Al-Ahram Weekly Online   8 - 14 April 2004
Issue No. 685
Published in Cairo by AL-AHRAM established in 1875

Magic pills

When it comes to diets, pills will not provide the answer. Yasmine El-Rashidi uncovers the menace behind the magic

It seems, of course, too good to be true: pills that profess to burn, block and zap the fat away. Consumer magazines show off men and women who have lost 10, 20, 50 kilos and "transformed their lives in a matter of weeks". "Before and after" pictures reveal transformations not just from fat to thin, but miraculously, from flabby to firm. "Burn fat and calories", the advertisements declare. "And curb your appetite as well."

As the world gets fatter, the temptation for a quick fix grows. In recent years, the globe has been swept up in the pill-popping frenzy in a desperate attempt to get thin. Egyptians, of course, have joined the crowd. In office corridors, coffee shops and walking tracks around the nation, talk of the most popular dietitians and their prescribed pills of choice is inescapable.

From the appetite suppressants to the fat blockers, carbohydrate stoppers and fat burners, the local market is flooded with weight loss magic capsules -- both imported, and increasingly, locally produced. On some level, it must be said, they do yield results. But in the process of downing them and losing the pounds, chronic dieters are putting themselves at risk of health hazards -- and even death.

The questions that most fail to ask before self-prescription are what are these pills made of, and how exactly do they work?

FAT BURNERS/ENERGY BOOSTERS: These include: Xenadrine, Xenical, Hydroxycut, DietFuel, Ginseng Energy Formula, Ultra Energy Now, Fat Burner (brand name), all available over the counter at pharmacies.

A few years after they bombarded the market, fat burners (thermogenics) continue to be the rage, boasting a following of over 15 million men and women around the world. What most local consumers are unaware of is that they have killed hundreds of their patrons and threatened the lives of tens of thousands of others. When one breaks down the mechanics of how they work, the death toll makes perfect sense.

Fat burners do not act specifically on fat cells. To start with, think of how you would feel walking around a track. You are relaxed, you are cool, and you can breathe at a comfortable rate. As that walk turns into a jog, run, and then sprint, your body heats up, your heart beats faster, and your system as a whole works harder as it uses up more energy. In other words, you are burning calories. It's exhausting, and chances are you are panting and boiling hot.

Fat burners have a similar effect.

The idea behind them is that they speed up the body's metabolism -- the rate at which the body uses energy/burns calories. This happens through raising the body's core temperature, hence the term "thermogenic", which comes from "thermo" as in temperature. The metabolism in turn is raised, and the body works faster, burning, in the process, more calories.

In reality, your metabolism does in fact speed up, you have more energy, and you burn more calories. As a consequence, you ultimately lose weight. The problem, however, is that this accelerated pace at which your body is functioning comprises every organ in your body -- including your heart. The pills force it to beat harder and faster, far above its natural rate. Some hearts can take the pressure, but the countless deaths serve as proof that many cannot. Cardiac arrests resulting from thermogenics have been reported in many countries around the world, including Egypt. Heart failure can result even from one-off use.

The active ingredient in these pills is ephedra, similar in its effect to amphetamines (speed). By law, labels on dietary supplements must list and indicate the total quantity of all dietary ingredients. But ephedra, the natural source of the chemical ephedrine, is often listed under other names, such as epitonin, ma huang, sida cordifolia, and sinica. They are thus often sold and labelled as "natural" ingredients.

Fat burners also frequently contain caffeine. Combining this substance with ephedrine was banned in the United States in the early 1980s because of its potential health risks. Today, the combination is still circulating, with the caffeine component of such pills disguised under names such as guarana, kola nut, maté, paullinia cupana, and tea extracts. Caffeine content alone often totals 900 milligrams per recommended daily intake dose -- the equivalent of six strong cups of coffee.

Other side effects include heart palpitations, tremor, dizziness, shortness of breath, insomnia, anxiety, irritability, depression, high blood pressure, heart rhythm changes and stroke. They have led to permanent disability and personality changes.

And even if you survive one bottle of the pills, there is another factor to consider: once you come off the pill, and your body returns to its normal functioning rate, unless you drastically cut your food intake, your weight will quickly increase again.

On 6 February the United States Food and Drug Administration (FDA) issued a statement banning the sale of any epehdra-containing products 60 days from the statement's publication date. The ban came into effect this week in the US. In Egypt, epehdra-containing products remain easily purchasable, and highly popular amongst teenagers -- girls and boys alike.

