Somebody started calling them the -tide drugs, which is neat and concise; and Leon Gussow, M.D., an expert in the areas of emergency medicine and poisons, writes about them. GLP-1 receptors occur in the stomach, the pancreatic islet cells, and the brain, from where they send messages to each other and the rest of the body, answering vital questions. Is it time for the stomach to empty? How much insulin needs to be produced? Are we full yet?
And here is the answer to a question that is rarely addressed in the popular press: Why does this stuff have to come in a needle, anyway? Dr. Gussow writes,
Naturally occurring GLP-1 has a half-life of a minute or two, while semaglutide has a half-life of 165 hours, which allows it to be injected subcutaneously once a week. These drugs […] do not rev up metabolism. Semaglutide and tirzepatide can be thought of as eating disorders in an injection pen.
As we know, malnutrition is not good for anybody, even one that is trying to lose weight. But Dr. Gussow also mentions that patients who take semaglutide or tirzepatide can get queasy just by looking at food, sometimes to the point where they prefer not to eat. It sounds as if a person could get the same effect and save $1,000 a month, just by carrying around a photo of something aversive (yucky), and looking at it periodically.
A deep downside
He also brings up details that not enough people seem aware of: “[W]eight reduction from the drugs alone can involve significant loss of lean body mass,” and oh, by the way, when the patient stops using the -tide drug, not only will the weight return, but instead of lean body mass it will be fat.
Some would say the solution is obvious: Just stay on the drug forever. At this point, that seems unlikely. Mansur Shaheen reported for The Messenger:
32% of patients using Wegovy, Ozempic, or a similar competitor were still using the medication a year after prescription. A British study published last year, partially funded by Wegovy and Ozempic manufacturer Novo Nordisk, found that users of these drugs regain around two-thirds of lost weight after stopping the injections.
In other words, around two-thirds of patients quit just after the one-year mark. Cost is definitely a factor. Because of the expense, the shortages which will probably recur at least periodically in the future, and the side effects, it seems reasonable to expect that most users will soon just give up.
Obesity medicine specialist Dr. Christopher McGowan reminds us, “As I stress with all my patients, medications like Wegovy and Ozempic are designed for chronic, continuous, potentially life-long use. They are not short-term solutions.”
The lizard king
As for the new weight-loss drugs, Dr. Gussow wrote about the original members of the group:
These injectable synthetic drugs — semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro) — are derived from a peptide found in Gila monster venom.
In itself, that is not a bad thing. Nature is a bountiful pharmaceutical resource, and humans have always been grateful to get the medicine out of any obliging plant or animal.
Almost 30 years ago, endocrinologist Daniel Drucker was fascinated to learn that the poison produced by a lizard could regulate blood sugar. He put that together with the ever-increasing diabetes demographic, got his own Gila monster, and went to work. Recently, Julia Belluz elaborated on the subject:
Ten years later, a synthetic version of a hormone in the venom became the first medicine of its kind approved to treat type 2 diabetes. Known as a GLP-1 (for glucagon-like peptide-1) receptor agonist, the medicine set off a cascade of additional venom-inspired discoveries.
Your responses and feedback are welcome!
Source: “More Questions than Answers about Injectable Weight Loss Drugs,” Journals.lww.com, July 2023
Source: “A Majority of Ozempic, Wegovy, Patients Stop Using the Medication After Only a Year, Likely Regaining Lost Weight,” TheMessenger.com, 07/12/23
Source: “How a lizard’s venom inspired the promising weight loss drug Wegovy,” Vox.com, 07/05/23
Image by Verde Canyon Railroad/CC BY-ND 2.0