When supplies resume, should governments subsidise drugs like Ozempic for weight loss? We asked 5 experts
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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.
You’ve no doubt heard of Ozempic but have you heard of Wegovy? They’re both brand names of the drug semaglutide, which is currently in short supply worldwide.
Ozempic is a lower dose of semaglutide, and is approved and used to treat diabetes in Australia. Wegovovy is approved to treat obesity but is not yet available in Australia. Shortages of both drugs are expected to last throughout 2024.
Both drugs are expensive. But Ozempic is listed on Australia’s Pharmaceutical Benefits Schedule (PBS), so people with diabetes can get a three-week supply for A$31.60 ($7.70 for concession card holders) rather than the full price ($133.80).
Wegovy isn’t listed on the PBS to treat obesity, meaning when it becomes available, users will need to pay the full price. But should the government subsidise it?
Wegovy’s manufacturer will need to make the case for it to be added to the PBS to an independent advisory committee. The company will need to show Wegovy is a safe, clinically effective and cost-effective treatment for obesity compared to existing alternatives.
In the meantime, we asked five experts: when supplies resume, should governments subsidise drugs like Ozempic for weight loss?
Four out of five said yes
This is the last article in The Conversation’s Ozempic series. Read the other articles here.
Disclosure statements: Clare Collins is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), the Medical Research Future Fund (MRFF), the Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, the Western Australian Department of Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk (for weight management resources and an obesity advisory group), Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update, the Heart Foundation evidence reviews on meat and dietary patterns and current co-chair of the Guidelines Development Advisory Committee for Clinical Practice Guidelines for Treatment of Obesity; Emma Beckett has received funding for research or consulting from Mars Foods, Nutrition Research Australia, NHMRC, ARC, AMP Foundation, Kellogg and the University of Newcastle. She works for FOODiQ Global and is a fat woman. She is/has been a member of committees/working groups related to nutrition or food, including for the Australian Academy of Science, the NHMRC and the Nutrition Society of Australia; Jonathan Karnon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment; Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd (a medical device company) and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design and testing; Priya Sumithran has received grant funding from external organisations, including the NHMRC and MRFF. She is in the leadership group of the Obesity Collective and co-authored manuscripts with a medical writer provided by Novo Nordisk and Eli Lilly.
Fron Jackson-Webb, Deputy Editor and Senior Health Editor, The Conversation
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Gut-Healthy Tacos
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Full of prebiotics and probiotics, healthy fats, colorful salad boasting vitamins and minerals aplenty, and of course satisfying protein too, these tacos are also boasting generous flavors to keep you coming back for more…
You will need
- 24 sardines—canned is fine (if vegetarian/vegan, substitute tempeh and season generously; marinade if you have time)
- 12 small wholewheat tortillas
- 1 14oz/400g can black beans, drained
- 1 ripe avocado, stoned and cut into small chunks
- 1 red onion, thinly sliced
- 1 little gem lettuce, shredded
- 12 cherry tomatoes, halved
- 1 bulb garlic, crushed
- 1 lemon, sliced
- 4 tbsp plain unsweetened yogurt (your choice what kind, but something with a live culture is best)
- 3oz pickled jalapeños, roughly chopped
- 1oz cilantro (or substitute parsley if you have the cilantro-tastes-like-soap gene), finely chopped
- 1 tbsp extra virgin olive oil
- 2 tsp black pepper
- 1 tsp smoked paprika
- Juice of 1 lime
- Optional: Tabasco sauce, or similar hot sauce
Method
(we suggest you read everything at least once before doing anything)
1) Preheat your oven to a low temperature; 200℉ or just under 100℃ is fine
2) Place the lemon slices on top of the sardines on top of foil on a baking tray; you want the foil to be twice as much as you’d expect to need, because now you’re going to fold it over and make a sort of sealed envelope. You could use a dish with a lid yes, but this way is better because there’s going to be less air inside. Upturn the edges of the envelope slightly so that juices won’t run out, and make sure the foil is imperfectly sealed so a little steam can escape but not much at a time. This will ensure it doesn’t dry out, while also ensuring your house doesn’t smell of fish. Put all this into the oven on a middle shelf.
3) Mix the lime juice with the onion in a bowl, and add the avocado and tomatoes, mixing gently. Add half the cilantro, and set aside.
4) Put the black beans in a sieve and pour boiling water over them to refresh and slightly warm them. Tip them into a bowl and add the olive oil, black pepper, and paprika. Mix thoroughly with a fork, and no need to be gentle this time; in fact, deliberately break the beans a little in this case.
5) Mix the yogurt, jalapeños, garlic, and remaining cilantro in a small bowl.
6) Get the warmed sardines from the oven; discard the lemon slices.
7) Assemble! We recommend the order: tortilla, lettuce, fish (2 per taco), black bean mixture, salad mixture, garlic jalapeño yogurt mixture. You can also add a splash of the hot sauce per your preference, or if catering for more people, let people add their own.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- We Are Such Stuff As Fish Are Made Of
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Making Friends With Your Gut (You Can Thank Us Later)
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Enjoy Pungent Polyphenols For Your Heart & Brain
Take care!
