Use of a pharmaceutically adulterated dietary supplement, Pai You Guo, among Brazilian-born women in the United States

J Gen Intern Med. 2012 Jan;27(1):51-6. doi: 10.1007/s11606-011-1828-0. Epub 2011 Aug 16.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Anti-Obesity Agents / adverse effects*
  • Anti-Obesity Agents / chemistry
  • Brazil / ethnology
  • Child
  • China
  • Cross-Sectional Studies
  • Cyclobutanes / adverse effects
  • Cyclobutanes / chemistry
  • Dietary Supplements / adverse effects*
  • Drug Contamination*
  • Drug Recalls / legislation & jurisprudence
  • Emigrants and Immigrants*
  • Female
  • Humans
  • Middle Aged
  • Obesity / drug therapy
  • Obesity / ethnology
  • Phenolphthalein / adverse effects
  • Phenolphthalein / chemistry
  • United States / ethnology
  • Young Adult


  • Anti-Obesity Agents
  • Cyclobutanes
  • Phenolphthalein
  • sibutramine