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:

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.❞

~ Zaazouee et al., 2022

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).❞

~ Wilding et al., 2021

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

Source: Gamechanger drug for treating obesity cuts body weight by 20% <- University College London Hospitals (NHS)

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:

Rybelsus / Ozempic / Wegovy

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  • California Becomes Latest State To Try Capping Health Care Spending

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    California’s Office of Health Care Affordability faces a herculean task in its plan to slow runaway health care spending.

    The goal of the agency, established in 2022, is to make care more affordable and accessible while improving health outcomes, especially for the most disadvantaged state residents. That will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.

    Can the new agency get insurers, hospitals, and medical groups to collaborate on containing costs even as they jockey for position in the state’s $405 billion health care economy? Can the system be transformed so that financial rewards are tied more to providing quality care than to charging, often exorbitantly, for a seemingly limitless number of services and procedures?

    The jury is out, and it could be for many years.

    California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets.

    Massachusetts, which started annual spending targets in 2013, was the first state to do so. It’s the only one old enough to have a substantial pre-pandemic track record, and its results are mixed: The annual health spending increases were below the target in three of the first five years and dropped beneath the national average. But more recently, health spending has greatly increased.

    In 2022, growth in health care expenditures exceeded Massachusetts’ target by a wide margin. The Health Policy Commission, the state agency established to oversee the spending control efforts, warned that “there are many alarming trends which, if unaddressed, will result in a health care system that is unaffordable.”

    Neighboring Rhode Island, despite a preexisting policy of limiting hospital price increases, exceeded its overall health care spending growth target in 2019, the year it took effect. In 2020 and 2021, spending was largely skewed by the pandemic. In 2022, the spending increase came in at half the state’s target rate. Connecticut and Delaware, by contrast, both overshot their 2022 targets.

    It’s all a work in progress, and California’s agency will, to some extent, be playing it by ear in the face of state policies and demographic realities that require more spending on health care.

    And it will inevitably face pushback from the industry as it confronts unreasonably high prices, unnecessary medical treatments, overuse of high-cost care, administrative waste, and the inflationary concentration of a growing number of hospitals in a small number of hands.

    “If you’re telling an industry we need to slow down spending growth, you’re telling them we need to slow down your revenue growth,” says Michael Bailit, president of Bailit Health, a Massachusetts-based consulting group, who has consulted for various states, including California. “And maybe that’s going to be heard as ‘we have to restrain your margins.’ These are very difficult conversations.”

    Some of California’s most significant health care sectors have voiced disagreement with the fledgling affordability agency, even as they avoid overtly opposing its goals.

    In April, when the affordability office was considering an annual per capita spending growth target of 3%, the California Hospital Association sent it a letter saying hospitals “stand ready to work with” the agency. But the proposed number was far too low, the association argued, because it failed to account for California’s aging population, new investments in Medi-Cal, and other cost pressures.

    The hospital group suggested a spending increase target averaging 5.3% over five years, 2025-29. That’s slightly higher than the 5.2% average annual increase in per capita health spending over the five years from 2015 to 2020.

    Five days after the hospital association sent its letter, the affordability board approved a slightly less aggressive target that starts at 3.5% in 2025 and drops to 3% by 2029. Carmela Coyle, the association’s chief executive, said in a statement that the board’s decision still failed to account for an aging population, the growing need for mental health and addiction treatment, and a labor shortage.

    The California Medical Association, which represents the state’s doctors, expressed similar concerns. The new phased-in target, it said, was “less unreasonable” than the original plan, but the group would “continue to advocate against an artificially low spending target that will have real-life negative impacts on patient access and quality of care.”

    But let’s give the state some credit here. The mission on which it is embarking is very ambitious, and it’s hard to argue with the motivation behind it: to interject some financial reason and provide relief for millions of Californians who forgo needed medical care or nix other important household expenses to afford it.

    Sushmita Morris, a 38-year-old Pasadena resident, was shocked by a bill she received for an outpatient procedure last July at the University of Southern California’s Keck Hospital, following a miscarriage. The procedure lasted all of 30 minutes, Morris says, and when she received a bill from the doctor for slightly over $700, she paid it. But then a bill from the hospital arrived, totaling nearly $9,000, and her share was over $4,600.

    Morris called the Keck billing office multiple times asking for an itemization of the charges but got nowhere. “I got a robotic answer, ‘You have a high-deductible plan,’” she says. “But I should still receive a bill within reason for what was done.” She has refused to pay that bill and expects to hear soon from a collection agency.

    The road to more affordable health care will be long and chock-full of big challenges and unforeseen events that could alter the landscape and require considerable flexibility.

    Some flexibility is built in. For one thing, the state cap on spending increases may not apply to health care institutions, industry segments, or geographic regions that can show their circumstances justify higher spending — for example, older, sicker patients or sharp increases in the cost of labor.

