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Alternative Approaches to Weight Loss: Exploring Non-Injectable Options

Updated: Sep 22, 2023



One of the presentations I attended at the International Conference on Nutrition in Medicine in Washington D.C. sponsored by the Physicians Committee for Responsible Medicine was a panel of experts discussing the obesity epidemic and the “new” injectable drugs that are taking the prescription drug market by storm.


The influx of obese patients that have been prescribed these GLP-1 analogs has created such a demand that pharmacies are having trouble keeping these medications in stock. Everyone seems to be trying to get a prescription for these medications (Mounjaro, Wegovy, Ozempic, Saxenda, etc). There was a significant back-order situation across the country and the pharmaceutical companies are making a lot of money off of these prescriptions. Many obese patients have tried to change their diet (most likely based on the dietary guidelines) and were not successful in losing weight. Many of these patients view these injectable medications as a safer and better alternative to bariatric surgery and see injections vs. surgery as their only options.


So, how do they work?


Let’s talk a little bit about the peptides and hormones in your digestive system.


Ghrelin: This is a peptide made in the mucus producing cells in your stomach that signals when you are hungry. Ghrelin also suppresses insulin secretion. This is involved in short-term appetite regulation.


Leptin: Produced by fat cells to signal the brain to let you know when you have eaten enough food. This is a trigger to stop eating. Leptin is involved in long-term energy balance and metabolism in your body.


PYY: Secreted in the intestines and used as a signal for how much food has been eaten. More is secreted with a high-protein meal vs fats or carbohydrates. It is usually highest 1 to 2 hours after a meal and helps to signal the brain that you are full.


GLP-1: Slows the emptying of the stomach and sends signals to the brain leading to a greater feeling of fullness. Increases insulin sensitivity, decreases insulin production, and decreases glucose production in the liver


These injectable medications are called GLP-1 Analogs, which means they mimic the functions of GLP-1 in the body. So, these medications have led to “significant” weight loss (up to 17.4%) and better blood sugar management.


So, if you do the math:


  • A person who weighs 250 pounds could lose up to 44 pounds and consequently weigh 206 pounds.


  • A 300 pound person could lose up to 52 pounds and weigh 248 pounds.



This weight loss can improve health and reduce some risk for heart attacks, strokes, and complications of diabetes. These medications have worked as a starting point for some people and they have successfully lost weight and improved their health. However, relying on these medications alone, the people mentioned in the examples above would still be classified as obese. So, they don’t really solve the obesity epidemic.


But our mainstream health system still thinks it’s a good idea to bring these medications to the masses to combat the obesity epidemic. However, there are some pretty significant side effects with these medications due to their mechanism of action. They slow the emptying of the stomach significantly making you feel fuller for longer. Typically, some food passes through your stomach in a matter of minutes (liquidy foods) to a couple of hours (heavier meals). However, these medications have been slowing the emptying to several DAYS.


This can lead to significant GI side effects like abdominal pain, diarrhea or constipation, nausea and vomiting, bloating, and heartburn. There have also been links to pancreatitis, gallbladder disease, and thyroid cancer, but these are still under review.


If you have ever had any kind of surgery, they always recommend you have no food 12 or so hours before surgery. Anesthesiologists have been complaining about the number of patients on these medications due to the fact the stomach does not empty prior to the surgery and there is risk of a patient aspirating their vomit and creating secondary infections and damage to the lung tissue. So, if you take any of these medications, the American Society of Anesthesiologists recommends discontinuing them 7 days prior to surgery to ensure the stomach is empty prior to surgery.


While these medications can help some people start their weight loss journey, the side effects from these medications make it difficult to continue them long term. Unfortunately, if the medication is discontinued, patients gain weight back faster than they lost it and usually end up weighing more than when they started the medication. Even in studies of people with diabetes who were put on lower doses of semeglutide (Ozempic), 70% of these patients discontinued the medication within 2 years due to intolerance of the side effects. The average length of therapy is only 13 months.


Once these medications are discontinued, patients gain weight back at a surprising rate. Usually the weight gained back exceeds the amount of weight lost. Therefore, dietary lifestyle changes in addition to these medications are needed for success with these medications and in general.


So, are there natural ways to increase GLP-1 and increase satiety in the body?



One study looked at natural products to influence GLP-1 and certain herbs, supplements, and foods including berberine, curcumin, cinnamon, soybeans, and resveratrol (a compound found in red grapes, blueberries, and other foods) can influence GLP-1 levels. There are also some dietary interventions that can naturally increase GLP-1 like increasing fiber (whole grains, legumes, vegetables, and fruits), using olive oil instead of animal fats (butter, lard, etc.), or incorporating nuts and seeds into the diet. Sounds like a whole-food, plant-based nutrition plan.



