You may have read news reports that the Food and Drug Administration approved the first ever officially sanction weight-loss drug for over-the-counter sales. The drug, Alli (generic name: orlistat), has been sold for the last eight years as the prescription drug Xenical. The difference between the OTC version and the prescription version is in the dosage. Alli will be sold as a 60 mg version whereas Xenecal has been sold as a 120 mg version. All consumers need to do to get the prescription dose of the drug is to take a double dose. But according to the manufacturer, even the lower dose is effective.

Glaxo studies have shown that the 60-milligram dose provides 85 percent of the weight loss of the higher dose. One capsule is supposed to be taken at mealtime.

Alli is not the drug you want to take if you’re following a low-carb diet.
MD and I have had extensive experience with this drug. Back in the early 1990s our clinic in Little Rock was one of the largest clinics participating in one of the stages of the orlistat study. In fact, our clinic was the largest in terms of number of patients in the orlistat maintenance study.
Since MD and I were the only physicians at our clinic, we both had a lot of hands-on experience dealing with patients taking orlistat. Or oily stat as we called it. Why oily stat? Well, because of the side effects.
The top three side effects of oily stat are: fecal incontinence, oil spotting, and my all time favorite, flatus with discharge. Any of these side effects can lead to a most unpleasant social situation.
These side effects are a function of how the drug works. Orlistat is a lipase inhibitor. Lipase is an enzyme in the small intestine that breaks fats down into their component fatty acids so that these fatty acids can be absorbed. When lipase enzymes are inhibited, the fats don’t break down, and, consequently, don’t absorb. When fats aren’t absorbed into the small intestine, they make their way down to the colon. Under normal situations the colon never has to deal with fat because it’s usually absorbed way upstream, so the colon isn’t prepared to deal with fat. The fat slides down the colon and makes its way out at the bottom end. If all goes well, it sees the light of day when you want it to. But often the colon gets rid of this fat on its own schedule, whether convenient for you or not.
Our patients used to complain bitterly about these unwanted and untimely discharges of fat that would ruin their clothing and sometimes even their furniture. We had one lady who termed the discharges themselves as cosmic pizza grease because that’s what they looked like. Soon, all of the patients were using this phrase to describe them.
Orlistat basically puts those who take it on a drug-induced low-fat diet. Consequently, those taking it suffer the same consequences as those on long-term low-fat diets: depression (we had many patients who had to be removed from the study due to depression), low-levels of vitamin K and other fat soluble vitamins, and gall bladder disease.
Let’s digress just for a moment to discuss gall bladder disease because many people don’t understand how a low-fat diet can cause gall bladder disease. The pancreas produces the lipase enzymes that break down fat, but these enzymes are helped by the bile salts produced by the liver. The liver makes these bile salts and stores them in the gall bladder, a little sack that sits underneath the liver. When a load of fat enters the small intestine, the gall bladder squirts a stream of bile salts into the load of fat going through to begin the breakdown process. The slurry of fat and bile salts are acted on by the lipase enzymes to complete the fat breakdown to individual fatty acids that can then be fully absorbed by the small intestine.
When people have problems producing bile salts, they have the same side effects as with orlistat. The mass of fat can’t be broken down completely for absorption by the lipase enzymes alone, so fat reaches the colon and causes problems.
As the bile salts finish their work with the fat, the liver plucks them out and recycles them, sending them back to the gall bladder. If very little fat enters the small intestine as a consequence of a low-fat diet, the gall bladder doesn’t get the signal to squirt out the bile acids. The bile acids in the gall bladder sit there and tend to concentrate over time. Since a major component of the bile salts is cholesterol, the cholesterol tends to supersaturate and can precipitate out as small cholesterol stones. (One family of cholesterol-lowering drugs work by preventing the re-absorption of cholesterol in the bile salts by the liver, allowing them to leave the GI tract through the stool.) These stones can cause real problems because they can work their way down the tiny ducts through which the gall bladder squirts its contents into the small intestine. What usually happens is that a person follows a low-fat diet for an extended period of time allowing stasis of the bile in the gall bladder and small stone formation. Then this person has a hankering for a big, greasy cheeseburger or other fat-filled meal and chows down on it. As the fat enters the small intestine it sends the normal signal to the gall bladder to release some bile salts. The gall bladder constricts to squirt the bile salts into the intestine and pushes one of these small stones into the duct. When that happens, the opposite of fun begins. As anyone can tell you who has had this happen, the pain is excruciating. Most people who have this happen blame the fatty food, but it isn’t the fatty food that causes the underlying problem. The underlying problem is set up by the low-fat diet.
In our clinical study we did gall bladder ultrasounds on all patients as they started. We eliminated from the study anyone who had gall stones. After six months on a low-fat diet, we redid the gall bladder ultrasounds of all the patients and found that about 10 percent of them had developed gall stones.
Orlistat works in theory by putting people on a drug-induced low-fat diet. In reality it works by putting people on an actual low-fat diet. Since orlistat prevents the absorption of about 25 percent of the fat coming down the GI tract, the more fat that is eaten, the greater the amount this 25 percent represents. There is a point at which the 25 percent that hits the colon causes the side effects. Patients on the drug quickly learned how much fat they could eat before they had problems, and kept their fat intake below this limit. The orlistat ended up acting like Antabuse for fat. (Antabuse is the drug that alcoholics take to prevent their drinking. If they take Antibuse and consume alcohol, they become seriously ill. So they avoid drinking.)
(Interestingly, when the representatives of the drug company that developed orlistat came and talked to us, they gave us a little history of the development of the drug. Like many drugs, orlistat was kind of a lab mistake. When the researchers realized that it was a lipase inhibitor that would decrease the absorption of fat, the first thing that popped into their minds was that they had a cholesterol-lowering drug on their hands. Makes sense, since ‘everyone’ knows that dietary fat makes cholesterol levels go up. Turns out that orlistat didn’t reduce cholesterol levels–if anything, it made them worse. So they scratched the idea of using it as a cholesterol-lowering drug and punted. They decided to use it as a weight-loss drug because ‘everyone’ knows that dietary fat causes obesity.)
How does all this apply to a low-carb diet? Well, by definition, a low-carb diet is in most cases a high-fat diet. If one takes orlistat while following a high-fat diet, very bad things happen. Very socially-embarrassing bad things. Cosmic pizza grease cubed. And at random times. Unbidden and unwanted. And unforgettable.
If you’re following a low-fat diet and you want to make sure you stick with it, give Alli a try.

