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Doctors' Answers to "Frequently Asked Questions" - Diet & Dieting

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Drugs for Weight Loss [posted 12/02/98]
Question: I am 5'tall and weigh 165 lbs. I am 49 years old. I have been taking Premarin .625 and provera 2.5 for 2 years. My periods have stopped for about 9 months now. I can sleep again relatively well and wake up occasionally to night sweats. I also am lactose intolerant, and I take tagment 400 mg. at night for my stomach. I also take bentyl 10 mg. 3 times daily. I take atenolol 25 mg. daily for my migraine headaches which are less frequent now since I don't consume chocolate and caffeine. I do take imitrex shots or pills if I get a migraine headache, they usually last 72 hours. I just recently started taking phentermine and super ditex w/3mg benzo to try and loose weight. My question is: with all these other drugs is there an interaction and what kind of side affects may I expect from these diet drugs. I also get diarrhea very easy. I could not take Redux when it was on the market at all. What else might help me cut down my weight and curb my appetite?

Answer: Meridia is an option, but doesn't work extremely well. We don't have good drugs for weight loss currently.

  Appredrine Concerns  [posted 12/02/98]
Question: My 17 year old has recently started taking something called Appredrine. I think it must be some kind of appetite suppressant. He is 6'4" and weighs about 235lbs. My question is are these appetite suppressors dangerous or even of any help? I am well aware that a heathly balanced diet and exercise are the best weight loss program, but what does a mother know, eh? Thanks for any information and education in this regard you can offer us.

Answer: Most of them don't work very well, or everyone would be on them. However, usually little risk except for cardiac irregularities. 

Diet Drugs [posted 11/17/98]
Question:  Is there any drug currently being considered to replace pondimin (sp)? I tried prozac + phentermine with little success.

Answer: Well, Meridia is touted;but, I haven't had much success. Worth a try however.

Nonfat Diet [posted 11/13/98]
Question: My husband(50 yrs old) is a strict vegetarian (no dairy products). He is also diabetic and showing signs of arthritis. Last year he was diagnosed as enemic (blood count was 5.3 which is now being controled with Prevacid) My concern is that he gets little or no fat in his diet. I can't believe that to be healthy. Any comments?

Answer: Should be very healthy, olive oil etc is very high in fat.

Medication & Your Diet [posted 10/28/98]
Question: Thank you for your excellent webpages. I'm wondering if you have or know of a resource where I can get information on how certain foods interact with certain drugs. For example, some drugs cause an increase in the excretion of potassium and that increase requires the patient to supplement that mineral. Some foods should, perhaps, be avoided when taking certain medications. I'm looking at this from a nutritional standpoint, rather than a medical one. For example, if a person has a high consumption in their diet of, say caffeine, should they be aware of caffeine's effects on any particular medication they may be taking. Any information you can provide would be extremely helpful.

Answer: Happy to help, but, I'm not sure what you are asking. Most "foods" would not affect potassium enough to bother with, an exception being English licorice.

Phen - Phen [posted 10/6/98]
Question: I was on phen-phen last year which worked GREAT. I am currently on Meridia (10 mg) daily and as I do not have any side effects I also DO NOT have any good effects of appetite suppression or weight loss. Any reason this just isn't working for me? I've heard others complain of the same--no weight loss, and the Rx is expensive. Should the dosage be higher?

Answer: Try increasing the dose. But, it doesn't seem to work as well as the other drugs -unfortunately.

Dietral Diet Pill [posted 10/1/98]
Question: I was hoping you could help me....I am looking for information on a diet drug called Dietral. My friend here in Australia saw it advertised in a magazine called Be Slim. Be Slim is a magazine from East Meadow New York.....I am trying to get as much information about it as possible....

Answer: Not a prescripton drug, I'm not familiar with it.

Salt In Your Diet [posted 10/1/98]
Question: How much salt is too much and what are the indications of too much salt? How much iodine is too much and what are the indications of too much iodine? (I have found info on the internet that indicates too much iodine results in such symptons as low body temp and dandruff.)

