Semaglutide’s Surprisingly Unexamined Effects
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Semaglutide’s Surprisingly Big Research Gap
GLP-1 receptor agonists like Ozempic, Wegovy, and other semaglutide drugs. are fast becoming a health industry standard go-to tool in the weight loss toolbox. When it comes to recommending that patients lose weight, “Have you considered Ozempic?” is the common refrain.
Sometimes, this may be a mere case of kicking the can down the road with regard to some other treatment that it can be argued (sometimes even truthfully) would go better after some weight loss:
How weight bias in health care can harm patients with obesity: Research
…which we also covered in fewer words in the second-to-last item here:
But GLP-1 agonists work, right?
Yes, albeit there’s a litany of caveats, top of which are usually:
- there are often adverse gastrointestinal side effects
- if you stop taking them, weight regain generally ensues promptly
For more details on these and more, see:
…but now there’s another thing that’s come to light:
The dark side of semaglutide’s weight loss
In academia, “dark” is often used to describe “stuff we don’t have much (or in some cases, any) direct empirical evidence of, but for reasons of surrounding things, we know it’s there”.
Well-known examples include “dark matter” in physics and the Dark Ages in (European) history.
In the case of semaglutide and weight loss, a review by a team of researchers (Drs. Sandra Christenen, Katie Robinson, Sara Thomas, and Dominique Williams) has discovered how little research has been done into a certain aspect of GLP-1 agonist’s weight loss effects, namely…
Dietary changes!
There’s been a lot of popular talk about “people taking semaglutide eat less”, but it’s mostly anecdotal and/or presumed based on parts of the mechanism of action (increasing insulin production, reducing glucagon secretions, modulating dietary cravings).
Where studies have looked at dietary changes, it’s almost exclusively been a matter of looking at caloric intake (which has been found to be a 16–39% reduction), and observations-in-passing that patients reported reduction in cravings for fatty and sweet foods.
This reduction in caloric intake, by the way, is not significantly different to the reduction brought about by counselling alone (head-to-head studies have been done; these are also discussed in the research review).
However! It gets worse. Very few studies of good quality have been done, even fewer (two studies) actually had a registered dietitian nutritionist on the team, and only one of them used the “gold standard” of nutritional research, the 24-hour dietary recall test. Which, in case you’re curious, you can read about what that is here:
Dietary Assessment Methods: What Is A 24-Hour Recall?
Of the four studies that actually looked at the macros (unlike most studies), they found that on average, protein intake decreased by 17.1%. Which is a big deal!
It’s an especially big deal, because while protein’s obviously important for everyone, it’s especially important for anyone trying to lose weight, because muscle mass is a major factor in metabolic base rate—which in turn is much important for fat loss/maintenance than exercise, when it comes to how many calories we burn by simply existing.
A reasonable hypothesis, therefore, is that one of the numerous reasons people who quit GLP-1 agonists immediately put fat back on, is because they probably lost muscle mass in amongst their weight loss, meaning that their metabolic base rate will have decreased, meaning that they end up more disposed to put on fat than before.
And, that’s just a hypothesis and it’s a hypothesis based on very few studies, so it’s not something to necessarily take as any kind of definitive proof of anything, but it is to say—as the researchers of this review do loudly say—more research needs to be done into this, because this has been a major gap in research so far!
Any other bad news?
While we’re talking research gaps, guess how many studies looked into micronutrient intake changes in people taking GLP-1 agonists?
If you guessed zero, you guessed correctly.
You can find the paper itself here:
What’s the main take-away here?
On a broad, scoping level: we need more research!
On a “what this means for individuals who want to lose weight” level: maybe we should be more wary of this still relatively new (less than 10 years old) “wonder drug”. And for most of those 10 years it’s only been for diabetics, with weight loss use really being in just the past few years (2021 onwards).
In other words: not necessarily any need to panic, but caution is probably not a bad idea, and natural weight loss methods remain very reasonable options for most people.
See also: How To Lose Weight (Healthily!)
Take care!
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Shredded Wheat vs Organic Crunch – Which is Healthier?
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Our Verdict
When comparing Shredded Wheat to Organic Crunch, we picked the Shredded Wheat.
Why?
In this battle of the cereals, it comes down to the ingredients:
- The Shredded Wheat cereal has two ingredients: wheat (shredded), and BHT. The latter is a phenolic compound and antioxidant.