    For those that exceed the limit without such justification, the first step will be a performance improvement plan. If that doesn’t work, at some point — yet to be determined — the affordability office can levy financial penalties up to the full amount by which an organization exceeds the target. But that is unlikely to happen until at least 2030, given the time lag of data collection, followed by conversations with those who exceed the target, and potential improvement plans.

    In California, officials, consumer advocates, and health care experts say engagement among all the players, informed by robust and institution-specific data on cost trends, will yield greater transparency and, ultimately, accountability.

    Richard Kronick, a public health professor at the University of California-San Diego and a member of the affordability board, notes there is scant public data about cost trends at specific health care institutions. However, “we will know that in the future,” he says, “and I think that knowing it and having that information in the public will put some pressure on those organizations.”

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • The Path to Longevity – by Dr. Luigi Fontana

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    We’ve reviewed other “expand your healthspan” books, and while they’re good (or else we wouldn’t include them), this is top-tier, up there with Dr. Greger’s books while being more accessible (more on this later).

    This book is far more informational than opinionated, and while some reviewers have described the book as motivating them, that’s not at all the tone, and it’s clear that (beyond hoping for the reader to have to information to promote a long healthy life), the author has no particular agenda to push.

    One example: while he gives a whole-foods, plant-based diet a “A+” rating, he puts the (often meat/fish-heavy) paleo diet at a close “A-“, depending on the animal products chosen (which can swing it a lot, and he discusses this in some detail).

    In the category of criticism… This reviewer has none. Sometimes it seemed something was going unaddressed, but it would be addressed later.

    Stylistically, the text is easy-reading and/but has a lot of references to hard science, complete with charts, diagrams, and so forth. The impression that this reviewer got is that Dr. Fontana took pains to convey as much science as possible, with (unlike Dr. Greger) as little jargon as possible. And that goes a long way.

    Bottom line: if you’re looking for a “healthy aging” book that has a lot more science than “copy the Blue Zone supercentenarians and hope” without being so scientifically dense as “How Not To Die” or “How Not To Age“, then this is the book for you.

    Click here to check out The Path to Longevity, and optimize the path you take!

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  • Spinach vs Chard – Which is Healthier?

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    Our Verdict

    When comparing spinach to chard, we picked the spinach.

    Why?

    In terms of macros, spinach has slightly more fiber and protein, while chard has slightly more carbs. Now, those carbs are fine; nobody is getting metabolic disease from eating greens. But, by the numbers, this is a clear, albeit marginal, win for spinach.

    In the category of vitamins, spinach has more of vitamins A, B1, B2, B3, B5, B6, B9, E, and K, while chard has more of vitamins C and choline. An even clearer victory for spinach this time.

    When it comes to minerals, spinach has more calcium, copper, iron, magnesium, manganese, phosphorus, selenium, and zinc, while chard has more potassium. Once again, a clear win for spinach.

    You may be wondering about oxalates, in which spinach is famously high. However, chard is nearly 2x higher in oxalates. In practical terms, this doesn’t mean too much for most people. If you have kidney problems or a family history of such, it is recommended to avoid oxalates. For everyone else, the only downside is that oxalates diminish calcium bioavailability, which is a pity, as spinach is (by the numbers) a good source of calcium.

    However, oxalates are broken down by heat, so this means that cooked spinach (lightly steamed is fine; you don’t need to do anything drastic) will be much lower in oxalates (if you have kidney problems, do still check with your doctor/dietician, though).

    All in all, spinach beats chard by most metrics, and by a fair margin. Still, enjoy either or both, unless you have kidney problems, in which case maybe go for kale or collard greens instead!

    Want to learn more?

    You might like to read:

    Make Your Vegetables Work Better Nutritionally ← includes a note on breaking down oxalates, and lots of other information besides!

    Enjoy!

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  • The Glucose Goddess Method – by Jessie Inchausspé

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve previously reviewed Inchausspé’s excellent book “Glucose Revolution”. So what does this book add?

    This book is for those who found that book a little dense. While this one still gives the same ten “hacks”, she focuses on the four that have the biggest effect, and walks the reader by the hand through a four-week programme of implementing them.

    The claim of 100+ recipes is a little bold, as some of the recipes are things like vinegar, vinegar+water, vinegar+water but now we’re it’s in a restaurant, lemon+water, lemon+water but now it’s in a bottle, etc. However, there are legitimately a lot of actual recipes too.

    Where this book’s greatest strength lies is in making everything super easy, and motivating. It’s a fine choice for being up-and-running quickly and easily without wading through the 300-odd pages of science in her previous book.

    Bottom line: if you’ve already happily and sustainably implemented everything from her previous book, you can probably skip this one. However, if you’d like an easier method to implement the changes that have the biggest effect, then this is the book for you.

    Click here to check out The Glucose Goddess Method, and build it into your life the easy way!

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  • The Five Key Traits Of Healthy Aging

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    The Five Keys Of Aging Healthily

    Image courtesy of Peter Prato.

