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Dopamine Nation: Finding Balance in a World of Excess

Dopamine Nation: Finding Balance in a World of Excess

by | Feb 7, 2024 | Patient News

It’s called the Plenty Paradox: an affluent environment with easy access to substances or behaviors perceived as pleasurable has actually been a key contributor to our national mental health crisis. So posits Dr. Anna Lembke, Medical Director of Addiction Medicine, Stanford University School of Medicine, who has extensively researched and treated patients struggling to find the right balance in what she terms our “Dopamine Nation.”

Constant over-exposure to drugs, tobacco, alcohol, unhealthy foods, social media or other activities can cause a surge in dopamine, the primary neurotransmitter in our brain regulating our experience of pleasure, motivation and reward. “We all have a baseline level of dopamine, and there is enormous variability among individuals as to what triggers the release of additional dopamine in their brains,” she explains. Once that occurs, the brain will work to restore any deviation from neutrality.

Dr. Lembke explains: “The brain adapts to a pleasurable stimulus by tipping to pain, which is the comedown or aftereffect sensation. If we wait, this will pass and homeostasis is restored. But if we continue to use our drug or activity of choice, the initial stimulus of pleasure gets weaker and shorter, and the aftereffect of pain gets stronger and longer, changing the hedonic, or joy, setpoint over time. Now we need more not to feel good, but just to level the balance and feel normal…because when we’re in a state of dopamine deficit, classic symptoms of withdrawal such as anxiety, irritability, insomnia and depression and craving are experienced, along with a diminished capacity to enjoy previous pleasures.”

Noting that rates of anxiety and depression have increased most quickly over the last 20 years in the richest nations, Dr. Lembke says: “We’re living in a world where you can binge on almost anything – gaming, exercise, romance novels – because so much has become more reinforcing, potent, novel and accessible. It’s a real mismatch between the way we were initially wired to survive in an environment of scarcity and overwhelming danger, and our modern dopamine-rich ecosystem.”

An early intervention: the dopamine fast

With the caveat that her approach is not appropriate for all (e.g. those at risk of life-threatening withdrawal from opioids, or those who have unsuccessfully and repeatedly tried to stop on their own), Dr. Lembke shares the basics of her innovative “dopamine fast” to address compulsive overconsumption.

  • Recall the quantity and frequency of your drug of choice, be it video games, cell phone use or cannabis, over the past week, going backwards in time. Identify your initial motivation for overconsumption (to have fun, to solve a problem, etc.) and consider if you now need more to achieve your objective.
  • Abstain for 3 to 4 weeks. “Although it may feel as if the drug of choice is the only thing that gives you a break from difficult circumstances, realize that it may actually be making you feel worse, and the only way to know is to abstain completely for at least 3 weeks. Stopping sooner will mean you experience only the hard challenges of the first two weeks, and none of the rewards when homeostasis begins to be restored after that.”
  • Maintain. During abstinence, learn to recognize triggers and create literal and cognitive barriers to press the pause button between desire and consumption. “With social media for example, you can delete apps, turn off alerts and create tech-free spaces in the home. Make a plan for how to integrate the habit back into your life as a useful tool while staying balanced, such as scheduling ‘intermittent fasting’ from your digital devices until you’ve accomplished specific tasks.”
  • Hormesis. Dr. Lembke refers to a growing body of literature showing that exposure to initially painful experiences can result in increased resilience. “In our social media example, hormesis can be achieved by unplugging from our devices and doing things that may seem hard such as exercising, playing an instrument, writing a thank you note, even taking a cold shower,” she says. “Paying for the dopamine surge upfront may help boost motivation and positive mood without the big comedown.”
Sustainable Eating: The Planetary Healthy Diet

Sustainable Eating: The Planetary Healthy Diet

by | Feb 7, 2024 | Nutrition, Patient News

The Lancet Planetary Health Diet

Is there a way to eat that not only reduces the risk of disease and promotes well-being, but is also sustainable? Could a certain diet provide enough food for the 9.8 billion people estimated to be living on earth by 2050? This was the challenge first taken on in 2019 by the EAT-Lancet Commission, comprised of top scientists from around the globe.

