Weighing in on "Alli": Is This Over-the-Counter Weight Loss Drug for You?

By now most of your have heard about, read about, or perhaps already used the new over the counter weight loss medication, called Alli. It’s the first FDA approved weight loss medication available without a prescription. This is big news since it's a step in the right direction for ensuring both safety and efficacy for weight loss products, which right now promise a lot, and don't deliver because of the lack of regulation.

Not surprisingly, this product is literally flying off the shelves. Is this a good thing? I'd love to hear your thoughts and comments. I’d also like to answer some of the most frequent questions I've been asked about it, and help separate the hype from what can potentially be a helpful weight loss tool for the right person.

Those who are looking at this product, even with the FDA "stamp of approval," as the magic bullet for permanent weight loss will be be greatly disappointed. For those who read the fine print, and are willing to make substantial lifestyle changes, it could be a promising tool.

How does Alli work?

Alli acts to block the absorption of some of the fat eaten in each meal, and eliminating it (in a bowel movement). The prescription version of this medicine, Xenical, blocks about 1/3rd of the fat eaten at each meal. Alli, a lower dose of Xenical, blocks about ¼ of the fat eaten at each meal. So, if you have a food with 16 grams of fat (say, a hot dog), with about 144 calories, you can expect to save 36 calories if you take Alli with the meal.

How much weight can you lose?

Studies show that combined with reduced fat and calorie intake, Alli can help promote further weight loss, when compared with lifestyle alone. The results indicate that up to 50% more weight can be lost with regular use of the medicine. How does this translate into pounds? The answer really depends on how much weight you need to lose for improved health. If you lose 20 pounds with lifestyle change alone, you might expect to lose up to 30 pounds along with regular use of the medication. If you lose 10 pounds with lifestyle, you could anticipate as much as 15 pounds of total weight loss. Far from a miracle pill, but that modest "value added" can be valuable when it comes to your health.

Remember that the caloric deficit comes from a savings from the fat calories only. It's a difficult balance to reduce both total calories and fat calories consumed. If you cut back on your fat, but don't cut your total calories (replacing those fat calories with protein and/or carbohydrates), you won't lose any extra weight.

Most importantly, modest weight loss–just 5-10% of your starting weight–can be health promoting. For someone starting at 180 pounds, that's just nine pounds to better health.

What are the risks?

We've all heard about the "side effects" of digestive problems, gas, and diarrhea. To me, this is not a side-effect, but the main effect to show that the drug is working. When too much fat is consumed, that 25% that is blocked is eliminated. It can be a VERY strong behavioral reinforcement to minimizing fat intake. Can they unpleasant symptoms be avoided? They can certainly be minimized by closely monitoring meal-to- meal fat consumption. Keeping the fat calories at 30% or less of the total meal is a good way to start. Some patients prefer to think of this in fat grams, where it's a good idea to aim for 15 grams of fat or less per meal.

Always check with your doctor or pharmacist before starting any over the counter product to help determine whether you are a good candidate.

Is this the same product found in the "light" potato chips?

Olestra is the non-digestible fat found in some chips and is unrelated to Alli. It has nothing to do with blocking fat in the digestive track. It is a formulation of natural fat that is not digested, and eliminated directly. Many people associate the two, because of the gastrointestinal effects, which are similar.

What do you think about this newest addition to support long term weight management? Thumbs up or thumbs down? I'd love to hear from you!

Restaurant Water Goes "Green"

An interesting "go green" trend is emerging in some of the nation's finest restaurants: the return of tap water. The marketing of bottled water has been a huge success, even spawning "water bars" stocked with a multitude of brands. However, we often don't think of the energy costs of producing and disposing of all of those plastic bottles, plus the energy costs of shipping water, especially from overseas.

The alternative? Tap water is being filtered, and served as an alternative to bottled water. Sometimes the water has been aerated, to provide a sparkling choice as well. While bottled water is still an option, patrons are being encouraged to try the in-house filtered approach.

While many debate the safety of unfiltered tap water in some areas, the filtering of tap water (with or without fizz) can provide a tasty option to bottled water, with a very positive nod to the environment.

Have you heard about this new trend? What do you think of simplifying water consumption?

Cereals Step Up to Better Nutrition

Do you agree with Tony the Tiger that Frosted Flakes are grrrreeeeaaat? If so, you're not alone, with the new labeling and advertising planned by Kellogg to help promote better nutrient content in their cereals. They plan to limit the advertising to children of products that do not meet fundamental nutritional standards. Voluntary changes are underway over the next 18 months for roughly half of the products the company presently markets to kids. It's pretty good advice for adults as well.

Here are the new cereal standards, based on a standard serving (listed on the box):

• no more than 200 calories


• no trans fat


• no more than 2 grams of saturated fat


• no more than 230 mg sodium


• no more than 12 grams of sugar

If a cereal does not meet these requirements, they won't be advertised to children (including mention of branded movie and/or TV characters). Some cereals will be reformulated to meet the new guidelines.

So, check out your own and your children's favorite cereals for their nutritional content, and see how they stack up.

I think this is a great step in the right direction in promoting more healthful cereal choices to both children and their parents! Can other food groups be far behind?

What do you thnk about all of this? A good thing, or government meddling?

