Alli questions

July 11, 2007 1:24 PM

Does anyone have any comments about the new diet drug Alli (orlistat)?

I've never heard of it until reading this Consumerist article today. Apparently it's a new OTC drug.

Please no derails regarding:
(1) the Olestraesque anal explosion issues -- if anything, that's the ONLY information I'm finding about Alli
(2) the merits of magic pill diets

I post this question seeking personal anecdotes and opinions about its efficiency, whether it can be a useful part of a diet/exercise program, and whether it is has a reasonable margin of safety, given that it's easy to find both bad and good clinical studies of almost any substance. Also any links to good diet forums where there's discussion of this would be useful.

I haven't been able to Google anything on this as a search brings up 41 million hits, most of it garbage, and I don't know where to begin narrowing it down.

posted by calhound to health & fitness (29 comments total)

Also if you want to discuss the anal explosion issues, that's fine, as long as the original question is being answered... I'm just worried about that becoming the central theme of this thread.
posted by calhound at 1:27 PM on July 11, 2007

This site says that 6 month clinical trials show only 50% of the takers lost weight and on average lost 6 lbs if you took three a day. That's 1 lb a month. This page claims losses of 7kg (15lbs) over the course of a year which is just over 1 lb a month.

Both figures are for when it's used with an existing diet.

That's too low for me to consider, especially since it causes reduced absorption of many fat soluble vitamins.
posted by hindmost at 1:44 PM on July 11, 2007

In clinical trials, those taking Alli for a full year lost an average of fewer than 3 pounds more than those who used diet and exercise alone. After 2 years, about 34% of the Alli group had maintained at least some of that weight loss, compared to 24% of those using just diet and exercise. The others had gained back all of the weight they lost or more. (Source)
posted by decathecting at 1:44 PM on July 11, 2007

Wasn't it marked under a different name as a perscription drug? I can't recall the name, but if you can find that, you should be able to find more info about long term use.
posted by Kellydamnit at 1:48 PM on July 11, 2007

Supposedly when used in conjunction with a healthy diet and exercise, it can increase weight loss about 50%. You would at most, while on a restrictive diet, lose maybe 3-4 lbs a week. Also, Orlistat will block the absorption of some vitamins into your system, as well as potentially interfere with medications you take with a meal.

I actually had debated trying it after my doctor offered to put me on Xenical (blegh), but knowing that I can consistently lose 1-2 lbs a week on WW, without worrying about vitamin absorption issues or the "treatment effects", I don't think the bonus 50% weight loss makes it worth it. It's also ridiculously expensive, IMHO.

I do know some people take it and use it as a behavior modification method to control their fat intake, because they know what will happen if they eat too much fat and that is a good deterrent for them.

For me, I don't have an issue with eating too much fats, either, and I don't believe my weight gain was due to a high fat diet. It's not going to help you with portion control, or refined carb intake, or general crappy nutrition and laziness.

If you're considering using it, I would just make a list of pro's and con's. Does the benefit of losing an extra .5-1 lb per week outweigh the treatment effects, potential vitamin deficiencies, and cost? If you think so, it seems harmless enough that I don't see a reason not to try it, as long as you know what you're getting into.
posted by tastybrains at 1:49 PM on July 11, 2007

Wasn't it marked under a different name as a perscription drug? I can't recall the name, but if you can find that, you should be able to find more info about long term use.

Xenical is also Orlistat and is available by prescription, still. It contains more Orlistat than the OTC version, Alli.
posted by tastybrains at 1:51 PM on July 11, 2007

Here's a good look at how effective it is, published in the Wall Street Journal. The author of that article also discussed it on a WSJ forum.
posted by croutonsupafreak at 1:58 PM on July 11, 2007

The side effects are real and significant.
posted by rcavett at 2:00 PM on July 11, 2007

Alli is a half dose of Xenical, which has been prescribed by doctors for several years now (I was working as a Pharmacy Tech between highschool and college when it was released and I remember people being pretty happy about it at the time).

It prevents your body from absorbing the fat in the foods you eat. In turn, you consume fewer calories, which causes weight loss. The nasty side effects come from eating foods too high in fat (which I guess is sort of an effective way of ensuring that people will eat low fat food instead).

