Dieting: a risky cocktail of drugs from Brazil

Spring is a time when many of us try to shed a few extra pounds that we've put on during winter.

But some Massachusetts residents are turning to a potent, illegal and potentially dangerous cocktail of drugs to lose weight. The pills come from Brazil and are largely unknown to state and federal health officials.

WBUR's health and science reporter Allan Coukell has our story.TEXT OF STORY

ALLAN COUKELL: One day, Odette Esselman noticed that a Brazilian acquaintance of hers seemed to be losing a lot of weight. Esselman wanted to shed a few pounds herself.

ODETTE ESSELMAN: So I asked her how she was doing it and she gave me the doctor's name and number to call in Brazil.

COUKELL: Odette phoned this doctor who took some information over the phone, and asked her to get some blood tests. She wired money to Brazil and the pills arrived in the mail a week. They packed a punch.

ESSELMAN: I wasn't hungry. I mean, my twelve hours shifts: sometimes I came home and said, 'oh my god, I haven't eaten.'

COUKELL: She had coffee in the morning and tried to force herself to eat a bowl of cereal in the evening. In three months, she dropped thirty seven pounds - going from a size 14 to a size 6, sometimes 4.

ESSELMAN: I'd go out and buy a pair of pants. The next day - the very next day! - the damn things were loose! So I was buying clothes weekly. (Laughs) It felt good.

COUKELL: Esselman recommended the pills to friends, but their experiences weren't as positive. For instance, her sister ended up in the hospital with heart palpitations.

Now, meet Paul. He knows that pattern well.

PAUL: Oh, the pills? Well, because I was gaining weight. And I don't like exercise at all.

COUKELL: Paul - who's asked that we use only his first name — runs a painting business in Stow.

PAUL: And I got a friend, he said, 'you know what, we've discovered a pill. It comes from Brazil. And that pill makes you lose about ten pounds per week. And then I took those pills.

COUKELL : Unlike Esselman, Paul didn't speak to a doctor. He bought his pills here, from a friend who had a supply. They cost the equivalent of six hundred dollars for one-month. Although, as it turns out, his stint on the medication didn't last that long.

PAUL: That really hearts my stomach. And I lost my appetite at all. I couldn't eat. I thought 'oh my god, this should be good'. I thought. And two weeks after, I lost 18, 20 lbs.

COUKELL: But by the end of the first week, Paul felt a pinching in his chest. He called his doctor, but didn't mention the diet pills. At a week and a half, his wife said he should go to the hospital. He didn't. By two weeks, it was really bad.

PAUL: And then I was here in my office. And then I couldn't work. And my left arm and my left leg was total numb. And my chest was pain. And then I said, 'whoa, what's going on with me?' They brought me to the hospital. And I had the heart attack right there.

COUKELL: The pills that Paul was taking are widely used among Brazilians in Massachusetts, but are largely under the official radar.

The US Food and Drug Administration has warned previously about certain brands of diet pills from Brazil. But neither FDA nor Massachusetts state health officials had heard of these pills, which are complex mixtures, developed by individual doctors in Brazil and manufactured in batches by Brazilian pharmacies.

PIETER COHEN: I have a few things to share with you...

COUKELL: Pieter Cohen probably knows more than anyone in Massachusetts about the pills. He's a Somerville primary care doctor who sees a lot of Brazilian patients.

COHEN: ...and we can see what the pills look like there...

COUKELL: The ingredients vary, but Cohen has found that the capsules typically contain multiple drugs.

COHEN: If we go down here, we can see that we have ephedra, diethylproprion, which are both amphetamine-type medications. We have Valium (diazepam), laxatives, thyroid hormone in this one, Lasix as a diuretic, caffeine, anti-nausea medication...

COUKELL: The pills are a cocktail of nearly every kind of drug ever tried for weight loss - as many as 17 jumbled together in one capsule.

Cohen has learned to ask his Brazilian patients if they are taking the pills. He says most users are women, most relatively young.

COHEN: And I would venture to guess that approximately one in five of my young Brazilian women have tried it at some time while they are here in the United States.

