I think the marketers have gotten very clever with the way that they studied human psychology and understand what the power of influence can do to an individual by putting certain buzzwords without even making a claim on a product.

For people who are looking to get healthy, maybe even shed some pounds, you got to be careful because there's a lot of bad information out there. So today I decided to turn to someone who could help us separate the facts from the fiction.

They know that if they trigger that insecurity, they can sell a product, especially if that product comes with a shortcut.

That's Mikhail Varshavski, better known as Doctor Mike. He's a practicing family medicine physician who you might have come across on YouTube. His videos there are dedicated to debunking misinformation and also educating viewers about their health. Over the last several years, he's given considerable thought to how misleading and false information can seep into our lives. It's something known as concept creep, and it can be really harmful. In a TEDX talk he gave back in 2017. He coined this term IKA experts or I know all experts.

There are too many of these experts out there claiming to have all of the answers. When the rest of the scientific community has questions.

You know, I have found there's often a direct correlation between how little knowledge someone has on a topic and how much confidence they have around that topic. The truth is, there's a lot of people out there making questionable promises, and this is especially true when it comes to weight loss. Let me give you an example. According to the National Institutes of Health, Americans spend about $2.1 billion a year on weight loss dietary supplements, banking on guaranteed results. And then there are these other weight loss products as well. Tummy teas, detoxes, juice cleanses, body wraps. Probably countless others I'm not even aware of. But if you spend any time on social media, they are hard to miss because these ads are everywhere. So today we're going to dive into the science behind some of these weight loss products. Here are the questions. Do any of them actually deliver? And is there any harm in trying out the latest weight loss fad? The thinking often seems to be it might help. It can't hurt, so why not? But is that really the case? We're going to explore why these products flourish and also how to be a smarter consumer. What is real? What is just marketing? I'm Doctor Sanjay Gupta, CNN's chief medical correspondent. And this is Chasing Life.

There are a lot of, as you call it, the know it all experts, IKA experts. I know it all experts out there. I think I know the answer to this. I think I know what you're going to say, Doctor Mike. But why is that? Why are we now in this age where there are so many of these experts out there who are not only know it alls, but they are sort of peddling these miracle cures?

I think it's not a new phenomenon. Ponce de Leon was searching for the fountain of youth many years ago, and yet we're still doing that to this day. I just think that the strategies have changed because we have this new added tool of social media that traditionally, doctors who are evidence based have shied away from. It allowed a prime opportunity for these IKA experts to come in and claim that they have all the answers. And that's really just a form of trust, hacking through mass confidence as if they know what's going on with you. In dark contrast to what a physician is trained to do. You know, we come in and we don't claim to know the exact diagnosis. We create one diagnosis along with a differential of other options it could be. When we recommend the treatment, we hedge and say it works x percentage of the time. But these IKA experts trust hack and say, "I know what's wrong with you. I know this is going to work for you. Take my miracle potion." and that sells very, very well.

It sounds like they're selling certainty. And people want certainty, right? I mean, ultimately medicine, even though it's not math or physics or, you know, a hard science like that, people want two plus two to equal four and to feel very certain about that, right?

Yeah. Of course. I mean, when a patient comes in into my office and says they have a headache, I'm going to ask a million questions before making a diagnosis. I'm gonna perform physical exam, I'm going to run tests. But you see these clips that go viral on social media of someone standing in front of the camera and saying, do you suffer from headaches? It's probably because you don't have enough pink Himalayan salt in your diet. And it sounds like I'm making like a hyperbole statement here. This exists. These clips are viral. They're celebrated by the biggest celebrities in the game, and no one out there, at least not enough of us are out there as doctors fact checking this and explaining that not only is this misinformation from the stance that no, most headaches are not caused by low pink Himalayan sea salt. But also this is not how science works. I think that's the more nefarious type of misinformation that's out there, where it's not like they're leading to direct harm, but more so that it's leading to direct misunderstanding of how health care works. And that innocuously creates a lot more damage to the health care system.

