Obesity

Complications? What Complications? (just another GLP-1 receptor agonist post)

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Adverse events are common in those using GLP-1 agonists, but the vast majority of these are minor. GI adverse effects are most common (20-70% of patients). Greater rate of GI effects with higher doses.

  • Most common problems: nausea (overall most common), vomiting, and diarrhea. Others included abdominal pain, dyspepsia, and constipation.
  • Symptoms are typically more severe within the first four weeks of therapy or with sudden escalation of therapy and tend to decrease over time.
  • Thought to be due to reduced gastric emptying and activation of centers involved in appetite regulation and nausea.
  • Severe diarrhea and vomiting may lead to volume loss, dehydration, and hypotension (not common).
  • There is an association with pancreatitis. GLP-1 agonists may stimulate pancreatic islet beta cells and exocrine duct cells leading to overgrowth and smaller duct size, which increase the pancreatic weight and risk of ductal occlusion.
    • Retrospective study published in 2022 of 81,752 adverse events associated with GLP-1 agonist therapy found an increased risk of pancreatitis, particularly with liraglutide (ROR 32.67; 95% CI 29.44-36.25). 2023 observational study found increased risk of pancreatitis (adjusted HR of 9.09, 95% CI 1.25-66).
  • Other GI issues include gallbladder and biliary tract disease (usually after 26 weeks of therapy and included cholelithiasis, cholecystitis, cholangitis), elevated LFTs, hepatitis, liver injury.
emDOCs Podcast – Episode 94: GLP-1 Agonist Complications — https://www.emdocs.net/?s=glp-1

But I Lost 25 pounds!

New Wonder Drug! Treat Diabetes, Obesity AND Addiction – (yup another GLP-1 receptor agonist post)

Why People Stop Using Drugs Like Ozempic – Wired (yet another GLP-1 receptor agonist post)

What the Scientists Who Pioneered Weight-Loss Drugs Want You to Know – Wired Magazine

Cannabis and Arrhythmia Risk, Stroke and Race, Why Weight Loss Drugs Stop Working

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Within 180 days, 42 medical cannabis users and 107 control participants developed arrhythmia, most commonly atrial fibrillation/flutter. Medical cannabis users had a slightly elevated risk for new-onset arrhythmia compared with nonusers (180-day absolute risk, 0.8% vs 0.4%). The 180-day risk ratio with cannabis use was 2.07 (95% CI, 1.34-2.80), and the 1-year risk ratio was 1.36 (95% CI, 1.00-1.73). Adults with cancer or cardiometabolic disease had the highest risk for arrhythmia with cannabis use (180-day absolute risk difference, 1.1% and 0.8%).

Medical Cannabis for Chronic Pain Tied to Arrhythmia Risk – Medscape – January 12, 2024 — https://www.medscape.com/viewarticle/medical-cannabis-chronic-pain-tied-arrhythmia-risk

The overall incidence of stroke and ischemic stroke (IS) decreased among both White and Black people over the past two decades, results of an updated analysis of stroke trends in a representative US population showed.

However, the study showed persistent racial disparities, with incident stroke rates 50%-80% higher in Black people than in their White counterparts. Incident stroke also occurred at an earlier age in Black patients than in White patients (mean age, 62 years vs 71 years, respectively).

The findings were published online on January 10, 2024, in Neurology.

New Data on Stroke Incidence Rates by Race – Medscape – January 12, 2024 — https://www.medscape.com/viewarticle/new-data-stroke-incidence-rates-race

And my favorite Saturday morning medical update…

But studies also have shown that once people stop taking these drugs — either by choice, because of shortage, or lack of access — they regain most, if not all, the weight they lost. Arguably more frustrating is the fact that those who continue on the drug eventually reach a plateau, at which point, the body seemingly stubbornly refuses to lose more weight. Essentially, it stabilizes at its set point, said Fatima Cody Stanford, MD, MPH, MPA, MBA, an obesity medicine physician at Massachusetts General Hospital and associate professor at Harvard Medical School in Boston.

Every study of weight loss drugs done over the past 40 years or so shows a plateau, Stanford told Medscape Medical News. “If you look at the phentermine/topiramate studies, there’s a plateau. If you look at the bupropion/naltrexone studies, there’s a plateau. Or if we look at bariatric surgery, there’s a plateau. And it’s the same for the newer GLP-1 drugs.”

The reason? “It really depends on where the body gets to,” Stanford said. “The body knows what it needs to do to maintain itself, and the brain knows where it’s supposed to be. And when you lose weight and reach what you feel is a lower set point, the body resists.”When the body goes below its set point, the hunger hormone ghrelin, which is housed in the brain, gets reactivated and gradually starts to reemerge, she explained. GLP-1, which is housed in the distal portion of the small intestine and in the colon, also starts to reemerge over time.

