People on Ozempic may have fewer heart attacks, strokes and addictions – but more nausea, vomiting and stomach pain
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Ozempic and Wegovy are increasingly available in Australia and worldwide to treat type 2 diabetes and obesity.
The dramatic effects of these drugs, known as GLP-1s, on weight loss have sparked huge public interest in this new treatment option.
However, the risks and benefits are still being actively studied.
In a new study in Nature Medicine, researchers from the United States reviewed health data from about 2.4 million people who have type 2 diabetes, including around 216,000 people who used a GLP-1 drug, between 2017 and 2023.
The researchers compared a range of health outcomes when GLP-1s were added to a person’s treatment plan, versus managing their diabetes in other ways, often using glucose-lowering medications.
Overall, they found people who used GLP-1s were less likely to experience 42 health conditions or adverse health events – but more likely to face 19 others.
What conditions were less common?
Cardiometabolic conditions
GLP-1 use was associated with fewer serious cardiovascular and coagulation disorders. This includes deep vein thrombosis, pulmonary embolism, stroke, cardiac arrest, heart failure and myocardial infarction.
Neurological and psychiatric conditions
GLP-1 use was associated with fewer reported substance use disorders or addictions, psychotic disorders and seizures.
Infectious conditions
GLP-1 use was associated with fewer bacterial infections and pneumonia.
What conditions were more common?
Gastrointestinal conditions
Consistent with prior studies, GLP-1 use was associated with gastrointestinal conditions such as nausea, vomiting, gastritis, diverticulitis and abdominal pain.
Other adverse effects
Increased risks were seen for conditions such as low blood pressure, syncope (fainting) and arthritis.
How robust is this study?
The study used a large and reputable dataset from the US Department of Veterans Affairs. It’s an observational study, meaning the researchers tracked health outcomes over time without changing anyone’s treatment plan.
A strength of the study is it captures data from more than 2.4 million people across more than six years. This is much longer than what is typically feasible in an intervention study.
Observational studies like this are also thought to be more reflective of the “real world”, because participants aren’t asked to follow instructions to change their behaviour in unnatural or forced ways, as they are in intervention studies.
However, this study cannot say for sure that GLP-1 use was the cause of the change in risk of different health outcomes. Such conclusions can only be confidently made from tightly controlled intervention studies, where researchers actively change or control the treatment or behaviour.
The authors note the data used in this study comes from predominantly older, white men so the findings may not apply to other groups.
Also, the large number of participants means that even very small effects can be detected, but they might not actually make a real difference in overall population health.
Other possible reasons for these links
Beyond the effect of GLP-1 in the body, other factors may explain some of the findings in this study. For example, it’s possible that:
- people who used GLP-1 could be more informed about treatment options and more motivated to manage their own health
- people who used GLP-1 may have received it because their health-care team were motivated to offer the latest treatment options, which could lead to better care in other areas that impact the risk of various health outcomes
- people who used GLP-1 may have been able to do so because they lived in metropolitan centres and could afford the medication, as well as other health-promoting services and products, such as gyms, mental health care, or healthy food delivery services.
Did the authors have any conflicts of interest?
Two of the study’s authors declared they were “uncompensated consultants” for Pfizer, a global pharmaceutical company known for developing a wide range of medicines and vaccines. While Pfizer does not currently make readily available GLP-1s such as Ozempic or Wegovy, they are attempting to develop their own GLP-1s, so may benefit from greater demand for these drugs.
This research was funded by the US Department of Veterans Affairs, a government agency that provides a wide range of services to military veterans.
No other competing interests were reported.
Diabetes vs weight-loss treatments
Overall, this study shows people with type 2 diabetes using GLP-1 medication generally have more positive health outcomes than negative health outcomes.
However, the study didn’t include people without type 2 diabetes. More research is needed to understand the effects of these medications in people without diabetes who are using them for other reasons, including weight loss.
While the findings highlight the therapeutic benefits of GLP-1 medications, they also raise important questions about how to manage the potential risks for those who choose to use this medication.
The findings of this study can help many people, including:
- policymakers looking at ways to make GLP-1 medications more widely available for people with various health conditions
- health professionals who have regular discussions with patients considering GLP-1 use
- individuals considering whether a GLP-1 medication is right for them.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Farmed Fish vs Wild Caught
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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 it good to eat farm raised fish?❞
We’ll answer this as a purely health-related question (and thus not considering economy, ecology, ethics, or taste).
It’s certainly not as good as wild-caught fish, for several reasons, some more serious than others:
Farmed fish can have quite a different nutritional profile to wild-caught fish, and also contain more contaminants, including heavy metals.
