A major new study examined the effects of Ozempic and other GLP-1 drugs on over two million veterans, revealing significant benefits including reduced risks of neurocognitive disorders, addiction, and suicidal ideation, but also highlighting potential adverse effects on the pancreas and kidneys. The study, published in Nature, found widespread positive associations for at least 42 conditions. While gastrointestinal issues are known side effects, the impact on the pancreas and kidneys is a new concern. Experts emphasize the need for informed discussions with healthcare providers to weigh the potential benefits and risks before initiating GLP-1 medication. The increased use of these drugs is anticipated due to their effectiveness in weight loss and overall health improvement.

Future Implications

Introduction:

This document summarizes the main findings from recent reports and a major study concerning the use of Glucagon-like peptide-1 receptor (GLP-1) agonists, primarily focusing on Ozempic and similar medications. These drugs, initially developed for type 2 diabetes and obesity, are now showing a wide range of unexpected effects, both positive and negative.

Key Themes and Findings:

1. Widespread Use and Growing Popularity:

• The text states that “One in eight adults in the U.S. has taken Ozempic or another type of GLP-1 drug.” This highlights the rapid adoption of these medications.
• There is a mention of “Ozempic ‘microdosing’ is the new weight-loss trend,” suggesting innovative and possibly unapproved ways people are using these drugs.

• The expectation is that GLP-1 drug use will likely continue to increase given their effectiveness in weight loss and health improvements.

1. Broad Spectrum of Health Benefits:

• A significant study published in Nature, involving over two million veterans, identified a wide range of benefits associated with GLP-1 agonists.
• These benefits included:
• Reduced risk of neurocognitive disorders: “Reduced risks of neurocognitive disorders like Alzheimer’s and dementia,”
• Reduced risk of seizures.
• Reduced addiction tendencies: “addiction to harmful substances such as alcohol, cannabis, stimulants and opioids.”
• Improved mental health: “lower risks of suicidal ideation, self-harm, bulimia and psychotic disorders such as schizophrenia.”
• According to lead study author Ziyad Al-Aly, “GLP-1s have many benefits for at least 42 conditions beyond weight loss – from addiction disorders to memory/cognition problems, blood clots, and infections.”

1. Mechanisms of Action (Proposed):

• The beneficial effects are possibly due to the way GLP-1 agonists work on brain receptors. As Al-Aly explained, “Ozempic and other GLP-1 drugs act on receptors in the brain that are involved in impulse control, reward and addiction,” which could explain the reduced cravings.
• Additionally, these drugs “reduce inflammation in the brain and result in weight loss; both of these factors may improve brain health,” contributing to cognitive benefits and reducing the risk of conditions like Alzheimer’s and dementia.

1. Potential Adverse Effects and Risks:

• While there are many benefits, the study also revealed several potential adverse effects:
• Gastrointestinal issues: including nausea, vomiting, diarrhea, and in rare cases, “paralysis of the stomach.” This was largely known before the study.
• Negative effects on the pancreas: “they can negatively affect the pancreas” and increase the risk of “pancreatitis (inflammation of the pancreas).”
• Kidney problems: The study also linked these drugs to “Kidney problems”. It is noted that “Kidney problems can occur without symptoms until the condition is at an advanced stage with limited treatment options.”
• Increased risk of arthritis: They were also linked to a “higher chance of developing arthritis.”

1. The Importance of Medical Supervision:

• The study’s authors and experts emphasize that while the benefits are significant, “physicians must be vigilant for signs of pancreatitis (inflammation of the pancreas) and monitor kidney function among people taking GLP-1RA medications.”
• Dr. Seth Kipnis notes that “GI problems and renal problems will always be seen if people are not eating correctly and maintaining hydration…If you take these medications without nutritional education, they can be harmful.”
• Al-Aly also recommends that people “should use the information to discuss with their provider whether GLP-1 is the right medication for them,” acknowledging that “a person with a lot of GI issues may find these meds intolerable.”

1. Impact on Obesity and Associated Conditions:

• The text highlights that weight loss is a primary benefit of GLP-1 agonists, and “decreased obesity has long been linked with less inflammation in every body system.”
• Dr. Kipnis believes that “This new class of drug, as it lowers obesity, has the potential to lower the use of every other drug that is used to treat obesity-related conditions.”

1. The Role of Nutrition Education:

• Dr. Kipnis stresses that these medications can be harmful if not taken properly. He notes “doctors with weight management programs and nutrition education programs would likely have better outcomes and fewer side effects,” emphasizing that proper nutritional education is key when using these medications.

1. Manufacturer Response:

• Novo Nordisk, the maker of Ozempic and Wegovy, stated that “Semaglutide has helped millions of people fight chronic diseases such as type 2 diabetes, cardiovascular disease and obesity,” and that “Patient safety is of utmost importance to Novo Nordisk.”
• They affirmed that they are actively exploring the “potential of semaglutide in several other disease states.”

Limitations of the Study:

• The study was a “discovery approach involving more than two million people and is not a randomized trial,” which means the findings are not as definitive as they would be with a randomized control trial.

