Semaglutide for Weight Loss?
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Semaglutide for weight loss?
Semaglutide is the new kid on the weight-loss block, but it’s looking promising (with some caveats!).
Most popularly by brand names Ozempic and Wegovy, it was first trialled to help diabetics*, and is now sought-after by the rest of the population too. So far, only Wegovy is FDA-approved for weight loss. It contains more semaglutide than Ozempic, and was developed specifically for weight loss, rather than for diabetes.
*Specifically: diabetics with type 2 diabetes. Because it works by helping the pancreas to make insulin, it’s of no help whatsoever to T1D folks, sadly. If you’re T1D and reading this though, today’s book of the day is for you!
First things first: does it work as marketed for diabetes?
It does! At a cost: a very common side effect is gastrointestinal problems—same as for tirzepatide, which (like semaglutide) is a GLP-1 agonist, meaning it works the same way. Here’s how they measure up:
- Head-to-head study: Effects of subcutaneous tirzepatide versus placebo or semaglutide on pancreatic islet function and insulin sensitivity in adults with type 2 diabetes
- Head-to-head systematic review: Semaglutide for the treatment of type 2 Diabetes Mellitus: A systematic review and network meta-analysis of safety and efficacy outcomes
As you can see, both of them work wonders for pancreatic function and insulin sensitivity!
And, both of them were quite unpleasant for around 20% of participants:
❝Tirzepatide, oral and SC semaglutide has a favourable efficacy in treating T2DM. Gastrointestinal adverse events were highly recorded in tirzepatide, oral and SC semaglutide groups.❞
What about for weight loss, if not diabetic?
It works just the same! With just the same likelihood of gastro-intestinal unpleasantries, though. There’s a very good study that was done with 1,961 overweight adults; here it is:
Once-Weekly Semaglutide in Adults with Overweight or Obesity
The most interesting things here are the positive results and the side effects:
❝The mean change in body weight from baseline to week 68 was −14.9% in the semaglutide group as compared with −2.4% with placebo, for an estimated treatment difference of −12.4 percentage points (95% confidence interval [CI], −13.4 to −11.5; P<0.001).❞
In other words: if you take this, you’re almost certainly going to get something like 6x better weight loss results than doing the same thing without it.
❝Nausea and diarrhea were the most common adverse events with semaglutide; they were typically transient and mild-to-moderate in severity and subsided with time. More participants in the semaglutide group than in the placebo group discontinued treatment owing to gastrointestinal events (59 [4.5%] vs. 5 [0.8%])❞
~ ibid.
In other words: you have about a 3% chance of having unpleasant enough side effects that you don’t want to continue treatment (contrast this with the 20%ish chance of unpleasant side effects of any extent)!
Any other downsides we should know about?
If you stop taking it, weight regain is likely. For example, a participant in one of the above-mentioned studies who lost 22% of her body weight with the drug’s help, says:
❝Now that I am no longer taking the drug, unfortunately, my weight is returning to what it used to be. It felt effortless losing weight while on the trial, but now it has gone back to feeling like a constant battle with food. I hope that, if the drug can be approved for people like me, my [doctor] will be able to prescribe the drug for me in the future.❞
~ Jan, a trial participant at UCLH
Is it injection-only, or is there an oral option?
An oral option exists, but (so far) is on the market only in the form of Rybelsus, another (slightly older) drug containing semaglutide, and it’s (so far) only FDA-approved for diabetes, not for weight loss. See:
A new era for oral peptides: SNAC and the development of oral semaglutide for the treatment of type 2 diabetes ← for the science
FDA approves first oral GLP-1 treatment for type 2 diabetes ← For the FDA statement
Where can I get these?
Availability and prescribing regulations vary by country (because the FDA’s authority stops at the US borders), but here is the website for each of them if you’d like to learn more / consider if they might help you:
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NADᐩ Against Aging
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Nicotinamide adenine dinucleotide, or “NAD” to its friends, is a coenzyme produced in the human body (amongst other places), and it is critical for cellular energy metabolism, but there’s more to it than that.
