Q1: What are they? How do they work?
They are drugs that mimic a hormone your body already produces (GLP-1), with the difference being that the synthetic version sticks around in the receptor for a long time. The GLP-1 your body makes is gone in about 2 min, whereas Ozempic has a half-life of 7 days.
GLP-1 impacts many parts of the body, but for weight loss the “business end” is in your brain, specifically in your hypothalamus. The hypothalamus controls many things – blood pressure, sleep-wake cycles, etc, and more relevant to this Q&A, the hypothalamus controls appetite, cravings, and many parts of addiction.
GLP-1’s suppress appetite and cravings (aka “food noise”) where they are controlled in your brain. The weight loss they can produce can have profoundly positive impacts on blood pressure, cholesterol levels, sleep apnea, and more.
Q2: Are they safe?
If you are asking “are these medications that have only positive effects, but no potential negative side effects?” The answer is obviously no. All medications that can have a positive impact necessarily carry risks of mild, moderate or severe side effects. Even inert placebos have negative side effects. The benefits outweigh the risks for some, and vice-versa for others.
GLP-1 medications absolutely make sense for some people. For example: if you have type-2 diabetes, the chances are good that you can go into remission* if you lose enough weight (~15% of your body weight). So, these medications can be part of eliminating or dramatically reducing the severity of type-2 diabetes. That is a HUGE deal.
The weight loss GLP-1’s can facilitate is a huge factor in many of the most common chronic disease in the world today. This includes high blood pressure, high cholesterol, sleep apnea, NAFLD, etc because losing about 10% of your bodyweight will greatly improve, if not eliminate most of these conditions.
*Thanks to Dr. Roy Taylor we’ve known for at least 15 years that type-2 diabetes is reversible.
Q3: Do you need to exercise on GLP-1’s?
Yes! Everyone should be exercising for their mental and physical health, and to remain able to do enjoyable things with their body. In many ways strength is youth, and weakness is a burden on ourselves, but even more so, for the people who need to care for us. GLP-1 medications make exercise more important.
One of the negative side effects of GLP-1’s is that you tend to lose more lean body mass using them than you would compared to lifestyle (meaning low calorie diet and exercise to lose weight at the same rate). I have a theory on why that it is that I will share below, but why it happens doesn’t change that it does happen, and keeping your muscles, bones and tendons strong is very important.
[my theory: when you stress your bones enough for your body to make them stronger they release something called undercarboxylated osteocalcin (ucOC). ucOC has impacts far beyond your skeleton – it triggers the release of GLP-1, and ucOC seems to be very important for increases in muscle & connective tissues strengthening. Meaning that building your muscles requires your bones to participate. GLP-1 medications reduce ucOC production, which in turn speed up losses in muscles, bone and connective tissue.]
Q4: Is it cheating?
Of course not. In the fitness industry there is an idea that either you lose weight with diet and exercise only, or you are an unhealthy loser and a cheat. People use many more words to dance around the point, but the preceding sentence is a faithful executive summary.
This isn’t a moral issue. Stealing, lying, etc are moral issues. Moral issues are black and white. However, whether or not to take a medication is an empirical question to discuss with your doctor.
Q5: What’s something surprising you’ve learned about GLP-1’s
They seem to be a very effective treatment for alcoholism without the negative side effects of other medications for alcoholism. GLP-1’s seem to work for many addictions by reducing what I will call “drug noise” (drug, alcohol, etc cravings) that people are overwhelmed by when trying to quit. You still need to put in the work to get sober, but they might be a game changer in addiction medicine.
Q6: What happens when you stop taking them?
A6: You start regaining the weight. Needing to take them indefinitely is something to consider. To put that in perspective, when most people start taking cholesterol or blood pressure medications they are usually on them indefinitely as well. Furthermore, GLP-1’s allow most people to get off of their cholesterol, blood pressure (and other) medications, so there’s often a net reduction in total medications consumed.