Excerpt: 'How the Rich Get Thin'

Sibutramine (Meridia) is a norepinephrine and serotonin reuptake inhibitor. Weight loss is dose dependent: It affects the appetite center of the brain, where it increases satiety so you feel full faster and with a smaller quantity of food. The drug has been extremely well studied. Clinical studies have shown that sibutramine is effective and safe, if properly prescribed. Blood pressure and heart rate must be monitored, however, as sibutramine can cause a dangerous rise in blood pressure. Sibutramine should never be used in patients with a history of coronary artery disease, congestive heart failure, cardiac arrhythmia, or stroke. Because its action affects the brain, it is not safe to take with most antidepressant drugs. The side effects of sibutramine include dry mouth, constipation, and insomnia.

Orlistat (Xenical) is unique in that it does not enter the circulation but rather works in the digestive system to block the absorption of fat, which is then eliminated from the body through the stool. If you eat too much fat, diarrhea is the unhappy result. Orlistat works well because its action is entirely within the digestive tract; it doesn't interact with other medications, and does not raise blood pressure or the heart rate. However, because it blocks absorption of fat, it blocks the absorption of the fat-soluble vitamins, and these should be taken separately.

The truth is that there is no ideal weight-loss pill. Medications are suitable for some people, and can assist in raising the metabolism forward, but they are useless if exercise and an optimal diet are not in place. You won't need drugs with my plan.

Nonprescription Weight-Loss Drugs

Drugs that are sold over the counter and over the Internet promise weight loss but deliver little in the way of results. Weight-loss supplements fall into two basic categories: those that claim to suppress appetite and those that block the absorption of food. The appetite suppressors contain caffeine like substances (such as ephedra or ma huang, which is now banned). Studies in animals have indicated a small appetite-suppressant effect, but the human studies have been too brief to support the claims.

Appetite suppressants have the side effects of increasing blood pressure, headache, insomnia, and heart palpitations. You will feel jittery, as is the case with too much coffee. The absorption-blockers seem to have a small effect, but cause side effects of bloating and gastrointestinal complaints.

The bottom line is: Over-the-counter and Internet-sold drugs do not work, and are usually not safe. Save your money. You have to change your diet and exercise routine to see a meaningful change in your weight.

The Park Avenue Mystique

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