Dealing with Xenical

October 15, 2008 5:37 AM

I'm overweight, I have a fatty liver, and I've just been put on Xenical by the doctor. Just how hideous is this going to be...?

Traditionally I've tended to eat what I want, and it shows. Meat has always been a big part of my diet (especially lamb, offal and the fattier bits of pork) as have things like bread. I have a very sweet tooth and I'm convinced my biggest issue is hard candies.

As a part of my attempt to fight the fatty liver I decided last week to go mock-vegetarian, cutting meat out whenever I can (which means every day except Saturdays) but leaving fish (even though I'm not a huge fan of wet fish).

Vegetables are painfully dull to me, so I have a feeling my diet is going to be kept 'interesting' using aubergines, sundried tomatoes, mushrooms, and chillies. Oh, and olive oil.

You've probably already seen the flaw in my plan.

Has anyone here already been through this? How bad are the side effects of this stuff? Does anyone have any great suggestions for ways to keep my diet interesting?

posted by anonymous to health & fitness (16 answers total)

A pinch of garlic powder and a bit of sea salt, plus a bit of pepper, make veggies so much more flavorful. The salt will need to be diluted by drinking more water, which is also good for you. Also, onions are your friend.
posted by notsnot at 5:56 AM on October 15, 2008

Vegetables taste better than meat to me. The trick is that if you stop eating meat, your taste is reset and more complex and light flavours of vegies come through. In the same way, if you eat a snickers bar and then eat an apple, it will taste bland; but if you eat an apple first it will taste more complex than snickers and very sweet (assuming it's a good apple to begin with). Learn to make pilafs with lentils, basmati brown rice, both with mixed vegetables, broccoli is awesome, add good non-stale spices to them, learn to make stews and soups, and yes, mushrooms are always nice. Meat is really crap. You'll finally learn about good, real food with complex flavours. For sweets, rahat-loukoum (aka turkish delight) also has a much more interesting and complex taste than hard candies.
posted by rainy at 6:01 AM on October 15, 2008 [2 favorites]

cut up some veggies (peppers, onions, asparagus, zucchini, mushrooms, carrots etc), coat them with kosher salt, fresh ground pepper and olive oil, put them on a baking pan. Roast at 400 degrees until they turn soft. Cook up a box of cous cous and you've got a meal for the ages. Roasting is one of the most flavorful way to enjoy vegetables because it really brings out the natural sugars.
posted by any major dude at 6:43 AM on October 15, 2008 [1 favorite]

First, IANAD, but I did have a fatty liver once (and was overweight). I'm putting this out there as a "plan B" that you might want to consider.

At the time I was uninsured. My free clinic doctor wanted to put me on a weight loss drug too, and I said no way. I went to the student health center at my school for a second opinion, and the doctor there pretty much did the exact opposite: she put me on a strict high-protein, minimal-carbohydrate, and NO processed foods eating plan. This means no grains, no sugar (and in my case, no fruit, because my body can't process fructose). The end result was no fatty liver, improved blood panels, and a weight loss of 50 pounds - all the while eating lamb, pork, and lots of green veggies of course.

As I understand it - again, IANAD - fatty liver is often a sign that one is insulin resistant (which I turned out to be). Old-school thinking is "lose weight, eat low fat," while newer research shows that this doesn't work nearly as well as "lose the sugar and processed foods, eat protein."

I know this doesn't answer your question, but I thought I'd put this out there as something you may want to look into and see if it's right for you. Best of luck!
posted by chez shoes at 6:45 AM on October 15, 2008 [6 favorites]

I don't have any experience with Xenical, but I spent about a month being pretty much vegetarian while awaiting gallbladder surgery last year. Plus, I was a serious late-bloomer in the "enjoying vegetables" department.

The way that I started enjoying vegetables in the first place was through ethnic food. In fact, many of the veggies I grew up with are still a big yawn to me, but ZOMG Thai, Indian, Malaysian, Moroccan, Vietnamese, Japanese, Korean, Ethiopian, etc! Not to mention real Chinese and real Italian!