Today we’ll be looking mostly at NAD+, of which the + indicates the positive formal charge of one of its nitrogen atoms. We won’t get too much into the chemistry of this, but we will mention that it’s a cofactor with NADH—the former accepting electrons and the latter donating electrons.
Both NAD+ and NADH are critical to good health, but we’re going to focus on NAD+ for the simple reason that it gets depleted with aging.
Note: it gets depleted with aging.
Chronological age is not so important here, but there is a direct relationship between biological aging and NAD+ depletion.
For example, healthy centenarians tend not to have depleted NAD+ levels. Further, its depletion (in those in whom it is depleted) is then a causal factor for many age-related diseases:
❝Remarkably, ageing is accompanied by a gradual decline in tissue and cellular NAD+ levels in multiple model organisms, including rodents and humans.
This decline in NAD+ levels is linked causally to numerous ageing-associated diseases, including cognitive decline, cancer, metabolic disease, sarcopenia and frailty.
Many of these ageing-associated diseases can be slowed down and even reversed by restoring NAD+ levels.❞
~ Dr. Rosalba Perrone et al.
Read in full: NAD+ metabolism and its roles in cellular processes during ageing
As for restoring those NADᐩ levels, that does help in interventional trials, whether by supplementing directly, or with NAD precursors*:
❝NAD+ levels steadily decline with age, resulting in altered metabolism and increased disease susceptibility.
Restoration of NAD+ levels in old or diseased animals can promote health and extend lifespan, prompting a search for safe and efficacious NAD-boosting molecules that hold the promise of increasing the body’s resilience, not just to one disease, but to many, thereby extending healthy human lifespan.❞
~ Dr. David Sinclair et al.
Read more: Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence
*There are actually also other NAD-boosting molecules besides NAD itself and its precursors. For example, the liver will not produce NADᐩ unless it has aminocarboxymuconate-semialdehyde decarboxylase (or “ACMSD”, to its friends), which limits the production of NADᐩ. Why, you ask? The theory is that it is a kind of evolutionary conservativism, much like not lighting a fire without the ability to put it out. In any case, taking ACMSD-blockers will thus result in an increased endogenous production of NADᐩ.
You can read about this here:
De novo NAD+ synthesis enhances mitochondrial function and improves health
Nor is taking supplements or drugs the only way to get more of it; there’s an enzyme nicotinamide phosphoribosyltransferase (“NAMPT”, to its friends) involved in the synthesis of NADᐩ, and exercise boosts levels by 127% (i.e., it more than doubles the levels), based on a modest three-week exercise bike regimen:
Skeletal muscle NAMPT is induced by exercise in humans
And to underline that point, another study found that resistance training (so, a different kind of exercise from that of the previous study) boosts levels of NADᐩ itself by the same 127%:
One way to get more out of NADᐩ
We’ll get straight to the point: it works very well paired with a senolytic agent, i.e. something that kills aging cells so that they get recycled sooner:
NAD+, Senolytics, or Pyruvate for Healthy Aging?
To read more about senolytics, check out:
Fisetin: The Anti-Aging Assassin
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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Healthy Tiramisu
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Tiramisu (literally “pick-me-up”, “tira-mi-su”) is a delightful dish that, in its traditional form, is also a trainwreck for the health, being loaded with inflammatory cream and sugar, not to mention the cholesterol content. Here we recreate the dish in healthy fashion, being loaded with protein, fiber, and healthy fats, not to mention that the optional sweetener is an essential amino acid. The coffee and cocoa, of course, are full of antioxidants too. All in all, what’s not celebrate?
