Low-carb over-the-counter-weight-loss-drug alert.
You may have read news reports that the Food and Drug Administration approved the first ever officially sanction weight-loss drug for over-the-counter sales. The drug, Alli (generic name: orlistat), has been sold for the last eight years as the prescription drug Xenical. The difference between the OTC version and the prescription version is in the dosage. Alli will be sold as a 60 mg version whereas Xenecal has been sold as a 120 mg version. All consumers need to do to get the prescription dose of the drug is to take a double dose. But according to the manufacturer, even the lower dose is effective.
Glaxo studies have shown that the 60-milligram dose provides 85 percent of the weight loss of the higher dose. One capsule is supposed to be taken at mealtime.
Alli is not the drug you want to take if you’re following a low-carb diet.
MD and I have had extensive experience with this drug. Back in the early 1990s our clinic in Little Rock was one of the largest clinics participating in one of the stages of the orlistat study. In fact, our clinic was the largest in terms of number of patients in the orlistat maintenance study.
Since MD and I were the only physicians at our clinic, we both had a lot of hands-on experience dealing with patients taking orlistat. Or oily stat as we called it. Why oily stat? Well, because of the side effects.
The top three side effects of oily stat are: fecal incontinence, oil spotting, and my all time favorite, flatus with discharge. Any of these side effects can lead to a most unpleasant social situation.
These side effects are a function of how the drug works. Orlistat is a lipase inhibitor. Lipase is an enzyme in the small intestine that breaks fats down into their component fatty acids so that these fatty acids can be absorbed. When lipase enzymes are inhibited, the fats don’t break down, and, consequently, don’t absorb. When fats aren’t absorbed into the small intestine, they make their way down to the colon. Under normal situations the colon never has to deal with fat because it’s usually absorbed way upstream, so the colon isn’t prepared to deal with fat. The fat slides down the colon and makes its way out at the bottom end. If all goes well, it sees the light of day when you want it to. But often the colon gets rid of this fat on its own schedule, whether convenient for you or not.
Our patients used to complain bitterly about these unwanted and untimely discharges of fat that would ruin their clothing and sometimes even their furniture. We had one lady who termed the discharges themselves as cosmic pizza grease because that’s what they looked like. Soon, all of the patients were using this phrase to describe them.
Orlistat basically puts those who take it on a drug-induced low-fat diet. Consequently, those taking it suffer the same consequences as those on long-term low-fat diets: depression (we had many patients who had to be removed from the study due to depression), low-levels of vitamin K and other fat soluble vitamins, and gall bladder disease.
Let’s digress just for a moment to discuss gall bladder disease because many people don’t understand how a low-fat diet can cause gall bladder disease. The pancreas produces the lipase enzymes that break down fat, but these enzymes are helped by the bile salts produced by the liver. The liver makes these bile salts and stores them in the gall bladder, a little sack that sits underneath the liver. When a load of fat enters the small intestine, the gall bladder squirts a stream of bile salts into the load of fat going through to begin the breakdown process. The slurry of fat and bile salts are acted on by the lipase enzymes to complete the fat breakdown to individual fatty acids that can then be fully absorbed by the small intestine.
When people have problems producing bile salts, they have the same side effects as with orlistat. The mass of fat can’t be broken down completely for absorption by the lipase enzymes alone, so fat reaches the colon and causes problems.
As the bile salts finish their work with the fat, the liver plucks them out and recycles them, sending them back to the gall bladder. If very little fat enters the small intestine as a consequence of a low-fat diet, the gall bladder doesn’t get the signal to squirt out the bile acids. The bile acids in the gall bladder sit there and tend to concentrate over time. Since a major component of the bile salts is cholesterol, the cholesterol tends to supersaturate and can precipitate out as small cholesterol stones. (One family of cholesterol-lowering drugs work by preventing the re-absorption of cholesterol in the bile salts by the liver, allowing them to leave the GI tract through the stool.) These stones can cause real problems because they can work their way down the tiny ducts through which the gall bladder squirts its contents into the small intestine. What usually happens is that a person follows a low-fat diet for an extended period of time allowing stasis of the bile in the gall bladder and small stone formation. Then this person has a hankering for a big, greasy cheeseburger or other fat-filled meal and chows down on it. As the fat enters the small intestine it sends the normal signal to the gall bladder to release some bile salts. The gall bladder constricts to squirt the bile salts into the intestine and pushes one of these small stones into the duct. When that happens, the opposite of fun begins. As anyone can tell you who has had this happen, the pain is excruciating. Most people who have this happen blame the fatty food, but it isn’t the fatty food that causes the underlying problem. The underlying problem is set up by the low-fat diet.
