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Weight-loss drugs being sold online to thousands of British women can cause strokes, panic attacks and worse

Diet pills: Dying to be slim

They claim to take the effort out of slimming. But weightloss drugs being sold online to thousands of British women can cause strokes, panic attacks and worse...

The testimonial on a leading diet website is gushing: "I lost all the weight I wanted and then more - now I really love my body!"

The endorsement is accompanied by a photograph of its author, Karen, and a week-by-week account of her dramatic weight loss.

Karen, a slim, perma-tanned, peroxide blonde in her 30s, says she weighed 111/2 stone.

Within ten days, she had lost 10lb, after two months she'd shed 28lb. After just six months, she had lost 33lb and weighed just over nine stone.

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Judging by the photo, Karen wasn't particularly-plump to start with. Still, messages of congratulations from other website users follow. "Wow! You look great!" exclaims one. "Thank you for inspiring us," writes another.

If Karen had stuck rigorously to a balanced diet and work-out regime to shed the pounds, her triumphant tone might be understandable. However, the secret of her slim-line figure has little to do with healthy living.

Like many of the women posting evangelical messages on this and many other dieting websites, much of Karen's weight loss is due to the work of a little white and blue speckled pill known as phentermine.

This drug, which is closely related to amphetamines, works as an appetite suppressant, stimulating the release of brain chemicals, which reduce sensations of hunger.

What Karen does not mention are the common side-effects of phentermine, which include mood swings, chest pain, tremors and irregular heartbeat.

And if you overdose, it can lead to hallucinations, seizures, severe headaches, blurred vision and vomiting.

What makes all this so alarming is that although phentermine is no longer prescribed in Britain, it is readily available on the internet.

Indeed, experts are warning that thousands of women are putting their lives at risk by buying diet drugs online.

For while it's illegal to supply such medications without prescription here, these laws don't apply to overseas pharmacies that sell via the web.

Research suggests there are almost 2,300 websites selling drugs direct to consumers, with global sales up to £30billion.

According to a report last month from the UN International Narcotics Control Board, phentermine is one of the most commonly abused prescription drugs, followed by a number of similar amphetamine-type drugs collectively known as "anorectics".

These include Ritalin, which is meant to treat Attention Deficit Hyperactivity Disorder (ADHD) in children, but which also has the side-effect of suppressing appetite.

The agency claims that worldwide, the number of people misusing prescription drugs is about to surpass those abusing illegal narcotics and has appealed to governments to help curb the sale of these drugs.

Their warnings follow the death of 21-year-old Brazilian model Ana Carolina Reston, who is suspected of having taken a cocktail of prescription drugs for slimming and pain relief shortly before she died.

Sally Webber discovered almost too late just how dangerous these drugs can be. Although not overweight - at 5ft 7in she weighed 10st - the 25-year-old human resources manager from Nottingham thought she'd "feel better" about herself if she was slimmer.

Browsing the web, she came across a site that offered phentermine for weight loss.

"I knew it was cheating, but I didn't think it could do any harm. I ordered two weeks' supply for around £100," she says.

"The instructions on the site said I should take one a day.

"I felt different almost as soon as I took one - more alert and awake, full of energy, and not hungry at all.

"After a few days, I began to feel really odd. I started shaking and grinding my teeth. I couldn't eat anything more than a few apples and a slice of toast."

At night, she'd lie awake staring at the ceiling. "I felt utterly exhausted, but within a week I'd lost 10lb, so it seemed worth it. No pain, no gain, I thought, so I carried on taking them.

"At work, I would burst into tears at the slightest thing. If I did try to eat a proper meal, I'd feel bloated and nauseous.

"I began to suffer from agonising stomach pains. But every time I stepped on the scales, I'd lost more weight and people were constantly complimenting me on how I looked."

Each time Sally reached her target of 8st and stopped taking the pills, she regained the weight.

"Then when I went back on the pills, it was harder to lose again. I began taking double and triple doses. The side-effects got worse, but I didn't care as long as I was getting thinner.

"I would weigh myself obsessively morning and evening. I hardly slept; I'd hallucinate, becoming convinced people were hiding in my room.

"I even passed out a few times. A friend eventually confronted me and said if I didn't get help she would tell my boss.

"My GP referred me for intensive psychotherapy. By then I weighed 7st and had been taking the pills on and off for three years."

Amphetamine diet pills are hardly new, according to Professor Hamid Ghodse, former president of the UN's International Narcotics Control Board and chairman of addiction psychiatry at StGeorge's Hospital, London.

"They've been around in various guises since the Sixties and are highly addictive. Users can experience painful withdrawal symptoms, including nausea, headaches and convulsions, when they try to stop taking the drug.

