Is the New OTC “Alli” Just Money Down the Toilet?

Who couldn’t lose a few pounds? Ok, we all know of some people who are perfect just the way they are, but if you are reeling from your Freshman 15, or are just suffering the consequence of 3 kids in 5 years (yes, you are reading that right), then maybe the new over-the-counter weight-loss option “Alli” has caught your attention.

Pronounced liked the wartime friend (not the boxer), Alli is causing a buzz in pharmacies and discount stores across the nation. Heavily advertised and readily available, it may first appear to be a safe alternative to weight-loss “miracles” loaded with ephedra or hoodia. Claiming to be in a league of its own, while free from the anxiety and nervousness-related side affects of previous diet pills, Alli promises results of 50% more weight-loss than dieting and exercise alone. But at what cost?

Critics of the pill are focusing in on the main ingredient of the once-prescribed formula. At only a half-strength of its prescription counterpart, the 60mg of Orlistat has been deemed safe enough to be taken without a doctor’s recommendation by the FDA. If you are not familiar with Orlistat, let me refresh your memory. Does anyone remember when Pringles Fat-Free chips were first manufactured? With Olestra being a main ingredient, consumers were suddenly introduced into the world of fecal incontinence and something referred to as “anal leakage.” (Sorry to gross you out folks, but this is important stuff here.) I remember laughing with my friends at a party where the chips were served. What kind of marketing genius puts the “may cause anal leakage” warning within an inch of “Now with more flavor!” on the chip canister?

At least the makers of Alli have been more than upfront about the casual side-effects of their new baby. Taken directly from the Alli website:


The active ingredient in alli attaches to some of the natural enzymes in the digestive system, preventing them from breaking down about a quarter of the fat you eat. Undigested fat cannot be absorbed and passes through the body naturally. The excess fat is not harmful. In fact, you may recognize it in the toilet as something that looks like the oil on top of a pizza.


WHAT?!? The website goes on to educate about side-effects or “treatment effects,” as they are so affectionately referred to by GlaxoSmithKline:


alli™ works by preventing the absorption of some of the fat you eat. The fat passes out of your body, so you may have bowel changes, known as treatment effects. You may get:

  • gas with oily spotting
  • loose stools
  • more frequent stools that may be hard to control”

Users are then encouraged to do the following:

You may feel an urgent need to go to the bathroom. Until you have a sense of any treatment effects, it's probably a smart idea to wear dark pants, and bring a change of clothes with you to work

You may not usually get gassy, but it's a possibility when you take alli. The bathroom is really the best place to go when that happens”


Phew! And just as I was starting to wonder where I will go in my workplace to spare my coworkers from the wrath of my flatulence…..

While any attempt to improve overall health by maintaining a healthy weight should be commended, my personal take on this product is clear. At $45-70 a month for something that will help me lose only 5 of the 15 pounds I will have to work hard to lose anyway, I think I’ll save my money. With what amounts to a day’s work, I can buy a good pair of running shoes, a decent multivitamin, and Subway; and none of my hard-earned money will end up in the toilet.

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Andrea Karim's picture

Thanks for looking at this, Linsey.

I was a little worried about diabetics taking this drug. See, fat can be a problem if you eat a block of cheese every day, but fat is also important in regulating how quickly sugars are absorbed into your blood stream. Carbs that are absorbed fast (like refined sugars) cause a quick upsurge in blood sugar levels, making you feel awful.

Fat slows down carb absorbtion (although not nearly enough if you eat really refined carbs). As a diabetic, if I want a piece of toast, I can slow down the sugar absorbtion by eating it with peanut butter. But if I take Alli, then the fat will not be absorbed at all, and the sugars will, and I'll have to take more insulin all at once in order to compensate for the sudden sugar surge.

Also, anal leakage. Ew.

Justin Ryan's picture

My mother (will I ever stop talking about her?) and her coworkers have all started taking this stuff, en masse...I don't think I'm going to drop by to visit anymore. Maybe a bouquet of Plug-ins would be in order, though...

Jessica Okon's picture

It is easy to laugh at the drug because of it's oh so fun side effects, but for those who have a whole lot more than 15 lbs to lose, those extra lbs can mean a whole lot. In fact if you have only 15 lbs to lose, you probably should not be taking it anyway.

No pun intended, but I don't  think we should all be so quick to poo-pooh the drug. For every person who is pooping themselves, there is someone taking itas directed and having success.  I do think it would be smarter if folks did check with their doctors prior to taking it.

