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Phentermine vs. the new weight loss surgery

Well, let’s start with the gossip and then get serious. It seems Gabourey Sidibe who was recently nominated for an Oscar for her role in Precious, has been approached by a weight loss company. It wants to help her lose weight and, of course, by doing so enhance its own reputation. What makes the story so interesting is the aggressiveness of the approach. Here is a young woman who is obviously not unhappy with the way she looks and is successful as she is. Yet a weight loss company thinks she should want to lose weight. Now we could assume this company is altruistic. It knows being obese significantly increases the risk of diabetes, arthritis, some cancers, a stoke or heart disease. If anyone overweight can lose between 5 and 10% of their body weight, these risks are reduced or completely disappear. So why look for celebrity endorsement? The answer lies in the national statistics.

In 2009, the National Institutes of Health reported obese people in the US represented 34% of the population while the number who were merely overweight represented only 32.7%. For the record, this classifies 72 million people as obese, i.e. their BMI is 30 or higher. In fact, the rate of obesity has doubled over the last thirty years and, being dispassionate about it, this represents a major market for weight loss products and services. Billions of dollars are at stake. Against this background, the San Diego Medical Center has been running a clinical trial on POSE (Primary Obesity Surgery Endolumenal). This is a new approach to bariatric surgery. The increasingly common lap band procedure requires the surgeon to enter the body through the abdomen and this inevitably leaves a scar. POSE is surgery performed using an endoscope. This is a device pushed down the throat and into the stomach without any need for an incision. Once inside the stomach, there are tools operated remotely by the surgeon. This allows the stomach walls to be sutured, reducing available space by about one-third. Thus, the effect is the same as in conventional surgery. Patients begin to feel full minutes after starting to eat. Thus, for those who have vanity issues and want to achieve a “body beautiful”, this form of surgery promotes weight loss without scars.

For the purposes of the trial, only people who have a long history of weight problems are being considered. But, if the trial proves a long-term success, you will probably see this type of procedure heavily advertized for people of all weights. It’s not our policy to argue people should not have surgery. There may come a time when people prove themselves so lacking in will power to diet and exercise that physically preventing them from overeating is the only way of saving their lives. But what does concern us is the notion that surgery should become the normal response to weight problems. As a nation, do we really want to spend millions of dollars every year on surgery when the solution to the problem is a diet, physical exercise and phentermine? Just think for a moment. Phentermine is an effective appetite suppressant. Why do people using it not lose weight in the long term? Because they continue to eat massive portions of unhealthy food. People are unable to prevent themselves from overeating. What does that say about the character of Americans? We have become a nation of food junkies, so addicted to eating, we cannot stop even when we know it’s killing us.

Is Viagra safe?

Is it safe for men with high blood pressure to take viagra?

As men getting older, their arteries become less flexible and blood pressure rises. This problem is aggravated by obesity, too much cholesterol in the blood, diabetes, kidney disease, and so on. Viagra works by allowing arteries to dilate. For those with erectile dysfunction, this is a good thing because dilation allows more blood to flow into the penis and creates an erection. But if more arteries are affected, blood flows more rapidly around the body and this causes a drop in blood pressure. Viagra is designed to be reasonably specific, i.e. only to affect the penis. But if you are also taking one of the drugs designed to reduce blood pressure, e.g. ACE inhibitors, diuretics, alphablockers, etc., it was suggested the interaction could produce a more rapid drop in pressure which might be dangerous.

The question, obviously, is short: “how dangerous?” In 2002, the drug companies ran a full clinical trial to find out. Men with high blood pressure were invited to participate and took both viagra and one of the other medications used to treat hypertension. Over time, less than 3% of the participants stopped taking the viagra. Indeed, some 75% found their erections improved without any side effect. The problem with a clinical trial is that this is one group of participants asked to report how they feel on a sensitive issue. It does not mean that viagra is safe for every man. So, if you have high blood pressure, viagra is probably safe and, more importantly, the improvement in sexual performance makes any actual side effects acceptable. But you should monitor the situation and, if you do experience problems, discuss them with your doctor. Remember, there is clear evidence that combining viagra with a nitrate is dangerous. This drug is usually prescribed to treat heart disease. Finally, you should take life easy for six months after a stroke or heart attack.

Can diabetics take viagra?

Diabetes can damage the nerve endings in different parts of the body. This interferes with the way in the body feels things and can cause erectile dysfunction. There have been a number of trials to measure the effectiveness of viagra among men with diabetes. To ensure a scientific result, the men were not told whether they were using viagra or a placebo. Some were allowed to change the dosage up or down from the standard 50 mg.

