How much are you willing to pay per pound to lose weight?

prairieecothrifter

The Food and Drug Administration (FDA) recently approved two new medications for weight loss.

Qsymia, is actually a combination of two older drugs – topiramate (Topamax), an anticonvulsant that helps increase satisfaction after eating, and phentermine, a psychostimulant and appetite suppressant. Using Qsymia combined with diet and exercise for a year led to an average weight loss of 8.4% of total body weight, or about 20 pounds.   

Qsymia is a controlled medication because it has a potential for addiction. Like other psychostimulants (think Adderall and Ritalin), it can cause a fast heart rate and a tingling sensation in the limbs. Other side effects include memory impairment and decreased concentration. Topiramate can cause birth defects as well.   

Belviq, is an entirely new class of medication called a serotonin 2C agonist.  It helps patients feel full sooner and eat less. Belviq was even less effective than Qsymia in helping with weight loss; it led to an average annual decrease of just 5% of total body weight, or about 7 pounds. The side effects from Belviq are minimal, but because older serotonin agents were associated with heart problems, everyone is keeping a close eye on it. 

Information about cost is hard to pin down exactly, but the best guesstimates are that Qysimia will cost about $6 a day and Belviq $8 a day.   

This made me wonder if we should approach these medicines as if they were in a refrigerator case at the grocery store and ask ourselves, “What am I paying per pound?”

When you look at it this way, these two new wonder drugs don’t look so great. Qsymia will run you about $109/pound of weight lost while Belviq will cost you about $417/pound.

To give you an idea of how that compares to other methods that have been around for a while:

  • Weight Watchers = $ 97/pound
  • Nutrisystem = $130/pound
  • Jenny Craig = $131-237.56/pound
  • Weight loss surgery = $235 – 400/pound
  • Diet and exercise = $0/pound!

As you can see, none of them are cheap, and the only one that doesn’t cost you any money costs you a little more in time and effort.  Unfortunately, it’s the only one that really works.  In fact, it’s the main ingredient in those super expensive drugs we’re talking about.  Read that description again – “using Qsymia combined with diet and exercise led to weight loss…”  The problem with diet pills is that not only do you gain the weight back as soon as you stop taking them, but without diet and exercise, they barely make a dent in your waistline.

Because of all of this – the cost, the side effects, the potential for addiction and the lack of any proven long-term benefit – we don’t even prescribe these medicines at the Student Health Center. We’d rather work with you one on one and help you take advantage of the resources available to you here at Ohio State.    

At Student Health Services, we can offer a “well person” exam with any indicated laboratory tests and refer you to one of our registered dieticians. Dining services offers some great online resources to help you keep tabs on your nutritional intake and Rec Sports has many facilities and programs to help you participate in any kind of exercise that you are interested in. 

We want you to succeed at getting to and maintaining your optimal healthy weight. As soon as it is as easy as taking a pill, we’ll let you know.  In the mean time, we’re here to help you do it the right way.

Jo Hanna Friend D’Epiro, PA-C, MPH
Student Health Services
The Ohio State University

Is 5-hour Energy safe in Pregnancy?

5-Hour Energy

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A sharp-eyed BuckMD reader read our original post on 5-Hour Energy and sent us the following note:

If 5-Hour Energy drinks are no more harmful than coffee, what are the risks of drinking less than a bottle daily during pregnancy?  I have read your site and found nothing specific on risks/side effects during pregnancy.  Are there any risks to the baby?

Good question.  The short answer comes straight from the horse’s mouth.  From the 5-Hour Energy website:

Who should not take 5-hour ENERGY®?

  • Women who are pregnant or nursing.
  • Children under 12 years of age.
  • People diagnosed with phenylketonuria (PKU)

So even though (or more accurately, because) the 5-Hour Energy folks have never had to concern themselves with ensuring that any of the ingredients in their product are safe or actually do anything, they draw the line at selling it to people who are pregnant. 

Like we said in our last post, despite 5-Hour Energy’s promotion of its B Vitamins and medical-yet-natural sounding “energy blend,” the only thing in it that has ever been proven to improve mental alertness is caffeine.  So the question really is, “is caffeine safe in pregnancy?”  And the answer to that question is… maybe.