Combining analysis of more than 30 years of the best available nutritional studies and randomized trials with planetary boundaries for key environmental systems and processes, in 2023, the Commission found it to be “an achievable reality that would improve the health and well-being of billions and allow us to pass on to our children a viable planet.” However, cautions Walter Willett, MD, professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health and Commission co-chair: “It won’t be easy and will take the engagement of almost everyone.”

Implementing and Following the Planetary Health Diet

The basics of the Planetary Health Diet include:

  • No more than one serving of protein, like poultry, fish, red meat or eggs, and one serving of dairy per day. Focus on fruits and vegetables (at least five servings daily), nuts, legumes (dry beans, lentils and peas), whole grains and plant oils. “We emphasize plant-based protein sources to help prevent major health issues such as diabetes, cardiovascular disease, cancer and dementia,” explains Willett. “We also explored if there is a certain amount of red meat, for example, that that could be consumed while still remaining at low risk for disease. One serving a week (about 14 grams daily) met our criteria, but increasing to two servings weekly made a significant, and unacceptable, increase in the risk for type 2 diabetes.”
  • Nutrient-dense items such as nuts and legumes are also emphasized to ensure food production and consumption practices will not exceed the earth’s ecological limits. Foods sourced from animals have a relatively high environmental footprint per serving compared to other food groups which impacts greenhouse gas emissions, land use and biodiversity loss, according to the Commission.
  • Among major protein sources, lentils are considered the healthiest, with the highest ratio of polyunsaturated fat to saturated fat, followed by tofu, almonds and salmon.
  • Less healthy foods to avoid include red meat, eggs, dairy, refined grains and sugar-sweetened beverages.

Variety Through a Flexible Diet

“It really comes down to a flexitarian diet. There’s incredible variety in the ways you can put it together and keep animal sources of protein to a minimum,” says Willett. His only asterisk: “Lower vitamin B12 levels can occur when less than two servings of animal protein is consumed daily, with serious health consequences.” He recommends getting adequate amounts of the vitamin through either supplements or fortified foods.

Only a few parts of the world currently meet scientific targets for the planetary health diet, and the U.S. in particular will need to significantly decrease consumption of animal proteins. “Higher intakes of vegetables, fruits, legumes, and especially nuts and whole grains would be desirable for almost every country, preventing about 11 million deaths per year,” says Willett. “It is not a question of all or nothing, but gradually making small changes for a large and positive impact.”

Pie chart of foods representing the planetary Health diet
The Planetary Health Diet is symbolically represented by half a plate of fruits and vegetables, and the other primarily of whole grains, plant proteins, unsaturated plant oils, modest amounts of meat and dairy, and some added sugars and starchy vegetables.

 Rooting for Vegetables

Bring the benefits of plant-forward eating to your table with seasonal root vegetables this winter. These veggies are high in vitamins and nutrients, and low in calories. Many root vegetables listed below may have anti-inflammatory, antioxidant and cholesterol lowering properties as well. Enjoy these versatile veggies:

  • Allium Bulbs (onions, shallots, garlic). Roast or caramelize for pizza garnishes, bread toppings and quesadilla fillings.
  • Avocados. At their creamy best for use in wraps, salads, and dips, including guacamole.
  • Belgian Endive. Chop for salads; braise whole or brush with a vinaigrette and grill for side dish.
  • Beets. Grate to sprinkle in salads or on sandwiches; sautee or roast with garlic and olive oil for side dish.
  • Broccoli/Broccoli Rabe/Broccolini. Use in pasta dishes and winter salads; puree for soup.
  • Brussels Sprouts. Roast for optimal flavor and serve as appetizer, side dish, even a pizza topping.
  • Carrots (white, yellow, purple, red and orange varieties). Eat raw with yogurt-based dip; steam, boil or roast for side dish.
  • Celeriac (celery root). Sub for potatoes in soups and stews; blend for creamy sauce; grate into salad.
  • Chayote. Add to salads; use as soup base.
  • Fennel. Chop raw and freeze for use in soups and stews.
  • Kale, Collards, Mustard and Turnip Greens. Roast or boil until tender and dress for salad while still warm.
  • Parsnips. Eat raw; boil lightly; roast with carrots and potatoes.
  • Rutabagas. Use in place of or in addition to turnips and potatoes.
  • Sunchokes (Jerusalem artichokes). Serve in salads; puree as base for main course; roast with olive oil for side dish.
  • Sweet Potatoes. Make healthy fries by quartering, drizzling with olive oil and baking at 400 degrees for 40-60 minutes; steam chunks and mash; bake whole and unpeeled.
  • Turnips. Bake, boil or steam like a potato; shred for coleslaw; julienne as garnish.
  • Winter Squash (butternut, acorn, delicata, kambocha, spaghetti and pumpkin varieties). Steam or microwave as low-calorie alternative to pasta; roast, stir fry or puree for soups.