Justin, please update us on your mom's progress.

Linsey Knerl's picture


I am with you on this. My intent was not to laugh it off. Afterall, it was a fairly heavily prescribed drug for a while. I just know of a lot of people seeing it on the counters of the Walgreens pharmacy thinking, "cool! A prescription weight-loss drug without a prescription." What really sets this one apart is that it is not an appetite suppressant, and someone less educated might think that it actually will help them proactively curb their appetite. The alli website actually mentions the bathroom side-effects as potentially having a behavior modification effect (think Pavlov's dog). Those who are not willing toaccept diarrhea as a reminder that they did a bad thing by eating a donut, may not want to participate in this drug's use.

But I will never, ever discourage someone who wants to be healthier from trying something new. Just wanting people to know that it isn't a quick or easy fix.

And while I wouldn't personally use a weight-loss drug for just 15 pounds, the alli website homepage gives the example of losing 15 with the drug (as compared to 10), therefore setting the expectation that it is reasonable for someone to use the drug for even small weight-loss goals.

Thanks for your comment!

Guest's picture

uuummm...yuck. I see this drug everytime I walk into walgreens. I'm glad I never wasted money on it. I don't need to be poo pooing everywhere :P

Andrea Karim's picture

I do. So I'm not laughing at anyone. But an appetite suppressant would be one thing, because peeople would be eating less - people using this drug are probably going to eat as much food (or more) as they used to. They're still going to absorb sugar. I wouldn't be surprised if this drug actually caused insulin resistance.

Jessica Okon's picture

of course this is just one study. and yeah, i agree there are going to be a lot of bozos taking it as lightly as Trim-Spa.


Linsey Knerl's picture

Not that one article is going to prove anything.. but the links to cancer will be closely studied over the next few years according to this article from Fox news.  I know that lots of things cause cancer, so I'm not going to bite yet.  Just found it interesting that this also discusses the history of the original drug and concerns it had raised with some health groups.

Justin Ryan's picture

Having emailed Mom a copy of this earlier today, it was the subject of tonight's dinnertime conversation. (One word: EWWWWWWWW!) Interestingly enough, one of the ladies in her office who has been taking Alli for several weeks actually had the "leakage" problem. Apparently, she and her husband went to Long John Silvers for dinner recently, and the next day, she had an "incident" in a local store. ("Oil slick" was the term used.) Since then, much of the office, including Mom, have decided not to take it.

If I hear any more, I'll be sure to add it here. 

Andrea Karim's picture

Nice work, Jessica. I hearby promise not to make pronouncements that I know nothing about.

Greg Go's picture
Greg Go

Oil on top of pizza, eh? That wins the funniest-disclaimer-of-the-week, hands down.

Guest's picture

While the website gives the example that for every 10 lbs you would normally lose, alli will help you lose 15, it is not recommended for people with that little to lose - it is just for visualization. If you read the back of the starter kit (the plastic box with the clear top), it has a table of heights and weights and says that if you weigh less than the entry for your height, that alli is not recommended. It really is meant for people with more weight to lose. (There are many categories in the message boards, including one specifically for those who have 100+ lbs to lose)

The treatment effects that are listed are the most common, but that doesn't mean that everyone gets them. If I remember correctly, the studies projected about 10%. Every medication has side effects. That's what all the fine print in magazine ads and the fast talking in TV/radio spots is for. Sure, the possibility may not be worth it for someone who has 20-30 lbs to lose, but for someone who has over 100+ lbs and wants to get out of the "danger zone" (morbidly obese) as soon as possible without surgery, alli can be a godsend. Looking at the packaging, promotional materials, and the website, they are quite clear that alli is a *supplement* to healthy lifestyle changes, not a replacement.

The pill itself binds to (a limited amount of) fat so your body can't digest it, and it passes through your system intact. So while it doesn't actually suppress appetite (you feel just as full, since you're eating a similar amount at first), it does lower the number of calories absorbed. There is a comprehensive program on the website that can be used with or without the pill, which includes diet modification, behavior modification and exercise (and has weekly checkins along with new tips to stay motivated or eat differently every week). For people who don't stay beneath the recommended # of calories and fat grams listed for their weight, they may get "treatment effects" - the gross symptoms you usually see listed. But from reading the message boards, most of the people with treatment effects are ignoring the directions.

There are also a couple of doctors and pharmacists officially on the board to answer questions and they will answer simple questions, although they are quick to tell people to see a doctor in person if something is out of their scope.