One note of warning, though -- it's not just meat you've got to watch if you're avoiding dietary fat -- butter can sneak up on you, too. You'll probably want to limit restaurant food to just small tastes, since you'll have no way of knowing how much butter (and duck fat, if it's a high-end place) is involved.
posted by desuetude at 6:50 AM on October 15, 2008

The trick is to use meat as an accent, rather than as the center of the meal. Use stronger tasting stuff like prosciutto or other cured meats (chorizo, salami, etc) and good homemade stock to make things taste like meat. A big plate of rice and vegetables with a little bit of salty pork in it is a wonderful thing. Spanish cooking is great for this (1080 Recipes is a great cookbook for this).

I'd also pick up some good vegetarian cookbooks. Start with this one: http://www.amazon.com/Vegetarian-Cooking-Everyone-Deborah-Madison/dp/0767900146
posted by paanta at 7:21 AM on October 15, 2008

Fat comes from calories, which can come from either carbohydrates or fats. You need to reduce the total input of both things, the sugars and the fats. You could cut out sugar and keep eating fats, as long as you didn't eat _more_ fat to compensate, and that would reduce your caloric intake and thus the amount of fat your body creates. Likewise, you can reduce the fat you eat, keeping the sugar intake constant, and that would be a net reduction. However, it may be that cutting just one thing -- e.g. the fat -- would still leave enough of the other thing -- e.g. the carbohydrates and simpler sugars -- that you wouldn't be reducing your overall caloric intake enough.

That said, there are also other benefits, besides reducing caloric intake, to reducing your meat consumption (cancer and disease protection, better for the environment).

And now, something immediately useful: try putting interesting vinegars on your vegetables and/or cooking with a little wine, and don't underestimate the helpfulness of cooking with mushrooms.
posted by amtho at 7:33 AM on October 15, 2008

Hooray for mushrooms!
posted by Echidna882003 at 8:26 AM on October 15, 2008

Seconding chez shoes's post. The "Calories In/Calories Out" is an oversimplified model of how fat loss works. Quality of calories--namely, cutting out sugars and grains--matters more. You can read more about it in Gary Taubes's "Good Calories, Bad Calories". It isn't a huckster diet book, it's a sophisticated review of the scientific literature surrounding nutrition by a respected science writer.

Flavoring vegetables is also all about how you cook 'em and how high-quality they are. I think a lot of people encounter vegetables through the overcooked mush they got as a kid (making the veggies taste bland or bitter) or through iceberg lettuce salads topped with a flavorless tomato slice. Buy a book on learning how to cook, Mark Bittman's "How to Cook Everything" is great and has a lot of simple, easily modifiable recipes. "The Joy of Cooking" is a classic. Learn to properly steam or roast your vegetables. And buy GOOD vegetables, see if there is a farmer's market near you and buy some of the fresh stuff and experiment with vegetables you haven't tried before! Seriously, the first time you try different varieties of heirloom tomatoes it will be a revelation.
posted by schroedinger at 8:49 AM on October 15, 2008 [1 favorite]

You could cut out sugar and keep eating fats, as long as you didn't eat _more_ fat to compensate, and that would reduce your caloric intake and thus the amount of fat your body creates. Likewise, you can reduce the fat you eat, keeping the sugar intake constant, and that would be a net reduction. However, it may be that cutting just one thing -- e.g. the fat -- would still leave enough of the other thing -- e.g. the carbohydrates and simpler sugars -- that you wouldn't be reducing your overall caloric intake enough.

amtho, Xenical works by reducing absorption of dietary fats. (You're right about cutting calories, of course, but too much carbohydrate-rich food won't produce the {ew!} adverse GI side effects of Xenical.)

