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Saturday, November 16, 2019  Spokane, Washington  Est. May 19, 1883
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Magic Pills? Two New Medicines, Redux And Fen/Phen, Are Proving Incredibly Popular With Dieters. Do They Work? And Are They Really Safe?

By Merri Lou Dobler Correspondent

Diane Coontz, a 34-year-old Spokane nursing assistant, loves the results of a new diet drug called fen/phen. Now she can finally tuck in her shirts and fit into Liz Claiborne’s regular sizes.

Coontz dropped from 236 to 170 pounds in her first five months on the drug. She went off fen/phen and regained 12 pounds. But since midDecember she’s resumed her prescription, and already she’s lost those 12 pounds and more.

“I’m excited about my looks,” says Coontz.

Fen/phen and its cousin Redux are part of the latest generation of diet drugs aimed at people at least 30 percent over their recommended weight. They work by raising the levels of chemicals in the brain which act to suppress the appetite and increase the person’s feelings of well-being.

And while questions remain about the drugs’ safety, chronic dieters have flooded doctors’ offices across the country in search of them. In just six months, there have been over 2 million prescriptions written for Redux alone.

You’ll find advertisements for these drugs in newspapers and on street corner signs. It seems so easy. Take a pill and your appetite is suppressed. There are many success stories. But there are also cautions to consider.

“I admit that appetite suppressants really do affect your appetite,” says Coontz, who is 5 feet, 2 inches tall. “In the beginning, I found myself forgetting to eat or I was just not as hungry. I had to force myself to eat small amounts.”

Coontz found that she had a dry mouth, the most common side effect of taking either Redux or fen/phen. The benefit, however, was that it forced her to drink lots of water. She weaned herself off Pepsi and started carrying around a water bottle. Her focus shifted from weight loss to a reduction in body fat. Coontz’s goal is to get healthy and fit.

Kathleen of Spokane, who did not want to use her last name, had a frightening experience with fen/phen.

“It’s very dangerous stuff,” says Kathleen, who was drawn to the medication because she saw friends having success with it. “Don’t try the quick-fix method. It’s not worth it in the long run.”

Kathleen, who in the past lost 70 pounds with Weight Watchers and kept it off for six years, took the anti-obesity pills for three weeks. She found her energy was zapped, and she felt constantly fatigued. The scale told her she was up 11 pounds, not down.

Then her blood pressure started rising. She had an anxiety attack. She immediately went to her doctor’s office.

“It was like having an overdose of pills, and my blood pressure was skyhigh,” says Kathleen, 36. Kathleen stopped the pills and went through drug withdrawal. The first week, she remembers, was bad. She hallucinated.

“I saw bugs on the floor, I thought I had bats in my hair,” says Kathleen. She quit her job as she tried to recoup from the medication.

Then she put 25 more pounds on her 5-foot, 5-inch frame, weighing in at 200 pounds. Her physician put her on anti-depressant medications. Now, five months later, she’s just beginning to feel like herself again.

“We’ve had some really good success with people who have a lot of weight loss - maybe 100, 150 pounds,” says Mary Kay Grossman, dietitian at the Women’s Workshop, a physician-supervised weight-reduction program in Spokane.

“They have to be willing to make a commitment to a lifestyle change, because we’re not just about handing out pills,” says Grossman.

“The ideal patient is someone who has already incorporated nutrition changes, they’re already cutting their fat in the diet, they’re reading labels, and they’re exercising,” explains dietitian Terry Perry of South Hill Family Medicine.

After clients at Berkeley Health Systems reach their weight-loss goal, they may enter a maintenance program.

Raoul Ennett, president of this physicians’ group, which has offices in both Spokane and Coeur d’Alene, says that after a year on maintenance, most clients are still within 5 pounds of their original goal.

Liz Word, a dietitian from Boston’s Harvard Community Health Plan, had one patient who started out at 303 pounds who dropped to 260.

“I had a woman who was a really terrific carbohydrate craver,” Word says, “and we got her away from that with the medication, but also with the diet.”

Educating people on the risks of taking diet pills is an important component of any program, and Dr. Danial Baker, a pharmacy professor at Washington State University at Spokane, warns that people should be cautious about taking diet drugs such as fen/phen and Redux.

“None are free of side effects today,” says Baker.

Grossman instructs her patients carefully.

“Some people find that they can’t sleep, and other people find that they are just terribly tired,” says Grossman. “Very rarely do we have someone who has more serious side effects.”

A rise in blood pressure, however, is a warning signal of a very rare but dangerous side effect: primary pulmonary hypertension. “We’re not going to take any chances if we see their blood pressure go up,” says Grossman.

Primary pulmonary hypertension, a lung disorder, has more than a 50 percent mortality, says Dr. Sima Issen of the Rockwood Clinic.

“Once you get it, it’s too late,” says Issen. “There’s no treatment for it. There’s no way to reverse it.”

This particular type of hypertension causes the heart to work harder to get blood to the lungs. It develops into significant heart disease, and the only treatment may be a heart-lung transplant.

Many people may shrug off information on primary pulmonary hypertension because it is so rare, but one physician reports a possible case in the Spokane area.

Much more common side effects are insomnia, nervousness, increased heart rate, dry mouth, tiredness and diarrhea.

There’s also the “serotonin syndrome,” says Baker. This occurs when people take one medication that affects serotonin, such as an antidepressant, with fenfluramine, one component of fen/phen. Symptoms of the syndrome include excitement, restlessness, loss of consciousness, confusion, disorientation, tremors and hyperthermia.

For some people, however, these new drugs actually improve their health.

Perry reports that some patients come off blood-pressure medication as their weight drops with fen/phen or Redux. However, Perry says the activity level of the person, rather than the medication they are on, may be of more value.

