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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Coca-Cola vs Diet Coke – Which is Healthier?
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Our Verdict
When comparing Coca-Cola to Diet Coke, we picked the Diet Coke.
Why?
While the Diet Coke is bad, the Coca-Cola has mostly the same problems plus sugar.
The sugar in a can of Coca-Cola is 39g high-fructose corn syrup (the worst kind of sugar yet known to humanity), and of course it’s being delivered in liquid form (the most bioavailable way to get, which in this case, is bad).
To put those 39g into perspective, the daily recommended amount of sugar is 36g for men or 25g for women, according to the AHA.
The sweetener in Diet Coke is aspartame, which has had a lot of health risk accusations made against it, most of which have not stood up to scrutiny, and the main risk it does have is “it mimics sugar too well” and it can increase cravings for sweetness, and therefore higher consumption of sugars in other products. For this reason, the World Health Organization has recommended to simply reduce sugar intake without looking to artificial sweeteners to help.
Nevertheless, aspartame has been found safe (in moderate doses; the upper tolerance level would equate to more than 20 cans of diet coke per day) by food safety agencies ranging from the FDA to the EFSA, based on a large body of science.
Other problems that Diet Coke has are present in Coca-Cola too, such as its acidic nature (bad for tooth enamel) and gassy nature (messes with leptin/ghrelin balance).
Summary: the Diet Coke is relatively less unhealthy, but is still bad in numerous ways, and remains best avoided.
Read more:
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What Flexible Dieting Really Means
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When Flexibility Is The Dish Of The Day
This is Alan Aragon. Notwithstanding not being a “Dr. Alan Aragon”, he’s a research scientist with dozens of peer-reviewed nutrition science papers to his name, as well as being a personal trainer and fitness educator. Most importantly, he’s an ardent champion of making people’s pursuit of health and fitness more evidence-based.
We’ll be sharing some insights from a book of his that we haven’t reviewed yet, but we will link it at the bottom of today’s article in any case.
What does he want us to know?
First, get out of the 80s and into the 90s
In the world of popular dieting, the 80s were all about calorie-counting and low-fat diets. They did not particularly help.
In the 90s, it was discovered that not only was low-fat not the way to go, but also, regardless of the diet in question, rigid dieting leads to “disinhibition”, that is to say, there comes a point (usually not far into a diet) whereby one breaks the diet, at which point, the floodgates open and the dieter binges unhealthily.
Aragon would like to bring our attention to a number of studies that found this in various ways over the course of the 90s measuring various different metrics including rigid vs flexible dieting’s impacts on BMI, weight gain, weight loss, lean muscle mass changes, binge-eating, anxiety, depression, and so forth), but we only have so much room here, so here’s a 1999 study that’s pretty much the culmination of those:
Flexible vs. Rigid Dieting Strategies: Relationship with Adverse Behavioral Outcomes
So in short: trying to be very puritan about any aspect of dieting will not only not work, it will backfire.
Next, get out of the 90s into the 00s
…which is not only fun if you read “00s” out loud as “naughties”, but also actually appropriate in this case, because it is indeed important to be comfortable being a little bit naughty:
In 2000, Dr. Marika Tiggemann found that dichotomous perceptions of food (e.g. good/bad, clean/dirty, etc) were implicated as a dysfunctional cognitive style, and predicted not only eating disorders and mood disorders, but also adverse physical health outcomes:
Dieting and Cognitive Style: The Role of Current and Past Dieting Behaviour and Cognitions
This was rendered clearer, in terms of physical health outcomes, by Dr. Susan Byrne & Dr. Emma Dove, in 2009:
❝Weight loss was negatively associated with pre-treatment depression and frequency of treatment attendance, but not with dichotomous thinking. Females who regard their weight as unacceptably high and who think dichotomously may experience high levels of depression irrespective of their actual weight, while depression may be proportionate to the degree of obesity among those who do not think dichotomously❞
Aragon’s advice based on all this: while yes, some foods are better than others, it’s more useful to see foods as being part of a spectrum, rather than being absolutist or “black and white” about it.