The manufacturer, GlaxoSmithKline, said it planned to sell the medication for $1 to $2 for a day’s dose. The company has predicted that five million to six million people a year will use the drug.

If you’re on a low-carb diet, don’t be one of them.


  1. Hi Dr. Eades,
    I’m one of “those” people who out of desperation to lose weight was put on Xenical years ago. Thinking it was a magic pill. ~ anyways, I’m here to say that your article describes EVERYTHING to a T! Right down to me losing my gallbladder, which I did.
    I had a suspicion that losing the gallbladder was directly due to taking that medication..and well, you just confirmed my intuition. Thanks for explaining.
    The ONLY good thing that came from that experience was that I was determined to live in a healthy way, and deciding that a “magic pill” wasn’t the way. My determination eventually lead me to your Protein Power plan! 🙂
    May my gallbladder rest in peace.
    Hi Missy–
    I suspect you are right about your gall bladder.  I’m glad you finally got on the right track.

  2. Thanks for the laugh!
    Unfortunately, I’m afraid many people are going to try this stuff. I guess if you believe that a low fat diet is healthy it might be more attractive.
    Curious that the side effect of elevated cholesterol isn’t mentioned much!!!! You’d think that alone would warrant a warning or two! hmmmm, maybe they could sell orlistat and lipitor together in 1 pill!
    Hi Cindy–
    It really didn’t raise cholesterol all that much, but it certainly didn’t lower it, which gave them no choice but to look for another use besides as a cholesterol-lowering drug.  Just remember this story, though, next time someone tells you a low-fat diet will lower your cholesterol.

  3. Eeeeeuuuuuuwwww!
    Thanks for the photo of the alli pill starter pack, too. Is the blue thingy above the pill bottle a “cosmic pizza grease cork” ????
    Hi Anna–
    No, the cork thingy isn’t a cosmic-pizza-grease cork.  The thing in the photo is blue; cosmic pizza grease is a shiny, sort of fluorescing, reddish, nasty oily looking stuff.

  4. I meant a cork to stop the flow of cosmic pizza grease :-).
    Ahhhh, I misunderstood.  It quite possibly is a cosmic-pizza-grease cork.  It’s probably blue so that it will stand out from the contents.

  5. Thanks for the excellent article. I have been researching this new product since I heard about it on Wednesday. However, I have a few questions….I read the manufacturer’s website, and they make it sound like the side effects are avoidable if you stick to a low calorie, reduced fat diet. Do you think that is true from your past experience with patients? Were they experiencing these effects after meals containing large amounts of fat? Thanks for you reply.
    P.S. They are calling that blue thing the Shuttle and you put your pills in it.
    Hi Teresa–
    The manufacturer’s website is correct.  As long as you stay on a low-calorie, low-fat diet, you shouldn’t have side effects.  The side effects occur when too much fat reaches the colon, an organ not designed by nature to deal with much fat.  Alli blocks about 25% of the fat eaten, and if this 25% is large enough – because of a large amount of fat in the diet – a larger amount of fat reaches the colon than the colon can handle and the side effects mentioned in the post occur.  A low-fat, low-calorie diet contains very little fat; the 25% of this small amount of fat that reaches the colon is a tiny enough so that – in most people – it doesn’t cause side effects.
    But, this raises the question, if you have to follow a low-fat, low-calorie diet to prevent the side effects, what’s the point of taking the drug?  Why not just follow a low-fat, low-calorie diet without the drug?

