Wilding 2020

You’ve likely heard the hype and headlines surrounding the new GLP-1 agonist drugs such as Wegovy, Ozempic, Trulicity, and Rybelsus. Originally intended to help manage blood glucose in people with type 2 diabetes, they were noted to also induce substantial weight loss by reducing appetite, and thereby calorie intake, and slowing gastric emptying. The weight loss effect has catapulted these drugs to quickly become among the bestselling drugs in history, expected to reach something like $18-19 billion per year over the next four years. But when you examine the track record of these drugs and the effects they have, you’ve got to wonder how in the world these agents ever obtained FDA approval in the first place.

Imagine a cancer chemotherapy drug that induced remission, costing many thousands of dollars, but allows the return of the cancer as soon as you stop the drug—the cancer is not eradicated, just held at bay. You are therefore held hostage for the rest of your life, purchasing the drug for as long as you and your healthcare insurer can afford it. And nothing stops the drug manufacturer from increasing the price at will.

So it goes with the GLP-1 agonists. The graph at the top of his page shows (black boxes) the initial weight loss on semaglutide (Wegovy) over 68 weeks (17 kg or 37.4 lbs). After cessation of the drug, much of the weight returns (11 kg or 24.2 lbs). In the study shown above, weight regain was associated with more than 50% of subjects becoming pre-diabetic or type 2 diabetics. In real life, it is not uncommon to regain all the weight.

Just as with all other methods that limit calorie intake, whether through diet, pharmaceuticals, or bariatric procedures, there is loss of muscle. With GLP-1 agonists, a third, sometimes half, of the weight lost is muscle. If you lost, say, 30 pounds, 10-15 pounds of lost weight is muscle. Loss of muscle means that your basal metabolic rate, i.e., the rate at which your body “burns” calories, drops by 15-27%, an effect that persists for years. This is why weight returns after any calorie-reducing measure, including the GLP-1 agonists. And weight regain is more heavily weighed towards fat. If you lost, say, 15 pounds of muscle, you typically regain only 7-8 pounds with weight regain. It means that you are more metabolically impaired compared to when you started, making it harder and harder to lose weight gain, pushing you closer and closer to type 2 diabetes, heart disease, cancers such as breast cancer, and cognitive impairment and dementia.

For anyone choosing this route, they have a choice to make: lose the weight temporarily, then experience the inevitable regain that leaves you less healthy and less able to lose weight ever again and increase risk for chronic diseases, or continue to be extorted by the pharmaceutical industry and continue paying them $1000-1500 per month for the rest of your life, while experiencing the nausea, vomiting, and diarrhea that often accompany these drugs. Why would the FDA approve such an awful class of drugs in the first place?

If you have been following my conversations, you know that losing weight is easy, but it will not involve any method of reducing calories. Instead, it involves:

  1. Normalization of insulin resistance—since insulin resistance is the process that triggers abdominal fat accumulation. We target abdominal fat loss first, as this accelerates release of fat stores. We normalize insulin resistance with a calorically UNrestricted diet and restoration of nutrients that influence insulin resistance: Mg, iodine, omega-3 fatty acids, vitamin D.
  2. Reduction of metabolic endotoxemia—accomplished via purposeful management of the gastrointestinal microbiome.
  3. Boost oxytocin—by replacing the lost microbe, Lactobacillus reuteri, through the L. reuteri yogurt that provides hundreds of billions of bacterial counts per serving. The boost in oxytocin is a powerful stimulus for muscle growth. We don’t lose muscle; we maintain or even increase it.
  4. Add the body shape- and composition-modifying effects of collagen peptides, hyaluronic acid, and carotenoids, natural components of diet that are lacking in modern lifestyles.

In other words, we are not just after weight loss. We are after a dramatic change in body composition: loss of abdominal visceral fat, some loss of subcutaneous fat, preservation or increase in muscle, all achieved by restoring natural factors lacking in modern lifestyles. You don’t have to worry about weight regain, becoming diabetic, nor pay pharmaceutical companies thousands of dollars per month.