Next: hit those perfect 10s… Imperfectly
The next decade expanded on this research, as science is wont to do, and for this one, Aragon shines a spotlight on Dr. Alice Berg’s 2018 study with obese women averaging 69 years of age, in which…
In other words (and in fact, to borrow Dr. Berg’s words from that paper),
❝encouraging a flexible approach to eating behavior and discouraging rigid adherence to a diet may lead to better intentional weight loss for overweight and obese older women❞
You may be wondering: what did this add to the studies from the 90s?
And the key here is: rather than being observational, this was interventional. In other words, rather than simply observing what happened to people who thought one way or another, this study took people who had a rigid, dichotomous approach to food, and gave them a 6-month behavioral intervention (in other words, support encouraging them to be more flexible and open in their approach to food), and found that this indeed improved matters for them.
Which means, it’s not a matter of fate or predisposition, as it could have been back in the 90s, per “some people are just like that; who’s to say which factor causes which”. Instead, now we know that this is an approach that can be adopted, and it can be expected to work.
Beyond weight loss
Now, so far we’ve talked mostly about weight loss, and only touched on other health outcomes. This is because:
- weight loss a very common goal for many
- it’s easy to measure so there’s a lot of science for it
Incidentally, if it’s a goal of yours, here’s what 10almonds had to say about that, along with two follow-up articles for other related goals:
Spoiler: we agree with Aragon, and recommend a relaxed and flexible approach to all three of these things
Aragon’s evidence-based approach to nutrition has found that this holds true for other aspects of healthy eating, too. For example…
To count or not to count?
It’s hard to do evidence-based anything without counting, and so Aragon talks a lot about this. Indeed, he does a lot of counting in scientific papers of his own, such as:
and
The effect of protein timing on muscle strength and hypertrophy: a meta-analysis
…as well as non-protein-related but diet-related topics such as:
But! For the at-home health enthusiast, Aragon recommends that the answer to the question “to count or not to count?” is “both”:
- Start off by indeed counting and tracking everything that is important to you (per whatever your current personal health intervention is, so it might be about calories, or grams of protein, or grams of carbs, or a certain fat balance, or something else entirely)
- Switch to a more relaxed counting approach once you get used to the above. By now you probably know the macros for a lot of your common meals, snacks, etc, and can tally them in your head without worrying about weighing portions and knowing the exact figures.
- Alternatively, count moderately standardized portions of relevant foods, such as “three servings of beans or legumes per day” or “no more than one portion of refined carbohydrates per day”
- Eventually, let habit take the wheel. Assuming you have established good dietary habits, this will now do you just fine.
This latter is the point whereby the advice (that Aragon also champions) of “allow yourself an unhealthy indulgence of 10–20% of your daily food”, as a budget of “discretionary calories”, eventually becomes redundant—because chances are, you’re no longer craving that donut, and at a certain point, eating foods far outside the range of healthiness you usually eat is not even something that you would feel inclined to do if offered.
But until that kicks in, allow yourself that budget of whatever unhealthy thing you enjoy, and (this next part is important…) do enjoy it.
Because it is no good whatsoever eating that cream-filled chocolate croissant and then feeling guilty about it; that’s the dichotomous thinking we had back in the 80s. Decide in advance you’re going to eat and enjoy it, then eat and enjoy it, then look back on it with a sense of “that was enjoyable” and move on.
The flipside of this is that the importance of allowing oneself a “little treat” is that doing so actively helps ensure that the “little treat” remains “little”. Without giving oneself permission, then suddenly, “well, since I broke my diet, I might as well throw the whole thing out the window and try again on Monday”.
On enjoying food fully, by the way:
Mindful Eating: How To Get More Nutrition Out Of The Same Food
Want to know more from Alan Aragon?
Today we’ve been working heavily from this book of his; we haven’t reviewed it yet, but we do recommend checking it out:
Enjoy!
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The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
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There’s a lot more to breast cancer care than “check your breasts regularly”. Because… And then what? “Go see a doctor” obviously, but it’s a scary prospect with a lot of unknowns.
Dr. Simmons demystifies these unknowns, from both her position as an oncologist (and breast surgeon) and also her position as a breast cancer survivor herself.
What she found, upon getting to experience the patient side of things, was that the system is broken in ways she’d never considered before as a doctor.