Taking all the trials together, none of the men reduced the dosage. The majority taking the standard or a higher dosage reported an improvement in their ability to achieve penetration and maintained the erection over time. Some 60% achieved significantly better levels of sexual satisfaction. This is a good performance from a group suffering nerve damage that cannot be cured. Only about 2% of the participants stopped using cheap viagra because of adverse side effects. The most common problem was feeling thirsty which was easily resolved by drinking water. More serious side effects were rare. A few suffered hypo- or hyperglycemic events, and one or two found their eyesight was affected.

It won’t make you go blind

It’s strange how the warnings given when you are young can still haunt you years later. Very early, parents and teachers muttered darkly that masturbation will make you go blind. This is a terrible warning to give a growing child. Everything in the world is shiny and new. You are just starting to drink in all the sights, sounds and new experiences. To suggest you will be denied sight if you pursue just a little personal pleasure in private is unkind to say the least. It goes way beyond the use of guilt and ordinary fear. This is the demonization of a natural activity that helps you learn about the way in which you body works. At a time when you should be exploring the relationship between your body and your emotions, you are left with nothing but frustration. Until you find a willing partner that is. Then the world takes on a different look and feel as “natural” emotions start to flow. Except you then run into a whole new set of barriers where parents expect you to wait until marriage before trying sex. Abstinence is the preferred message in modern sex education for growing children.

By a curious coincidence, the labels on the drugs used to treat erectile dysfunction also refer to various risks connected to eyesight. This is not a threat made to deter adults from sexual activity. Rather, it refers to a side effect experienced by some of the men who take the drugs. A very small number of men have reported a slight blurring of their vision, often accompanied by a blue tinge to what is seen. One or two have experienced a complete loss of vision. This latter is so remote a possibility that it can almost immediately be dismissed. The average man is never going to find his vision disappearing. To discover the extent of the risk of mere blurring, there has been a recent clinical trial involving almost 250 healthy men. None of the men had any problems with their vision and their eyes were tested before, during and after taking the relevant drugs (or a placebo) over a six month period.

The results were recently published and show no change to the eyesight of any of the men who participated. There are two minor comments that take the edge of the goodness of the news. The first is that the participants were given low doses of viagra. In the real world, the men who reported problems were all taking up to the maximum daily dose. Thus, the strength of the evidence is limited by the need to produce an ethical study. Researchers should not knowingly design a clinical trial likely to injure the participants. Secondly, none of the participants had any existing problem with their eyes. Again, the men who reported problems all had less than perfect vision. The study therefore suggests that it’s perfectly safe to take viagra. It will not make you go blind if you are taking a lower dose and you have no existing problems with your eyesight. Because this represents most men, this study confirms viagra’s reputation as safe and effective.

Your eyesight is not at risk

When I was growing up, my parents and other adults took up the challenge of trying to educate me in the ways of sex. It was dangerous work, but someone had to do it. One of the first pieces of advice that stuck concerned the activity of masturbation. Although no-one would give me a demonstration of what this thing was, I was led to understand that too much of it and I would go blind. Naturally, being of a stubborn disposition, I decided to keep the activity going, hoping I was only risking one eye. This is a classic use of fear and guilt to encourage people to modify their behavior. It came alongside a similar warning that watching too much television was also bad for my eyesight. Apparently, the cathode ray tube gave off radiation that would rot the lenses and turn my retinas to jelly. Or was it that my retinas were a kind of jelly and, as with a microwave, they would be cooked and stop admitting light. The details are hazy but the message was clear. The combination of television and sex were bad for the eyesight.

Coming forward to the new century and the FDA began to receive reports through the post-marketing monitoring program that some men were experiencing problems with their eyesight when using the little blue pills. Because they were blue pills, the men claimed their vision was tinged with blue and sometimes blurry. Actually, I made that up. The men made no such claim but their vision was tinged with blue. The reason was that PDE6 changes the way the retina works and the little blue pills are designed to affect PDE5 which is in the penis. Unfortunately, the pill is not always specific, what with sex and eyes being so closely connected.

At first, this was not thought to be a serious problem but it became so when one or two men reported actual vision loss. In a billion dollar US market, the notion that men may go blind is dangerous to future sales, so an immediate new clinical trial was ordered. Well, men can relax again (except after taking the pill, of course). This October has seen the publication of the report from a six month trial. In a double-blind, randomized trial, two-thirds of the participants took the real drug and one-third took a placebo. At the end of six months, there was no measurable difference in the eyesight of the participants in both groups. Allowing for natural ageing, their eyesight was unchanged from start to finish.

It’s a little ironic after all these years to see real panic at the notion that too much sex using viagra will make you go blind. My parents would have appreciated the temporary support to their own threats relating to masturbation. Although I do admit to having to wear spectacles these days, I am no different from the millions of older men. We Boomers wear our fading eyesight with pride. Despite all the sex over the years, we have managed to make it this far with only minor short-sightedness. With a little help from viagra when our muscles tire, we can expect to enjoy many more years of sex (or, at least, we can all risk one eye with that aim in mind).