FAT BLOCKERS: Such as Fat Blocker, Fat Magnet, Fat Trapper, Ultimate Fat Bloc, Chitosan Plus.

The claim is that if you take these super-powered pills, your body cannot absorb fat. The pills release a chemical that blocks the fat-absorbing channels in your body, traps the fat, and transports it out of the body as waste. So you can lose weight even when bingeing on your favourite fried and fat-filled foods, and without stepping into a gym.

The pills work through the active properties of chitosan, derived from chitin, a polysaccharide found in the exoskeleton of shellfish such as shrimp, lobster and crab. Many sellers claim that chitosan causes weight loss by binding fats in the stomach and preventing them from being digested and absorbed. The chilling fact, is that due to its extreme absorption properties, chitosan was first developed to absorb oil spills. Now, it has become one of the hottest weight loss miracle pills.

The reality is that chitosan does indeed interfere with nutrient absorption in the body. But while it may indeed decrease the body's ability to absorb and hence store fat, in the process it strips the body of many of its essential nutrient needs. Our bodies need fat for several critical reasons. Not only does fat act as a transportation vehicle for fat- soluble vitamins; A, D, E, and K but it is also essential for healthy skin and hair. Fats also provide the body with essential fatty acids that are needed for the regulation of blood pressure and cholesterol. When you consume too little fat, not only is your body deprived of these benefits, but it also goes into "fat starvation mode", so to speak. The body senses that it is not being fed the fat it needs to function properly, and so it holds on to the fat stores it has. Rather than burning the excess fat for energy, it turns to the easiest alternative -- muscle and its fuel, protein. So cutting fat from your diet, or blocking your body from absorbing it, ultimately leads to a flabbier you with bad skin, dry hair and nails that break. Chitosan's side effects also include increased urinary calcium excretion -- something that is especially worrying for women. Like fat burners, once off them, the body soaks up the fat.

APPETITE SUPPRESSANTS: Acutrim, Dexatrim, Vitaslim, Hungrex, Slimax, Sibotrim, Meridia.

These pills are easy to find, cheaper than their fat burning and blocking counterparts, and tempting with their promises to curb your appetite.

The first popular appetite suppressant to hit markets with a bang was Fen-phen, several years ago. The drug sold to millions. After killing some of its most staunch supporters, and sending others to hospital beds, it was found to damage heart valves. While the brand name of Fen-phen is no longer available, appetite suppressants now sold predominantly contain the same active ingredient, phenylpropanolamine (PPA). Other active agents with similar effects include phentermine, fenfluramine and dexfenfluramine.

PPA works on the hypothalamus, which is a control centre in the brain. The hypothalamus helps to tell the body when to give off hunger signals. PPA interrupts this system and thus, the individual's appetite is somewhat curbed. Appetite suppressants work on the assumption that if hunger is the physiological motivation for food, and appetite is the psychological motivation for food intake, then by curbing the appetite, weight loss will ultimately occur.

The premise, however, is problematic, given that the excess calories we consume (and hence store) are not ingested to feed hunger, but usually to fill an emotional gap. If as human beings we stopped eating when we were full, the diet industry would have little reason to exist. It is not quite so simple, of course. We eat when we are tired, lonely, sad, angry, frustrated, and also when feeling joyous or just bored. Perhaps a happy-pill would be a better fix.

Logic aside, the side effects are alarming. Such weight loss aids have been found to increase risk of bleeding strokes in women. Several cases of cerebrovascular haemorrhage, cardiac arrhythmias, intracerebral haemorrhage, acute dystonia, myocardial injury, psychosis, cerebral arteritis and hypersensitive crisis. Further research on these cases is currently being undertaken in the US and Europe. Other common side effects of appetite suppressants are thirst, irritability, palpitation, tiredness, nausea, constipation.

Another fact to ponder is that PPA first became known as a nasal decongestant, and is still frequently used in cough/cold remedies.

Where does all this leave desperate dieters? The unfortunate reality is that most dieters know the facts. Losing weight is simply a matter of feeding your body what it needs in the way of fat, carbohydrates, proteins, getting some activity into your day, and not starving because its ultimate destination is the dreaded binge. Perhaps the thing dieters most need to tackle is dealing with the emotional triggers that lead to the mindless consumption, and work on developing a healthy relationship with food.

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