Answer: Excess iodine intake can produce hypothyroidism in some patients. The exact dosage necessary varies a lot from person to person;but, I would not take any extra iodine intake personally. The information concerning salt intake is very hotly debated. Years ago, a low salt intake was about the only way to treat hypertension. Actually only about 10-25% of patients will actually respond to a low salt intake. This is usually 4 gms or less a day with a severe restriction of 2 gms a day. I would limit my salt intake-especially if you are not caucasian since patients of color tend to respond to salt restriction more than caucasians. However, at this point in medical research, I wouldn't make it a religion to avoid salt. It may well be that a high potassium/calcium diet(usually the opposite of high salt) is necessary for good health-not the actual salt content. But, hotly debated currently.

Diet Drugs [posted 8/11/98]
Question: I took adipex and pondomin for 2 years, lost a tremendous amount of weight, looked good, felt good, but then the media frightened everyone to death. My doctor took all his patients off the drugs and made everyone have an EKG, etc. I checked out okay. I have not taken it for almost 1 year now and have gained most of the weight back. I also feel depressed and sluggish.

Answer: Try Meridia, to be released this March. It's similar to the medications you were taking without the cardiac side effects.

Question: My husband was taking redux and now wants something else. Either something natural or a prescription. He needs to lose about 70 Pounds and is upset that he can no longer take redux.

Answer: So are a lot of people, but nothing seems to work nearly as well. Hopefully, they will restore the medication. Some people are combining Prozac with other drugs, but this is not currently researched very well.

Question: Have there been any studies of the effect of a high fat diet on individuals who are quite active and are therefore underweight or normal weight? Is there any evidence that a high fat diet for those individuals is unhealthy?

Answer: So far, we haven't found any subgroup of individuals for which a high fat diet is healthy. It is clear that young children need more fat in their diet to synthesize myelin and aid in brain growth. However, adult fat need is far less than growing children. There are some fats that appear to be tolerated better than others and some fats(like olive oil) may actually be somewhat protective against heart disease. In general, a lower fat diet is beneficial to most adults.

Dietary calcium
Question: What form of supplemental dietary calcium (OTC) is most effectively absorbed? Are any forms just not absorbed at all?

Answer: Calcium carbonate is easily absorbed and is usually the drug given by physicians.

Phen-Fen Diet
Question: Is there any information on Phentermine 8mg. I am on the Phen-Fen diet I would like more info If possible.

Answer: This drug seems fairly safe; however, there have been recent reports of valvular damage in patients taking the drug for over one year(reported by the Mayo Clinic). 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. A recent editorial in the New England Journal of Medicine recommended only treatment of patients with diabetes mellitus, elevated cholesterol, etc. where the benefit of weight loss clearly outweighed the risks.

Zoloft & Fastin
Question:I am approx. 50 lbs overweight. I have been prescribed Zoloft and Fastin at my request for assistance to lose weight. I am concerned if this is safe. With all of the publicity with Phenfen I need to know if what I have been taking could cause me side effects or life threatening conditions.

Answer: There is a specific warning not to use Fastin with any SRI antidepressant like Zoloft. Having said this, I am aware that many physicians have prescribed this combination-I would not recommend it.

Heart Surgery Diet
Question:HI! My dad just had open heart I was wondering what kind of foods he should eat?

Answer: Best to ask the dietitian at the hospital. But, generally-low fat foods.

Question:I have read the negative reports regarding the diet drugs Redux and fen(not sure of spelling). I have lost 47 lbs. taking phenetermine (blue oval pill) for past year or so. Are the same warnings being applied to taking phenetermine only?

Answer: Not clear ;but, appears to be only Redux and fenfluramine.

Question: Recently I've seen reported in the news that the drug combo fen-phen has been linked to primary pulmonary hypertension in some pts. The reports usually mention that one or the other or both of these medications work on serotonin in some way. I became worried because I take prozac (20mg/day) which I know works on serotonin in some way as well. Is there any evidence that Prozac could cause PPH too? What exactly is PPh? And what is "serotonin syndrome"? Thanks in advance for your response!

Answer: These drugs are now off the market being re-evaluated. There is currently no evidence that the SRI antidepressants produce this problem. The serotonin syndrome is seen in Carcinoid Syndrome and is symptoms caused by high levels of serotonin. This is flushing, diarrhea and sometimes dyspnea.

