Duke Researcher Pits A Low-Fat Diet Plus Orlistat (Alli) vs. A High-Fat, Low-Carb Ketogenic Diet

Duke University School of Medicine researcher Dr. William Yancy

Brand new weight loss methods are introduced to the general public each and every year and people are left to their own devices wondering how to decipher the differences between the good and the bad. With slick marketing claims like “scientifically-proven” and even “FDA-approved,” Joe and Jane Consumer out there doesn’t know who or what to believe. One of the most heavily-promoted diet concepts to hit the American market in recent years is the weight loss medication called orlistat, commonly known as and sold commercially as Alli. Maybe you’ve seen television commercials like this one:

In the marketing pharmaceutical company GlaxoSmithKline created to market their “miracle” drug for weight loss, you heard them boldly proclaim that “Alli is proven to help boost your weight loss by 50 percent.” PROVEN? By what? Just because the U.S. Food & Drug Administration (FDA) has approved it to be sold as an over-the-counter medication (keep in mind, this is the exact same FDA that says low-carb diets are “sheer nonsense”)? That’s hardly proof of anything. And you never hear anything about the nasty negative side effects of taking Alli as well as the rampant abuse of the drug all in the name of losing weight. It’s sickening to say the least!

How does a low-fat diet with Alli perform compared with a low-carb diet?

But what if we really did have proof from the scientific community that looked at whether or not drugs like Alli/orlistat along with a “sensible” low-fat diet outperformed by 50 percent other diets like a high-fat, low-carb one, for example? Well, now we do thanks to Duke University researchers who released a new study published in the January 25, 2010 issue of Archives of Internal Medicine. They wanted to compare the effects of a low-carb, ketogenic diet (LCKD) with a orlistat therapy combined with a low-fat diet (O + LFD).

Lead researcher Dr. William S. Yancy, Jr., Associate Professor of Medicine in the Division of General Internal Medicine at the Duke University School of Medicine, observed 146 overweight or obese study participants from the Department of Veterans Affairs primary care clinics in Durham, North Carolina for 48 weeks and placed them at random on one of the two prescribed weight loss methods:

LCKD: Less than 20g carbs daily, unlimited meat and eggs, limited cheese, leafy greens, and non-starchy vegetables, no calorie restriction

OR

O + LFD: Restrict fat to less than 30% of calories, saturated fat to less than 10% of calories, cholesterol less than 300 mg daily, calorie-restriction 500-1,000 kcal below weight maintenance intake, and 120 mg orlistat prior to meals three times a day

The average age of the study participants was 52 and their mean body mass index (BMI) was 39.3. Nearly three-fourths of them were men, over half were African-American, and just under one-third had Type 2 diabetes. A total of 57 members of the LCKD group (79%) made it to the end while 65 members of the O + LFD group (88%) completed the full 48-week study. This was the first time a direct comparison between these two weight loss protocols had ever been studied and the results were stunning!

Weight loss between the two groups was statistically identical while blood pressure levels had a more beneficial impact with the LCKD group. Although HDL cholesterol and triglycerides improved similarly among both groups, the O + LFD group was the only one to see an improvement in LDL cholesterol. However, the LCKD group saw improved blood sugar levels, insulin and HgA1c levels better than O + LFD. In the end, though, Dr. Yancy did not find a significant statistical difference between the two groups regarding the health and weight changes.

What does this mean for those claims that Alli/orlistat “is proven to help boost your weight loss by 50 percent?” It’s dead wrong! Even more compelling is the fact that the dosage of orlistat used in this study (120 mg) is TWICE as potent as what is found in Alli (60 mg). Imagine if the researchers has chosen to use Alli rather than the stronger prescription medication (Xenical) — it’s quite probable that the differences between the two study groups would have been even more stark in favor of the LCKD.

Interestingly, both groups shared specific adverse effects from being on their chosen diet. The LCKD group complained of constipation, increased urination, bad breath, and leg muscle cramps. The researchers note this underlines “the importance of combining intensive dietary counseling and medical management with these interventions.” Meanwhile, not surprisingly, the O + LFD group reported increased flatulence, loss of bowel control, and diarrhea. Neither of these issues caused a mass exodus from following the prescribed diet for the study as “adherence was high over the 48 weeks.”

The LCKD group consumed more than 55 percent of their calories from dietary fat, although the researchers noted that the actual amount of total fat consumed was “identical to their baseline diet.” Meanwhile, the O + LFD group found it necessary to lower their fat consumption in half because of the fat absorption blocking nature of the drug. Calories were naturally reduced on the LCKD while caloric intake in the O + LFD group were artificially lowered because of the orlistat.

I was curious to see how many carbohydrates the LCKD study participants consumed since most so-called “low-carb diet studies” do not come close to restricting carbohydrates enough to see real results. But I was pleased to see Dr. Yancy’s study participants consumed an average of 62g carbs per day, or 15 percent of their total caloric intake in week 48. This is huge since most of these studies comparing low-carb with a low-fat diet have participants eating upwards of 120-190g carbs daily, or 33 to 45 percent of their calories. Yikes! So this truly was a low-carb diet comparison study and the results against one of the most powerful weight loss medications to ever hit the market were virtually identical.

Don’t you think if you could produce similar weight and health improvements on a deliciously healthy high-fat, low-carb lifestyle change without having to shell out the $50/month cost for Alli as well as being forced to suffer through the hunger-inducing impact of a low-fat diet that you’d be more apt to do that instead? Of course you would. But don’t expect to see any television advertisements like the ones you’ve seen for Alli promoting livin’ la vida low-carb because there’s no money to be made from doing that. This is a grassroots word-of-mouth campaign that is gonna take the efforts of people like you and me who have had our lives changed forever for the better because of low-carb living.

Let Dr. William Yancy know how much you appreciate his research showing the low-carb lifestyle performing as well and sometimes even a little better than the most potent weight loss drug on the market today. You can e-mail him you personal thanks at yancy006@mc.duke.edu. Isn’t it good to know your low-carb life works as well as a prescription — without a prescription?!