No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including lowering the risk of a having a heart attack or stroke, while also silencing “food noise”.
As demand for semaglutide increases, so are claims that taking it is “cheating” at weight loss or the “easy way out”.
We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out.
Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise.
How does it work?
Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called GLP-1 for short, work better.
GLP-1 gets secreted by cells in your gut when it detects increased nutrient levels after eating. This stimulates insulin production, which lowers blood sugars.
GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating.
GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action.
Some studies have found less GLP-1 gets released after meals in adults with obesity or type 2 diabetes mellitus compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more.
GLP-1 has a very short half-life of about two minutes. So GLP-1RA medications were designed to have a very long half-life of about seven days. That’s why semaglutide is given as a weekly injection.
What can users expect? What does the research say?
Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly).
A large group of randomised controlled trials, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs.
Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections led to 6–12% greater weight loss compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up.
Weight reduction due to semaglutide also leads to a reduction in systolic and diastolic blood pressure of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in triglyceride levels (a type of blood fat) and improved physical function.
Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a 20% lower risk of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up.
Who is eligible for semaglutide?
Australia’s regulator, the Therapeutic Goods Administration (TGA), has approved semaglutide, sold as Ozempic, for treating type 2 diabetes.
However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use.
The TGA has approved Wegovy to treat obesity but it’s not currently available in Australia.
When it’s available, doctors will be able to prescribe semaglutide to treat obesity in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications.
What else do you need to do during Ozempic treatment?
Checking details of the STEP trial intervention components, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials.
Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of moderate-to-vigorous physical activity, like brisk walking, dancing and gardening each week.
STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling.
A review of obesity medication trials found people reported they needed less cognitive behaviour training to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and avoiding things that trigger eating.
But what are the side effects?
Semaglutide’s side-effects include nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain.
In one study these led to discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos.
More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions.
To reduce risk or severity of side-effects, medication doses are increased very slowly over months. Once the full dose and response are achieved, research indicates you need to take it long term.
Given this long-term commitment, and associated high out-of-pocket cost of medication, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”.
Read the other articles in The Conversation’s Ozempic series here.
Clare Collins, Laureate Professor in Nutrition and Dietetics, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Swordfish vs Tuna – Which is Healthier?
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Our Verdict
When comparing swordfish to tuna, we picked the tuna.
Why?
Today in “that which is more expensive is not necessarily the healthier”…
Considering the macros first, swordfish has more than 8x more total fat, about 9x more saturated fat, and yes, more cholesterol. On the other hand, tuna has more protein. An easy win for tuna.
In terms of vitamins, swordfish has more of vitamins A, B5, D, and E, while tuna has more of vitamins B1, B2, B3, B6, and B12. A marginal win for tuna, unless you want to weight the other vitamins more heavily, in which case, more likely a tie, or maybe even an argument for swordfish if you have a particular vitamin deficiency on that side.
When it comes to minerals, swordfish has more calcium and zinc, while tuna has more iron, magnesium, manganese, phosphorus, potassium, and selenium. A clear win for tuna.
One other thing: they’re both very rich in mercury, and while tuna is bad for that, swordfish has nearly 3x as much.
In short, both have a good spread of vitamins and minerals, and both are quite tainted with mercury, but in relative terms, there’s a clear winner even before considering the very different macros, and the winner is tuna.
Want to learn more?
You might like to read:
Farmed Fish vs Wild Caught: Important Differences
Take care!
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All In Your Head (Which Is Where It’s Supposed To Be)
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Today’s news is all about things above the neck, and mostly in the brain. From beating depression to beating cognitive decline, from mindfulness against pain to dentistry nightmares to avoid:
Transcranial ultrasound stimulation
Transcranial magnetic stimulation is one of those treatments that sounds like it’s out of a 1950s sci-fi novel, and yet, it actually works (it’s very well-evidenced against treatment-resistant depression, amongst other things). However, a weakness of it is that it’s difficult to target precisely, making modulation of most neurological disorders impossible. Using ultrasound instead of a magnetic field allows for much more finesse, with very promising initial results across a range of neurological disorders
Read in full: Transcranial ultrasound stimulation: a new frontier in non-invasive brain therapy
Related: Antidepressants: Personalization Is Key!