In our clinical study we did gall bladder ultrasounds on all patients as they started. We eliminated from the study anyone who had gall stones. After six months on a low-fat diet, we redid the gall bladder ultrasounds of all the patients and found that about 10 percent of them had developed gall stones.
Orlistat works in theory by putting people on a drug-induced low-fat diet. In reality it works by putting people on an actual low-fat diet. Since orlistat prevents the absorption of about 25 percent of the fat coming down the GI tract, the more fat that is eaten, the greater the amount this 25 percent represents. There is a point at which the 25 percent that hits the colon causes the side effects. Patients on the drug quickly learned how much fat they could eat before they had problems, and kept their fat intake below this limit. The orlistat ended up acting like Antabuse for fat. (Antabuse is the drug that alcoholics take to prevent their drinking. If they take Antibuse and consume alcohol, they become seriously ill. So they avoid drinking.)
(Interestingly, when the representatives of the drug company that developed orlistat came and talked to us, they gave us a little history of the development of the drug. Like many drugs, orlistat was kind of a lab mistake. When the researchers realized that it was a lipase inhibitor that would decrease the absorption of fat, the first thing that popped into their minds was that they had a cholesterol-lowering drug on their hands. Makes sense, since ‘everyone’ knows that dietary fat makes cholesterol levels go up. Turns out that orlistat didn’t reduce cholesterol levels–if anything, it made them worse. So they scratched the idea of using it as a cholesterol-lowering drug and punted. They decided to use it as a weight-loss drug because ‘everyone’ knows that dietary fat causes obesity.)
How does all this apply to a low-carb diet? Well, by definition, a low-carb diet is in most cases a high-fat diet. If one takes orlistat while following a high-fat diet, very bad things happen. Very socially-embarrassing bad things. Cosmic pizza grease cubed. And at random times. Unbidden and unwanted. And unforgettable.
If you’re following a low-fat diet and you want to make sure you stick with it, give Alli a try.
The manufacturer, GlaxoSmithKline, said it planned to sell the medication for $1 to $2 for a day’s dose. The company has predicted that five million to six million people a year will use the drug.
If you’re on a low-carb diet, don’t be one of them.
I am considering taking Alli and have been reading a lot of information on it but have yet to see any comments or any information for people that have had their gallbladder removed. Is it still okay to take Alli if I’ve had my gallbladder removed?
Should be less of a problem than if your gall bladder were still in place.
I’m currently on a low-carb diet and have lost over 100-lbs but have about 10-15 lbs more I would like to drop and have “stalled” I was curious would alli be good idea just to help drop those last 10-15 lbs? From what I’ve heard Alli would also help to keep things moving as low carb tends to back things up a lil bit…
It will certainly un-back things up, but probably not in a fashion you would enjoy. It would be difficult to use Alli on a low-carb diet because a low-carb diet is typically a higher-fat diet. Alli blocks the fat absorption, so excess fat moves on out in a most unpleasant fashion. If I were you, I would switch to shakes and other lower-cal, low-carb foods to knock of the last 10-15 pounds. Then go on a good quality low-carb maintenance diet.
I started taking Alli the last week of November 2009 and then on January 1 2010 I had my first gallbladder attack. During the time I took Alli, (about 5 weeks total) a lost about 17 lbs. Of course I was excercising every day and following a very low fat low calorie diet. My first gallbladder attack scared me, so I stopped taking Alli right away and didn’t use it during the month of January because I figured this was what was causing the bouts of pain. But, even without the pills I continued to have the attacks and ended up in the ER on Feb 6 2010. I was diagnosed with gallstones AND severe pancreatitis -doctors said due to the gallstones. Anyone who’s ever had this knows it is not fun at all. I even heard one woman say that the pain is worse than being in labor. Anyway, I was in the hospital for about a week and a half -they had to wait for my pancreas to become less inflamed before the could remove my gallbladder. No food or drink during this time -not even water. I have for the most part been a generally healthy person ( with of course the exception of needing to lose a few). I can tell you that being in the hospital with pancreatitis was hands down the worst experience of my life! I just turned 25, and if I could do it over again I would have NEVER taken Alli. I firmly believe this drug was the cause of my recent health problems and I will tell anyone and everyone I know not to use it because it’s not worth sacrificing your health and well being. Lose weight the natural way! I did it before, and I wish I would have had enough common sense to do it this time.
