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Thursday, February 29, 2024

The case in opposition to GLP-1 agonists


By now, most of you acknowledge that typical weight reduction recommendation—lower your energy; transfer extra, eat much less; every thing sparsely; eat many small meals each two hours all through the day, and many others.—is ineffective and doesn’t result in long-term weight reduction success. In reality, it’s effectively established that such recommendation doesn’t work and causes well being to deteriorate, to not point out it makes you depressing, combating in opposition to the incessant starvation it creates. Ineffective recommendation from healthcare suppliers subsequently opened the door to pharmaceutical brokers and bariatric procedures for weight reduction, incentivizing healthcare suppliers to the circulate of revenues into their pockets.

The brand new class of GLP-1 agonist medicine, corresponding to Ozempic, Wegovy, Rybelsus, and Mounjaro, are skyrocketing in recognition attributable to their weight reduction results. Persons are scrambling to acquire these medicine, anticipated to be a $19 billion/yr alternative for the pharmaceutical business in brief order. Regardless of their recognition, I query whether or not these medicine ought to have been authorized by the FDA within the first place, given their long-term potential for damaging well being results. So let’s contemplate this wildly widespread class of medication and the results they wreak on well being.

Initially meant to scale back blood glucose in kind 2 diabetics, it was famous that substantial weight reduction additionally happens. In a single latest scientific trial, for instance, as soon as weekly injections (solely Rybelsus is oral; all others are injectable) led to 52 kilos misplaced over a yr and a half. This ignited wild and unprecedented demand for these medicine, a lot in order that many weight reduction applications like Weight Watchers, Noom, and Calibrate embraced the medicine, including them to their applications (making you marvel, if all these applications need to depend on a drug, what’s the aim of this system when you possibly can simply go to your major care physician and get a prescription?). Three medicine on this class, Wegovy, Saxenda, and Mounjaro, have been FDA-approved for a weight reduction indication, whereas the others are used off-label, which means that healthcare insurers might want to determine whether or not they may cowl the prices of the medicine authorized for weight reduction, spreading out the prices to you and me as payers of healthcare insurance coverage premiums.

Let’s put apart the side-effects (nausea, vomiting, diarrhea, pancreatitis) and absurd prices (sometimes $1000 to $1500 monthly). Let’s contemplate the long-term penalties of taking these medicine.

Say you spent round $15,000 over one yr by injecting one in all these medicine and misplaced 30 kilos. Of that 30 kilos, about 50% of misplaced fats is subcutaneous (buttocks, thighs, arms, chest, and many others.), 50% is stomach visceral fats, the fats chargeable for many of the issues related to extra weight (insulin resistance, kind 2 diabetes, cardiovascular danger, fatty liver, elevated danger for Alzheimer’s dementia, breast most cancers, stroke, and many others.). In different phrases, the medicine will not be selective for probably the most problematic type of fats, stomach visceral fats. Metabolic advantages on blood glucose, blood strain, and many others. are subsequently restricted. Recall that stomach visceral fats, not subcutaneous fats, is chargeable for producing insulin resistance that causes weight achieve, blocks weight reduction from fats shops. Preferentially dropping stomach visceral fats that results in diminished insulin resistance would subsequently speed up weight reduction; the GLP-1 agonists will not be selective for stomach visceral fats.

One other problematic challenge: Of the 30 kilos misplaced, roughly 10 kilos is muscle—that’s plenty of muscle. Take into consideration 10 kilos of beef and dropping that quantity out of your arms, chest, again, thighs, face. Not solely are you weaker, much less assured in navigating stairs, mountain climbing, finishing up garden work, and many others., you might be additionally extra liable to falls, fractures, and frailty over time. Muscle mass is the first determinant of basal metabolic fee (BMR), i.e., the speed at which your physique “burns” energy to maintain the work of respiration, gastrointestinal digestion, upkeep of physique temperature, and many others., physique actions which can be ongoing and beneath aware route. Lack of muscle subsequently sometimes results in 15-27% discount in BMR, an impact that persists for a lot of years after muscle loss. It’s a survival mechanism: a discount in calorie consumption is perceived by your physique as a scarcity of assets, hunger, and metabolic fee is diminished to make sure your survival. However it additionally ensures weight regain—even for those who keep a low-calorie life-style. Dropping muscle mass with weight reduction is subsequently a pivotal and crippling growth of any technique of decreasing energy, whether or not it’s a GLP-1 agonist, a bariatric process, or calorie restriction. You will regain the load.

Worse: If you regain the load, it’s principally fats. Of the ten kilos of muscle you misplaced, you’ll regain, at greatest, 5 kilos of muscle together with round 25 kilos of fats. You might be subsequently in worse form metabolically after the drug than you had been earlier than taking it. Your danger for circumstances corresponding to coronary coronary heart illness and coronary heart assault, kind 2 diabetes, cognitive impairment and dementia, breast most cancers, hypertension and others is elevated. Had the FDA required long-term follow-up proof for the results of those medicine, they’d have seemingly acknowledged that these medicine enhance mortality, i.e., they enhance potential for quite a few ailments and shorten your life.

With GLP-1 agonists, you subsequently have a selection: Cease the drug after spending 1000’s of {dollars} and regain the load or keep on the drug without end, paying the pharmaceutical business lots of of 1000’s of {dollars} over time to keep up your extra slender weight. Think about a most cancers chemotherapy drug that doesn’t remedy the most cancers, however retains it from rising and metastasizing. Cease the drug and the most cancers grows and spreads, ultimately killing you. Keep on the drug at the price of many 1000’s of {dollars} and it retains the most cancers managed. You might be, in impact, held hostage by the drug and the pharmaceutical firm. That is how it’s with the GLP-1 agonists.

And wait till all these Hollywood sorts who inject GLP-1 medicine to drop pounds acknowledge what occurs to your look while you lose subcutaneous fats and muscle from the face and elsewhere: You look 10-20 years older.

But strategies to particularly goal lack of stomach visceral fats can be found. Methods to extend lean muscle mass with out train can be found. In brief, you’ll be able to obtain slenderness, restore youthful muscularity, get pleasure from regular wholesome physique composition. However it gained’t contain medicine, procedures, or the misguided recommendation of your physician. Return via the numerous discussions I’ve posted on this weblog and elsewhere and it can save you your $15,000 and keep away from antagonistic well being results whereas having fun with youthful slenderness. The concepts I initially articulated in my Wheat Stomach books are a begin. However, since then, the methods we use to regain youthful physique composition—enhance oxytocin with restoration of L. reuteri, push again SIBO by restoring microbes that colonize the small gut and produce bacteriocins, add the body-shape modifying results of collagen peptides and hyaluronic acid absent from fashionable existence, and others, all pure however missing in most individuals’s lives—can be found, efficient, secure, and restore a number of features of well being and youthfulness.

 

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