This may cause more pain and damage, but at least it’s more expensive too…
While socialized healthcare systems sometimes run into the problem of not wanting to spend money where it actually is needed, private healthcare systems have the opposite problem: there’s a profit incentive to upsell to more expensive treatments. Here’s how that’s played out in dentistry:
Read in full: Dentists are pulling healthy and treatable teeth to profit from implants, experts warn
Related: Tooth Remineralization: How To Heal Your Teeth Naturally
Mindfulness vs placebo, for pain
It can be difficult with some “alternative therapies” to test against placebo, for example “and control group B will merely believe that they are being pierced with needles”, etc. However, in this case, mindfulness meditation was tested as an analgesic vs sham meditation (just deep breathing) and also vs placebo analgesic cream, vs distraction (listening to an audiobook). Mindfulness meditation beat all of the other things:
Read in full: Mindfulness meditation outperforms placebo in reducing pain
Related: No-Frills, Evidence-Based Mindfulness
Getting personal with AI doctors
One of the common reasons that people reject AI doctors is the “lack of a human touch”. However, human and AI doctors may be meeting in the middle nowadays, as humans are pressed to see more patients in less time, and AI is trained to be more personal—not just a friendlier affect, but also, such things as remembering the patient’s previous encounters (again, something with which overworked human doctors sometimes struggle). This makes a big difference to patient satisfaction:
Read in full: Personalization key to patient satisfaction with AI doctors
Related: AI: The Doctor That Never Tires?
Combination brain therapy against cognitive decline
This study found that out of various combinations trialled, the best intervention against cognitive decline was a combination of 1) cognitive remediation (therapeutic interventions designed to improve cognitive functioning, like puzzles and logic problems), and 2) transcranial direct current stimulation (tDCS), a form of non-invasive direct brain stimulation, similar to the magnetic or ultrasound methods we mentioned earlier today. Here’s how it worked:
Read in full: Study reveals effective combination therapy to slow cognitive decline in older adults
Related: How To Reduce Your Alzheimer’s Risk
Take care!
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Rest For The Restless (Legs)
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Any tips for dealing with restless legs syndrome?❞
As a neurological disorder (Willis-Ekbom Disease, as it is also called
by almost nobody outside of academia), there’s a lot that’s not known about its pathology, but we do know that looking after one’s nerves can help a lot.This means:
- Avoid alcohol, as this is bad for everything, including nerves
- See also: How To Reduce Or Quit Alcohol
- Don’t smoke, as this is bad for everything, including nerves
- Do exercise those restless legs! It may sound funny, but in seriousness, movement promotes nerve health
- See also: Walking… Better.
- Take care of your blood sugars, because diabetic neuropathy can also cause this
- See also: 10 Ways To Balance Blood Sugars
- Massage your legs, and enjoy a hot bath/shower
You can also take into account the measures recommended for dealing with peripheral neuropathy, e.g:
Peripheral Neuropathy: How To Avoid It, Manage It, Treat It
There are also medication options for RLS; most of them are dopamine agonists, so if you want to try something yourself before going the pharmaceutical route, then things that improve your dopamine levels will probably be a worth checking out. In the category of supplements, you might enjoy:
NALT: The Dopamine Precursor And More
Take care! And… Want something answered here? Send us your questions!
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- Avoid alcohol, as this is bad for everything, including nerves
The Many Health Benefits Of Garlic
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The Many Health Benefits of Garlic
We’re quite confident you already know what garlic is, so we’re going to leap straight in there with some science today:
First, let’s talk about allicin
Allicin is a compound in garlic that gives most of its health benefits. A downside of allicin is that it’s not very stable, so what this means is:
- Garlic is best fresh—allicin breaks down soon after garlic is cut/crushed
- So while doing the paperwork isn’t fun, buying it as bulbs is better than buying it as granules or similar
- Allicin also breaks down somewhat in cooking, so raw garlic is best
- Our philosophy is: still use it in cooking as well; just use more!