You will need
- 2 cups silken tofu (no need to press it) (do not substitute with any other kind of tofu or it will not work)
- 1 cup oat cream (you can buy this ready-made, or make it yourself by blending oats in water until you get the desired consistency) (you can also just use dairy cream, but that will be less healthy)
- 1 cup almond flour (also simply called “ground almonds”)
- 1 cup espresso ristretto, or otherwise the strongest black coffee you have facility to make
- ¼ cup unsweetened cocoa powder, plus more for dusting
- 1 pack savoiardi biscuits, also called “ladyfinger” biscuits (this was the only part we couldn’t make healthy—if you figure out a way to make it healthy, let us know!) (if vegan, obviously use a vegan substitute biscuit; this writer uses Lotus/Biscoff biscuits, which work well)
- 1 tsp vanilla essence
- ½ tsp almond essence
- Optional: glycine, per taste
- Garnish: roasted coffee beans
Method
(we suggest you read everything at least once before doing anything)
1) Add glycine to the coffee first if you want the overall dish to be sweeter. Glycine has approximately the same sweetness as sugar, and can be used as a 1:1 substitution. Use that information as you see fit.
2) Blend the tofu and the cream together in a high-speed blender until smooth. It should have a consistency like cake-batter; if it is too liquidy, add small amounts of almond flour until it is thicker. If it’s too thick, add oat cream until it isn’t. If you want it to be sweeter than it is, add glycine to taste. When happy with its taste and consistency, divide it evenly into two bowls.
3) Add the vanilla essence and almond essence to one bowl, and the cocoa powder to the other, mixing well (in a food processor, or just by using a whisk)
4) Coat the base of a glass dish (such as a Pyrex oven dish, but any dish is fine, and any glass dish will allow for viewing the pretty layers we’ll be making) with a very thin layer of almond flour (if you want sweetness there, you can mix some glycine in with the almond flour first).
4) One by one, soak the biscuits briefly in the coffee, and use them to line to base of the dish.
5) Add a thin layer of chocolate cream, ensuring the surface is as flat as possible. Dust it with cocoa powder, to increase the surface tension.
6) Add a thin layer of vanilla-and-almond cream, ensuring the surface is as flat as possible. Dust it with cocoa powder, to increase the surface tension.
7) Stop and assess: do you have enough ingredients left to repeat these layers? It will depend on the size and shape dish you used. If you do, repeat them, finishing with a vanilla-and-almond cream layer.
8) Dust the final layer with cocoa powder if you haven’t already, and add the coffee bean garnish, if using.
9) Refrigerate for at least 8 hours, and if you have time to prepare it the day before you will eat it, that is best of all.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Easily Digestible Vegetarian Protein Sources
- Why You Should Diversify Your Nuts!
- The Bitter Truth About Coffee (or is it?)
- The Sweet Truth About Glycine
- Tiramisu Crunch Bites ← craving tiramisu but not keen on all that effort? Enjoy these!
Take care!
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Heart Rate Zones, Oxalates, & More
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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
❝I think the heart may be an issue for lots of us. I know it is for me due to AFib. When I’m in my training zone like on a treadmill, I’m usually around 110 to 120. But there are occasionally times when I’m at 140 or 150. How dangerous is that? If I use that formula of 180 minus age, thats 103. I get nothing from that. My resting heart rate is in the 50 to 60 range.❞
First, for safety, let us draw attention to our medical disclaimer at the bottom of each email, and also specifically note that we are not cardiologists here, let alone your cardiologist. There’s a lot we can’t know or advise about. However, as general rules of thumb:
For people without serious health conditions, it is considered good and healthful for one’s heart rate to double (from its resting rate) during exercise, with even more than 2.5x resting rate being nothing more than a good cardio workout.
As for “180 minus age” (presuming you mean: to calculate the safe maximum heart rate), more common (and used by the American Heart Association) is 220 minus age. In your case, that’d give 143.
Having atrial fibrillation may change this however, and we can’t offer medical advice.
We can point to this AHA “AFib Resources For Patients and Professionals”, including this handy FAQ sheet which says:
“Am I able to exercise?” / “Yes, as long as you’re cleared by your doctor, you can perform normal activities of daily living that you can tolerate” (accompanied by a little graphic of a person using an exercise bike)
You personally probably know this already, of course, but it’s quite an extensive collection of resources, so we thought we’d include it.
