Prescription Alternatives
Page 45
CAUTION!
This is a new drug. Please consider yourself a guinea pig if you take it. This drug can interact dangerously with many other drugs, and because it hasn’t been on the market very long, new interactions will emerge over time. Be very cautious about taking any new prescription or over-the-counter drug or supplement if you’re taking this drug.
What Are the Interactions with Food? Even though this is an injection, Byetta works much better when taken at least 30 minutes before eating.
Sitagliptin (Januvia)
This is another new diabetes drug that works by increasing levels of human glucagon-like peptide-1 (GLP-1), which plays a role in regulating glucose metabolism and insulin secretion. Although this drug is currently said to have fewer side effects than other diabetes drugs, it’s new, which means we don’t yet know the full extent of its side effects, especially long-term. You should consider yourself a guinea pig if you’re taking it.
What Does It Do in the Body? It helps control blood sugar by stimulating insulin secretion in the pancreas and lowering blood glucose.
What Is It Prescribed For? This drug is prescribed for blood sugar control in type 2 diabetes.
What Are the Possible Side Effects? Side effects can include hypoglycemia, serious hyper-sensitivity reactions (anaphylaxis, angioedema, rash, urticaria, and exfoliative skin conditions, including Stevens-Johnson syndrome), common cold symptoms such as stuffy nose, upper respiratory infection, and headache.
Repaglinide (Prandin)
What Does It Do in the Body? This drug stimulates the pancreas to make more insulin. It is meant to be taken with meals to reduce blood sugar spikes after eating. It acts quickly and loses its effect quickly.
What Is It Prescribed For? This drug is prescribed for blood sugar control in type 2 diabetes.
What Are the Possible Side Effects? Hypoglycemia, sinusitis, rhinitis, bronchitis, nausea, diarrhea, constipation, vomiting, dyspepsia, musculoskeletal pain, arthralgia, back pain, headache, paresthesia, chest pain, and urinary tract infection.
Nateglinide (Starlix)
What Does It Do in the Body? Nateglinide is a D-phenylalanine derivative that lowers blood glucose levels by stimulating insulin secretion from the pancreas. It is fast-acting, and its effect doesn’t last long; it is meant to help control blood sugar at mealtimes.
What Is It Prescribed For? This drug is pres- cribed for blood sugar control in type 2 diabetes.
What Are the Possible Side Effects? Side effects can include hypoglycemia, upper respiratory infection, back pain, flu symptoms, dizziness, arthropathy, diarrhea, accidental trauma, bronchitis, coughing, and hypersensitivity reactions (rash, itching, and urticaria). Jaundice, cholestatic hepatitis, and elevated liver enzymes have been reported—all symptoms of a damaged liver. Symptoms of hypoglycemia can include blurred vision, cold sweats, dizziness, fast heartbeat, fatigue, headache, hunger, light- headedness, nausea, and nervousness. Like all diabetes drugs, this drug can be hard on the liver.
CAUTION!
This is a relatively new drug. Please consider yourself a guinea pig if you take it. New side effects and long-term side effects will undoubtedly emerge over time.
Obesity Epidemic
Adult-onset diabetes and obesity go hand-in-hand. Most people with type 2 diabetes or insulin resistance—a condition with the potential to progress to full-blown diabetes—are overweight. Weight loss dramatically improves insulin resistance, but many diabetics who struggle to lose weight are caught in a vicious cycle: chronically high insulin levels prime their bodies to store away any available calories as fat, and the fatter they get, the worse their insulin resistance becomes and the higher their insulin levels go to try to overcome that resistance. Eventually the pancreas becomes exhausted from the effort and can no longer maintain any semblance of blood sugar balance. That’s when insulin becomes necessary.
Metabolic Syndrome: The Disease of the New Millenium
We now have a medical term in common usage for the cluster of problems caused by poor diet and obesity: metabolic syndrome. The term has actually been in use in medical research since the mid-1960s, but it wasn’t widely recognized or accepted by the medical community until a few years ago.
