The BEST Diets on Orlistat

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You may have heard that you need to follow a low-fat diet on orlistat, but over the years I’ve come to realize why this is terrible advice to give to some patients.

Let’s talk about why.

Why low-fat is often recommended

You first need to understand why most clinicians will tell you to go on a low-fat diet if you’re on orlistat, in the first place.

The first reason is because of how the drug works.

Orlistat works by blocking fat from being absorbed in your intestines. Because the fat you eat isn’t absorbed, and fat is pretty high in calories, the result is that you’ll be absorbing less overall calories.

Unfortunately, all that undigested fat is going to come out the other end, and for some people, in a truly unceremonious fashion.

The second thing you should know is what doctors are usually thinking about when they prescribe a patient orlistat.

Fatty stools are not pleasant, and many clinicians consider it an adverse effect that should be avoided.

Whenever a drug is prescribed, we always make it a point to notify patients of the adverse reactions they might face, as well as ways they might be able to manage or avoid it.

We know that the more fat you have on orlistat, the more fat comes out the other end, and the higher likelihood that a patient will experience unpleasant side effects.

Therefore, the reasonable thing to suggest is that the patient should have less fat in their diet, in other words, a low-fat diet.

Admittedly I’ve also given this advice many times, mainly because it’s convenient and quick to say, and sometimes I don’t have much time to explain everything out carefully.

So today, I’m going to try to explain everything a little more carefully.

Why low-fat advice is awful

The first problem with this advice is that the only reason we are recommending a low-fat diet is to help reduce the risk of side effects, not because low-fat diets are more effective on orlistat.

Technically speaking, the less fat you have in your diet, the less effective orlistat will be, since it ends up blocking less fat.

The second problem with this advice is that just telling you to follow a low-fat diet is too vague. Not every low-fat diet is effective with orlistat.

For example, a diet with lots of fruits and pasta might fit the bill for a low-fat diet, but is not going to be very effective with orlistat, since most of those calories come from sugars and carbohydrates, and because orlistat can only block fat, it has nothing to block.

In fact, orlistat needs some fat in your diet to block, otherwise it wouldn’t be doing anything.

A no-fat diet while on orlistat might not cause any side effects, but would render the medication completely useless, since it has no fat to block.

Best diets on orlistat

So what types of diets are the most effective with orlistat?

Many types of low and even moderate-fat diets work well with orlistat. This means low carbohydrate and high protein diets will be effective. You could do the Mediterranean diet, a moderate fat Atkins diet, or even a high protein paleo diet.

You just need to make sure you have enough soluble fiber with it. Soluble fiber helps to bind up undigested fats and prevent it from creating an oily mess on the other end.

This means having a good amount of vegetables, or things like oatmeal, flax seeds, or chia seeds with each meal you take orlistat.

You can even take a soluble fiber supplement like Glucomannan, Metamucil or Benefiber with your meals.

If you’re big into high protein diets, I usually recommend taking a soluble fiber supplement, since these diets tend to be low in fiber. The good news is that orlistat tends to work well with these types of diet, particularly the ones that also allow animal-based protein.

High-fiber diets also work well with orlistat, as long as they’re paired with enough protein and fat. For example, vegetarian style diets could work well depending on what you eat. If your diet had a decent amount of nuts, seeds, and dairy, orlistat could be helpful.

But if it was mostly lentils, beans, pasta, or fruits, orlistat would likely be of little help.

Diets that include some dairy products is also a good idea, since the calcium content in dairy may also help work with orlistat to excrete more fat into the stools.

So having some milk, yogurt, or even taking a calcium supplement if you can’t tolerate dairy products, can make orlistat more effective.

Worst diets on orlistat

The diets that are the least effective with orlistat are ironically the ones that have the lowest amounts of fat.

This means things like fruititarian diets or juicing diets would be ineffective with orlistat.

High-fat diets are also not a great idea mainly because it would be extremely uncomfortable to do.

So you probably shouldn’t attempt the high-fat keto diet while on orlistat, although if you could deal with constantly pooping yourself, it would actually be moderately effective.

I mean maybe you could wear some adult diapers and it could work.

When to actually go low-fat

But does this mean you shouldn’t ever bother with low-fat?

No, controlling the fat levels of your diet while on orlistat is still important. Many of the low and moderate fat diets I’ve suggested so far are focused on making orlistat effective for you. However, they might not be the most comfortable to use with orlistat.

You need to figure out how much fat you can have in your diet without it being too uncomfortable for you.

For example, if you’re experiencing too many side effects, like gas, bloating and diarrhea, and it’s becoming difficult to manage, slowly reducing the amount of fat in your diet while increasing the amount of soluble fiber you eat could help to control your symptoms, and allow you to continue on orlistat.

Choosing a diet on orlistat

So how do you know if the diet you’re following is going to work with orlistat?

A good way is to see how your diet divides up the three major macronutrients. Find out approximately how much of your diet consists of protein, fat, and carbohydrates.

You can use a food tracking app or just Google the diet you might be following to see what category it falls into.

Having about 30% fat in your diet is a good start, and make sure you have enough protein as well.

If it has too much carbohydrate or too little fat, orlistat is not going to work as effectively.

If you have more fat, you’ll need more soluble fiber to avoid gastrointestinal issues.

Ultimately, you should figure out how much fat you can feasibly tolerate while on orlistat:

• The more fat you have, the more orlistat can block, and the more effective orlistat will be, but the more gastrointestinal issues you might face.
• The less fat you have, the less gastrointestinal issues you’ll experience, but the less effective orlistat will be.

You’ll need to balance both out yourself, and find a dietary fat level that works for you.

Learn more about

• What to Expect With Orlistat
• 6 Mistakes People Make When Taking Orlistat
• Other weight loss medications

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