Weight Loss Drugs: Is the Magic Pill Here at Last? (Part 2)

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Last week, we looked at a few prescription weight-loss drugs—some that can lead to dependency, and one that has yet to be approved. What else is available? If you’ve been in your local pharmacy recently, you may have seen displays heralding the arrival of "alli" (spelled with a small "a" and pronounced "ally"). What’s this all about, and why is it sold over the counter rather than by prescription?

You may recall the advent of Xenical (orlistat) almost 10 years ago. Xenical is a different kind of weight-loss drug in that it works on the gastrointestinal (GI) tract, and not on the appetite center in the brain. Specifically, Xenical prevents about one-third of the fat a person eats from being absorbed. And we all know that fat is a concentrated source of calories, so by preventing some of it from being digested and absorbed, people using Xenical end up taking in fewer calories and losing weight. What happens to the fat? The person eliminates it. Unfortunately, there are some rather unpleasant side effects, including an increased number of bowel movements, increased urgency, gas with oily discharge, and anal leakage. These symptoms are more likely to occur if the user’s fat intake exceeds more than 30% of his calories; therefore, there’s a kind of negative reinforcement that comes along with using this drug. In addition, Xenical can prevent the absorption of some fat-soluble vitamins, so it’s recommended that a person take a multivitamin while using this medicine. Xenical is taken as a 120-milligram capsule, up to three times per day.

The newer drug alli is Xenical’s lower-dose cousin. It works exactly the same way, by blocking some fat absorption, and the side effects are the same. In fact, alli’s Web site, www.myalli.com, nicely describes this undigested fat appearing in your toilet as looking like “the oil on top of a pizza.” Hmmm.

alli is taken as a 60-milligram capsule up to three times per day. The expectation is that a person will also follow a low-fat eating plan while taking alli; therefore, for every five pounds he loses on the low-fat diet, alli can help him lose an extra two to three pounds. Most of the weight lost while taking alli will occur during the first six months. Fortunately, alli’s Web site recommends working with a registered dietitian for safe and effective weight loss, which is always sage advice.

Not sure if alli is for you? Well, if you have Type 2 diabetes and are taking metformin, a sulfonylurea, a thiazolidinedione (rosiglitazone [brand name Avandia] or pioglitazone [Actos]), or any combination of these drugs, you might talk to your physician about taking Byetta (exenatide). Byetta is a newer type of drug called an incretin mimetic that can help improve blood glucose control. Interestingly, it’s derived from the saliva of a lizard called the Gila monster. It’s not approved for use in people with Type 1 diabetes.

Byetta works to control fasting and post-meal blood glucose levels by restoring first-phase insulin secretion and suppressing glucagon secretion (glucagon is a hormone that raises blood glucose levels). Byetta also slows gastric emptying, which means that it can suppress appetite and lead to weight loss, which has been quite significant in many people. And it’s been shown to lower triglyceride levels and raise HDL (or “good”) cholesterol levels, as well. Side effects of Byetta include nausea, which is usually temporary, and possibly hypoglycemia if it is taken along with a sulfonylurea. Also, Byetta is given as an injection (just like insulin), using a pen device. For more information, check out www.byetta.com.

So, no magic weight loss pill (or injection) is available yet. However, more and more options are becoming available. If you’re interested in any of these medicines, talk to your health-care team about the best option for you.

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