Risks and Clinical Considerations

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It blends psychological profiling with high-stakes investigations while also exploring the pressure of his personal life. So if you need your fill of darkness, it's right here on Prime Video. Subscription required except to rent or buy. Content may include ads. 18 plus terms and conditions apply. Arrayo Original Podcast . Hi, I'm Catherine Ryan, and this is Dr. Nicholas Second Opinion. Your backstage Sit tight as we take a deeper dive into the research we covered on this week's episode, giving you more clarity, more context, and more Con lin.. Plus, Dr Nick will be serving up her quick fix so you can take action to slow down your aging right now. First up, we're taking a look at some of the wider issues that came up in conversation with Vanessa Feltz on What's My Age Again. Dr. Nicola's second opinion. Hi everyone. It is great to be back with you all. Now in a recent episode with Vanessa Feltz, she spoke very openly about her lifelong struggle with her weight and her decision to undergo weight loss surgery , and how, in her words, if weight loss injections had existed back then, she might have never chosen to undergo this surgery. And that really struck me because weight loss injections have gone from being something that was fairly niche, like a medical treatment, to something that suddenly seems to be absolutely everywhere. It feels like overnight they've moved from clinics into almost mainstream culture with social media influencers and celebrities and everyone and the dog almost seems to be talking about them. And I'm getting constantly asked about them now. So in this episode, I really want to unpack the science behind them. What are these drugs? How do they actually work? What do we know about them? And more importantly, what do we not know about them yet? But first, let's go into the science bit. So first of all, let's just start with the basics. So you'll have heard of the brand names of these weight loss injections. They are Ozempic, Wygovi, and Manjaro. And these are the big ones that you'll be hearing about all the time. So Azempic and Wygovi actually both contain the same drug. And this drug is called semiglutide. And the reason that they're marketed as two different brands is because basically that's prescribed at different doses for different medical conditions. So Azemp ic is a lower dose that's prescribed for weight loss, and Wygovi is a higher dose that is prescribed for type 2 diabetes, but underneath they have exactly the same active drug, which is semiglutide. So what is semiglutide and what does it do? Well, it's what we call a GLP1 receptor agonist. Now GLP1 stands for glucagon like peptide 1. That's glucagon like peptide 1. Science word of the week . GLP1 is basically a hormone that your body naturally produces in your gut every time you eat. And it's got a couple of jobs. Now, one is to stimulate insulin production to control your blood sugar. Another job is to slow the rate at which your stomach empties. And a third job is to send signals to the brain to tell your body that you are full. So in simple terms, the G LP1 naturally found in your body will help you to feel full when you eat and also to regulate your blood sugar. Now, a GLP1 agonist is basically a drug that mimics this horm one. So it activates the same receptor or the same switch in your body, but it works for longer and it's much more powerful than the natural GLP one that you produce. So what happens is it means that when you take these injections, you feel fuller, faster, you stay fuller for longer, and you significantly reduce your appetite . Now, Manjaro works slightly differently because it contains a drug called teaser peptide and it works in a slightly different way. Now, how this one works is it activates both the GLP1 receptor and another hormone pathway called GIP, which is glucose dependent insulantrophic pelly peptide, meaning that Manjaro actually has a dual mechanism, so it appears to make it even more potent for weight loss in clinical trials. Now here's the important part . These medic ations were originally developed for type 2 diabetes to improve blood sugar control and to reduce cardiovascular risk. But the weight loss was initially observed as a secondary benefit. So over time, higher dose versions were approved specifically for obesity and weight loss. And they are incredibly effective , it must be said. They really do work. So clinical trials have shown that you will get an average weight loss of around 15 to 20% of your body weight, and this is actually comparable to some weight loss surgeries. And this matters because being overweight is very strongly associated with increased risk of many serious diseases, things like diabetes, cardiovascular disease, certain cancers, and even osteoarthritis. So anything that can meaningfully reduce excess fat mass can actually reduce the risk of all these diseases and improve your health and potentially also improve biological age markers. But and this is really crucial, there's a significant caveat to this. And that's when people stop these drugs, most of them will regain the majority of the weight within 12 to 18 months. And that tells us something really important. It tells us that these drugs are suppressing your appetite while you are on them, but they don't permanently reset your metabolism or help to change any lifestyle patterns that may have caused the weight gain in the first place. So, for many people, this will become a lifelong medic ation. And taking a medication for a significant amount of time for life, potentially, is not without risk. And we know that these drugs do have some common side effects. They have things like nausea, vomiting, diarrhea, and even fatigue and brain fog. And there's also some more serious risks that are emerging, including pancre atitis, which is basically inflammation of the pancreas. And this occurs in one in one hundred people. So that is not insignificant. That's quite a lot of people. Another growing concern is malnutrition because when people are taking these weight loss injections, their appetite is so significantly suppressed that