The Visual Weight Loss System - VEEP

Understanding Alli

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June is a big month in the weight loss industry. Xenical (Orlistat) goes over the counter under the trade name Alli (Sounds just like the word ally). In this article, we will help you understand what Alli/Xenical/Orlistat is, how it works and how it may best be utilized to aid weight loss.

Xenical or Alli helps weight loss by blocking pancreatic lipase. Pancreatic lipase is an enzyme secreted by the pancreas into the small intestine where it works to break down fats. Without pancreatic lipase, fats cannot be converted into free fatty acids that your body can utilize. Fats are instead passed through stools and eliminated from the body unmetabolized.

In practice, if you take Alli as indicated, 3 times per day before meals, about 30% of the fat you eat will pass through unabsorbed.

Alli has a total of 7 clinical weight loss studies so far on approximately 4,100 patients.  The raw numbers for weight loss with Alli are impressive. At 52 weeks, those taking the drug averaged 13.4 pounds of weight loss versus 5.8 pounds of weight loss for subjects using diet alone. 

It’s also worth pointing out that Alli has not been studied beyond 2 years. Further, after discontinuing Alli, a significant number of users gained up to 35% of the lost weight back.

Now that we have the facts and figures on Alli, let’s examine its proper use. LookCut is reality driven and metabolically based. We focus on what tends to really happen in practice, with an emphasis on preventing metabolic decline from aging as the best way to be lean and fit for life. That said, let's take a look at Alli in practice, and if there is any room for Alli to help keep our metabolism young. 

First, let's look at Alli in practice.

There is some unflattering clinical evidence on the long-term use of Orlistat.  One study, encompassing over 17,000 users of Orlistat (Xenical) identified that in actual practice only 10% of users actually made it to 1 year using Orlistat, and only 2% actually made it to 2 years.

To understand the reasons Xenical/Alli seems to have such a high attrition rate, you just need to come back to what it does.  Remember, Alli keeps you from absorbing fat by passing that fat through the colon. Reports range from gas, to the feeling of cooking oil coming out your nethers. To be fair to this, you can follow what real users report in the forums.

Now let's look at it from the basis of keeping you metabolically young

Periodic fullness, flavor and satisfaction from food is essential for long term weight management. In simplest terms, you need to be in a place of being ‘over’ the desire for more food versus ‘dying’ of hunger.  Periodic big, flavorful meals can really help with this. The problem is understanding how to do periodic pig outs in such a way that doesn’t do more harm than good.

If you don't experience too much discomfort, perhaps the real value of Alli could be as a tool, something to use surgically for that one or two large, fat laden pleasure meals you need to have once or twice per week for satiety sake. In my upcoming book, I detail the need for these meals and how to do them right.

From the perspective of keeping the metabolism young, one of the most powerful things we can do is simply not overeat. These periodic satiety meals can greatly help with keeping the need to overeat in check. If Alli is a tool that can enable you to have these periodic meals, then it serves the purpose of helping to keep you young metabolically.  It's just a theory.  Over the next year, we will put it too the test so keep coming back and we will update you.

Finally,  I don’t think medicating your weight loss is something that you can or should do over the long haul. Granted, Orlistat was positioned as an obesity drug. However, since we are talking about Orlistat/Alli as an over the counter weight loss pill and not the scenario of being under medical treatment for obesity, I’ll confine the discussion to a weight loss context and not the case of a person with obesity under the care of a physician.

Here are 3 things to consider

-The long-term effects of suppressing pancreatic lipase are not known. In fact, there are now a couple of studies popping up with respect to Orlistat use and a few isolated incidents of kidney failure. See 'Reference' below.

-The assumption of blocking 30 percent of the fats you ingest gives no consideration to the types of fats you are ingesting. This is a very significant variable. Further, the clinical data on Orlistat can be somewhat misleading. Orlistat was compared to the same diet with or without Orlistat, not Orlistat against different types of diets. The drug maker claims Orlistat delivers 50% more weight loss, but this does not mean that Orlistat delivers 50% more weight loss than any other diet or protocol. It only means that in clinical trials, Orlistat delivered 50% more weight loss over a control group following the same diet.

-  We are concerned with what really works and what people tend to actually be able to do in the long haul in the real world.  In practice, most people will simply not take Orlistat 3x per day before meals. It’s a good idea in theory, but not something most people will actually do in reality.

Long-term persistence with orlistat and sibutramine in a population-based cohort.
Padwal R, Kezouh A, Levine M, Etminan M.

Acute oxalate nephropathy associated with orlistat, a gastrointestinal lipase inhibitor.
Singh A, Sarkar SR, Gaber LW, Perazella MA.