    This is Dr. Daniel Levitin. He’s a neuroscientist, and his research focuses on aging, the brain, health, productivity, and creativity. Also music, and he himself is an accomplished musician also, but we’re not going to be focusing on that today.

    We’re going to be looking at the traits that, according to science, promote healthy longevity in old age. In other words, the things that increase our healthspan, from the perspective of a cognitive scientist.

    What does he say we should do?

    Dr. Levitin offers us what he calls the “COACH” traits:

    1. Curiosity
    2. Openness
    3. Associations
    4. Conscientiousness
    5. Healthy practices

    By “associations”, he means relationships. However, that would have made the acronym “CORCH”, and decisions had to be made.

    Curiosity

    Leonardo da Vinci had a list of seven traits he considered most important.

    We’ll not go into those today (he is not our featured expert of the day!), but we will say that he agreed with Dr. Levitin on what goes at the top of the list: curiosity.

    • Without curiosity, we will tend not to learn things, and learning things is key to keeping good cognitive function in old age
    • Without curiosity, we will tend not to form hypotheses about how/why things are the way they are, so we will not exercise imagination, creativity, problem-solving, and other key functions of our brain
    • Without curiosity, we will tend not to seek out new experiences, and consequently, our stimuli will be limited—and thus, so will our brains

    Openness

    Being curious about taking up ballroom dancing will do little for you, if you are not also open to actually trying it. But, openness is not just a tag-on to curiosity; it deserves its spot in its own right too.

    Sometimes, ideas and opportunities come to us unbidden, and we have to be able to be open to those too. This doesn’t mean being naïve, but it does mean having at least a position of open-minded skepticism.

    Basically, Dr. Levitin is asking us to be the opposite of the pejorative stereotype of “an old person stuck in their ways”.

    Associations

    People are complex, and so they bring complexities to our lives. Hopefully, positively stimulating ones. Without them to challenge us (again, hopefully in a positive way), we can get very stuck in a narrow field of experience.

    And of course, having at least a few good friends has numerous benefits to health. There’s been a lot of research on this; 5 appears to be optimal.

    • More than that, and the depth tends to tail off, and/or stresses ensue from juggling too many relationships
    • Fewer than that, and we might be only a calendar clash away from loneliness

    Friends provide social stimulation and mutual support; they’re good for our mental health and even our physiological immunity (counterintuitively, by means of shared germs).

    And, a strong secure romantic relationship is something that has been found time and again to extend healthy life.

    Note: by popular statistics, this benefit is conferred upon men partnered with women, men partnered with men, women partnered with women, but not women partnered with men.

    There may be a causative factor that’s beyond the scope of this article which is about cognitive science, not feminism, but there could also be a mathematical explanation for this apparent odd-one-out:

    Since women tend to live longer than men (who are also often older than their female partners), women who live the longest are often not in a relationship—precisely because they are widows. So these long-lived widows will tend to skew the stats, through no fault of their husbands.

    On the flipside of this, for a woman to predecease her (statistically older and shorter-lived) husband will often require that she die quite early (perhaps due to accident or illness unrelated to age), which will again skew the stats to “women married to men die younger”, without anything nefarious going on.

    Conscientiousness

    People who score highly in the character trait “conscientiousness” will tend to live longer. The impact is so great, that a child’s scores will tend to dictate who dies in their 60s or their 80s, for example.

    What does conscientiousness mean? It’s a broad character trait that’s scored in psychometric tests, so it can be things that have a direct impact on health, such as brushing one’s teeth, or things that are merely correlated, such as checking one’s work for typos (this writer does her best!).

    In short, if you are the sort of person who attends to the paperwork for your taxes on time, you are probably also the sort of person who remembers to get your flu vaccination and cancer screening.

    Healthy practices

    This means “the usual things”, such as:

    Want to learn more?

    You can check out his book, which we reviewed all so recently, and you can also enjoy this video, in which he talks about matters concerning healthy aging from a neuroscientist’s perspective, ranging from heart health and neurodegeneration, to the myth of failing memory, to music and lifespan and more:

    !

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  • Black Bean Hummus Panini

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    A recipe for a sandwich? Try it once, and you’ll see why. Welcome to your new favorite!

    You will need

    Method

    (we suggest you read everything at least once before doing anything)

    1) Grill the eggplant slices until soft.

    2) Spread hummus generously on one side of both slices of bread.

    2) Add the black beans on top of one slice (the hummus will help them stay in place), followed by the sun-dried tomatoes and then the eggplant. Top with the other slice of bread, hummus-side down.

    3) Coat (carefully, please) the inside of the panini press (both interior sides) with olive oil. If you don’t have sprayable oil, using a sheet of kitchen roll to apply the oil is a good way to do it without making a mess.

    4) Grill the assembled sandwich, until the bread starts to brown and the insides are warm; this should take about 4 minutes.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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