In order for Alli/Xenical to work, you are expected to adhere to a low fat, low calorie diet (no more than 30% of calories from fat), and an exercise plan. People have experienced success with Xenical along with a low fat/calorie diet and an exercise plan, sure, but you could probably do almost as well without it. Xenical has been proven to have a reasonable margin of safety.

Here is the wiki on Orlistat, including Xenical and Alli.
posted by mewithoutyou at 2:03 PM on July 11, 2007

It's awfully expensive for a diet tool that may cut your calorie absorption from fat (only from fat) in half. Around a buck a pill? I read up on it and considered it, but at that price, it's just not worth it.
posted by Ambrosia Voyeur at 2:05 PM on July 11, 2007

My coworker is doing this and if you keep your fat intake to 15 grams or less, you will not have anal leakage.
posted by spec80 at 2:06 PM on July 11, 2007

alli is the nonprescription version of xenical, which has been around for years and is twice as powerful. I too xenical once upon a time and it works just as advertised. the discharge begins really quickly though, so stay close to a restroom if you are having a pizza.

I would consider alli more as an eye opener. you eat a pizza and pay dearly for it - who would have thought there is *THAT MUCH* fat in a damn pizza? I had no other side effects.

it does not cancel out the calories you take in via chocolate bars and such. there is a good chance you will lose some weight but balloon back up if you don't maintain a real diet.
posted by krautland at 2:09 PM on July 11, 2007

I guess another issue I take up with it is that I don't really think fat in & of itself is bad for you, and I think 15g of fat per day (and if you don't absorb half of it, 7.5 g of fat per day) is healthy.

I mean, didn't we all learn how low fat isn't the key to weight loss in the 80's/90's when Snackwells & fat free ice creams didn't turn chubby folks into supermodels?

Some fat in a meal helps a person to feel fuller longer. If you cut your fat intake too low, I can't imagine that you'll feel very satisfied on an also low-calorie diet. And your skin will probably get really dry & gross.
posted by tastybrains at 2:15 PM on July 11, 2007

Fat's also important for your nervous system.
posted by Ambrosia Voyeur at 2:24 PM on July 11, 2007

"My coworker is doing this and if you keep your fat intake to 15 grams or less, you will not have anal leakage."

"I guess another issue I take up with it is that I don't really think fat in & of itself is bad for you, and I think 15g of fat per day (and if you don't absorb half of it, 7.5 g of fat per day) is healthy."

Fat is not just not bad for you. It is a crucial part of a well balanced diet, and 15g per day (less than 150 cal per day from fat) is extremely low. (I hope the earlier commenter meant 'per meal.') A healthy daily minimum of calories from fat is closer to 20% (recommended range is 20% to 35%), so you'd have to be happily thriving on 750 cals a day for 150 from fat to be in a healthy range. (For comparison, estimates of daily calories for prisoners at Nazi concentration camps and ghettos range from around 400 to around 1300, maybe 1700 for people doing hard labor. This is, Godwin aside, the kind of territory we're in.)
posted by caitlinb at 2:44 PM on July 11, 2007

I think for a person that needs the threat of anal leakage if they eat a slice of pizza or have some fries is a perfect candidate for this. Sure, to people that have the willpower to diet and exercise, this is a waste of money. But I can totally see how some people will just turn the switch on and really control their diet because of the Alli even though they could have done it before on their own without the pill.
posted by spec80 at 2:44 PM on July 11, 2007

If you are limiting yourself to 15 grams of fat per day and Alli prevents the absorption of half of that, then you are only saving yourself 67.5 calories.

Hardly seems worth it.
posted by sourwookie at 2:49 PM on July 11, 2007

spec80: You raise a good point. Obviously, though, an outright dependency on this pill or reliance on it as a threat of punishment for deviation from a strict diet is not a long-term solution.
posted by Ambrosia Voyeur at 2:51 PM on July 11, 2007

From the WSJ article:

The [Alli] site suggests it's probably a "smart idea" to wear dark pants and bring a change of clothes to work if you use Alli.

