There have been several large double blind studies that have been completed to test the efficacy of this medication. Two of these studies tested 120 mg of Xenical taken three times daily with a low calorie diet for one year followed by a second year of treatment while on a weight maintenance diet (JAMA, 281:235, 1999; Lancet, 352:167, 1998). The group given the medication lost approximately 19.8 – 22 pounds during the course of the study compared to an average of 13.2 pounds in the placebo group a difference of 6.6 – 8.8 pounds. In the second year of the study the placebo group regained between 8.8 – 13.2 pounds while the treatment group gained back 3.3 – 6.6 pounds. In a third study, patients were put on a low calorie diet which resulted in a weight loss of 22 pounds. Half the group was then given Xenical while the other group was given placebo. After one year the Xenical group had gained back 5.7 pounds while the placebo group regained 9.7 pounds. In addition, 24% of the group taking Xenical did not regain any weight while 16% of the placebo group remained weight stable. A fourth study tested the effect of Xenical in diabetic patients. The group given Xenical lost approximately 4 pounds more than the placebo group (Am J Clin Nutr, 69: 1108, 1999). The conclusion of the sum of these trials is that Xenical does in fact promote weight loss. This data does not tell us how much of the weight loss comes from muscle and how much comes from fat. It can be assumed that weight loss from fat restriction will result in loss from fat and muscle to a certain degree. These data can not guarantee sustained weight loss past two years because the subjects in the studies were only followed for this period.

Neglecting the Side Effects

The most recent study out of Quebec City confirmed the above stated results. Dr. Michael Lean (could the last name be a coincidence?) stated, “This drug works effectively for around three-quarters of the people who take it… because the drug is not absorbed, side effects are negligible, provided patients stay on a low fat diet.” This is an interesting statement because we have never met a patient on Xenical who said that the side effects are negligible and we are willing to bet that Dr. Lean has not spent too much time taking Xenical himself. These side effects include flatulence with discharge, oily spotting and fecal urgency in 20 – 40% of the patients. These side effects are significantly less if the patient stays on a low fat diet. This begs the question, why are we giving a fat blocker to someone who needs to be on a low fat diet anyway? Is the weight loss due to the efficacy of the medication or is it the intentional or subconscious fat restriction due to fear of “negligible” side effects?

Aside from the uncomfortable side effects listed above there are many more significant side effects that happen “behind the scenes.” To begin with, fat absorption is non-selective. There are two main fats that are found in the diet… omega-3 and omega-6 (this is an oversimplified for the point of this brief discussion). The omega-6 fats are the fats that are primarily responsible for fat gain, blood clotting and inflammation. These fats are found in abundance in vegetable oils, farm grown animal fats and certain nuts such as peanuts and cashews. The omega-3 fats are responsible for increasing metabolism, decreasing inflammation, protecting the blood vessels and inhibiting clotting. These fats are found in wild harvested, cold Atlantic fish, certain seeds such as flax seed, certain nuts such as walnuts and range grown animal foods. Xenical does not distinguish between the two fats and thus will inhibit both. This would normally not be a problem if, as a result of the Standard American Diet (SAD), we were not so deficient in omega-3 fats. However, a patient taking Xenical may run the risk of serious health effects as a result of a deficiency of these healthy fats.

A study recently published in the reputable journal, Archives of Internal Medicine, reviewed the current literature on omega-3 fats and came to some astonishing conclusions. The main conclusion was that the omega-3 fats from dietary sources could prevent cardiac death and nonfatal heart attack (Arch Intern Med 2001; 161: 2185-92). An earlier review of the literature found that people who were at high risk of heart disease could decrease their risk of heart disease related death by 40 – 60% simply by eating 1.3 – 2 oz of fish weekly (Eur J Clin Nutr 1999; 53: 585-90). The average Xenical patient may need to double or triple this amount in order to maintain healthy levels of this fat, and that is assuming that the person has chosen the proper kind of fish and prepared it properly.