Why Do GLP-1 Drugs Stop Working, and What to Do About It? – Medscape – January 12, 2024 — https://www.medscape.com/viewarticle/why-do-glp-1-drugs-stop-working-and-what-do-about-it

That’s it for this Saturday. Time to go to the Y and read a book later.

But I Lost 25 pounds!

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The recent analysis in JAMA focused on serious stomach disorders and GLP-1 agonists.

Researchers in Canada compared safety outcomes for GLP-1 agonists and bupropion-naltrexone, an older class of weight-loss medication. The retrospective analysis included 4144 people with obesity who were prescribed liraglutide, 613 prescribed semaglutide, and 654 prescribed the older treatment. People with a diabetes code in their health record were excluded from the study.

The GLP-1 group had a 9 times greater risk of pancreatitis, a 4 times greater risk of bowel obstruction, and a more than 3 times greater risk of gastroparesis, which causes stomach paralysis. The absolute risks in the GLP-1 group, however, were all about 1% or less per year of GLP-1 use. And semaglutide and liraglutide were not associated with biliary disease, which affects the gallbladder and bile production.

As Semaglutide’s Popularity Soars, Rare but Serious Adverse Effects Are Emerging — https://jamanetwork.com/journals/jama/fullarticle/2812192

Sorry, but as a reasonably normal human who lost >200 pounds without surgery or drugs I just don’t get it. We all want the easy way out I guess.

Nature Wants Us to be Fat

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Evidence that Obesity and Diabetes are Driven by a Diet-Induced Biological Switch: How it Works and How it Might be Prevented — https://www.vumedi.com/video/evidence-that-obesity-and-diabetes-are-driven-by-a-diet-induced-biological-switch-how-it-works-and-h/

Blog post title is the same as the title of Dr. Richard J. Johnson’s book. The link takes you to a video that is approximately 37 minutes long. Enjoy!

New Wonder Drug! Treat Diabetes, Obesity AND Addiction – (yup another GLP-1 receptor agonist post)

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Previous research has found that activating GLP-1 receptors in rats’ brain causes the animals to eat less of a high-sugar chow, which they would normally prefer over a less delicious but healthier bland meal when given the option. This suggests that GLP-1 makes unhealthy food less rewarding. Schmidt’s team found the same to be true with cocaine: rats that received a GLP-1 agonist took less cocaine when it was offered. The researchers are now repeating the experiments in rats addicted to opioids or fentanyl. Several other studies have shown that GLP-1 agonists cause rats to drink less alcohol and produce less dopamine when they do drink, suggesting that the activity is no longer as pleasurable.

…it’s too early to say whether people recovering from addiction would need to take an GLP-1 agonist for the rest of their lives, like people with diabetes do, or whether these drugs could be short-term treatments that curb cravings long enough for people to make lifestyle changes to stay sober. People who stop taking semaglutide for weight loss quickly gain the weight back, and study animals that stop taking it return to alcohol and drug use, but “I don’t think we know enough yet” in humans, Simmons says.

Could New Weight-Loss Drugs like Ozempic Treat Addiction? — https://www.scientificamerican.com/article/could-new-weight-loss-drugs-like-ozempic-treat-addiction1/

The rest of this post is a repost of April Fools 2023 (this is a GLP-1 receptor agonist post). Enjoy!

Ozempic and a similar drug, Wegovy, are weekly shots you give yourself that cause the body to produce insulin. Insulin lowers blood sugar, slows digestion and makes people feel full. Carter-Williams tried it and was amazed.

“You are not hungry,” she says. “Like, I actually have to set timers to make sure that I do eat, because otherwise you actually forget to eat.”

‘You forget to eat’: How Ozempic went from diabetes medicine to blockbuster diet drug https://www.npr.org/2023/04/01/1166781510/ozempic-weight-loss-drug-big-business

Everyone wants the easy way out. I sometimes forget to eat but not because of a miracle drug. You wonder if those of us wanting to lose weight know you can’t stop taking this drug once you start it.

Patients discontinuing the use of weight-loss drugs such as Wegovy risk regaining their original body weight in about five years, a Novo Nordisk official said on Wednesday.

Novo Nordisk Says Stopping Obesity Drug May Cause Full Weight Regain in 5 Years–https://www.medscape.com/viewarticle/990267?src=rss

Side effects?

Just a few https://www.wegovy.com/taking-wegovy/side-effects.html

  • Possible thyroid tumors, including cancer.
  • Inflammation of your pancreas (pancreatitis)
  • Gallbladder problems
  • Increased risk of low blood sugar (hypoglycemia) in patients with type 2 diabetes, especially those who also take medicines for type 2 diabetes such as sulfonylureas or insulin
  • Kidney problems (kidney failure)
  • Serious allergic reactions
  • Change in vision in people with type 2 diabetes.
  • Increased heart rate
  • Depression or thoughts of suicide.