  6. Given the shoots and spotting and all, perhaps the drug works best as a Hard Incentive to stay on your very hard to follow low fat, calorie restricted eating disorder diet?
    I think it’s funny, in a very sick way (and I’m sorry about Missy’s gallbladder, and anyone else’s). Folks get this looking for a magic bullet. Those folks are probably the people who would have the hardest time making the lifelong, Hard Commitment to any diet. So, they take a pill. With very icky side effects and a very stern warning about what I understand is a very painful downside (gallstones). They get a magic bullet alright. Essentially, they get the magic creation of the hard commitment they couldn’t do without the pill.
    Ergo, it might be very effective. With high suicide rates as a side effect. Oh, and we’ll keep the gall bladder removal surgeons in business. This is, in a sick way, brilliant for the economy.
    Hi Max–
    It is indeed brilliant.  Buy the drugs, which puts money into the coffers of the pharmaceutical industry.  Suffer the side effects, which spreads even more money throughout the rest of the medical establishment.

  7. Dr. Mike
    I knew you’d have to blog on Xenical and you didn’t disappoint. Some good material here, and like you, I’m especially attracted to the phrase “flatus with discharge”. For starters, I can imagine many situations out on the links where hauling out the phrase at the opportune time would lead to some good belly laughter. Butt, I think the main reason I like the “flatus” phrase is that, syllabically it reminds me of a favorite and infinitely more appealing event –“massage with release”.
    Cheers, and good luck trying to salvage this comment for an acceptable release into Eades’ cyberspace.
    Hello James–
    I’m posting your comment as is so that readers will get some idea of what kind of people I hang out with.  As to the two “sylabically” similar events, I’ve experienced neither, but, given the choice, I think I would prefer the latter.

  8. Most will agree these days, even the misguided fanatics like Ornish, that you require some sort of fat in your diet.
    So if you follow a low fat, low calorie diet(as you must) and take this new drug, isn’t there a worry that you’ll become fat deficient?
    Seems very misguided to me.
    Hi Angelyne–
    It is misguided.  As we found in our study, many people taking the drug became deficient in fat-soluble vitamins.  Also, many of the phytochemicals that are good for us require fat for absorption.

  9. It seems to me that by focusing on the “low fat, low calorie” instructions, the point is being missed that to avoid the side effects, one must indeed, follow a low fat diet, but that does not necessarily mean that the diet is also low calorie. Since the side effects do not occur with high SUGAR intake, one could very well avoid the side effects and still gain weight handily. Not to mention diabetes, insulin resistance, etc. etc. that go with high sugar intake.
    Hi Martha–
    You are absolutely correct.

  10. So what would be the best treatment for gallstones? My SIL is currently on a low-fat diet, but it would seem like that would be making things worse, not better?
    Hi Danielle–
    As I remember it from my surgery days, the best treatment for gallstones is surgical removal.  I would check with a surgeon who is a little bit more up to date on the latest treatments than I am.
    If the gallbladder is occluded with stones, it may not be working properly, in which case it isn’t squirting the bile acids in response to a fat load.  If that is the case, a low-fat diet may work the best to prevent problems.  If the gallbladder contains small stones, the kind that can make their way down into the ducts, then a low-fat diet is really the best choice until the problem is resolved.

  11. Ugh! Talk about unintended consequences. What a bummer if you had a hot date.
    The ironic thing about this is, at least in my experience, a high carb diet causes digestive problems anyway even without this drug. My tummy feels MUCH better since I cut out all grains. (I still get maybe 60-70 grams of carbs per day from fruit, veggies, dairy, and nuts, all of which I tolerate very well.)
    Hi Paul–
    The high-carb diet does indeed cause digestive problems in many people, but I don’t think these problems are of the same magnitude as those driven by orlistat.

  12. “Cosmic pizza grease”….oy! That sounds absolutely horrible. Avoid the drugs…lose weight the natural way.
    Well said!

  13. This is why I stick to the most basic supplements, and have never tried either prescription or OTC weight loss drugs… like TrimSpa. (I don’t care what anybody says, I feel sorry for Anna Nicole Smith.)
    There are too many ingredients we know nothing about.
    As to Xenical, once again, this is a case of too much hope and too much reliance on the medical profession without doing the necessary research for yourself.
    Hi LC–
    I, too, feel sorry for ANS; I always thought she was kind of pitiful.

  14. If I recall correctly, wasn’t the fat substitute, “Olestra”, a bit of a flop, due to the “anal leakage” issue?
    It seems to me that this product will have the same problem, multiplied tenfold. Who wants to take something that causes “flatus with discharge”?
    Hi Dave–
    Right you are.  Plus it tasted kind of nasty. A bad combo.


  15. UGH! It amazes me that anybody would actually voluntarily take this … don’t they realize what goes in has to come out in some form?!
    Wonder if the pharmaceutical company selling this junk OTC also owns an adult diaper company? That’d be a nice scam.
    I had a doctor try to put me on this once. The funniest thing was I hadn’t gone to him for weight loss advice–I’d gone to get an antidepressant! He seemed to feel if I wasn’t overweight that’d cure it. I can’t think of many more depressing things than uncontrollable “flatus with discharge”!
    Hi Alisha–
    This medication is the absolutely last one you would want to take if you were already depressed.  It’s probably not a coincidence that as the bookshelves in bookstores were loaded with low-fat diet books they were also filled with books on dealing with depression.  A low-fat diet, in my opinion, promotes depression.  The brain needs fat and the brain needs cholesterol to function properly.  And, elevated insulin levels have negative effects on the brain just as they do on the heart, blood vessels, and other tissues.  Orlistat puts one on a drug-induced low-fat diet, so depressive symptoms will get worse, not better.  And that doesn’t even include worrying about ‘flatus with discharge.’