- Supplements (capsule form etc) use typically use extracts and potency varies (from not great to actually very good)
Read more about that:
- Short-term heating reduces the anti-inflammatory effects of fresh raw garlic extracts
- Allicin Bioavailability and Bioequivalence from Garlic Supplements and Garlic Foods
Now, let’s talk benefits…
Benefits to heart health
Garlic has been found to be as effective as the drug Atenolol at reducing blood pressure:
It also lowers LDL (bad cholesterol):
Benefits to the gut
We weren’t even looking for this, but as it turns out, as an add-on to the heart benefits…
Benefits to the immune system
Whether against the common cold or bringing out the heavy guns, garlic is a booster:
- Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey
- Supplementation with aged garlic extract improves both NK and γδ-T cell function and reduces the severity of cold and flu symptoms: a randomized, double-blind, placebo-controlled nutrition intervention
Benefits to the youthfulness of body and brain
Garlic is high in antioxidants that, by virtue of reducing oxidative stress, help slow aging. This effect, combined with the cholesterol and blood pressure benefits, means it may also reduce the risk of Alzheimer’s and other forms of dementia:
- Antioxidant health effects of aged garlic extract
- Effects of garlic consumption on plasma and erythrocyte antioxidant parameters in elderly subjects
- Garlic reduces heart disease and dementia risk
There are more benefits too…
That’s all we have time to dive into study-wise today, but for the visually-inclined, here are yet more benefits to garlic (at a rate of 3–4 cloves per day):
An incredible awesome recipe using lots of garlic:
- Take small potatoes (still in their skins), cut in half
- Add enough peeled cloves of garlic so that you have perhaps a 1:10 ratio of garlic to potato by mass
- Boil (pressure-cooking is ideal) until soft, and drain
- Keeping them in the pan, add a lashing of olive oil, and any additional seasonings per your preference (consider black pepper, rosemary, thyme, parsley)
- Put a lid on the pan, and holding it closed, shake the pan vigorously
- Note: if you didn’t leave the skins on, or you chopped much larger potatoes smaller instead of cutting in half, the potatoes will break up into a rough mash now. This is actually also fine and still tastes (and honestly, looks) great, but it is different, so just be aware, so that you get the outcome you want.
- The garlic, which—unlike the potatoes—didn’t have a skin to hold it together, will now have melted over the potatoes like butter
You can serve like this (it’s delicious already) or finish up in the oven or air-fryer or under the grill, if you prefer a roasted style dish (an amazing option too).
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- Garlic is best fresh—allicin breaks down soon after garlic is cut/crushed
All In Your Head (Which Is Where It’s Supposed To Be)
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Today’s news is all about things above the neck, and mostly in the brain. From beating depression to beating cognitive decline, from mindfulness against pain to dentistry nightmares to avoid:
Transcranial ultrasound stimulation
Transcranial magnetic stimulation is one of those treatments that sounds like it’s out of a 1950s sci-fi novel, and yet, it actually works (it’s very well-evidenced against treatment-resistant depression, amongst other things). However, a weakness of it is that it’s difficult to target precisely, making modulation of most neurological disorders impossible. Using ultrasound instead of a magnetic field allows for much more finesse, with very promising initial results across a range of neurological disorders
Read in full: Transcranial ultrasound stimulation: a new frontier in non-invasive brain therapy
Related: Antidepressants: Personalization Is Key!
This may cause more pain and damage, but at least it’s more expensive too…
While socialized healthcare systems sometimes run into the problem of not wanting to spend money where it actually is needed, private healthcare systems have the opposite problem: there’s a profit incentive to upsell to more expensive treatments. Here’s how that’s played out in dentistry:
Read in full: Dentists are pulling healthy and treatable teeth to profit from implants, experts warn
Related: Tooth Remineralization: How To Heal Your Teeth Naturally
Mindfulness vs placebo, for pain
It can be difficult with some “alternative therapies” to test against placebo, for example “and control group B will merely believe that they are being pierced with needles”, etc. However, in this case, mindfulness meditation was tested as an analgesic vs sham meditation (just deep breathing) and also vs placebo analgesic cream, vs distraction (listening to an audiobook). Mindfulness meditation beat all of the other things:
Read in full: Mindfulness meditation outperforms placebo in reducing pain
Related: No-Frills, Evidence-Based Mindfulness
Getting personal with AI doctors
One of the common reasons that people reject AI doctors is the “lack of a human touch”. However, human and AI doctors may be meeting in the middle nowadays, as humans are pressed to see more patients in less time, and AI is trained to be more personal—not just a friendlier affect, but also, such things as remembering the patient’s previous encounters (again, something with which overworked human doctors sometimes struggle). This makes a big difference to patient satisfaction:
Read in full: Personalization key to patient satisfaction with AI doctors
Related: AI: The Doctor That Never Tires?
Combination brain therapy against cognitive decline
This study found that out of various combinations trialled, the best intervention against cognitive decline was a combination of 1) cognitive remediation (therapeutic interventions designed to improve cognitive functioning, like puzzles and logic problems), and 2) transcranial direct current stimulation (tDCS), a form of non-invasive direct brain stimulation, similar to the magnetic or ultrasound methods we mentioned earlier today. Here’s how it worked:
Read in full: Study reveals effective combination therapy to slow cognitive decline in older adults
Related: How To Reduce Your Alzheimer’s Risk
Take care!
