GLP-1 Drugs and Babies, Part 2

Any factor with the potential to affect a baby throughout its entire lifetime is not a thing to be taken lightly. A number of authorities have something to say about the subject of GLP-1 drugs in conjunction with pregnancy.

Many media articles mention Ozempic, a drug which, because of its early and widespread popularity, seems to stand in for and take the fall for the whole group of similar meds. But that one preparation does not represent the entire range of risk. Another brand’s packaging, for instance, warns of increased risk to the fetus, of cleft lip and cleft palate.

The Food and Drug Administration states that no one should take GLP-1 drugs if they are trying to become pregnant. For those who are planning on motherhood and are on a GLP-1, the FDA recommends stopping the medication at least two months before trying to conceive.

Jamie Winn, Pharm.D., told journalist Cathy Cassata,

While no studies have been conducted on pregnant people taking GLP-1 drugs, studies in animals such as rats, rabbits, and monkeys showed that these animals experienced high rates of miscarriages when they were given an injectable GLP-1 medication. The babies the animals gave birth to were smaller in size than usual and with more birth defects.

Just to complicate matters, pregestational diabetes has long been known to “increase the risk for potential pregnancy, including birth defects, miscarriage, fetal growth restriction, premature labor, and preeclampsia.” Some professionals believe that so far, weight-loss drugs offer no greater risk than insulin, which pregnant women with diabetes have needed to take.

Still, clinical endocrinologist Dr. Sethu Reddy has said that no GLP-1 receptor agonist is “indicated for improving fertility” and that “risk can not be ruled out.” On the other hand, GLP-1 receptor agonists seem to perform no worse than insulin, and patient acceptability and adherence are great advantages.

But this only applies to the small percentage of potential mothers who must receive extra protection because of their diabetes. Dr. Sonia Hernández-Díaz is quoted as saying,

[T]he safety of these agents in pregnancy is largely unknown, as pregnant women are typically excluded from clinical trials; hence, treatment guidelines do not recommend these agents in pregnancy.

Around the same time, a Swedish study provided reassurance about the prenatal exposure experienced by fetuses when the mothers are treated for obesity with semaglutide. Only a month later, it was announced that a study of 50,000 pregnancies in six countries, followed up for the first year after birth, provided “reassuring” answers regarding the GLP-1 drugs. Still, even though they apparently post no greater risk than insulin, one year of follow-up cannot tell the whole story.

A researcher who wants to know everything about the effects these drugs have on mothers and their babies cannot simply round up a group of suitable female subjects and keep them on the premises, while hourly monitoring every body function. Nor can they even pay women who have used or are using the substances to turn themselves and their fetuses into lab specimens.

(To be continued…)

Your responses and feedback are welcome!

Source: “Ozempic’s Effects on Pregnancy and Fertility: Experts Answer 4 Common Questions,” Healthline.com, 08/14/24
Source: “Are Weight Loss Drugs Like Ozempic Safe While Trying to Get Pregnant?,” Healthline.com, 04/25/23
Source: “Are GLP-1 receptor agonist drugs safe to use in pregnancy?,” MedicalNewsToday.com, 12/16/23
Source: “Prenatal exposure to GLP-1 receptor agonists and other second-line antidiabetics may not pose greater risk to infants than insulin,” Harvard.edu, 12/11/23
Source: “First Large Study of GLP-1 Receptor Agonists During Pregnancy,” JAMANetwork.com, 01/02/24
Image by Vladimir Pustovit/Attribution 2.0 Generic

Childhood Obesity Awareness Month — Odds and Ends

Dengue fever is one of the reasons to avoid mosquitoes if at all possible. Millions of people catch it every year, and while four out of five don’t even show symptoms, others get it really bad — as in, total body pain, and bleeding from places that do not normally bleed. While many cases may be almost negligible, the disease can also usher in a miserable death. The same person might have a barely noticeable case one time, and the next time a fatal one.

To make matters worse, dengue has traveled to geographical areas where it did not use to exist, like the southern United States. And according to other recent news, both obesity and diabetes are risk factors that increase the likelihood of a person’s case of dengue being severe.

