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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Mediterranean Diet… In A Pill?
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Does It Come In A Pill?
For any as yet unfamiliar with the Mediterranean diet, you may be wondering what it involves, beyond a general expectation that it’s a diet popularly enjoyed in the Mediterranean. What image comes to mind?
We’re willing to bet that tomatoes feature (great source of lycopene, by the way, and if you’re not getting lycopene, you’re missing out), but what else?
- Salads, perhaps? Vegetables, olives? Olive oil, yea or nay?
- Bread? Pasta? Prosciutto, salami? Cheese?
- Pizza but only if it’s Romana style, not Chicago?
- Pan-seared liver, with some fava beans and a nice Chianti?
In fact, the Mediterranean diet is quite clear on all these questions, so to read about these and more (including a “this yes, that no” list), see:
What Is The Mediterranean Diet, And What Is It Good For?
So, how do we get that in a pill?
A plucky band of researchers, Dr. Chiara de Lucia et al. (quite a lot of “et al.”; nine listed authors on the study), wondered to what extent the benefits of the Mediterranean diet come from the fact that the Mediterranean diet is very rich in polyphenols, and set about testing that, by putting the same polyphenols in capsule form, and running a randomized, double-blind, placebo-controlled, crossover clinical intervention trial.
Now, polyphenols are not the only reason the Mediterranean diet is great; there are also other considerations, such as:
- a great macronutrient balance with lots of fiber, healthy fats, moderate carbs, and protein from select sources
- the absence or at least very low presence of a lot of harmful substances such as refined seed oils, added sugars, refined carbohydrates, and the like (“but pasta” yes pasta; in moderation and wholegrain and served with extra sources of fiber and healthy fats, all of which slow down the absorption of the carbs)
…but polyphenols are admittedly very important too; we wrote about some common aspects of them here:
Tasty Polyphenols: Enjoy Bitter Foods For Your Heart & Brain
As for what Dr. de Lucia et al. put into the capsule, behold…
The ingredients:
- Apple Extract 10.0%
- Pomegranate Extract 10.0%
- Tomato Powder 2.5%
- Beet, Spray Dried 2.5%
- Olive Extract 7.5%
- Rosemary Extract 7.5%
- Green Coffee Bean Extract (CA) 7.5%
- Kale, Freeze Dried 2.5%
- Onion Extract 10.0%
- Ginger Extract 10.0%
- Grapefruit Extract 2.5%
- Carrot, Air Dried 2.5%
- Grape Skin Extract 17.5%
- Blueberry Extract 2.5%
- Currant, Freeze Dried 2.5%
- Elderberry, Freeze Dried 2.5%
And the relevant phytochemicals they contain:
- Quercetin
- Luteolin
- Catechins
- Punicalagins
- Phloretin
- Ellagic Acid
- Naringin
- Apigenin
- Isorhamnetin
- Chlorogenic Acids
- Rosmarinic Acid
- Anthocyanins
- Kaempferol
- Proanthocyanidins
- Myricetin
- Betanin
And what, you may wonder, did they find? Well, first let’s briefly summarise the setup of the study:
They took volunteers (n=30), average age 67, BMI >25, without serious health complaints, not taking other supplements, not vegetarian or vegan, not consuming >5 cups of coffee per day, and various other stipulations like that, to create a fairly homogenous study group who were expected to respond well to the intervention. In contrast, someone who takes antioxidant supplements, already eats many different color plants per day, and drinks 10 cups of coffee, probably already has a lot of antioxidant activity going on, and someone with a lower BMI will generally have lower resting levels of inflammatory markers, so it’s harder to see a change, proportionally.
About those inflammatory markers: that’s what they were testing, to see whether the intervention “worked”; essentially, did the levels of inflammatory markers go up or down (up is bad; down is good).
For more on inflammation, by the way, see:
How to Prevent (or Reduce) Inflammation
…which also explains what it actually is, and some important nuances about it.
Back to the study…
They gave half the participants the supplement for a week and the other half placebo; had a week’s gap as a “washout”, then repeated it, switching the groups, taking blood samples before and after each stage.
What they found:
The group taking the supplement had lower inflammatory markers after a week of taking it, while the group taking the placebo had relatively higher inflammatory markers after a week of taking it; this trend was preserved across both groups (i.e., when they switched roles for the second half).