There are other worries regarding Xenical’s potential harmful effects to the heart, and overall health. It is well known that Xenical will prevent your body from absorbing fat soluble vitamins such as A, D, E and K. Vitamin E plays an important role in the prevention of heart disease and immune function, vitamin K is important in the maintenance of healthy clotting and vitamin D is important in the prevention of calcification of the arteries (Circulation. 1997; 96: 1755-1760) and proper maintenance of strong bones.

Although these vitamins can be replaced through supplementation, another class of vital nutrient is not so simple to replace. These nutrients make up a class called carotenes that are found in colorful fruits and vegetables such as carrots, tomatoes, radishes, etc. The carotenes include beta carotene, alpha carotene, gamma carotene, lutein, lycopene, zeaxanthine, and many others. Scientists believe that they have only touched the surface of the list of carotenes to be found in foods. Because there are literally hundreds of carotenes in nature, we cannot readily supplement appropriately. Studies have determined that higher carotene intake results in a protective effect against heart disease (J Nutr 1999;129:5–8 [review]) and cancer. Research has also determined that Xenical may decrease circulating carotenes by as much as 50%. This would surely have a negative effect on the cardiovascular system and immune system. The maker of Xenical suggests that Xenical has been shown to improve blood pressure, cholesterol and blood sugar, thus resulting in protection from heart disease. They conveniently fail to mention the miniscule amounts by which these parameters change such as a 2 point decrease in blood pressure, 5 point decrease in total cholesterol and a change in hemoglobin A1C (long term blood glucose control) of one-fifth of one percent (0.18%). They also fail to take into account the effect of decreased omega-3 fats, fat-soluble vitamins and carotenes.

Data pooled from seven controlled studies showed that 9 out of 747 patients on Xenical developed breast cancer compared to only 1 out of 579 on placebo. These results could not be confirmed in the two published two-year studies (Medical Letter 41: 1055 June 18, 1999: 56). Although we cannot definitively link Xenical use to breast cancer at this time, the possibility is there and needs to be considered when choosing this therapy. Alpha linolenic acid, one of the omega-3 fatty acids, and the carotenes may help prevent breast cancer. Xenical’s inhibitory effect on the absorption of this fat may predispose the patient to breast cancer.

The last issue worth mentioning is that when a person takes “a pill” to lose weight, many other healthy habits have a tendency to disappear, with the underlying thought that “I’m taking a pill, so I don’t have to exercise, etc.” Ever see a person order a Diet Coke with their piece of cake for dessert?

The Cost of Weight loss

Xenical is very expensive, with a monthly cost of $118. This translates into approximately $3000 per two-year course of treatment at which time you can expect to lose a maximum of 15 pounds. Thus the cost of one pound of weight loss is approximately $200 (this does not factor in the cost of new undergarments or the use of Depends for the up to 40% of people with the “negligible” side effects). Compared to other, more traditional forms of weight loss, including proper exercise, this is very expensive. Some people will make the argument that their insurance pays for it, but keep in mind that one way or another we end up paying for those drugs, usually through increased insurance premiums.

I Have Read… but I Still Want to Take Xenical

Thank you for educating yourself before choosing your path. As an educated consumer you can now work to decrease the potential for side effects. Below we have listed some suggestions for foods and products that may help you maintain at least a minimal level of health while on this medication.

Eat foods that are high in carotenes. These include any of the following: carrots, sweet potatoes, squash, corn, tomatoes, watermelon, spinach, colorful peppers, lemons, oranges, prunes, greens, mangoes, tangerines. Any fruit or vegetable that is colorful is likely to have larger amounts of carotenes. A dietary supplement containing mixed carotenoids should be added as well. One such product is Caroteam by Vitamin Research Products.
When you eat foods with fat try to eat cold Atlantic fish or range grown meats such as range grown cattle and/or chickens. Range grown refers to animals that are permitted to graze in fields eating live food instead of processed animal feeds. This will help assure the presence of healthy fats. Those who cannot work these foods into their lifestyle should take an essential fatty acid supplement such as potent fish oil capsules.
You should get at least 800 I.U. of vitamin E, 25,000 IU of mixed carotenes and 1,000-2,000 mg of vitamin D daily. Although these suggestions exceed the RDA, keep in mind that the RDA was not designed to apply to people on Xenical.

