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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Hearty Healthy Ragù
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Ragù is a traditional Italian meaty sauce with tomato, and is the base for a number of other Italian dishes. It can be enjoyed as-is, or with very minor modifications can be turned into a Bolognese sauce or a lasagna filling or various other things. Our variations from tradition are mainly twofold here: we’re using nutrition-packed lentils instead of meat (but with a couple of twists that make them meatier), and we’re not using wine.
Traditionally, red wine is used in a ragù (white wine if you want to make it into a Bolognese sauce, by the way), but with all we’re doing it’s not necessary. If you want to add a splash of wine, we’re not going to call that a healthy ingredient, but we’re also not the boss of you
You will need
- 1 large onion (or equivalent small ones), chopped roughly
- 1 bulb garlic (or to your heart’s content), chopped finely or crushed
- 4 large tomatoes, chopped (or 2 cans chopped tomatoes)
- 1 tube (usually about 7 oz) tomato purée
- 1 cup brown lentils (green lentils will do if you can’t get brown)
- 1 tbsp chia seeds
- 1 tbsp black pepper, cracked or coarse ground
- 1 bunch fresh basil, finely chopped (or 1 tbsp, freeze-dried)
- 1 bunch fresh oregano, finely chopped (or 1 tbsp, freeze-dried)
- 1 tbsp nutritional yeast (failing that, 1 tbsp yeast extract, yes, even if you don’t like it, we promise it won’t taste like it once it’s done; it just makes the dish meatier in taste and also adds vitamin B12)
- 1 tsp cumin, ground (note that this one was tsp, not tbsp like the others)
- 1 tsp MSG, or 2 tsp low-sodium salt
- 4 cups water
- Olive oil for frying (ideally Extra Virgin, but so long as it’s at least marked virgin olive oil and not cut with other oils, that’s fine)
- Parsley, chopped, to garnish
Method
(we suggest you read everything at least once before doing anything)
1) Put the lentils in a small saucepan, or if you have one, a rice cooker (the rice cooker is better; works better and requires less attention), adding the chia seeds, MSG or low sodium salt, and nutritional yeast (or yeast extract). as well as the cumin. Add 4 cups boiling water and turn on the heat to cook them. This will probably take about 15–20 minutes; you want the lentils to be soft; a tiny bit past al dente, but not so far as mushy.
2) Fry the onion in some olive oil in a big pan (everything is going in here eventually if the pan is big enough; if it isn’t, you’ll need to transfer to a bigger pan in a bit). Once they’re nearly done, throw in the garlic too. If the lentils aren’t done yet, take the onions and garlic off the heat while you wait. After a few times of doing this recipe, you’ll be doing everything like clockwork and it’ll all align perfectly.
3) Drain the lentils (if all the water wasn’t absorbed; again, after doing it a few times, you’ll just use the right amount of water for your apparatus) but don’t rinse them (remember you put seasonings in here!), and add them to the pan with the onions and garlic; add a splash more olive oil if necessary, and stir until all the would-be-excess fat is absorbed into the lentils.
Note: the excess fat to be absorbed by the lentils was a feature not a bug; we wanted a little fat in the lentils! Makes the dish meatier and tastier, as well as more nutrient-dense.
4) add the tomatoes and tomato purée, stirring them in thoroughly; add the basil and oregano too and stir those in as well. Set it on a low heat for at least 10–15 minutes, stirring occasionally to let the flavors blend.
(if you happen to be serving pasta with it, then the time it takes to boil water and cook the pasta is a good time for the flavors to do their thing)
5) take it off the heat, and add the parsley garnish. It’s done!
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- What Is The Mediterranean Diet, Anyway?
- Four Ways To Upgrade The Mediterranean
- Eat More (Of This) For Lower Blood Pressure ← one more reason for the brown lentils today
- Chia: The Tiniest Seeds With The Most Value
- Black Pepper’s Impressive Anti-Cancer Arsenal
- The Many Health Benefits of Garlic
- Olive Oil: Is “Extra Virgin” Worth It?
Take care!
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Beetroot vs Pumpkin – Which is Healthier?
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Our Verdict
When comparing beetroot to pumpkin, we picked the beetroot.