EGAD.

Just go for a walk man. Compared to a 50% chance of losing a pound in a month, it sounds better all the time.
posted by 4ster at 3:09 PM on July 11, 2007 [1 favorite]

here's a funny translation of the warnings GSK issued with the drug.
posted by Mick at 3:09 PM on July 11, 2007

I wanted to clarify my last comment. Even if the weight loss numbers were higher I would not endorse using Alli for the reasons that many people have already listed. Fats, especially good fats are associated with good skin, mood, improved mental performance and possibly reducing depression. 3lbs a year difference versus diet and exercise without Alli is just laughably low for them to be touting it's magical effects.
posted by hindmost at 4:17 PM on July 11, 2007

My sister is taking Alli, and I just spoke with her about it. You're not limited to 15 grams of fat a day, but actually 15 grams of fat per meal, which is just under the USDA daily recommendations and quite a good deal of fat. She says that as long as she keeps her fat intake below 15 grams per a meal, she does not have stomach issues. She said that she didn't feel like there's much of an intrinsic weight loss benefit to Alli, rather it helps her with will power. She knows if she eats chicken strips and fries for dinner, she's going to have some serious problems.
posted by lunalaguna at 4:26 PM on July 11, 2007

I'll share my experience (with xenical not alli), but the gory details are beyond what I will share here on ask.me. If you want to email me, I'll be happy to share my experience.
posted by necessitas at 5:31 PM on July 11, 2007

Alli acts on the outside of your body - yes, the stomach really is the outside of your body, if you think about it topologically. It's blocking the enzymes that break down fat. Because it's working on the outside of your body, you're not going to get the sort of side effects that you might see with a drug that actually gets into your bloodstream.

Keep in mind that it might slow the absorption of fat-soluble vitamins, so take a multivitamin. That's important for weight loss too, because your metabolism is like a chain - if you have a missing link in the form of a vitamin deficiency, the whole thing slows down.

Probably the reason you keep hearing about the anal leakage issue is that it's the only real side effect. Also, people just like saying "anal leakage." Anal leakage. Anal leakage.
posted by selfmedicating at 7:27 PM on July 11, 2007

Probably the reason you keep hearing about the anal leakage issue is that it's the only real side effect. Also, people just like saying "anal leakage." Anal leakage. Anal leakage.

Knowing people who are taking Alli, it's not an exaggeration, Orlistat is designed to block the fat absorption, so it has nowhere to go but out if you take in too much. And if you eat too much fat, you *will* have gas, oil spots in your underwear, and loose stools.

The reason they call them "treatment effects" and not side effects is because they are expected and intended results of eating too much fat while on this pill.
posted by tastybrains at 8:02 PM on July 11, 2007

You're not limited to 15 grams of fat a day, but actually 15 grams of fat per meal, which is just under the USDA daily recommendations and quite a good deal of fat. She says that as long as she keeps her fat intake below 15 grams per a meal

Yipes! I'll relay that to my coworker.
posted by spec80 at 8:27 PM on July 11, 2007

I know commenters don't get thanked very often for their help, but as the OP I want to do that. This is good food for thought.
posted by calhound at 8:40 PM on July 11, 2007

I think a previous Consumerist article said something like if you take it for a year, you'll only lose 3 pounds more than if you hadn't taken it.

I am wary of diet drugs. I know it didn't have the same mechanism (blocking fat), but Redux, years ago, got recalled for causing heart problems. Of course, these days the way drugs get rushed out, you should be cautious of any new drug. Maybe wait a while until there's more details? So many drugs get recalled after a few years.
posted by IndigoRain at 1:55 AM on July 12, 2007

I've been taking it for about a month, with nothing really bad happening. If you are going to take it, I would start slowly and only take it maybe once a day to see how your stomach reacts. I've had some stomach cramps and some minor stomach issues, but nothing horrible. I don't take it when I'm having a really fattening meal and know I won't be near a bathroom, but really that's more my own paranoia, I actually don't think it's necessary.

Bottom line, everyone's body is different. Start slow and see how you tolerate it.
posted by whoaali at 4:04 PM on July 12, 2007