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YOUR BODY ALREADY HAS ITS OWN VERSION OF OZEMPIC  
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Christopher Damman
January 16, 2024
The Conversation
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_ Despite our great aspiration for quick fixes, it’s very possible
that a healthy lifestyle remains the most important way to manage
metabolic disease and overall health _

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Wegovy, Ozempic and Mounjaro
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are weight loss and diabetes drugs that have made quite a splash in
health news
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They target regulatory pathways involved in both obesity and diabetes
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breakthroughs for weight loss and blood sugar control.

But do these drugs point toward a root cause of metabolic disease?
What inspired [[link removed]] their development in
the first place?

It turns out your body produces natural versions of these drugs –
also known as incretin hormones [[link removed]]
– in your gut. It may not be surprising that nutrients in food
[[link removed]] help regulate these hormones.
But it may intrigue you to know that the trillions of microbes in your
gut
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are key for orchestrating this process.

I am a gastroenterologist
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Washington who studies how food and your gut microbiome
[[link removed]] affect health and disease. Here’s an
inside-out perspective on the role natural gut hormones and healthy
food play in metabolism and weight loss.

A broken gut

Specialized bacteria in your lower gut take the components of food you
can’t digest like fiber
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plants that are removed in many processed foods – and transforms
them into molecules that stimulate hormones to control your appetite
and metabolism [[link removed]]. These
include GLP-1, a natural version of Wegovy and Ozempic.

GLP-1 [[link removed]] and other hormones
like PYY [[link removed]] help
regulate blood sugar through the pancreas. They also tell your brain
that you’ve had enough to eat and your stomach and intestines to
slow the movement of food along the digestive tract to allow for
digestion. This system even has a name: the colonic brake
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[Diagram showing the effects of GLP-1 on various organs of the body]
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GLP-1 serves many functions in the body. Lthoms11/Wikimedia Commons
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Prior to modern processed foods, metabolic regulatory pathways were
under the direction of a diverse healthy gut microbiome
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naturally regulate your metabolism and appetite. However, food
processing [[link removed]], aimed at
improving shelf stability and enhancing taste, removes the bioactive
molecules like fiber [[link removed]] and
polyphenols [[link removed]] that help
regulate this system.

Removal of these key food components and the resulting decrease in gut
microbiome diversity may be an important factor contributing to the
rise in obesity and diabetes
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A short track to metabolic health

Wegovy and Ozempic reinvigorate the colonic brake downstream of food
and microbes with molecules similar to GLP-1. Researchers have
demonstrated their effectiveness at weight loss and blood sugar
control [[link removed]].

Mounjaro has gone a step further and combined GLP-1 with a second
hormone analogue derived from the upper gut called GIP, and studies
are showing this combination therapy to be even more effective at
promoting weight loss [[link removed]] than
GLP-1-only therapies like Wegovy and Ozempic.

These drugs complement other measures like gastric bypass surgery
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extreme cases of metabolic disease. These surgeries may in part work
much like Wegovy and Ozempic [[link removed]]
by bypassing digestion in segments of the gastrointestinal tract and
bathing your gut microbes [[link removed]]
in less digested food. This awakens the microbes to stimulate your gut
cells to produce GLP-1 [[link removed]]
and PYY [[link removed]], effectively
regulating appetite and metabolism.

Many patients have seen significant improvements to not only their
weight and blood glucose but also reductions in important
cardiovascular outcomes like strokes and heart attacks
[[link removed]]. Medical guidelines
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new incretin-based medications like Wegovy, Ozempic and Mounjaro to
manage the interrelated metabolic conditions of diabetes, obesity and
cardiovascular disease.

Considering the effects incretin-based medications have on the brain
and cravings, medical researchers are also evaluating their potential
to treat nonmetabolic conditions like alcohol abuse
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A near-magic bullet – for the right folks

Despite the success and prospect of these drugs to help populations
that may benefit most from them, current prescribing practices
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Should people who are only a little overweight use these drugs? What
are the risks of prescribing these drugs to children and adolescents
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lifelong weight management?

While incretin-based therapies seem close to magic bullets, they are
not without gastrointestinal side effects like nausea, vomiting,
diarrhea and constipation
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related to how the drugs work to slow the gastrointestinal tract.
Other more severe, but rare, side effects include pancreatitis and
irreversible gastroparesis [[link removed]],
or inflammation of the pancreas and stomach paralysis.

These drugs can also lead to a loss of healthy lean muscle mass
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particularly in the absence of exercise. Significant weight gain
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further questions about long-term effects
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transition back to using only lifestyle measures to manage weight.

All roads lead to lifestyle

Despite our greatest aspirations for quick fixes, it’s very possible
that a healthy lifestyle
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most important way to manage metabolic disease and overall health.
This includes regular exercise, stress management, sleep, getting
outdoors and a balanced diet.

For the majority of the population who don’t yet have obesity or
diabetes, restarting the gut’s built-in appetite and metabolism
control by reintroducing whole foods and awaking the gut microbiome
may be the best approach to promote healthy metabolism.

Adding minimally processed foods back to your diet, and specifically
those replete in fiber
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and polyphenols
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like flavonoids and carotenoids, can play an important and
complementary role to help address the epidemic of obesity and
metabolic disease at one of its deepest roots.[The Conversation]

_Christopher Damman
[[link removed]],
Associate Professor of Gastroenterology, School of Medicine,
University of Washington
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_This article is republished from The Conversation
[[link removed]] under a Creative Commons license. Read
the original article
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* microbiome
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* Science
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* health
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* Obesity
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* diabetes
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