Some studies have reported an association between caffeine intake and adverse pregnancy outcomes while others haven’t.  These studies are inconsistent because it’s very difficult to control for all the factors that affect a pregnancy, not to mention accurately measure how much caffeine research participants really consumed.  The best we can say is that women who are pregnant or trying to become so should probably limit caffeine consumption to less than 200 to 300 mg per day to reduce their risk of possible adverse reproductive effects

The problem is that because 5-Hour Energy is sold as a supplement and not a medication, the company is not required to disclose their products’ caffeine content.  All it says on its website is that it “contains about as much caffeine as a cup of premium coffee.”  So what does that mean?  According to Energy Fiend, a 12oz Starbucks coffee has 260mg of caffeine while a 10oz Tim Horton’s coffee has 100mg.  So sometimes a cup is more than a cup.

What about the excess of B Vitamins in 5-Hour Energy?  Are they safe in pregnancy?

A can of 5-Hour Energy contains 30mg of B3 (Niacin), 40mg of B6 and 500mcg of B12.  The recommended daily allowance of these vitamins in pregnancy is 18mg of B3, 1.9mg of B6 and 2.6mcg of B12, so one can of 5-Hour Energy gives you way more than you need, especially since you’re more than likely getting enough from your diet anyway.  In general, B Vitamins aren’t dangerous in large amounts because they’re water soluble – once your body has enough, the extra is just excreted in your urine – so other than making your pee more expensive, 5-Hour Energy is unlikely to be dangerous.  However, an excess of Vitamin B3 (Niacin) can produce an uncomfortable flushing sensation.  

When in doubt, talk to your health care provider about anything you’re putting into your body when you’re pregnant or nursing.  If you are a student at Ohio State and have questions about pregnancy planning or other issues related to your reproductive health, you can make an appointment with our women’s services department; they are always happy to help you. 

John A. Vaughn, MD
Student Health Services
The Ohio State University

Will my buddy make me fail a drug test?

Laboratory

altmedicinesecrets.blogspot.com

Q: While I was at a party a few weeks ago I was around a lot of people who were smoking pot. I have a urine drug test coming up and I’m wondering if I might test positive.

A: The urine marijuana test detects a chemical called tetrahydrocannabinol (THC), which is the active drug in marijuana. THC is stored in body fat and excreted in the urine. For someone who smokes a single marijuana cigarette, THC metabolites are detectable for several days. For chronic marijuana smokers, the level of THC builds up in the body fat over time and is excreted for weeks after the last time they used the drug.  Urine drug tests are set with a high threshold to eliminate false positives (people that test positive but do not use the drug).

Traces of marijuana may be detectable in the urine for a day or two in someone who was around marijuana smoke, but if you didn’t personally smoke it, you likely have nothing to worry about.  Smelling marijuana smoke at an outside event is very unlikely to result in a positive test, but it’s probably a good idea to avoid enclosed areas where people are smoking, like cars and closed rooms.  

BTW, if you are getting drug tested, it is wise to bring along all prescription and non-prescription medicines you are currently taking.  Prescription drugs are increasing becoming popular drugs of abuse, and so, are being tested for in many drug screens.  If a drug is found in your pee, it avoids a lot of problems if you can prove that it should be there. 

Good Health!

John Vaughn, MD and Roger Miller, MD (OSU Student Health Services)

Give Student Health Your Old Drugs!

legislatorford.gov

The Student Health Services Pharmacy will be holding our 2nd annual DEA-approved drug Take-Back Day this Wednesday, May 30th, from 9:00 a.m. to 2:00 p.m. 

All students, staff, and faculty are invited to bring unused or expired medicines to be disposed of in a safe, legal, and environmentally-friendly way.  This service is entirely free of charge and is completely anonymous.  No questions asked!  We will take any expired, damaged or and unused medications (even if they are a controlled substance like narcotic pain medication or ADD medication), as well as sharps containers (containers that store used needles). 

Please note: Do not remove medication labels before drop-off.  Syringes, needles, and thermometers will not be accepted.