This book is the product of the things she’s learned both within her field, and elsewhere because of realizing the former’s areas of shortcoming.
She gives a step-by-step guide, from diagnosis onwards, advising taking as much as possible into one’s own hands—especially in the categories of information and action. She also explains the things that make the biggest difference to cancer outcomes when it comes to eating, sleeping, and so forth, the best attitude to have to be neither despairing and giving up, nor overconfident and complacent.
She does also talk complementary therapies, be they supplements or more out-of-the-box approaches and the evidence for them where applicable, as well as doing some high-quality mythbusting about more prescription-based considerations such as HRT.
Bottom line: if you or a loved one have a breast cancer diagnosis, or you just prefer knowing this sort of thing than not, then this book is a top-tier “insider’s guide”.
Click here to check out the Smart Woman’s Guide To Breast Cancer, and take control!
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Here’s how to help protect your family from norovirus
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.
What you need to know
- Norovirus is a very contagious infection that causes vomiting and diarrhea.
- The best way to help protect against norovirus is to wash your hands often with soap and warm water, since hand sanitizer may not be effective at killing the virus.
- If someone in your household has symptoms of norovirus, isolate them away from others, watch for signs of dehydration, and take steps to help prevent it from spreading.
If you feel like everyone is sick right now, you’re not alone. Levels of respiratory illnesses like COVID-19, flu, and RSV remain remain high in many states, and the U.S. is also battling a wave of norovirus, one of several viruses that cause a very contagious infection of the stomach and intestines.
Although norovirus infections are more common during the colder months—it’s also called the “winter vomiting disease”—the virus can spread at any time. Right now, however, cases have more than doubled since last year’s peak.
Read on to learn about the symptoms of norovirus, how it spreads, and what to do if someone in your household gets sick.
What are the symptoms of norovirus?
Norovirus is a very contagious infection that causes vomiting and diarrhea, which typically begins 12 to 48 hours after exposure to the virus. Additional symptoms may include stomach pain, body aches, headaches, and a fever. Norovirus typically resolves within three days, but people who are infected may still be contagious for up to two days after symptoms resolve.
Norovirus may cause dehydration, or a dangerous loss of fluids, especially in young children and older adults. See a health care provider if you or someone in your household shows signs of dehydration, which may include decreased urination, dizziness, a dry mouth and throat, sleepiness, and crying without tears.
How can you help protect against norovirus?
You can get norovirus if you have close contact with someone who is infected, touch a contaminated surface and then touch your mouth or nose, or consume contaminated food or beverages.
The best way to help protect yourself and others against norovirus is to wash your hands often with soap and warm water, since hand sanitizer may not be effective at killing the virus. Other ways to help protect yourself may include cooking food thoroughly and washing fruits and vegetables before eating them.
You can get sick with norovirus even if you’ve had it before, since there are many different strains.
How can families help protect against the spread of norovirus at home?
If someone in your household has symptoms of norovirus, isolate them away from others and watch for signs of dehydration. If you are sick with norovirus, do not prepare food for others in your household and use a separate bathroom, if possible.
When cleaning up after someone who has norovirus, wear rubber, latex, or nitrile gloves. Then wash your hands thoroughly.
Clean surfaces using a solution containing five to 25 tablespoons of bleach (that’s 12.5 fluid ounces, or just over ¾ cup), per gallon of water. Leave the bleach-water mix on surfaces for at least five minutes before wiping it off.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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The Alzheimer’s Gene That Varies By Race & Sex
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The Alzheimer’s Gene That Varies By Race & Sex
You probably know that there are important genetic factors that increase or decrease Alzheimer’s Risk. If you’d like a quick refresher before we carry on, here are two previous articles on this topic:
- Genetic Testing: Health Benefits & Methods (about personal genomics and health, including Alzheimer’s)
- The Surprising Link Between Type 2 Diabetes & Alzheimer’s (about the APOE-ε4 allele that is implicated in both)
A Tale of Two Alleles
It has generally been understood that APOE-ε2 lowers Alzheimer’s disease risk, and APOE-ε4 increases it.