Oh and also, if you think the cosmic pizza grease stuff is unpleasant, wait till you start experiencing pain from your gallbladder having gallstones in it. It will make that other stuff seem EVER so trivial.
My mom is currently in the hospital with Pancreatitis and they are sending her in for surgury to remove her gall bladder tomorrow morning. If anyone else has experienced anything like this please email me at Ashleigh_animelover@yahoo.com and tell me your story, We would like to have as many takes on what others are or have gone through and any advice would be extremly helpful.
I have taken Alli for the past three weeks, following the diet pretty strictly. I have had no problems with “treatment effects” or any pain. I did have my Gallbladder out a year before I started this plan so I am not effected that way. I found that if you follow the diet as it’s meant to be, it can work for you. I have lost 15 pounds so far and have a long ways to go but I am going to continue with Alli. So not all is bad with Alli if you follow the diet they way your supposed to, I’m sorry to hear about all the people having Gallbladder problems and think that maybe it may be something else that caused this problem and Alli just made you all aware that there was a problem.
“A very low-fat diet” with Alli? Alli assumes that you are eating about 45g of fat a day. From what I have read, 27-30g a day is needed just for good health. If you are eating less than that and/or blocking that fat needed for good health with the Alli, yes, there will be problems.
I have Alli, but since my diet is very low-fat I don’t take it everyday. I know I need some fat for my health and don’t want to block that with the Alli. I think that Alli is fine if you are eating 45+ grams of fat a day, but if you are getting 30g or less you are wasting your money and ruining your health.
i have my gall bladder removed for 8yrs now.. should i not take alli?
The big risk is an acute gall bladder attack, so the fact that yours has been removed gets rid of most of that risk. Some people develop an increase in size of the duct that use to carry the bile from the gall bladder and can still have problems, so the risk isn’t zero.
Other risks are depression and lack of absorption of fat-soluble vitamins.
I have been diagnosed with dysfunctional Gall Bladder, have chosen to forego the surgery for removal, and alter my diet. (Which was already reletively healthy). I have always been slim, until recently. (within the last couple of years.) Since that time, I have gradually added approx. 20 lbs, and cannot lose them, no matter what I try. I decided to try alli, because these 20 lbs are driving me crazy. Now that I am reading all these posts, I worry that Alli will “annoy” my already grouchy gall bladder.
My question is this…. if not Alli, what then should I try to shed these unwantedly annoying pounds?
I started taking Alli a few weeks ago. I had a baby about 3 months ago, and only lost about 1/2 the weight I gained during the pregnancy. I was overweight to begin with, and the pregnancy took me into the obese category. I started having treatment side effects when I started Alli, but they are controllable and actually help regulate my previously irregular digestive system. I do worry about more harmful side effects, but I needed SOMETHING to get my weight loss started again postpartum. I was average/thin in high school, and the past 10 years I have been experiencing steady weight gain. I’ve attempted lots of diets, but my will-power sucks. Having Alli to assist me has been helpful thus far. I have lost 5-10 pounds. I am able to eat a better diet and exercise some, but when I “fall off the wagon” and eat a fatty meal, side effects become less manageable. Having something physically happen VERY soon after my fatty meal helps me stay on track with my diet – psychologically. This is the first thing that’s really been working for me, and I plan to stick with it. I feel like once I get my weight where it needs to be, I will want to maintain it because I hate being fat. I used to love my body, but it’s been such a struggle for me to lose any weight that I put on. I’m also wondering if doubling my Alli dosage will expedite or help my results at all? I know I probably shouldn’t mess with what’s working but I’m ready to feel better about myself. And as far as depression goes, I understand that chemical reactions are what causes depression. But losing weight and feeling thinner/better help me NOT to be depressed because I know I am getting healthier and looking better. It’s quite the opposite for me – the “happy” neurotransmitters are being released! I guess some people need something like this for the assist. Like others have said, if diet/exercise was easy enough for EVERYONE, no one would need this. Obviously some people do, and I’m one of them. I’m almost back to my pre-baby weight (overweight), and I’m very excited to keep moving down the scale. I don’t expect to be the size I was in high school, but somewhere in the neighborhood WILL be great. So again, what about doubling Alli to get the prescription strength of 120mg? (I know taking more than 120mg has proven to not be beneficial.)
