Losing Weight in 2023
It is harder to lose weight in 2023 than it was in 1993, as pollution is making “fat stem cells” that birth new fat cells, birth harder to lose nastier acting fat cells.
Thus, all of us have a harder time shedding love handles.
Ozempic is flying off the shelves. Though it can also be compounded by compounding pharmacists.
It is a hot new weight loss med that works…Fast!
In my office in Naples, Florida (Naples’ Center for Functional Medicine) this med is “flying off the shelf” by demand of patients wanting to lose weight.
But, if you give too much too fast, it can cause pancreatitis. A patient of mine was given a hefty dose by a doc, as he was at a hefty weight, and ended up in the ICU down a rabbit hole for a month out of his life.
These weight loss drugs do work well for some patients. PCOS patients are all standing in line, as that disease that now affects 1 out of 10 young women globally, causes extreme difficulty in losing weight.
Any other issues with these meds that sensitize the insulin receptor to help the body lose weight? Read on. There are some definite contraindications with a personal or family history of some issues.
What are these new weight loss meds?
These meds are glucagon-like peptide 1 (GLP-1) receptor agonists, like semaglutide, classically used for treating type 2 diabetes and now recently as meds for weight loss.
Large clinical trials have documented the benefits of this medication class not only for weight reduction but also for cardiovascular and renal benefits in patients with diabetes.
These meds are delivered by subcutaneous injections (called SubQ).
They work by promoting insulin secretion, slowing gastric emptying, and suppressing glucagon secretion. With a low risk for hypoglycemia. (BTW my new product receptor detox also works in a similar manner though through nutritional and botanical means. Though it would take longer as it’s more “natural”.)
The US Food and Drug Administration (FDA) approved daily-injection of GLP-1 agonist liraglutide for weight loss in 2014, and weekly injection of semaglutide for chronic weight management in 2021, in patients with a BMI ≥ 27 with at least one weight-related condition or a BMI ≥ 30.
The brand name for semaglutide approved for weight loss is Wegovy, and the dose is slightly higher (maximum 2.4 mg/wk) than that of Ozempic (maximum 2.0 mg/wk), which is semaglutide approved for type 2 diabetes.
In trials for weight loss, data showed a mean change in body weight of almost 15% in the semaglutide group at week 68 compared with placebo, which means these meds do help many folks lose weight. Fast.
The newest synthetic dual-acting agent is tirzepatide, which targets GLP-1 but is also a glucose-dependent insulinotropic polypeptide (GIP) agonist. The weekly subcutaneous injection was approved in May 2022 as Mounjaro for treating type 2 diabetes and produced even greater weight loss than semaglutide in clinical trials. Tirzepatide is now in trials for obesity and is under expedited review by the FDA for weight loss.
There is a Concern About Thyroid Cancer
Early on with the FDA approvals of GLP-1 agonists, a warning accompanied the products' labels to not use this class of medications in patients with medullary thyroid cancer, a family history of medullary thyroid cancer, or multiple endocrine neoplasia syndrome type 2. This warning was based on data from animal studies.
Human pancreatic cells aren't the only cells that express GLP-1 receptors.
These receptors are also expressed by parafollicular cells (C cells) of the thyroid, which secrete calcitonin and are the cells involved in medullary thyroid cancer.
A dose-related and duration-dependent increase in thyroid C-cell tumor incidence was noted in rodents.
The same relationship was not demonstrated in monkeys. Humans have far fewer C cells than rats, and human C cells have very low expression of the GLP-1 receptor.
But we do animal studies to get an idea of human response.
Over a decade ago, a study examining the FDA's database of reported adverse events found an increased risk for thyroid cancer in patients treated with exenatide, another GLP-1 agonist.
Many subsequent studies did NOT confirm this relationship.
The LEADER trial looked at liraglutide in patients with type 2 diabetes and showed no effect of GLP-1 receptor activation on human serum calcitonin levels, C-cell proliferation, or C-cell malignancy.
A large meta-analysis in patients with type 2 diabetes didn't find a statistically increased risk for thyroid cancer with liraglutide, and no thyroid malignancies were reported with exenatide.
And a recent meta-analysis of 45 trials showed no significant effects on the occurrence of thyroid cancer with GLP-1 receptor agonists. But it did find an increased risk for overall thyroid disorders, although there was no clear statistically significant finding pointing to a specific thyroid disorder.
However, a recent nationwide French healthcare system study provided newer data suggesting a moderately increased risk for thyroid cancer in a cohort of patients with type 2 diabetes who were taking GLP-1 agonists. The increase in relative risk was noted for all types of thyroid cancer in patients using GLP-1 receptor agonists for 1-3 years.
Do “not” use this med if:
If you have a personal history of pancreatitis or a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2.
Knowledge is Power
Dr. B.
Reference:
Rachel Pessah-Pollack. TikTok's Fave Weight Loss Drugs: Link to Thyroid Cancer? - Medscape - Mar 15, 2023.
Thank you dr.Berkson for all information!
Yes “knowledge is power” 🙏🏻
Hi Dr.Berkson, I have been wondering about these type of drugs. I do have an autoimmune dis-ease called Myasthenia Graves but no thyroid condition. I have a lot of weight to lose, 60 lbs, and a lot of it came from Covid and stress. I tend to a mother with Alzheimer's, and my resolve has waned and I am trying to find it again. I might need therapy instead, but the weight gain has me becoming more of a recluse. Is this a viable option or just try and put the pedal to the metal and do the hard work and dig deep to find it? I love your articles