However, for reasons beyond the scope of this article, research populations for genetic testing are overwhelmingly white. If you, dear reader, are white, you may be thinking “well, I’m white, so this isn’t a problem for me”, you might still want to read on…
An extensive new study, published days ago, by Dr. Belloy et al., looked at how these correlations held out per race and sex. They found:
- The “APOE-ε2 lowers; APOE-ε4 increases” dictum held out strongest for white people.
- In the case of Hispanic people, there was only a small correlation on the APOE-ε4 side of things, and none on the APOE-ε2 side of things per se.
- East Asians also saw no correlation with regard to APOE-ε2 per se.
- But! Hispanic and East Asian people had a reduced risk of Alzheimer’s if and only if they had both APOE-ε2 and APOE-ε4.
- Black people, meanwhile, saw a slight correlation with regard to the protective effect of APOE-ε2, and as for APOE-ε4, if they had any European ancestry, increased European ancestry meant a higher increased risk factor if they had APOE-ε4. African ancestry, on the other hand, had a protective effect, proportional to the overall amount of that ancestry.
And as for sex…
- Specifically for white people with the APOE-ε3/ε4 genotype, especially in the age range of 60–70, the genetic risk for Alzheimer’s was highest in women.
If you’d like to read more and examine the data for yourself:
APOE Genotype and Alzheimer Disease Risk Across Age, Sex, and Population Ancestry
Want to reduce your Alzheimer’s risk?
We have just the thing for you:
How To Reduce Your Alzheimer’s Risk: It’s Never Too Early To Do These 11 Things
Take care!
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What families should know about whooping cough
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What you need to know
- Whooping cough is a bacterial respiratory illness that can cause long-term symptoms and even death.
- Two types of vaccines protect against it: The DTap vaccine is given to babies and children up to 6 years old, while the Tdap vaccine is given to children 7 years and older and adults.
- If you or your child has symptoms of whooping cough, isolate them from vulnerable family members and seek treatment early to reduce the risk of serious illness.
Whooping cough, also called pertussis, is a highly contagious respiratory illness that’s particularly dangerous for babies. Cases are now at least four times as high as they were at this time last year. Fortunately, vaccines are extremely effective at preventing the disease across age groups.
Read on to learn about the symptoms and risks of whooping cough, who should get vaccinated, and what to do when symptoms appear.What are the symptoms of whooping cough?
Early symptoms of whooping cough typically appear five to 10 days after exposure and may include a runny or stuffy nose, a low fever, and a mild cough. One to two weeks later, some people may experience extreme coughing fits that can cause shortness of breath, trouble sleeping, vomiting, fatigue, and rib fractures. These fits usually last one to six weeks, but they can last up to 10 weeks after infection.
About one in three babies under 1 year old who contract whooping cough require hospitalization, as they may experience life-threatening pauses in breathing (called apnea), pneumonia, and other complications. Children and adults who have asthma or are immunocompromised are also more likely to develop severe symptoms.
Which vaccines protect against whooping cough, and who is eligible?
Two types of vaccines protect against whooping cough: The DTap vaccine is given to babies and children up to 6 years old, while the Tdap vaccine is given to children 7 years and older and adults. Both vaccines protect against infections from diptheria, tetanus, and pertussis.
The Centers for Disease Control and Prevention recommends that pregnant people receive a single dose of the Tdap vaccine between 27 and 36 weeks of pregnancy, as this lowers the risk of whooping cough in babies younger than 2 months old by 78 percent.
Multiple doses are required for the best protection. Learn more about DTaP and Tdap vaccine schedules from the CDC, and talk to your health care provider about how many doses you and your children need.
What should families do when whooping cough symptoms appear?
If you or your child has symptoms of whooping cough, isolate the infected person from vulnerable family members. It’s also important to seek treatment early to reduce the risk of serious illness. Health care providers typically prescribe antibiotics to those recovering at home.
Over-the-counter cough and cold medicine is not recommended for children under 4 years old. However, limiting smoke, dust, and chemical fumes at home and using a humidifier can reduce coughing. If you are caring for someone with whooping cough who exhibits pauses in breathing or develops gray or blue skin, call 911 immediately.
For more information, talk to your health care provider.Don’t Forget…
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