Mallory asked me to make my newsletters shorter – then she asked me to write a newsletter about the new weight loss injections!! I have a lot to say about this topic so I apologize for its length. LET’S DIVE IN…..
THE NEW WEIGHT LOSS MEDICATIONS – THRU THE LENS OF A SEASONED HEALTH CARE PROVIDER
In this month’s newsletter I want to share with you some important information gleaned from my years of experience that will help you put the CURRENT MEDICAL CRAZE – WEIGHT LOSS INJECTIONS – into perspective. For 37 years I experienced many new drugs hitting the market and I helped many women manage their weight through many different weight loss crazes. If you are struggling with your weight and considering the new weight loss injections – Semaglutide and Tirzepatide (I will be using the actual drug names – not the branded names) – I hope this information helps you objectively evaluate them and decide if they are a good fit for you.
SIDE NOTE – these medications have also been approved for treating type 2 diabetes – but that’s not the focus of this newsletter.
FIRST AND FOREMOST – THE EPIDEMIC OF OBESITY IS A THREAT TO OUR WELLBEING AND LONGEVITY:
The number of children and adults dealing with extra weight in our society is staggering and just keeps increasing. Since extra weight can affect quality of life and is associated with increased disease – promoting weight loss has become a priority and a huge industry.
I don’t like putting people into boxes and will freely admit that obesity is not a PROBLEM for some women. Despite being overweight these women are happy with their bodies and their medical markers do not indicate disease. Lets just admit that not everyone is genetically designed to be thin but that doesn’t mean they are unhealthy. BUT ….. In my practice – I rarely encountered these women. The majority of women in my previous practice (weight gain during peri-menopause and menopause is extremely common) did have concerns about optimizing their weight or their laboratory studies revealed abnormalities that put them at risk for disease. These women wanted to lose weight and/or medically I recommended they lose weight.
LET’S START WITH THE OBVIOUS – LOSING WEIGHT IS NOT ALWAYS EASY!!
The purpose of this newsletter is not to educate you on the causes of obesity but let’s look at a brief list – THE CULPRITS ARE THINGS I HAVE MENTIONED MANY TIMES IN MY NEWSLETTERS. We all know that weight is not just calories in and calories out. Truth be told – our modern lifestyle is rarely conducive to good health. Metabolic disrupters such as highly palatable ultra-processed foods, chemicals from our environment that confuse our metabolic chemistry, hormone imbalances which affect weight, sedentary lifestyle, exposure to non-native electromagnetic frequencies (such as the blue light of our screens increasing blood sugar), hectic and stressful schedules that can elevate Cortisol, lack of circadian rhythm and lack of exposure to nature can all contribute to a confused and poorly functioning metabolism.
Sometimes the weight loss solutions for my patients were simple as almost everyone can work to upgrade their diet and move more – they just needed a little motivation and guidance to obtain their goal. Sometimes balancing their hormones would result in weight loss (female hormones, thyroid, adrenal and pancreatic hormones can all affect weight) and other times working to reduce inflammation (there is such a thing as inflammatory weight) or working to avoid toxins allowed their metabolism to normalize. BUT IT WASN’T ALWAYS EASY- throughout my career my patients and I have always been looking for additional weight loss solutions. When the new weight loss injections came on the scene with the approval of Wegovy (semaglutide) in 2021 and Zepbound (tirzepatide) in 2023. I was so pleased that new solutions were available. Especially since these medications are peptides that our own bodies produce naturally. I have prescribed natural hormones for years and already had experience using several peptides with good results – such as GHK-Cu for skin health.
EXCITED BUT PROCEEDING WITH CAUTION:
Despite my optimism I knew it was important to evaluate the new weight loss injections carefully. My experience has taught me to proceed slowly and objectively when new ‘wonder drugs’ hit the market. To illustrate this fact – let’s look at some examples of FDA APPROVED AND highly touted medications that were later found to be HARMFUL. Drug studies are not always as well planned and objective as you would think – since they are conducted by the drug companies themselves.