Our goal is to address a vital public safety and public health issue by removing potentially dangerous prescription drugs from your backpacks and medicine cabinets. 

  • Since 2007, more Ohians have died from unintentional drug overdosing than motor vehicle accidents.
  • More than 7 million Americans currently abuse prescription drugs, according to the 2009 Substance Abuse and Mental Health Administration’s National Survey on Drug Use and Health. 
  • Each day, approximately 2,500 teens use prescription drugs for the first time to get high, according to the Partnership for a Drug Free America. 
  • Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet. 

These expired medicines can be as bad for our environment as they are for our health.  Measurable quantities of some common medications are showing up in lakes, reservoirs, and municipal water supplies, thought to be due in large part to improper flushing of medications down sinks and toilets.

So make the right choice and join us for our 2nd Annual Medication Disposal Day!  It’s a great way to keep yourself healthy and our campus safe! 

This event is jointly sponsored by Student Health Services (Office of Student Life), Department of Public Safety, and Generation Rx. 

Phil Anderson, RPh
Student Health Services
The Ohio State University

Reasons to quit smoking that you might actually care about

photo: nytimes.com

Q: Yeah, yeah, yeah… smoking might give me lung cancer when I’m like 80.  So why should I worry about it now when I can just quit when I’m old?

A: Sure, lung cancer is one of the main reasons to quit, but we know you college (and graduate) students are invincible and don’t really care about little things like mortality, so here are a few other good reasons to quit smoking that might hit a little closer to home:

Tooth Loss

  • It is well known among dentists that smoking dramatically increases your chances of “edentulism” (i.e having no teeth). Smoking causes gum disease and plaque build-up which lead to tooth decay and loss. One study showed that the risk of tooth loss in smokers is more than 4 times that of non-smokers! Think you look cool holding that cigarette? Just think how much cooler you’ll look with dentures. The good news is that the risk of tooth loss decreases with smoking cessation.

Wrinkles

  • Smoking is one of the leading causes of premature skin aging. (One of the identical twins in the photo at the right smokes and has been in the sun more than the other – can you tell which one it is?) Tobacco leads to degradation of the collagen and elastic fibers that keep skin looking smooth and young, leading to premature wrinkles, especially around the mouth and eyes. The mechanisms for this are thought to be similar to the damaging effects of ultraviolet radiation on the skin – so stop tanning too while you’re at it!

Cervical cancer

  • Ladies, did you know that if you have been infected with certain types of Human Papillomavirus (HPV), smoking increases your risk of developing cervical cancer compared to nonsmokers? Researchers are still looking into why this is, but they have actually detected nicotine in the cervical mucous of smokers!  And cervical cancer isn’t one of those things you only have to worry about in the distant future; it is increasingly affecting women in their 20s and 30s. The risk gets higher the longer you smoke, so the sooner you quit the better.

Birth defects

  • It is amazing that in this day and age we still need to tell people to quit smoking before they become pregnant, but unfortunately we still see it all the time. Smoking increases a woman’s risk of premature delivery, still birth, low infant birth weight, and sudden infant death syndrome (SIDS). Since roughly 50% of pregnancies are unplanned, the time to quit is now!

Limb amputation

  • Smoking is one of the major risk factors for peripheral arterial disease (loss of blood flow to the extremities which can lead to tissue damage and amputation). Ok, maybe this is another one of those long term problems you don’t want to think about while you’re young and indestructible, but it’s out there and it affects many people as they get older.

Poverty

  • We know that financial concerns are far and away the biggest stressors for students: tuition, rent, books, fees, not having enough time to study for your classes because you have to work so many hours to pay for them. A pack of cigarettes costs around $5, so a pack-a-day habit costs you $1825 a year! Think about that. How many months of rent or credit hours would that buy? How many student loans could you pay off (or not take out in the first place)? Even if you’re just a casual smoker who only buys a pack on the weekend when you go out drinking, that’s $250 in a year. That would buy you an iTouch!

