New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link
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The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was originally developed to help people with type 2 diabetes manage their blood sugar levels.
However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for weight loss, and hundreds of thousands of people around the world are using it for this purpose.
Evidence has also shown the drug can help manage heart failure and chronic kidney disease in people with obesity and type 2 diabetes.
Now, a study published in the New England Journal of Medicine has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked?
Osteoarthritis and obesity
Osteoarthritis is a common joint disease, affecting 2.1 million Australians. Most people with osteoarthritis have pain and find it difficult to perform common daily activities such as walking. The knee is the joint most commonly affected by osteoarthritis.
Being overweight or obese is a major risk factor for osteoarthritis in the knee. The link between the two conditions is complex. It involves a combination of increased load on the knee, metabolic factors such as high cholesterol and high blood sugar, and inflammation.
For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the development of osteoarthritis.
Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. International and Australian guidelines suggest losing as little as 5% of body weight can help.
But losing weight with just diet and exercise can be difficult for many people. One study from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten.
Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness.
Semaglutide for osteoarthritis?
The rationale for the recent study was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight.
They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight.
As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group.
The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group.
This is much greater than the pain reduction in another recent study among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale.
The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as anti-inflammatories, opioids and antidepressants.
Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test.
How could semaglutide reduce knee pain?
It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain.
But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have anti-inflammatory properties, and could even protect against cartilage wear and tear.
While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not.
The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis are prescribed opioids. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity.
It’s also important to consider semaglutide can have a range of side effects, including gastrointestinal symptoms and fatigue.
There are some concerns that semaglutide could reduce muscle mass and bone density, though we’re still learning more about this.
Further, it can be difficult to access.
I have knee osteoarthritis, what should I do?
Osteoarthritis is a disease caused by multiple factors, and it’s important to take a multifaceted approach to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of self-management. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.
Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney and Christina Abdel Shaheed, Associate Professor, School of Public Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Chocolate & Health
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Chocolate & Health: Fact or Fiction?
“Chocolate Is Good For The Heart”
“When making chocolate chip cookies, you don’t measure using cups, you measure by heart”
…but how good is chocolate when it comes to heart health?
First, what is heart health?
A healthy heart typically has a low resting pulse rate and a strong, steady beat. This is affected strongly by exercise habits, and diet plays only a support role (can’t exercise without energy from food!).
It is also important to have blood pressure within a healthy range (with high blood pressure being a more common problem than low, so things that lower blood pressure are generally considered good).
- Flavanols, flavonoids, and polyphenols in chocolate contribute to lower blood pressure
- Dark chocolate is best for these, as milk chocolate contains much less cocoa solids and more unhelpful fats
- White chocolate contains no cocoa solids and is useless for this
- Some of the fats in most commercial chocolate can contribute to atherosclerosis which raises blood pressure and ultimately can cause heart attacks.
- If you’re diabetic, you will probably not get the usual heart-related benefits from chocolate (sorry)
The Verdict: dark chocolate, in moderation, can support good heart health.
“Chocolate Is Good For The Brain”
Chocolate has been considered a “brain food”… why?
- The brain uses more calories than any other organ (chocolate has many calories)
- The heart benefits we listed above mean improved blood flow—including to your brain
- Chocolate contains phenylethylamine, a powerful chemical that has a similar effect to amphetamines… But it’s metabolized in digestion and never makes it to the central nervous system (so basically, this one’s a miss; we had a good run with the other two, though!)
The Verdict: dark chocolate, in moderation, can support good brain health
“Chocolate Is An Aphrodisiac”
“If chocolate be the food of love, pass me that cocoa; I’m starving”
Most excitingly, chocolate contains phenylethylamine, the “molecule of love” or, more accurately, lust. It has an effect similar to amphetamines, and while we can synthesize it in the body, we can also get it from certain foods. But…
Our body is so keen to get it that most of it is metabolized directly during digestion and doesn’t make it to the brain. Also, chocolate is not as good a source as cabbage—do with that information what you will!
However!
Chocolate contains theobromine and small amounts of caffeine, both stimulants and both generally likely to improve mood; it also contains flavonoids which in turn stimulate production of nitric oxide, which is a relaxant. All in all, things that are convivial to having a good time.
On the other hand…
That relaxation comes specifically with a reduction in blood pressure—something typically considered good for the health for most people most of the time… but that means lowering blood pressure in all parts of your body, which could be the opposite of what you want in intimate moments.
Chocolate also contains zinc, which is essential for hormonal health for most people—the body uses it to produce testosterone and estrogen, respectively. Zinc supplements are popularly sold to those wishing to have more energy in general and good hormonal health in particular, and rightly so. However…
This approach requires long-term supplementation—you can’t just pop a zinc tablet / bar of chocolate / almond before bed and expect immediate results. And if your daily zinc supplementation takes the form of a 3.5oz (100g) bar of chocolate, then you may find it has more effects on your health, and not all of them good!