- The Organic Crunch cereal has lots of ingredients, of which the first two are wheat flour, and sugar.
This means that, per serving…
- The Shredded Wheat cereal has 7g fiber and 0g sugar
- The Organic Crunch cereal has 3g fiber and 12g sugar
Quite a difference! Sometimes, the “Organic Crunch” of a product comes from crunchy sugar.
You can check them out side-by-side here:
Shredded Wheat | Organic Crunch
Want to know more?
There’s a popular view that the only way to get fiber is to eat things that look (and potentially taste) like cardboard. Not so! There are delicious options:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Enjoy!
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Why do I need to get up during the night to wee? Is this normal?
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It can be normal to wake up once or even twice during the night to wee, especially as we get older.
One in three adults over 30 makes at least two trips to the bathroom every night.
Waking up from sleep to urinate on a regular basis is called nocturia. It’s one of the most commonly reported bothersome urinary symptoms (others include urgency and poor stream).
So what causes nocturia, and how can it affect wellbeing?
A range of causes
Nocturia can be caused by a variety of medical conditions, such as heart or kidney problems, poorly controlled diabetes, bladder infections, an overactive bladder, or gastrointestinal issues. Other causes include pregnancy, medications and consumption of alcohol or caffeine before bed.
While nocturia causes disrupted sleep, the reverse is true as well. Having broken sleep, or insomnia, can also cause nocturia.
When we sleep, an antidiuretic hormone is released that slows down the rate at which our kidneys produce urine. If we lie awake at night, less of this hormone is released, meaning we continue to produce normal rates of urine. This can accelerate the rate at which we fill our bladder and need to get up during the night.
Stress, anxiety and watching television late into the night are common causes of insomnia.
Sometimes we need to get up late at night to pee.
Christian MoroEffects of nocturia on daily functioning
The recommended amount of sleep for adults is between seven and nine hours per night. The more times you have to get up in the night to go to the bathroom, the more this impacts sleep quantity and quality.
Decreased sleep can result in increased tiredness during the day, poor concentration, forgetfulness, changes in mood and impaired work performance.
If you’re missing out on quality sleep due to nighttime trips to the bathroom, this can affect your quality of life.
In more severe cases, nocturia has been compared to having a similar impact on quality of life as diabetes, high blood pressure, chest pain, and some forms of arthritis. Also, frequent disruptions to quality and quantity of sleep can have longer-term health impacts.
Nocturia not only upsets sleep, but also increases the risk of falls from moving around in the dark to go to the bathroom.
Further, it can affect sleep partners or others in the household who may be disturbed when you get out of bed.
Can you have a ‘small bladder’?
It’s a common misconception that your trips to the bathroom are correlated with the size of your bladder. It’s also unlikely your bladder is smaller relative to your other organs.
If you find you are having to wee more than your friends, this could be due to body size. A smaller person drinking the same amount of fluids as someone larger will simply need to go the bathroom more often.
If you find you are going to the bathroom quite a lot during the day and evening (more than eight times in 24 hours), this could be a symptom of an overactive bladder. This often presents as frequent and sudden urges to urinate.
If you are concerned about any lower urinary tract symptoms, it’s worth having a chat with your family GP.
There are some medications that can assist in the management of nocturia, and your doctor will also be able to help identify any underlying causes of needing to go to the toilet during the night.
A happy and healthy bladder
Here are some tips to maintain a happy and healthy bladder, and reduce the risk you’ll be up at night:
- make your sleep environment comfortable, with a suitable mattress and sheets to suit the temperature
- get to bed early, and limit screens, or activites before bed
- limit foods and drinks that irritate the bladder, such as coffee or alcohol, especially before bedtime
- sit in a relaxed position when urinating, and allow time for the bladder to completely empty
- practice pelvic floor muscle exercises
- drink an adequate amount of fluids during the day, and avoid becoming dehydrated
- maintain a healthy lifestyle, eat nutritious foods and do not do anything harmful to the body such as smoking or using illicit drugs
- review your medications, as the time you take some pharmaceuticals may affect urine production or sleep
- if you have swollen legs, raise them a few hours before bedtime to let the fluid drain.