Researchers in Sri Lanka looked at 4,782 cases among young people aged 10 to 18. The Conclusions follow:

Obesity appears to be associated with an increased risk of hospitalization in dengue, which should be further investigated in longitudinal prospective studies. With the increase in obesity in many countries, it would be important to create awareness regarding obesity and risk of severe disease and hospitalization in dengue.

Another source pins down the hospitalization risk for obese children as being twice as high as for the others. The same report notes that “there has been limited focus on the impact of obesity on many infectious diseases.” Furthermore, the odds are worse for girls than for boys. (This caveat also applies to influenza, COVID-19, and “many other infections.”) Dengue has been identified as a Neglected Tropical Disease, so maybe having this connection pointed out will lead to more strenuous efforts toward prevention.

They just can’t seem to get it right

A study published in Nutrients reveals that “60% of all baby foods don’t meet standards established by the World Health Organization.” The research team tested 651 products sold by 10 different major retail chains and found that infant and toddler foods on supermarket shelves contain too much bad stuff and not enough good stuff:

In fact, researchers discovered that only about 30% of these products complied with the WHO’s protein recommendations and only 56% complied with sugar guidelines.

During the first year, a child does just fine with breast milk or iron-fortified formula. In the words of neonatal dietician Chelsea Britton, “Food before one is just for fun,” which is an excellent reason to ignore the commercial offerings and start acclimating a child to real food.

Recommended are “natural purees like yogurt, hummus, smashed beans, and smashed avocado.” Aim for protein, iron and calcium, and don’t add any salt or sugar. Let a child become accustomed to what real, genuine food is supposed to taste like, and don’t assume that your own jaded palate and overworked taste buds can be the judge of that.

In a separate but equally appalling offense, no brands meet the promotional standards set by the WHO, meaning that their advertising is misleading and the information they provide for the buyer is incorrect. It is forbidden to advertise a product as organic, non-GMO, BPA-free, or without artificial flavors or colors, if this claim is not factually true.

Forbidden, but apparently not enforceable. Another example would be calling something a fruit snack, whose main ingredient is flour. Lead researcher Daisy Coyle found that the average infant/toddler food label includes several prohibited claims. Only four products were found whose packaging featured no prohibited claims.

And don’t even look at the front label. Turn the jar around, take out your magnifier, and check the ingredients list and nutrition label, for the real story. Baby food from a grocery shelf should have a very short list of ingredients — the main vegetable, fruit or meat, and enough water to make it spoonable. The cereals, like oatmeal and rice, ought to contain added minerals and vitamins.

Your responses and feedback are welcome!

Source: “Dengue fever,” MayoClinic.org, undated
Source: “Is the rise in childhood obesity rates leading to an increase in hospitalizations due to dengue?,” AC.uk, 2024
Source: “Childhood obesity tied to double the risk of dengue hospitalization,” UMN.edu, 06/28/24
Source: “Most Baby & Toddler Foods Don’t Meet Nutrition Standards, Study Finds,” Parents.com, 08/28/24
Image by markus119/Attribution 2.0 Generic

Exactly How Multifactorial Is Childhood Obesity?

The full title of this study is “Unraveling Childhood Obesity: A Grounded Theory Approach” to Psychological, Social, Parental, and Biological Factors.” Its four authors are from three different universities and they look at seven major categories of interest: social factors; biological and genetic factors; psychological factors; family condition-related factors; feeding and health-related practices; parenting style factors; and consequences of obesity.

These are further broken down into a couple of dozen subcategories. In other words, there is very thorough coverage of everything that is known, or suspected, to affect the bodies of young humans. Why? Because…

Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration.

This work was done in order to come up with a “grounded theory” that includes them all. According to the study authors,

Grounded theory, as a qualitative research methodology, shows great potential for solving the complexities inherent in multifactorial issues. The aim […] is to construct a theoretical framework or a cohesive explanatory mechanism that explains the phenomena being studied. The application of grounded theory methodology includes analyzing and interpreting data that are mostly qualitative like observations, interviews, texts, and documents.

Needless to say, the numerous factors “interact in complex ways, highlighting the multifactorial nature of childhood obesity.” The authors begin by discussing BMI (body mass index) and other measurement tools, and note that “the absence of a universally agreed-upon definition” of childhood obesity makes every aspect of the search for knowledge more challenging. But it is more necessary than ever, because…

[…] obesity represents a significant component of the worldwide challenge of chronic illness and disability, carrying substantial social and psychological consequences that impact individuals of all ages and socioeconomic backgrounds.

