Semaglutide (and other drugs like it that imitate the intestinal hormone GLP-1 (Glucagon-like peptide-1)) has been hailed as the holy grail, the gastric-bypass in a pill, the final and total cure…. of obesity. The only slight drawback is that it costs upward from $2000 a month and you would have to take it forever. That is quickly more expensive than gastric bypass.
GLP-1 simulators do a lot of things many of which could aid in weight loss, like slowing down stomach emptying and promoting satiety in your brain that reduces food and water intake. But it conversely increases insulin manufacture and secretion which should cause weight gain. Two very prominent side effects of GLP-1 type drugs are nausea and vomiting and to my lame way of thinking that may be how it causes weight loss since slight nausea could also be called decreased appetite which is the claim to fame of this breakthrough class of anti-obesity drugs.
Seems like causing ever-so-slight nausea should be an easy cheap thing to do. Hunger, appetite, satiety, and nausea happen in the brain like those other impossible to define things like happiness, self esteem and no dignity. An article that reviews new discoveries about how the brain causes hunger (1) is in the same issue of The New England Journal of Medicine as the basis of my last column about salt.
The author of this report invents the word “hangry” which is the unpleasant feeling of hunger associated with a need to obtain food, like the “you’re not yourself when you’re hungry” Snickers commercial. Newly identified nerve circuits can shut off the distressing aspects of hunger and they do it quickly and can be trained the way that things usually happen in the brain. Is this the way that GLP-1 and it’s simulators work? Another new medication called cagrilintide that mimics a hormone made in the pancreas called amylin may also send messages from the guts and trigger signals in those parts of the brain. (2)
Who ever thought that obesity would be so easy to cure?
1. Betley JN. Eliminating the “hanger” from hunger. Clinical Implications of Basic Research. N Engl J Med 385;21:2005-7.
2. Lau DCW et al. Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial. The Lancet November 16, 2021. DOI:https://doi.org/10.1016/S0140-6736(21)01751-7
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- [email protected] or phone-354-6605.