For most women with PCOS, one of the most common recommendations is to lose weight. But the challenge is that it’s also often the hardest. PCOS often leads to insulin resistance. This makes it difficult for the body to utilize glucose efficiently. The dual combination of unused insulin and unutilized glucose in blood leads to an imbalance of hormones. More specifically, it leads to an increase in the production of male hormones. And when male hormones go up, they lead to a range of problems. A common problem is weight gain, especially around the abdomen. Fat deposits around the abdomen make PCOS sufferers vulnerable to heart diseases.
Sadly, some doctors resort to shortcuts to reduce weight. Instead of advising holistic changes to diet and lifestyle, they end up prescribing medications. Orlistat is a commonly prescribed drug for PCOS weight loss.
While orlistat works for weight loss, like all medications, it has its side effects.
Side Effects of Orlistat
Common Orlistat Side Effects:
- A change in your bowel routine
- Oily spotting or loose stools
- Light-colored stools
- Difficulty in controlling bowel movements
- Increased frequency of bowel movements
- Pain in the stomach and rectum
- Irregular menstruation
- Cold symptoms (stuffy nose, cough, sore throat, fever, chills)
- Severe lower back pain
- Bloody urine
- Infrequent urination
- Increased thirst
- Mood swings
- Shortness of breath
- Weight gain
- Severe pain in the upper stomach area
- Yellowing of the skin and eyes
- Loss of appetite
- Dark-colored urine
Side Effects If You’re Allergic to Orlistat:
- Difficulty in breathing or swallowing
The most common short-term side effect of orlistat is irregular bowel movements. You may experience these irregularities for the first couple of weeks of starting orlistat treatment.
If you continue to experience any of these side effects for long, we advise you to stop using Orlistat and consult your doctor.
How to Reduce Orlistat Side Effects?
If you choose to take Orlistat, most of the immediate side effects will resolve on their own within a couple of weeks. If they persist, make sure the fat component in your meals does not exceed 30%. You can also ask your doctor to adjust dosage to help reduce side effects.
How Does Orlistat Help in Reducing Weight?
Our bodies have specific enzymes for digestion of fats. These enzymes are secreted by the stomach as well as the pancreas. Orlistat can bind to these enzymes and limit the digestion of fats. This process makes them go right through the body without being absorbed. That’s why you get the oily stools – stools which have a lot of fatty substance, are oily to look at and float in the toilet water.
Popular Brands of Orlistat
In many countries, Orlistat is available as a prescription drug as Xenical. The drug contains 120 mg of the active compound in a capsule form. It is available as an over-the-counter drug under the brand name Alli. The OTC drug contains 60 mg of the active compound. Xenical was a patented drug until 2009. Generic formulations are now sold in many countries under a variety of brand names like:
- Venustat (Iran)
- Orlean, Vyfat, Olistat, Obelit, Orlica, & Reeshape (India)
- Xenalten, and Orsoten (Russia)
- Slimox (Austria)
- Cuvarlix (Malaysia)
How to Take Orlistat?
Orlistat is usually available as a capsule to be taken orally, three times a day if you’re eating fat-rich meals. It can also be taken up to one hour after a meal. If you miss a meal or if you are eating a fat-free meal, you may skip the dose. Follow the instructions of your doctor, and do not take less or more of the drug than prescribed.
Is Orlistat Safe In the Long Term?
Orlistat impairs fat digestion. This means fat-soluble vitamins will not be absorbed by the body efficiently. Vitamins A, D, E, K are fat-soluble vitamins. To negate the side effects of orlistat, take a high-quality multivitamin two hours before or after taking the drug.
In a study conducted at the University of Rhode Island, Professor Bingfang Yan found that orlistat also limits an enzyme called carboxylesterase-2. This enzyme plays a vital role in the detoxification processes within the liver, kidneys as well as the digestive tract. Limiting the action of this enzyme can lead to severe liver failure and other serious conditions. In 2010, the US FDA announced safety concerns regarding the effect of orlistat on liver. Liver failure cases were also noted by the government.
Related article: Metformin Side Effects
Safety and Precautions for using Orlistat
Before starting to take orlistat, inform your doctor if you are allergic to the drug or if you have any other allergies. You should also inform your doctor if you have any of the following health conditions:
- Chronic malabsorption syndrome (an inability to absorb nutrients from the digestive tract)
- Cholestasis (a condition in which bile cannot flow from liver to small intestines)
- Hypothyroidism (under-active thyroid)
- Kidney stones
- Eating disorders, like anorexia or bulimia
- HIV infection
Care needs to be taken if you are on other prescription drugs or health supplements (including herbal products) while taking orlistat. Pregnant women should not use orlistat as it can harm the development of the baby. While there is no evidence of orlistat passing into breast milk, it is better to consult your doctor before breastfeeding while on orlistat.
Does Orlistat Interact With Other Drugs?
Orlistat severely impairs the activity of cyclosporine and HIV drugs. Orlistat also interacts with “blood thinners” like warfarin, anti-diabetic medications like glipzide, glyburide, metformin and insulin. Orlistat decreases the efficiency of thyroid medications in controlling blood pressure and any other weight loss drugs.
Dietary Considerations While Taking Orlistat
It is advisable to eat a low-fat, low-calorie diet along with orlistat therapy. Divide the amounts of carbohydrates, fats and proteins evenly between three meals a day. Your fat intake per meal should not exceed 30%. Cut down on foods that contain fat greater than 30%. Add more grains, vegetables and fruits to your diet. Choose lean meat and cut down on portion size (eat around 2 to 3 ounces per meal). Eat low-fat dairy products and use less fat for cooking. Avoid pre-packaged and processed foods as they contain high amounts of fat.
Very Important Note: Sepalika does not prescribe a low fat diet to most people. We believe that industrially processed vegetable oils, empty processed carbs and lack of good saturated fats in our diet are the core of several modern lifestyle diseases including PCOD. The advice on ‘how to eat while taking Orlistat’ assumes that a woman wants to take orlistat a personal choice.
Storage and Disposal of Orlistat
Store the medicine in a clean, dry and tightly closed container. Do not keep it in humid places (the bathroom, for example). Do not refrigerate the medicine. Store the container in a dry place away from excess light and heat.
Always store medicines away from young children and pets. Unused and expired medicines should be disposed of in ways that they do not get consumed by pets, children and other people. Never flush the medicines. If you are not sure about the disposal of the medicine, take it back to your pharmacist.
Orlistat Side Effects: The Final Verdict
Obesity is a major problem in women with PCOS. While PCOS itself is a frustrating disorder to contend with, obesity brings along with it the risks of many serious health complications like cancer, heart disease and type 2 diabetes. It is thus important to manage weight.
While weight loss drugs like orlistat seem to help reduce weight, reviews of several studies show that the average weight loss with orlistat is a mere 7 pounds more than when the drug isn’t used. Most people eventually gain the weight after they stop taking orlistat. The question then is whether it is worth taking the risk of all the above-mentioned short term and serious long term side effects to lose 7 pounds more over a period of more than one year?
We agree that losing weight is difficult and what is even more difficult is to stay off the lost pounds. But the role of orlistat in PCOS should not be overestimated. A disciplined and a sustainable diet and lifestyle plan can help in effectively reducing weight which can be maintained. For those who are keen to lose weight as a major part of their PCOS therapy, it is advisable to consider intermittent fasting and an LCHF diet. Both these lifestyle changes have shown to have substantial benefits for people with insulin resistance and diabetes.