COUKELL: Members of the Brazilian community told us - and in some cases WBUR confirmed directly - that the pills are available from a cafe in Alston, a jewelry store in Somerville and extensively through other informal sales networks.

WBUR arranged for the chemical analysis of pills purchased locally, without a prescription. In a single capsule, we found numerous drugs, including two amphetamine-like compounds and two Valium-like tranquilizers.

Mike Montagne, a professor at the Massachusetts College of Pharmacy, says such sales of pharmaceuticals are highly illegal.

MIKE MONTAGNE: Because in addition to being medications brought in from outside the country, they are also controlled substances and there are very serious penalties, both in terms of fines and jail time for those.

COUKELL: The pills are illegal, but how risky are they? Pieter Cohen says most patients experience some side effects - often tremors, nausea, dizziness and mood swings.

I met Camila Vieda in East Cambridge. She'd just stopped taking diet pills prescribed by her mother's doctor in Brazil. Earlier, she'd tried pills sold right here in Massachusetts.

CAMILA VIEDA: We call it "Mouse Venom" because it is very dangerous.

Vieda says she stopped the "Mouse Venom" pills after only three days, because she began to get heart palpitations. But she knows a woman who has been taking them for years.

CAMILA VIEDA: I have a friend who takes these diet pills for a long time and I think it is very dangerous. Even if she's not on medication, she's shaking and I can tell she is addicted to that medication. And she knows that she's addicted too.

COUKELL: Sudden weight loss itself carries a risk, as does rapid, rebound weight gain. The thyroid hormones in the pills are another risk.

MELANIE BRUNT: OK, so here's here blood test. She has way too much T3 in her system...

COUKELL: In her office at Cambridge Hospital, endocrinologist Melanie Brunt has just seen a patient referred for thyroid abnormalities. The patient has been taking Brazilian diet pills, and the label on the bottle indicates that the pills contain whopping doses of three different thyroid hormones, which regulate metabolism.

Brunt has seen several such patients, and regularly gets calls from primary care doctors about others.

BRUNT: The normal range is 87 to 178. Her level is 432, which is very elevated. And this is somebody who has a psychiatric disorder that could be made worse by this.

COUKELL: So how big a health risk do you think this is?
BRUNT: She's likely if she stays on it long enough to develop signs of toxicity, which would be very fast heart beat or arrhythmias. She could develop insomnia, tremulousness, extreme anxiety.

COUKELL: And for another patient with underlying heart disease, it could be life threatening?

BRUNT: Yes, definitely.

COUKELL: In the course of reporting this story, we repeatedly heard of patients hospitalized after taking the pills. Most of these accounts were impossible to confirm.

But one study from Brazil suggests surprising toxicity. A survey of more than a thousand diet pill users found that 86 percent reported some kind of adverse effect. Almost forty percent sought medical attention. And four percent of patients — one out of every twenty five who took the pills - had been hospitalized because of side effects.

It is a steep price to pay for thinness, but Dr Helena Santos-Martins says many in Brazil are willing to pay it.

SANTOS-MARTINS: The fact is, in Brazil, the culture of the body is quite important.

COUKELL: Santos sees a large Brazilian population at East Cambridge Health Center. She says her patients often gain weight when they come to the US, so many turn to pills and cosmetic surgery, which are common back home. Indeed, it's been only been a year since a young woman in Framingham died from an illegal liposuction procedure performed by a doctor from Brazil. Santos says that puts the pills in context.

SANTOS-MARTINS: I've seen by speaking to some of my patients that they think they were making the safest decision: They are not going under anesthesia; they are not going into an operating room.

COUKELL: Those attitudes may be common. Doctors confirm that they are starting to see use of the diet pills by non-Brazilian patients.

One of them is Odette Esselman, who went from size 14 to size 6 on the pills. She gained back all that weight when she stopped taking the pills. She says her blood pressure went 'through the roof' and has stayed high. Still, she says, it's tempting...

ESSELMAN: If I knew that it wasn't the pills that did my blood pressure... it had to have been. But if I knew for a fact that it was not? I'd do it again.

COUKELL: As long as the pills are sold in Massachusetts, it seems likely that others will too. For WBUR, I'm Allan Coukell.