{"id":20485,"date":"2025-09-16T19:44:06","date_gmt":"2025-09-16T19:44:06","guid":{"rendered":"https:\/\/www.newsbeep.com\/il\/20485\/"},"modified":"2025-09-16T19:44:06","modified_gmt":"2025-09-16T19:44:06","slug":"if-glp-1-drugs-are-good-for-everything-should-we-all-be-on-them","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/il\/20485\/","title":{"rendered":"If GLP-1 Drugs Are Good for Everything, Should We All Be on Them?"},"content":{"rendered":"<p>To read more of Derek\u2019s reporting on GLP-1 drugs, you can subscribe to his Substack\u00a0<a href=\"https:\/\/www.derekthompson.org\/p\/why-does-it-seem-like-glp-1-drugs\" rel=\"nofollow noopener\" target=\"_blank\">here<\/a>.<\/p>\n<p>GLP-1 drugs like Ozempic and Zepbound don\u2019t just help with type 2 diabetes and weight loss. They seem to curb alcohol, cocaine, and tobacco use among addicts. In some studies, they <a href=\"https:\/\/www.nature.com\/articles\/d41586-024-03074-1\" rel=\"nofollow noopener\" target=\"_blank\">prevent<\/a>\u00a0strokes, heart attacks, chronic kidney disease, sleep apnea, and Parkinson\u2019s disease. They\u2019re associated with\u00a0<a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2820833\" rel=\"nofollow noopener\" target=\"_blank\">a lower risk<\/a>\u00a0of several cancers, including pancreatic cancer and multiple myeloma. Arthritic patients on the drugs\u00a0<a href=\"https:\/\/www.nature.com\/articles\/d41586-024-03512-0\" rel=\"nofollow noopener\" target=\"_blank\">experienced<\/a>\u00a0relief from knee pain that was \u201con par with opioid drugs.\u201d A small study\u00a0<a href=\"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.14991\" rel=\"nofollow noopener\" target=\"_blank\">found<\/a>\u00a0that they reduce migraine headaches by 50 percent. And emerging research suggests they might even slow the rate of memory loss among people diagnosed with Alzheimer\u2019s.<\/p>\n<p>Is all of this real? And if it\u2019s real, how is one drug doing so many different things? And if it is doing all those things, why shouldn\u2019t we be developing versions of the drug for just about everyone?<\/p>\n<p>Today we have two guests: David D\u2019Alessio, chief of endocrinology and metabolism at the Duke University School of Medicine, and Randy Seeley, a professor of surgery, internal medicine, and nutritional sciences at the University of Michigan. We talk about how these drugs work\u2014why they seem to do everything\u2014and how our understanding of them could make them better, more effective, more broadly useful.<\/p>\n<p>If you have questions, observations, or ideas for future episodes, email us at\u00a0PlainEnglish@Spotify.com.<\/p>\n<p>Disclosure: Dr. Seeley has received research support from several pharmaceutical companies, including Eli Lilly, Diasome, and Amgen.<\/p>\n<p>In the following excerpt, Derek chats with Randy Seeley and David D\u2019Alessio about the ways that GLP-1 drugs interact with both the gut and the brain and how those interactions lead to weight loss.<\/p>\n<p>Derek Thompson: So I want this episode to be clear, and in honor of the podcast name, Plain English, I want people to be able to follow it. I also want this episode to be a little bit nerdy. I want to understand, as much as I can, how these drugs do some of the strange and amazing things that they seem to do. So I was thinking that we would structure the conversation this way. I want to walk through some of the effects of GLP-1 drugs. And I want you to first give me a simple answer to my questions, like: Why are they good at helping people lose weight? And then I want to go a level or two deeper, and I want you to have the opportunity to nerd out a little bit and explain in greater detail how and what is happening to our bodies. Does that sound OK, that we\u2019ll start with the basics, and then my follow-up questions will sort of lead us down, down, down the rabbit hole?<\/p>\n<p>Randy Seeley: You\u2019ve come to the right place for nerds, right?<\/p>\n<p>Thompson: Excellent.<\/p>\n<p>Seeley: So no problem.<\/p>\n<p>Thompson: So David, let\u2019s start with you. Really simple question. Why are GLP-1 drugs so good at helping people lose weight?<\/p>\n<p>David D\u2019Alessio: I mean, it turns out that they shut down your desire to eat food. They\u2019re satiety drugs, or they commandeer the satiety system that\u2019s baked into all of us.<\/p>\n<p>Thompson: And what does that mean, they commandeer the satiety system? What is that?<\/p>\n<p>D\u2019Alessio: Yeah. So I mean, the reality is that, at some point, even if it\u2019s your favorite meal, you will put down your fork and stop eating. And that constitutes a control of meal size that we all have. And there\u2019s a number of factors that regulate this, including neural loops and neural reflexes and circulating factors like hormones. And it\u2019s a complex mechanism.<\/p>\n<p>And I think in terms of the physiology of GLP-1, it is just a bit player in this. And my view is that there\u2019s not enough GLP signal after a normal meal to be the whole satiety effect. But if you give a large dose of a drug that will activate the GLP system, you can sort of drive that system, drive the neural factors that are downstream of it, and cause people to just eat less.<\/p>\n<p>And when I see patients in the clinic, and they come back after their first three months on the drug, and they\u2019ve lost 18 or 20 pounds, and they\u2019re just sort of ebullient that this has happened, they say, \u201cI thought it was going to make me eat less.