The not-so-amazing Bangkok pills

Q. A friend who has been taking Bangkok pills has lost significant weight. I am obese and would like to try it. Is it safe?

– P.A., Quezon City

A. According to Health Intel, a publication of the Zuellig Foundation, laboratory studies have shown that these multicolored unmarked pills from Thailand contain phentermine, fenfluramine, dexfenfluramine (which has been withdrawn from the global market because of cardiac toxicity), pseudoephedrine, furosemide (diuretic), bisacodyl (laxative) and diazepam (sedative).

There had been adverse reactions reported following the intake of Bangkok pills. These include hallucinations, paranoia, agitation, depression, suicidal tendencies, insomnia, anorexia, metabolic imbalance, and cardiac arrhythmia (irregular heartbeat). Some users may not also be aware that these pills may have serious life-threatening interactions with other medications. Those negative side effects are not worth the "benefit" of quick weight loss. Don’t take these pills. If you are obese, consult your doctor.

AIDS TO QUIT SMOKING

Q. I have already tried twice to stop smoking but had been unsuccessful. Are there medically-proven methods that can help?

– E.C., Marikina City

A. Yes, there are. Many smokers like you mistakingly believe that quitting merely requires willpower, and they therefore try to quit on their own. The truth is fewer than 10 percent of those who go it alone are actually successful in the long run. On the other hand, a review article in the February 14, 2002 issue of the New England Journal of Medicine reports that people who avail themselves of counseling and other cessation aids can more than double their chances of long-term success.

These smoking-cessation aids include the following:

• Nicotine patch. Provides stable dose of nicotine for 16 to 24 hours but does not produce peak level until two to four hours after application.

• Nicotine gum. Increases blood level of nicotine within 20 minutes of use, but level begins to decline within two hours.

• Nicotine nasal spray. Increases blood level of nicotine within five to 10 minutes of application, but it can irritate the nose, throat, and mouth.

• Nicotine vapor inhaler. Similar to nicotine gum in rapidity of effect but is also irritating and requires frequent puffing.

• Bupropion (zyban, wellbutrin). Must be started one to two weeks before target cessation date. Should not be used by people with a history of seizures or eating disorders.

• Nortriptyline (aventyl, pamelor). Must be started two to four weeks before target cessation date. May be problematic in people with heart disease.

• Counseling. Especially useful when combined with other smoking-cessation aids. Efficacy increases with time spent in counseling.

• Hypnosis. Remains largely unstudied. Anecdotal reports of success unproven.

• Acupuncture. Does not appear to improve smoking-cessation success rates in randomized trials.

Nicotine is highly addictive, so people who stop smoking experience cravings and withdrawal symptoms such as irritability, anxiety, and depression. What’s more, smokers tend to gain weight after they quit, and some people are reluctant to trade cigarettes for unwanted pounds.

Counseling helps smokers identify the cues that trigger cravings, such as finishing a meal or socializing with friends. Counseling teaches smokers to anticipate these cues and rehearse coping strategies. For example, smokers accustomed to smoking after a meal learn to sidestep their cravings by beginning an activity unrelated to smoking immediately after eating.

Nicotine replacement therapy (gum, patches, inhalers, and nasal sprays) help smokers wean themselves from their nicotine addiction over a period ranging from eight weeks to six months. While the replacements carry the risk of continued addiction, they deliver nicotine in a far less detrimental way than cigarettes do, and they avoid the problem of second-hand smoke.

For unknown reasons, the antidepressants bupropion and nortriptyline improve smoking-cessation rates. Smokers should start using antidepressants a few weeks before the target quit date, and they must slowly wean themselves from the drugs before stopping antidepressant therapy. Because a depressed mood can hamper cessation success, antidepressants are a good quitting approach for smokers prone to depression.

Combining the nicotine patch with nicotine gum or an inhaler or nasal spray is safe and more effective than using the patch alone, but combining bupropion with nicotine replacement therapy does not seem to improve success rates any more than either approach used alone.

On average, smokers gain five to 10 pounds after quitting smoking. Quitters can avoid weight gain by initiating an exercise routine. Indeed, exercise itself may help dissipate some of the restlessness and depression that accompany nicotine withdrawal.

When you’re ready to quit smoking, speak to your doctor about which smoking-cessation aids are right for you. If you’ve tried quitting before, it will be helpful for your doctor to know what caused your previous relapses. Line up counseling and set a quit date. In preparation for your "Q-Day," eliminate as many smoking triggers as possible. (Put away ashtrays and have your clothes washed or dry-cleaned to remove the tobacco smell.) Ask your family and friends for encouragement, and find a smoking support group through your doctor or hospital. And when the quit date arrives, stay busy.

So, if you’ve tried and failed, try again, and this time seek help.

A DRINK TO YOUR HEALTH

Q. You have written previously about the health benefits of light-to-moderate alcohol consumption. What is really the definition of "light-to-moderate" alcohol intake? What is a standard-sized drink? Can you provide an illustration so we can understand it better?

– J.S., Iloilo City

A. Low-to-moderate alcohol consumption is defined as no more than two standard-sized drinks per day for men and only one standard-sized drink per day for women – under age 65. A standard-sized drink is the equivalent of either 5 ounces of wine, or 12 ounces of beer, or 1.5 ounces of 80-proof liquor (please see illustration).

Women have a lower limit because their bodies contain less water than men’s bodies. Experts say people over age 65 should cut those amounts in half because of age-related changes in the way alcohol is metabolized.

So, lift a glass (but not too many) to health!