The Pros and Undisclosed Cons in Today’s Medical Weight Loss

In the ever-evolving world of medicine, dramatic developments are common, and today we're diving into the high-stakes arena of GLP-1 agonist medications. These drugs have stirred up quite a storm in the medical community, raising both hopes and concerns. I'm here to shed some light on the pros and cons of GLP-1 agonist medications, providing you with a clincian’s narrative that explores the drama surrounding these drugs.

How do these medicines work?
GLP-1 (Glucagon-Like Peptide-1) agonists are a class of medications used primarily to treat type 2 diabetes. They mimic the effects of GLP-1, a naturally occurring hormone that regulates blood sugar levels and appetite. GLP-1 agonists work by stimulating the release of insulin, slowing down the absorption of sugar from the digestive tract, and reducing appetite. These medications can help improve blood sugar control, promote weight loss, and potentially offer cardiovascular benefits. Three notable GLP-1 agonists in the market are Ozempic, Wegovy, and Mounjaro - once a week injections.

General +/-

Pros:

• Weight Loss: Wegovy has shown remarkable effectiveness in promoting weight loss, with some individuals experiencing significant reductions in body weight.

• Appetite Control: It reduces appetite, making it easier for people to consume fewer calories.

• Metabolic Benefits: It can lead to improvements in blood pressure, cholesterol levels, and insulin sensitivity.

Cons:

• Side Effects: Nausea is the most common side effect, however vomiting, constipation, diarrhea, abdominal pain and fatigue are common side effects.

• Long-Term Safety: The long-term safety of Ozempic, Wegovy and Mounjaro are still being studied.

Long-Term Safety Explained:

Development of Diabetes, Pancreatitis, Gallbladder Issues: Another common concern of the medication and its safety is the development of diabetes after stopping the medication. This is a common and valid concern, which points to our distrust in the medicine. To be frank, we can’t say for certain yet. With many medications, we don’t have decades of human research to foresee the longterm impact on human health. However, using current tools and our understanding of the endocrine system, we can help to protect patients from unwanted longterm consequences. Every medication has a known toxic level and places a strain on the body to some extent. These medications are no different.

Clinically speaking, we have easy access to tools that can safely use this medication to prevent against longterm side effects:

1. Body composition vs BMI: Body composition; fat vs muscle vs water is a recent and easilabily accruable tool for understanding health. We can estaimate these through scales and bio-impedence. BMI: body mass index ht vs weight is a simple measure not scientifically sound in health outcomes. This being said, a standard adipose measurement should be used to dictate a starting and maximum dose based on a total body weight, rather than an arbitrary BMI number.

2. Insulin Sensitivity/Resistance: As this medication increases insulin by asking more of our pancreatic beta cells, can we adapt? The medication is significantly proven to work even if your insulin resistant, however, it seems to be forced and dose dependent. Most patients with a testable insulin resistance will require a higher dose and/or will receive the “be patient” directive. However, with an underlying insulin resistance, the increased dose these patients will need to achieve their descried goal, will more than likely

3. Side effects: With any medication we try to avoid side effects and it means we need to lower the dose. If any patient gained 30-60 lbs within 6 months, then we probably have a treatable medical issues. However, most individuals don’t gain weight this quickly, so losing weight in such a concerted time frame , my overdosing medications, will more than likely cause unwanted longterm consequences.

Thyroid cancer: Overall, the increased risk of thyroid cancer or multiple endocrine neoplasia 2 (MEN2) is quite uncommon. And yes, it is an increased risk for those with a family history, however, only 47% precent medullary thyroid cancers have the GLP-1 receptor. Meaning even if you have this cancer, while starting these medications, you have a 50/50 odds that it will grow.

Here we must explore cancer. Everyone has cells that have the potential to grow into cancer. The speed at which they multiply is the factor that defines if we do or don’t have cancer. If these cells become measurable then we can diagnose. If not, we are none the wiser.

That being said, is this medication going to cause cancer. Well yes, if you already have the genetic or change in cells and we add gasoline to the flame. However, due to the overwhelming amount of evidence, on obesity-related conditions that are likely to contribute to a higher mortality, this medications risk for a rare cancer is more beneficial than should cause concern.

Other Odd Side Effects:

Hair loss, dry skin, and fatigue: As with all medications that cause a change in eating habits, most people can develop nutrient deficiencies that contribute to the rise of clinical symptoms. On average due to the higher incident of anemia or iron deficiency that women experience, we typically see more subtle side effects with treatment. It is always recommended to work with a trained health care provider while undergoing any medical treatment. Adequate nutritional and lifestyle guidance and interactions with medications should be assessed before initiating any medical treatment.

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