\u201d And I say, \u201cWell, it is, isn\u2019t it?\u201d And they say, \u201cYeah, I guess a little bit, a forkful here or a skip that dessert there.\u201d But it\u2019s not dramatic. It\u2019s not like your appetite goes away completely. It\u2019s just a few bits, a little bit every day. But that\u2019s how you lose weight, is a few calories at a time.<\/p>\n<p>Thompson: So I\u2019ve read several explanations for what\u2019s happening here. One explanation is that it\u2019s working on the gut. It\u2019s slowing gastric emptying, the rate at which food leaves the stomach. Another is that it\u2019s working on the brain; it\u2019s reducing food noise, the chatter that\u2019s constantly telling us, \u201cI\u2019m hungry. Where am I getting that next food?\u201d What else might contribute to an explanation of how exactly these drugs are helping people lose weight so easily?<\/p>\n<p>D\u2019Alessio: I mean, I think you\u2019ve hit on a number of them. The gastric emptying, gastric motility may play a role, although these drugs work in people with bariatric surgery who don\u2019t have normal gastric function anymore. The side effects that are common are nausea, sometimes to the point of vomiting. And that probably contributes a little bit too. In the clinical trials, there hasn\u2019t been a strong correlation between nausea and food intake. And I don\u2019t know that that question\u2019s been asked at the right level of precision. But it\u2019s not just that you\u2019re queasy all the time. I mean, I think it actually makes you feel fuller or turns down the drives to get seconds or take another piece of pie or whatever it is. So it\u2019s a complex mechanism. But again, I think when we give these drugs, we\u2019re giving GLPs at such a high level that it sort of activates a broad range of effects. That\u2019s always been my view. That it\u2019s not just tweaking normal physiology, it\u2019s just putting your foot all the way to the floor and turning the accelerator wide open.<\/p>\n<p>Thompson: Randy, I feel like I want to bring you in to talk a little bit about the brain here. What is the brain-gut axis, and how does the brain fit into this weight loss picture?<\/p>\n<p>Seeley: So you can imagine that your gut\u2019s a really important part of your body, right? It\u2019s absolutely essential for your survival. Which means your brain has to know what\u2019s going on in your gut and be able to change what happens in your gut. And your gut is a completely adaptive organ. It has to be different under different circumstances. You turn over your entire GI tract every seven days. So it\u2019s a very plastic organ. So you can imagine your brain has to be intimately involved in understanding what\u2019s happening in your gut and then being able to direct it as well.<\/p>\n<p>And I think this goes into the issue about: Why is it these drugs cause weight loss? I think the simplest way to think about this is that they change the defended level of weight. So we all defend a level of weight, some higher, some lower, based on both the genetics that you have and the environment that you live in. And what these drugs do is lower that weight that the body thinks is appropriate.<\/p>\n<p>And the magic of what happens with these drugs is that people lose weight, and they\u2019re less hungry while losing weight. If I taped your mouth shut, you\u2019d lose weight. But would you be less hungry or more hungry? And the answer is you\u2019d be more hungry. So the magic of what happens here is that while people are losing weight, they\u2019re not experiencing the normal response to weight loss. They\u2019re not experiencing what would normally make you hungry. And again, you talked about food noise: That\u2019s where it comes from. It\u2019s when you\u2019re underweight, you can imagine that all of your physiology is now oriented to all of the cues in your environment that might be related to food. That\u2019s what your body is now oriented to do. And what these drugs do is they lower that set point so that in fact you can lose weight and be less hungry while it happens. And that happens in the brain. So then the direct actions of these drugs in the brain are what drive that particular weight loss.<\/p>\n<p>The excerpt has been edited and condensed.<\/p>\n<p>Host: Derek Thompson<br \/>Guests: David D\u2019Alessio and Randy Seeley<br \/>Producer: Devon Baroldi<\/p>\n","protected":false},"excerpt":{"rendered":"To read more of Derek\u2019s reporting on GLP-1 drugs, you can subscribe to his Substack\u00a0here. GLP-1 drugs like&hellip;\n","protected":false},"author":2,"featured_media":20486,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33],"tags":[163,85,46,482],"class_list":{"0":"post-20485","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-medication","8":"tag-health","9":"tag-il","10":"tag-israel","11":"tag-medication"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/20485","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=20485"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/20485\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/20486"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=20485"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=20485"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=20485"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}