Sources: Have a Plant, Spruce Eats, Datassential

 

Every Walk is a Step in the Right Direction

Every Walk is a Step in the Right Direction

by | Oct 18, 2023 | Patient News

“If you are in a bad mood, go for a walk. If you are still in a bad mood, go for another walk.” – Socrates

No one has a negative word to say about the benefits of walking. Accessible to most, with no special equipment or training needed, stepping out regularly can bring a plethora of health gains: improved bone density, lower blood pressure, reduced mental stress and depression and decreased risk of cardiovascular disease and stroke.

What we still don’t know is just how many steps are needed to begin reaping these benefits, nor when a plateau occurs or the peak of optimization is reached. As data continues to flow in from numerous research studies and millions of personal fitness trackers, one well-known goal is clearly being walked back – 10,000 steps a day is not the magic number for all. In fact, far fewer steps can prevent disease and promote well-being.

According to one of the world’s largest studies on walking, a meta-analysis examining almost 227,000 participants over 7 years, just 2,500 steps daily benefits the heart and blood vessels,  while reaching the 4,000-step mark significantly reduces the risk of dying from any cause. However, keep on track because more is better, as the risk of death falls by 15% for every additional 1,000 steps taken, and the highest reduction in mortality was seen among those who ramped it up to between 6,000 and 7,000 steps daily. This correlates with the 150 minutes of moderate activity per week recommended in the Physical Activity Guidelines for Americans, which translates to approximately 7,000 steps per day/5 days per week.

Also heartening for those who find it difficult to exercise regularly is a 2023 cohort study which showed that taking 8,000 steps just one or two days during the week can result in a substantially lower risk of cardiovascular and all-cause mortality.

Most reassuring: “While the longer you have consistently followed a walking routine the higher the chance for life extension, beginning at any age will positively impact your health,” shares Dr. Maciej Banach, meta-analysis study lead and adjunct professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine. “If you first start walking for exercise at age 60, or 65, or 70,  and commit to it regularly, you can still experience all these important health benefits.”

Ready to take the first step toward your health and fitness goals? “Start small,” advises American Council on Exercise expert Chris Gagliardi. “Breaking it down into manageable chunks of 10-minute walks makes it easier to find the time and energy to get it done, and that success will motivate you to do more. Think about it this way…if you replace 10 minutes of sitting with 10 minutes of walking, you’ve made a 100% improvement in your fitness goal!”

If you’re looking to step it up, try some of these walking challenges:

  • High intensity interval training (HIIT) alternates short bursts of intense effort with short periods of recovery. After a good warm-up, increase your speed and go as fast as you can for 20 to 30 seconds. Return to a comfortable walking pace for a minute or two, and repeat for a few cycles. Start with one short HIIT walk weekly, and add more to your routine as desired.
  • Rucking is the act of walking while carrying a loaded backpack or wearing a weighted vest. Derived from military drills, rucking combines cardiorespiratory activity with muscular strength training, and can help reduce the risk of age-related health conditions such as type 2 diabetes and osteoporosis. To ensure comfort and safety, opt for a vest or load 5 to 10% of your body weight.
  • Walking poles help distribute upper-body weight into the arms and can increase the amount of calories burned by 20%. They can be used on flat surfaces as well as when hiking.
  • Add a level of difficulty by increasing speed, seeking out hills and inclines, and varying your walking surface.