More on Food Addictions

I'd like to address some of the responses to an earlier blog about food addictions. Many wrote passionately of their personal stuggles and ways of coping. The blog title was "are food addictions real?" Judging by many comments, pehaps the title should have read "what are food addictions" ?

I do believe that food addictions are very real to many people, who struggle daily. The question is whether this is a biological drive, an emotional drive, or some combination of the two. From the feedback, it seems that there are many ways to deal with these overwhelming drives to eat. And, as with many body-issues, both biology and behavior need to be addressed.

In my own practive, I have seen that each response is so individual. For some, abstaining from the problem food is the issue. Many people "just do it". Out of sight out of mind. For others, the cold turkey approach doesn't work, and leads to deprivation and overeating. For this group, finding a reasonable substitute is a help. Portion control seems the least helpful when people are trying to make that initial change. Better to learn another way to manage.

Is professional help needed to help manage these overwhelming urges to eat? You be the judge. When some of the strategies I talked about earlier do not help, it is important to reach out for help. It is not a sign of weakness to ask for help, but a sign of strength.

What are your own views on food addictions? I'd like to hear from you - and learn how you define this term, and what it means to you.

Feel-Good Foods

I am pleased to be part of the iFeel Good series, both onlinewith you, and for a Today Show segment.

What are "feel-good" foods? While we all need food to survive, and know the basics of eating to promote good health, are these really the same foods that make you feel good? Foods make us feel good for so many reasons—whether it's comfort, great taste, pleasant memories, social situations, nutrient values, or even ways to use food as beauty products. I'd like to share my favorites, and also learn about yours.

Sometimes when I think of food, I'm reminded of a really old Saturday Night Live skit (one of the fake commercials), when a couple is arguing over whether some product is a dessert topping or a floor wax. The moderator (Chevy Chase) intervened and suggested it was both.

"Yumm. Tastes terrific" said the husband (Dan Aykroyd), as he took a spoonful from the container while the wife (Gilda Radner) mopped the floor and remarked, "And just look at that shine!"

So, what does this have to do with feel-good foods? Foods can have more than one use—and while we all know about the help we get on the inside of our bodies with healthy foods, here are some other uses, to also feel good on the outside:

Avocado
Healthy fat, vitamins B,E, fiber: Skin moisturizer and makeup remover

Cucumbers
Vitamin C, fiber, water, molybdenum: Reduces eye puffiness

Oatmeal
Fiber, omega-3-fats, B-vitamins: Skin exfoliator

Olive Oil
Heart Healthy Fat: Hair conditioner

Lemons
Vitamin C: Hair-lightener

So many beauty products contain these foods as a tiny part of the ingredient, but I say, why not use the real thing? Do you have other "feel good outside" functional foods to add?

Another important part of feel-good foods is the association between taste, smell, and comfort. Just look at the variety of candles available that have scents said to relax you and help reduce stress. There is some good science behind some of this, but much is also the situation in which you find yourself.

While smells like vanilla, cinnamon, and lavender have been shown to be "stress-relieving" scents, others like pumpkin pie or "Christmas cookie" (seen around the winter holidays), trigger what I call "smell memory." These are hard-wired imprints that your brain remembers as pleasant, and you get the recurring feel-good sense when you smell these things.

What's great is that this is different for everyone...and has no calories! Feel-good food smells range from chicken soup to meatballs to apple pie to barbecued foods, and whatever else you can imagine. This falls into the range of "comfort" foods or foods that soothe, which can be a very good tool when done in moderation.

Another feel-good food group is one that forces you to change your behavior, and results in a short amount of down-time to relax. Hence, the stress-reducing benefits of green tea. (In addition to all the fabulous antioxidants for inside health.) We need to take a few minutes to brew it, and then sit and drink it in a more relaxed setting, which gives us a breather for the day. It's the same with making soup at home.

I have a friend who makes vegetable soup for herself and other loved ones when she's stressed. The act of cutting vegetables, stirring the soup, and creating a wonderful warm dish gives her a sense of calm and helps her to de-stress.

Then there are the feel good foods that, for me, are a treat to the taste-buds, fun to eat, and good for the body. These are the foods that are good for the inside and out. For me, these are juicy summer berries (a treat I wait for all year) and fresh nuts—especially almonds and walnuts. I always look for the freshest nuts, so I can get the most flavor "bang" for the calories.

For me, in the perfect world, nuts would have the same calories as grapes. Oh well, I'll just keep working on portion control! The combination of nutrients, texture and taste are a real pleaser for my taste buds. Don't get me wrong, my taste buds also enjoy a little stimulation from a square of dark chocolate, or a slice of my own homemade apple pie, but I monitor those portions more carefully and use them as a special treat food, and not part of my daily eating. There's not a lot of hard science to this, but the specialness of the food because of the infrequent consumption is a particular treat for me.

What are some of your favorite feel-good foods? Do you know why? Just writing down my thoughts has made me think more about why some foods really make me feel good. We all need to make friends with food since we all have to eat to survive!

Food serves so many wonderful purposes, and it's a shame that in our culture so many of us only feel bad and guilty about food. Time to revisit this and feel good about eating!

Watch the iFeel Good segment from TODAY:

Click image to view.