The Verdict: dark chocolate, in moderation, may promote “the mood”, but could be a double-edged sword when it comes to “the ability”.
“Chocolate Is Good During Menstruation”
The popular wisdom goes that chocolate is rich in iron (of which more is needed during menstruation), and indeed, if you eat 7oz (150g) of dark chocolate made with 85% cocoa, you’ll get a daily a dose of iron (…and nearly 1,000 calories).
More bang-for-buck dietary sources of iron include chickpeas and broccoli, but for some mysterious reason, these are not as commonly reported as popular cravings.
The real explanation for chocolate cravings is more likely that eating chocolate—a food high in sugar and fat along with a chemical bombardment of more specialized “hey, it’s OK, you can relax now” molecules (flavanols/flavonoids, polyphenols, phenylamines, even phenylethylamine, etc) gives a simultaneous dopamine kick (the body’s main “reward” chemical) with a whole-body physiological relaxation… so, little wonder we might crave it in times of stress and discomfort!
The Verdict: it helps, not because it serves a special nutritional purpose, but rather, because the experience of eating chocolate makes us feel good.
Fun fact: Tiramisu (this writer’s favorite dessert) is literally Italian for “pick-me-up”
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Blackberries vs Blueberries – Which is Healthier?
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Our Verdict
When comparing blackberries to blueberries, we picked the blackberries.
Why?
They’re both great! But the humble blackberry stands out (and is an example of “foods that are darker are often more nutrient-dense”).
In terms of macronutrients, they’re quite similar, being both berry fruits that are mostly water, but blackberries do have 2x the fiber (and for what it’s worth, 2x the protein, though this is a small number obviously), while blueberries have 2x the carbohydrates. An easy win for blackberries.
When it comes to vitamins, blackberries have notably more of vitamin A, B3, B5, B9, C, and E, as well as choline, while blueberries have a little more of vitamins B1, B2, and B6. A fair win for blackberries.
In the category of minerals, blackberries have a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Blueberries are not higher in any minerals. Another easy win for blackberries.
Blueberries are famous for their antioxidants, but blackberries actually equal them. The polyphenolic content varies from one fruit to another, but they are both loaded with an abundance (thousands) of antioxidants, especially anthocyanins. Blackberries and blueberries tie in this category.
Adding up the sections makes for an easy, easy win for blackberries—but diversity is always best, so enjoy both!
Want to learn more?
You might like to read:
- Cherries vs Blueberries – Which is Healthier?
- Strawberries vs Cherries – Which is Healthier?
- Strawberries vs Raspberries – Which is Healthier?
- Goji Berries vs Blueberries – Which is Healthier?
Take care!
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Scarcity Brain – by Michael Easter
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After a brief overview of theevolutionary psychology underpinnings of the scarcity brain, the author grounds the rest of this book firmly in the present. He explains how the scarcity loop hooks us and why we crave more, and what factors can increase or lessen its hold over us.
As for what things we are wired to consider “potentially scarce any time now” no matter how saturated we are in them, he looks at an array of categories, each with their nuances. From the obvious such as “food” and “stuff“, to understandable “information” and “happiness“, to abstractions like “influence“, he goes to many sources—experts of various kinds from around the world—to explore how we can know “how much is enough”, and—which can be harder—act accordingly.
The key, he argues, is not in simply wanting less, but in understanding why we crave more in the first place, get rid of our worst habits, and use what we already have, better.
Bottom line: if you feel a gnawing sense of needing more “to be on the safe side”, this book can help you to be a little more strategic (and at the same time, less stressed!) about that.
Click here to check out Scarcity Brain, and manage yours more mindfully!
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Self-Compassion In A Relationship (Positives & Pitfalls)
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Practise Self-Compassion In Your Relationship (But Watch Out!)
Let’s make clear up-front: this is not about “…but not too much”.
With that in mind…
Now let’s set the scene: you, a happily-partnered person, have inadvertently erred and upset your partner. They may or may not have already forgiven you, but you are still angry at yourself.
