Vinegar for Obesity?

Trying To Lose Weight

Is there an effective, inexpensive, non-prescription treatment for overweight and obese teens and young adults? There may be at least one available.

Researchers in Lebanon studied teen and young adult research subjects with obesity or being overweight. The research subjects were given either apple cider vinegar (5, 10, or 15 ml) or a liquid placebo three times a day for 4-12 weeks.

Vinegar has acetic acid. Prior research showed that it may reduce fat and improve metabolism.

The results of the research were encouraging. The research showed that “… daily consumption of the three doses of ACV (apple cider vinegar) for a duration of between 4 and 12 weeks is associated with significant reductions in … weight, body mass index, waist/hip circumferences and body fat ratio, blood glucose, triglyceride and cholesterol levels.”

Despite these good results, it is challenging to recommend using apple cider vinegar three times daily to lose weight based on just one study.

Also, the research only included teens and young adults so we can’t be sure these results would benefit other age groups.

Small doses of apple cider vinegar three times a day should be tolerated by most adults. However, there are exceptions. For example people with acid reflux may get worse.

The research was published by Abou-Khalil and colleagues in the BMJ Nutrition, Prevention and Health 2024; e000823.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Leprosy in the U.S.?!

Patch of Leprosy on Chest Skin

Who knew? Leprosy is still found throughout the world including the U.S. The states most affected are Arkansas, California, Florida, Hawaii, Louisiana, New York, and Texas.

Most cases arise in people who have lived overseas where leprosy is more common. The highest number of cases in the world are in India.

The proper name for leprosy is Hansen’s Disease. The name comes from the scientist in Norway who discovered the bacteria that causes it (Mycobacterium leprae).

Florida currently has the highest rate in the U.S. There were 15 new cases in 2023. The nine-banded armadillo is a natural host, and the new cases were in locations where these animals are more common.

Hansen’s Disease (leprosy) is most often identified by finding a discolored patch or patches of skin that are often numb. This is due to the bacteria damaging nerves to the skin patches.

Infected individuals may also have enlarged nerves visible under the skin. Also, their skin tends to be thick, stiff, and/or dry.

In more advanced cases, they may have painless ulcers on the bottom of their feet. Other signs may include loss of eyebrows or eyelashes or painless swelling or lumps on their face.

It usually takes a long time (years) after being infected before signs of the illness appear.

Diagnosis is made by a biopsy of the involved skin. Treatment is very effective. It requires 2 or 3 different antibiotics given for one or two years.

The CDC also points out that “ancient leprosy,” such as is mentioned in religious texts, is not the same as modern leprosy. For example, the Greek word translated into English as leprosy actually just means any skin disorder or may refer to “mildew on clothes, possessions, or living quarters.”

Once treatment begins, in just a few days the patients are no longer contagious and can safely go to school or jobs. In reality, Hansen’s Disease is not very contagious; it usually requires prolonged exposure to an infected individual before someone else can get it from them.

Also, according to the CDC, “95% of adults are immune” due to a vigorous immune response to the bacteria.

We often imagine Hansen’s Disease as causing fingers, toes, and noses to be missing. This is because the bacteria attacks the nerves to these areas so that cuts and trauma can go unrecognized.

Over time, these untreated wounds lead to destruction and resorption of those structures. It is a very late finding so it is now rare.

Hansen’s Disease is frightening to many people. This is mainly based on stories from past centuries. We now have highly effective treatments.

If you or someone you know may have been exposed, e.g., touched an armadillo, and now have one or more numb, discolored skin patches, it is a good idea to see a physician.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Non-prescription Oral Birth Control Pill Available

Taking a Daily Pill

The over-the-counter (no prescription needed) oral birth control pill is now available online. The pill’s name is Opill and is manufactured by Parrigo.

It is a progestin-only pill (norgestrel). It does not contain any estrogen. It should be taken every day at the same time.

The pill is 98% effective at preventing pregnancy when taken as directed. It begins working 48 hours after the first dose.

The pill can be ordered online at Opill.com and Amazon. It is likely that other sites will soon be available.

Current pricing:

One month supply $19.99

Three month supply $49.99

Six month supply $89.99

To learn more including contraindications, potential side-effects, and other important information, see my blog on this topic from March 5, 2024 on this site.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

New Indications for a Weight Loss Medication (WEGOVY)

Wanting to Lose Weight Safely

The Food and Drug Administration (FDA) granted a new indication for the weight loss medication, Wegovy (semaglutide). The FDA pointed out that “obesity or overweight affects approximately 70% of American adults.”

They state that these are “serious health issues that increase the risk for premature death and a variety of health problems, including heart attack and stroke.”

A high quality, multinational research study showed that Wegovy was superior to a placebo in its ability to reduce the risk of heart disease and stroke.

In addition to receiving either Wegovy or placebo, the research included standard medical treatment (e.g., blood pressure control), and “healthy lifestyle counseling, including diet and physical activity.”

The FDA noted that “Wegovy is also approved to reduce excess weight and maintain weight reduction long-term in certain adults with obesity or overweight and children with obesity, for use in addition to a reduced calorie diet and increased physical activity.”

Demonstration that Wegovy can reduce the risk of cardiovascular disease and stroke increases its value as part of the treatment of obesity or overweight individuals. It should be given along with a reduced calorie diet and increased physical activity.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Non-prescription Oral Birth Control Available Soon

Taking Oral Contraceptive

Very soon, an over-the-counter oral birth control pill will be available for purchase in stores and online. The tablet is named, Opill and costs $19.99 for a blister pack of 28 tablets.

One pill must be taken every day at the same time of day without interruption. This is different than prescription oral contraceptives that usually have a one week break every month when an inactive pill is taken.

“Opill tablets are not for use as emergency contraception,” according to the FDA.

This contraceptive uses a synthetic form of the female hormone, progesterone. The synthetic form is named, norgestril and comes as a 0.75 mg tablet.

It is “more effective than condoms, spermicides and other nonprescription methods” to prevent pregnancy. However, it does not provide any protection against sexually transmitted infections.

Like any contraceptive method, Opill is not 100% effective in preventing pregnancy. The pregnancy rate for progesterone oral contraceptives is approximately 2 pregnancies per 100 woman years. It is assumed that this will be the rate for Opill.

Use of Opill is contraindicated in women with any of these conditions: being pregnant, cancer of the breast or other progesterone-sensitive cancer (if you have cancer ask your cancer specialist if Opill is safe for you), undiagnosed abnormal uterine bleeding, hypersensitivity to any of the pill ingredients including inactive ingredients such as the dye, and benign or malignant liver tumors.

Potential side effects include: headache; dizziness; nausea; increase in appetite; abdominal pain, cramps and bloating; and others. “Irregular menstrual blood patterns are common.” Discontinue the pills if you develop jaundice (yellow coloration of the white of the eyes).

Ectopic pregnancy can rarely occur while taking Opill. Ectopic means the fertilized egg implants outside of the uterus such as in a fallopian tube.

There are a number of drug-drug interactions with Opill. If you are on other medications ask your doctor or a pharmacist if it is OK to take Opill.

Fertility returns to normal when the pill is discontinued. Do not assume you won’t get pregnant just because you stopped the pill only a short time ago.

Opill represents an inexpensive non-prescription option for sexually active women who want to avoid pregnancy.

[Quotes are from the FDA as is most of the information in the blog.]

Peter M. Hartmann, MD

Family Medicine & Psychiatry