Why?
It was close! And an argument could be made for either.
In terms of macros, beetroot has about 3x more protein and about 3x more fiber, as well as about 2x more carbs, making it the “more food per food” option. While both have a low glycemic index, we picked the beetroot here for its better numbers overall.
In the category of vitamins, beetroot has more of vitamins B6 and B9, while pumpkin has more of vitamins A, B2, B3, B5, E, and K. So, a fair win for pumpkin this time.
When it comes to minerals, though, beetroot has more calcium, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while pumpkin has a tiny bit more copper. An easy win for beetroot here.
In short, both are great, and although pumpkin shines in the vitamin category, beetroot wins on overall nutritional density.
Want to learn more?
You might like to read:
No, beetroot isn’t vegetable Viagra. But here’s what it can do
Take care!
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Blood and Water
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Q&A with the 10almonds Team
Q: I really loved the information about macular degeneration! I was wondering if you have any other advice about looking after eye health?
A: We may well do a full feature on it sometime! Meanwhile, some top tips include:
- Eat your greens (as you know from this last Tuesday’s edition of 10almonds)!
- Exercise! Generally. We’re not talking about eye exercises here, we’re talking about exercises that will support:
- Healthy heart rate
- Healthy blood pressure
- Healthy blood oxygenation
- Healthy blood sugar levels
- Healthy blood flow in general (so keep hydrated too! There’s a reason phlebotomists ask you to be well-hydrated before they take blood)
Eye health is a good indicator for a lot of other things, and that’s because whether or not the eyes are the window to your soul, they’re definitely the window to what your blood’s like, and that affects (and is affected by) so many other things.
- On that note, don’t smoke!
- Protect your eyes physically, too. This means:
- UV-blocking sunglasses when appropriate
- Protective eye-wear when appropriate
You think safety glasses are for laboratories and construction sites, then you go and do comparable tasks in your home? Your eyes are just as damageable in your kitchen or garden as they would be in a lab or workshop.
Some bits and bobs that can help:
- Safety sunglasses! Because a thing can do two jobs (useful in the garden now the days are brightening up!)
- Pulse oximeter! Check your own heart rate, pulse strength, and blood oxygenation at home!
- Blood pressure monitor! Because it’s so important for a lot of things and you really should have one.
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Which Plant Milk?
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Plant-based milks—what’s best?
You asked us to look at some popular plant milks and their health properties, and we said we’d do a main feature, so here it is!
We’ll also give a quick nod to environmental considerations at the end too (they might not be quite what you expect!). That said, as a health and productivity newsletter, we’ll be focusing on the health benefits.
While we can give a broad overview, please note that individual brands may vary, especially in two important ways:
- Pro: many (most?) brands of plant milks fortify their products with extra vitamins and minerals, especially vitamin D and calcium.
- Con: some brands also add sugar.
So, by all means use this guide to learn about the different plants’ properties, and/but still do check labels later.
Alternatively, consider making your own!
- Pros: no added sugar + cheaper
- Cons: no added vitamins and minerals + some equipment required
Almond milk
Almond milk is low in carbs and thus good for a carb-controlled diet. It’s also high in vitamin E and a collection of minerals.
Oat milk
Oats are one of the healthiest “staple foods” around, and while drinking oat milk doesn’t convey all the benefits, it does a lot. It also has one of the highest soluble fiber contents of any milk, which is good for reducing LDL (bad) cholesterol levels.
See for example: Consumption of oat milk for 5 weeks lowers serum cholesterol and LDL cholesterol in free-living men with moderate hypercholesterolemia
Coconut milk
Coconut has a higher fat content than most plant milks, but also contains medium-chain triglycerides (MCTs). These raise HDL (good) cholesterol levels.
Read the study: How well do plant based alternatives fare nutritionally compared to cow’s milk?
Hemp milk
Being made from hemp seeds that contain a lot of protein and healthy fats (including omega-3 and omega-6), hemp milk packs a nutritious punch. It’s carb-free. It’s also THC-free, in case you were wondering, which means no, it does not have psychoactive effects.