Anonymous: I know several people with dietary restrictions that can result in some unpleasant GI issues involving absorption of fat. One piece of advice I'd give is that some people talk themselves into a sort of vicious cycle of indulging in too much fatty food and then feeling like they deserve to pay the unpleasant bathroom price. And then resolving that this is their new normal, rather than changing their diet enough to avoid these side effects. Try to think of the medicine as a sort of dietary Jiminy Cricket or motivational coach or whatever, rather than punishment for the sin of loving pork. Easier said than done, I know.
posted by desuetude at 9:14 AM on October 15, 2008

I have used xenical in the past and I have previously written on askme on topics like this. there is a lot of really solid diet-talk on askme and you should do a search as well if you want to know more.

the following is pretty impossible to not end up somewhat gross as it deals with digestion, this just for casual readers.

xenical is twice as powerful as alli, the non-prescription version. it basically separates the fat from the food you eat. the fat looks a lot like olive oil when you discharge it, though it's a bit thicker and more orange. I strongly suggest you try xenical out on a day off as it works fast. eat a pizza after throwing in a pill if you want an eye-opening experience. you will be running for the restroom before you're half done. it's seriously that quick and this is not going to be a "oh, I wouldn't mind a restroom" but a full-on "three-alarm-fire I need to go NOW." I promise you that you will never again look at a slice of pizza as something that you can eat "just this once" or that "can't be all that bad." you will spend a lot of time sitting.

you are correct in assuming that your sweet tooth will massively boycott any diet and that xenical will not help here. it will however mercilessly do its job whenever you use it with regular meals. your diet will change just because you don't want to spend an hour in the restroom. this is a bit like having diarrhea. the fat runs thin and it seems to never end. it will go on and on and on like a little, steady stream. eat tons of fatty foods and you'll be rather sore within a week. at that point you will either cave in and give up to get your social life/daily routines back or you will change what you eat. xenical will force a decision but it's up to you to take the one that helps you lose weight.

just wait and see how good a banana will suddenly look to you.

you will have problems if you use xenical during a lunch break as you will spend the next two hours somewhat running back and forth and nothing beats the feeling of "oh shit, I just crapped my pants" when you are trying to concentrate. consider eating your warm meals at night at home.

I warned you this was going to be gross.

please be aware that your chances of ballooning back up to your original weight and even more are extremely high if you don't change your behavior fundamentally. people go off xenical and go right back up. I have seen it. the good news is that humans are creatures of habit. you say you don't like fruits and veggies - that may be so for a month but I guarantee you they will taste much different if you force yourself into a new routine. the same is true for daily gym grinds and avoiding candy with the tv sessions in the evening. it's all about changing habits.

xenical will open your eyes. it will make you think "oh fuck, THAT food item I just ate was THAT bad?" a million times. it will make you feel as if you are taking in a bucket of fat every day without noticing. it will make you feel guilty as hell. as for other side effects: it drains wallets just as quickly as it deals with your digestive system but that's about it.

oh yeah... skip the dry fruits and nuts. they're poison if you want to diet.
posted by krautland at 9:24 AM on October 15, 2008 [1 favorite]

I can't speak to Xenical effects but for low fat healthy food.. have you tried 0% Greek yogurt, such as the Fage brand? It's delicious.. if you add a bit of honey it tastes much like a very rich dessert, but is high protein and low/no fat.
posted by citron at 9:42 AM on October 15, 2008

Someone I know was prescribed this drug. On the basis of that I would say you have to be very careful you obey the no-/low-fat rules while taking it, or accidents of various kinds will be in store, unfortunately. I'd guess you've read the side-effects section in the Wikipedia page.
posted by galaksit at 10:17 AM on October 15, 2008

Hmm, I didn't preview. Seconding Krautland.
posted by galaksit at 10:19 AM on October 15, 2008

I used Xenical for a while. I didn't have any side effects because I ate very little fat. My doctor said I was missing the point -- that fat makes food tastier and more filling, and Xenical is meant to let you eat some fat without adding as many calories and other bad things. I was afraid to use it the way he described. There are many who use Xenical sort of the way a drinker uses Antabuse: "This stuff will punish me if I consume the bad substance."

A super-low fat diet isn't for everyone. But if you want to try it, Xenical is a great idea. You'll either have to experiment to find out how much fat you can ingest without intolerable effects, or just stay away from marbled meats, oil, butter, most desserts... you get the picture. If you hate it, you can switch to eating very small portions of foods containing moderate fat.
posted by wryly at 10:48 AM on October 15, 2008

Don't know about Xenical but I use Mrs. Dash to season steamed and roasted vegetables and I think you might enjoy them more too, if you were to try it.
posted by Lynsey at 10:50 AM on October 15, 2008