By Dr. Colin Michie FRCPCH
A great meal blesses us with a feeling of being well-fed. Its secrets lie in a chef’s skills and those sauces, but satisfaction is also biochemical. After eating, our tripes release messenger molecules into the bloodstream. Guts call out to chatter with our brains!
One of their messenger signals, GLP-1, works within minutes – and only for a few minutes too. This incretin hormone comes from the lower gut and acts on the brain and pancreas. It makes us feel full and helps direct the production of other hormones. High protein, high fibre foods and dark chocolate particularly encourage our GLP-1 production. Medicines that copy natural GLP-1 signals have been synthesised to work for longer periods – the glutides, or GLP-1 receptor agonists. Semaglutide was first employed to help treat diabetes 20 years ago. It reduced glucose levels. Glutides were found safe and helped patients lose weight.
Dramatic increases in the use of semaglutide (Ozempic is one name for this drug) shows voracious appetites for this medication, socially and clinically, against the backdrop of a growing obesity epidemic. US prescriptions for Ozempic totalled over 2 million and sales generated more than $6 billion in 2022. Viewings of glutide videos on social media platforms increased from millions to several billion during 2023. In trials, glutides reduce appetites – users eat less because they feel full. Glutide medications, mostly given by an injection under the skin, work more effectively when used together with a healthy diet and increased physical activity. This is true for all ages, especially for weight loss. Skeletal muscle, the major consumer and store of glucose, needs to be involved in any realistic treatment plan! Some patients claim to have lost 15-25% of their body weight using semaglutide preparations.
Binge eating is a common eating disorder contributing to obesity. This food addiction is encouraged by the “Food Noise” of food-saturated public environments where attractive high sugar, high fat, high salt foods are powerfully advertised. Glutides reduce the cravings or food addictions and effectively treat binge habits. It has become clear that they reduce other addictive behaviours too, whether these involve alcohol, tobacco, cannabis, cocaine or opioids. It is possible glutides do this by reducing our normal dopamine reward pathways. However they work, this is a breakthrough! These effects are not seen after bariatric surgery. Glutides are contributing to medical strategies to help reduce the blights addictions put on individuals, families and communities.
Glutides have further benefits. Over long periods of time, they improve cardiovascular, kidney and liver health in those taking them for diabetes and obesity. Sleep apnoea may improve too. These are valuable outcomes because strokes, heart damage and renal failure all contribute to a lower quality of life, health expenses and lifespan in those with obesity and diabetes. One group of patients with obesity showed a 15% weight loss and 20% reduction in cardiovascular risk on glutide therapy. Glutides have anti-inflammatory actions in several organ systems including the brain – they are antioxidant, protecting nerve cells and may prove useful in the pharmacological care of Alzheimer’s, dementia and Parkinson’s diseases. They are being trialled to reduce the toxic side-effects of some forms of chemotherapy too, such as in the liver.
How does all this good news look in real-world studies? Sadly, up to half of those prescribed incretins stop taking them, or reduce their doses within a year because of side-effects such as nausea, stomach aches or digestive problems. Although complications reduce over time and can be managed, the effects of glutides on weight reduction do not appear as great as seen in clinical trials. Bodybuilding cultures commonly experiment with new medications. Online research into their folk pharmacology found no evidence of new risks or serious complications from glutides, but, as expected, these medications can cause low blood sugars and muscle wasting.
Social media has delivered patchy health information about glutides, making their use appear normal, with little mention of their success rates or side effects. For instance, these medications are not likely to help change your body shape over months for a beach holiday. It is not certain whether genuine injections are supplied by all online sources and the roles of commercial actors in this pharmacological frenzy are often unclear. Glutides have very different pricing structures in different countries, so their use is best part of a careful clinical plan.
Successes with glutides such as Ozempic have spurred on the next generation of similar medications. Although medications cannot control the obesity epidemic (which will require widespread and dramatic improvements to our eating) it is probable that many of us will benefit from incretins. The many ways our gourmand brains and gut communicate to keep us healthy are not all obvious or known; many others are yet to be found.
Dr. Colin Michie specializes in paediatrics, nutrition, and immunology. Michie has worked in the UK, southern Africa and Gaza as a paediatrician and educator and was the associate Academic Dean for the American University of the Caribbean Medical School in Sint Maarten a few years ago.
Useful resources:
www.nhs.uk/conditions/obesity/treatment/
www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss
