The Pulse


No Gimmicks : Why Diet Pills Don't Work

by Patrick Reynolds

As part of our #NoGimmicks campaign we asked new Kenzai trainees to send in photos of products that failed to deliver fitness results. There were quite a few items that promised weight loss effects from consuming a pill:

I can understand the allure of these products. If we can design medicines that are effective for everything from cancer to erectile dysfunction, what's so implausible about a diet pill that would increase metabolism and burn fat?

The answer lies a single word. HOMEOSTASIS.

All animal life exists through the conversion of matter into energy. This conversion relies on a cocktail of enzymes that use biochemical reactions to unlock the energy stored within food. The enzymes that mammals prefer work best within a very specific set of conditions. The process of maintaining these internal conditions is called homeostasis.

Mammals have evolved a suite of feedback mechanisms that ensure the body remains within a narrow band of body set-points. The most familiar example of this is body temperature. Isn't it amazing that a person living in Svalbard, north of the Arctic Circle, and a person living in Timbuktu, Mali, at the foot of the Sahara, will record the exact same internal body temperature of 37°C? The body has a bag full of tricks to keep itself at that temperature. Sweating, vascular constriction, hormones that evoke a heat response from the organs, and fat storage or shedding are all tweaked to keep your thermostat at 37°, no matter who or where you are.

There's a similar set of tricks for every variable you can imagine. The body's acidity, hydration, glucose, barometric pressure, salinity, and iron level all have their very specific set points, along with a multi-tiered feedback system in place to make sure they stay there. If something goes wrong and you stray from this narrow band of homeostasis, your body will pull a series of switches to get you back in the zone. If it can't get you back to homeostasis, you'll soon become sick. Stay out of the band for too long and you die. 

Homeostasis is the law of the land, when it fails you either end up in the hospital or the funeral home.

It's like a ball at the bottom of a curved bowl. You can try to set the ball somewhere else in the bowl, but, after a few oscillations it'll always roll back to the exact center.

Your body is in the same stable equilibrium. Homeostasis is the law of the land. When it fails you either end up in the hospital or the funeral home.

With that established, we can finally talk about diet pills. These pills promise that they'll strategically enter your body and toggle one of your internal switches so that you'll lose body fat without effort. They claim to do this in a two different ways:

1. Suppressing the appetite

The majority of diet pills fall into this category. By activating certain hormones, a substance can kick-start your body's sympathetic response (fight-or-flight) system. When your body is in the hyper-alert, ready-for-action state, your appetite disappears. This is very useful for dealing with a one-off emergency, but when you keep your body in this state day after day, you start to feel pretty horrible. Common complaints are insomnia and jitteriness, along with hypertension as the heart pumps in emergency like conditions all day.

If you stay on these pills for too long, your body's need for homeostasis will assert itself, and the neurotransmitters that the pill triggers will be dampened or ignored by the body. So you've significantly damaged your brain's ability to regulate stress and enter the "rest and repair" state where your body creates new tissue and fights disease. This is a pretty big deal. Appetite suppressants are pulled from the market every few years because (surprise!) it turns out prolonged use elevates the risk of depression, dementia, stroke, and heart attack.

2. Blocking the absorption of food

There's just one approved drug that does this, Orlistat. It inhibits lipase (one of those all-important enzymes the body is maintaining homeostasis for) so your stomach can only digest 2/3rds of the fats that enter your stomach. Instead of processing the other 1/3rd of fats, the body flushes them through the digestive track, resulting in uncontrollable oily diarrhea for 90% of users in the first year. Good times.

The oily bowel discharge lessens with time, but when you dive into the research you find that most of this is due to people consuming far less fat than before (because fatty meals = severe diarrhea). This is also a form of homeostasis. When you find a food that makes you ill, your body has a series of tools it can use to make sure you don't eat it again. The taste of that food becomes less appealing. The sight or smell of it can make you feel queasy. This is the true mechanism by which Orlistat works. It makes eating fatty food so disgusting and uncomfortable that you start to avoid it.

The funny thing about these pills is that every single one says you'll lose weight "in combination with a balanced diet and exercise." Even giving these substances the kindest reading, they "boost" fat loss by 10-15% at most. A healthy diet and exercise are doing the rest. I'd rather tighten up my nutrition and exercise by 10% than cheat that 10% with an expensive pill with dreadful side-effects.

So that's the state of modern diet pills. Pretty unimpressive. But there is a diet pill out there that truly works. It's a pesticide from the 1930's called dinitriphenol (DNP for short), and it is a helluva drug.

The substances we discussed above all try to tweak things at the digestive level. DNP actually changes the way your cells work. The molecular biology here is quite intense (dive in if you're feeling brave), but the overview is that DNP lets the protons in your mitochondria pass through the mitochondrial membrane without having to undergo ATP synthesis. Basically, your cells become much less efficient at producing energy, because the fuel for the reaction is leaking out through holes in the gas tank.

This means that your body has to use a ton of energy to maintain itself. Your body accesses fat stores to make up the difference and voila, you lose significant body fat quickly.

So why aren't we all popping some DNP with our lunch burritos? You guessed it. HOMEOSTASIS!

It turns out that decoupling those protons releases a bit of excess heat. When every cell in your body starts to release heat, your body temperature rises. Dinitriphenol gives you a wicked fever. Bodybuilders who have tried it recount sweating profusely day and night, unable to go about their normal life in the fog of heat. The Russian army even tried using it to keep their soldiers warm during winter warfare. 

Larger doses of DNP release more and more protons, the heat rises, and the body continues to attempt homeostasis by putting all available resources to the cool-down effort. You can take so much DNP that you literally cook yourself from the inside out, succumbing to hyperthermia, your organs shutting down one by one in a fatal internal heat stroke. There are a few DNP deaths every year, even to this day. 

So DNP is a pretty dangerous thing to mess with. That's why the FDA banned it. In 1938.

I bring up DNP because THIS is what it looks like when one of these pills actually works. If you actually bought a diet pill that significantly alters your body's fat-storage mechanism in a meaningful way, it will result in immediate and dramatic physical changes. Because you can't just do that kind of thing without disrupting homeostasis, setting off a chain of unwanted side-effects that end up damaging the overall system.

This is why we've been able to send people to the moon but haven't made much progress with fat-loss wonder-drugs. We're fighting a deeply entrenched mechanism 265 million years in the making. Maybe one day we'll crack it. But today is not that day.

Until then we're left with the stuff you already know. A balanced diet consisting mostly of plants, and consistent, moderate exercise. This is the combination that works with homeostasis rather than against it. You have within you an exquisitely balanced system for regulating fat and muscle. Your body is doing the heavy lifting, all it asks you to do is eat well and get off your ass.

Is that really such a bitter pill to swallow?

Check out the rest of the #nogimmicks series : fitness trackers, exercise gear, and detoxes.


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