  16. I think someone at work is using this stuff. A couple of days ago I saw a ring of orange, greasy matter around the waterline in the toilet bowl.
    Sounds like the stuff.  Charming!

  17. i have a friend thinking of taking this drug, but dont have a gallbladder. Is there a cause for concern? outside of all u have mentioned already?
    It depends upon how long she has been without her gallbladder and a number of other issues beyond the scope of this blog.  I wouldn’t take it.

  18. thanks for the help she doesnt have a dr (no insurance) so i showed her what u wrote and decided against taking the drug

  19. Hello Dr. Eades,
    I live a low carb lifestyle (20 grams of carbs a day, maybe a bit more) and my fat intake is moderately high (100 grams a day). I am in perfect health and my doctor says that my blood tests are perfect. I have recently started taking alli to boost my fat loss. I am not overweight but I could stand to lose 10 pounds.
    I am of the belief that alli is next to useless if you are on a low fat diet – for instance, if you eat a…lets say turkey sandwich that contains 9 grams of fat, then alli elimitates 25% of the fat calories which is a measly 20-25 calories. That is next to useless and adds up to a few pounds of extra weight loss a year.
    I believe alli is most effective on a low carb diet. I just ate a double whopper with a salad. The whopper had about 45 grams of fat. With alli, I eliminate 100+ calories from that meal and retain the metabolic advantage inherent in low carb dieting.
    The side effects have been quite manageable. I have some extra gas and my bowel movements include the “pizza grease” but I do not stain my underwear from “flatus discharge” like some other users report. I don’t understand why you think alli would not be an extra edge for someone on a low carb diet. I think alli is perfect for low carb diets. If you cite side effects, then you should be preaching “buyer beware” and not that alli is inappropriate for low carbers.
    Hello Jerry–
    I will freely admit that I never thought of this angle.  You’re right.  Alli will certainly get rid of excess fat calories, and as long as you can stand the side effects, it should help you lose weight faster.
    I’ve had a lot of experience with patients taking this drug, and most couldn’t tolerate the side effects.
    If anyone else tries this strategy with a low-carb diet, be sure to let me know how it works out for you.

    1. I’m on Atkins and Alli. When I was on Alli, I would see the cosmic pizza grease. I thought it was a great thing, because if the fat was in the commode then it wasn’t in my body. We could actually see the fat gone. But, I did not lose any weight. I gained 4 lbs. It was awful. I spent a lot of money on the no fat foods and I either had to cover everything with spices or enjoy a great tasteless meal. So, I went on Atkins, I did it ten years ago and lost 30 lbs and was thin again, and kept it off for a very long time until I had open heart surgery for my mitral valve and came out of the hospital 20lbs heavier than I went in. Over the past two years I have gained another 25 lbs. Something had to be done. Low fat was not doing it (I swear I did not cheat) I was doing it for four months. Alli was showing the fat in the commode but I gained 4 lbs. I exercise, treadmill 2 miles, and Zumba 4-5 days a week. So, I’m trying Atkins again. I figured, hey, wait a second, if I did Atkins and Alli I would lose a lot of weight. Our bodies burn carbs before fat, limit your carbs and it goes straight to burning the fat. Yea! Right? So, if I’m in ketosis and burning fat due to lack of carbs than how can Alli not be an extra power pack booster to that goal?
      I have not had the cosmic pizza grease in the commode, though. I have…green sewage. I have always been a veggie eater so it cannot be an excess of green veggies, that has not changed much, so why have I lost the cosmic pizza grease?

  20. Well frankly, I HAVE TRIED IT ALL…and the only think that truly worked was phen-fen (whooshing sound as air sucks out of room…) Yeh, I said it… PHEN-FEN!!! That’s the drug the FDA should’ve left alone. The people who had problems were members of the “if 1 is good, 2 is better, so I’ll take 3” club. Abuse leads to problems. Heck, you can pickle your liver with Tylenol if you wanted to. As far as Alli or Xenical is concerned though, I agree with the majority…if you could stick to a low fat, low cal diet to begin with your big butt wouldn’t need the orlistat stuff. The problem is the desire to eat and phen-fen actually removed my desire to eat. I could cook a meal and not get hungry and my family would have to remind me to eat. If the FDA would bring it back I’d do it again. I lost the 45 lbs I needed to but when the meds stopped, the desire returned and VOILA…55 lbs returned. It sux.
    Hi Pat–
    There’s no question that Phen-fen worked (works).  The problem is that there are some pretty bad side effects for a small percentage of people who take it, and it’s not something one can take forever.  You lost 45 lbs, quit taking it, and all the weight came back.  Even if Phen-fen causes no problems for you in terms of bad side effects, it’s not something you can take for the rest of your life.  Nor is it something you could take to lose 50 lbs, then regain the 50 lbs, then take Phen-fen again, and so on.  At some point you’ve got to make changes in the way you eat.  Sad to say, but that’s the only way to lifelong health.