Thanks
Firstly – I have suffered from taking years of widely accepted medical ‘knowledge’ and experience as cardiac nurse too seriously. My long term low fat diet I believe led me to develop gallstones and pancreatitis. I had my gallbladder removed just over a year ago and use Alli combined with a low to moderate carb diet. I don’t take the Alli with every meal, just when I eat more fat calories than I should (don’t see the point otherwise). I always make sure I have had enough health fats and never take it with fish etc.
At first I found the side effects a little unpleasant but not uncontrollable but I have found that drinking a couple of tablespoons of psyllium husk mixed with water either just before or within an hour of the Alli prevents any of the nasty effects. I guess the bulking out makes the fat easier to deal with.
This may not work for everyone but worth a try maybe.
Regards, Angela
I took Alli from May until the end of October, and I lost 30 lbs.
I LOVED Alli, but I keep having terrible pains, that have nearly lead me to the hospital about 10 times now. Def gall attacks.
Will I ever get better? Is Surgery a must? I’d love a few emails if anyone has info.
Snowewinter123@yahoo.com
I took the drug for 4 months, lost 25lbs, was the happiest i had ever been in a long time. Did have a few “Treatment affects” when i would eat a piece of pizza but it wasn’t a big deal to me.. I never pooped myself or had any discharge anywhere it didn’t belong!
Did everyone in your study have problems with there gall bladder? I stopped using Alli when my family and i decided to go camping as i couldn’t stay with my low fat diet and The only effects i had after i stopped was a stomach ache every time i ate something that was high in fat. I have since bought another bottle and plan to start it up again. I hope this article isn’t to discourage people from trying it out! I know that taking it and losing that much weight was very beneficial to my mood! I was ecstatic to be under my normally overweight weight!
~Joelle
I was on Alli for 5/6 months… changed my way of eating did great on it..then started having problems with my gallbladder ..and had it removed….and to this day I have digestive problems..and struggle to eat..many doctors later..never
Heard anything about the drug maybe causing gallbladder problems didn’t say on my bottles…wow be careful what ya wish for I can’t keep certain foods down and don’t gain weight….good luck people.
Hi,
I’m so happy I read this article! I bought the Alli starter kit and was going to use it with the Atkins diet tomorrow, Jan.31, 2011. Atkins has been the only diet that has worked for since I’ve gotten older and a bit heavier… I guess I’ll have to get my money back for the Alli. Thank you again!
Kind regards,
…Marisa
Wonderful blog! I found it while surfing around on Yahoo News. Do you have any tips on how to get listed in Yahoo News? I’ve been trying for a while but I never seem to get there! Thank you
So let me see if I understand.
It’s not the Alli itself that is causing the gall bladder issues, but the low fat diet that one has to maintain?
If fats in low intestine cause the gall bladder to activate, and a low fat diet leaves it inactive for too long, leaving the contents to sit and form stones, then a low fat diet WITHOUT the Alli would have had the same effects, right? If one eats fat, it’s still going to hit the small intestine, and signal the gall bladder to activate. Doesn’t Alli just keep some of that fat from being absorbed? It doesnt prevent that fat from signaling the gall bladder, does it?
Please someone clarify. Thanks.
I have been using Alli for one week at the pres. dose. The only time you have side effects is when you eat too much fat…just like the doc said in his reference to drinkers taking anti abuse you drink you get sick…with Alli it teaches you to eat better and seems to lower your appetite some and I believe that comes from lowering isulin and cortisol from better eating….
[...] The Blog of Michael R. Eades, M.D. » Low-carb over-the-counter-weight-loss-drug alert. Mary Dan Eades, M.D. » Oh, the Gall of It All Maybe there is a clue in there somewhere. Look in the [...]
Dr. Eades,
Thank you for the informative article. I stumbled upon it, when googling about orlistat and gallbladder disease. Ironically, it was after taking my gf to the Ed for what presented like cholecystitis. I’m a PA in primary care FYI. At any rate, after the US and labs came back normal and after we’d left ( and after some discussion of a hida-scan) I realized that she had failed to mention her recently starting this medication. I wondered if there was any connection with it and dysfunctional gallbladder disease or intermittent symptoms. Your article makes great sense regarding the physiology behind the issues with this drug. I suspect that her “episode” was induced by the combination of her diet and initiation of alli. Her low fat diet for a few weeks, followed by a weekend of high fat consumption landed her in the Ed. It’s not definitive but certainly makes enough sense for her to stop it, which she has. Thanks for your article!