The results were very significant (p=0.01 or thereabouts), and yet at the same time, quite modest (i.e. the supplement made a very reliable, very small difference), probably because of the small dose (150mg) and small intervention period (1 week).
What the researchers concluded from this
The researchers concluded that this was a success; the study had been primarily to provide proof of principle, not to rock the world. Now they want the experiment to be repeated with larger sample sizes, greater heterogeneity, larger doses, and longer intervention periods.
This is all very reasonable and good science.
What we conclude from this
That ingredients list makes for a good shopping list!
Well, not the extracts they listed, necessarily, but rather those actual fruits, vegetables, etc.
If nine top scientists (anti-aging specialists, neurobiologists, pharmacologists, and at least one professor of applied statistics) came to the conclusion that to get the absolute most bang-for-buck possible, those are the plants to get the phytochemicals from, then we’re not going to ignore that.
So, take another list above and ask yourself: how many of those 16 foods do you eat regularly, and could you work the others in?
Want to make your Mediterranean diet even better?
While the Mediterranean diet is a top-tier catch-all, it can be tweaked for specific areas of health, for example giving it an extra focus on heart health, or brain health, or being anti-inflammatory, or being especially gut healthy:
Four Ways To Upgrade The Mediterranean
Enjoy!
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Yes, you still need to use sunscreen, despite what you’ve heard on TikTok
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Summer is nearly here. But rather than getting out the sunscreen, some TikTokers are urging followers to chuck it out and go sunscreen-free.
They claim it’s healthier to forgo sunscreen to get the full benefits of sunshine.
Here’s the science really says.
Karolina Grabowska/Pexels How does sunscreen work?
Because of Australia’s extreme UV environment, most people with pale to olive skin or other risk factors for skin cancer need to protect themselves. Applying sunscreen is a key method of protecting areas not easily covered by clothes.
Sunscreen works by absorbing or scattering UV rays before they can enter your skin and damage DNA or supportive structures such as collagen.
When UV particles hit DNA, the excess energy can damage our DNA. This damage can be repaired, but if the cell divides before the mistake is fixed, it causes a mutation that can lead to skin cancers.
The energy from a particle of UV (a photon) causes DNA strands to break apart and reconnect incorrectly. This causes a bump in the DNA strand that makes it difficult to copy accurately and can introduce mutations. NASA/David Herring The most common skin cancers are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Melanoma is less common, but is the most likely to spread around the body; this process is called metastasis.
Two in three Australians will have at least one skin cancer in their lifetime, and they make up 80% of all cancers in Australia.
Around 99% of skin cancers in Australia are caused by excessive exposure to UV radiation.
Excessive exposure to UV radiation also affects the appearance of your skin. UVA rays are able to penetrate deep into the skin, where they break down supportive structures such as elastin and collagen.
This causes signs of premature ageing, such as deep wrinkling, brown or white blotches, and broken capillaries.
Sunscreen can help prevent skin cancers
Used consistently, sunscreen reduces your risk of skin cancer and slows skin ageing.
In a Queensland study, participants either used sunscreen daily for almost five years, or continued their usual use.
At the end of five years, the daily-use group had reduced their risk of squamous cell carcinoma by 40% compared to the other group.
Ten years later, the daily use group had reduced their risk of invasive melanoma by 73%
Does sunscreen block the health-promoting properties of sunlight?
The answer is a bit more complicated, and involves personalised risk versus benefit trade-offs.
First, the good news: there are many health benefits of spending time in the sun that don’t rely on exposure to UV radiation and aren’t affected by sunscreen use.
Sunscreen only filters UV rays, not all light. Ron Lach/Pexels Sunscreen only filters UV rays, not visible light or infrared light (which we feel as heat). And importantly, some of the benefits of sunlight are obtained via the eyes.
Visible light improves mood and regulates circadian rhythm (which influences your sleep-wake cycle), and probably reduces myopia (short-sightedness) in children.
Infrared light is being investigated as a treatment for several skin, neurological, psychiatric and autoimmune disorders.
So what is the benefit of exposing skin to UV radiation?
Exposing the skin to the sun produces vitamin D, which is critical for healthy bones and muscles.
Vitamin D deficiency is surprisingly common among Australians, peaking in Victoria at 49% in winter and being lowest in Queensland at 6% in summer.
Luckily, people who are careful about sun protection can avoid vitamin D deficiency by taking a supplement.