Conclusion:

GLP-1 agonists like Ozempic and Wegovy hold significant promise for treating a wide range of conditions beyond just diabetes and obesity, with potential benefits extending to cognitive health, addiction, and mental well-being. However, they are not without risks, including gastrointestinal issues, potential harm to the pancreas and kidneys, and the possibility of arthritis. Careful medical supervision, nutritional education, and informed patient decision-making are crucial for safely maximizing the potential benefits of these drugs. The need for these drugs should be thoroughly evaluated based on each individual’s health profile.

This briefing document will be updated as new information and studies become available.

FAQ: Ozempic and GLP-1 Agonists

• What are GLP-1 agonists like Ozempic and what are they typically prescribed for?
• GLP-1 (Glucagon-like peptide-1) agonists, such as Ozempic (semaglutide) and others like liraglutide, are medications primarily prescribed to treat type 2 diabetes and obesity. They work by mimicking a natural hormone in the body, which helps to regulate blood sugar and appetite. These drugs are not only used to manage blood glucose levels in diabetic patients but also to reduce body weight in both diabetic and obese individuals. Ozempic is specifically approved for type 2 diabetes and reducing cardiovascular risk. Wegovy, another semaglutide medication by the same company, is approved for weight management and cardiovascular risk reduction.
• Beyond diabetes and obesity, what other health benefits have been linked to GLP-1 drugs?
• Recent studies, including one involving over two million veterans, have shown that GLP-1 agonists have a wide range of potential benefits extending beyond their primary uses. These include reduced risks of neurocognitive disorders like Alzheimer’s disease and dementia, as well as decreased risks of seizures, addiction to harmful substances (alcohol, cannabis, stimulants, and opioids), suicidal ideation, self-harm, bulimia, and psychotic disorders like schizophrenia. Additionally, these medications appear to have a broad benefit across at least 42 conditions beyond weight loss, from addiction disorders to memory and cognitive issues, blood clots, and infections. These benefits are thought to be linked to the drugs’ ability to impact the brain’s reward and impulse control centers, as well as reducing inflammation and promoting weight loss.
• What are the known and newly identified side effects of taking GLP-1 agonists?
• The known side effects of GLP-1 agonists primarily involve the gastrointestinal system, including nausea, vomiting, diarrhea, and, in rare cases, paralysis of the stomach. A significant new finding from recent research is that these drugs can also negatively impact the pancreas and kidneys. There is also an association with an increased risk of developing arthritis. While these adverse effects are not common, they can be serious. Patients on GLP-1 agonists should be closely monitored for signs of pancreatitis and their kidney function should be assessed regularly as kidney problems may not be symptomatic until an advanced stage.
• How do GLP-1 agonists affect the brain, and how might this explain their broad benefits?
• GLP-1 agonists act on receptors in the brain that are involved in impulse control, reward, and addiction. This mechanism is thought to contribute to their effectiveness in reducing cravings for food and addictive substances. Furthermore, these drugs can reduce inflammation in the brain, and this, combined with weight loss, may explain the reduced risk of neurocognitive conditions like Alzheimer’s and dementia. These effects show that the impact of GLP-1 medications is not solely confined to the gastrointestinal tract or metabolism but has broader effects on brain function and general health.
• What are some important factors to consider before starting a GLP-1 agonist medication?
• It is essential that individuals discuss their full health profile with a healthcare provider before starting GLP-1 medications. People with significant gastrointestinal issues may find these drugs difficult to tolerate. However, individuals attempting to lose weight and quit smoking or drinking could see substantial benefits from GLP-1s. Because these drugs have potential serious, though uncommon, side effects like pancreatitis and kidney issues, medical supervision is essential for the safe use of these medications. The benefit vs. risk profile of GLP-1s should always be determined on a case-by-case basis in discussion with a doctor.
• What role does nutrition education play in the effectiveness and safety of GLP-1 medications?
• Nutrition education is essential for patients taking GLP-1 agonists. The benefits from these drugs will be most effective when used in conjunction with a good diet, and nutritional education will help to minimize potential side effects. The gastrointestinal and kidney-related side effects of these drugs can be exacerbated if people are not eating correctly and maintaining hydration, indicating that using these medications effectively is directly correlated to patient education. Medical professionals who are trained in nutrition management are better equipped to prescribe and monitor patient care for those using these medications.
• How does the reduction of obesity potentially relate to the various health benefits seen from using GLP-1 agonists?
• The reduction of obesity that typically occurs with GLP-1 agonists is strongly linked to many of the other health benefits seen in studies. Decreased obesity is known to reduce overall inflammation throughout the body, which can help improve various body systems. Since obesity is a risk factor for a wide range of health problems, including heart disease, diabetes, and arthritis, GLP-1 agonists’ ability to lower obesity has the potential to decrease the use of other medications that are typically used to treat obesity-related conditions. Weight loss is also known to have positive effects on the mental state of patients, with those losing weight often reporting a better sense of empowerment and happiness.
• Given the potential benefits and risks of GLP-1 drugs, what is the likely future trend in their usage?
• Given the effectiveness of GLP-1 agonists in causing weight loss and improving numerous other health conditions, it is likely that their usage will increase significantly. However, because of the risks that are also associated with these medications, particularly around the pancreas, kidneys, and gastrointestinal systems, it will be important for healthcare providers to carefully evaluate individual patients to determine the best course of treatment. Additionally, it is important to remember that these medications should be used as part of an overall health management plan, and not as a standalone solution. Furthermore, more medical professionals will likely require training in weight management and nutritional education programs in order to better monitor and treat patients on these medications.