DrMirkin's eZine: New weight loss drugs, controlling blood pressure, more . . .
Published: Thu, 06/09/22
June 12, 2022
On May 13, 2022, the U.S. Food and Drug Administration approved tirzepatide (Mounjaro), from Lilly, for the treatment of type 2 diabetes. The drug has not been approved for weight loss, but so far studies show that tirzepatide with a weight loss diet causes significant weight loss in diabetics and sent 50 percent of them into remission as long as they kept taking the drug. The most recent study found that 63 percent of 2,539 obese, non-diabetic adults who
were put on a weight loss diet and received tirzepatide once a week achieved at least 20 percent body weight reduction in 72 weeks (NEJM, June 4, 2022). The patients were given either 0, 5, 10, or 15 mg of tirzepatide per day, and those given:
• 5 mg lost an average of 35 pounds
• 10 mg lost an average of 49 pounds
• 15 mg lost an average of 52 pounds
Patients receiving placebo injections lost an average of five pounds.
Higher doses of tirzepatide led to more weight loss, but they caused more side effects, mainly nausea, diarrhea, vomiting, and constipation. Other studies report similar weight loss with this class of drugs (Diabetes Obes Metab, Jun 2020;22(6):938–946). Similar drugs such as semaglutide are restricted to a maximum of two years, not to be repeated.
How These Drugs Work
These drugs mimic two hormones called GLP-1 and GIP that our bodies naturally release after a meal to help regulate appetite and food intake by making us feel full. They stimulate the body to secrete more insulin and less glucagon, which help lower blood sugar levels and are involved in sending fullness signals from the gut to the brain. You eat less, and people who take the drug often find that when they eat too much food, the food comes back up. This can lead to the most common side
effects: nausea, vomiting, diarrhea and stomach cramps. A variety of other side effects and cautions are also listed, including low blood sugar levels. However, the risk of low blood sugar levels is usually only increased if the person is taking another medication known to lower blood sugar at the same time, such as sulfonylureas or insulin.
Other type II diabetes drugs in the GLP-1 agonists class include:
Dulaglutide (Trulicity), taken by injection weekly
Exenatide extended release (Bydureon), taken by injection weekly.
Exenatide (Byetta), taken by injection twice daily.
Semaglutide (Ozempic), taken by injection weekly.
Semaglutide (Rybelsus), taken by mouth once daily.
My Recommendations
Diets and food restrictions often fail miserably to control obesity. These recent studies on tirzepatide seem to show that GLP-1 agonists may help to control overweight when combined with a sensible calorie-restricted diet. If more studies show similar success rates and do not raise serious safety concerns, I expect that these drugs will soon be approved for use on general weight loss, without limiting them to diabetics. They are likely to be very expenive.
A study of 14,392 individuals with high blood pressure, followed for 5-10 years, found that those who adopted a healthful lifestyle along with taking medication had a much lower risk for suffering heart attacks and lived significantly longer than those who treated their high blood pressure just with drugs (JAMA Netw Open, Feb 1, 2022;5(2):e2146118). The lifestyle factors studied were:
• not smoking
• eating an anti-inflammatory diet
• exercising regularly
• avoiding overweight
• getting seven hours of sleep each night
More than 1.13 billion adults worldwide (Lancet, 2017;389(10064):37-55) and nearly half of U.S. adults (116 million) have hypertension, defined as a systolic blood pressure greater than 130 mm Hg or a diastolic blood pressure greater than 80 mm Hg, or currently taking medication for hypertension (CDC Facts About Hypertension, Jan 28, 2020). In spite of the many blood pressure medicines on the market today, the incidence of high blood pressure has increased considerably over the past 40 years (Nat Rev Nephrol, 2020;16(4):223-237) and today causes more than 10 million deaths per year (JAMA Cardiol, 2017;2(7):775-781). Following a healthful lifestyle may be more important than just taking medication in the treatment for high blood pressure (BMJ, 2019;364:l571; J Am Coll Cardiol, 2018;71(19):e127-e248) because it lowers both high blood pressure and heart attack risk (Nat Rev Cardiol, 2021;18(4):251-275). There is data to show that people who adopt a healthful lifestyle without taking medication have a lower risk of stroke or heart failure, compared with those who used antihypertensive medications but did not adhere to a healthful lifestyle (J Hypertens, 2013;31(11):2158-2164).
How Anti-Inflammatory Habits Can Lower Blood Pressure
High blood pressure can be caused by an overactive immune system (Hypertension Research, Apr 7, 2016;39:567–573). When a germ enters your body, your immune system produces white blood cells and chemicals called cytokines that attach to and try to kill the invading germ, but as soon as the germ is gone, your immune system is supposed to dampen down. If your immune system stays active all the time (called "inflammation"), it uses the same cells and chemicals to attack you. The same thing happens when tissue is damaged; your immune system uses the cells and chemicals to help tissue heal. Any invading germs and anything that damages tissue can cause your immune system to turn on and cause inflammation. An overactive immune system can constrict blood vessels and prevent them from widening, which causes high blood
pressure. Everyone with high blood pressure should adopt an anti-inflammatory lifestyle to help treat their hypertension, and people without high blood pressure should do the same to help prevent high blood pressure in the future.
Following an Anti-Inflammatory Diet
• Anti-inflammatory foods include vegetables, fruits, nuts, whole (unground) grains, beans, coffee and tea, and oily fish such as salmon, mackerel or sardines. Virtually all fruits and vegetables are anti-inflammatory because they contain polyphenols that help to protect you from chronic inflammation, such as the isorhamnetin, resveratrol, curcumin, or vanillic acid found in onions, turmeric, grapes and so forth (Br J Nutr, May 28, 2016;115(10):1699–1710).
• Foods that cause inflammation ("Pro-inflammatory foods") include sweetened beverages and sugar-added foods, foods made with flour and other refined carbohydrates, fried foods, meat from mammals, processed meats, and milk, butter, margarine, shortening and lard. See Anti-Inflammatory and Pro-Inflammatory Foods
Other Lifestyle Habits That Increase Inflammation
For most people, correcting a faulty diet is the most important lifestyle change to reduce inflammation, but other unhealthful lifestyle habits can also promote chronic inflammation. Scientists have not worked out all of the mechanisms, but it appears that any infection, anything that damages cells in your body, or anything that promotes high blood sugar levels can cause inflammation, such as smoking, drinking too much alcohol, being overweight, not exercising, or vitamin D deficiency. Other
sources of chronic inflammation include:
• exposure to X rays and other radiation, including excessive sunlight
• exposure to harmful chemicals such as certain insecticides, herbicides or industrial chemicals
• a chronic infection anywhere in the body
My Recomendations
High blood pressure can shorten your life, and while your doctor may recommend drugs, lifestyle changes may be even more important for lowering your high blood pressure and prolonging your life.
Ludwig van Beethoven was a composer and concert pianist whose symphonies and other compositions are still among our most-beloved and often-performed classical music. Beethoven started to lose his hearing at age 31 and spent his last years feeling very sick, but he continued to compose incredible music until his horrible death at age 56 of liver failure, kidney failure and pneumonia (Otology & Neurotology, October 2020;41(9):1305-1308). More than 150 years after his death, scientists at the University if Chicago’s Argonne National Laboratory analyzed a sample of his hair and offered an explanation: lead poisoning. Read more
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