For example, farmed fish tend to have much higher fat content for the same amount of protein, but lower levels of minerals and other nutrients. Here are two side-by-side:
Wild-caught salmon | Farmed salmon
See also:
Quantitative analysis of the benefits and risks of consuming farmed and wild salmon
Additionally, because fish in fish farms tend to be very susceptible to diseases (because of the artificially cramped and overcrowded environment), fish farms tend to make heavy use of antibiotics, which can cause all sorts of problems down the line:
So definitely, “let the buyer beware”!
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CBD Oil’s Many Benefits
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CBD Oil: What Does The Science Say?
First, a quick legal (and practical) note:
CBD and THC are both derived from the hemp or cannabis plant, but only the latter has euphoriant psychoactive effects, i.e., will get you high. We’re writing here about CBD derived from hemp and not containing THC (thus, will not get you high).
Laws and regulations differ far too much from place to place for us to try to advise here, so please check your own local laws and regulations. And also, while you’re at it, with your doctor and/or pharmacist.
As ever, this newsletter is for purposes of education and enjoyment, and does not constitute any kind of legal (or medical) advice.
With that in mind, onwards to today’s research review…
CBD for Pain Relief
CBD has been popularly touted as a pain relief panacea, and there are a lot of pop-science articles out there “debunking” this, but…
The science seems to back it up. We couldn’t find studies refuting the claim (of CBD as a viable pain relief option). We did, however, find research showing it was good against:
Note that that latter (itself a research review, not a single study, hence covering a lot of bases) describes it matter-of-factly, with no caveats or weasel-words, as:
“CBD, a non-euphoriant, anti-inflammatory analgesic with CB1 receptor antagonist and endocannabinoid modulating effects”
As a quick note: all of the above is about the topical use of CBD oil, not any kind of ingestion
CBD for Anxiety/Depression
There’s a well-cited study with what honestly we think was a bit of a small sample size, but compelling results within that:
A study published in the Brazilian Journal of Psychiatry tested the anxiety levels of 57 men in a simulated public speaking test.
Compared to placebo…
- Those who received 300mg of CBD experienced significantly reduced anxiety during the test.
- Those who received either 150mg or 600mg of CBD experienced more anxiety during the test than the 300mg group
- This means there’s a sweet spot to the dosage
There was also a clinical study that found CBD to have anti-depressant effects.
The methodology was a lot more robust, but the subjects were mice. We can’t have everything in one study, apparently! There is probably a paucity of human volunteers to have their brain slices looked at after tests, though.
Anyway, what makes this study interesting is that it measured quite an assortment of biological markers in the brain, and found that the CBD had a similar physiological effect to the antidepressant imipramine.
CBD for Treating Opioid Addiction
There are a lot of studies for this, both animal and human, but we’d like to put the spotlight on a human study (with the participation of heroin users) that found:
❝Within one week, CBD significantly reduced cravings, anxiety, resting heart rate, and salivary cortisol levels. No serious adverse effects were found.❞
This is groundbreaking because the very thing about heroin is that it’s so addictive and the body rapidly needs more and more of it. You might think “duh”, but most people don’t realize this part:
Heroin is attractive because it offers (and delivers) an immediate guaranteed “downer”, instant relaxation… with none of the bad side effects of, for example, alcohol. No nausea, no hangover, nothing.
The problem is that the body gets tolerant to heroin very quickly, meaning your doses need to get bigger and more frequent to have the same effect.
Before you know it, what seemed like an affordable “self-medication for a stressful life” is very much out of control! Many doctors have personally found this out the hard way.
So, it’s ruinous:
- first to your financial health, as the costs rapidly spiral
- then to your physical health, as you either suffer from withdrawal or eventually overdose
Consequently, heroin is an incredibly easy drug to get hooked onto, and incredibly difficult to get back off.
So CBD offering relief is really a game-changer.
And more…
CBD has been well-studied and found to be effective for a lot of things, more than we could hope to cover in a single edition here.
Some further reading that may interest you includes:
- CBD against Diabetes in mice / in vitro / in humans
- CBD against neurological diseases (in general, in humans)
- CBD against arthritis in mice / in humans
- CBD specifically against the pain of rheumatoid arthritis / of osteoarthritis
Let us know if there’s any of these (or other) conditions you’d like us to look more into the CBD-related research for, because there’s a lot! You can always hit reply to any of our emails, or use the feedback widget at the bottom
Read (and shop, if you want and it’s permitted where you are):
10 Best CBD Oils of 2023, According to the Forbes Health Advisory Board
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Ikigai – by Héctor García and Francesc Miralles
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Ikigai is the Japanese term for what in English we often call “raison d’être”… in French, because English is like that.