Christian Moro, Associate Professor of Science & Medicine, Bond University and Charlotte Phelps, Senior Teaching Fellow, Medical Program, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Younger – by Dr. Sara Gottfried
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Does this do the things it says in the subtitle? In honestly, not really, no, but what it does do (if implemented) is modify your gene expression, slow aging, and extend healthspan. Which is all good stuff, even if it’s not the snappy SEO-oriented keywords in the subtitle.
A lot of the book pertains to turning certain genes (e.g. SIRT1, mTOR, VDR, APOE4, etc) on or off per what is sensible in each case, noting that while genes are relatively fixed (technically they can be changed, but the science is young and we can’t do much yet), gene expression is something we can control quite a bit. And while it may be unsettling to have the loaded gun that is the APOE4 gene being held against your head, at the end of the day there are things we can do that influence whether the trigger gets pulled, and when. Same goes for other undesirable genes, and also for the desirable ones that are useless if they never actually get expressed.
She offers (contained within the book, not as an upsell) a 7-week program that aims to set the reader up with good healthy habits to do just that and thus help keep age-related maladies at bay, and if we slip up, perhaps later in the year or so, we can always recommence the program.
The advice is also just good health advice, even without taking gene expression into account, because there are a stack of benefits to each of the things in her protocol.
The style is personable without being padded with fluff, accessible without dumbing down, and information-dense without being a challenging read. The formatting helps a lot also; a clear instructional layout is a lot better than a wall of text.
Bottom line: if you’d like to tweak your genes for healthy longevity, this book can help you do just that!
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Singledom & Healthy Longevity
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Statistically, those who live longest, do so in happy, fulfilling, committed relationships.
Note: happy, fulfilling, committed relationships. Less than that won’t do. Your insurance company might care about your marital status for its own sake, but your actual health doesn’t—it’s about the emotional safety and security that a good, healthy, happy, fulfilling relationship offers.
We wrote about this here:
Only One Kind Of Relationship Promotes Longevity This Much!
But that’s not the full story
For a start, while being in a happy fulfilling committed relationship statistically adds healthy life years, being in a relationship that falls short of those adjectives certainly does not. See also:
Relationships: When To Stick It Out & When To Call It Quits
But also, life satisfaction steadily improves with age, for single people (the results are more complicated for partnered people—probably because of the range of difference in quality of relationships). At least, this held true in this large (n=6,188) study of people aged 40–85 years:
❝With advancing age, partnership status became less predictive of loneliness and the satisfaction with being single increased. Among later-born cohorts, the association between partnership status and loneliness was less strong than among earlier-born cohorts. Later-born single people were more satisfied with being single than their earlier-born counterparts.❞
Note that this does mean that while life satisfaction indeed improves with age for single people, that’s a generalized trend, and the greatest life satisfaction within this set of singles comes hand-in-hand with being single by choice rather than by perceived obligation, i.e., those who are “single and not looking” will generally be the most content, and this contentedness will improve with age, but for those who are “single and looking”, in that case it’s the younger people who have it better, likely due to a greater sense of having plenty of time.
For that matter, gender plays a role; this large survey of singles found that (despite the popular old pop-up ads advising that “older women in your area are looking to date”), in reality older single women were the least likely to actively look for a partner:
See: A Profile Of Single Americans
…which also shows that about half of single Americans are “not looking”, and of those who are, about half are open to a serious relationship, though this is more common under the age of 40, while being over the age of 40 sees more people looking only for something casual.
Take-away from this section: being single only decreases life satisfaction if one doesn’t enjoy being single, and even then, and increases it if one does enjoy being single.
But that’s about life satisfaction, not longevity
We found no studies specifically into longevity of singledom, only the implications that may be drawn from the longevity of partnered people.
However, there is a lot of research that shows it’s not being single that kills, it’s being socially isolated. It’s a function of neurodegeneration from a lack of conversation, and it’s a function of what happens when someone slips in the shower and is found a week later. Things like that.
For example: Is Living Alone “Aging Alone”? Solitary Living, Network Types, and Well-Being
What if you are alone and don’t want to be?
We’ve not, at time of writing, written dating advice in our Psychology Sunday section, but this writer’s advice is: don’t even try.
That’s not nihilism or even cynicism, by the way; it’s actually a kind of optimism. The trick is just to let them come to you.
