Dr. Michael Greger is famous for several books including “How Not to Die,” and for his website nutritionfacts.org. He recently wrote a primer on the new injectable weight loss drugs: “Ozempic, Risks, Benefits, and Natural Alternatives to GLP-1 Weight-Loss Drugs.” This column is a summary.

What is GLP-1?

 GLP-1 is short for glucagon-like peptide-1, which is one of the 20 or more peptide hormones secreted by cells lining our digestive tract that control how much we eat. This hormone triggers satiety (a feeling of fullness), and slows down digestion. The primary stimuli for secreting GLP-1 are high fat and carbohydrate meals.

GLP-1 is broken down rapidly by our bodies. Several years ago, a GLP-1-like compound was discovered in the saliva of the Gila monster lizard that is resistant to breakdown, which led to development of GLP-1-like pharmaceuticals. In 2017 Ozempic (generic name semaglutide) was approved for diabetes, and it became apparent that overweight people taking it lost weight. Subsequently, semaglutide was approved for weight loss under the name Wegovy. Since then, additional similar drugs were approved for weight loss.

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The obesity epidemic

Currently three out of four adults in the U.S. are overweight or obese, which increases their risk of hypertension, type 2 diabetes, heart attacks, strokes, dementia, fatty liver, sleep apnea, degenerative arthritis, infertility, and several forms of cancer. Obesity is a huge financial burden on our healthcare system.

 Over the past few decades, pre GLP-1 drugs, multiple weight loss drugs were developed, but they weren’t very effective. Furthermore, most were eventually pulled from the market due to side serious side effects that became apparent with mass use.

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We have not always had an obesity epidemic—it started just a few decades ago. As Dr. Greger says, “obesity is not a disease caused by a GLP-1 hormone deficiency. It’s the food.” He goes on to say “the real solution involves fixing the broken food system, but, as an editorial in the leading medical ethics journal asked, ‘why would Big Food change its ways if obesity can be treated with drugs.'”

The cells that secrete GLP-1 are located in the distal end of the small intestine (called the ilium). The processed food most people eat these days gets absorbed in the upper small intestine—it doesn’t make it down far enough for our natural GLP-1 appetite control system to kick in. Most weight loss surgery involves rearranging the GI tract so the food reaches the ilium, so that our natural GLP-1 satiety feedback loop does what it’s meant to do.

Side effects of Ozempic-like drugs

Most of these drugs are given by weekly injection, and one of the major drawbacks is the cost. Whether or not Medicare and insurances should pay for them is controversial. Common side effects include nausea, vomiting, diarrhea, and constipation. Because they slow down digestion, anesthesiologists recommend that people stop taking them for several days prior to major surgery, to avoid vomiting and aspiration. Another issue is that up to 40 percent of weight loss patients experience with these drugs is due to loss of muscle rather than fat. Serious side effects include increased risk of bowel obstruction, and pancreatitis. There is some concern that GLP-1 drugs might increase risk of thyroid and pancreatic cancer slightly but that’s not clear yet.

Effectiveness

These drugs are effective, although weight loss with them plateaus after a year, and excess weight tends to recur when the drugs are stopped. Semaglutide results in about 27 pounds of weight loss, which translates to about 3 ½ inches off the waist. Tirzepatide (sold as Mounjaro and Zepbound) results in about 45 pounds of weight loss—5 ½ inches off the waist.

Bottom line is that there are now four options if you want to lose excess weight:

• Stay as you are, but then you increase your risk of several health problems, including shortened life span.
• Obesity surgery. Liposuction isn’t the answer because it only removes subcutaneous (just underneath the skin) fat, which isn’t the type of fat that causes health problems (health-harming fat is called visceral fat—located in and around your internal organs and in your muscle cells).
• New obesity drugs—pros and cons of which are discussed above.
• The best option is free, effective, and has no side effects: making use of your natural GLP-1 appetite suppression system by eating primarily unprocessed vegetables, legumes, fruit, grains, nuts, and seeds–which contain fiber and aren’t absorbed before they reach the lower small intestine.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfmd41@gmail.com or 970-379-5718.