DES ( a synthetic hormone given to many women and even put into hundreds of brands of prenatal vitamins) was found to cause cancers, Thalidimide another drug given to pregnant women was found to cause congenital abnormalities, highly used menopause hormones such as Prempro were dethroned in 2002 (after years of being the number one block buster drug) when a study revealed risks. The birth control pills were originally VERY HIGH doses of synthetic hormones that were found to increase risks – so the doses were lowered, Phen-Fem, Meridia and Belviq were weight loss drugs that were withdrawn from the market due to serious side effects. The list during my career also includes Vioxx and some vaccines being withdrawn from the market. Then we have drugs such as the opioids and amphetamines that have not been withdrawn but were inappropriately promoted to the masses. All reasons to proceed with caution when considering the use of a new drug.
REALIZE THAT DRUG MARKETING IS A SALES FUNNEL:
Indulge me as I get long winded and share with you some important lessons I have learned that have helped me when evaluating whether to personally use a new drug or prescribe a new drug for my patients. This information will help put drug marketing which can be very powerful (especially with the help of social influencers) in perspective.
OVER THE YEARS I HAVE OBSERVED THAT THE MARKETING OF NEW DRUGS OR TREATMENTS IS VERY ORCHESTRATED AND OFTENTIMES SEEMS TO FOLLOW A SCRIPT.
In the beginning – the benefits can seem TOO GOOD TO BE TRUE. I remember when cardiologists called for putting statin medications in our public water supply since they have some anti-inflammatory benefits. Fast forward and the data on their benefits is much more nuanced and has revealed their use should be limited to a much SMALLER population. I have also seen this with female hormone therapy – estrogen and progesterone are very important and currently highly promoted but they will not solve ALL YOUR PROBLEMS as is often touted.
After convincing you a drug has fabulous benefits the messaging switches to convincing you that – YOU NEED THE DRUG. It goes like this – your body is failing you and this drug is your solution (no mention of the multitude of lifestyle changes that might help). An example is when menopause hormones first became popular after a doctor wrote the Feminine Forever book. In that book women were told the natural process of menopause was now deemed a disease – a disease that caused them to be a less than desirable dried up woman! No surprise that menopausal hormone therapy became a blockbuster drug after that. I love that in the modern world we have learned how to prolong health but I hate that these messages are designed to convince you of your defective nature instead of empowering you – IT IS POSSIBLE TO BE HEALTHY WITHOUT DRUGS.
To the drug companies – the best drug is one you need forever. Marketing often is geared to convince you that you will ALWAYS need the drug. Examples are – the message that menopause is the rest of your life- so despite many health variables that may change over time – there is no need to reevaluate your use of the drug – you simply will need it for the rest of your life.
Now that you are convinced you need a drug – of course – you can only get it from the company that developed (patented) it. This almost always means (in the United States) you are paying a high price. NO WORRIES – they have a coupon that makes you go ahead and try that drug.
Since “everyone wants it” the drug can end up in short supply – this exclusivity only makes you want it more! Again NO WORRIES – they have a solution to help more and more people get on the drug. Compounding pharmacies are allowed to produce their drug during a shortage (funny since typically drug companies try to convince you compounding pharmacies are not safe).
SIDE NOTE – I have used compounding pharmacies for years and consider ones with a long and safe track record to be very valuable. Sometimes you need to individualize a patient’s prescription so that it is safer for them (example – in 1993 when only non-bioidentical hormones were available for women from drug companies I helped them obtain bioidentical hormones from a trusted compounding pharmacy), compounders can provide a drug without ingredients such as dyes and fillers that patients want to avoid, sometimes medications are cheaper through a compounding pharmacy and sometimes such as during shortages they can help manufacture a needed drug. It’s good to know – Compounding pharmacies use active pharmaceutical grade ingredients sourced from FDA registered facilities and compounding pharmacies are regulated by their state with FDA oversight. 503b compounders exist to mass produce medications in short supply while 503a compounders do individual prescriptions.
Now that the drug is a blockbuster with MANY people dependent upon it – the coupons run out and it’s again only available from the drug manufacturer that has the patent (the compounding pharmacies are now vilified). This can make previously accessible drugs not accessible for some people. It’s very unfortunate and unfair.
Finally, as the patent is about to expire on the drug which will finally reduce the cost, a new way to deliver the drug (such as a patch or “extended” version) or a new indication for that drug is found resulting in a “new” drug version that maintains the patent. Usually along the way, many more versions of the initial drug that are “even better” come on the scene so that the highly lucrative drug pipeline is maintained.