    1. Hi there. I just wanted to make a suggestion. Have u tried Reductil or Phentermine? Very similar but of the 2 Phentermine would have less adverse side effects. The best one is Phentermine 37.5 mg

  21. I agree with MRE. I consume about 20 grams of carbs each day and take 1 or 2 Alli capsules with my evening meal in order to reduce the fat calories. I experienced the now well-known side effects for the first couple of weeks, but they have largely subsided since. The greatest benefit is that it helps alleviate occasional constipation. I don’t plan on using Alli over the long term, but I am finding it to be an extremely helpful part of my weight-loss plan.
    I’m glad it’s working for you. Keep me posted on the long-term effects.

  22. So, I get what all is being said about this pill. One question! If your gallbladder has been removed about 9 yrs ago, should you Not take this pill even if you can manage the spillage?
    Hi Lisa–
    You should discuss the situation with your doctor who knows you much better than I. I would imagine that you have compensated for not having a gall bladder after 9 years, however.

  23. I started Alli about 2 weeks ago and experienced the side effects for about a week. Yep, had to ditch a pair of undies at work as well. By now said side effects have mostly gone away and the grease get’s discharged while using the bathroom.
    I now started back with low carb eating as well, last year I dropped 25 pounds avoiding carbs, I would think with Alli as a partner it’ll only work faster.
    Interesting. Keep me posted on your results.

  24. This has been bugging me for a while and the official Alli forums weren’t helpful. They are full of people reporting the various normal side effects.
    First, I eat a fairly low-fat, controlled-carb, high-protein diet. I decided to try Alli to see if it could help me get those last few pounds off. To my utter surprise I have had NO side effects. I can take a double dose (prescription strength) and eat a ton of fat and still…nothing. Stools might be a little softer than normal, and that could just as well be the magnesium I take.
    My question is: Is it normal NOT to have side effects? Or does that mean that it’s not working? I don’t want to waste my money, but after all the side effect hype… Is this normal?
    Hi Victoria–
    The drug works by preventing the absorption of fat in the GI tract, which means that this fat travels on out as part of the feces. If you are seeing no change, then maybe the dose isn’t high enough for you. The dose in the OTC version isn’t very high. Perhaps you should get a prescription for a stronger dose and give that a try.
    Keep me posted.

  25. I sometimes take two tablets, which is a prescription dose, and even that doesn’t seem to help. Are you saying I should take more than that?
    I can’t give medical advice over the internet. Maybe others who comment on this blog have had experience that they can share.
    Hope you understand.

  26. I’ve been taking the alli pill since June of 07, with good results. In November of 07 I started to experience pain. I stopped taking the alli pill until January of 08. On January 18 the pain came back. I went to the hospital and was diagnosed with Pancreatitis . My gallbladder had to be removed. I’ve never had issues with my digestive system prior to taking alli. I have been in contact with the manufacturer and they are sending me forms to submit to my doctor.
    Interesting. Since Alli causes symptoms if one eats fat, most people cut down on their fat intake. A reduced fat diet can lead to gall bladder disease because without fat coming down the intestine, the gall bladder doesn’t contract. If it doesn’t contract and squirt out the bile within the bile begins to form stones. These stones can cause all the problems you experienced.

  27. I have been low carb dieting for awhile. I started taking Alli because I figured it was a perfect match for a moderate to high fat diet if I could tolerate the side effects. Should 75-100 grams of fat a day be enough to ward off worries of gall bladders troubles? Also if I do a ketone test I show negative to minimal. Is this due to the fat passing out of my body but not through my urine?
    75-100 gm of fat per day should be enough to keep the gall bladder functioning properly. (I say ‘should’ because there is no one size fits all in medicine.) It also might be enough to cause some nasty side effects with the Alli. If you have much carb intake throughout the day you won’t be in much, if any, ketosis. The state of ketosis has nothing to do really with how much fat passes through the GI tract.

  28. Hi,
    Is that the reason why a lot of the low fat / lean diets say that it is OK to have one bad day a week and eat whatever you want – as a precaution against gallbladder problems?
    I suppose it could be, but I think it’s more likely that the promoters of these diets realize that people have difficulty staying on them for the long term without being given breaks during which they can eat real food.

  29. I just had my gallbladder taken out about 3 weeks ago. I need to lose about 50 lbs. Can I take the alli?
    I’ve had no experience with patients who have had their gall bladders removed taking Alli. I don’t see a reason that one couldn’t take it, but you should check with your own physician first.

  30. Hi ~ I’m considering taking Alli but have not gotten any definitive answer in regard to how it affects a body that does not have a gallbladder. I had my gallbladder removed about 25 years ago. I’ve always eaten fatty foods and have had to deal with pain and inconsistent bowels. I know that Alli requires a low-fat diet and exercise to work effectively. So, I guess my question is: If you use Alli as a jumpstart, along with starting a routine of eating low-fat foods and exercise, will the absence of a gallbladder really affect your system that much? I’m just looking to have a bit of help initially and then slowly getting away from the pill and easing into a healthier eating and exercise life plan. I’m 52. I’ve been busy raising a family and going to college F-O-R-E-V-E-R — if my body was a fit as my mind, I’d be wearing a size 8!
    I have no experience with patients who have no gall bladder taking Alli. I can’t think of why it might cause a problem, but it’s something you need to ask your own physician.

