<p><a href="https://peterattiamd.com/ama45/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230313-pod-ama45&utm_content=230313-pod-ama45-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230313-pod-ama45&utm_content=230313-pod-ama45-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230313-pod-ama45&utm_content=230313-pod-ama45-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>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."</p> <p>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 <a href="https://peterattiamd.com/members/private-podcast-feed/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230313-pod-ama45&utm_content=230313-pod-ama45-podfeed">private RSS feed </a>or our website at the <a href="http://peterattiamd.com/ama45/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230313-pod-ama45&utm_content=230313-pod-ama45-podfeed">AMA #45 show notes page</a>. If you are not a subscriber, you can learn more about the subscriber benefits <a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230313-pod-ama45&utm_content=230313-pod-ama45-podfeed">here</a>.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>The hype around semaglutide, tirzepatide, and other GLP-1 agonists for weight loss [2:30];</li> <li>Overview of GLP-1 agonists and why these drugs are getting so much attention [6:15];</li> <li>Defining the term "geroprotective" [13:30];</li> <li>Semaglutide: background, brand names, indications, and more [15:15];</li> <li>Tirzepatide: background, brand names, indications, and more [19:15];</li> <li>How semaglutide and tirzepatide compare in their efficacy in terms of weight loss and other metabolic health metrics [23:45];</li> <li>Data showing sustained weight loss and improved metabolic metrics with after more than a year of using semaglutide and tirzepatide [29:00];</li> <li>What happens to body weight when a patient discontinues the medication? [34:45];</li> <li>Noteworthy side effects of GLP-1 agonists and similar classes of drugs [40:45];</li> <li>Increased resting heart rate and other concerning trends in patients using GLP-1 agonists [45:15];</li> <li>Changes in body composition (body fat and lean muscle) in patients on GLP-1 agonists [50:45];</li> <li>Possible reasons for the loss of lean muscle mass and tips for protecting lean mass [59:00];</li> <li>GLP-1 agonists and thyroid cancer [1:01:30];</li> <li>Who might be a candidate for GLP-1 agonists? [1:03:45];</li> <li>The large financial cost of this class of drugs [1:08:30];</li> <li>Metformin as a geroprotective drug: origin of the idea that metformin could be a longevity agent even for non-diabetic patients [1:11:30];</li> <li>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];</li> <li>Peter's current approach with metformin for his patients [1:25:15]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Seek Professional Medical Advice
This podcast is for general informational purposes only and not a substitute for professional medical advice; always seek assistance from healthcare professionals for any medical conditions.
2. Prioritize Insulin Sensitivity
When addressing type 2 diabetes, the primary goal should be to increase insulin sensitivity, as this will ultimately result in a reduction in blood glucose levels.
3. Evaluate GLP1 Use Critically
Critically evaluate the use of GLP1 agonists for weight loss, especially if not genuinely overweight, as many individuals seek them for minor cosmetic weight loss rather than medical necessity.
4. Explore Gyroprotective Drugs
Consider exploring “gyroprotective” drugs such as rapamycin, SGLT2 inhibitors, or metformin, as they appear to act broadly across various hallmarks of aging to improve overall lifespan and healthspan.
5. Lower Blood Glucose Strategy
An important strategic plan to lower blood glucose involves using things that either stimulate insulin release or inhibit glucagon release, as both actions reduce blood glucose levels.
6. Listen to Richard Miller (148)
To understand the science, testing, and considerations for “gyroprotective” drugs, listen to podcast episode 148 featuring Richard Miller for amazing insights.
7. Consider Oral Semaglutide
If you prefer not to inject or face refrigeration challenges, consider oral semaglutide as an alternative to injectable GLP1 agonists, though it is also very expensive.
8. Understand GLP1 Agonists
If you are thinking about taking, currently taking, or curious about GLP1 agonists like semaglutide (Ozempic, Wegovy) or terzepatide, listen to this episode for deep insights and reservations.
If you have an interest in metformin, particularly its potential “gyroprotective” effects beyond diabetes, this episode delves deeper into the relevant studies.
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