But in other words: ikigai is one’s purpose in life, one’s reason for living.
The authors of this work spend some chapters extolling the virtues of finding one’s ikigai, and the health benefits that doing so can convey. It is, quite clearly, an important and relevant factor.
The rest of the book goes beyond that, though, and takes a holistic look at why (and how) healthy longevity is enjoyed by:
- Japanese people in general,
- Okinawans in particular,
- Residents of Okinawa’s “blue zone” village with the highest percentage of supercentenarians, most of all.
Covering considerations from ikigai to diet to small daily habits to attitudes to life, we’re essentially looking at a blueprint for healthy longevity.
For a book whose title and cover suggests a philosophy-heavy content, there’s a lot of science in here too, by the way! From microbiology to psychiatry to nutrition science to cancer research, this book covers all bases.
In short: this book gives a lot of good science-based suggestions for adjustments we can make to our lives, without moving to an Okinawan village!
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Tinnitus: Quieting The Unwanted Orchestra In Your Ears
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Tinnitus—When a “minor” symptom becomes disruptive
Tinnitus (typically: ringing in the ears) is often thought of less as a condition in and of itself, and more a symptom related to other hearing-related conditions. Paradoxically, it can be associated with hearing loss as well as with hyperacusis (hearing supersensitivity, which sounds like a superpower, but can be quite a problem too).
More than just ringing
Tinnitus can manifest not just as ringing, but also as whistling, hissing, pulsing, buzzing, hooting, and more.
For those who don’t suffer from this, it can seem very trivial; for those who do… Sometimes it can seem trivial too!
But sometimes it’s hard to carry on a conversation when at random moments it suddenly sounds like someone is playing a slide-whistle directly into your earhole, or like maybe a fly got stuck in there.
It’s distracting, to say the least.
What causes it?
First let’s note, tinnitus can be acute or chronic. So, some of these things may just cause tinnitus for a while, whereas some may give you tinnitus for life. In some cases, it depends on how long the thing in question persisted for.
A lot of things can cause it, but common causes include:
- Noise exposure (e.g. concerts, some kinds of industrial work, war)
- High blood pressure
- Head/neck injuries
- Ear infection
- Autoimmune diseases (e.g. Type 1 Diabetes, Lupus, Multiple Sclerosis)
So what can be done about it?
Different remedies will work (or not) for different people, depending on the cause and type of tinnitus.
Be warned also: some things that will work for one person’s tinnitus will make another person’s worse, so you might need to try a degree of experimentation and some of it might not be fun!
That in mind, here are some things you might want to try if you haven’t already:
- Earplugs or noise-canceling headphones—while tinnitus is an internal sound, not external, it often has to do with some part(s) of your ears being unduly sensitive, so giving them less stimulus may ease the tinnitus that occurs in reaction to external noise.
- A great option (that this writer uses personally and considers a life-changer) is silicon earplugs that live in a little case on a keyring when not in use—no more heart-racing fleeing from supermarket checkout boops or pedestrian crossing bips or traffic noises or babies crying or (etc)
- White noise—if you also have hyperacusis, a lower frequency range will probably not hurt the way a higher range might. If you don’t also have hyperacusis, you have more options here and this is a popular remedy. Either way, white noise outperforms “relaxing” soundscapes.
- Hearing aids—counterintuitively, for some people whose tinnitus has developed in response to hearing loss, hearing aids can help bring things “back to normal” and eliminate tinnitus in the process.
- Customized sound machines—if you have the resources to get fancy, science currently finds this to be best of all. They work like white noise, but are tailored to your specific tinnitus.
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Managing Major Chronic Diseases – by Alexis Dupree
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Our author, Alexis Dupree, is herself in her 70s, and writing with more than three decades of experience of surviving multiple chronic diseases (in her case, Multiple Sclerosis, and then a dozen comorbidities that came with such).
She is not a doctor or a scientist, but for more than 30 years she’s been actively working to accumulate knowledge not just on her own conditions, but on the whole medical system, and what it means to be a “forever patient” without giving up hope.
She talks lived-experience “life management” strategies for living with chronic disease, and she talks—again from lived experience—about navigating the complexities of medical care; not on a legalistic “State regulations say…” level, because that kind of thing changes by the minute, but on a human level.
Perhaps most practically: how to advocate strongly for yourself while still treating medical professionals with the respect and frankly compassion that they deserve while doing their best in turn.
But also: how to change your attitude to that of a survivor, and yet also redefine your dreams. How to make a new game plan of life—while working to make life easier for yourself. How to deal, psychologically, with the likelihood that not only will you probably not get better, but also, you will probably get worse, while still never, ever, giving up.