In the realm of causation classification, which area holds the most sub-categories? Perhaps surprisingly to some interested parties, “social factors” includes an abundance of categories, five to be exact. One of them has to do with specific time periods, which in turn will surely be divided into even more sub-categories.

Three possibilities spring to mind. First, there is the historical era. When Americans plodded westward with covered wagons pulled by horses, very few cases of childhood obesity existed. Another place where time makes a difference is in the child’s lifespan. As one example, there appears to be a stage of infancy when trying to shovel solid food into a baby can cause lifelong damage to the digestive system.

Likewise, there is a specific time period during which a problem can be solved. Younger people are more likely to be able to lose weight through one means or another, while adults are more likely to stay fat. That is simply how things are and, as always, further research is needed on every front.

The “biological and genetic factors” category has four sub-categories, and so does “family condition-related factors.” Perhaps it is unfair, that what parents say, do, practice, preach, model, ignore, punish, reward, discuss, clam up about, encourage, discourage, and pay for (or don’t), makes so much difference. Family influence (and lack of it) is responsible for an awful lot, and there is no point in pretending.

One way or another, childhood obesity ends up being everybody’s problem. On the importance of starting early, agreement is universal. The need is felt to construct a theoretical framework that includes all the recognized factors and all the connections between them.

Your responses and feedback are welcome!

Source: “Unraveling Childhood Obesity: A Grounded Theory Approach,” ResearchGate.net, August 2024
Image by Roy Patrick Tan/Attribution-ShareAlike 2.0 Generic

Childhood Obesity Awareness Month — Present and Accounted for

Without bringing up a single political point, it is still obvious that America thinks about childhood obesity a lot less than we used to when Michelle Obama was on the case. This seems like an appropriate time to mention a few current happenings that are intriguing, though difficult to categorize. Some ideas that appeared a while back might still have potential.

About six years ago, Dr. Liad Uziel of Bar-Ilan University discussed the belief that, despite a pile of contrary evidence, self-control might be a possible remedy for obesity. However, and sadly, it seems that a high capacity for self-control is a double-edged sword:

Not acknowledged enough are potential undesired personal and societal consequences associated with high self-control and the pursuit of higher self-control. Examples include inflexible behavioral patterns, over-emphasis on norm adherence at the expense of personal discretion, and strict emphasis on cold and rational thinking while overlooking intuition and emotional inputs.

Anyone can easily think of examples of “potentially problematic implications” accruing to an overabundance of self-control. For instance, the trait carries with it the possibility that a person’s information-processing ability might be negatively affected, as they wrongly assume that such a capability is universally distributed among the populace.

In this respect, all people are not created equal, but someone who can do it might unjustly blame others for not using the self-control they are assumed to possess. In the same way, someone with a knack for musical improvisation might assume that anyone can pick up an instrument and just jam… when they just can’t.

Such a mistaken assumption might blossom into a tendency to blame others for not making correct decisions that in reality they simply don’t have the capacity for. Blind faith in the idea that everyone should be able to exhibit extreme self-control can cause rough spots in social and interpersonal relationships.

It gets worse. Dr. Uziel’s research has revealed that “wanting to have more self-control can actually be an obstacle to achieving more self-control,” which is rather alarming:

Intensive self-regulatory efforts can lead to all sorts of problems, including health problems associated with intense stress. On that background, wanting to have more self-control contributes additional stress, and, in the short-run, demotivates one and reduces one’s belief that she or he can actually demonstrate good self-control.

After old notes were reviewed, an attempt was made to chase down a 2015 story headlined, “Childhood Obesity Rates Drop As A Result of Vegetable Spiral Slicer,” which was broadcast by a New York news program. Apparently, cooler editorial heads prevailed and all traces of that piece were removed from the internet.

However, it was possible to find another article about the device, which contains no mention of a decrease in the rate of childhood obesity but does tout the virtues of the Very Healthy Spiral Slicer, saying:

[I]t provides an excellent way to get children excited about fruit and vegetables… It is widely believed that the fun and colourful results produced by the spiral slicer will appeal to children. It is essentially a subtle way to introduce vegetables into a meal in a form that won’t immediately be recognised as a vegetable… Through creating long spirals of vegetables similar to spaghetti, it makes it easy to replace pasta in meals.

