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Is this really a miracle solution for weight loss?


This month a new weight loss drug has been hitting the headlines and is expected to be available to NHS patients soon. So what is this drug, how does it work and is it really the “game-changer” it is purported to be? And is there a natural way of creating the same effect without the need for a drug?


How it works and who it is recommended for

The drug, semaglutide, imitates the effects of a gastrointestinal hormone called glucagon-like peptide-1 (GLP-1) which suppresses your appetite, reducing the amount of food you consume.

In the STEP 5 clinical trial, participants who received a weekly semaglutide injection lost an average of 15.2% of their body weight over two years. (Most participants were women, with a mean age of 47.3 years, body mass index of 38.5 and weight of 106 kg.)

Semaglutide will not be available to everyone on the NHS. The National Institute For Health And Care Excellence (NICE) has recommended its use for adults with a BMI of 35 plus, who have at least one weight related comorbidity.* But even if you are eligible, there are downsides.


Downsides

Side effects

The most common side effects are gastrointestinal disorders such as nausea, diarrhoea, vomiting and constipation as well as headaches and fatigue. But it may also cause serious side effects including suicidal thoughts, gall bladder and kidney issues and possibly thyroid cancer.


Long term medication

You have to keep taking semaglutide otherwise you are likely to regain the weight. (Currently it can only be prescribed for a maximum of two years.)


Doesn’t change your food choices - or set up the conditions in your body to sustain your weight loss

Semaglutide reduces your appetite, so you eat less. But it doesn’t change your food choices or mean you eat healthy foods. You may continue to eat in the same way that led to the weight gain, only consume less of it. Many of us have grown up with the message that to lose weight we just need to consume less calories. (But this is only part of the picture. For more on this, see my blog It’s Not Just About The Calories.)


Whilst eating less may help you lose weight in the short term, it doesn’t stop your cravings or desire for unhealthy foods. It doesn’t align your appetite with your needs or stop the biochemical messengers in your body telling you to store fat. Basically it doesn’t set up the conditions in your body to sustain your weight loss.

The way you eat, for example, may be perpetuating the hormone or gut bacterial imbalances that triggered your weight gain in the first place. If you are eating less but not making healthy food choices, you may be low in nutrients. If you are low in the nutrients that regulate fat storage, this encourages your body to store more fat.


So, on the one hand, you are reducing your appetite but on the other you may be exacerbating conditions that, when you stop the drug, make the weight regain almost inevitable.

Doesn’t address the root cause of why your appetite regulation is disrupted

Our bodies know what we need. They are designed to keep us in balance, to maintain a healthy weight. We have a homeostatic appetite regulation system that works to keep our weight stable. As we gain weight, it reduces our appetite. So if this system is working properly, as you gain weight you should want to eat less.

But this may not be your experience! The problem is modern diets and lifestyles - they can disrupt this system and cause us to overeat.


Taking a drug to increase your GLP-1 levels doesn’t address the root causes of why your appetite regulation system has been disrupted. It doesn’t address factors such as lack of sleep, stress or hormone imbalances, which can all play a role. Nor does it change dietary factors such as overeating high-sugar and high fat foods or consuming monosodium glutamate, a food additive which disrupts appetite regulation.


Is there a natural way of increasing GLP-1 and reducing your appetite

Yes! What you eat affects the amount of GLP-1 that you release.


Consuming high-fiber foods such as vegetables, fruit, legumes and whole grains boosts your GLP-1 levels, so you feel fuller. A plant based meal has been found to increase levels of this satiety hormone.


The type of fats you eat can also affect your GLP-1 levels. Reducing saturated fats (in meat and dairy) and increasing monounsaturated and omega 3 fats raises your GLP-1. Monounsaturated fats are found in olive oil, avocado, nuts and seeds. Oily fish, flaxseed, chia and hempseed are sources of omega 3 fats. It is best to avoid processed meat. Not only is it associated with increased health risks it also impairs the release of GLP-1.

Protein foods may also increase GLP-1 release, particularly when combined with calcium containing foods. So have some green leafy veg with your meal! (Many of us think of dairy when it comes to calcium, but it is best to consume dairy in moderation and include a variety of other sources. Other calcium containing foods include nuts, seeds, tofu, sardines, cooked dried beans, cabbage and other green leafy vegetables)


Your ‘good’ gut bacteria also play a role in increasing GLP-1, by breaking down fermentable dietary fibre. This produces short chain fatty acids which promote GLP1 secretion. Fermentable dietary fibre includes beans, lentils, chickpeas, oats, barley, onions and artichokes. To boost your ‘good’ gut bacteria it is helpful to include fermented foods such as miso, sauerkraut, kefir and kimchi.


How to make it easier to lose weight, without drugs

When you work with your body and start to address the biochemical imbalances (such as GLP-1 levels), then it becomes so much easier to lose weight and sustain it. However, to make lasting changes, you need to bring your whole body into balance rather than focusing on one aspect in isolation. When you do this, you reduce and ultimately eliminate your cravings and overeating. You let your body know that it can let go of the excess weight.




*It may also be prescribed for people with a BMI of 30+ with a weight related comorbidity who are eligible for referral to specialist weight management services. Semaglutide, also called Wegovy, is recommended to be used alongside a reduced-calorie diet and increased physical activity.


References

Drucker, D.J., 2006, ‘The biology of incretin hormones’, Cell Metabolism, 3, 3, 153-65.


Garvey, W.T. et al., 2022, ‘Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial’, Nature Medicine, 28, 2083–2091.


Hermanussen, M. et al., 2006, ‘Obesity, voracity, and short stature: the impact of glutamate on the regulation of appetite’, European Journal of Clinical Nutrition, 60, 1, 25–31.

Kahleova, H. et al., 2019, ’A Plant-Based Meal Stimulates Incretin and Insulin Secretion More Than an Energy- and Macronutrient-Matched Standard Meal in Type 2 Diabetes: A Randomized Crossover Study’, Nutrients,11,3, 486.


Kim, G.W. et al., 2011, ‘Regulation of appetite to treat obesity’, Expert Rev Clin Pharmacol, 4, 2, 243–59.


Watkins, J.D. et al., 2021, ’ Protein- and Calcium-Mediated GLP-1 Secretion: A Narrative Review’ Advances in Nutrition, 12, 6, 2540–2552.




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