Alli for weight loss? Side effects outweigh benefits

Next week an old drug under a new name, Alli, is being launched for over the counter sale. Previously on sale under prescription as Orlistat (xenical) it has attracted heaps of criticism. It works by inhibiting fat digestion. The immediate potential side effects are gas with discharge, oily or fatty stools, oily discharge and an inability to control bowel movements. If that doesn’t put you off, more worrying are it’s inhibition of absorption of fat soluble vitamin D, E and essential fats, vital for reducing risk of cancer and heart disease. Since vitamin D and essential fats are probably the most commonly deficient nutrient in Britain, the last thing you want is to swallow something that stops you from using the little there is in your diet.

In my opinion this drug is a step backwards because the primary driver of obesity is high carb and sugar diets, not fat. Almost every study comparing low Glycemic load (GL) diets, that aim to prevent blood sugar lows – the primary driver of hunger, to traditional low fat/ low calorie diets has shown that low GL diets are more effective, not only for weight loss, but also for health gain. Alli only inhibits the digestion of fat. The side effects listed on their site are politely called ‘gas with oily spotting.. loose stools.. more frequent stools that may be hard to control’ but they fail to mention that vital and widely deficient fat-based nutrients such as essential omega 3 fats, as well as vitamins D and E, cannot be effectively absorbed. Lack of omega 3 is linked to the growing incidence of depression, aggression and even dementia, as well as heart disease and arthritic pain.

Vitamin D and E depletion raises risk of cancer and heart disease. There are also worrying concerns regarding increasing incidence of gall stones and colon cancer. In the US the Public Citizen’s Health Research Group petitioned the FDA to remove the drug on the basis of research showing that orlistat can cause pre-cancerous changes in the lining of the intestines. The Alli website doesn’t mention these downsides but has a highly creative spin on the ‘anal leakage’ side-effects touting them as a potential benefit of the drug. ‘ likes experiencing treatment effects..If you think of it like that, Alli can act like a security guard for your late-night cravings..’ although they recommend as a precaution ‘It’s probably a smart idea to wear dark pants, and bring a change of clothes with you to work.’ They recommend reducing your fat intake. But do people on the drug really eat less fat as a result?

A recent study by the British Dietetic Association’s journal found that people taking this drug, versus placebo don’t make any more changes at all. ‘The use of orlistat compared with placebo in a lifestyle modification programme does not appear to influence dietary intake.’ say the authors. However, carbohydrate intake went up. And that’s the point. The whole idea that the solution to obesity is to eat less fat, or inhibit fat absorption, means that hungry people, instead of eating fat end up eating more high sugar foods –which increases diabetes risk as well as weight gain. The drug hasn’t even proven that effective as a prescription drug. The positive studies have used double the dosage recommended for Alli, and downplay the side-effects, but even with double the dosage the results aren’t that stunning. For example a key paper in the Lancet medical journal shows a difference, after one year, of 8.5 lbs versus placebo.

Many people on my low GL diet report 3lbs weight loss a week with diet alone – no drugs. Another study showed no benefit compared to placebo. Since Alli has no effect on carbohydrate digestion or sugar cravings it tackles the wrong underlying cause in the wrong way, with extremely worrying side-effects. It isn’t difficult to lose weight once you know how to stabilise your blood sugar. This immediately stops you feeling hungry and reduces cravings for both sugar and fat. However it takes a couple of hours to learn how to do this effectively. That’s why I am on a nationwide tour lecturing in twelve major cities giving seminars on how to lose weight, and gain health, and reverse diabetes and heart disease with a low GL diet. For details see What do you think about this drug? Will you try it? What have you found that works for weight loss?