Dear Alice,

I've been concerned about my weight all through college. I have what you would call a sub-clinical eating disorder that never goes so far as anorexia or bulimia. My question is: I have been using diet suppressants (phenylpropanolamine HCL 75mg) bought over the counter for months. Sometimes I don't take them for a week, but usually I take one dose a few times a week. I know it's not recommended to take them longer than three months. Exactly what are the side effects of this drug? Am I endangering my health by taking them? Sometimes they don't even work.

Sincerely,
Dexatrim Junkie

Dear Dexatrim Junkie,

It's great that you're asking these questions, as being more informed about the effects of products you put into your body can help you be a more informed consumer. It may be helpful to start with a quick overview of phenylpropanolamine. Phenylpropanolamine (PPA) is an amphetamine-like substance that's been the principal ingredient in several weight-loss products sold over-the-counter (OTC). PPA disrupts hunger signals to the brain and dries out the mouth, making food taste bland and unappetizing. However, according to a warning issued by the U.S. Food and Drug Administration (FDA), PPA is no longer considered safe for consumption due to its unsafe side effects. The FDA asked manufacturers of products that contain the compound (including weight loss products and many OTC allergy and cold medications) to use another active ingredient in their formulations. This means Dexatrim, the product you referenced, no longer has PPA. Speaking with a health care provider before consuming any supplements can help ensure you're taking products that are appropriate for you. Additionally, as you mentioned that you live with disordered eating, they may be able to help you with your eating concerns when you feel ready.

The FDA's warning about PPA was primarily due to an increased risk of hemorrhagic stroke (bleeding into or around the brain) associated with PPA. Other side effects include nervousness, restlessness, sleep issues, headaches, nausea, dizziness, increased blood pressure, cardiac injury, and feelings of chest tightness. PPA is especially risky for pregnant or postpartum people and people with pre-existing conditions such as diabetes, high blood pressure, heart disease, hyperthyroidism, glaucoma, prostatic hypertrophy, renal disease, hypersensitivity history, and depression (especially if taking monoamine oxidate inhibitors, which are frequently called MAOIs).

You also mentioned that you've struggled with your weight and live with a subclinical eating disorder. The medical community has no set standards or criteria for subclinical eating disorders, and the term disordered eating is more commonly used. That being said, those who experience disordered eating often exhibit some of the signs or behaviors of eating disorders, while not meeting the threshold for a diagnosable eating disorder (which can only be diagnosed by a health care provider). If you're looking for assistance with managing your appetite or weight, consider contacting a health care provider to discuss the options that would be appropriate for you. They may be able to refer you to a specialist, such as a registered dietitian, to discuss your eating behaviors and weight concerns (if and when you're ready). You may also find it helpful to talk to a mental health professional about your concerns. Additionally, the National Eating Disorders Association (NEDA) also has a number of resources, including a helpline and a tool to help find treatment. This can help connect you to people who are specifically trained to help those with disordered eating. For more information and resources, check out the Q&As in the Go Ask Alice! Disordered Eating and Eating Disorders category of the Nutrition and Physical Activity archives.

Alice!

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