So if you want to lose weight by taking a GLP-1 receptor agonist remember the risks of side effects including the real possibility of having to take a drug that costs up to $1600.00 a month for the rest of your life.

Good luck with that.

As an FYI this drug class is being investigated by the EU for a small number of cases reporting suicidal ideation https://www.latimes.com/business/story/2023-07-10/ozempic-weight-loss-drugs-probed-over-reports-of-suicidal-thoughts.

But we already knew this.

Why People Stop Using Drugs Like Ozempic – Wired (yet another GLP-1 receptor agonist post)

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One study looked at GLP-1 RAs prescribed in the UK between 2009 and 2017. Out of the 589 patients who started taking a GLP-RA, 45 percent stopped taking the drug within 12 months, and 65 percent within 24 months. The same group of scientists also looked at people taking GLP-1 RAs in the US across a similar period of time. That study included a much larger group of diabetes patients but found that people quit taking the drugs at a similar rate as in the UK. Within 12 months, 47 percent of patients stopped taking their GLP-1 AR; after 24 months that figure was 70 percent. On average, people in that study spent around 13 months using the drug before they stopped taking it.

Why People Stop Using Drugs Like Ozempic —https://www.wired.com/story/ozempic-wegovy-quitting-weight-loss/?utm_source=pocket-newtab

For my last GLP-1 RA post see Tirzepatide Reduces Appetite, Energy Intake, and Fat Mass in People With Type 2 Diabetes — https://doi.org/10.2337/dc22-1710

To reduce the number of clicks the rest of this post is a repost of April Fools 2023 (this is a GLP-1 receptor agonist post). Enjoy!

Ozempic and a similar drug, Wegovy, are weekly shots you give yourself that cause the body to produce insulin. Insulin lowers blood sugar, slows digestion and makes people feel full. Carter-Williams tried it and was amazed.

“You are not hungry,” she says. “Like, I actually have to set timers to make sure that I do eat, because otherwise you actually forget to eat.”

‘You forget to eat’: How Ozempic went from diabetes medicine to blockbuster diet drug https://www.npr.org/2023/04/01/1166781510/ozempic-weight-loss-drug-big-business

Everyone wants the easy way out. I sometimes forget to eat but not because of a miracle drug. You wonder if those of us wanting to lose weight know you can’t stop taking this drug once you start it.

Patients discontinuing the use of weight-loss drugs such as Wegovy risk regaining their original body weight in about five years, a Novo Nordisk official said on Wednesday.

Novo Nordisk Says Stopping Obesity Drug May Cause Full Weight Regain in 5 Years–https://www.medscape.com/viewarticle/990267?src=rss

Side effects?

Just a few https://www.wegovy.com/taking-wegovy/side-effects.html

  • Possible thyroid tumors, including cancer.
  • Inflammation of your pancreas (pancreatitis)
  • Gallbladder problems
  • Increased risk of low blood sugar (hypoglycemia) in patients with type 2 diabetes, especially those who also take medicines for type 2 diabetes such as sulfonylureas or insulin
  • Kidney problems (kidney failure)
  • Serious allergic reactions
  • Change in vision in people with type 2 diabetes.
  • Increased heart rate
  • Depression or thoughts of suicide.

So if you want to lose weight by taking a GLP-1 receptor agonist remember the risks of side effects including the real possibility of having to take a drug that costs up to $1600.00 a month for the rest of your life.

Good luck with that. This joke’s on you.

As an FYI this drug class is being investigated by the EU for a small number of cases reporting suicidal ideation https://www.latimes.com/business/story/2023-07-10/ozempic-weight-loss-drugs-probed-over-reports-of-suicidal-thoughts.

But we already knew this.

What the Scientists Who Pioneered Weight-Loss Drugs Want You to Know – Wired Magazine

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What happens is that you lose your appetite and also the pleasure of eating, and so I think there’s a price to be paid when you do that. If you like food, then that pleasure is gone. The craving for food for some people is taken away when they take GLP-1 drugs.

So you don’t eat through GLP-1 therapy because you’ve lost interest in food. That may eventually be a problem, that once you’ve been on this for a year or two, life is so miserably boring that you can’t stand it any longer and you have to go back to your old life.

What the Scientists Who Pioneered Weight-Loss Drugs Want You to Know – https://www.wired.com/story/obesity-drugs-researcher-interview-ozempic-wegovy/

Just another GLP-1 receptor agonist post. See Tirzepatide (another GLP-1 receptor agonist post) for more on the new miracle weight loss drugs that were originally developed to treat duodenal ulcer disease (bet you thought it was diabetes).

The entire article is worth reading.