garcinia cambogia (malabar tamarind) are highly toxic compounds that can injure the liver so badly that they can kill. The person dies of multiple organ failure. This man was on two products that contained both. It's criminal.”
Studies have examined the relationship between the consumption of green tea extract and liver injury. A review published in February 2020 by an expert panel in the peer-reviewed journal Toxicology Reports said, “It is reasonable to conclude that risks of hepatotoxicity due to GTE (green tea extract) intake are real, and exposure may lead to liver injury, including serious liver injury.”
In fact, a scientific opinion from the European Food Safety Authority (EFSA) concluded that consumption of more than 800 milligrams of epigallocatechin (chemical name of green tea extract) per day as a food supplement has been shown to induce a statistically significant increase of serum transaminases (signs of liver damage).
As obesity rates are expected to considerably increase in India, the quest to lose weight has catapulted the weight management market size to a $23 billion market in 2023, according to an independent market research company IMARC. Earlier reports have also highlighted how the introduction of numerous dietary and weight loss supplements feed into the growth of the market.
Interestingly, these pills and concoctions are readily available to purchase online and the use of buzzwords like “natural”, “herbal”, and “fat burning” in their advertisement add a perception of credibility to these supplements.
Pallav’s father had bought the medicines after seeing multiple ads on Facebook but after his story went viral, the company removed its posts. Logically Facts also contacted Prakash Kumar, a part of senior management at Vihan Herbal, who said the company has given their products to Food Safety Standards Authority of India (FSSAI) for testing and is awaiting results.
Many other companies selling these supplements with similar claims are easily available on the social media platforms and other marketplaces like Amazon and NetMeds.
Nutraceuticals sold on Amazon containing garcinia cambogia, green tea extract, and green coffee extract (Source: Amazon.in/Screenshot)
For instance, a Facebook page for a vitamin supplement shop that has over 121,000 followers also promotes products with green tea extract. The page bio has a link to a website that has a category for ‘Ayurveda and Herbs’ within which a sub-section for weight loss sells products with green tea extract, garcinia cambogia, and coffee bean extract for approximately Rs. 500.
“The U.S. Food and Drug Administration (FDA) does not approve of these so-called fat burners. They have not been shown to cause weight loss in clinical trials. Fat burners work by elevating blood pressure and increasing overall energy expenditure, which may eventually lead to weight loss over time. If someone already has high blood pressure, they should be careful using these,” Dr. Sudeep Khanna, an intestinal and liver disease specialist told Logically Facts.
The veracity of these supplements has been under the radar for many decades. Between 2020 and 2023, FDA called out 22 tainted weight-loss products. In addition, a 2011 study published in the Canadian Journal of Gastroenterology and Hepatology recommended higher scrutiny when consuming pills with ingredients such as green tea and guggul extracts after cases of patients having liver failure came to light.
Another study published by the same journal in 2022 showed that garcinia cambogia, either alone or in combination with green tea, causes moderate to severe liver injury. The study enrolled 1987 patients in the Drug-Induced Liver Injury Network (DILIN) from 2004 to 2018.
“These nutraceuticals in foods might be okay, because they are in small quantities but once they are extracted and they are in purified form they can become highly toxic or potent. It depends on the underlying condition of the person, you and I might respond differently to the same medicine,” Dr. Sylvia Kapagam, a public health doctor and researcher, told us.
We further looked at 20 other weight-loss products available in India on Netmeds and Amazon that come packaged as pills. These pills are available without a prescription at a cost between Rs. 500 to Rs. 2,000.
Logically Facts contacted Sky Herbal Life on their helpline number, where a professional claiming to be a doctor said the nutraceuticals are made from 12 to 15 herbs with “guaranteed no side-effects”. On inquiring about the products she said, “It burns tough fat, you’ll see results in seven to eight days and good results in a month. You’ll pass urine that makes you lose more weight.” When we asked about her credentials as a doctor, she replied she is a fat loss professional.
Netmeds, Amazon.in and other websites selling supplements. (Source: Online marketplaces/Screenshot)
However, natural doesn’t necessarily mean safe. Researchers from the University of Sydney have conducted a global review of herbal medicines for weight loss. The study analyzed the latest international research in this area, finding 54 randomized controlled trials comparing the effect of herbal medicines to placebo for weight loss in over 4,000 participants. They concluded that there is currently insufficient evidence to recommend any herbal medicines for weight loss included in the present review.
Selling nutraceuticals currently comes under the FSSAI, which stipulates that if certain standards are unspecified the purity criteria generally accepted by Indian, American and British pharmacopeias — that provide standards for pharmaceutical substances and medicinal products — may be adopted by food business operators. Among them, the criteria set by the Ayurvedic Pharmacopoeia of India is also considered acceptable.
Dr Kapagam highlighted that these regulations leave a lot of room for misinterpretation and said, “What they’re saying is you go with these texts, which is problematic because they’ve been derived by oral traditions.” She added, “I don't think these kinds of products should just be given over the counter or definitely not online, there should be strict control.”
In its FAQ section, the FSSAI clarifies that there are no specific restrictions for combining ingredients. “It is the responsibility of FBO (Food Business Operators) to keep in mind the potential interactions amongst a combination of ingredients leading to impact on stability, bioavailability, safety, and efficacy. FBOs are required to provide data on the scientific rationale for formulating such combinations, based on the scientific literature in peer reviewed publications or data generated by innovators or suppliers of such ingredients.”
Makers are also not allowed to state the product has the property of preventing, treating, or curing human diseases — however online advertisements of these supplements continue making wide ranging claims.
“I think FSSAI should state they are not able to keep track unless they have a way of monitoring small manufacturers. I can sit in my home and put together something, have a good website and a marketing strategy and sell it nationwide,” Karpagam said.
As the dangers of an unregulated online market for such products comes to light, the Economic Times reported that the government has recently formed a panel to examine whether nutraceuticals should come under drug regulator Central Drugs Standard Control Organisation rather than the FSSAI. The Print, too, quoted a senior government official saying, “We are increasingly concerned that many of these products despite getting approval as a nutraceutical are making these claims.”
(Logically Facts has reached out to Amazon, Meta, and Netmeds to understand how these supplements are easily sold on their platforms. The story will be updated if and when we receive a response.)