Metabolic syndrome describes an obese person with central or abdominal obesity (a fat stomach) who also tends to have a poor cholesterol profile, high blood sugar and insulin and the attendant insulin resistance, high blood pressure, and clogged arteries—in other words, diabetes or heart disease is waiting to happen.
Hormonally, a woman with metabolic syndrome tends to have high androgen (male hormone) levels, high estrogen levels (the fat cells are making estrogen from androgens), high cortisol, and low thyroid—in other words, breast cancer waiting to happen.
Men with metabolic syndrome tend to have low testosterone and high estrogen—in other words, prostate problems waiting to happen.
Both men and women with metabolic syndrome are more prone to inflammation, which predisposes one to heart disease, arthritis, and headaches.
Diet Sodas Increase the Risk for Metabolic Syndrome
Published in the journal Circulation, a study of more than 9,500 middle-aged men and women whose health was tracked for nine years found what was expected: the typical Western diet high in red meat, white flour, and fried foods increased the risk of metabolic syndrome by nearly 20 percent. What surprised the researchers was the finding that those who consumed diet soda—even one can a day—increased their risk of developing metabolic syndrome by 34 percent compared to those who didn’t drink diet soda.
Following these findings, nutrition researchers now theorize that the sweet taste of artificially flavored foods stimulates the pancreas to make insulin in preparation for the onslaught of sugar it thinks is coming. Insulin without a job (carrying sugar into cells) is dangerous, causing inflammation and causing the body to store fat more readily. The intensely sweet taste of diet sodas combined with caffeine seems to be habit forming, but this would be a great one to let go of. One way to wean yourself away from diet sodas is to mix a small amount of fruit juice (e.g., pomegranate juice) with some carbonated water.
Over the past three decades, the number of obese Americans has more than doubled. Sixty-one percent of American adults are overweight, meaning they weigh up to 30 pounds more than they should. Some 26 percent of the adult American population is more than 30 pounds over their ideal weight—in other words, they’re obese. It’s estimated that by the year 2030, roughly 86 percent of Americans ages 18 and older may be overweight or obese.
Health Problems Related to or Aggravated by Obesity
The health problems related to these extra pounds are costing the health care system at least $93 billion a year, and by the year 2030 they could cost nearly a trillion dollars a year.
Even more worrisome is the fattening of American children. According to the Centers for Disease Control and Prevention, 32 percent of American schoolchildren are overweight or obese. These children are developing type 2 diabetes and heart disease, life-threatening chronic diseases previously seen only in adults. According to pediatric endocrinologist Naomi Neufeld, M.D., overweight children are 20 to 30 percent heavier today than they were 10 years ago.
Extra weight and obesity are independent risk factors for many of the chronic diseases that affect Americans today. This means that even if you have no other risk factors for these diseases, simply being fat will still significantly increase your risk of developing them. Obesity also aggravates a number of other conditions.
While diabetes is one of the major risks inherent in being overweight, you can avoid many other conditions by staying within a healthy weight range. Men who are 20 percent over their desirable weight have a 20 percent increased likelihood of dying from all causes. They are 10 percent more likely to die from stroke, have 40 percent greater risk of gallbladder disease, and have double the risk of developing diabetes. For a man between ages 19 and 35, at 25 to 35 percent over ideal weight, the risk of dying from al
l causes is 170 percent—almost double—that of a man of ideal weight. At 40 percent above desirable weight, the likelihood of dying from diabetes complications skyrockets 400 percent, and the risk of dying from stroke rises 75 percent.
Adults between the ages of 20 and 45 who are overweight are six times more likely to have high blood pressure. For every 10 percent increase in body weight over ideal, there is a 20 percent increase in the incidence of heart disease, a 6.5 mm Hg increase in blood pressure, a 12 mg/dL increase in blood cholesterol levels, and a 2 mg/dL increase in fasting blood sugar levels (the higher this number, the greater the risk of developing type 2 diabetes). Overweight men are much more likely to develop colorectal cancer, while heavy women are at increased risk of uterine and ovarian cancers. Women who are abdominally obese—who carry their excess weight in the upper body rather than in the hips and thighs—are at greater risk of breast cancer.