Sources:

Maciej Banach et al, on behalf of the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group and the International Lipid Expert Panel (ILEP). The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis, European Journal of Preventive Cardiology, 2023; zwad229, https://doi.org/10.1093/eurjpc/zwad229

Inoue K, Tsugawa Y, Mayeda ER, Ritz B. Association of Daily Step Patterns With Mortality in US Adults, JAMA Netw Open. 2023;6(3):e235174, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802810

American Council on Exercise, Walking Toolkit, https://acewebcontent.azureedge.net/assets/about-ace/advocacy/Walking_Toolkit_Community.pdf

Walk This Way

Perfect your walking form in 8 easy steps.

  1. Stand tall. Imagining a wire attached to the crown of your head is gently pulling you upward will help you walk more briskly.
  2. Look to the horizon to help avoid stress on the neck.
  3. Lift your chest and tighten your abs to take pressure off your back.
  4. Drop your shoulders down and allow your arms to bend naturally at the elbow. Swing your arms to increase speed.
  5. Maintain a neutral pelvis. Don’t tuck your tailbone under or overarch your back.
  6. Keep your front leg straight but not locked for a smoother stride.
  7. Aim your knees and toes forward to reduce chance of injury.
  8. Land on your heel to facilitate the heel to toe motion that carries you the furthest and fastest.
AI in Healthcare: An Early Look at the Power, Promise and Peril of Tech’s Latest Tool

AI in Healthcare: An Early Look at the Power, Promise and Peril of Tech’s Latest Tool

by | Oct 18, 2023 | Patient News

Whether you are an enthusiastic adopter of virtual assistants like Alexa and Siri, and apps to monitor everything from glucose to sleep patterns— or consider them error-prone and intrusive—it’s impossible to ignore the growing influence of Artificial Intelligence (AI) and ChatGPT.

To quickly define terms, AI is the capability of a computer system to mimic human cognitive functions, such as learning and problem solving. A large language model (LLM) is a type of AI that uses deep learning techniques and large data sets to understand, summarize, generate and predict new content. ChatGPT, powered by LLM, is a generative AI model designed to understand and produce human-like text responses based on input provided. Released last November by OpenAI, ChatGPT now has 100 million users worldwide; alternatives include Google’s Bard and Microsoft’s Bing.

We share an early overview of some of the most compelling benefits and drawbacks of AI’s use in medicine, albeit with a few crucial caveats. While the rise of AI may be viewed as alarming, keep in mind that it is a nascent, still-evolving technology. What is true today will be superseded by new developments, improvements and regulations tomorrow. Additionally, the physician’s oath to ‘first, do no harm’ will continue to guide medicine’s measured approach to implementing technological advances. If you’re interested in learning more, we recommend the M.I.T. Technology Review podcast ‘In Machines We Trust’, and the books The AI Revolution in Medicine: GPT-4 and Beyond by Lee, Goldberg and Kohane, and Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again by Eric Topol, MD.

Technology titans like Microsoft co-founder Bill Gates have described its promise in sweeping terms: “AI is on the verge of making our lives more productive and creative. But it also has the potential to help us solve some of society’s biggest challenges, like improving healthcare, saving energy, and making it easier to feed the world,” he said. Dr. Andrew Ng, a recognized pioneer in machine learning described it as the “new electricity,” adding “I have a hard time thinking of an industry that I don’t think AI will transform in the next several years.”

In medicine, the potential is particularly exciting, according to Eric Topol, MD, a renowned physician-scientist and futurist. “The next big thing is multimodal AI, which collects all the data that makes us unique—anatomical imaging, physiological sensors, genome, microbiome, metabolome, immunome, environmental and social determinants, our electronic health records with lab results, family history and longitudinal follow-up—along with sources of medical knowledge, and quickly processes and analyzes it. Once you do that, you not only can better manage a condition like diabetes or hypertension in real-time, but in the future, prevent conditions that people are at high risk for from ever occurring.”

Douglas Grimm, attorney and healthcare practice leader at ArentFox Schiff also views AI’s predictive capabilities as its greatest promise. “AI may someday inspire a paradigm shift in care – instead of the patient calling the physician at 3 a.m. with concerning symptoms, the physician will have earlier received an analysis of the patient’s risk based on data from AI-enabled remote monitoring, and proactively guided them to prevent a cardiac event.”

For all its potential however, Grimm recommended a cautious approach to AI, due to a lack of regulation regarding data security and confidentiality as well as the need for guardrails to mitigate potential medical misinformation.