After all, many things are easily treatable today that mere decades ago were death sentences, and science is progressing all the time. We just have to stay alive, and in as good a condition as we reasonably can, to benefit from those advances!
Bottom line: if you have a chronic disease, or if a loved one does, then this is an immensely valuable book to read.
Click here to check out Managing Major Chronic Diseases, and make life easier!
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Only walking for exercise? Here’s how to get the most out of it
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We’re living longer than in previous generations, with one in eight elderly Australians now aged over 85. But the current gap between life expectancy (“lifespan”) and health-adjusted life expectancy (“healthspan”) is about ten years. This means many of us live with significant health problems in our later years.
To increase our healthspan, we need planned, structured and regular physical activity (or exercise). The World Health Organization recommends 150–300 minutes of moderate-intensity exercise – such as brisk walking, cycling and swimming – per week and muscle strengthening twice a week.
Yet few of us meet these recommendations. Only 10% meet the strength-training recommendations. Lack of time is one of the most common reasons.
Walking is cost-effective, doesn’t require any special equipment or training, and can be done with small pockets of time. Our preliminary research, published this week, shows there are ways to incorporate strength-training components into walking to improve your muscle strength and balance.
Why walking isn’t usually enough
Regular walking does not appear to work as muscle-strengthening exercise.
In contrast, exercises consisting of “eccentric” or muscle-lengthening contractions improve muscle strength, prevent muscle wasting and improve other functions such as balance and flexibility.
Typical eccentric contractions are seen, for example, when we sit on a chair slowly. The front thigh muscles lengthen with force generation.
When you sit down slowly on a chair, the front thigh muscles lengthen.
buritora/ShutterstockOur research
Our previous research found body-weight-based eccentric exercise training, such as sitting down on a chair slowly, improved lower limb muscle strength and balance in healthy older adults.
We also showed walking down stairs, with the front thigh muscles undergoing eccentric contractions, increased leg muscle strength and balance in older women more than walking up stairs. When climbing stairs, the front thigh muscles undergo “concentric” contractions, with the muscles shortening.
It can be difficult to find stairs or slopes suitable for eccentric exercises. But if they could be incorporated into daily walking, lower limb muscle strength and balance function could be improved.
This is where the idea of “eccentric walking” comes into play. This means inserting lunges in conventional walking, in addition to downstairs and downhill walking.
In our new research, published in the European Journal of Applied Physiology, we investigated the effects of eccentric walking on lower limb muscle strength and balance in 11 regular walkers aged 54 to 88 years.
The intervention period was 12 weeks. It consisted of four weeks of normal walking followed by eight weeks of eccentric walking.
The number of eccentric steps in the eccentric walking period gradually increased over eight weeks from 100 to 1,000 steps (including lunges, downhill and downstairs steps). Participants took a total of 3,900 eccentric steps over the eight-week eccentric walking period while the total number of steps was the same as the previous four weeks.
We measured the thickness of the participants’ front thigh muscles, muscle strength in their knee, their balance and endurance, including how many times they could go from a sitting position to standing in 30 seconds without using their arms. We took these measurements before the study started, at four weeks, after the conventional walking period, and at four and eight weeks into the eccentric walking period.
We also tested their cognitive function using a digit symbol-substitution test at the same time points of other tests. And we asked participants to complete a questionnaire relating to their activities of daily living, such as dressing and moving around at home.
Finally, we tested participants’ blood sugar, cholesterol levels and complement component 1q (C1q) concentrations, a potential marker of sarcopenia (muscle wasting with ageing).
Regular walking won’t contract your muscles in the same way as eccentric walking.
alexei_tm/ShutterstockWhat did we find?
We found no significant changes in any of the outcomes in the first four weeks when participants walked conventionally.
From week four to 12, we found significant improvements in muscle strength (19%), chair-stand ability (24%), balance (45%) and a cognitive function test (21%).
Serum C1q concentration decreased by 10% after the eccentric walking intervention, indicating participants’ muscles were effectively stimulated.
The sample size of the study was small, so we need larger and more comprehensive studies to verify our findings and investigate whether eccentric walking is effective for sedentary people, older people, how the different types of eccentric exercise compare and the potential cognitive and mental health benefits.
But, in the meantime, “eccentric walking” appears to be a beneficial exercise that will extend your healthspan. It may look a bit eccentric if we insert lunges while walking on the street, but the more people do it and benefit from it, the less eccentric it will become.
Ken Nosaka, Professor of Exercise and Sports Science, Edith Cowan University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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