Please realize that following the above suggestions will most definitely result in weight loss, regardless of taking Xenical or not. In our opinion it makes sense to try the less expensive way first.

**Xenical is a registered trademark of Roche

Everyone knows that good nutrition is an important part of a healthy lifestyle, but very few people realize how profoundly what we eat influences our daily experience of life. The food we put into our mouths begins changing our brain and body chemistry within minutes, with far reaching effects on our energy levels, mood, and ability to focus and think clearly. Brain chemicals that help us pay attention like dopamine and epinephrine are built from the foods we eat, and we cannot produce optimal levels of these chemicals without a healthy diet. The same holds true for chemicals like serotonin and endorphins, which affect our mood and sense of wellbeing. What we put into our mouths begins changing the levels of these brain chemicals within minutes, with profound changes occurring over a 1-3 hour window after a meal. This is why you can get a quick buzz from eating sugar – it rapidly elevates brain serotonin levels. However sugar causes a surge in energy levels and mood that is inevitably followed by a crash. Healthy whole foods, on the other hand, create more moderate sustainable improvements in brain chemistry. To build a stable supply of healthy brain chemicals, increase your intake of high quality protein foods like truly free range poultry, grass fed beef, wild caught salmon, and wild caught shrimp. Beans, raw nuts, and raw seeds provide decent vegetables sources of protein. The healthy brain chemicals that you build out of these foods also help your body perform better.

The immediate effects of what we eat on how we function and feel are substantial. The effects of food on our brains and bodies over the long term are even more profound. We all know that our heart health, GI health, and even our susceptibility to many cancers are powerfully dependent on diet. However, the knowledge that poor food choices may lead to disease down the road doesn’t motivate all of us to make changes in the way we eat now. Instead of focusing on eating healthfully to prevent disease, I encourage my clients to focus on eating in a way that helps them feel best, allowing them to live their lives with more energy, stamina, and joy. When we eat healthful foods that are right for our individual bodies every day it builds a robust biochemical foundation in our brains and bodies that allows us to live fuller, more enjoyable lives and better express our potential. This is also the only way to create sustainable, healthy weight loss.

Eating to live as well as possible means finding a nutrition strategy that both supports optimal mental and physical health, and fills your life with foods that you enjoy. To do this, you first have to understand what really constitutes health food. Eating healthy is not about eating a low calorie, low carb diet. It’s about eating foods that are in harmony with your basic biological design as a human being and which are also a match for your individual nutrition needs. All of us share a basic biological design, and as a general rule, all of our bodies function better when we eat the foods that our bodies are designed to eat. These are foods like vegetables, fruits, raw nuts and seeds, free range meats, wild caught fish, beans, and true whole grains – so called “whole foods” which have not been altered from the form that they occur in out in nature. At the same time, all of us have different metabolisms and unique nutrition needs that depend partly on our genetics and partly on our lifestyle. My goal as a counselor and teacher is to first educate people about the basic nutrition principles that apply to all of us, and, on this foundation, help people determine how to eat right for their unique bodies. To do this, we need to fund ways to make healthy food tasty without having to invest a lot of time in preparation. This is a major focus of my counseling work and my classes.
For more on my nutrition philosophy, visit my information website – www.reevolution.com. Or to read more about me, and the services and classes that I offer, visit www.vaughngray.com. I teach nutrition classes at Your Rx for Health. The next class “Total Nutrition: From Weight Loss to Wellness” begins Thursday Jan. 14th at 7pm. For more information or to register call Your Rx for Health or email me at info@vaughngray.com .

They gave them a popular blood pressure medication.