American Medical Association President Jesse Ehrenfeld, M.D., M.P.H, expressed the concerns of many in healthcare when he told us: “While AI-enabled products show tremendous promise in helping alleviate physician administrative burdens and may ultimately be successfully utilized in direct patient care, OpenAI’s ChatGPT and other generative AI products currently have known issues, including fabrications, errors, and inaccuracies. For AI-enabled tools to truly live up to their promise, they must first earn—and then retain—the trust of patients and physicians. Just as we demand proof that new medicines and biologics are safe and effective, so must we insist on clinical evidence of the safety and efficacy of new AI- enabled healthcare applications.”

According to Alan Karthikesalingam, MD, PhD, Google Health’s lead researcher on Med-PaLM 2, an AI tool that made headlines for achieving 85% accuracy on the U.S. medical licensing exam: “AI on its own cannot solve all of healthcare’s problems. Data and algorithms must be combined with language and interaction, empathy and compassion. What makes us healthy is complicated.”

Tinglong Dai, PhD, professor at Johns Hopkins University who has extensively studied AI’s effects on healthcare, said he has high confidence in its assessment of radiological images, but lower confidence in its ChatGPT guidance. “AI can eventually serve as a very capable colleague, and the physicians I work with here are amazed at its accurate, and even compassionate responses. But 20% of the time the advice is completely wrong or unfounded—it’s like an eager medical student who wants to make an impression on their professors and tries to pick up patterns, but misses the underlying logic. Right now it’s still being tested and used in situations where no harm can occur, but if people start relying on it, that would be dangerous.”

Dr. Isaac Kohane, chair of the Department of Biomedical Informatics at Harvard Medical School, advised: “At present, AI should be used for where human beings are the weakest — namely, in knowing everything about all their patients and being as alert at 6:00 in the evening as they are at 8:00 in the morning. I don’t think that AI should be used instead of the human intuition, the human contact, and the human common sense that doctors bring to their patient interactions.”

As an addition to the physician’s growing toolbox, AI has potential value, believes Specialdocs Consultants CEO Terry Bauer, a senior healthcare executive who’s worked with thousands of doctors in his decades-long career. “It could help practices with administrative tasks, data entry and report generation and possibly claims documentation and denial management. AI may also enhance the diagnostic process, and as a result, minimize unnecessary testing. All this said, I cannot envision AI matching the judgment, intelligence or experience of a dedicated physician who thoroughly examines and listens to their patients.”

When asked about its own future, ChatGPT thoughtfully responded: “Ensuring patient privacy, addressing biases in AI, and maintaining the human touch in healthcare are critical considerations that must be addressed. ChatGPT is not a replacement for human expertise but a valuable ally in the pursuit of better healthcare outcomes for all.”

AI in Action in Medicine

From early disease detection to accelerated drug discovery to 24/7 virtual health assistants, the applications for AI abound. Below are just a few examples of AI being utilized in healthcare:

✚ At Google Health, AI research led to the development of an automated tool that uses an AI camera to detect diabetic retinopathy in less than two minutes.

✚ At Cedars Sinai, investigators are leveraging AI’s algorithms to identify early signs of pancreatic cancer, and to predict the likelihood of coronary heart disease and sudden cardiac arrest.

✚ At Mayo Clinic, the cardiology team uses AI-guided electrocardiograms to detect faulty heart rhythms before symptoms appear, and to identify the presence of a weak heart pump, preventing future heart failure.

✚ At the AI & Tech Collaboratory for Aging Research at Johns Hopkins, the team is exploring robots that can help patients with cognitive impairments, dementia or Alzheimer’s navigate daily living tasks; using Alexa to administer cognitive tests at home; and configuring Apple Watches to provide alerts of possible falls or wandering.

