Dr. Manoj Sharma-
[Dr. Manoj Sharma is a Professor in the Department of Social and Behavioral Health and an Adjunct Professor of Internal Medicine at the University of Nevada, Las Vegas, USA. He is a global health promotion expert and president of Health for All, Inc.]
The newer class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide (Ozempic®) or tirzepatide (Mounjaro®, Zepbound®) are gaining popularity all over the world. It is reported that already 2-3% of Americans are taking these drugs. J.P. Morgan Research projects that by 2030, approximately 30 million people, or 9% of the U.S. population may be taking GLP-1 agonists.
The popularity is due to their remarkable effect on weight loss, ability to manage blood sugar in type 2 diabetes, and management of obstructive sleep apnea. The ease of taking once-a-week subcutaneous injections is also helping with popularity. These newer drugs are also sometimes called “nutrient-stimulated hormone-based therapies.” These are typically used for diabetes but have become popular as anti-obesity drugs as besides stimulating insulin secretion (which is needed for diabetes) they delay the emptying of the stomach. Tirzepatide is a much more advanced and potent drug as it is both a GLP-1 receptor agonist and a gastric inhibitory polypeptide (GIP) receptor.
A recent research article published in the journal, Nature Medicine, showed that these GLP-1 agonists may have potential risk reduction effects on substance use disorders, suicidal ideation, schizophrenia, Alzheimer’s disease, dementia, clotting disorders, chronic obstructive pulmonary disease, and liver diseases. However, more research is needed to establish these assertions.
These drugs also have side effects. The more common ones are nausea, vomiting, constipation, heartburn, decreased appetite, diarrhea, indigestion, abdominal pain, and gastroparesis (slow movement of food in the stomach).
Other side effects include allergic reactions, low blood sugar, fainting, low blood pressure, sleep problems, gall bladder problems, headaches, kidney stones, kidney inflammation, and pancreatitis (inflammation of the pancreas).
A recent article in the journal, JAMA Ophthalmology, also raised concerns reporting eye complications though very rare such as nonarteritic anterior ischemic optic neuropathy (NAION) leading to blindness. For those using it for weight loss, it has been seen that after stopping these medications the weight is regained.
These drugs are very expensive and a month’s supply without insurance can cost as much as $700 to $1,400 in the U.S. market. Further, there is an acute shortage of these drugs due to growing demands. As a result, microdosing or giving low doses has gained currency on some websites and is being practiced by some providers. This is a new and controversial practice that is not approved by the Food and Drug Administration (FDA).
The chief advantages being touted by those in favor of this practice, besides low cost, are reduced side effects and usefulness in maintaining weight after reduction. The downsides of microdosing are its unknown effectiveness, sometimes increased risk of side effects because of non-monitoring, the potential for overdose due to overconsumption, and no guarantee of quality.
Further, a recent research letter published in JAMA Health Forum found that compounded medications (that use microdoses of GLP-1 agonists along with other “inactive” ingredients) advertised on websites are often untruthful, misleading, and inaccurate. Almost 11% of consumers take these compounded GLP-1 agonists. So, it is very important not to fall prey to advertisements and go through one’s primary care provider or a provider referred to by them to take these and ask for FDA-approved products. Education about those planning to take these drugs is very important.
