Do Diets Work?
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Depending on the duration of the diet, the reduction in metabolism is contributed to largely by loss of body tissues (fat and non-fat) and also to some extent by the actual reduction in the metabolic activity of the cells of the body. When one stops dieting, this lowered metabolism implies that in order to remain at the new body weight one has to eat less since one's body metabolism is now lower. One's energy needs are also lower since the body weight is lower than before going on a diet. So any increase in intake that is even slightly more than the amount of total energy spent by that person in a day will be stored. An excess of 40 calories per day i.e. 10 grams of sugar (two teaspoons!) may lead to a weight gain of 4.5 to 10 grams per day depending on whether it is stored as fat or carbohydrate and in the latter case the weight gain can be even more since water is also trapped and stored in the process. One can readily see how difficult it is to lose weight and how easy it is to gain weight again. This is the common experience of people who frequently go on a diet. An additional complication is that people who do this all the time i.e. those who yo-yo or weight cycle will find it even more difficult to lose weight but gain it readily thereafter. The process of weight cycling leads to the body adjusting itself even more readily to the changes that follow when you go on a diet and to compensate by gaining weight even more readily. This is one of the big problems with losing weight on a diet and one possible way by which one could attempt to reduce to a small extent the tendency to gain weight rapidly is to reduce physical inactivity at this stage. There are hundreds of dieting drugs out there - Redux, Phentermine, Phen-Fen, Zoloft and Fastin, fenfluramine, dinintel and dnromine, Dexitrim, Acutrim, phendimetrazine to name a few. Many have side effects or even cause life threatening conditions. There have been recent reports of valvular damage in patients taking Phen-Fen for over one year (reported by the Mayo Clinic) and other side effects such as PPH, stroke and hypertension. This is in addition to reports of increased numbers of patients with pulmonary hypertension (a potentially fatal disease). While the numbers appear small and the data is early, it has made most physicians be careful in their prescribing. There is a specific warning not to use Fastin with any SRI antidepressant like Zoloft, yet many physicians in America prescribed this combination when it would not be recommend. There are negative reports regarding the diet drugs Redux and fenfluramine. Reports in the American news that the combo fen-phen has been linked to primary pulmonary hypertension in some patients and that the medication works on serotonin in some way. Luckily these drugs are now off the market for re-evaluating thanks to the FDA. The serotonin syndrome is seen in Carcinoid Syndrome and is symptoms (flushes, diarrhea and sometimes dyspnea) caused by high levels of serotonin. Dinintel and dnromine are a type of sliming pills which will suppress your diet and make you feel full for the rest of the day, but patients had slimmed down from 60kg to 45kg in 3 months with proper diet and exercise. In general, anorectics like these will not cause infertility unless one loses sufficient body mass to decrease or stop your period - a normal function of body mass, not the pill you take to lose mass. Further, it is not know if there is any long/short toxicity of the anorectic Dexitrim when taken as suggested. Although Phendimetrazine does act by suppressing appetite, there are other, less well understood ways in which this medication produces its effect. According to the Physician's Desk Reference, the medication, once absorbed from the intestinal tract is cleared from the body by the kidneys. The half-life of the medication, or the time it takes for one half of the medication to be cleared from the system, is 1.9 hours (or 9.8 hours for the timed release form). Patients who have advanced arteriosclerosis ("hardening of the arteries"), heart disease high blood pressure, hyperthyroidism, glaucoma, or patients on any other nervous system stimulants should avoid its use. Tolerance to the drug's effect does occur, in other words, after some time of its use, the ability of the drug to suppress appetite decreases. The dose should not be increased, but rather should be stopped. Many of these medications have not been tested for safety in pregnancy and should be stopped under the supervision of your health care provider prior to attempting a pregnancy, unless under the strict direction of your health care provider, and only if the risks outweigh the benefits. Side effects can include, but are not limited to rapid heart rate, high blood pressure, restlessness, anxiety, insomnia, headache, tremor, dry mouth, constipation or diarrhea, nausea, urinary symptoms, and changes in sexual function. If you are experiencing a symptom that you feel may be related to a medication, visit your health care provider. He or she can determine whether the symptom is possibly due to the drug, and determine the best course of action to take. by DP.Shetty MD, PhD |
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