Likely next steps include all or any of:
- continuing to apologise and try to explain
- self-deprecatory diatribes
- self-flagellation, probably not literally but in the sense of “I don’t deserve…” and acting on that feeling
- self-removal, because you don’t want to further inflict your bad self on your partner
As you might guess, these are quite varied in their degree of healthiness:
- apologising is good, as even is explaining, but once it’s done, it’s done; let it go
- self-deprecation is pretty much never useful, let alone healthy
- self-flagellation likewise; it is not only inherently self-destructive, but will likely create an additional problem for your partner too
- self-removal can be good or bad depending on the manner of that removal: there’s a difference between just going cold and distant on your partner, and saying “I’m sorry; this is my fault not yours, I don’t want to take it out on you, so please give me half an hour by myself to regain my composure, and I will come back with love then if that’s ok with you”
About that last: mentioning the specific timeframe e.g. “half an hour” is critical, by the way—don’t leave your partner hanging! And then do also follow through on that; come back with love after the half-hour elapses. We suggest mindfulness meditation in the interim (here’s our guide to how), if you’re not sure what to do to get you there.
To Err Is Human; To Forgive, Healthy (Here’s How To Do It) ← this goes for when the forgiveness in question is for yourself, too—and we do write about that there (and how)!
This is important, by the way; not forgiving yourself can cause more serious issues down the line:
If, by the way, you’re hand-wringing over “but was my apology good enough really, or should I…” then here is how to do it. Basically, do this, and then draw a line under it and consider it done:
The Apology Checklist ← you’ll want to keep a copy of this, perhaps in the notes app on your phone, or a screenshot if you prefer
(the checklist is at the bottom of that page)
The catch
It’s you, you’re the catch 👈👈😎
Ok, that being said, there is actually a catch in the less cheery sense of the word, and it is:
“It is important to be compassionate about one’s occasional failings in a relationship” does not mean “It is healthy to be neglectful of one’s partner’s emotional needs; that’s self-care, looking after #1; let them take care of themself too”
…because that’s simply not being a couple at all.
Think about it this way: the famous airline advice,
“Put on your own oxygen mask before helping others with theirs”
…does not mean “Put on your own oxygen mask and then watch those kids suffocate; it’s everyone for themself”
So, the same goes in relationships too. And, as ever, we have science for this. There was a recent (2024) study, involving hundreds of heterosexual couples aged 18–73, which looked at two things, each measured with a scaled questionnaire:
- Subjective levels of self-compassion
- Subjective levels of relationship satisfaction
For example, questions included asking participants to rate, from 1–5 depending on how much they felt the statements described them, e.g:
In my relationship with my partner, I:
- treat myself kindly when I experience sorrow and suffering.
- accept my faults and weaknesses.
- try to see my mistakes as part of human nature.
- see difficulties as part of every relationship that everyone goes through once.
- try to get a balanced view of the situation when something unpleasant happens.
- try to keep my feelings in balance when something upsets me.
Note: that’s not multiple choice! It’s asking participants to rate each response as applicable or not to them, on a scale of 1–5.
And…
❝Women’s self-compassion was also positively linked with men’s total relationship satisfaction. Thus, men seem to experience overall satisfaction with the relationship when their female partner is self-kind and self-caring in difficult situations.
Unexpectedly, however, we found that men’s relationship-specific self-compassion was negatively associated with women’s fulfillment.
Baker and McNulty (2011) reported that, only for men, a Self-Compassion x Conscientiousness interaction explained whether the positive effects of self-compassion on the relationship emerged, but such an interaction was not found for women.
Highly self-compassionate men who were low in conscientiousness were less motivated than others to remedy interpersonal mistakes in their romantic relationships, and this tendency was in turn related to lower relationship satisfaction❞
~ Dr. Astrid Schütz et al. (2024)
And if you’d like to read the cited older paper from 2011, here it is:
Read in full: Self-compassion and relationship maintenance: the moderating roles of conscientiousness and gender
The take-away here is not: “men should not practice self-compassion”
(rather, they absolutely should)
The take-away is: we must each take responsibility for managing our own mood as best we are able; practice self-forgiveness where applicable and forgive our partner where applicable (and communicate that!)…. And then go consciously back to the mutual care on which the relationship is hopefully founded.
Which doesn’t just mean love-bombing, by the way, it also means listening:
The Problem With Active Listening (And How To Do Better)
To close… We say this often, but we mean it every time: take care!
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What you need to know about the new weight loss drug Zepbound
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In a recent poll, KFF found that nearly half of U.S. adults were interested in taking a weight management drug like the increasingly popular Ozempic, Wegovy, and Mounjaro.
“I can understand why there would be widespread interest in these medications,” says Dr. Alyssa Lampe Dominguez, an endocrinologist and clinical assistant professor at the University of Southern California. “Obesity is a chronic disease that is very difficult to treat. And a lot of the medications that we previously used weren’t as effective.”
Now, there’s a new option available: In November 2023, the FDA approved Zepbound, another weight management medication, developed by the pharmaceutical company Eli Lilly. Zepbound is different from other drugs in many ways, including the fact that it’s proven to be the most effective option so far.