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Lucid Dreaming – by Stephen LaBerge Ph.D.
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For any unfamiliar: lucid dreaming means being aware that one is dreaming, while dreaming, and exercising a degree of control over the dream. Superficially, this is fun. But if one really wants to go deeper into it, it can be a lot more:
Dr. Stephen LaBerge takes a science-based approach to lucid dreaming, and in this work provides not only step-by-step instructions of several ways of inducing lucid dreaming, but also, opens the reader’s mind to things that can be done there beyond the merely recreational:
In lucid dreams, he argues and illustrates, it’s possible to talk to parts of one’s own subconscious (Inception, anyone? Yes, this book came first) and get quite an amount of self-therapy done. And that hobby you wish you had more time to practice? The possibilities just became limitless. And who wouldn’t want that?
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Vaginal Probiotics: What Does The Science Say?
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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 😎
❝Is there any merit to vaginal probiotics?❞
What a fun question! First let’s break it down, as this could mean two different things:
- Probiotics, which you consume, using your mouth, which are marketed as benefiting vaginal health
- Probiotics taken as a vaginal pessary/suppository, to act directly there
The former has limited evidence for it, but generally speaking, improving one’s gut health improves all other areas of health, so it’s not surprising if it helps this too.
See for example:
Some notes:
- candidal vaginitis means a yeast infection causing vaginal inflammation
- bacterial vaginosis means a vaginal bacterial imbalance (generally also featuring vaginal inflammation, though it can be asymptomatic)
In the latter case, the “imbalance” in question is usually a shortage of Lactobacillus sp. (that is to say, the diverse species of the Lactobacillus genus) resulting in an overgrowth of other kinds of bacteria, which in turn results in changing the vaginal microbiome to make it warmer and more acidic than it should be.
While a healthy vagina shouldn’t smell of roses, it shouldn’t smell fishy either; if it does, that’s a sign of bacterial vaginosis.
What it’s supposed to be like: slightly bitter, slightly salty, distinctly umami, along with a cocktail of personal pheromones (and if menstruating or otherwise* vaginally bleeding, then of course add: iron/”metallic”). The pheromones will also reflect any hormonal changes, but should never make anything smell bad, just different.
*e.g. due to PCOS, fibroids, etc. Note that in the case of PCOS, it may also smell a little different (if it does, then usually: a little more musky), due to often different hormone levels. Again: it still shouldn’t smell bad, though, just different.
In the above-linked study, taking more live Lactobacillus acidophilus (in yogurt, eating it, with their mouths) improved levels of L. acidophilus in the vagina. While the study authors concluded “this ingestion of yogurt may have reduced episodes of bacterial vaginosis”, which is rather a weak claim, it can be argued that it merely improving the levels of L. acidophilus in the vagina was already a win.
That was a small (n=42, and only 7 followed through to completion) and old (1996) study, and it bears mentioning that most of the studies into this seem to be small and old, but conclude similarly with weakly positive statements.
However, it does make a difference what kind of Lactobacillus is used, for example in this next study…
- L. fermentum RC-14 worked well (90% success rate)
- L. rhamnosus GR-1 worked somewhat (40% success rate)
- L. rhamnosus GG did not work (0% success rate)
So, diversity is key, and getting a wide range of Lactobacillus sp. seems to be a safe bet.
Short version: enjoying probiotics as part of your diet probably improves vaginal health, just like it improves pretty much everything else.
See also: Make Friends With Your Gut (You Can Thank Us Later)
You would think that this would mean that taking probiotics as a vaginal pessary/suppository would be even better, but the results are weaker, as in this study, which produced temporary improvements in about half the study group, with only 3 out of 28 being free of bacterial vaginosis the next month:
Treatment of bacterial vaginosis with lactobacilli
This study got better results, with a 61% success rate:
Important note
Do note that this last category, involving topical treatments (i.e., manually introducing Lactobacillus sp. to the vagina) were all in cases of pre-existing bacterial vaginosis, not as a prophylactic and/or general health-improving thing.
If your vagina seems happy right now, then do not mess with its happy bacterial balance!
And at all times (regardless of whether it seems happy right now or not): do not douche (it does not need it and will not benefit from it; the vagina is self-cleaning*) as this will wash out many of your Lactobacilli and will do absolutely nothing against any Candida there (C. albicans being a rooted fungus, whereas Lactobacillus is a sausage-shaped bacterium with many tiny appendages but no actual ability to stay put), so Candida will flourish in the Lactobacillus’s absence.
*by the vagina, we are referring to the vaginal canal. The vulva—the outside part consisting of the two pairs of labia, the glans clitoris, and clitoral hood—are not self-cleaning, and should just be washed gently per your normal bath/shower routine; that’s perfectly fine and good.
And definitely don’t put any “cleansing” toiletries inside the vagina (or any toiletries at all, for that matter), even if they are sold and marketed for that purpose; they will not help and they will harm.