The thought of becoming a poor, wrinkly, stressed out, toothless, cancer-ridden amputee still not enough reasons to quit?  Check out the CDC’s website for more useful information on the risks of smoking and resources for quitting.  We’ll follow up with another post listing some local resources for quitting soon.

Angela Walker (Ohio State College of Medicine)

John A. Vaughn, M.D (Ohio State Student Health Services)

How to check on your pee

buzzle.com

Order-It-Yourself Testing

The Student Health Center

Q: I am a first year transfer student at OSU, and new to your services. I was wondering if you offer urine screenings?

A: Thanks for your question.  The answer depends on what type of urine screening is desired.  We do three types of urine screening as “OIY (Order-It-Yourself)” tests –

  • drug abuse screens
  • gonorrhea/chlamydia testing
  • pregnancy tests

These are all at your own cost.  For more information on OIY, check out Order-It-Yourself (OIY) Testing at our Student Health web site.  The web site also has a lot of other information, such as our location, hours, and a calendar of events.

If you are interested in some other type of urine screening, you should consider making an appointment with a healthcare provider for an evaluation and discussion of your concerns.  If you see one of our providers, we can order your test right away, and most appointments are available either the same day or within a few days. 

Wish to see a provider outside of Student Health?  Our laboratory can still process most lab orders, if you bring in or the provider sends us a written request. 

Hope this answers your question.  You may also wish to call our Advice/Appointments area (614) 292-4321 and discuss your concerns with our Advice Nurse.

Good Health!

Roger Miller, MD, (OSU Student Health Services) 

What can I do if I think I’ve been given a “date rape” drug?

www.silc.ku.edu

While thankfully rare, incapacitated sexual assault does occur on college campuses.  Womens Services at Student Health has put together some really useful information about what Ohio State students can do if they feel that they were the victim of a “date rape” drug. 

Please check it out.  And remember to be careful when going out to bars or parties or any other place where you might be given a drink from someone you don’t know.  Keep your friends close by to make sure you all get home safely.  

Beth Askue, MS, CNP
Student Health Services
The Ohio State University

Is it OK to share my ADD medicines?

Don't end up like this guy!

ADD medicine

Q:  Is it OK to give my friend one of my ADD pills to help him study for a test?

A:  Before we answer that question, let me ask you another one.  Would you sell that pill to a stranger for $50?  I’m guessing – hoping – your answer is an emphatic “NO.”  Well, from a legal point of view, these two questions are identical.

Most ADD medications (such as Concerta, Ritalin, Adderall, Focalin, Metadate, Methylin, and Daytrana) are Schedule II controlled substances because of their serious side effects and potential for addiction.  They are monitored very closely by doctors, pharmacists, and the Drug Enforcement Agency (DEA).  We’re not lawyers here at Student Health, but we do know that… 

It is a violation of Section 2925.03 of the Ohio Revised Code (Ohio law) to sell another person a controlled substance.  The important thing to remember here is that the legal definition of “sell” includes “delivery, barter, exchange, transfer, or gift…”  

So even if you are just trying to help out your friend – and getting nothing in exchange for it – you are breaking the law.  And we’re not talking about a speeding ticket here.  You are committing a 4th degree felony, which is punishable by 6-18 months in prison and/or a $5,000 fine.  And assuming you are anywhere on or near campus, the felony gets bumped up to 3rd degree and you’re looking at 1-5 years in prison and/or a $10,000 fine.  Not to mention the fact that you could lose your financial aid and/or get kicked out of school.  

Now granted, the odds of someone busting into your dorm room and catching you in the act are very slim.  And unless you really don’t get along with your roommates or neighbors, odds are no one is going to turn you in.  But forget about the legal stuff for a minute.

  1. These medications are addictive and there’s a real chance your friend could get hooked on this stuff.  You don’t want to risk sending someone down that dark road.
  2. While these medications have a calming effect on people with ADD, they are actually central nervous system stimulants so in addition to things like headache, insomnia, anorexia, agitation, anxiety, tremors, vertigo, depression, and nervousness, they can cause life-threatening problems like heart attacks, increased heart rate, increased blood pressure, and heart arrhythmias.  Doctors evaluate people for these conditions prior to starting these medications and monitor them closely while they’re taking them.  Without knowing your friend’s health history, you could literally be putting his life at risk – and no test is worth that much. 

