You might want to think twice about using an appetite suppressant to quickly shed a few pounds from your widening waist or fatty thighs. A recent study has found that a key ingredient in over-the-counter diet pills can increase the risk of stroke in women.
Based on the investigation of stroke patients by the Yale University School of Medicine, a U.S. Food and Drug Administration (FDA) advisory panel recommended that phenylpropanolamine (PPA) be removed from over-the-counter appetite suppressants and cold medicines. The federal agency is evaluating whether PPA should be discontinued as an active ingredient in over-the-counter medication.
The Yale University study is not the first time that health experts and nutritionists have questioned the safety of PPA, the only approved active ingredient in over-the-counter appetite suppressants. Diet pills containing PPA can cause fatigue, insomnia, mood changes, irritability, high blood pressure, abnormal heart rhythm, heart and kidney damage, and seizures, says nutritionist Frances Berg, publisher of the Healthy Weight Journal and an adjunct professor at the University of North Dakota School of Medicine.
PPA and stroke risks
Products containing PPA should either be sold as prescription medication or made available only to adults, Berg says. "There's been evidence for years and years about the health risks of PPA," Berg says. "Even when used correctly, it can cause dangerous reactions."
Products with PPA are responsible for an estimated 200 to 500 strokes each year in people ages 18 to 49, primarily women and first-time users of the drug, according to the FDA's staff analysis of the Yale University study. The five-year investigation of 702 stroke patients ages 18 to 49 found that the risk of hemorrhagic stroke (bleeding in the brain) was 15 times higher in women who took appetite suppressants in the three days before the stroke.
The Consumer Healthcare Products Association (CHPA), a trade group that represents makers of nonprescription drugs and the financial sponsor of the Yale University study, said the results showed no conclusive proof that PPA is linked to strokes. The CHPA says products containing PPA are safe and effective when used according to instructions on the packaging label.
Do diet pills work?
Besides being risky to your health, diet pills are not a permanent solution to controlling your weight, Berg says. The members of the FDA advisory committee agree, commenting at their recent meeting that almost all consumers who take appetite suppressants eventually regain the pounds they shed, FDA spokesman Jason Brodsky says.
"People should not be using these appetite suppressants," Berg says. "Lose-weight-fast gimmicks and schemes have not helped anyone. Often a person will regain more than they lost."
Diet pills have gained popularity among teenage girls, who often equate being fat to being a failure in today's weight-obsessed culture, Berg writes in her book, Afraid to Eat: Children and Teens in Weight Crisis. In a study of Michigan State University students, one in five said they started using diet pills between ages 12 to 16, and nearly half of the women in the study group had tried a dietary drug, according to Berg. None consulted a doctor before trying an over-the-counter weight-loss remedy, and many took more than the recommended daily dosage.
Controlling your weight safely
The lure of diet pills comes at a time when more Americans than ever are overweight. Being overweight - as are 60 percent of adults and 11 percent of children ages 6 to 17 - can lead to serious health problems, such as heart disease, cancer, and diabetes. An all-time high of 16 million Americans have diabetes, and the rate of diagnosed cases is expected to continue climbing because Americans are getting heavier each year, says the Centers for Disease Control and Prevention.
According to the National Institutes of Health (NIH), the most successful weight-loss strategies include calorie reduction combined with increased physical activity and behavior-modification therapy designed to improve eating and exercise habits. Here are some suggestions on what you and your family can do to lose weight and keep it off without resorting to appetite suppressants:
- Seek your doctor's advice before launching into any weight-loss program or taking any over-the-counter diet pill or supplement. Also, for proper nutrition habits, seek the assistance of a registered dietitian. Be wary of fad diets and rapid weight-loss programs - they may provide dramatic short-term results but can be hazardous to your long-term health. On any non-medically supervised weight-loss program, women should consume at least 1,200 calories a day and men at least 1,600 per day, according to health experts at Johns Hopkins University. If you consume too few calories, your body will go into starvation mode, your metabolism will slow down in order to store fat and weight loss will become even more difficult.
- Set realistic weight-loss goals, such as 1 to 2 pounds a week or 8 pounds a month. And don't give up just because you've reached a plateau or binged over the weekend.
- Exercise. According to the NIH, 25 percent of adults and 14 percent of young people (ages 12 to 21) claim they do no physical activity during their leisure time. If your schedule seems too jammed for exercise, be willing to give up something else. But if you've been sedentary for years, doing too much too soon can lead to burnout and injuries. Try to get in a total of at least 150 minutes of walking or other physical activity per week.
- Know what you're eating and how much. Try to keep your daily fat intake to less than 30 percent of your total daily calories. But remember that reducing dietary fat alone without reducing calories will not produce weight loss. Some fat-free food products are high in sugar and actually contain more calories than their fat-containing counterparts. So it's important to practice portion control, and eat a diet rich in vegetables, fruits, whole grains and beans.
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External Sources
 | FDA Ban Sought on Chemical Used for Cold Remedies, New York Times, Oct. 20, 2000
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| CHPA Reaffirms Safety and Efficacy of PPA, news release, Oct. 19, 2000
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| Phenylpropanolamine and Risk of Hemorrhagic Stroke, Final Report of The Hemorrhagic Stroke Project, Yale University School of Medicine, May 10, 2000
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| National Institutes of Health
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| Centers for Disease Control and Prevention
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This article was reviewed and updated June 2007.
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