Alli- what's the story?

So guess what. There's a new over-the-counter weight loss pill just approved by the FDA.

It's called Alli, it's made by GlaxoSmithKline, and early reports are that it's flying off the shelves.

So what's the deal?

Alli is actually Orlistat, which is actually Xenical. Xenical has been around for a while, didn't work very well, and has now been given a face lift; they took it off prescription-only status and repackaged it as Alli.

This is not the first time the clever marketers at Big Pharma have done this. Not too long ago, Eli Lilly took Prozac, dressed it up in nice pink and purple colors and rechristened it "Sarafem" for PMS.

But I digress.

So what do we know about Xenical (oh, excuse, me, Alli)..

Well let's start with this: it didn't work very well in the first place when it was known as Xenical. I'm not sure why changing the name and making the dosage smaller would fix the problem, but hey, what do I know?

Alli is a member of a category of weight loss drugs that might be called "digestive inhibitors". It blocks some of the fat that you eat from being digested and assimilated, and it does this by blocking the digestive enzyme lipase- which breaks down fat. The result? As much as 30 percent of the fat you eat doesn't go to your hips. Questions, anyone?

How 'bout this one: "What does it do to the fat that's already on your hips?"

Answer: Zip-i-dee-doo-dah.

People lose weight on Xenical- 'scuse me, Alli- because it essentially lowers caloric intake automatically. If you, for example, were eating a nice hefty 2500 calories a day and 30 percent of them happened to come from fat, you would normally be taking in 750 fat calories. By taking Xenical with a fatty meal, about one third of those fat calories aren't absorbed, so the 750 calories becomes, theoretically, 500 calories. You've "saved" 250 calories while eating the same meal (note the operative word theoretically). Stick to that plan for a week and you've "saved" 250 times 7 calories or a grand total of 1750 calories or... let's see... ummm... one half pound?

Yup.

And that's theoretically.

Nowlet's go to the videotape.

The first big study to put Xenical on the map was a two-year European study which showed that patients on Xenical lost between 2 and 3 percent more weight than those on a placebo. A second two year European trial put obese patients on a reduced-calorie diet and gave them 120 mg of Xenical 3 times a day. At the end of the year they had lost about 9 pounds more than the placebo group. Read that carefully. Nine pounds a year which translates to 3/4 pound a month.
A similar study in the US produced 1/2 pound per month for Xenical users.

So is Alli the answer? Hardly. Unless maybe if you're a stockholder in Glaxo.

Can it help if you're already doing all the right stuff, like eating well, eating clean, exercising, and taking care of yourself in a profoundly nurturing way? Maybe so. Maybe it can add a little tiny extra that could be meaningful to some people.

But unless you use it in conjunction with all that other good stuff- that so many people seem to want to bypass- it's just not going to do diddly squat.

autism- what's the story?

For years people have been battling over whether or not childhood vaccines cause autism. It's hard to think of a better example of opposing views fueled by (understandable) passion, each bolstered by statistics which- like all statistics- lend themselves to multiple interpretations depending on whose side you're on. It has the usual cast of characters - activists (usually parents) feeling betrayed and ignored and lied to, apologists maintaining steadfastly that the protesters are delusional and the science doesn't support their views.

Sound familiar? Hint: silicone breast implants.

Now this week for the first time, the case is going to court. Sort of. A special court will pit scientists against activists in the debate over whether vaccines cause autism. There's a test case involving a 12 year old Michelle Cedillo of Arizona and more than 4,800 cases are pending, filed by parents who believe the vaccines caused their kids autism. They're seeking payment under the National Vaccine Injury Compensation Program. The US Court of Federal Claims has set up an omnibus hearing in Washington and the first case is expected to last three weeks.

The nay-sayers say the issue is settled and that vaccines are not linked to the disorder. And there's good science- meaning statistical correlations- to support their case.

Now hold that thought for a moment.

Recently there was a terrific study done on diet and weight loss out of Children's Hospital in Boston (I'll blog about it in more detail this week). They wanted to test whether low-glycemic diets do better than standard low-calorie diets for weight loss, blood lipids, all the usual stuff. They divided everyone into two groups, gave one group the low-cal diet, one group the low-glycemic diet.

No difference.

But wait, there's more.

The researchers tested everyone in the study with a glucose tolerance test. This basically shows how your body responds to sugar- some people secrete a ton of insulin, some.. not so much. Then, with this info in hand, they re-analyzed the data. And found that when you looked at the sub-group of people who were "high insulin secretors", there was indeed a huge, significant difference in how the two diets worked. High insulin secretors lost way more weight and did much better in general on the low-glycemic diet. But in the larger picture, this sub-group was "lost" in the general statistics, and there was no significant difference between the two overall groups.

Back to autism.

I'm absolutely, unequivocably convinced that there is a subgroup of kids who can't detox the mercury in vaccines. This subgroup is "lost" in the overall statistics allowing apologists to say, "hey, vaccines don't cause autism". But if you were to somehow isolate this subgroup and analyze the stats on them, you'd find a big correlation between the vaccine and the onset of autism. I can't prove this but I'm sure of it.

Think about it. Our liver puts out enzymes called the cytochrome P-450 enzymes, that are involved in two distinct phases of detoxifcation. It's a complex process. Among individuals there are huge variations in the amount of these enzymes, their effectiveness, their activity. It's no doubt true that when you look at the statistics on autism and vaccination on millions of people, a correlation doesn't show up, much like it didn't on the low-glycemic and low-calorie diet study. But if you were to somehow identify a sub-population who had less than optimal cytochrome P-450 enzyme activity, and then analyzed just that population, I'm pretty sure you'd see the mercury- autism connection boldly and clearly. It's just masked when this subgroup is folded into the overall population.