Semaglutide for Weight Loss?

Plus: Exercising with T1D

Author

The 10almonds Team
April 17, 2023

The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.

⏰ IN A RUSH?

Today’s 30-Second Summary

If you don’t have time to read the whole email today, here are some key takeaways:

  • Semaglutide, a GLP-1 agonist, is a weight-loss wonder-drug:

    • It helps users lose up to 20% of their bodyweight (see main feature for details)

    • It gives weight loss results about 6x better than without it (see main feature for details)

    • It works by helping the pancreas to produce insulin, while maintaining insulin sensitivity

    • It was developed for people with type 2 diabetes, and is now being trialled for obesity

      • Of the main brands of semaglutide, only Wegovy is FDA-approved for weight loss so far

  • It does have some down-sides:

    • Unpleasant gastrointestinal side effects are common (20%ish) but not too serious for most people (see main feature for details)

    • If you stop taking it, weight regain is likely

  • Type 1 Diabetes can’t be helped with this drug, sadly (but check out our book of the day, though)

Read on to learn about these things and more…

👀 WATCH AND LEARN

How the food you eat affects your brain - Mia Nacamulli

When it comes to what you eat, your choices have a direct and long-lasting effect on the most powerful organ in your body: your brain. Mia Nacamulli takes you into the brain to learn more in this short (4:52), well-subtitled video:

You can also find the full lesson, here! ← when you get there, we recommend to click on “Dig Deeper” for more really cool (non-video) resources

💊 MAIN FEATURE

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.❞

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:

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%])❞

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:

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:

🌍 AROUND THE WEB

What’s happening in the health world…

More to come tomorrow!

📖 ONE-MINUTE BOOK REVIEW

Exercise with Type 1 Diabetes: How to exercise without scary lows or frustrating highs - by Ginger Vieira

If you or a loved one has Type 1 Diabetes, you'll know that exercise can be especially frustrating...

  • If you don't do it, you risk weight gain and eventual insulin resistance.

  • If you do it, you risk dangerous hypos, or perhaps hypers if you took off your pump or skipped a bolus.

Unfortunately, the popular medical advice is "well, just do your best".

Ginger Vieira is Type 1 Diabetic, and writes with 20+ experience of managing her diabetes while being a keen exerciser. As T1D folks out there will also know, comorbidities are very common; in her case, fibromyalgia was the biggest additional blow to her ability to exercise, along with an underactive thyroid. So when it comes to dealing with the practical nuts and bolts of things, she (while herself observing she's not a doctor, let alone your doctor) has a lot more practical knowledge than an endocrinologist (without diabetes) behind a desk.

Speaking of nuts and bolts, this book isn't a pep talk.

It has a bit of that in, but most of it is really practical information, e.g: using fasted exercise (4 hours from last meal+bolus) to prevent hypos, counterintuitive as that may seem—the key is that timing a workout for when you have the least amount of fast-acting insulin in your body means your body can't easily use your blood sugars for energy, and draws from your fat reserves instead... Win/Win!

That's just one quick tip because this is a 1-minute review, but Vieira gives:

  • whole chapters, with example datasets (real numbers)

  • tech-specific advice, e.g. pump, injection, etc

  • insulin-specific advice, e.g. fast vs slow, and adjustments to each in the context of exercise

  • timing advice re meal/bolus/exercise for different insulins and techs

  • blood-sugar management advice for different exercise types (aerobic/anaerobic, sprint/endurance, etc)

...and lots more that we don't have room to mention here

Basically... If you or a loved one has T1D, we really recommend this book!

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Wishing you a wonderful week ahead,

The 10almonds Team