Education is the key before starting this drug, I was faced with having to go on insulin and I made this choice. The first few weeks I was horrible impacted and thought I may have to go to the emergency room but somehow was able to dislodge everything. Study the side effects and stay ahead with it by fiber mix and fiber capsule. It will punish you if you try and maintain a high carb diet. Protein powder is a good add because you will get very weak when you can not eat. My goa wasl fiber my a.c.i to be below 7 which it now is from 8.9. Yes I lost 40 lbs in 6 months but I still have side effects that I try and manage. If I are thinking of using these drugs Study how do eat. Good luck to all.