"People take them innocently, thinking it might be an easy way to lose weight, but become hooked.

"The big difference is that now, it seems, instead of having to find an unscrupulous doctor to prescribe the pills, people can simply buy them on the internet."

The drugs work by stimulating the central nervous system, mimicking the natural effect of adrenalin by increasing the heart rate and suppressing the appetite.

"Users also feel euphoric and have increased energy levels," says Prof Ghodse. "However, this also leads to insomnia. Over time, sleep deprivation, coupled with weight loss caused by what basically amounts to starvation, can cause extreme changes in behaviour.

"Users have hallucinations, mood swings, become anxious, paranoid and sometimes violent.

"Because of extreme stress on the heart and raised blood pressure, side-effects can include convulsions, heart attacks, strokes and even death in extreme cases.

"There have been scandals about certain diet pills due to these side-effects.

"The manufacturers have responded by simply removing the drug from the market, changing the formulation slightly and bringing out what is basically the same substance under a different name."

Endocrinologist Dr Nicola Bridges, an authority on the medical treatment of obesity, says anorectic diet drugs rarely help people lose weight in the long term.

"Most people simply put the weight back on once they stop taking the drugs," she says.

"These are extremely dangerous in the wrong hands. They have to be prescribed by a doctor who has carefully assessed the risk versus benefit for the patient."

The National Institute for Clinical Excellence (NICE) recommends that anorectics should be prescribed only to people with a BMI of 27 or over, for short-term use.

Yet despite having a healthy BMI of 22, during this investigation I was able to buy an array of prescription-only appetite suppressants-from internet sources - despite flagging up medical conditions that should have prevented me taking such drugs.

When I typed the word "phentermine" into a search engine, it returned more than 43 million hits.

Even the WeightWatchers community chat website had more than 80 message-board entries in which users talked about using phentermine - also commonly sold online under the brand names Duromine, Ionamine, Adipex and Fastin.

One website, which claimed to be "the official phentermine site", featured photographs of doctors in white coats and promised "no prescription required, no appointments, no waiting rooms and no embarrassment".

I ordered 30 tablets of phentermine for £67. Before giving my credit card number, I was asked to fill out a medical questionnaire.

I put in my low BMI - which should instantly preclude me from taking diet medication - and claimed that I am a smoker with high blood pressure and cholesterol, and have a family history of heart attacks.

Though none of this is true, they are conditions which would make taking a drug such as phentermine, which raises the heart rate, extremely dangerous.

Despite this, my order is processed and within a week a small plastic bottle containing 30 tablets arrives in a packet postmarked Pakistan. The label, which looks as if it has been made using a home computer, simply says "phentermine, 37.5mg".

From a Swedish site, I buy amfepramone, identified by the UN as another highly abused anorectic, and phenylpropanolamine, a diet pill no longer prescribed in Britain or the U.S. because it was found to cause strokes.

Again the site asks for a short medical history and I claim to suffer from chronic heart disease and hypertension. Regardless, after handing over my credit card details, the order is processed.

Three days later, a package arrived containing blister medication packs taped to a piece of A4 paper and a "prescription" from Dr Thomas Wehrle MD, a specialist in "internal medicine" based in Solothurn, Switzerland.

It advised me to read the "approved labelling and manufacturer's package insert for further information, especially on sideeffects and precautions".

Unfortunately, the labelling and instructions are in German.

I also bought the ADHD drug Ritalin, from a source in the Philippines. The tablets arrived ten days later, taped to a blank piece of paper, with no instructions.

And I bought the steroid Clenbuterol - which is not prescribed in this country for human or even animal use because it causes side-effects such as arrhythmia, the sudden speeding up and slowing down of the heart rate.

Despite all this, within ten days I received the pills, stuck between two layers of masking tape. Again, there were no instructions.

Many anorectic drugs are considered so dangerous they are in the same class as cocaine in the U.S. In Britain, regulations aren't so strict and most, except for Ritalin, are Class C.

Despite the known dangers of these medications, when the Mail contacted the Home Office - which classifies narcotics and misused prescription drugs - it said it was an issue for the Department of Health.

The Department of Health said diet pills are the responsibility of the Medicines and Healthcare Products Regulatory Agency (MHRA).

Although the MHRA is investigating a number of British-based pharmacies for selling prescription medication online, the majority of these drugs are imported from foreign sources, via the postal service, which, they say, makes it an issue for the Home Office and Customs.

They all agreed it was "a bit of a grey area".

In the meantime, websites continue to sell miracle pills to women across Britain, promising them an easy way to lose weight, when in reality there is no such thing.

For help and information on diet pill addiction, visit www.promis.co.uk Some names in this article have been changed.

