Pharmacy/Xenical?

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QUESTION: My husband, 55, has finally been able to lose a little weight with the help of Alli, the OTC form of Orlistat/Xenical. He has had no side effects except some loose poops, which is normal.
Now he wants to get a prescription for Xenical, as it would be even more effective, and covered under are health plan.
Here is my worry. He is a drinker, and although he drinks less than he used to, he still drinks too much. I think the booze is part of his weight problem, especially his big hard belly. It is huge for days after a binge. He counts calories ans stays pretty low, around 1500,, but he doesnt count the booze calories and on weekends often binges.
He doesnt have cirrhosis or diabetes (yet) although he does have high blood pressure, and I know he lies to the doctor about his drinking.
I have read that Xenical can affect the liver, and his liver is probably stressed out now. If anything he should stick to the milder Alli formulation.
What do you think?

ANSWER: Sue

Two things to bear in mind. Alli / Xenical work by blocking fat absorption from the GI tract, so increasing the dose may be more effective, but also means the side effects may be more pronounced. Careful management of fat intake in food will obviously help. This also means that orlistat has no effect on weight gained from carbohydrate consumption, including alcohol. Excess carbohydrate is only converted into body fat after they have been absorbed and so orlistat will produce no weight loss for this fat.

If your husband is seeing a doctor and being monitored, then that is good and hopefully that screening will include regular blood tests to check his liver function. So he should intervene if significant anomalies are found. Doctors realise that patients will frequently under-declare issues such as alcohol consumption, but if you are able to express your concerns to the doctor (perhaps by accompanying your husband to an appointment?) - then it may help.

It sounds as though your husband, while apparently OK at the moment, may be at increasing risk. Have you thought of contacting a specialist support group such as Al Anon, which specialises in providing support to families of problem drinkers? They may be able to help and guide you into getting him to recognise problems and overcome them.

I hope this helps.



---------- FOLLOW-UP ----------

QUESTION: Thanks Nigel
He has been tapering off, and no binges for a while. Will moderating his alcohol consumption to a couple drinks a day, maybe three or four-but no more, on the weekends, help? Also, should he cut back on his carbs as well? Thanks so much!

Answer
Sue

Cutting down on alcohol consumption is guaranteed to be beneficial, both in terms of general health and calorie load. Any further reduction in calorie intake (particularly carbohydrates and fats) will also benefit. In very simple terms:

      Eat more calories than you work off  =  Weight gain
      Work off more calories than you eat  =  Weight loss

If your husband cuts down on alcohol and calories, he may understandably find it frustrating, and like so many New Year resolutions, the good intentions may fall by the wayside. If he can be persuaded, then filling his time with some diversion, then it will help - if that diversion is healthy, or burns more calories then so much the better. I'm not necessarily suggesting he takes to the gym, unless he wants to, but something like walking to the shop, around the block or local park will help improve his general health and help improve his weight. It's also something you can do together, improving commitment and helping two people at once!

I hope everything goes well for you both.

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Nigel Simmons

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I am happy to answer general questions on medicines and hospital care. If possible, please use approved / chemical names rather than brands which are not internationally recognised. Like all health professionals I am bound by a duty of care which prevents me giving detailed information about medication or treatment of people other than the questioner. I will endeavour to help wherever possible or point towards more appropriate advice. If however your question crosses too far into patient confidentiality, I hope you will understand why I cannot answer your question. Consider.. would you want me to discuss your care with a friend or relative without your knowledge?

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