people are just simply not eating. So they're not getting enough protein, they're not getting all the micronutrients and not really getting enough calories to sustain everyday activity. So what we start to see is reports of muscle loss and people becoming nutrient deficient in some poorly supervised cases where people aren't using it correctly. Now, don't get me wrong, I think these drugs are a huge medical breakthrough, and under proper medical supervision for the right person, these drugs can be life-changing. But we also have to remember that these are powerful metabolic drugs and they deserve to be treated that way. And I think that's where my main concern lies around these because people are talking about them like their supplements or like they're the latest gadget and access to them has become incredibly easy. You can literally go online and get a consultation with minimal oversight by a qualified medical person and I've actually heard many stories about people manipulating photos using things like fat filters or basically lying about the weight to qualify for these injections that are then just sent out in the post . And that means people are using them when they really don't need them and they're actually unaware or uninformed about the risks. So if you are thinking about weightless injections, I strongly suggest that you have a face-to-face consultation with a doctor so you can fully discuss the pros and cons and understand the risks and then make an informed decision about whether you think this is something for you.. Dr Nicholas's second opinion. So in season two of What's My Age Again, Catherine and I were joined on the sofa by a professor who's sometimes known as the gut father in this world. This is Professor Tim Spector. And it's safe to say that I think he was quite impressed by the potential that these weight loss jobs have. It's probably the biggest medical breakthrough in my career. Yeah. If you have obesity, it's a game changer. But if you don't, but you have an audition . Then uh it's really unclear whether the risks outweigh the benefits. Okay. The context is absolutely crucial here. Yeah. You know, this could be a transformative drug for our public health, preventing diabetes . Um and in overweight diabetic uh patients taking it, you know, they get half the rate of nearly all the disease we've looked at so far. It's going to be the continuing story for the next uh decade or so. The pills will be coming out soon. Um but we desperately need more studies to to work this out. But I think what's really interesting is they probably have these anti inflammatory effects. Yeah. Which are nothing to do with the actual uh GLP one, which is this gastric hormone, you know, sending signals of fullness to your brain. Yeah, so I think it's really good to hear that Professor Tim Specter has many of the same views as I do on this topic. And I think we're both really excited of the future potential that these drugs have. Dr. Nicola's second opinion. Okay, so now we're gonna head into some questions. And it's safe to say that we have had a lot of questions on this topic in our social media feed. And Catherine's got the first one. Hi Dr. Nick, it's Rachel from Leeds. I've been on weight loss jabs for three months and while it's helping, I'm worried about what it might be doing to my metabolism long term. Could you explain what we know so far about how these medications affect aging and whether they can help change my biological age in any way? Okay, so that is a great question because there is emergent evidence that GLP1 agonists actually reduce inflammation in our body. They also improve insulin sensitivity and reduce our cardiovascular risk, all of which are associated with healthier aging . And some researchers are now exploring whether microdosing these drugs might have longevity benefits through the anti-inflammatory pathways and improved metabolism that they lead to . But this is still early data, but biologically it is plausible. So it's definitely something that I am excited about and that I'm following in the scientific space. Because we know that lower inflammation and better glucose control often correlate with better biological age. But we don't yet have these long-term longevity trials in healthy populations, so we need to wait for this picture to evolve a little bit. Okay, so our next question is from Donna, who's 36, and she says, I've struggled with weight fluctuations since my second baby. My GP suggested I consider a weight From a longevity perspective, what should woman my age be thinking about before starting these treatments? I've been trying to develop muscle mass post birth. Okay, Donna. So this is a really important consideration because if you have been trying to increase your muscle mass, clinical trials have shown that actually 20 to 30 percent of the weight that people lose on these drugs can come from muscle mass . So this is kind of a little bit of a caveat here and we know that for longevity and aging muscle is very protective because it supports our metabolic health, it supports our bone density and also the control of glucose in our body. So I'd say for a woman like yourself who's in the 30s or 40s, especially postpart um, building and preserving muscle should be a priority. And if weight loss is achieved using these jabs without adequate protein intake and also resistance training, there is a large risk that you might lose muscle alongsized fat. So, from a longevity perspective, what I would say is that lifestyle interventions like strength training, optimizing your diet and protein and sleep should absolutely be explored first before jumping for these medic ations. This episode of What's My Age Again is sponsored by Med Express, the UK online pharmacy. If you've been trying to manage your weight but feel like nothing's really working, MedExpress connects you with UK registered clinicians who assess your situation and create a treatment plan to support your weight management goals. With over 1.5 million customers, MedExpress is one of the country's leading online pharmacies, and they offer access to licensed, evidence-based treatment under medical supervision. And the whole process