Sources:

AI in Healthcare with Dr. Eric Topol https://youtu.be/s7vur7ckBE0?si=_9sewIVcAAHc2n1g

AI Will Make Medicine More Human Again https://youtu.be/zmID4msEk-Y?si=qzwFsRBUE2gsNT0U

Groundbreaking Research in Health AI, The Check Up, Google Health https://youtu.be/3Ud-BMOCkDI?si=dOsnjb4LMKiinMta

Is Medicine Ready for AI? NEJM podcast https://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMdo007065&aid=10.1056%2FNEJMp2301939&area=

Widner, K., Virmani, S., Krause, J. et al. Lessons learned from translating AI from development to deployment in healthcare. Nat Med 29, 1304–1306 (2023). https://doi.org/10.1038/s41591-023-02293-9

A Better Model of Heart Disease Prediction https://www.cedars-sinai.org/discoveries/better-model-heart-disease-prediction.html

AI in Cardiovascular Medicine https://www.mayoclinic.org/departments-centers/ai-cardiology/overview/ovc-20486648

Can We Trust AI? https://hub.jhu.edu/2023/03/06/artificial-intelligence-rama-chellappa-qa/

 

Doctors of Distinction – Outstanding Team Winners

Doctors of Distinction – Outstanding Team Winners

by | Oct 17, 2023 | Industry Insights, Patient News

Congratulating our own Doctors of Distinction!

 

About Darien Signature Health

In 2017 Amanda Collins-Baine, MD, founded Darien Signature Health, a concierge internal medicine practice, to offer patients the highest level of personalized care and attention. Dr. Jen Drummond joined the team in 2022, bringing more than a decade of experience as a hospitalist and a shared passion for practicing excellent medicine with empathy and kindness. The number of patients cared for at Darien Signature Health is limited to ensure benefits that include direct after-hours communications, same day sick appointments, comprehensive visits, and a focus on proactive wellness. The practice, located at 53 Old Kings Highway North in Darien, CT, is affiliated with Yale New Haven Health and Greenwich, Stamford and Norwalk Hospitals. For more information, call 203.286.5604 or visit www.DarienSignatureHealth.com.

A New Era for Diabetes and Weight Loss Drugs

A New Era for Diabetes and Weight Loss Drugs

by | Jul 11, 2023 | Medications, Patient News

For patients seeking new solutions to managing type 2 diabetes and obesity, the introduction of a class of drugs called GLP-1 receptor agonists (RA) has simultaneously inspired hope and excitement along with misuse and confusion. We developed the following Q&A to go beyond the headlines and explore how Ozempic and similar drugs work, who may benefit most from them, and why they may ultimately represent a true breakthrough in the way these chronic conditions are classified, considered and treated.

What defines type 2 diabetes?

More than 37 million Americans have type 2 diabetes, a chronic disease that affects the ability of the body to regulate glucose (blood sugar) levels. This leads to an increase of glucose over
time which significantly increases the risk for complications to vital organs such as the heart, kidneys, eyes and nerves. Diagnosis is made when testing shows: fasting glucose of 126 mg/dl or higher; or non-fasting glucose of 200 mg/dl or higher; or A1C (average of glucose over the past 3 months) of 6.5% or higher.

How was type 2 diabetes previously treated?

Approved by the FDA in 1994, Metformin is well established as the first line therapy for management of type 2 diabetes if lifestyle changes (low-carbohydrate diet, weight loss and exercise activity) are not enough to bring blood sugar levels down near the normal range. Metformin works by decreasing the amount of blood sugar produced by the liver in a fasting state, decreasing the absorption of food through the intestines, and restoring the body’s response to insulin.

What is different about the GLP-1 RA drugs?

Among the major benefits this class of drugs brings to patients with type 2 diabetes is
lowering their risk for heart disease and stroke, and providing a significant boost to weight loss, in addition to helping reduce glucose levels to a near-normal range. As a result of the positive outcome reported in trials, the American Diabetes Association changed its longstanding guidelines for first-line treatment of type 2 diabetes to include recommendations for GLP-1 RA drugs in patients at high risk for cardiovascular disease or with risk factors such as high blood pressure, high cholesterol, or chronic kidney disease.

How do GLP-1 RA drugs work?

Known as incretin mimetics, this class of drugs mimics the effect of a hormone, glucagon- like peptide-1, or GLP-1, which is normally produced naturally to stimulate the release of insulin secretion after eating a meal. Receptors to GLP-1 are found in the pancreas, the brain and elsewhere in the body. The drug enhances these receptors, which help the pancreas release more insulin and help reduce blood sugar levels without raising the risk for hypoglycemia (too- low blood sugar levels). By limiting the amount of sugar the liver releases into the bloodstream in a fasting state, and slowing down how long food stays in the stomach, the drug promotes a feeling of satiety, leading people to be satisfied with eating smaller portions. In addition, some patients have reported a marked decrease in cravings for carbohydrate-rich and fatty foods.