It appears that this tool is still available, although whether it is capable of reducing childhood obesity rates is yet to be determined.

Your responses and feedback are welcome!

Source: “Intricacies of the pursuit of higher self-control,” ScienceDaily.com, 03/26/18
Source: “Varietyland Launches New Vegetable Slicer To Revolutionise Healthy Dieting,” PRWeb.com, 04/21/15
Image by Jonas Zeschke/Attribution-ShareAlike 2.0 Generic

Anything Goes? The Epigenetics Challenge

The whole field known as epigenetics is like a wild and wooly frontier. A Harvard University publication calls it an emerging area of research. Basically,

[…] the DNA that make up our genes accumulates chemical marks that determine how much or little of the genes is expressed… The different experiences children have rearrange those chemical marks…

Which explains the mystery of why identical twins can have quite diverse skills and personalities, and different levels of health and achievement. One consequence of this malleability is that arguing “Nature versus Nurture” is a waste of breath. The parental genes a person receives are not the final word on anything, and because developmental experiences “rearrange the epigenetic marks that govern gene expression, they can change whether and how genes release the information they carry.”

A child’s early experiences alter gene expression and affect long-term development whether we like it or not, and whether or not we believe it. Events and circumstances can influence how easily a gene may be switched off or on, and may leave a temporary or permanent mark. To express the concept in a more colloquial way, pretty much everything is up for grabs.

Outcomes depend on such variables as learning opportunities, supportive or destructive family relationships, and the general stressfulness of the surroundings, which may be anything from an odious intellectual environment of stultifying boredom to a catastrophic war zone:

The “biological memories” associated with these epigenetic changes can affect multiple organ systems and increase the risk not only for poor physical and mental health outcomes but also for impairments in future learning capacity and behavior.

The realization that nothing is “set in stone” can be crushing or exhilarating, and the exciting challenge of working with the concept that change may be just within our reach surely fuels the souls of many scientists.

It gets crazier

Things really changed in this area of knowledge with such events as wartime famine in the Netherlands which indicated the possibility of traits that were not genetic, yet nevertheless were heritable. A study showed that men who were still in the womb when their mothers experienced malnutrition tended to have children with a tendency to become overweight adults.

Just when everything already seems complicated enough, the pipeline delivers more baffling information. According to a brand new Northwestern University/University of Texas report, explained by its originators in advance of official publication, “Temporary stress can cause heritable changes without altering the genetics…”

What now? Some of us have just become used to a packet of new ideas about how things work, and already we have to revise them? What exactly is going on here anyway? Well, it seems that…

Bacterial cells can “remember” brief, temporary changes to their bodies and immediate surroundings… And, although these changes are not encoded in the cell’s genetics, the cell still passes memories of them to its offspring — for multiple generations.

Human have entertained a lot of notions about how simple little bacteria inherit and pass along their physical characteristics, and it now appears that this understanding was incomplete. The need for revisionist thinking began to be suspected as far back as 2001, with the Human Genome Project.

Adilson Motter, the new study’s senior author, explained to interviewers that among bacterial biologists, it has long been assumed that DNA is the chief determiner of physical characteristics. However, as it turns out, “information also can be stored at the level of the network of regulatory relationships among genes.”

Scientists wondered whether characteristics can be transmitted from one generation of bacteria to the next by some means other than DNA encoding. Could the cause be the regulatory network itself? Because “the echoes of changes affecting their parents persist in the regulatory network while the DNA remains unchanged.”

Genes interact not only with each other, but with elements of the environment like temperature, available nutrients, and acidity. Excitement is in the air, for it appears that a lot of big discoveries are on the horizon:

For example, researchers could circumvent antibiotic resistance by subtly tweaking a pathogenic bacterium to render its offspring more sensitive to treatment for generations. Image the repercussions of harnessing that sort of knowledge.

Your responses and feedback are welcome!

Source: “What is Epigenetics?,” Harvard.edu, undated
Source: “Bacterial cells transmit memories to offspring,” ScienceDaily.com, 08/29/24
Image by Bernd Thaller/Attribution 2.0 Generic