If you’re uncertain about whether you fall into the category of “overweight” or “obese,” calculate your body mass index (BMI): Multiply your weight in pounds by 703; then divide the result by your height in inches squared. If your BMI is 25 to 29.9, you’re overweight; if it’s over 30, you’re obese.
Ninety-five percent of people who do manage to lose weight end up gaining it back again; those few who do manage to maintain weight loss have to work very, very hard at it. The human body is designed to gain weight; so to lose it, you’re going to have to work against this natural design. Humans have evolved over millennia of food scarcity, and the body that readily stores food away as fat is actually better adapted for survival when food is not plentiful—which has been the case for most of human history.
In today’s environment, where high-calorie, low-nutrition, toxin-filled junk food is so much more available, popular, and affordable than natural, organic whole foods, it’s harder than ever to lose weight and keep it off. It’s tough to resist the appeal of carbohydrate- and fat-filled comfort foods when life gets stressful. Once you have grown accustomed to the tastes, textures, and convenience of processed foods, it may seem impossible to make the shift to whole foods prepared in your own kitchen, but with some attention and awareness, you can reacclimate yourself to the tastes and textures of wholesome foods.
The news stories about new obesity theories often do little more than add to the difficulty. Is it a slow metabolism? Is it a genetic glitch that you can’t control? Will any one diet or exercise program change the way your body works enough to help you lose weight? What is it that makes one person gain pound after pound on a typical American diet, while another who lives on super-sized portions of fast food and sweets stays thin as a rail? The short answer, in the words of the American Obesity Association, is this: “Once attributed mainly to lack of will power, obesity is now understood to result from a complex interaction of genetic, metabolic, behavioral, and environmental factors.” In other words, no single factor causes obesity, and no single magic bullet is going to cure it.
Just about everyone can control their weight by eating smaller amounts of healthier foods and getting plenty of exercise. The bottom line is that it really is about the food—that’s why the various stomach-shrinking surgeries are so successful. If you’re not going to shrink your stomach (which we don’t recommend unless the problem is severe), then exercise is essential. And you don’t need to look like the models on the exercise machine infomercials to be healthy. You don’t need to be thin, slim, or buff. Almost everyone gains weight as they age, and that’s fine—you don’t need to look like a 20-something to be healthy, either. In fact, recent research has shown that it’s more important to be fit than to conform to an “ideal” body weight.
We list the following weight loss drugs primarily to illustrate how dangerous they are. We do not recommend them—period. It’s not worth the risk, and not one of them has been shown to keep weight off. There is no safe magic pill for losing weight.
Weight Loss and Appetite Control Drugs
Examples of Anorexiants
Benzphetamine HCl (Didrex)
Diethylpropion HCl (Diethylpropion, Tenuate, Tenuate Dospan)
Phendimetrazine tartrate (Phendimetrazine, Bontril, Plegine, Bontril Slow-Release, Dital, Dyrexan-OD, Melfiat-105 Unicelles, Prelu-2, Rexigen Forte)
Mazindol (Mazanor, Sanorex)
Phentermine HCl (Phentermine, Ionamin, Fastin, Adipex-P, Obe-Nix 30)
What Do They Do in the Body? They suppress appetite and increase metabolic rate and blood pressure.
What Are They Prescribed For? As a short-term (8- to 12-week) adjunct to a regimen of weight loss based on caloric restriction. In some instances, a physician may prescribe intermittent courses of therapy, with three to six weeks on and half of the treatment period off before starting the drug again.
What Are the Possible Side Effects? Palpitations, tachycardia, arrhythmias, high blood pressure, low blood pressure, fainting, pain, pulmonary hypertension (the potentially fatal problem that got Fen-phen recalled after several people died), changes in electrocardiogram readings (diethylpropion only), overstimulation, nervousness, restlessness, dizziness, insomnia, weakness, fatigue, malaise, anxiety, tension, euphoria, elevated mood, drowsiness, depression, agitation, tremor, confusion, lack of coordination, headache, change in libido, dry mouth, unpleasant taste, nausea, vomiting, abdominal discomfort, diarrhea, constipation, stomach pain, urinary problems, impotence, menstrual problems, testicular pain (mazindol only), bone marrow and blood cell abnormalities, eye irritation, blurred vision, hair loss, muscle pain, chest pain, excessive sweating, clamminess, chills, flushing, fever, and growth of breasts in males.