What are GLP-1 RA drugs intended to treat – diabetes, obesity, or both?

Under certain names, GLP-1 RA drugs are FDA-approved only for treatment of type 2 diabetes while offering added benefits of weight loss and cardiovascular protection; under other names, the drugs are indicated only for weight loss, but not for treatment of diabetes. While the ingredients can be identical, the difference is in dosage amounts and whether the trials focused on the drug’s impact on blood sugar or weight changes. For example, semaglutide, a GLP-1 drug, is approved to treat diabetes under the name Ozempic; a higher-dose version of semaglutide, Wegovy, is only FDA approved for weight loss. The same is true for liragutide, approved for type 2 diabetes as Victoza, and for weight loss as Saxenda.

Are there side effects?

Most side effects for these types on drugs are gastrointestinal, including nausea, diarrhea or constipation, abdominal pain.

How effective are GLP-1 RA drugs like Saxenda and Wegovy for weight loss?

Trials to date have shown excellent results, with patients able to lose between 5 to 20% of their total body weight. However, these drugs are not meant for people wanting to lose 10 or 15 pounds. They are indicated for those who are obese, as measured by a body mass index (BMI) of 30 or higher; or for people with a BMI of 27 or greater with at least one weight-related coexisting condition such as high blood pressure, elevated cholesterol levels. It’s important to note that obesity is a chronic disease, and these drugs may be needed as a long-term treatment to help lose pounds and maintain weight loss, along with lifestyle changes that include a healthy diet and 150 minutes a week of moderate-intensity aerobic and muscle-strengthening activities.

How do SGLT2 inhibitors fit into the mix of drugs for diabetes?

This is a newer class of drugs that lowers blood sugar levels by preventing the kidneys from reabsorbing glucose back into the bloodstream but instead releasing it through urine. Originally intended only for lowering blood sugar, later research data showed the drugs offered significant benefits for type 2 diabetes patients with coexisting conditions. Now some SGLT2 drugs- Invokana (canaglifozin), Farxiga (dapaglifozin), and Jardiance (empagliflozin) – have also been approved for use by non-diabetic patients with a history of chronic kidney disease or congestive heart failure.

Are other drugs in the wings?

Mounjaro, a GLP-1 RA drug that also promotes a second gut hormone (glucose-dependent
insulinotropic polypeptide, or GIP) is currently approved for treatment of type 2 diabetes, and on a fast track approval by the FDA to be used as a weight loss medication.

How will I know which drug is right for me?

This is a decision best made on an individual basis with your physician, who will consider factors such as your overall health status, drug intolerances, risk factors for developing diabetes-related complications, benefits versus possible harm from side effects, and preferred formulation (oral or injection).

Drugs with Benefits: A Guide to GLP-1 RA Therapies

NOTE: Non-GLP-1 RA drugs used for weight loss are not listed here… Please consult with your healthcare provider regarding your best option.

Brand Name Active Ingredient Dosage/Form Approved For Also Beneficial For
Ozempic Semaglutide Weekly injection Type 2 diabetes Weight loss; decreased risk of stroke and heart attack
Wegovy Semaglutide Weekly injection Weight Loss n/a, studies not conducted
Rybelsus Semaglutide Daily pill Type 2 diabetes Weight loss, cardiovascular safety
Trulicity Dulaglutide Weekly injection Type 2 diabetes Weight loss; decreased risk of stroke and heart attack
Victoza Liraglutide Daily injection Type 2 diabetes Weight loss; decreased risk of stroke and heart attack
Saxenda Liraglutide Daily injection Type 2 diabetes n/a, studies not conducted
Soliqua Insulin glargine & lixisenatide Daily injection Type 2 diabetes Weight loss
Byetta Exenatide Twice daily injection Type 2 diabetes Weight loss
Bydureon BC Exenatide Weekly injection Type 2 diabetes Weight loss
Mounjaro (GLP-1 RA/GIP) Tirzepatide Weekly injection Type 2 diabetes Weight loss

Sources: GoodRx, American Diabetes Association