Keep reading to find out more about Zepbound, including who can take it, its side effects, and more.
What is Zepbound?
Zepbound, one of the brand names for tirzepatide, is an injectable drug with a maximum dosage of 15 mg per week. It’s based on incretin, a hormone that’s naturally released in the gut after a meal. (Mounjaro is another brand name for tirzepatide.)
Tirzepatide is considered a dual agonist because it activates the two primary incretin hormones: the glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP) hormones.
According to Dr. Katherine H. Saunders, an obesity medicine physician at Weill Cornell Medicine and co-founder of Intellihealth, tirzepatide is involved with several processes that regulate blood sugar, slow the removal of food from the stomach, and affect brain areas involved in appetite.
This means that people taking the medication feel less hungry and get fuller faster, leading to less food intake and, ultimately, weight loss.
How is Zepbound different from Ozempic?
The medications are different in many ways. Ozempic and Wegovy, which are both brand names for semaglutide, only target the GLP-1 hormone. Studies have shown that Zepbound can lead to a higher percentage of total body weight loss than semaglutide medications. In addition to being more effective, there is some evidence that Zepbound is overall more tolerable than Ozempic or Wegovy.
“I have seen overall lower rates in severity of side effects with the tirzepatide medications. Mounjaro [tirzepatide] in particular is the one that I’ve used up until this point, but there’s a thought that the GIP component of the medication actually decreases nausea,” adds Lampe Dominguez. “Anecdotally, patients that I have switched from semaglutide or Ozempic to Mounjaro say that they have less side effects with Mounjaro.”
How is Zepbound different from Mounjaro?
Zepbound and Mounjaro are the same medication—tirzepatide—but they’re approved for different conditions. Zepbound is FDA-approved for weight loss, while Mounjaro is approved for type 2 diabetes. (However, Mounjaro is also at times prescribed off-label for weight loss.)
What are some of Zepbound’s side effects?
According to the FDA, side effects include nausea, vomiting, diarrhea, constipation, stomach discomfort and pain, fatigue, and burping. See a more comprehensive list of side effects here.
Who can take Zepbound?
Zepbound is FDA-approved for adults with obesity (a BMI of 30 or greater) or who have a BMI of 27 or greater with at least one weight-related condition, like high blood pressure, type 2 diabetes, or high cholesterol.
“I tend to advise patients who don’t meet those criteria to not take these medications because we really don’t know what the risks are,” says Lampe Dominguez, adding that people with lower BMI weren’t included in the medication’s studies. “We don’t know if there are specific risks to using this medication at a lower body mass index [or] if there might be some negative outcomes.”
Both doctors agree that it’s important for people who are interested in starting any weight loss medication to talk to their doctors about the potential risks and benefits. For instance, the FDA notes that Zepbound has caused thyroid tumors in rats, and while it’s unknown if this could also happen to humans, the agency said the medication shouldn’t be used in patients with a personal or family history of medullary thyroid cancer.
“Zepbound is a powerful medication that can lead to severe side effects, vitamin deficiencies, a complete lack of appetite, or too much weight loss if prescribed without the appropriate personalization, education, and close monitoring,” says Saunders.
“With all of these medications, and particularly with Zepbound, we would want to make sure that [patients] don’t have a family history of a specific type of thyroid cancer called medullary thyroid cancer,” says Lampe Dominguez.
How long should people take Zepbound for?
“Anti-obesity medications like Zepbound are not meant for short-term weight loss, but long-term treatment of obesity, which is a chronic disease,” explains Saunders. “We prepare our patients to be on the medication (or some type of medical obesity treatment) long term for their chronic disease, which is only controlled for the duration of time they’re being treated.”
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Break the Cycle – by Dr. Mariel Buqué
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Intergenerational trauma comes in two main varieties: epigenetic, and behavioral.
This book covers both. There’s a lot more we can do about the behavioral side than the epigenetic, but that’s not to say that Dr. Buqué doesn’t have useful input in the latter kind too.
If you’ve read other books on epigenetic trauma, then there’s nothing new here—though the refresher is always welcome.
On the behavioral side, Dr. Buqué gives a strong focus on practical techniques, such as specific methods of journaling to isolate trauma-generated beliefs and resultant behaviors, with a view to creating one’s own trauma-informed care, cutting through the cycle, and stopping it there.
Which, of course, will not only be better for you, but also for anyone who will be affected by how you are (e.g. now/soon, hopefully better).
As a bonus, if you see the mistakes your parents made and are pretty sure you didn’t pass them on, this book can help you troubleshoot for things you missed, and also to improve your relationship with your own childhood.
Bottom line: if you lament how things were, and do wish/hope to do better in terms of mental health for yourself now and generations down the line, this book is a great starting point.
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