It’s important to recognize that these diet drugs are designed only for the truly obese, doctors say. Many physicians are very cautious about giving diet pills to just anyone who asks for them.

There are charts to help identify people who are greatly overweight.

Yet physicians and pharmacists report that people wanting to lose 15 pounds for a high school reunion and housewives yearning to lose 20 also request the drugs.

“If we choose patients who really are at their wits’ ends, or have lost and gained hundreds of pounds over the course of their life, then I think the medications are used in a rational way,” says Issen.

Psychologically, many people may place all their hopes in a pill. They expect their life to change with weight loss and all their problems to disappear.

They may also have a mistaken impression about how the pills work.

The weight loss is not as smooth as people expect, says Word. A person’s weight may plateau after a while, she notes. Among her patients, only about 10 percent have major success stories.

Some people are actually on a semistarvation diet because their appetite is so depressed, Word cautions.

“You have to have a low-fat, well-balanced diet to go along with it,” says Word.

“Now it’s absolutely essential that in conjunction with the medication, whether it be Redux or fen/phen, that people eat well-balanced meals, that they get in enough water and that they do begin incorporating exercise,” says Ennett of Berkeley Health Systems.

Most people are able to lose weight, with or without pills. The big question is whether they keep the weight off.

“The real crux of the issue is long-term,” says Issen. “The patients of mine who have stopped the medication, for whatever the reason, the overwhelming majority are inching back up the scales, with ease.”

That happened to Devon Croston, a Spokane administrative assistant from Post Falls. She took fen/phen for six months and lost 35 pounds. When she stopped, she gained 25 pounds of that back. Now she is back on the pills.

Croston, however, remains optimistic.

“I want to lose that extra bit of weight,” she says.

“I got so laid back and started eating the wrong things and not paying attention to what I was doing. This kind of gives me a jump-start back into it.”

, DataTimes ILLUSTRATION: Staff illustration by Molly Quinn

MEMO: Two sidebars appeared with the story: 1. Diet drugs cut appetite, stimulate body Taking Redux or fen/phen is a little like making a fire in your fireplace. You get a warm, toasty house without having to turn up the thermostat. These new drugs warm you up with a satisfying feeling of fullness while they burn your body’s excess fuel. They work differently than over-the-counter diet medications, such as Dexatrim, which contain the decongestant phenylpropanolamine. This decongestant acts as a stimulant to make the body burn calories faster. Fen/phen is a combination of two different drugs - fenfluramine, sold under the brand name Pondimin, and phentermine, sold as Fastin. Fenfluramine increases levels of the chemical serotonin in the brain, which improves a person’s mood and sense of well-being. Phentermine stimulates the central nervous system and decreases appetite. The combination of the two drugs affects appetite. Redux, or dexfenfluramine, also affects serotonin levels since it is similar to fenfluramine. Its effect is probably a little slower than the fen/phen combination drugs, with a reduced risk of side effects. Merri Lou Dobler

2. Where to begin Consult with your family physician first if you are considering Redux or phen/fen. He or she knows your history and may be willing to prescribe for you. Understand that the pills are designed for the truly obese. Many doctors are reluctant to prescribe these drugs if you only need to lose 10 to 15 pounds. Consider a structured program. The Women’s Workshop, for example, offers nutrition counseling, cooking classes and seminars on topics ranging from self-esteem to aromatherapy. Berkeley Health Systems also offers blood screening and exercise testing. Read up on the topic. Try “Thinner At Last” by Steven Lamm (Fireside Books, $13) or “The Redux Revolution” by Sheldon Levine (William Morrow, $20.) Investigate other programs, such as Weight Watchers, or consult a registered dietitian to help you make dietary changes as you lose weight. Don’t forget to add the psychological benefits of exercise. - Merri Lou Dobler

Two sidebars appeared with the story: 1. Diet drugs cut appetite, stimulate body Taking Redux or fen/phen is a little like making a fire in your fireplace. You get a warm, toasty house without having to turn up the thermostat. These new drugs warm you up with a satisfying feeling of fullness while they burn your body’s excess fuel. They work differently than over-the-counter diet medications, such as Dexatrim, which contain the decongestant phenylpropanolamine. This decongestant acts as a stimulant to make the body burn calories faster. Fen/phen is a combination of two different drugs - fenfluramine, sold under the brand name Pondimin, and phentermine, sold as Fastin. Fenfluramine increases levels of the chemical serotonin in the brain, which improves a person’s mood and sense of well-being. Phentermine stimulates the central nervous system and decreases appetite. The combination of the two drugs affects appetite. Redux, or dexfenfluramine, also affects serotonin levels since it is similar to fenfluramine. Its effect is probably a little slower than the fen/phen combination drugs, with a reduced risk of side effects. Merri Lou Dobler

2. Where to begin Consult with your family physician first if you are considering Redux or phen/fen. He or she knows your history and may be willing to prescribe for you. Understand that the pills are designed for the truly obese. Many doctors are reluctant to prescribe these drugs if you only need to lose 10 to 15 pounds. Consider a structured program. The Women’s Workshop, for example, offers nutrition counseling, cooking classes and seminars on topics ranging from self-esteem to aromatherapy. Berkeley Health Systems also offers blood screening and exercise testing. Read up on the topic. Try “Thinner At Last” by Steven Lamm (Fireside Books, $13) or “The Redux Revolution” by Sheldon Levine (William Morrow, $20.) Investigate other programs, such as Weight Watchers, or consult a registered dietitian to help you make dietary changes as you lose weight. Don’t forget to add the psychological benefits of exercise. - Merri Lou Dobler

Wordcount: 1781

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