Nick Stenson, co-host and health expert, dives into the intricate world of GLP-1 agonists like semaglutide and tirzepatide, discussing their effectiveness and potential side effects for weight loss. They also explore the rising interest in metformin as a longevity drug, addressing its applications beyond diabetes management. The conversation humorously touches on branding changes in weight loss medications, raising ethical questions about their use among non-overweight individuals. This engaging discussion offers a deep look at the future of these transformative therapies.
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GLP-1 Agonists for Weight Loss
GLP-1 agonists like semaglutide and tirzepatide, initially diabetes drugs, are now popular for weight loss.
They work by acting on gut hormones to reduce appetite, but the exact mechanism isn't fully understood.
question_answer ANECDOTE
Demand for GLP-1 Drugs
Peter Attia receives daily inquiries about GLP-1 drugs, mostly for weight loss, not diabetes management.
Some inquiries come from individuals who are not overweight but seek cosmetic weight loss.
insights INSIGHT
Geroprotective Drugs
Geroprotective drugs like metformin or SGLT2 inhibitors target various aging hallmarks.
They aim to improve lifespan and healthspan more broadly than single-disease treatments.
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In this “Ask Me Anything” (AMA) episode, Peter focuses the discussion on two topics getting a lot of attention recently. He first dives deep into GLP-1 agonists, most notably semaglutide and tirzepatide, which originally came to market as diabetes drugs but are now being studied and prescribed for weight loss. He walks through the data and compares the effectiveness of the two drugs, the side effects, and perhaps more importantly, his reservations around wide use of these drugs and who he would consider to be a candidate for them. Next, Peter discusses how metformin, another drug originally brought to market for diabetes management, gained popularity as a potential longevity drug even for non-diabetics. Peter gives his take on this possibility and reviews data from a more recent study investigating the question of whether metformin should be used for general “geroprotection.”
If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #45 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
The hype around semaglutide, tirzepatide, and other GLP-1 agonists for weight loss [2:30];
Overview of GLP-1 agonists and why these drugs are getting so much attention [6:15];
Defining the term “geroprotective” [13:30];
Semaglutide: background, brand names, indications, and more [15:15];
Tirzepatide: background, brand names, indications, and more [19:15];
How semaglutide and tirzepatide compare in their efficacy in terms of weight loss and other metabolic health metrics [23:45];
Data showing sustained weight loss and improved metabolic metrics with after more than a year of using semaglutide and tirzepatide [29:00];
What happens to body weight when a patient discontinues the medication? [34:45];
Noteworthy side effects of GLP-1 agonists and similar classes of drugs [40:45];
Increased resting heart rate and other concerning trends in patients using GLP-1 agonists [45:15];
Changes in body composition (body fat and lean muscle) in patients on GLP-1 agonists [50:45];
Possible reasons for the loss of lean muscle mass and tips for protecting lean mass [59:00];
GLP-1 agonists and thyroid cancer [1:01:30];
Who might be a candidate for GLP-1 agonists? [1:03:45];
The large financial cost of this class of drugs [1:08:30];
Metformin as a geroprotective drug: origin of the idea that metformin could be a longevity agent even for non-diabetic patients [1:11:30];
A 2022 study on metformin sheds more light on the question of whether metformin should be used for “geroprotection” in non-diabetics [1:21:00];
Peter’s current approach with metformin for his patients [1:25:15]; and
The Peter Attia Drive 