Living Low Carb (59 page)

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Orlistat (Xenical)

Marketed under the trade name Xenical, orlistat is the only member of the second category of weight-loss drugs, a category that could be called “digestive inhibitors.” And it’s the only drug other than sibutramine (Meridia) currently approved for long-term use. Xenical works by blocking some of the fat that you eat from being digested and assimilated. It does this by blocking up to 75% of the digestive enzyme lipase (which breaks down fat), resulting in as much as 30% of the fat you eat not going to your hips. What should be immediately apparent is that it does nothing for the fat that is
already
on your hips. People lose weight on Xenical—especially in conjunction with a lower-calorie diet—because it essentially lowers caloric intake automatically. If you, for example, were eating 2,000 calories a day and 30% of them were from fat, you would normally be taking in 600 fat calories. By taking Xenical with a fatty meal, you are now essentially taking in only about 400 calories from fat. Stick to that plan and you’d be consuming about 1,400 fewer calories a week, which adds up to… about
⁴
/
₁₀
pound a week.

The first big study to put Xenical on the map was a two-year European study.
¹¹
During the first year, participants were put on a lower-calorie diet; during the second year, they adhered to a maintenance diet. The Xenical group lost between 2 and 3 percent more weight than the placebo group. In a second two-year European trial, obese patients were put on a reducedcalorie diet (reduced from their regular intake by 600 calories a day) and given 120 milligrams of Xenical three times a day.
¹²
At the end of the year, they had lost about 9 pounds more than the placebo group (about ¾ pound a month). A similar design was used in a two-year study in the United States that produced an average of a mere ½ pound a
month
more in the Xenical group than in the placebo group.
¹³

Does it get any better? Not much. Another study showed that 120 milligrams three times a day produced weight loss of no more than
¹
/
₃
to ½ pound per week greater than placebo, and another showed 6.6 pounds greater than placebo over the course of a
year
(basically pound a month).
¹⁴

Xenical has a great safety profile, but there’s a catch. Because the drug keeps some fat from being absorbed, it can have a bunch of very unpleasant side effects, euphemistically grouped under the term
anal leakage
. Typical symptoms: flatus with discharge, oily spotting, fecal urgency, fatty/oily stools, oily diarrhea, fecal incontinence, and increased defecation and spotting. When you’re laying out anywhere from $169 to $259 a month for that extra ½ pound of weight loss, don’t forget to stock up on Depends.

Starch Blockers

Starch blockers are a recent addition to the ever-expanding list of over-thecounter potions sold for weight loss. Introduced in the 1970s, starch blockers were found to be ineffective and were taken off the market in 1982. But the new breed of starch blocker—appropriately named Phase 2—has a lot of promise. Made from a refined, potent extract of white kidney beans, the starch blocker binds to an enzyme called amylase, preventing it from breaking starch down into sugar. The company that makes Phase 2, which is the ingredient in most commercial formulas you’ll find at the store, claims that when you take it immediately before a starch-heavy meal, up to 66% of the starch in the meal is blocked from absorption.

The studies on Phase 2 have not been published and were commissioned by the manufacturer of the starch blocker, so we need to wait and see about the long-term efficacy of this product. The plus side: it lets you do a low-carb diet and occasionally have some pasta or other high-carb dish. The negative side: the amount of starch you
do
absorb may still be too much for some very sugar-sensitive people, and the illusion that you can now eat these foods “safely” may be a really slippery slope for carb, sugar, and grain addicts. Finally, not absorbing most of the calories doesn’t mean that you’re protected from the effects of compounds in some starches that may be allergenic (such as gluten). With very careful use, these products might have a place, but I’ll have to wait and see before recommending them.

Ephedra

Virtually all of the commercial dietary “miracle” products—TrimSpa, Metabolife, Ripped Fuel, Xenadrine, and the rest—work by two pathways: suppressing appetite, and increasing metabolic rate (called thermogenesis, which is the production of heat from food). They do so with varying degrees of success. The active ingredient in all of them is—or at least used to be—ephedra. A ton of information has come down the pike recently about ephedra, much of it inflammatory and a great deal of it inaccurate.

