Why "Bangkok Pills" Are Not Good For You

The diet pills, known as "Bangkok pills", are the latest craze in "effortless" weight reduction. Readers tell me that their hairdressers, their masseuses, their doctors, even their neighbors are selling the pills - it seems that people from all walks of life are involved in this underground venture.

I first heard about the "Bangkok pills" about three years ago from a relative who told me about her traumatic experience with them. For the first two weeks, she was feeling fine. She had extra energy and a smaller appetite. Then, disaster struck. She woke up at 3:00 in the morning because her heart was palpitating wildly. She had to be brought to the emergency room of a nearby hospital where doctors injected her with something to make her heart rate return to normal. Needless to say, that was the last time she ever took those pills. She is a lucky girl because she stopped taking the pills before they could do worse damage to her health.

Last week, the Department of Health issued a statement that "Bangkok pills" (so-called because they are smuggled in from Thailand) have been analyzed by the department's Bureau of Food and Drugs and discovered to contain ephedrine, phentermine and fenfluramine.

Ephedrine is a prescription only drug that is banned for sale over-the-counter. Fenfluramine and phentermine are the infamous duo otherwise known as "fen-phen". In September 1997, the U.S. FDA banned fenfluramine (Pondimin) and dexfenfluramine (Redux or Adifax) due to reports of heart valve damage among users. Here's a closer look at those ingredients and what they can actually do to your body.

Ephedrine is an asthma drug that is structurally similar to amphetamines or "speed". It is found in its natural form, ephedra, in the Chinese herb ma huang. The drug's stimulant effect increases heart rate, metabolic rate and alertness.

Common side effects are anxiety, insomnia, palpitations, trembling, weakness, sweating, a feeling of warmth or "burning" in the muscles, nausea, and vomiting. More serious but less common side effects are chest pain, hypertension, seizures, stroke (in high doses), and sudden rapid heart rate (just like what my relative experienced).

The U.S. FDA does not approve of ephedrine as a safe and effective way to lose weight because of all the negative side effects it can produce. In fact, the FDA has received more than 800 reports of adverse effects from mostly young to middle-aged healthy adults using ephedrine for weight control. It has also received reports of 15 deaths associated with the drug. A few years ago, the Adverse Drug Reaction Monitoring Program of the University of the Philippines-Philippine General Hospital reported the death of a 19-year old girl due to a weight loss product that contained ma huang. Her relatives noted that she was feeling unusually warm, was sweating profusely and was suffering from frequent diarrhea before she died. They said she acted like she was "high".

The diet drugs, fenfluramine (Pondimin) and phentermine (Ionamin), have both been around for twenty years but were never very popular because of the unpleasant side effects they created.

Fenfluramine can cause dry mouth, excessive drowsiness, fatigue, abdominal pain, short-term memory loss and diarrhea. Phentermine, meanwhile, because of its similarity to amphetamines and ephedrine can cause nervousness, insomnia, restlessness, anxiety, increased heart rate, increase blood pressure, irritability, dry mouth, vomiting, irregular heart beat, constipation, and a decreased sense of fatigue (however, the body becomes immune over a short time, then fatigue and depression may set in).

In 1992, Michael Weintraub, a medical doctor doing research at the University of Rochester, discovered that by combining the two drugs, the side effects were lessened and weight loss results were increased. Fenfluramine makes you feel full and reduces cravings for carbohydrates while phentermine suppresses your appetite.

After Weintraub's findings were published, sales for both fenfluramine and phentermine increased dramatically. The fen-phen craze was off and running.

Following close on the heels of fen-phen's success was dexfenfluramine, a variation of fenfluramine, sold under the brand names Redux or Adifax. Dexfenfluramine was approved by the FDA as a prescription drug against obesity.

However, it didn't take long for a controversy to explode. A Mayo Clinic research study discovered 24 women who had developed heart valve problems. The common denominator linking them together? They were all fen-phen users. Not one of the 24 women died but five had to undergo heart surgery. Dr. Michael Freidman, FDA Acting Commissioner, said that examination of the heart valve tissue of the five patients strongly suggested that their disorder was drug related. Subsequently, 58 more cases of heart valve problems were reported to the FDA. Finally, in 1997, the FDA banned all sales of fenfluramine and dexfenfluramine (phentermine is still allowed for sale by prescription).

The Mayo Clinic researchers suggest that anyone who has been taking fenfluramine or dexfenfluramine and is experiencing shortness of breath or fatigue should see a cardiologist to check for heart murmurs or other signs of heart or lung disease. The U.S. Department of Health and Human Services, meanwhile, advises an echocardiogram for all former fenfluramine and dexfenfluramine users before undergoing any kind of invasive surgical procedure even if they have no symptoms of heart or lung disease.

PPH -- rare but fatal disease.

Heart valve problems are not the only damage that can happen to your body when you take fenfluramine. You could also develop a rare but fatal disease called "primary pulmonary hypertension" (PPH) which is characterized by a tightening of the blood vessels in the lungs. This condition causes the heart to work harder to pump the blood through the narrowed blood vessels. Eventually, the heart fails. Nearly half of all PPH patients die from heart failure within four years.

Dr. Gloria Troendle, Deputy Director of the FDA's Metabolism and Endocrine Division (FDA Consumer Magazine) states that the risk of getting PPH due to fenfluramine or dexfenfluramine use is 23 to 46 cases per million. This may not sound like much of a risk until one realizes that this is 23 times higher than the disease normally occurs (eight of the 24 women in the Mayo Clinic study also developed PPH aside from heart valve troubles).

"Bangkok pills" not worth it.
If you were dying of cancer or AIDS and the "Bangkok pills" were being offered to you as a possible cure, it would be understandable to take them in spite of the risk. But is weight loss worth risking your health for? Besides, for all that trouble, the weight loss is not even permanent. When you stop taking the pills, the weight returns with a vengeance.

In the end, regular exercise and sensible eating habits are still the only truly safe, effective, and permanent ways to stay slim and healthy at the same time.

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