Question: Does fen phen work when the person is on 40 mils of prozac and is it safe? If not what can they do?

Answer: This is not a good combination and there is a specific warning not to mix SRI antidepressants and fen-phen. However, the fen part is now off the market.

Dinitel & Dnromine
Question: I have been consuming dinintel and dnromine for a certain time. These are a type of sliming pills which will suppress your diet and make you full for the rest of the day. Initially, I had slimmed down from 60kg to 45kg in 3 months times with proper diet and exercise. However, I had regained my weight to 50kg lately. I am thinking of taking the pills again. It is advisable and safe? What are the side effects if consumed for a long period and will I become infertile if I take it on and off for a long period of time?

Answer: I am not familiar with these drugs. In general, anorectics will not cause infertility unless one loses sufficient body mass to decrease or stop your period. This is a function of body mass, not the pill you take to lose mass.

Question: I'm on the diet pills "Dexitrim". How effective is it with 45 minutes of the StairMaster every other day?

Answer: Like any anorectic it varies with the individual. We currently don't know of any long/short toxicity of Dexitrim when taken as suggested. Using the stairmaster will accelerate the weight loss ;but, has no effect on the Dexitrim or vice versa.

Question: A couple of years and about 60 pounds ago, I took Acutrim as a dietary aide. It worked great and I really loved it. Since then, I have had twins and I now weigh right around 300 pounds. I am desperate to lose the weight and nothing seems to help. I am in great physical shape (so says my doctor) so I was wondering how dangerous it would be for me to take two Acutrim rather than just one? It's not that I think it will work faster, it's that when I take it now, it does nothing for my appetite. Is that related to my extra weight and because of that weight, might I need more mgs for awhile? I appreciate your help.

Answer: If it worked before don't mess with success. Start with one and see if it works. Two would probably not be a problem; but, is less predictable in side effects. Your lean body mass will predict your side effects, not your total weight.

Question: Are there side effects with this drug [ phentermine ] as with the drug PHEN-FEN ? Example PPH, stroke, Hypertension, etc.?

Answer: Don't know really, research in progress-I'd avoid it for the time being.

Question: I have been taking prescription diet pills labeled “phendimetrazine 35 mg have been prescribed up to 7 of these a day. They don’t seem to curb my appetite, but do give a “buzz”. What can you tell me about these pills?

Answer: Phendimetrazine is a medication that is used for weight control. Although the medication 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 atherosclerosis (“hardening of the arteries”), heart disease high blood prcssurc, hypcrthyroidism, glaucoma, or patients on any other nervous system stimulants should avoid the use of this medication. 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 will decrease. The dose should not be increased above recommended levels, but rather should be stopped, and the patient switched to a new medication. This medication has 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.

Phn-Fen & &chocardiogram
Question: I am a 43 year old female with low blood pressure and cholesterol. I have just stopped taking Phen-Fen due to the FDA recall. I was on this combination for about 5 months - always through my doctor who made me come in monthly to listen to my heart and lungs. I had none of the serious side effects and feel great, having lost 5 of the 60 pounds I planned on losing. I do 10 minutes daily on my Nordic Track and have no shortness of breath (a vast improvement over my previous condition). My doctor said that he could not hear any heart murmur when listening, and that he did not feel I needed to go for an echocardiogram. I tend to agree with him, however I have many concerned friends and family members who feel otherwise. I am also a little disappointed that I knew more about the FDA recall than he did 4 hours after the news story broke. Do you feel that a test should be conducted? If so, what is involved and is it an expensive or time consuming procedure?

Answer: I have had over 200 patients on this medication and have seen none of the described valvular problems. All of my patients received an initial and a follow up echocardiogram at 3 months or so. This is the definitive test and will cost $325 or so(usually covered by insurance). It is similar to the echo test done on pregnant women-just a different processor and is painless. I doubt that you would have problems at 5 months. Most of the patients experienced problems at one year or so. However, we don't know the true incidence or the true causal factors yet. If you are concerned I would get an echo.

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