Also, due to their neighborliness, messing up the microbiome inside the vagina is a common way to also get Candida inside the urethra:
How To Avoid Urinary Tract Infections (UTIs)
One other option
Finally, unless you have a “very good friend” you have a pressing urge to swap germs with, you might want to leave this one to the scientists, but we share this paper just for interest:
Lastly…
Going back to oral supplementation, if you’d like to try that then check out this for further notes on what, why, how, etc:
How Much Difference Do Probiotic Supplements Make To Health?
Take care!
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Butternut Squash vs Pumpkin – Which is Healthier?
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Our Verdict
When comparing butternut squash to pumpkin, we picked the butternut squash.
Why?
Both are great! But the butternut squash manages a moderate win in most categories.
In terms of macros, butternut squash has more of everything except water. Most notably, it has more protein and more fiber. Yes, more carbs too, but the fiber content means that it also has the lower glycemic index, by quite a bit.
When it comes to vitamins, pumpkin does have a little more of vitamin B1 and a lot more of vitamin E, while butternut squash has more of vitamins B3, B5, B9, C, K, and choline. They’re about equal in the other vitamins they both contain. A fair win for butternut squash.
In the category of minerals, butternut squash has more calcium, magnesium, manganese, and selenium, while pumpkin has more copper, iron, and phosphorus. They’re about equal in potassium and zinc. A marginal win for butternut squash.
Adding up the strong win, the fair win, and the marginal win, makes for an easy overall win for butternut squash!
Want to learn more?
You might like to read:
Superfood-Stuffed Squash Recipe
Take care!
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The Lost Art of Silence – by Sarah Anderson
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From “A Room Of One’s Own” to “Silent Mondays”, from spiritual retreats to noise-cancelling headphones, this book covers the many benefits of silence—and a couple of downsides too.
In an age where most things are available at the touch of a button, a little peaceful solitude can come at quite a premium, but what it offers can effect all manner of physical changes, from reduced stress responses to increased neurogenesis (growing new brain cells).
The tone throughout is a combination of personal and pop-science, and it’s very motivating to find a little more space-between-the-things in life.
The book is best enjoyed in a quiet room.
Bottom line: if you get the feeling sometimes that you could rest and recover fully and properly if you could just find the downtime, this book will help you find exactly that.
Click here to check out the Lost Art of Silence, and find peace and strength in it!
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Dr. Greger’s Daily Dozen
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Give Us This Day Our Daily Dozen
This is Dr. Michael Greger. He’s a physician-turned-author-educator, and we’ve featured him and his work occasionally over the past year or so:
- Brain Food? The Eyes Have It! ← this is about dark leafy greens, lutein, & avoiding Alzheimer’s
- Twenty-One, No Wait, Twenty Tweaks For Better Health ← he says 21, but we say one of them is very skippable. Check it out and decide what you think!
- Dr. Greger’s Anti-Aging Eight ← his top well-evidenced interventions specifically for slowing aging
But what we’ve not covered, astonishingly, is one of the things for which he’s most famous, which is…
Dr. Greger’s Daily Dozen
Based on the research in the very information-dense tome that his his magnum opus How Not To Die (while it doesn’t confer immortality, it does help avoid the most common causes of death), Dr. Greger recommends that we take care to enjoy each of the following things per day:
Beans
- Servings: 3 per day
- Examples: ½ cup cooked beans, ¼ cup hummus
Greens
- Servings: 2 per day
- Examples: 1 cup raw, ½ cup cooked
Cruciferous vegetables
- Servings: 1 per day
- Examples: ½ cup chopped, 1 tablespoon horseradish
Other vegetables
- Servings: 2 per day
- Examples: ½ cup non-leafy vegetables
Whole grains
- Servings: 3 per day
- Examples: ½ cup hot cereal, 1 slice of bread
Berries
- Servings: 1 per day
- Examples: ½ cup fresh or frozen, ¼ cup dried
Other fruits
- Servings: 3 per day
- Examples: 1 medium fruit, ¼ cup dried fruit
Flaxseed
- Servings: 1 per day
- Examples: 1 tablespoon ground
Nuts & (other) seeds
- Servings: 1 per day
- Examples: ¼ cup nuts, 2 tablespoons nut butter
Herbs & spices
- Servings: 1 per day
- Examples: ¼ teaspoon turmeric
Hydrating drinks
- Servings: 60 oz per day
- Examples: Water, green tea, hibiscus tea
Exercise
- Servings: Once per day
- Examples: 90 minutes moderate or 40 minutes vigorous
Superficially it seems an interesting choice to, after listing 11 foods and drinks, have the 12th item as exercise but not add a 13th one of sleep—but perhaps he quite reasonably expects that people get a dose of sleep with more consistency than people get a dose of exercise. After all, exercise is mostly optional, whereas if we try to skip sleep for too long, our body will force the matter for us.
Further 10almonds notes:
- We’d consider chia superior to flax, but you do you. Flax is a fine choice also.
- We recommend trying to get each of these top 5 most health-giving spices in daily if you can.
Enjoy!
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