When ephedra has been used in supervised weight-loss research studies, it’s been given in the dosage of 60 milligrams per day in three divided dosages of 20 milligrams, each combined with 200 milligrams of caffeine. In any supervised study using this dose, ephedra has not shown itself to be dangerous, and the side effect of “the jitters” was usually pretty well tolerated.
¹⁵
It is not—I repeat,
not
—for people with high blood pressure
or
for people who are sensitive to ephedrine or caffeine
or
for people who have any kind of heart, kidney, or liver problems
or
for people taking any medication, including over-the-counter meds (unless you check with your doctor).

Ephedra works by stimulating brown-fat metabolism, thereby increasing the bodily production of heat (upping your metabolism
slightly
), and by suppressing your appetite. The possible side effects are very annoying and include nervousness, insomnia, and possibly dizziness. The benefits in the way of fat loss are very mild but do exist. Ephedra can definitely raise your blood pressure and may interact with other medications.

One of the problems with ephedra is that people are using amounts that are way higher than the recommended dosage, which is generally about 25 milligrams. Ephedra products with as much as 250 milligrams per tablet are available at every mall and drugstore. Many people take it for “energy” or as a party drug, and many high school and college athletes take it because they think it will enhance athletic performance. Probably more than a few of them don’t pay any attention to the conditions under which you should never take the stuff.

There are many nutritionally oriented health practitioners who are fans of ephedra when it’s used properly (though they are certainly a minority), notably Dr. Shari Lieberman, author of
The Real Vitamin and Mineral Book
, and Dr. C. Leigh Broadhurst. But it probably doesn’t matter any more. “Its time is over,” says Broadhurst. There’s just too much bad publicity and public outcry about it, and it will almost certainly be taken off the market soon. The new ephedra-free diet pills have simply replaced ephedra with
Citrus aurantium
(bitter orange), which has many of the same “fat-burning/ appetite-suppressing” effects but doesn’t yet have the bad rap. (See page 307 for more about bitter orange.)

If ephedra
does
manage to dodge the bullet and stay on the market—and you decide to try it—make sure that you do not fit into any of the categories mentioned above, and
never
take more than the recommended dosage. When all is said and done, it is still an adrenal stimulant—a kind of legal speed, if you will—and it’s hard to believe that longtime use can have any beneficial effects on your health.

Alli—Promise: 10; Delivery: Not so much

In February 2007, amidst huge fanfare and accompanied by an almost obscenely expensive marketing campaign, the FDA approved Alli as the firstever officially sanctioned weight-loss drug to be sold without a prescription.

Alli is actually
Orlistat
, which is actually
Xenical
. Xenical (see page 286) has been around for a while, didn’t work very well, and has now been given a facelift; they took it off prescription-only status and repackaged it as Alli.

This is not the first time the clever marketers at Big Pharma have done this. Not too long ago, Eli Lilly took Prozac, dressed it up in nice pink and purple colors, and rechristened it “Sarafem” for PMS.

So, what do we know about Xenical (oh, excuse, me, Alli)?

Well, let’s start with this: it didn’t work very well in the first place when it was known as Xenical. I’m not sure why changing the name and making the dosage smaller would fix the problem, but hey, what do I know?

Alli (Xenical) is a member of a category of weight-loss drugs that might be called “digestive inhibitors.” It blocks some of the fat that you eat from being digested and assimilated, and it does this by blocking the digestive enzyme
lipase
—which breaks down fat. The result? As much as 30% of the fat you eat doesn’t go to your hips.

Quick-thinking readers might be forgiven for asking the obvious question: “What does it do to the fat that’s already
on
your hips?”

And the answer is… let’s see … Zip-i-dee-doo-dah.

