AMA: What is your opinion on GLP-1s?
What a time to be alive. Never in all of my studies did I anticipate anything remotely close to the normalization of the term “GLP-1” OR it existing so predominantly in the cultural zeitgeist. Alas, here we are.
First, what it is (incredibly succinctly). At this point most people are probably aware that GLP-1 refers to an actual hormone produced in the body — glucagon-like peptide. GLP-1 triggers the pancreas to release insulin which, in turn, encourages the rest of the cells in the body to take in the available glucose circulating throughout the body. GLP-1 pharmaceuticals basically force that same insulin response (and are more resistant to break down which means they have a longer mechanism of action) and help to keep blood sugar levels stable, while also affecting the hunger and satiety signaling of the central nervous system. This has incredible positive downstream systemic effects from the heart to the liver to the kidneys to even the brain but, also inhibit other pathways related to the metabolism of our food and the ability for our bodies to access stored glucose when we need it (gluconeogenesis for my fellow nerds out there). Unfortunately, we don’t yet know the consequences of that type of pathway disruption, though it seems to be transient.
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Second, where it comes from. GLP-1 is synthesized endogenously (i.e. in our bodies) in the large intestine, pancreas, and in neurons of the brainstem (note that oddly enough GLP-1 does not cross the blood brain barrier which indicates that any neurological benefits of GLP-1 medications would likely be a result of the blood sugar homeostatic effects). The large intestine is a critical element here, especially when it comes to how I think about weight loss and diabetes from a nutrition standpoint. More on that later.
My take: Yes, but/and.
My argument for GLP-1s:
This class of pharmaceuticals has the potential to be life changing for those whose lives may be cut short prematurely as a result of diabetes and the associated complications. It just has to be used (and dosed) correctly and safely.
Even for people who just need to lose weight to avoid the diagnosis of a chronic disease, it isn’t the worst thing. The weight loss that can come with the pharmaceutical is sometimes enough to motivate someone to continue making other lifestyle changes, and perhaps can even give them the energy and mobility required to be able to make the necessary adjustments that will have lasting impacts on their health. The motivation from the weight loss leads them to ultimately adopt healthier habits in the long term which also has the potential of mitigating any rebound weight gain if they were to ever discontinue the medication.
Continue reading on Substack.