    1. I had my gallbladder removed 24 years ago and I just purchased Alli today. I’ll wait a couple weeks and let you all know how it goes. I don’t have insurance at the moment and I also don’t think my current doctor could give me any valid advise since he’s only been my doctor a couple years now. I also don’t believe I have a problem absorbing any nutrients, nor have I had any problems with digestion since having my gallbladder removed. I still might send an email to my doctor, but I won’t hold my breath for an answer as they aren’t real good about responding. I’ll post again in about 2-3 weeks?

  31. I have been taking Alli for about 2 months now on a high-fat, high-protien, low carb diet. I have not had any of the “bad” side effects. I guess I have to “go” a bit more often and it’s sometimes more of a “I need to go NOW” rather than “I can hold it for a while” situation, but no biggie. And even those things don’t happen all that often.
    Since then I have lost about 10 pounds which isn’t a lot of weight, but I have lost quite a bit of inches in my stomach area.
    I would say to take the advice of a good doctor. I have an awesome dr and he gave me the go-ahead. With it not having side effects such as heart problems or jitteryness, it’s not all that bad. And I have a mild heart condition as well as hypothyroidism.
    So talk to your dr and do what you think is right!
    And one last note – I totally agree with those who take it on a low carb diet. It makes sense. If I eat a low-fat diet and then the pill takes away some of that fat/calories, that has LITTLE impact. But if I eat a low carb diet saturted with healthy fats, then the percentage of calories removed would be great, thus doubling the positive impact of a low-carb diet.
    Hi Samantha–
    Thanks for the history. It should have much more impact on fat calories from low-carb diets because there are so many more of them. But it should also create many more symptoms with such a diet as well. I’m glad to read that you have escaped them.

  32. When on a low-carb diet and you reach “ketosis state”, what is the average weight loss by day during that state?
    It depends on caloric intake. Take a look at this post.

  33. Hey, the little blue thing within the package looks a bit like a piece of you-know-what. Maybe the makers of orlistat are trying to send a subliminal message to users about what they can expect. Heh heh.

  34. I have been taking Alli now for 3 months at a super low dose hoping to avoid the Pizza grease. This has worked and with diet and exercise I have lost 15 pounds and look great. However after suffering 3 weeks of severe stomach pain and being tested by my Dr I now suffer from gall bladder issues. My healthy diet is continuing now only to avoid further pain and suffering. Will the gall bladder heal?
    Occasionally a gall bladder will ‘heal,’ if that’s the word, but more often than not if stones develop some sort of surgical procedure is require to get rid of them.

  35. I started using Alli December 2008 and stopped taking it around the end of September 2009. I am currently experiencing a gallbladder attack from thanksgiving dinner! About 2 months ago (when I stopped taking Alli for good!), I was experiencing sharp pain in my right abdomen that was radiating around my navel. I thought it was my appendix so I went to the ER. The only thing they could find (after many tests) was that my gallbladder was inflamed with fluid around it. They sent me home with no instructions other than come back if the pain returned within the week. I’ve never had problems with my gallbladder or any other medical problems prior to Alli use. I plan on talking to my doctor about it next week and was wondering what I should mention, ask, or even if I’m on the right track here. I just drank apple cider and lemon juice and that seems to help so far. I am a 21 y/o female nursing student and am very concerned about my gallbladder and hoping for suggestions or advice. Thank you!!

  36. I am considering taking Alli and have been reading a lot of information on it but have yet to see any comments or any information for people that have had their gallbladder removed. Is it still okay to take Alli if I’ve had my gallbladder removed?
    Should be less of a problem than if your gall bladder were still in place.

  37. I’m currently on a low-carb diet and have lost over 100-lbs but have about 10-15 lbs more I would like to drop and have “stalled” I was curious would alli be good idea just to help drop those last 10-15 lbs? From what I’ve heard Alli would also help to keep things moving as low carb tends to back things up a lil bit…

    1. It will certainly un-back things up, but probably not in a fashion you would enjoy. It would be difficult to use Alli on a low-carb diet because a low-carb diet is typically a higher-fat diet. Alli blocks the fat absorption, so excess fat moves on out in a most unpleasant fashion. If I were you, I would switch to shakes and other lower-cal, low-carb foods to knock of the last 10-15 pounds. Then go on a good quality low-carb maintenance diet.