Pea milk
It’s very high in protein, and contains an array of vitamins and minerals. It’s not very popular yet, so there isn’t as much research about it. This 2021 study found that it had the nutritional profile the closest to cow’s milk (beating soy by a narrow margin) and praised it as a good alternative for those with a soy allergy.
This is Research Review Monday so we try to stick to pure science, but for your interest… here’s an interesting pop-science article (ostensibly in affiliation with the pea milk brand, Ripple) about the nutritional qualities of their pea milk specifically, which uses particularly nutrient-dense yellow peas, plus some extra vitamin and mineral fortifications:
Read: Ripple Milk: 6 Reasons Why You Should Try Pea Milk
Soy milk
Perhaps the most popular plant milk, and certainly usually the cheapest in stores. It’s high in protein, similar to cow’s milk. In fact, nutritionally, it’s one of the closest to cow’s milk without involving cows as a middleman. (Did you know three quarters of all soy in the world is grown to feed to livestock, not humans? Now you do).
And no, gentlemen-readers, it won’t have any feminizing effects. The human body can’t use the plant estrogens in soy for that. It does give some isoflavone benefits though, which are broadly good for everyone’s health. See for example this research review with 439 sources of its own:
Read: Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature
Quick note on flavor: nut milks have the flavor of the nut they were made from. Coconut milk tastes of coconut. The other milks listed above don’t have much of a flavor—which in many cases may be what you want.
Note on environmental considerations:
A lot of us try to be as socially responsible as reasonably possible in our choices, so this may be an influencing factor. In a nutshell:
- Oats and Soy are generally grown as vast monocrops, and these are bad for the environment
- They are still better for the environment than cow’s milk though, as for example most soy is grown to feed to cows, not humans. So including cows in the process means four times as much monocrop farming, plus adds several other environmental issues that are beyond the scope of this newsletter.
- Almonds are particularly resource-intensive when it comes to water use.
- Still nowhere near as much as cows, though.
- Peas are grown in places that naturally have very high rainfall, so are a good option here. Same generally goes for rice, which didn’t make the cut today. (Nor did hazelnuts, sorry—we can only include so much!)
- Hemp is by far and away the most environmentally friendly, assuming it is grown in a climate naturally conducive to such.
- Making plant milk at home is usually most environmentally friendly, depending on where your ingredients came from.
- Literally any plant milk is much more environmentally friendly than cow’s milk.
See the science for yourself: Reducing food’s environmental impacts through producers and consumers
See also (if you like graphs and charts): Environmental footprints of dairy and plant-based milks
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What You Should Have Been Told About The Menopause Beforehand
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What You Should Have Been Told About Menopause Beforehand
This is Dr. Jen Gunter. She’s a gynecologist, specializing in chronic pain and vulvovaginal disorders. She’s also a woman on a mission to demystify things that popular culture, especially in the US, would rather not talk about.
When was the last time you remember the menopause being referenced in a movie or TV show? If you can think of one at all, was it just played for laughs?
And of course, the human body can be funny, so that’s not necessarily the problem, but it sure would be nice if that weren’t all that there is!
So, what does Dr. Gunter want us to know?
It’s a time of changes, not an end
The name “menopause” is misleading. It’s not a “pause”, and those menses aren’t coming back.
And yet, to call it a “menostop” would be differently misleading, because there’s a lot more going on than a simple cessation of menstruation.
Estrogen levels will drop a lot, testosterone levels may rise slightly, mood and sleep and appetite and sex drive will probably be affected (progesterone can improve all these things!) and
not to mention butwe’re going to mention: vaginal atrophy, which is very normal and very treatable with a topical estrogen cream. Untreated menopause can also bring a whole lot of increased health risks (for example, heart disease, osteoporosis, and, counterintuitively given the lower estrogen levels, breast cancer).However, with a little awareness and appropriate management, all these things can usually be navigated with minimal adverse health outcomes.
Dr Gunter, for this reason, refers to it interchangeably as “the menopausal transition”. She describes it as being less like a cliff edge we fall off, and more like a bridge we cross.
Bridges can be dangerous to cross! But they can also get us safely where we’re going.
Ok, so how do we manage those things?
