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Monday 25 June 2007

Many doctors are not loyal to Alli

The recent debut of Alli, the first over-the-counter slimming pill approved by federal regulators, no doubt has some dieters dashing to drugstores and supermarkets. But shortly thereafter, critics warn, they'll be dashing to the bathroom.

Alli is a lower-dose version of the prescription drug Xenical, which blocks about 25 percent of fat from being absorbed into the body by attaching itself to fat-dissolving enzymes. Problem is, the unabsorbed fat then may exit forcefully and frequently.

"We have the makings of some very embarrassing moments," says Jeffrey Novick, nutrition director for the Pritikin Longevity Center & Spa in Aventura. "This is not new news. Just old news repackaged."

Dr. Andrew Larson, bariatric surgeon at JFK Medical Center in Atlantis, isn't an Alli fan, either.

"I think it's going to be a total flop," he says. "Some people might expect a little buzz, like you'd get with Dexatrim or other diet pills. But with this, you're not going to feel anything — except the side effects."

Alli literature states: "While no one likes experiencing treatment effects, they might help you think twice about eating questionable fat content. If you think of it like that, Alli can act like a security guard for your late-night cravings."

An article in last week's Wall Street Journal, meanwhile, gives potential buyers some math to chew on:

A half-cup serving of Häagen-Dazs ice cream has about 320 calories and 19 grams of fat. Alli, which is taken with meals, would stop the body from absorbing about 4.75 fat grams or about 43 calories.

If you consume 2,000 calories a day and eat 30 percent fat, the fat-blocking benefits of Alli would translate to approximately 150 calories a day. A pound of weight loss equals 3,500 calories.

Critics insist that if you're committed to healthier eating and exercise, like Alli recommends, you don't need the drug.

"Why bother?" says Dr. Kenneth Woliner, a family practitioner in Boca Raton. "The only advantage of this pill is if you can't stop yourself from eating regular cheese or the skin off a chicken. You'll quickly regret it. But if you cut out the fat, you're doing what you need to do anyway."

Xenical (generically known as orlistat) has been available in 120-milligram pills since 1999, with prescriptions falling from 1.5 million in 2002 to 623,000 four years later. GlaxoSmith Kline acquired the over-the-counter rights from Roche in February and spent $150 million aggressively marketing Alli, which hit stores June 14.

There's an Alli book, Are You Losing It?, with diet tips and low-calorie recipes. And www.myalli.com offers a message board and personalized action plan.

GlaxoSmithKline says dieters can lose 50 percent more weight with Alli (pronounced AL-eye) than with dieting alone. The 60-milligram pill, taken three times a day, doesn't suppress appetite or affect the brain.

But doctors are concerned that Alli, approved by the U.S. Food and Drug Administration for adults 18 and older, also may block absorption of fat-soluble vitamins, such as A, D, E and K.

"Low vitamin D can push you toward dry skin, psoriasis, depression and cancer," Woliner says, adding that the drug doesn't distinguish between "bad" fats and "good" ones, such as the essential fatty acids found in fish oil.

Insufficient vitamin D also may raise the risk of brittle bones, gum disease and diabetes.

Woliner predicts that consumers will buy Alli only once or twice, which still means a hefty payday for GlaxoSmithKline.

Walgreens and CVS, for example, charge $49.99 for a 60-pill starter pack and $59.99 for 90 pills. Publix charges $46.99 for the starter pack and $69.95 for 120 pills.

"I don't think it's going to be a success," Larson says, advising people to eat more fiber and choose healthier foods instead. "I personally don't like it at all. It's a weak pill."

Via www.palmbeachpost.com

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