Beware Untested Diet Pills

We've heard about the dangers of popping weight-loss pills. But there are safe ways to drop extra pounds using supplements -- yes, even ephedra -- and prescriptions.

3 min read

Seventeen days of taking usnic acid to promote weight loss was all it took for Jennifer Rosenthal of Long Beach, Calif., to go from being a healthy, active 28-year-old to being in a coma on life support. An emergency liver transplant saved her life.

Rosenthal's story, though extreme, points to the problem of the many untested and unregulated products sold on the Internet and in some drug and health-food stores.

"This is a young woman who almost lost her life," said Rosenthal's transplant surgeon, Ronald W. Busuttil, MD, in an interview with The New York Times. "Although she's got her life back now, she has to be under lifelong medical care. Her life has been altered forever. The fact that you can get these things over the Internet is mind-boggling."

Usnic acid is an antibacterial substance made from lichens. But online marketers sell it as a weight-loss drug and performance enhancer. Since it falls under the FDA category of a dietary supplement, its sale and use is entirely unregulated.

In that regard, usnic acid is not unlike ephedra, another weight-loss pill that is sold online and in many thousands of neighborhood health-food and drugstores. Ephedra has been implicated in the death last month of Baltimore Orioles pitcher Steve Bechler, who succumbed to heat stroke on a Broward County, Fla., practice field after reportedly taking an ephedra-containing weight-loss supplement.

Does all this mean there are no useful, safe weight-loss drugs?

If you're really serious about taking weight-loss pills, there's a safer way to go about it. First, work with a medical professional to develop a treatment plan that fits your needs.

There's no reason to go trolling the Internet for weight-loss magic, says Steven Heymsfield, MD, deputy director of the New York Obesity Research Center at St. Luke's-Roosevelt Hospital in New York City. There are safe drugs that can really make a big difference in getting to a healthy weight.

There are three drugs most commonly prescribed for weight loss:

  • Phentermine, an appetite suppressant, was approved for use in 1959 and is the most commonly prescribed prescription because it costs less than the other major drugs. Some users report it can make them feel jumpy.
  • Xenical inhibits lipase -- an enzyme that breaks down fat in the intestines. Xenical decreases the amount of fat your body absorbs from food by 30%, which results in lower calorie intake. But all that undigested fat can make sudden, unwelcome appearances in the form of diarrhea.
  • Meridia increases levels of brain chemicals that help reduce appetite. Appetite-suppressants work by increasing serotonin or catecholamine chemicals that alter mood and appetite through means that are not well understood. Since Meridia can raise blood pressure and heart rate, people with any kind of heart disease shouldn't take this drug.

These drugs are all moderately useful and approved for use over various periods of time, says Heymsfield. But increasingly we are seeing these used in combinations or cocktails to decrease side effects and maintain weight loss, which tends to slow over time. Phen-pro is a weight-loss cocktail that combines phentermine with Prozac or other antidepressants. The use of the antidepressant in these cocktails is not to treat depression. No one is quite sure exactly why these combinations appear to improve weight loss. Some doctors also will prescribe combinations of Xenical or Meridia with phentermine.

Along with the cocktails, other drugs are increasingly being used for weight loss, says Heymsfield. Some of these include:

  • Topamax, an antiseizure medication approved for use in the treatment of epilepsy
  • Wellbutrin, an antidepressant

    Using prescription drugs that aren't officially approved by the FDA for weight loss is commonplace, but the doctor needs to be very, very careful, says Heymsfield. You don't want a truck driver or someone who operates heavy machinery taking an antiseizure medication because fatigue or euphoria can be a side effect.

    And medical researchers are pressing very hard to develop new weight-loss pills. One of the most promising drugs in development is Axokine, says Heymsfield. It is in the final phase of testing, and it not only looks like it will be important for weight loss, but it may also help people with type 2 diabetes.