(sample size of one here, but this writer has never looked for a relationship in her life, they’ve always just found me, and now that I’m widowed and intend to remain single, I still get offers—and no, I’m not a supermodel, nor rich, nor anything like that)
Simply: instead of trying to find a partner, just work on expanding your social relationships in general (which is much easier, because the process is something you can control, whereas the outcome of trying to find a suitable partner is not), and if someone who’s right for you comes along, great! If not, then well, at least you have a flock of friends now, and who knows what new unexpected romance may lie around the corner.
As for how to do that,
How To Beat Loneliness & Isolation
Take care!
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Meningitis Outbreak
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Don’t Let Your Guard Down
In the US, meningitis is currently enjoying a 10-year high, with its highest levels of infection since 2014.
This is a big deal, given the 10–15% fatality rate of meningitis, even with appropriate medical treatment.
But of course, not everyone gets appropriate medical treatment, especially because symptoms can become life-threatening in a matter of hours.
Most recent stats gave an 18% fatality rate for the cases with known outcomes in the last year:
CDC Emergency | Increase in Invasive Serogroup Y Meningococcal Disease in the United States
The quick facts:
❝Meningococcal disease most often presents as meningitis, with symptoms that may include fever, headache, stiff neck, nausea, vomiting, photophobia, or altered mental status.
[It can also present] as meningococcal bloodstream infection, with symptoms that may include fever and chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, diarrhea, or, in later stages, a dark purple rash.
While initial symptoms of meningococcal disease can at first be non-specific, they worsen rapidly, and the disease can become life-threatening within hours. Immediate antibiotic treatment for meningococcal disease is critical.
Survivors may experience long-term effects such as deafness or amputations of the extremities.❞
~ Ibid.
The good news (but still don’t let your guard down)
Meningococcal bacteria are, happily, not spread as easily as cold and flu viruses.
The greatest risks come from:
- Close and enduring proximity (e.g. living together)
- Oral, or close-to-oral, contact (e.g. kissing, or coughing nearby)
Read more:
CDC | Meningococcal Disease: Causes & How It Spreads
Is there a vaccine?
There is, but it’s usually only offered to those most at risk, which is usually:
- Children
- Immunocompromised people, especially if HIV+
- People taking certain medications (e.g. Solaris or Ultomiris)
Read more:
CDC | Meningococcal Vaccine Recommendations
Will taking immune-boosting supplements help?
Honestly, probably not, but they won’t harm either. The most important thing is: don’t rely on them—too many people pop a vitamin C supplement and then assume they are immune to everything, and it doesn’t work like that.
On a tangential note, for more general immune health, you might also want to check out:
Beyond Supplements: The Real Immune-Boosters!
The short version:
If you or someone you know experiences the above-mentioned symptoms, even if it does not seem too bad, get thee/them to a doctor, and quickly, because the (very short) clock may be ticking already.
Better safe than sorry.
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Cabbage vs Cauliflower – Which is Healthier?
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Our Verdict
When comparing cabbage to cauliflower, we picked the cauliflower.
Why?
First, let’s note: these are two different cultivars of the same species (Brassica oleracea) and/but as usual (we say, as there are a lot of cultivars of Brassica oleracea, and we’ve done a fair few pairings of them before) there are still nutritional differences to consider, such as…
In terms of macros, cabbage has very slightly more carbs and fiber, while cauliflower has very slightly more protein. However, the numbers are all so close (and the glycemic index equal), such that we’re going to call the macros category a tie.
In the category of vitamins, cabbage has more of vitamins A, B1, E, and K, while cauliflower has more of vitamins B2, B3, B5, B6, B7, B9, C, and choline. Superficially, this is a clear 8:4 win for cauliflower; it’s worth noting though that the differences in amounts are mostly small, so this isn’t as big a win as it looks like. Still a win for cauliflower, though.
When it comes to minerals, it’s a similar story: cabbage has a little more calcium, iron, and manganese, while cauliflower has a little more copper, magnesium, phosphorus, potassium, and zinc. This time a 6:3 win for cauliflower, and again, the margins are small so there’s really not as much between them as it looks like. Still a win for cauliflower, though.
In short: enjoy either or both (diversity is good), but the most nutritionally dense is cauliflower, even if cabbage isn’t far behind it.
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
Don’t Forget…
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