  38. I started taking Alli the last week of November 2009 and then on January 1 2010 I had my first gallbladder attack. During the time I took Alli, (about 5 weeks total) a lost about 17 lbs. Of course I was excercising every day and following a very low fat low calorie diet. My first gallbladder attack scared me, so I stopped taking Alli right away and didn’t use it during the month of January because I figured this was what was causing the bouts of pain. But, even without the pills I continued to have the attacks and ended up in the ER on Feb 6 2010. I was diagnosed with gallstones AND severe pancreatitis -doctors said due to the gallstones. Anyone who’s ever had this knows it is not fun at all. I even heard one woman say that the pain is worse than being in labor. Anyway, I was in the hospital for about a week and a half -they had to wait for my pancreas to become less inflamed before the could remove my gallbladder. No food or drink during this time -not even water. I have for the most part been a generally healthy person ( with of course the exception of needing to lose a few). I can tell you that being in the hospital with pancreatitis was hands down the worst experience of my life! I just turned 25, and if I could do it over again I would have NEVER taken Alli. I firmly believe this drug was the cause of my recent health problems and I will tell anyone and everyone I know not to use it because it’s not worth sacrificing your health and well being. Lose weight the natural way! I did it before, and I wish I would have had enough common sense to do it this time.

    1. Oh and also, if you think the cosmic pizza grease stuff is unpleasant, wait till you start experiencing pain from your gallbladder having gallstones in it. It will make that other stuff seem EVER so trivial.

    2. My mom is currently in the hospital with Pancreatitis and they are sending her in for surgury to remove her gall bladder tomorrow morning. If anyone else has experienced anything like this please email me at and tell me your story, We would like to have as many takes on what others are or have gone through and any advice would be extremly helpful.

    3. this is very interesting what you are saying here, i even thought that i wrote it, this is a copy of my story, i was taking alli on and off, until i got pregnant and i stop using it, but just after a couple of weeks of my pregnancy i had my first gallbladder attack, i thought it was the pregnancy that was doing it, so I put up with it, but then over and over again until it send me to the ER, once, twice they couldnt do anything since i was expecting, when i had my baby i had another attack so i went to the ER once again they had to keep me there for a week because the pancreatitis that i was having and after that the gallbladder removal, i always thought it was the alli that gave that problem and now with your letter i am convinced, and now i have the enough common sense to say No to Alli, excercise is the best to lose those extra pounds.

  39. I have taken Alli for the past three weeks, following the diet pretty strictly. I have had no problems with “treatment effects” or any pain. I did have my Gallbladder out a year before I started this plan so I am not effected that way. I found that if you follow the diet as it’s meant to be, it can work for you. I have lost 15 pounds so far and have a long ways to go but I am going to continue with Alli. So not all is bad with Alli if you follow the diet they way your supposed to, I’m sorry to hear about all the people having Gallbladder problems and think that maybe it may be something else that caused this problem and Alli just made you all aware that there was a problem.

  40. “A very low-fat diet” with Alli? Alli assumes that you are eating about 45g of fat a day. From what I have read, 27-30g a day is needed just for good health. If you are eating less than that and/or blocking that fat needed for good health with the Alli, yes, there will be problems.
    I have Alli, but since my diet is very low-fat I don’t take it everyday. I know I need some fat for my health and don’t want to block that with the Alli. I think that Alli is fine if you are eating 45+ grams of fat a day, but if you are getting 30g or less you are wasting your money and ruining your health.

    1. The big risk is an acute gall bladder attack, so the fact that yours has been removed gets rid of most of that risk. Some people develop an increase in size of the duct that use to carry the bile from the gall bladder and can still have problems, so the risk isn’t zero.
      Other risks are depression and lack of absorption of fat-soluble vitamins.

      1. I have been diagnosed with dysfunctional Gall Bladder, have chosen to forego the surgery for removal, and alter my diet. (Which was already reletively healthy). I have always been slim, until recently. (within the last couple of years.) Since that time, I have gradually added approx. 20 lbs, and cannot lose them, no matter what I try. I decided to try alli, because these 20 lbs are driving me crazy. Now that I am reading all these posts, I worry that Alli will “annoy” my already grouchy gall bladder.
        My question is this…. if not Alli, what then should I try to shed these unwantedly annoying pounds?

  41. I started taking Alli a few weeks ago. I had a baby about 3 months ago, and only lost about 1/2 the weight I gained during the pregnancy. I was overweight to begin with, and the pregnancy took me into the obese category. I started having treatment side effects when I started Alli, but they are controllable and actually help regulate my previously irregular digestive system. I do worry about more harmful side effects, but I needed SOMETHING to get my weight loss started again postpartum. I was average/thin in high school, and the past 10 years I have been experiencing steady weight gain. I’ve attempted lots of diets, but my will-power sucks. Having Alli to assist me has been helpful thus far. I have lost 5-10 pounds. I am able to eat a better diet and exercise some, but when I “fall off the wagon” and eat a fatty meal, side effects become less manageable. Having something physically happen VERY soon after my fatty meal helps me stay on track with my diet – psychologically. This is the first thing that’s really been working for me, and I plan to stick with it. I feel like once I get my weight where it needs to be, I will want to maintain it because I hate being fat. I used to love my body, but it’s been such a struggle for me to lose any weight that I put on. I’m also wondering if doubling my Alli dosage will expedite or help my results at all? I know I probably shouldn’t mess with what’s working but I’m ready to feel better about myself. And as far as depression goes, I understand that chemical reactions are what causes depression. But losing weight and feeling thinner/better help me NOT to be depressed because I know I am getting healthier and looking better. It’s quite the opposite for me – the “happy” neurotransmitters are being released! I guess some people need something like this for the assist. Like others have said, if diet/exercise was easy enough for EVERYONE, no one would need this. Obviously some people do, and I’m one of them. I’m almost back to my pre-baby weight (overweight), and I’m very excited to keep moving down the scale. I don’t expect to be the size I was in high school, but somewhere in the neighborhood WILL be great. So again, what about doubling Alli to get the prescription strength of 120mg? (I know taking more than 120mg has proven to not be beneficial.)

