The FDA has approved an over-the-counter version of the prescription drug Xenecal for weight loss. The questions, of course are:

Does alli work? What are the side effects? Is it safe? Is alli worth the cost?

Does it work?

GlaxoSmithKline chose the name “alli” for their new pill because it’s supposed to be “allied” with a weight-loss program, including exercise and healthy eating. (But that’s 90% of the problem to begin with, isn’t it?) In other words, alli needs to be used in combination with a diet and exercise program or it has virtually no effect. When taken with meals, alli blocks the absorption of about one-quarter of any fat consumed — about 150 to 200 calories worth. In other words, alli gives you about the same effect as using less salad dressing on a big salad or not adding a large dollop of sour cream to your baked potato. Bottom line: for every 6 pounds you lose through diet and exercise, you may lose an extra 3 pounds using Alli — but nothing if you don’t diet and exercise.

What are the side effects?

The most common side effect of the product is a change in bowel habits including loose stools and some oily spotting. About half of patients in trials experienced gastrointestinal side effects. Hey, is it just me, or doesn’t this sound a lot like Olestra and its problems with “anal leakage?”

Is it safe?

According to Dr. Sidney M. Wolfe, Director of Public Citizen’s Health Research Group:

“At a time when colon cancer is a leading cause of death and disease in the United States, the Food and Drug Administration’s (FDA) decision to approve, for over-the-counter use, a drug that clearly causes pre-cancerous lesions of the colon (aberrant crypt foci or ACF) is the height of recklessness and shows a profound lack of concern for the public’s health. This marks the first time, to my knowledge, that the FDA has approved a drug for over-the-counter use despite knowing in advance that the drug causes either cancer or pre-cancerous lesions. This decision raises very serious questions about the competence of former National Cancer Institute Director Dr. Andrew von Eschenbach in allowing the approval of a drug that may well increase the incidence of colon cancer in this country.”

And is it worth the cost?

Financially, it only costs $1-2 a day, not that much. Its effect is definite but marginal, slightly better than all the modified chitosan supplements that people were taking several years ago, but with more side effects and a fairly significant potential risk of colon cancer down the road.

Bottom line: when it comes to the issue of fat and losing weight, it isn’t so much the amount of fat that people eat that’s the problem, but the kinds of fat they eat. The right kind of fat is essential for health. If people just stopped eating large amounts of fatty meat and dairy, foods containing trans fatty acids, all heavily processed vegetable oils, and anything made with any of those ingredients, their fat consumption would drop by more than Alli inhibits anyway. It’s also worth noting that if you do eat any healthy fats (olive oil, avocado, virgin coconut, Omega-3 fatty acids, etc). alli is going to inhibit their absorption too by about 25% — not to mention the absorption of fat soluble vitamins such as vitamins A, D, E, K, and all the carotenoids. That can’t be good.