When you think about these issues and you translate them to weight loss, because this is an area that is ripe with these things, everywhere you look you see supplements and diet products and all these things. They basically promise to make weight loss easier. And a lot of them make these promises, in a way that we know, you and I know, are simply not true. We read this, we say that's not true, but most people don't know that. Metabolism boosters, tummy teas, all these sorts of things. And oftentimes they're right there at the store alongside very legitimate products. So, you know, it's not like it's it's all like, here's the garbage and here's the good stuff. It's all intertwined. How did that happen, do you think, Doctor Mike? How is it that these products are allowed to exist in that way?

I think the marketers have gotten very clever with the way that they studied human psychology and understand what the power of influence can do to an individual by putting certain buzzwords without even making a claim on a product, they know that it will trigger the same thought process, so they understand that quite well and have sort of learned these little tools to convince us that their products work. I think another problem here is that we, as doctors, oftentimes get handcuffed into this situation of saying we can't even truly, if we're being honest with the scientific method, say that's not true, because then we would need evidence saying we disprove that which we oftentimes don't have. What we can say is that's not proven. That's the honest thing to say. But that takes away a lot of power from us to say something's not proven versus it's not true. And what we need to do as physicians is be able to find the correct way to market the idea of something being unproven, so that people will be better guarded against making these bad decisions. The marketers, they do a great job at targeting the most vulnerable populations. Those have been that have been hurt by the health care system, which is traditionally women, because we've done a terrible job at not only researching their health conditions, but also treating and communicating with that. We also mistreat individuals who have autoimmune conditions, who have nonspecific symptoms fatigue, joint aches, those who have trouble losing weight. And then also we have them targeting folks that have terrible insecurities. They know that if they trigger that insecurity, they can sell a product, especially if that product comes with a shortcut. And that shortcut we know in health care doesn't really exist. But unless we find a unique way to communicate that to the general public, they will not be aware of that and will fall prey and victim to these scammers.

It seems like a lot of people like their general sort of attitude is might help, won't hurt. Why not? And if we dive right into this and look at some of these products, like tummy teas, for example, which recently I've seen a lot of celebrities online pushing these these tummy teas on social media. But the fact is they've been around for a long time. Right. So what are these teas and what does happen to someone if they drink them?

I think that initial notion of won't hurt might help kind of falls flat when you actually look at the evidence and what the ingredients are in a lot of these tummy teas, the reason why some people may see some sort of change from consuming tummy teas is that many of them contain laxatives, diuretics. So they're literally losing fluids and dehydrating themselves, which will definitely hurt, we know that, in order to potentially look good for a very short period of time. And look good, I'm really putting in quotes here because for the general public, losing this amount of water weight in a short period of time won't actually help them look good. We know skin doesn't look good when it's dehydrated. We know that the brain doesn't perform well when it's dehydrated. We know that you get out of breath sooner when you're dehydrated. So the idea of what these things are selling is it's fixing or at least pretending to fix one problem, but creating ten more.

Can you just speak to the the sort of difference, then, between fat versus bloating versus water retention? How does someone, the average person, sort of differentiate between these things? Because I think it speaks to what you're talking about with tummy teas.

I think the general premise that folks should focus on is that when you're looking for weight loss, targeting bloating and targeting water retention will not help, especially long term. And when we look at why people struggle to lose weight, it's not because they can't lose weight. In fact, there's so many diets out there and even strategies where you can lose weight. It's about keeping the weight off. It's a weight loss retention problem that we actually have in health care. So when folks are looking to lose weight, you need to think about something that's going to be sustainable and long term. Otherwise, you're actually doing harm to yourself by yo yoing your weight. We've seen the negative repercussions of that. And then when it comes to the symptom of bloating, that's one of these nonspecific symptoms that our health care system doesn't really know how to treat properly. And as a result, folks get very frustrated, leave the traditional health care system in looking for a cause and end up on the supplement shelves trying to find a solution where there's miracle promises galore. When you look at water retention, individuals are saying, oh, I look puffy. I think this will help. We need to figure out why you think you look puffy. We need to figure out if you're truly puffy, why that's happening. And then we can usually treat that in health care. But to say that I'm going to solve this issue by causing myself to urinate more, you're actually creating a longer term problem and not creating the benefit that you want long term. So you're almost working against yourself.

One of the things that's sort of made a comeback, I think, because I hear about colonics in a big way every few years, it seems. And then I can tell probably you can as well from your media work, where you're suddenly starting to get lots of comments or questions about it. Colonics, colon hydrotherapy. I wonder if you could just for the listeners, explain what they are and if you think they are in any way safe, is there any any utility for them at all?