The worse culprits

Amfepramone: 30 tablets, £60. Source: Switzerland.

Professor David Heal, professor of pharmacology at the University of Bath, says: This drug, known as "diethylpropion" in the UK, was a prescription appetite suppressant branded as Apisate or Tenuate banned by the European Medicine Approval Agency in 1999 because of safety concerns. It works by mimicking the effects of noradrenaline in the nervous system to suppress hunger.

Phenylpropanolamine (PPA): 30 capsules, Source: Switzerland.

Prof Heal says: PPA is a vasoconstrictor used in nasal congestants and cough medicines, it is not approved in the UK for the treatment of obesity. Still used to control urinary incontinence in dogs.

Ritalin (Methylphenidate): 50 tablets, £45. Source: Philippines.

Prof Heal says: Ritalin is approved for the treatment of Attention Deficit Hyperactivity Disorder, not forweight loss. Side-effects are increased heart rate and raised blood pressure, which can greatly stress the cardio-vascular system. A schedule 2 controlled drug, classed alongside amphetamines.

Clenbuterol: 500 tablets, £110. Source: Romania.

Prof Heal says: Clenbuterol was originally developed as an asthma treatment, but also seems to increase metabolic rate and causes people to lose fat and gain muscle. It is banned by the International Olympic Committee because of its abuse by athletes and body builders. Clenbuterol is also used in a veterinary product to treat breathing problems in horses. After poisoning episodes linked to the consumption of meat containing Clenbuterol residues its use is strictly controlled.

Phentermine: 30 tablets, £70. Source: Pakistan. Prof Heal says: Closely related to amphetamine, phentermine is dangerous for people with high blood pressure or heart problems. Common side-effects include mood swings, chest pain, tremors, and irregular heartbeat. Overdose can cause hallucinations, seizures, severe headaches, blurred vision and vomiting. Rarely prescribed in the UK. People should not buy it over the internet.

4 people have commented on this story so far.
Here's a sample of the latest comments published.

This is ridiculous - a healthy diet, the odd bad snack and lots of walking will resolve the need for these extreme pills! We don't even know what is in half of them.

- Kirsty, London, UK

Those drugs are dangerous and not worth it. Also, as soon as you go off them, you're just going to pile the pounds back on. If people ate healthy there would be no need for people to want to take these drugs and there'd be less health risks.

- Kirsty Louise Bannister, South Wales

Yes they are dangerous. People take these drugs because the only images we see are of beautiful slim models who are then airbrushed to perfection. Normal women, size 10-12 have been marginalised in favour of waifs six sizes smaller. Responsibility lies with the promotion of unattainable beauty.

- Anna Gilbert, colchester essex

Diabetic food is a waste of your money

Last updated at 12:25pm on 24th April 2007

Every Tuesday, Britain's leading nutritionist, Jane Clarke, explains how to eat your way to health. This week, why diabetic food is a waste of your money and the benefits of hemp oil

I've been recently diagnosed with type 2 diabetes, and have been told that grapes and bananas are not good for me. Is that right, and do I need to buy the special diabetic products?

Jennifer House, by e-mail.

Type 2 diabetes is the most common form of diabetes in the UK, and is caused by problems with the hormone insulin. Our bodies need insulin in order to use glucose, the basic fuel for the cells.

Glucose comes from the food we eat and is absorbed through the digestive system into the bloodstream. Insulin then moves it from the blood to the cells, where it is converted into energy.

If we don't have enough insulin - either because the body does not produce enough, or if it does, the cells don't respond to it as they should - glucose builds up in the blood.

This can cause two problems. Your cells are starved of energy, which is why people with undiagnosed or uncontrolled diabetes can lose weight and feel exhausted.

And over time, uncontrolled high blood glucose levels can damage your kidneys, nerves, heart - or eyes. In fact, some people discover they have type 2 diabetes only when they go to the optician.

However, most people discover they're diabetic during a routine urine test. You may have been feeling more tired than usual, or needing to go to the toilet more often, or have an unquenchable thirst - the last two are signs that the body needs more water to produce urine, which is the way it gets rid of excess sugar.

Type 2 diabetes can occur as we get older, but it is most common in overweight people.

Unlike those who suffer from type 1 diabetes - they don't produce any insulin at all and have to inject themselves with it - type 2 diabetics can often control their blood glucose levels by eating healthily, staying fit and losing excess weight.

The less weight you carry, the better the body's response to the insulin that your pancreas does produce.

Sometimes, type 2 diabetics need medication to stimulate the pancreas. But regardless of whether you are on medication, it's important to slim down gradually and healthily if you are overweight.