It’s certainly a good idea for everyone to be aware of their healthy heart rate ranges, regardless of having a known heart condition or not, though!
American Heart Association: Target Heart Rates Chart
❝I would like to see some articles on osteoporosis❞
You might enjoy this mythbusting main feature we did a few weeks ago!
The Bare-Bones Truth About Osteoporosis
❝Interesting, but… Did you know spinach is high in oxylates? Some people are sensitive and can cause increased inflammation, joint pain or even kidney stones. Moderation is key. My sister and I like to eat healthy but found out by experience that too much spinach salad caused us joint and other aches.❞
It’s certainly good to be mindful of such things! For most people, a daily serving of spinach shouldn’t cause ill effects, and certainly there are other greens to eat.
We wondered whether there was a way to reduce the oxalate content, and we found:
How to Reduce Oxalic Acid in Spinach: Neutralizing Oxalates
…which led us this product on Amazon:
Nephure Oxalate Reducing Enzyme, Low Oxalate Diet Support
We wondered what “nephure” was, and whether it could be trusted, and came across this “Supplement Police” article about it:
Nephure Review – Oxalate Reducing Enzyme Powder Health Benefits?
…which honestly, seems to have been written as a paid advertisement. But! It did reference a study, which we were able to look up, and find:
In vitro and in vivo safety evaluation of Nephure™
…which seems to indicate that it was safe (for rats) in all the ways that they checked. They did not, however, check whether it actually reduced oxalate content in spinach or any other food.
The authors did declare a conflict of interest, in that they had a financial relationship with the sponsor of the study, Captozyme Inc.
All in all, it may be better to just have kale instead of spinach:
- 20 Foods High in Oxalates to Limit if You Have Kidney Stones
- The Kidney Dietician: The Best Low Oxalate Greens
We turn the tables and ask you a question!
We’ll then talk about this tomorrow:
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Gut Health for Women – by Aurora Bloom
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First things first: though the title says “For Women”, almost all of it applies to men too—and the things that don’t apply, don’t cause a problem. So if you’re cooking for your family that contains one or more men, this is still great.
Bloom gives us a good, simple, practical introduction to gut health. Her overview also covers gut-related ailments beyond the obvious “tummy hurts”. On which note:
A very valuable section of this book covers dealing with any stomach-upsets that do occur… without harming your trillions of tiny friends (friendly gut microbiota). This alone can make a big difference!
The book does of course also cover the things you’d most expect: things to eat or avoid. But it goes beyond that, looking at optimizing and maintaining your gut health. It’s not just dietary advice here, because the gut affects—and is affected by—other lifestyle factors too. Ranges from mindful eating, to a synchronous sleep schedule, to what kinds of exercise are best to keep your gut ticking over nicely.
There’s also a two-week meal plan, and an extensive appendix of resources, not to mention a lengthy bibliography for sourcing health claims (and suggesting further reading).
In short, a fine and well-written guide to optimizing your gut health and enjoying the benefits.
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10 Lessons For A Healthy Mind & Body
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Sadia Badiei, food scientist of “Pick Up Limes” culinary fame, has advice in and out of the kitchen:
Pick up a zest for life
Here’s what she picked up, and we all can too:
- “I can’t do it… yet”: it’s never too late to adopt a growth mindset by adding “yet” to your self-doubt, focusing on progress and the possibility of improvement.
- The spotlight effect: people are generally too absorbed in their own lives to focus on you, so don’t worry too much about others’ perceptions.
- Nutrition by addition: focus on adding healthier foods to your diet rather than eliminating the less healthy ones to avoid restrictive mindsets. You can still eliminate the less healthy ones if you want to! It just shouldn’t be the primary focus. Focusing on a conceptually negative thing is rarely helpful.
- It’s ok to change: embrace change as a sign of growth and evolution, rather than seeing it as a failure or waste of time.
