How many of us can honestly say we don't desire to lose at least two to five kilos, if not more? And how we wish it won't require us to sweat it out and cut back on our favourite food.

In the Heart2Heart article of April 13 last year, I wrote about how the shape of your body could determine the shape of your heart — obesity being regarded as a major risk factor for coronary heart disease.

I also shared my personal experience of being labeled "fat" by my patient.

That somehow led me to become a soi-disant (so called) weight-loss expert using an 'eat less eat slow' regime which shaved 12 kilos off my weight.

While this worked for me, I know a few who tried it but were unsuccessful.

Obesity has long been regarded as more of an image rather than a health problem. You won't find many 'not-so-skinny' ladies featuring prominently on the cover of fashion or teen magazines.

As a quick-fix measure, many have resorted to liposuction and taking pills which can be bought over the counter without a doctor's prescription.

Of the prescription-only anti-obesity medicines in the last decade, three immediately spring to mind. Orlistat, (Xenical™), became popular at the turn of the millennium.

It acts by inhibiting lipases, fat enzymes from the pancreas, which leads to reduced fat absorption from the intestine and effective calorie intake resulting in weight loss.

Orlistat also lowers blood pressure and prevents the onset of diabetes. Perhaps the most exciting anti-obesity drug to have emerged is rimonabant (Acomplia™).

It's an appetite suppressant that was shown to not just reduce blood pressure, cholesterol and blood sugar on top of reducing weight, its effect on the overall cardiometabolic risk made it a very attractive weight-losing drug.

Unfortunately, rimonabant was shown to cause serious adverse psychiatric effects such as depression and even suicide.

This drug was withdrawn from the worldwide market about a year ago. That leaves us with the last of the three drugs – sibutramine, which is partly the reason for my writing this article.

Being commercially available from the late 90s, sibutramine makes you full and eat less by increasing the levels of serotonin and noradrenaline — two neurotransmitters in the brain.

It's an effective weight-losing drug but unfortunately, sibutramine has recently been shown to increase blood pressure and lead to increased risks of heart attacks and strokes. What about 'natural' weight-loss products like herbal slimming pills?

Herbal weight-loss products are very attractive because they are sourced from nature and are, therefore, assumed to be safe.

They are available without prescription and are generally cheaper than weight-loss medicines. This is a thriving industry that is worth billions of Ringgits.

However, it is very crowded and over-hyped, over-exaggerated and ultimately disappointment are commonplace.

There is no doubt that the herbal slimming pills have helped millions to shed kilos and get them into one or two dress sizes smaller, but there are also pills that fail to lighten anything but your wallet.

As they are not subject to the same rigorous standards as are prescription medication, there is limited information on actual effectiveness and safety. In fact, there are some herbal products which are downright dangerous.

Take ephedra for instance. It is an important herb in traditional Chinese medicine used for over 4,000 years as therapy for asthma, cough and joint symptoms. In recent years, it has also been used as a weight-loss remedy.

Of great concern is that ephedra has been linked to serious adverse conditions such as high blood pressure, irregular heart rhythm, heart attack and stroke. In fact, ephedra is currently banned in the US.

To sum it all up, please consider the following:

• Obesity is not an image issue but a heart and health concern.

• There is no magic bullet for losing weight. The tried and tested way is still through strict lifestyle changes of eating low-calorie but healthy foods and engaging in regular exercise. Like everything worthwhile, it takes time and effort. No pain, no gain right?

• Sit down with your doctor and ask him about your ideal weight and how best to achieve it.

• Keep in mind that if you are taking slimming pills, you still have to take in fewer calories than your body uses in order to lose weight.

• Be careful about the products out there in the market. Please check with your doctor if they are safe.

• Find a strong reason why you should lose weight and then make a firm decision to do so.

Have a goal with a time frame and then sweat it out!

If you have any questions or comments, please write to me at haizal@tropicanamedicalcentre.com.

See you next week.

 

QUESTION

Dizziness due to a heart condition?

Dear Dr Haizal

I'm in my sixties with high blood pressure. I've been suffering from dizziness for some time. It usually happens when I stand up and will last for a few seconds. My doctor has tried me on ‘anti-dizzy pills’ but it didn't work. After reading your article, I am now afraid if my dizziness is due to a heart condition.

Simon
Petaling Jaya

Dear Simon

Momentary dizziness when standing after a prolonged sitting or lying position is called postural dizziness. It is common and can happen to any healthy person.

However, if it occurs all too frequently, then it is a cause for concern. Postural dizziness, almost invariably, is because of a decrease in blood flow to the brain due to a drop in blood pressure upon standing.

This phenomenon is called postural hypotension and can be a debilitating condition associated with increased risk of injury from accidents and falls.

This is probably why anti-dizziness pills have not been effective for you.

So what then is postural hypotension and what causes it? When you are lying in a horizontal position, the pressure throughout your body is roughly the same.

However, when you're in a standing position, pressure tends to increase at the feet and fall dramatically at the head causing dizziness unless there exists a complex but highly effective reflex mechanism involving special pressure sensors in blood vessels and involuntary nervous systems to regulate and maintain normal blood pressures and flow to the brain.

In postural hypotension, this reflex mechanism goes out of whack and may lead to dizziness and even collapse.

A simple method to document postural hypotension is by taking blood pressure readings in both the lying and standing positions.

A systolic blood pressure drop of greater than 20 mmHg is considered significant and likely to cause some degree of dizziness. Very often, a careful history and physical examination are all that is required to identify the cause.

The causes of postural hypotension can be broadly divided into:

• Blockage of the normal heart or blood vessel reflex mechanism.

• Autonomic nervous system (ANS) dysfunction

• Low blood volume.

To stop postural dizziness, you have to find and correct any underlying causes although many times, no cause can be found.

Other approaches are support hose for the legs and adrenal gland medications such as fludrocortisone with salt and fluid loading in cases of adrenal failure.

Be mindful to stand up slowly and hold on to the chair or furniture before starting to walk.