All of this may sound tricky, but your diet will be almost the same as it should be for the rest of us - healthy and balanced, with plenty of starchy carbohydrates, especially wholegrain and low glycaemic index foods such as porridge oats, lentils and beans.

You should also have lots of fresh fruit and vegetables.

Plenty of water is also key, and moderate amounts of lean meat, fish and some lower-fat dairy products.

You need to keep your fat intake down - this means choosing lean cuts of meat and using semi-skimmed or skimmed milk.

Not overdosing on animal fats is particularly important - diabetes increases your risk of developing heart disease and you don't want a high cholesterol level to exacerbate the problem.

Saturated fat, found in foods such as butter, cream, fatty meat, cheese, pastries and cakes made with butter, can increase levels of what's known as bad LDL (low-density lipoprotein) cholesterol, so you need to watch these.

And avoid foods that contain hydrogenated fats (e.g. some processed pastries and spreads — look for the word hydrogenated on the label), as these may contain transfats, which have an even more detrimental effect on your LDL levels.

Choose skimmed milk, low-fat yoghurt, cheeses that are naturally lower in fat, such as Edam, or just eat smaller amounts of the higherfat cheeses.

Sometimes we forget that there is no difference between a large amount of a lower-fat food and a small amount of a higher-fat food.

I'd rather have a small amount of a higher-fat cheese, but it takes willpower to stop at just a little.

I think a little natural Greek-style yoghurt is better than more of a watery no-fat yoghurt, especially as no-fat yoghurts are often high in added sugar.

And you want to avoid this, as sugar is quickly absorbed into the body and can cause your blood sugar level to shoot up.

The best sorts of fat are olive oil, hemp oil and other types of vegetable oil, such as rapeseed, which can be found in health-food stores as well as some supermarkets.

Other good fats include nuts and nut oils, as these are rich in polyunsaturated and monounsaturated fat, the healthiest type. But do watch how much you have, as fat of any sort is calorie-loaded.

Diabetics need to stick to foods that produce small, slow rises in blood sugar levels. For this reason, it's best to minimise the amount of foods high in added sugar, such as biscuits, cakes, ice cream and chocolate.

However, the old advice that type 2 diabetics need to avoid anything that's sweet isn't true - you can have a little.

But I'd suggest saving it until after a meal, as the body can cope much better with something sweet on a full rather than empty stomach.

This is because the proteins from the first course, such as meat or fish, slow down the absorption of sugar.

The best sweet food is fresh fruit, as not only is the sugar natural, but the fruit also provides vitamins and minerals.

You don't have to stick to less-sweet fruits such as apples and pears - bananas, pineapple, mango or grapes are fine, in moderation.

You shouldn't eat two large ripe bananas in one go, or tuck into a large bowl of pineapple on an empty stomach, as these fruits have high GIs and could send your blood sugar level a little high.

I'd advise, rather, a selection of different types of fresh fruit, some with low GIs. Alternatively, add plain yoghurt - and definitely aim for five portions of fresh fruits and vegetables each day.

Finally, you don't need to bother with special diabetic products such as chocolate and biscuits. Not only are they expensive, but they frequently contain a type of sugar substitute that can have a laxative effect.

They also make you feel as if you have a problem, requiring you to be on a special diet, which isn't the case.

WHAT is hemp oil? I keep reading about it. Is it healthier than olive oil?

Geoff Barnes, London.

Say the word 'hemp' and most people think of the illegal drug. The hemp plant, Cannabis sativa, is a member of the Cannabaceae family, to which marijuana also belongs.

However, all hemp used in the production of hemp oil has had the tetrahydrocannabinol (THC), the ingredient with hallucinogenic properties, removed.

I'm a big fan of hemp oil. Not only is the taste a little different, but using small amounts of a variety of oils means you enjoy the benefits of all.

Hemp oil is rich in omega 3, 6 and 9 fatty acids, which our bodies don't produce naturally, but which are crucial for healthy circulation, cell growth and the immune system.

A good balance of these omegas has been linked to helping maintain a healthy heart and brain - especially in unborn babies - and relieving conditions such as PMS, eczema, psoriasis, even improving children's behaviour and concentration.

I use hemp oil in cakes and biscuits, as well as in dressings (mix equal measures of olive oil and hemp oil, if you prefer) or drizzled over vegetables. There's no need to replace olive oil with hemp - just start including it in your diet.

As with any fat, hemp oil is high in calories, so if you're watching your weight, don't use too much of any oil.

Hemp oils vary - some taste a little rank and are far too strong.

Check out Good Oil (from supermarkets or www.goodoil.co.uk) and Hugh Fearnley-Whittingstall's River Cottage Oil (www.rivercottage.net), both of which I really like. Good Oil is producing a lighter-tasting hemp oil that will be in the shops soon.