Exposing the skin to UV radiation might have benefits independent of vitamin D production, but these are not proven. It might reduce the risk of autoimmune diseases such as multiple sclerosis or cause release of a chemical that could reduce blood pressure. However, there is not enough detail about these benefits to know whether sunscreen would be a problem.
What does this mean for you?
There are some benefits of exposing the skin to UV radiation that might be blunted by sunscreen. Whether it’s worth foregoing those benefits to avoid skin cancer depends on how susceptible you are to skin cancer.
If you have pale skin or other factors that increase you risk of skin cancer, you should aim to apply sunscreen daily on all days when the UV index is forecast to reach 3.
If you have darker skin that rarely or never burns, you can go without daily sunscreen – although you will still need protection during extended times outdoors.
For now, the balance of evidence suggests it’s better for people who are susceptible to skin cancer to continue with sun protection practices, with vitamin D supplementation if needed.
Katie Lee, PhD Candidate, Dermatology Research Centre, The University of Queensland and Rachel Neale, Principal research fellow, QIMR Berghofer Medical Research Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cranberries vs Goji Berries – Which is Healthier?
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Our Verdict
When comparing cranberries to goji berries, we picked the cranberries.
Why?
Both are great! And your priorities may differ. Here’s how they stack up:
In terms of macros, goji berries have more protein, carbs, and fiber. This is consistent with them generally being eaten very dried, whereas cranberries are more often eaten fresh or from frozen, or partially rehydrated. In any case, goji berries are the “more food per food” option, so it wins this category. The glycemic indices are both low, by the way, though goji berries are the lower.
When it comes to vitamins, cranberries have more of vitamins B1, B2, B3, B5, B6, B9, E, K, and choline, while goji berries have more of vitamins A and C. Admittedly it’s a lot more, but still, on strength of overall vitamin coverage, the clear winner here is cranberries.
We see a similar story when it comes to minerals: cranberries have more copper, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while goji berries have (a lot) more calcium and iron. Again, by strength of overall mineral coverage, the clear winner here is cranberries.
Cranberries do also have some extra phytochemical benefits, including their prevention/cure status when it comes to UTIs—see our link below for more on that.
At any rate, enjoy either or both, but those are the strengths and weaknesses of these two berries!
Want to learn more?
You might like to read:
- Health Benefits Of Cranberries (But: You’d Better Watch Out)
- Goji Berries: Which Benefits Do They Really Have?
- The Sugary Food That Lowers Blood Sugars ← this is also about goji berries
Take care!
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Easing Election Stress & Anxiety
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At the time of writing, the US is about to have a presidential election. Most of our readers are Americans, and in any case, what the US does tends to affect most of the world, so certainly many readers in other countries will be experiencing stress and anxiety about it too.
We’re a health science publication, not a political outlet, so we’ll refrain from commenting on any candidates or campaign policies, and we’d also like to be clear we are not urging you to any particular action politically—our focus today is simply about mental health.
First, CBT what can be CBT’d
Cognitive Behavioral Therapy (CBT) is far from a panacea, but it’s often a very good starting point. And when it seems the stakes are high, it’s easy to fall into such cognitive distortions as “crystal ball” and “catastrophization”, that is to say, predicting the future and feeling the impact of that (probably undesired version of the) future, and also feeling like it will be the end of the world.
Recognizing these processes and how they work, is the first step to managing our feelings about them.
Learn more: The Art of Being Unflappable (Tricks For Daily Life)
Next, DBT what can be DBT’d
A lot of CBT hinges on the assumption that our assumptions are incorrect. For example, that our friend does not secretly despise us, that our spouse is not about to leave us, that the symptoms we are experiencing are not cancer, and in this case, that the election outcome will not go badly, and if it does, the consequences will be less severe than imagined.
But… What if our concerns are, in fact, fully justified? Here’s where Dialectic Behavior Therapy (DBT) comes in, and with it, what therapists call “radical acceptance”.
In other words, we accept up front the idea that maybe it’s going to be terrible and that will truly suck, and then either:
- there’s nothing we can reasonably do about it now (so worrying just means you’ll suffer twice), or
- there is something we can reasonably do about it now (so we can go do that thing)
After doing the thing (if appropriate), defer processing the outcome of the election until after the election. There is no point in wasting energy to worry before then. In a broadly two-party system where things are usually close between those two largest parties, there’s something close to a 50% chance of an outcome that’s, at least, not the worst you feared.