Yeah. So they gain this popularity by individuals thinking that they need to clean out their colons, their large intestines, by, shooting a jet of water into their large intestine through the anus. And there's been additives put into this where people are putting coffee enemas in. And I, frankly am confused as to why, if you think about the GI tract going from mouth to anus, you would need to put coffee in your anus as opposed to in your mouth. If you want the potential benefits of coffee, like enjoy the taste, it's going to be much bette if you start it at the top rather than at the bottom, right. Then there is this notion of dirtiness of the colon that exists, which is just so untrue. And the body itself does a great job at making sure that your colon stays clean, that your body detoxifies itself. We have organs for this. The liver, the kidneys, the lungs. They're doing that all the time. Whether or not we're putting a colon cleanse in our body. And I've seen tremendous harm that can come from this directly, where you see individuals going for a treatment and they have either direct damage to their intestine, they have some electrolyte shifts that cause problems, cardiac problems in their body, or to the point where they leave the traditional health care system when they're having a symptom, end up getting this care that they think is beneficial and end up missing things that were potentially curable, things that were treatable, colon cancers. And that is where my greatest frustration comes from, because these are folks we could help. And instead we're missing the ability to help them because they've moved so far away from the traditional health care system.

Yeah. So so the won't hurt sort of part of the mantra is it's really not true, in the sense that A. It can hurt, some of these products. But also on one hand, it's it's a great thing that people want to have autonomy over their health. They want to be engaged about their health. But to the extent that it takes them away from people who could actually help them with their health, that's potentially hurtful as well. That could be harmful as well to them. And I also think this idea that your body is designed to be able to detoxify. And yet sometimes people think, well, if my body's detoxifying, giving it a little boost, what's the problem with that? Liver cleanses. Apple cider vinegar cleanses, bone broths, things like that. What do you think of those products? Is there any value in adding a boost to the detoxification process? Is it even possible?

I think the idea of boost just goes completely against what the body stands for. Our bodies keeps itself in homeostasis, which is a very careful balance. Even if you look at the pH of our blood being between 7.35 and 7.45 pH, we have this very, very careful balance that our body's trying to keep. And yet people think that if you boost, which means hyper optimize, you're somehow going to be better. No, the reality is what the body will intrinsically do, any time you go to the extreme, either positive or negative, it will have the opposite effect and try and bring you to normal. So, for example, antioxidants, when taken in extreme amounts can actually become pro oxidative where they actually cause inflammation. So we need to be really careful of taking something that we know works within the norm. And assuming that if we just double up or triple up on it, we're going to get more. It's the equivalent of thinking that if you go to the gas station, you fill your tank up, and then you just spray your car with extra gasoline, you're going to go further. No, your car is going to become flammable when you do that. So I think it's that notion that actually Jonathan Haight says quite well, it's concept creep, where we understand this concept of what an antioxidant is, and we know it's important and we think, oh, let's just make it even better. But that's not how the human body works.

Now again to be charitable. I think many people genuinely want to do the right thing for their bodies. The problem is that too many of them are also falling prey to these companies, pushing products that may not help and might be harmful. All of this makes it just super challenging to figure out what is real and what is a ruse. So after the break, we're going to talk about how to safely navigate the world of weight loss products.

When it comes to these cleanses and they come to you and say, but Doctor Mike, I feel better when I use this stuff. Now, I think you're probably like me in this regard. Who am I to tell someone that they don't feel better? Right? You say you feel better, okay. You feel better. I can't argue with how someone tells me that they feel. So when they tell you this anecdotally, how do you respond?

My goal is to never challenge individuals who are seeing benefit or wish to do a specific task. My goal is to challenge the individuals spreading the misinformation and the companies selling miracle cures. When individuals come and they say that this is working well for them, my goal as a doctor is only one thing. Educate them on what the science says, which are the risks of taking the medicine, and the fact that all the quote unquote benefits are actually unproven. Once I do that, my job is complete. Patients are allowed body autonomy. They're allowed to make their own decisions for their health care based on the information I'm presenting. Much in the same way, I shouldn't be judging as a doctor someone's risk tolerance. Look, skydiving is a risky sport. People love it. I would never tell a patient, you should not do this. I can perhaps guide them on the risks of if they have a cardiovascular condition, and how risky it could be for them. But it's not my job to say yes or no. So I will only present the evidence to the best of my ability, and allow the patient to make the decision for themselves, ultimately what they want to do.