People lose weight on Xenical—’scuse me,
Alli
—because it essentially lowers caloric intake automatically. If you, for example, were eating a nice hefty 2,500 calories a day and 30% of them happened to come from fat, you would normally be taking in 750 fat calories. So the appeal is this: if you keep over-eating the same junk you’ve always eaten, you’re actually taking in a few fewer calories for the same bad meal. By taking Xenical with a fatty meal, for example, about one third of those fat calories aren’t absorbed, so the 750 calories becomes, theoretically, about 500 calories. You’ve “saved” 250 calories while eating the same meal (note the operative word
theoretically
). Stick to that plan for a week, and you’ve “saved” 250 times 7 calories, or a grand total of 1750 calories, or… let’s see … ummm… one half pound?

Yup.

And that’s
theoretically
.

Remember, the first big study to put Xenical on the map was a two-year European study that showed that patients on Xenical lost between 2% and 3% more weight than those on a placebo. A second two-year European trial put obese patients on a reduced-calorie diet and gave them 120 mg of Xenical, 3 times a day. At the end of the year, they had lost about 9 pounds more than the placebo group. Read that carefully. Nine pounds a
year
, which translates to ¾ pound a month. A similar study in the U.S. produced ½ pound
per month
for Xenical users.

So is Alli the answer? Hardly. Unless maybe you’re a stockholder in Glaxo.

To their credit, Glaxo has not tried to sell this as a “magic pill” solution, and has tried to package it as part of an overall program. The drug is sold with a lot of support materials that discuss the importance of a healthful diet and exercise. If you’re motivated to do an overhaul in your eating and exercise patterns, it might be considered helpful. But it’s important to know that Alli is not going to cause any weight to come off just by taking it and doing nothing else. Truth be told, I think you could achieve exactly the same results by doing the overhaul and skipping the pill.

Save your money and use it for something better—like better-quality food and some decent supplements.

The bottom line is this: medications don’t
cause
you to lose weight. They
may
—and this is a big “may”—make it easier for you to choose better foods, such as proteins over carbohydrates, and they may help you to keep portions under control. Medications may help you follow a lifestyle plan, and you have to be willing to see them in that light. Steiner summed it up best: “Pills don’t work alone.
Programs
, however, do.”

Supplements

Memorize this: there are no supplements you can take for weight loss that will cause the pounds to just melt off without your having to do anything at all.

That doesn’t mean there aren’t supplements you need to take. There are. What supplements
can
do is correct deficiencies and help with metabolic issues that might be
standing in the way
of your losing weight. In that sense, they are essential to your overall program.

Normalizing blood sugar and insulin response is one of the most important keys to weight loss for many—if not most—people. Making a positive impact on the blood sugar–insulin continuum is the main purpose of the low-carb diets discussed in this book. Other conditions that get in the way of weight loss are low energy and fatigue, nutrient deficiencies, adrenal stress, yeast overgrowth, thyroid problems, depression, sleep disorders, food cravings, and even an overtaxed liver. Proper supplements can make a serious positive impact on many, if not all, of these conditions.

Some of the supplements discussed here will help with blood-sugar control; others with energy, liver health, or relaxation and sleep; and still others with cravings or appetite.

Some will do double duty, helping a number of conditions simultaneously. Remember that improving one or more of these things can have a profound effect on your ability to follow a program, but there isn’t one that you can simply take and watch the weight drop off. (If there were, I would probably be selling it and writing this book from a villa on the beach in St. Martin. Then again, as my father used to say,
if my grandmother had wheels, she’d be a wagon
.)

One more note: virtually no supplement—vitamin, mineral, or herb—does just one thing in the body. Most work synergistically and on a number of different pathways, doing good all over the place. A full discussion of the benefits and purposes of, say, vitamin C or vitamin E would fill a small book (for those interested, there are several excellent books on supplements listed in Resources). So understand that, for the purposes of
Living Low Carb
, I’m just going to discuss the aspects of the following supplements that affect weight loss and closely related issues. That should not be taken to mean that these fellows don’t do a heck of a lot more than the things we’re talking about, just that this discussion is intentionally narrowed to the scope of this book.