Learn more: CBT, DBT, & Radical Acceptance
Lastly, empower yourself with Behavioral Activation (BA)
Whatever the outcome of any given election, the world will keep turning, and the individual battles about any given law or policy or such will continue to go on. That’s not to say an election won’t change things—it will—but there will always still be stuff to do on a grassroots level to make the world a better place, no matter what politician has been elected.
Being involved in doing things on a community level will not only help banish any feelings of despair (and if you got the election outcome you wanted, it’ll help you feel involved), but also, it can give you a sense of control, and can even form a part of the “ikigai” that is often talked about as one of the pillars of healthy longevity.
Learn more: What’s Your Ikigai?
And if you like videos, then enjoy this one (narrated by the ever soothing-voiced Alain de Botton):
Watch now: How To Escape From A Despairing Mood (4:46) ← it also has a text version if you prefer that
Take care!
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Walk Like You’re 20 Years Younger Again
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How fit, healthy, strong, and mobile were you 20 years ago? For most people, the answer is “better than now”. Physiotherapist Dr. Doug Weiss has advice on turning back the clock:
The exercises
If you already have no problems walking, this one is probably not for you. However, if you’re not so able to comfortably walk as you used to be, then Dr. Weiss recommends:
- Pillow squat: putting pillow on a chair, crossing hands on chest, standing up and sitting down. Similar to the very important “getting up off the floor without using your hands” exercise, but easier.
- Wall leaning: standing against a wall with heels 4″ away from it, crossing arms over chest again, and pulling the body off the wall using the muscles in the front of the shin. Note, this means not cheating by using other muscles, leveraging the upper body, pushing off with the buttocks, or anything else like that.
- Stepping forward: well, this certainly is making good on the promise of walking like we did 20 years ago; there sure was a lot of stepping forward involved. More seriously, this is actually about stepping over some object, first with support, and then without.
- Heel raise: is what it sounds like, raising up on toes and back down again; first with support, then without.
- Side stepping: step sideways 2–3 steps in each direction. First with support, then without. Bonus: if your support is your partner, then congratulations, you are now dancing bachata.
For more details (and visual demonstration) of these exercises and more, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
4 Tips To Stand Without Using Hands
Take care!
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How to Fall Back Asleep After Waking Up in the Middle of the Night
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Dr. Michael Bruce, the Sleep Doctor, addresses a common concern: waking up in the middle of the night and struggling to fall back asleep.
Understanding the Wake-Up
Firstly, why are we waking up during the night?
Waking up between 2 AM and 3 AM is said to be normal, and linked to your core body temperature. As your body core temperature drops, to trigger melatonin release, and then rises again, you get into a lighter stage of sleep. This lighter stage of sleep makes you more prone to waking up.
Note, there are also some medical conditions (such as sleep apnea) that can cause you to wake up during the night.
But, what can we do about it? Aside from constantly shifting sleeping position (Should I be sleeping on my back? On my left? Right?)
Avoid the Clock
The first step is to resist the urge to check the time. It’s easy to be tempted to have a look at the clock, however, doing so can increase anxiety, making it harder to fall back asleep. As Dr. Bruce says, sleep is like love—the less you chase it, the more it comes.
It may be useful to point your alarm clock (if you still have one of those) the opposite direction to your bed.
Embracing Non-Sleep Deep Rest (NSDR)
Whilst this may not help you fall back asleep, it’s worth pointing out that just lying quietly in the dark without moving still offers rejuvenation. This revujenating stage is called Non-Sleep Deep Rest (otherwise known as NSDR)
If you’re not familiar with NSDR, check out our overview of Andrew Huberman’s opinions on NSDR here.
So, you can reassure yourself that whilst you may not be asleep, you are still resting.
Keep Your Heart Rate Down
To fall back asleep, it’s best if your heart rate is below 60 bpm. So, Dr. Bruce advises avoiding void getting up unnecessarily, as moving around can elevate your heart rate.
On a similar vain, he introduces the 4-7-8 breathing technique, which is designed to lower your heart rate. The technique is simple:
- Breathe in for 4 seconds.
- Hold for 7 seconds.
- Exhale for 8 seconds.
Repeat this cycle gently to calm your body and mind.
As per any of our Video Breakdowns, we only try to capture the most important pieces of information in text; the rest can be garnered from the video itself:
Wishing you a thorough night’s rest!
Do you know any other good videos on sleep? Send them to us via email!
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