I find it interesting when I see something like Coolsculpting on the market because it is FDA approved. It seems to help people with specific areas of fat by cooling the fat. We get a lot of questions about this. I imagine you do as well. What do you say? Is it effective for losing weight? Is it effective for reducing fat?

Yeah, the number one thing I will say it's not effective for losing weight. That's the biggest statement I want folks to take into account when they're thinking of coolsculpting. It does not seek to change your weight. It seeks to reduce fat tissue in a specific area. And when we say it's FDA approved to do that, we know that it lowers even when it's working at its most optimal. Over multiple sessions, over multiple months, over thousands of dollars. 10 to 20% reduction in fat in the area. And we need to think about this and zoom out a little bit. What that actually means is that enough of a change for you that you're willing to take on the potential risks of going for this procedure? The financial burden that you could be placed by going for this procedure, and if it is patient, is well versed on the risks, the potential benefits. They can feel free to make the best decision for themselves.

Is there a harm with doing this?

'There is always a harm - anything in healthcare, I mean, you know this so well that anything we do, whether we intervene or not, there's going to be harms and benefits. And in a condition like this one that stands out, what's coolsculpting is there's a condition that exists called PAH, paradoxical adipose hyperplasia, where after you have this destruction of the adipose tissue, you actually have regrowth and a larger size of fat in a specific area where sometimes it doesn't even happen in the exact area where the fat was destroyed. And there's been some controversy around this. The New York Times has done some fantastic reporting covering, paradoxical adipose hyperplasia, where the rates that they said this occurred was 1 in 20,000. Over the years, the rate has now increased to 1 in 3000. And there's physicians who do this quite often that say that they believe that rate to be even potentially higher and underreported. So the fact that people will see this and assume that there's no potential risk is incorrect. There's always a risk. And you need to understand if that risk is acceptable to you, and it may be for the potential benefit of that very small reduction of fat tissue.

We asked the Coolsculpting folks about this specifically, and they confirm that the reported PAH rate is 1 in 3000 and remains within the classification of rare adverse events. They also say the procedure has been cleared by the FDA since 2010 for fat reduction. It's also been well studied with more than 100 scientific publications.

Again, I think I'm pretty sure how you're going to answer some of these questions. But, you know, there's diets that come out, the watermelon diet, which I think most people, not everybody, but I think most people would say, look, that's probably not going to work. But then there's things like keto diet, there's paleo diet, there's these meal supplements, you know, some fast things like that. What do you say to those?

I think that calories in, calories out is very accurate. It's nuanced. And there's a lot of things that need to be taken into consideration with calories in and calories out. But the science is there. If you overeat calories and you under burn calories, you will put on weight if you keep it out of balance. You will stay weight neutral and if you flip those around, you will lose weight. So any time you find your diet restricting you in some way, whether it's because of restricting you to a specific time window, when to eat like intermittent fasting leading you to eat less, that's one way. If you're consuming foods that aren't very easy to overeat, like in keto, you're eating these high fat meals that are. It's very dense, and it's hard to overeat heavy, fatty foods because it makes your body feel uncomfortable, or you go into a specific diet where you're just limiting which types of foods you can eat. You get into a place where you're restricting your calories and what we've seen. And actually, I had a great PhD nutrition expert on my podcast the other day who said, whichever one of these restrictive diets you think you could stay on for the rest of your life because they don't feel as restrictive to you, because they match your lifestyle, they match your tastes. That's ultimately what's going to help you lose weight and keep the weight off. We can argue the semantics of which one is ultimately healthier, but we don't even have great evidence to support one being significantly healthier for everybody.

I am curious, you know, you got you got a situation now in the United States where I think greater than 40% have obesity. It's pretty startling. When I when I graduated medical school, I think it was closer to 10%. So it's really changed a lot over 30 years. So no surprise then that a lot of people want to navigate the world of weight loss products. Where would you tell them to start?

Primary care.