But, there really is no quick fix to our nation’s obesity epidemic. If you start paying attention to advertisements on TV, social media platforms, and billboards, we are inundated with messages from the food industry telling us it’s ok to eat certain foods “in moderation” or that we just need to exercise more. We are handed convenience foods, fast foods, highly processed foods at a bargain price due to subsidies, while healthy food seems too expensive. You might be surprised how much room is in your budget when you don’t have to spend it on dairy products, meats, and processed foods.


However, the price tag on these injectable medications really takes the cake (so to speak). According to Dr. Neal Barnard, MD, President of the Physicians Committee for Responsible Medicine, for the cost of Wegovy per month ($1300), our health system could pay for a weekly visit with a registered dietician, a monthly grocery stipend of $500, a monthly gym membership at $80, AND $120 in vacation money to reduce stress!

PER MONTH

PER YEAR

DIETICIAN VISIT WEEKLY

$600

$7200

BAG OF GROCERIES

$500

$6000

GYM MEMBERSHIP

$80

$960

VACATION MONEY

$120

$1440

TOTAL

$1300

​$15,600


So, I guess it’s up to you! You can try an expensive injectable “quick-fix” or pivot your lifestyle to include whole-food, plant-based nutrition for lasting health and wellness.


Are you ready to start your journey to a healthier, more balanced life?



References:


Aldawsari M, Almadani FA, Almuhammadi N, Algabsani S, Alamro Y, Aldhwayan M. The Efficacy of GLP-1 Analogues on Appetite Parameters, Gastric Emptying, Food Preference and Taste Among Adults with Obesity: Systematic Review of Randomized Controlled Trials. Diabetes Metab Syndr Obes. 2023 Mar 2;16:575-595. doi: 10.2147/DMSO.S387116. PMID: 36890965; PMCID: PMC9987242.


Bodnaruc, A.M., Prud’homme, D., Blanchet, R. et al. Nutritional modulation of endogenous glucagon-like peptide-1 secretion: a review. Nutr Metab (Lond) 13, 92 (2016). https://doi.org/10.1186/s12986-016-0153-3


Hruby A, Manson JE, Qi L, Malik VS, Rimm EB, Sun Q, Willett WC, Hu FB. Determinants and Consequences of Obesity. Am J Public Health. 2016 Sep;106(9):1656-62. doi: 10.2105/AJPH.2016.303326. Epub 2016 Jul 26. PMID: 27459460; PMCID: PMC4981805.


Karra E, Chandarana K, Batterham RL. The role of peptide YY in appetite regulation and obesity. J Physiol. 2009 Jan 15;587(1):19-25. doi: 10.1113/jphysiol.2008.164269. Epub 2008 Dec 8. PMID: 19064614; PMCID: PMC2670018.


Müller TD, Finan B, Bloom SR, D'Alessio D, Drucker DJ, Flatt PR, Fritsche A, Gribble F, Grill HJ, Habener JF, Holst JJ, Langhans W, Meier JJ, Nauck MA, Perez-Tilve D, Pocai A, Reimann F, Sandoval DA, Schwartz TW, Seeley RJ, Stemmer K, Tang-Christensen M, Woods SC, DiMarchi RD, Tschöp MH. Glucagon-like peptide 1 (GLP-1). Mol Metab. 2019 Dec;30:72-130. doi: 10.1016/j.molmet.2019.09.010. Epub 2019 Sep 30. PMID: 31767182; PMCID: PMC6812410.


Weiss T, Carr RD, Pal S, Yang L, Sawhney B, Boggs R, Rajpathak S, Iglay K. Real-World Adherence and Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists Therapy in Type 2 Diabetes Mellitus Patients in the United States. Patient Prefer Adherence. 2020 Nov 27;14:2337-2345. doi: 10.2147/PPA.S277676. PMID: 33273810; PMCID: PMC7708309.


Wright N, Wilson L, Smith M, Duncan B, McHugh P. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutr Diabetes. 2017 Mar 20;7(3):e256. doi: 10.1038/nutd.2017.3. PMID: 28319109; PMCID: PMC5380896.


Yaribeygi H, Jamialahmadi T, Moallem SA, Sahebkar A. Boosting GLP-1 by Natural Products. Adv Exp Med Biol. 2021;1328:513-522. doi: 10.1007/978-3-030-73234-9_36. PMID: 34981502.


Zhang F, Chen Y, Heiman M, Dimarchi R. Leptin: structure, function and biology. Vitam Horm. 2005;71:345-72. doi: 10.1016/S0083-6729(05)71012-8. PMID: 16112274.


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