Don’t Forget…
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Fixing Fascia
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Fascia: Why (And How) You Should Take Care Of Yours
Fascia is the web-like layer of connective tissue that divides your muscles and organs from each other. It simultaneously holds some stuff in place, and allows other parts to glide over each other with minimal friction.
At least, that’s what it’s supposed to do.
Like any body part, it can go wrong. More on this later. But first…
A quick note on terms
It may seem like sometimes people say “myofascial” because it sounds fancier, but it does actually have a specific meaning too:
- “Fascia” is what we just described above
- “Myofascial” means “of or relating to muscles and fascia”
For example, “myofascial release” means “stopping the fascia from sticking to the muscle where it shouldn’t” and “myofascial pain” means “pain that has to do with the muscles and fascia”. See also:
Myofascial vs Fascia: When To Use Each One? What To Consider
Why fascia is so ignored
For millennia, it was mostly disregarded as a “neither this nor that” tissue that just happens to be in the body. We didn’t pay attention to it, just like we mostly don’t pay attention to the air around us.
But, much like the air around us, we sure pay attention when something goes wrong with it!
However, even in more recent years, we’ve been held back until quite new developments like musculoskeletal ultrasound that could show us problems with the fascia.
What can go wrong
It’s supposed to be strong, thin, supple, and slippery. It holds on in the necessary places like a spiderweb, but for the most part, it is evolved for minimum friction.
Some things can cause it to thicken and become sticky in the wrong places. Things such as:
- Physical trauma, e.g. an injury or surgery—but we repeat ourselves, because a surgery is an injury! It’s a (usually) necessary injury, but an injury nonetheless.
- Compensation for pain. If a body part hurts for some reason, and your posture changes to accommodate that, doing so can mess up your fascia, and cause you different problems somewhere else entirely.
- This is not witchcraft; think of how, when using a corded vacuum cleaner, sometimes the cord can get snagged on something in the next room and we nearly break something because we expected it to just come with us and it didn’t? It’s like that.
- Repetitive movements (repetitive strain injury is partly a myofascial issue)
- Not enough movement: when it comes to range of motion, it’s “use it or lose it”.
- The human body tries its best to be as efficient as possible for us! So eventually it will go “Hey, I notice you never move more than 30º in this direction, so I’m going to stop making fascia that allows you to go past that point, and I’ll just dump the materials here instead”
“I’ll just dump the materials here instead” is also part of the problem—it creates what we colloquially call “knots”, which are not so much part of the muscle as the fascia that covers it. That’s an actual physical sticky lumpy bit.
What to do about it
Firstly, avoid the above things! But, if for whatever reason something has gone wrong and you now have sticky lumpy fascia that doesn’t let you move the way you’d like (if you have any mobility/flexibility issues that aren’t for another known reason, then this is usually it), there are things can be done:
- Heat—is definitely not a cure-all, but it’s a good first step before doing the other things. A heating pad or a warm bath are great.
- Here’s an example of a neck+back+shoulders heating pad; you can get them for different body parts, or just use an electric blanket!
- Massage—ideally, by someone else who knows what they are doing. Self-massage is possible, as is teaching oneself (there are plenty of video tutorials available), but skilled professional therapeutic myofascial release massage is the gold standard.
- Foam rollers are a great no-skill way to get going with self-massage, whether because that’s what’s available to you, or because you just want something you can do between sessions. Here’s an example of the kind we mean.
- Acupuncture—triggering localized muscular relaxation, an important part of myofascial release, is something acupuncture is good at.
- See also: Pinpointing The Usefulness Of Acupuncture ← noteworthily, the strongest criticism of acupuncture for pain relief is that it performs only slightly better than sham acupuncture, but taken in practical terms, all that really means is “sticking little needles in does work, even if not necessarily by the mechanism acupuncturists believe”
- Calisthenics—Pilates, yoga, and other forms of body movement training can help gradually get one’s fascia to where and how it’s supposed to be.
- This is that “use it or lose it” bodily efficiency we talked about!
Remember, the body is always rebuilding itself. It never stops, until you die. So on any given day, you get to choose whether it rebuilds itself a little bit worse or a little bit better.
Take care!
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