  42. Firstly – I have suffered from taking years of widely accepted medical ‘knowledge’ and experience as cardiac nurse too seriously. My long term low fat diet I believe led me to develop gallstones and pancreatitis. I had my gallbladder removed just over a year ago and use Alli combined with a low to moderate carb diet. I don’t take the Alli with every meal, just when I eat more fat calories than I should (don’t see the point otherwise). I always make sure I have had enough health fats and never take it with fish etc.
    At first I found the side effects a little unpleasant but not uncontrollable but I have found that drinking a couple of tablespoons of psyllium husk mixed with water either just before or within an hour of the Alli prevents any of the nasty effects. I guess the bulking out makes the fat easier to deal with.
    This may not work for everyone but worth a try maybe.
    Regards, Angela

  43. I took Alli from May until the end of October, and I lost 30 lbs.
    I LOVED Alli, but I keep having terrible pains, that have nearly lead me to the hospital about 10 times now. Def gall attacks.
    Will I ever get better? Is Surgery a must? I’d love a few emails if anyone has info.

  44. I took the drug for 4 months, lost 25lbs, was the happiest i had ever been in a long time. Did have a few “Treatment affects” when i would eat a piece of pizza but it wasn’t a big deal to me.. I never pooped myself or had any discharge anywhere it didn’t belong! 🙂
    Did everyone in your study have problems with there gall bladder? I stopped using Alli when my family and i decided to go camping as i couldn’t stay with my low fat diet and The only effects i had after i stopped was a stomach ache every time i ate something that was high in fat. I have since bought another bottle and plan to start it up again. I hope this article isn’t to discourage people from trying it out! I know that taking it and losing that much weight was very beneficial to my mood! I was ecstatic to be under my normally overweight weight!

  45. I was on Alli for 5/6 months… changed my way of eating did great on it..then started having problems with my gallbladder ..and had it removed….and to this day I have digestive problems..and struggle to eat..many doctors later..never
    Heard anything about the drug maybe causing gallbladder problems didn’t say on my bottles…wow be careful what ya wish for I can’t keep certain foods down and don’t gain weight….good luck people.

  46. Hi,
    I’m so happy I read this article! I bought the Alli starter kit and was going to use it with the Atkins diet tomorrow, Jan.31, 2011. Atkins has been the only diet that has worked for since I’ve gotten older and a bit heavier… I guess I’ll have to get my money back for the Alli. Thank you again!
    Kind regards,

  47. Wonderful blog! I found it while surfing around on Yahoo News. Do you have any tips on how to get listed in Yahoo News? I’ve been trying for a while but I never seem to get there! Thank you

  48. So let me see if I understand.
    It’s not the Alli itself that is causing the gall bladder issues, but the low fat diet that one has to maintain?
    If fats in low intestine cause the gall bladder to activate, and a low fat diet leaves it inactive for too long, leaving the contents to sit and form stones, then a low fat diet WITHOUT the Alli would have had the same effects, right? If one eats fat, it’s still going to hit the small intestine, and signal the gall bladder to activate. Doesn’t Alli just keep some of that fat from being absorbed? It doesnt prevent that fat from signaling the gall bladder, does it?
    Please someone clarify. Thanks.

  49. I have been using Alli for one week at the pres. dose. The only time you have side effects is when you eat too much fat…just like the doc said in his reference to drinkers taking anti abuse you drink you get sick…with Alli it teaches you to eat better and seems to lower your appetite some and I believe that comes from lowering isulin and cortisol from better eating….

  50. Dr. Eades,
    Thank you for the informative article. I stumbled upon it, when googling about orlistat and gallbladder disease. Ironically, it was after taking my gf to the Ed for what presented like cholecystitis. I’m a PA in primary care FYI. At any rate, after the US and labs came back normal and after we’d left ( and after some discussion of a hida-scan) I realized that she had failed to mention her recently starting this medication. I wondered if there was any connection with it and dysfunctional gallbladder disease or intermittent symptoms. Your article makes great sense regarding the physiology behind the issues with this drug. I suspect that her “episode” was induced by the combination of her diet and initiation of alli. Her low fat diet for a few weeks, followed by a weekend of high fat consumption landed her in the Ed. It’s not definitive but certainly makes enough sense for her to stop it, which she has. Thanks for your article!

  51. I was on xenical for 3 months and had servere gall stones afterwards, it’s funny my mum and sister where also on the drug and they have both had there gall bladder taken out too – all this hAppend after use of xenical

Leave a Reply

Your email address will not be published. Required fields are marked *