Reality bites
I always say that if something seems too good to be true, it generally is, and unfortunately that goes for diet pills too. The truth is this: NO pill, whether prescription or not will make you lose weight WITHOUT a reduced calorie diet and exercise. Dang! Okay, but I can't open a magazine or read the news without seeing some new product. Surely something works...even...a little?

A checkered past for pills
The search for a magic diet pill is nothing new. In the early 1930's, two physicians from Stanford University (no less!) discovered that the industrial chemical dinitrophenol (DNP) had the ability to speed up the metabolism. In other words, food energy wasn't turned to fat, but instead dissipated as heat. By 1934, it's estimated that over 100,000 people had tried DNP. Two people had already died as well, from high fevers possibly tied to high doses.

The U.S. Office of Drug Control, forerunner to today's Food and Drug Administration, investigated and found a link between DNP and deaths due to fevers, as well as links to other injuries such as blindness. When the agency got the power to remove drugs from the marketplace in 1938, DNP was one of its first targets.

Rather than speed the metabolism, how about suppress appetite? In the 1950's, scientists discovered that amphetamines did that pretty well - if it weren't for the little problem of addiction - along with racing heart rates, insomnia and mood swings. By the 1970's, the FDA restricted the use of amphetamines for weight-loss to a few weeks at a time, and they eventually fell out of favor.

Fast-forward to 1992, when the results of a small study from the University of Rochester showed seemingly positive results of combining two existing appetite suppressants, fenfluramine and phentermine, dubbed "fen-phen." In 1996, the FDA cleared the drug, making it the first medicine approved for the treatment of obesity in 23 years. According to Time magazine, within three months of approval, doctors were writing 85,000 prescriptions a week. However, less than two years later, doctors at the Mayo Clinic published an article reporting unusual heart valve trouble in women taking fen-phen, and within a month, the FDA removed both dexfenfluramine and fenfluramine from the market. Phentermine is still available by itself as a controlled substance.

Big drug companies, big promises
None of the previous failures have deterred big pharmaceutical companies from trying to find a magic pill to fight the fat, and several currently have FDA approval.

Sibutramine, marketed as Meridia, is another centrally-acting stimulant, chemically related to amphetamines - and is therefore also a controlled substance. Orlistat, marketed as Xenical, inhibits the body's ability to absorb fat. But neither of these drugs is meant for casual dieters. To be prescribed, you must be officially obese and have no risk factors such as insulin resistance or high blood pressure. These diet drugs are of course prescribed in conjunction with a healthy diet and regular exercise, and they're not meant to achieve instant results. They're considered successful if just 5 to 10 percent of body weight is kept off for a year or more.

The makers of Orlistat recently received FDA approval for an over-the-counter, lower-dose form called Alli (pronounced like "ally" - not "a LIE"). Alli works by preventing absorption of dietary fat by about 25 percent, and claims to help you lose potentially 50% more weight than you would from diet and exercise alone. The thing is, you still have to follow a calorie-restricted, low-fat diet, taking only about 15 percent of your calories from fat daily, AND you have to exercise.

But that's not all...Alli contains a built-in deterrent to eating fat, which I call a very unpleasant side-effect and they call a "treatment effect."

The fat your body doesn't absorb is eliminated through your bowels. The more fat you eat, the more has to come out, potentially causing gas with oily stools (as if gas wasn't enough), loose stools and more frequent stools that may be hard to control (oh my).

The problem is, Alli can't discriminate between fats - you need to rigidly control all of them. So all the good things like nuts and seeds, olives, olive oil and avocados are just as evil as potato chips, chocolate cake and whipped cream. According to Susan Burke, spokesperson for the Florida Dietetic Association, "My biggest complaint about this drug is that it doesn't' teach you how to eat healthfully, because the drug doesn't discriminate between good and bad fats. All fat has got to be rigidly controlled, otherwise the side effect is a very unpleasant loss of control of bowels."

I must agree - that's one of the most unpleasant side effects I've ever heard about. I've got too much crap in my life as it is.

Are dietary supplements the answer?
So I did some digging on the biggest-name diet pills (technically "dietary supplements") to see if perhaps I'd find my magic pill.

Star Caps have been recently in the news because they were developed by glamorous socialite, Nikki Haskell. The active ingredients in Star Caps are papaya (a "digestive enzyme that metabolizes protein") and garlic ("a natural diuretic)." For maximum efficacy, you should also avoid sugar, butter and cheese while taking Star Caps. There doesn't appear to be anything particularly dangerous in Star Caps, but nothing particularly effective either.

Hoodia Gordonii is a type of plant native to South Africa, which has some affect as an appetite suppressant. In fact, in the late 90's Pfizer began working on isolating the ingredient and attempting to synthesize it. However in 2002, the company discontinued the work. According to Jasjit Bindra, lead researcher for Hoodia at Pfizer, states there were indications of unwanted effects on the liver caused by other components, which could not be easily removed from the supplement, adding "Clearly,Hoodia has a long way to go before it can earn approval from the Food and Drug Administration. Until safer formulations are developed, dieters should be wary of using it." And just in case you can't wait to try it, many products claiming to contain Hoodia do not actually contain the active ingredient alleged to suppress appetite. Only the South African product has the claimed properties. An ongoing review of Hoodia pills by Alkemists Pharmaceuticals found that at least half of the products advertised as containing Hoodia contained none.

CortiSlim and Relacore supposedly counteract increased levels of a stress hormone called cortisol in your body. When your cortisol is up, your stress level is up and you tend to eat too much. Both supplements contain similar ingredients, including extracts of magnolia bark, green tea and bitter orange. Green tea leaf extract contains high amounts of caffeine, and bitter orange, also known as synephrine, is a stimulant, much like the now banned ephedra. While stimulants can sometimes artificially raise metabolism, they can have adverse, sometimes even deadly, effects on dieters, because they can raise the heart rate and blood pressure. And just so you know, the makers of CortiSlim were just fined $12 million by the FTC for false advertising claims.

Anorex, Leptoprin and Leptropril are all made by the same company, and were cited by the FTC in 2004 for making unsubstantiated claims. These supplements are built on the "ECA Stack" which contains ephedrine to stimulate metabolism, caffeine, which inhibits the body's ability to normalize metabolism, and aspirin to help prolong the effects. Basically, these ingredients work together to suppress your appetite and heat up your metabolism. There have been no major studies demonstrating any effectiveness in weight loss with these products.

TrimSpa, made famous by Anna Nicole Smith, contains hoodia gordonii, along with caffeine and two other mild stimulants (theobromine and synephrine), which work in similar fashion to the ECA Stack. Of course, there have been no confirmed research studies on these pills regarding weight loss or safety and TrimSpa was fined at the same time as CortiSlim for false claims.

The bottom line is, I couldn't really find any good news for any kind of diet pill. "People want an easy and fast answer for fat loss, says Raphael Calzadilla, Chief Fitness Pro for eDiets.com, "but in reality even if you were to take a diet pill (which I never recommend), you'd still need to be in somewhat of a caloric deficit to initiate fat loss- and unfortunately that's what people are really trying to avoid. The real answer lies in a lifestyle change of proper eating and moderate exercise."

Sigh. It always comes back to that. I have to behave.