That’s right, they gave them a medication called a “beta blocker” that is very commonly prescribed to overweight, obese and diabetic patients with high blood pressure. This class of medication is, more accurately, called a beta adrenergic blocker. This means that the medication blocks certain receptors which bind to adrenaline, a hormone produced by the body which causes the heart to race, the blood vessels to constrict and thus blood pressure to increase. By blocking the beta adrenergic receptors of the body, the heart does not beat as strongly or as fast and the blood vessels relax thus lowering blood pressure. Unfortunately, the beta adrenergic receptors on fat cells get blocked as well and thus a decrease in fat loss occurs as well as an increased propensity to store fat.

Does anyone see a problem with this?

As I mentioned previously, the people who are most prone to high blood pressure are people who already have too much fat in their bodies. These include diabetics, people with pre-diabetes, as well as the overweight and obese. We give these people a medication which further inhibits fat use thus stoking the fire of their metabolic difficulties. Perhaps this is why many studies on these medications have resulted in an increased risk of disease and premature death. That’s right, not only have studies not proven these medications to prolong life, many have even shown them to shorten life.

It never ceases to amaze me how the medical establishment can turn a blind eye to the side effects of their treatments. The use of beta blockers to inhibit fat loss is apparently a standard practice in research studies and yet medicine just brushes it aside and convinces themselves that this class of medication is safe to use in overweight and obese people who are already afflicted with fat-clogged cells.

We need to open our eyes and accept the fact that medications are not nearly as effective as they are made out to be. We need to convince ourselves that the right approach is to take the reins of health into our own hands and although it is not as easy as popping a pill in the morning it is far better than the delusion that there is a medication for every disease…that, ladies and gentlemen, is nothing more than a mirage created by the drug industry.

For those of you who have high blood pressure and may have been prescribed a beta blocker such as propranolol, metoprolol or any other generic medication ending in “olol” I am not recommending that you stop your medication. In fact, to do so may cause a rebound elevation in blood pressure that could put you in the hospital or worse. I am simply saying, perhaps there is a better way to control blood pressure. In our experience, people can start living the right lifestyle can find that the need for the medication decreases or goes away as they get healthier. At this time you can work with your doctor to start weaning yourself from the medication. If you would like to learn more about natural methods for controlling blood pressure, check out our “Health Issues” section of this website. If you are looking for help developing a healthy lifestyle, learn about First Line Therapy that we offer at our wellness center.

Unfortunately, if fat loss is your goal, you should likely avoid agave nectar as a sweetener. There are many problems with this syrup that is marketed as a healthy sweetener for diabetics and those looking to lose weight:

Most commercial agave is processed. The processing involves heating the product to break the carbohydrates down into simple carbohydrates, most of which is fructose.
Fructose, the primary sugar in agave, has been linked to diabetes, weight gain and elevated triglycerides.
Fructose appears to enter the cell without stimulating insulin. This appears to be beneficial on the surface, however, science has shown that excessive levels of processed fructose can cause biochemical imbalance that can set the stage for diabetes and fat accumulation in the blood and fat cells.
As the agave plant gets more rare, some manufacturers may be cutting their agave syrup with plain old corn syrup. There is little control over this as many manufacturers are located in Mexico.
The body appears to lack the ability to sense that energy from fructose has entered the body. This means that if you are getting calories from processed fructose products, such as agave, the calories may not register in the brain and thus you may eat more calories throughout the day.
Dr. Ray’s Notes:

I really, REALLY wish I had better news as it pertains to agave because it is SO good! The truth is, our tongues are completely desensitized to sweetness due to the abundance of sugar and artificial sweeteners in our diets. We need to retrain our taste buds to taste again by removing unnecessary sweeteners in our diet so that we can start tasting food again! The smartest minds in food science have been unable to produce a sweetener that is 100% safe and tastes like sugar and I have little hope that they will succeed. If you need to sweeten your coffee in the morning, you can add a bit of honey or try a bit of xylitol or erythritol. These sugar alcohols can be used sparingly but remember, our goal is to try to eat foods in the package that nature provides! All of nature’s foods come with a sticker that reads “No ADDED sugar!”