Expert Advice

Ask the Joslin Dietitian

Q. Are there any diet pills or weight loss supplements that one can use without becoming addicted?

A. Overweight and obesity are serious conditions associated with a number of chronic health problems. More than two-thirds of the American adult population are considered overweight or obese.

The cornerstone of successful weight loss involves lifestyle changes, such as eating a healthful, high-fiber, lower-calorie diet, being physically active, and behavior modification. In addition, there are several prescription medications that can augment the benefits of these lifestyle changes. Like many medications, weight loss drugs do have side effects and these effects are sustained only for the time the medication is used.

The two medications approved by the U.S. Food and Drug Administration (FDA) for long-term weight loss are sibutramine (Meridia™) and orlistat (Xenical™). Meridia™ works by tricking the brain into making you feel full quickly. It can cause increased blood pressure, headache, dry mouth and constipation. Xenical prevents your body from absorbing fat. It can interfere with the absorption of fat-soluble vitamins, and cause diarrhea and abdominal pain. Neither medication is considered high risk for developing a dependence, although care should be taken in those with a history of drug or alcohol abuse.

There are several new drugs in clinical trials, many of which work by stimulating or suppressing the body's own hormones. Whether they turn out to be effective and safe long term is a question for the future. There are also numerous over-the-counter supplements and remedies that claim to induce weight loss. Most are appetite suppressants or diuretics of one sort or another. None have been found to be effective long term and some, like ephedra, which is now banned, have been linked to serious side effects.

Some issues to think about before considering a weight loss medication:

1. Your degree of overweight: weight loss medications are usually prescribed for people with a body mass index (BMI) over 27 who have additional complications, such as diabetes; or for those with BMIs over 30 without complications. BMI is a measure of weight status: people with BMIs from 25 to 29.9 are considered overweight; those with BMIs of 30 and above are considered obese.
2. Your degree of success with other weight loss programs or methods.
3. Your ability to comply with taking the medications and making long-term lifestyle changes.

Weight loss is a serious, long-term endeavor. You should always discuss the various options with your health care provider or consult a registered dietitian.

Q. Does caffeine affect diverticulitis? Should certain foods be avoided?

A. Diverticulosis and diverticulitis are two common conditions that are often confused. Although diverticula can occur anywhere in the gastrointestinal tract, the colon is the most common site. Diverticula are outpockets or pouches that form in the lining of the colon. These outpockets are thought to form due to high colonic pressures needed to move hard, dense stool through the colon. Diverticular disease is much more common in Western nations where fiber intake is significantly less than in developing countries. Diverticulitis occurs when the outpockets become inflamed. Abdominal pain, infection, fever and pain may result. Diverticulitis can also lead to bleeding, perforations or tears, or blockages. If the infection spreads into the abdominal cavity, the wall of the abdomen may become infected and inflamed, a condition called peritonitis. Peritonitis requires immediate surgery to repair the abdominal cavity and remove any damaged parts of the colon.

Interestingly, the dietary treatment for the two diseases represents opposite sides of the same coin. While the bowel is healing from a bout of diverticulitis, a low-fiber diet is often prescribed. This diet limits intake of raw fruits and vegetables, whole grain bread and cereals, nuts, seeds and legumes. Fiber intake is usually limited to less than 10-15 grams per day.

Once the infection has cleared, fiber is gradually reintroduced into the diet until a goal of 20-35 grams of fiber is reached. The foods that were once limited for diverticulitis are now encouraged. Some physicians still recommend that nuts and seeds be avoided but this is controversial. As fiber intake is increased, it is important to drink enough fluid to prevent constipation.

Caffeine has many effects in the body, including stimulating the central nervous system, which, if over stimulated, can lead to restlessness, anxiety, irritability and sleeplessness; increasing free fatty acid release from fatty tissue; and increasing urination. In addition, if ingested in high amounts (more than 600 milligrams of caffeine per day, the amount found in three to seven cups of coffee), nausea, vomiting or diarrhea can occur in some people. Caffeine also interacts with certain antibiotics, increasing the length of time the caffeine remains in the body. So, although you don't need to stop caffeine altogether while on a diet for diverticulitis, it's a good idea to avoid taking in too much while your bowel is healing.

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