I think it's a lost art. I think for young folks especially, primary care is being replaced by urgent care model. These private equity groups will sell you urgent care as if it's a replacement for primary care, because it's in their financial best interest. And what I found time and time again that that is certainly not true. We need to have a long term relationship with the patient, continuity of care to get ideal outcomes. And why I think that's even more important for weight loss is because how in the world can you help someone sustain weight loss if there's no continuity of care? It's by definition mandatory for it. So I think you need to develop a good relationship with the primary care doctor, who will know your medical history, who will be sharp enough to check. Are there any medical conditions leading you to struggle with weight loss? That happens so often where patients come in and they say, hey, I've tried this supplement, I've tried this medication, it's not working. And we check and we find they're hypothyroid or they're anemic, and there's all sorts of situations where doctors who are primary care would catch those. And that's the medical side. There's also the whole mental health side of things, and how much our mental health plays a role in whether or not we lose weight successfully. And I know how the urgent care model is. There is no way in a 15 minute, not even 15 minute in most cases, ten minute urgent care visit, you're going to have any concentration on mental health when it comes to losing weight or any medical condition. So I think it needs to really start with the primary care model and people focusing on creating these long lasting continuity care relationships.

'If people are going online, which a lot of people do. Look - initially, they just start to search themselves. It's that autonomy, which I think you and I both realize can be important, because people being engaged in their own health care is fundamentally a good thing. But the problem, again, just like with the supplement industry, is... It's not regulated. You don't know what to trust. That's the challenge. I mean, we saw it during the pandemic where people should find trusted sources of information. How would you navigate that for them?

I think you need to try your best to look at the major organizations that show the CDC, Food Safety.gov from the FDA. I think these are good initial resources. And there's a group of doctors, and I would say it's probably a significant majority who get frustrated when patients Google. They have these mugs that say "your Google search is not equivalent to my medical degree", and we make jokes about it. But I've never once gotten upset that a patient was engaged in their own health to go and look something up before they came in for a visit. So what that tells me is it's less important what source they use before they come in, but it's that you have to pair your own research with a visit to your trusted primary care provider, because ultimately, that's going to be the failsafe if you're getting misinformation or the confirmation that you're, in fact, getting good information.

'You know, I've been a doctor for 30 years now, and the idea that very well-intentioned, very smart people often get sucked into some of these products and claims it still surprises me sometimes. Maybe it shouldn't. After all, a lot of information out there takes advantage of our trust, preys on our insecurities, and it makes it hard to tell what is fact and what is fiction. So here are a few top line things to keep in mind. First of all, if something sounds like it's too good to be true, it likely is. There are no quick and easy fixes. There are no miracle shortcuts when it comes to weight loss. If there were, I promise that we'd be talking about it on this podcast and you probably would have heard about it by now.

Second of all, be aware of buzzwords and fuzzy claims on products. Pay attention to the language. And finally, remember that the FDA, the Food and Drug Administration, while not perfect, has worked to make regulated products some of the safest in the world, and anything not regulated by the FDA does not have to adhere to their strict standards of safety or effectiveness. Look, I get it. It can be overwhelming. Sometimes people don't know where to turn, but I hope people do turn to sources like Doctor Mike or their own doctors when they have concerns or questions. And remember, asking questions is never a bad thing. It's a sign that you are actively invested in your health, something we should all be doing more of.

Next week on the podcast, we're going to talk about diets. Do they actually work? And besides calories, how much does what we eat and when we eat really impact our weight?

So we don't want you to be hungry. We want you to eat until you're satiated.

'One more thing before we go. I know we've been talking a lot about weight this season, but let's not forget how food also brings us joy. What is your favorite comfort food and why? Give us a call (470) 396-0832 or leave a message. Or you can record a voice memo and email it to ask sanjay@cnn.com. We might even use it in a future episode.

Chasing Life is a production of CNN audio. Our podcast is produced by Erin Mathewson, Jennifer Lai and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Kane is our medical writer and Tommy Barzarian is our engineer. Dan Dzula is our technical director. And the executive producer of CNN Audio is Steve Lickteig, with support from Jamus Andrest, Jon Dianora, Haley Thomas, Alex Manasseri, Robert Mathers, Lainey Steinhardt, Nichole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker, Amanda Sealy, and Nadia Kounang of CNN Health and Katie Hinman.