Dr. Gunter is a big fan of evidence-based medicine, so we’ll not be seeing any yonic crystals or jade eggs. Or “goop”.
See also: Meet Goop’s Number One Enemy
For most people, she recommends Menopausal Hormone Therapy (MHT), which falls under the more general category of Hormone Replacement Therapy (HRT).
This is the most well-evidenced, science-based way to avoid most of the risks associated with menopause.
Nevertheless, there are scare-stories out there, ranging from painful recommencement of bleeding, to (once again) increased risk of breast cancer. However, most of these are either misunderstandings, or unrelated to menopause and MHT, and are rather signs of other problems that should not be ignored.
To get a good grounding in this, you might want to read her Hormone Therapy Guide, freely available as a standalone section on her website. This series of posts is dedicated to hormone therapy. It starts with some basics and builds on that knowledge with each post:
Dr. Gunter’s Guide To The Hormone Menoverse
What about natural therapies?
There are some non-hormonal things that work, but these are mostly things that:
- give a statistically significant reduction in symptoms
- give the same statistically significant reduction in symptoms as placebo
As Dr. Gunter puts it:
❝While most of the studies of prescription medications for hot flashes have an appropriate placebo arm, this is rarely the case with so-called alternative therapies.
In fact, the studies here are almost always low quality, so it’s often not possible to conclude much.
Many reviews that look at these studies often end with a line that goes something like, “Randomized trials with a placebo arm, a low risk of bias, and adequate sample sizes are urgently needed.”
You should interpret this kind of conclusion as the polite way of saying, “We need studies that aren’t BS to say something constructive.”❞
However, if it works, it works, whatever its mechanism. It’s just good, when making medical decisions, to do so with the full facts!
For that matter, even Dr. Gunter acknowledges that while MHT can be lifechanging (in a positive way) for many, it’s not for everyone:
Informed Decisions: When Menopause Hormone Therapy Isn’t Recommended
Want to know more?
Dr. Gunter also has an assortment of books available, including The Menopause Manifesto (which we’ve reviewed previously), and some others that we haven’t, such as “Blood” and “The Vagina Bible”.
Enjoy!
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Sleeping on Your Back after 50; Yay or Nay?
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Sleeping Differently After 50
Sleeping is one of those things that, at any age, can be hard to master. Some of our most popular articles have been on getting better sleep, and effective sleep aids, and we’ve had a range of specific sleep-related questions, like whether air purifiers actually improve your sleep.
But perhaps there’s an underlying truth hidden in our opening sentence…is sleeping consistently difficult because the way we sleep should change according to our age?
Inspired by Brad and Mike’s video below (which was published to their 5 million+ subscribers!), there are 4 main elements to consider when sleeping on your back after you’ve hit the 50-year mark:
- Degenerative Disk Disease: As you age, your spine may start to show signs of wear and tear, which directly affects comfort while lying on your back.
- Sleep Apnea and Snoring: Sleep Apnea and snoring become more of an issue with age, and sleeping on your back can exacerbate these problems; when you sleep on your back, the soft tissues in your throat, as well as your tongue, “fall back” and partly obstruct your the airway.
- Spinal Stenosis: Spinal Stenosis–the often-age-related narrowing of your spinal canal–can put pressure on the nerves that travel through the spine, which equally makes back-sleeping harder.
- GERD: The all-too-familiar gastroesophageal reflux disease can be more problematic when lying flat on your back, as doing so can allow easy access for stomach acid to move upwards.
Alternatives to Back Sleeping
Referencing the Mayo Clinic’s Sleep Facility’s director, Dr. Virend Somers, today’s video suggests a simple solution: sleeping on your side. The video goes into a bit more detail but, as you know, here at 10almonds we like to cut to the chase.
Modifications for Back Sleeping
If you’re a lifelong back-sleeping and cannot bear the idea of changing to your side, or your stomach, then there are a few modifications that you can make to ease any pain and discomfort.
Most solutions revolve around either leg wedges or pillow adjustments. For instance, if you’re suffering from back pain, try propping your knees up. Or if GERD is your worst enemy, a wedge pillow could help keep that acid down.
As can be expected, the video dives into more detail:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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