- The way you do one thing is the way you do everything: be mindful of how you approach small tasks, regular tasks, boring tasks, unwanted tasks—you can either create a habit of enthusiasm or a habit of suffering (it’s entirely your choice which)
- Setting goals for success: set goals based on actions you can control (inputs) rather than outcomes that are uncertain. Less “lose 10 lbs”, and more “eat fiber before starch”, for example.
- You probably can’t have it all at once: you can achieve all your dreams, but often not simultaneously; goals and desires unfold in stages over time.
- The five-year rule: before adopting a new lifestyle or habit, ask yourself if you can realistically sustain it for five years to ensure it’s not just a short-term fix. If you struggle with this prognostic, look backwards first instead. Which healthy habits have you maintained for decades, and which were you never able to make stick?
- Are you afraid or excited?: reframe fear as excitement, as both emotions share similar physical sensations and signify that you care about the outcome.
- The voice you hear most: speak kindly to yourself in self-talk to create a softer, more compassionate tone. Your subconscious is always listening, so reinforce healthy rather than unhealthy thought patterns.
For more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
80-Year-Olds Share Their Biggest Regrets
Take care!
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Sesame & Peanut Tofu
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Yesterday we learned how to elevate tofu from “nutrition” to “nutritious tasty snack” with our Basic Baked Tofu recipe; today we’re expanding on that, to take it from “nutritious tasty snack” to “very respectable meal”.
You will need
For the tofu:
- The Basic Baked Tofu that we made yesterday (consider making this to be “step zero” of today’s recipe if you don’t already have a portion in the fridge)
For the sauce:
- ⅓ cup peanut butter, ideally with no added sugar or salt (if allergic to peanuts specifically, use almond butter; if allergic to nuts generally, use tahini)
- ¼ bulb garlic, grated or crushed
- 1 tbsp tamarind paste
- 1½ tbsp tamari sauce (or low-sodium soy sauce, if a substitution is necessary)
- 1 tbsp sambal oelek (or sriracha sauce, if a substitution is necessary)
- 1 tsp ground coriander
- 1 tsp ground black pepper
- ½ tsp ground sweet cinnamon
- ½ tsp MSG (or else omit; do not substitute with salt in this case unless you have a particular craving)
- zest of 1 lime
For the vegetables:
- 14 oz broccolini / tenderstem broccoli, thick ends trimmed (failing that, any broccoli)
- 6 oz shelled edamame
- 1½ tsp toasted sesame oil
For serving:
- 4 cups cooked rice (we recommend our Tasty Versatile Rice recipe)
- ½ cup raw cashews, soaked in hot water for at least 5 minutes and then drained (if allergic, substitute cooked chickpeas, rinsed and drained)
- 1 tbsp toasted sesame seeds
- 1 handful chopped cilantro, unless you have the “this tastes like soap” gene, in which case substitute chopped parsley
Method
(we suggest you read everything at least once before doing anything)
1) Combine the sauce ingredients in a bowl and whisk well (or use a blender if you have one that’s comfortable with this relatively small quantity of ingredients). Taste it, and adjust the ingredient ratios if you’d like more saltiness, sweetness, sourness, spiciness, umami.
2) Prepare a bowl with cold water and some ice. Steam the broccolini and edamame for about 3 minutes; as soon as they become tender, dump them into the ice bathe to halt the cooking process. Let them chill for a few minutes, then drain, dry, and toss in the sesame oil.
3) Reheat the tofu if necessary (an air fryer is great for this), and then combine with half of the sauce in a bowl, tossing gently to coat well.
4) Add a little extra water to the remaining sauce, enough to make it pourable, whisking to an even consistency.
5) Assemble; do it per your preference, but we recommend the order: rice, vegetables, tofu, cashews, sauce, sesame seeds, herbs.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Tofu vs Seitan – Which is Healthier?
- Plant vs Animal Protein: Head to Head
- Sweet Cinnamon vs Regular Cinnamon – Which is Healthier?
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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