Like the amphetamines sold on the street, these drugs are addictive, and everyone who uses them for long enough eventually develops tolerance. Increasing the dosage in response to tolerance is a very bad idea.
Going off these drugs can cause dizziness, fatigue, and depression. Use Caution when driving or performing other tasks that require you to be alert.
CAUTION!
Don’t Take These Drugs If . . .
• You have heart disease.
• You have high blood pressure.
• You have hyperthyroidism (overactive thyroid).
• You have glaucoma.
• You tend to be anxious or agitated.
• You have a history of drug abuse.
• You take MAOIs or stopped taking them less than 14 days ago.
• You are taking another drug that has stimulant effects on the central nervous system.
• You have any kind of psychological disturbance. These drugs can make it worse.
• You are epileptic. Some patients have had increased seizures while taking diethylpropion.
• You tend to have low blood sugar (hypoglycemia). Mazindol increases muscle glucose uptake, which can cause a hypoglycemic episode.
• You are sensitive to tartrazine. Asthma and other allergic reactions can result.
What Are the Interactions with Food? Take these drugs on an empty stomach. If mazindol causes gastrointestinal irritation, it can be taken with food.
Stay Away from Phenylpropanolamine (PPA)
The stimulant drug phenylpropanolamine (PPA) is the active ingredient in several diet aids (Phenoxine, Dexatrim Pre-Meal, Maximum Strength Dexatrim, Phenyldrine, Control, Unitrol, Acutrim 16 Hour, Acutrim Late Day, Acutrim II Maximum Strength, Spray-U-Thin). These drugs were available over-the-counter until research linked PPA to dramatic increases in the risk of stroke in people under the age of 50. They are now available only by prescription. Avoid these drugs and any others that contain PPA.
Sibutramine (Meridia)
What Does It Do in the Body? It reduces appetite by inhibiting the reuptake of the neurotransmitters dopamine, norepinephrine, and serotonin, in effect increasing their levels in the brain. This is a dangerous drug that has caused at least 50 deaths, and it doesn’t even work very well. Why is it still on the market?
What Is It Prescribed For? Management of obesity, including weight
loss and maintenance of weight loss.
What Are the Possible Side Effects? Heart attack and death may be side effects of this drug. Dry mouth (in 17.2 percent of patients), insomnia (in 10.7 percent of patients), rapid heartbeat, sudden drops in blood pressure, migraine, high blood pressure, palpitations, dizziness, nervousness, anxiety, depression, sleepiness, central nervous system stimulation, mood swings, anorexia, constipation (in 11.5 percent), increased appetite, nausea, upset stomach, stomach inflammation, vomiting, menstrual problems, urinary tract infection, thirst, edema, muscle pain, joint pain, runny nose, throat irritation, increased cough, laryngitis, changes in sense of taste, ear pain, headache (in 30.3 percent, compared with 18.6 percent of placebo patients), back pain, flu syndrome, injury accidents, abdominal pain, chest pain, neck pain, and allergic reaction.
CAUTION!
Think Twice About Taking This Drug If . . .
• You have a history of drug addiction. This drug can be addicting.
• You have a history of seizures. This drug could increase your chances of having them.
• You have high blood pressure. Sibutramine raises blood pressure by an average of 1 to 3 mm Hg (systolic and diastolic) and raises heart rate an average of four to five beats per minute. Higher doses cause more pronounced increases.
• You have glaucoma.
• You have kidney or liver disease.
CAUTION!
Don’t Take This Drug If . . .
• You are taking other weight loss drugs or MAOIs.
• You have any type of cardiovascular disease.
• You could become pregnant. Be sure to use adequate contraception while taking Meridia; it has been shown to cause birth defects in lab animals.
Don’t combine sibutramine with other drugs that raise blood pressure, such as decongestants or cold, cough, and allergy medicines that contain pseudoephedrine, ephedrine, or PPA.