What is Stomach Botox, the illicit weight loss procedure that has alarmed Europe

In recent days, the European Center for Disease Prevention and Control (ECDC) has reported 67 cases of botulism (paralytic disease caused by the bacteria
Clostridium botulinum
) in patients injected with botulinum toxin in Turkey, an advertised weight loss treatment not approved by Western drug agencies. The procedure, which promises to make you lose weight with a much less invasive procedure than bariatric surgery, has been christened «stomach botox». Injection of botulinum toxin into the stomach is done with an endoscope through the mouth. The drugs immobilizes the muscles of the stomach wall and prevents them from contracting. This keeps food in the stomach longer slows down digestion and maintain the feeling of satiety for longer. This is an experimental treatment, completely off labelthat falls outside the recommendations for the use of botulinum toxin, which is widely used in the aesthetic field.

Symptoms

The cases of botulinum poisoning were almost all registered in Turkey, a dozen in Germany, one in Austria and one in Switzerland. All patients were referred to two clinics Istanbul or Izmir to undergo gastric botox between February 22 and March 1. Currently no deaths were reported but many patients have complained weakness, tiredness, difficulty swallowing and breathing, double vision, slurred speech, nausea, diarrhoea. Some people have been taken to hospital, others inside intensive care and they were given antibodies to neutralize the toxin. Statistically, it happens a death from botulinum toxin poisoning in 15-20% of cases. Those who have suffered the effects of the paralyzing poison may take months to fully recover. When dealing with one of the deadliest poisons in the world, absolute safety is difficult to guarantee and there is not much leeway in calculating a safe and effective dose where one nanogram of toxin per kilogram of mass is considered lethal.

What does the science say about the procedure

There is no scientific evidence that stomach botox is really effective for weight loss. Studies with small numbers of patients conducted in Turkey and Egypt concluded that the treatment could lead to 10-15% weight loss with minimal side effects and a minimally invasive and inexpensive procedure. Even a team of researchers from Malaga had already concluded in 2017 with a review that botulinum toxin could be effective against obesity with a weight loss of up to 5% compared to the placebo drug. However, the same researchers have shown that the quality of the works was poor, the trials were non-randomized and double-blind, and the samples were very small, which would have required a more structured experiment. The same Malaga team recently published another study showing that the weight loss was only short-lived. Another review conducted by researchers from Qatar concluded the same: there is no evidence that botox in the stomach leads to lasting and noticeable weight loss. In fact, the effect of the injection is temporary, lasting about three months and the procedure must be repeated at least every month, with a range of possible side effects, even unknown ones.

The investigations

It is not yet clear what exactly happened in the two clinics in Turkey. The botulinum toxin was in fact of an authorized type (although used in this case off label) and the authorities are investigating whether there was a problem mode of administration or dosage in any case, ECDC invites European citizens not to travel to Turkey to undergo gastric botox, a procedure not approved in Europe and in the West: the risk of botulism is high.