Managing your health is a serious responsibility and that’s especially true if you have ADD.  If you’re taking one of these medications, the best thing to do is keep it to yourself – if no one knows you have the pills, they won’t be able to ask you for one.  And if you have a friend who is taking these medicines, don’t pressure them into giving you one.  It’s more likely to hurt you than help you, and it’ll just put everyone at risk for serious trouble. 

If you have any questions about these or other medications you may be taking, the staff of Student Health Services pharmacy is always available to help!

Jason Goodman, PharmD, RPh (OSU SHS)

Black Out In a Can

nydailynews.com

In November, students were appalled when their beloved “black out in a can,” AKA Four Loko, announced that they would be removing the caffeine from their beverages.  The U.S. Food and Drug Administration (FDA) had sent out a warning letter to four manufacturers of alcoholic caffeinated beverages stating that these drinks were unsafe and subject to seizure. 

What’s the big deal?  What’s so dangerous about mixing alcohol and energy drinks?

Combining alcohol and caffeine creates a “wide-awake drunk” – because of the stimulating effect of the caffeine, you don’t feel the fatigue that you normally do with alcohol consumption alone.  In other words, you don’t feel as drunk as you really are.  So you end up knocking a few more back than you might otherwise and keeping the party going way longer than it should. 

The problem is that your blood alcohol level goes up the same whether your drinks contains caffeine or not; all you’re doing is adding the nasty risks of caffeine intoxication to the already dangerous risks of alcohol intoxication – horrible hangover, insomnia, vomiting, palpitations, dehydration, elevated blood pressure and even cardiovascular failure (otherwise known as death).  Scary stuff.

On top of that, a 2008 study of college students showed that mixing alcohol and energy drinks led to a higher prevalence of being taken advantage of (or taking advantage of someone) sexually, getting into a car with a drunk driver and suffering injuries that require medical treatment. 

If you and your friends are still looking to get a little “loko” this weekend, here are some tips to follow that will hopefully keep you a little safer.    

  • Split the drink with a friend
  • Dilute your drink with soda, juice, or lots of ice
  • Don’t drink on an empty stomach
  • Drink lots of water throughout the night

Alexandra Hinkley
Senior, School of Allied Medical Professions
The Ohio State University

John A. Vaughn, MD
Student Health Services
The Ohio State University

You’ll huff and you’ll dust and you’ll sniff your brain down!

VernonHills.org

According to a 2006 survey, 11% of high school seniors had abused inhalants.  Most users stop by late adolescence so you don’t see too much huffing (or sniffing, snorting or dusting) on college campuses, but since a small percentage of users continue into adulthood you might run into it.     

Inhalants are gas or vapors in common household products that produce a high when inhaled in concentrated quantities. Common examples include glue, keyboard cleaner, spray paint, air fresheners, liquid eraser (WhiteOut), vegetable cooking spray, and whipped cream. 

Inhalants produce their high by quickly passing through the lungs and into the bloodstream, where they travel to the brain and dissolve into the fatty tissue surrounding it.  While the high only lasts a few minutes, the effects – especially with repeated use – can last a lifetime.  Inhalants block the ability of blood to transport oxygen so major organs like the brain, heart, kidneys, lungs, liver and muscles can’t work properly.  For more details, check out the National Inhalant Prevention Coalition and livestrong

It’s also important to know that it isn’t just chronic use that is dangerous.  Up to 22% of people who’ve died from “sudden sniffing syndrome” – a condition where the heart flips into an irregular and lethal rhythm – were first time users.  So trying it just once can kill you. 

If you are concerned about yourself or a friend, get help!  Talbot Hall at OSU East provides alcohol and drug recovery services 24/7/365, and the fine folks at the Student Wellness Center and Counseling and Consultation Service can direct you to other helpful resources as well.

Cheryl Czapla, Med IV
College of Medicine
The Ohio State University

John A. Vaughn, MD
Student Health Services
The Ohio State University