Eventually – the too good to be true drug – loses its shine as the high cost, side effects and even newly discovered harms diminish its appeal. Unfortunately, during my time in medicine – the perfect drug – has never been discovered. In my experience, despite the initial hype when a new drug is released, some version of this story almost always plays out and diminishes its appeal.
HEALTH YOURSELF ACTION – BE CAUTIOUS AND BE OBJECTIVE WHEN A NEW DRUG IS MARKETED. Case in point – Eli Lilly, which makes Tirzepatide was fined billions in the past for deceptive marketing of an antipsychotic drug.
MOVING ON TO SOME OF MY THOUGHTS ABOUT THE PRO’s AND CON’S OF WEIGHT LOSS INJECTIONS:
DISCLAIMER : I AM NOT GIVING MEDICAL ADVICE AND MAKING MEDICAL DECISIONS FOR YOU – THAT SHOULD BE DONE WITH YOUR PROVIDER. I AM NOT PROVIDING AN EXHAUSTIVE REVIEW OF THESE MEDICATIONS, THEIR INDICATIONS FOR USE OR THEIR DOSAGES – AGAIN THAT SHOULD BE DISCUSSED WITH YOUR PROVIDER. IN THIS NEWSLETTER I JUST WANT TO HIGHLIGHT SOME INFORMATION THAT OFTENTIMES IS NOT DISCUSSED. THIS INFORMATION MAY HELP YOU MAKE A MORE INFORMED DECISIONS IF YOU ARE USING OR CONSIDERING THESE MEDICATIONS.
Since an in-depth discussion of exactly how these medications work and the benefits and risks of these injections is not practical in this newsletter I will refer you to (this article) on Semaglutide and (this article) on Tirzepatide for more in-depth information. Currently the majority of the research has been on GLP – 1 drugs which have been in use in different medications since 2005. A GLP -1 is in both the new weight loss injections but the concentration is much lower in Tirzepatide as it also contains an additional peptide called GIP.
DOES THE USE OF WEIGHT LOSS INJECTIONS ALIGN WITH YOUR PERSONAL HEALTH PHILOSOPHY? EXAMPLE – if you prefer to avoid medications and strive to do things naturally you may prefer to avoid these medications, wait until you have tried lifestyle changes first or at least wait until they have been studied longer. My own health philosophy is to ALWAYS work hard on improving my lifestyle before considering any medication. Don’t let hype and marketing derail your core beliefs. Medications are not always the best option.
COST -Drug treatment should be evaluated on an individual basis. Don’t let drug marketing override your unique situation and needs. All drugs have financial costs, health benefits and health risks. Carefully evaluate all of these factors with a provider if you are considering them. Cost is a very big issue when considering these injections since the drug companies classify them as lifetime medications and the data gathered since they were introduced shows very few people successfully transition off of them without regaining the weight (the appetite suppression and metabolic benefits of these medications diminish when you stop them). Since many people use these medications but do not qualify for insurance reimbursement it’s important to consider cost – since over time these costs can be very significant.
Currently both Eli Lilly (through a program called Lilly Direct) and Novo Nordisk (through a program called NovoCare) are offering a discounted (direct to consumer price) for their weight loss injections – you can find information on their websites (spoiler alert – it is still expensive).
The price of these injections is usually cheaper from a compounding pharmacy – but it’s unclear if getting them from compounding pharmacies will continue to be an option. Currently both the name brand drugs are not in short supply so the mass production 503b compounders should not be producing it. The drug companies would also prefer that it was not available from 503a compounders that serve individuals who need a unique prescription. However, some 503a compounders are continuing to provide these medications under the assumption that as long as they are not an exact copy of the patented name brand drug they are allowable. An example is that they can offer a dosage not available from the drug companies, they can add additional substances to these medications such as vitamin B12 etc that make the final product – not an exact copy. Who knows how long this will last – The drug companies are currently suing online companies that have been selling compounded versions to the masses such as Mochi Health and in general they are attempting to stop all compounding by suing some compounding pharmacies.
SIDE NOTE: I have seen things like this play out before – since I have been prescribing compounded hormone therapy for years. Ever since compounding pharmacies began offering bioidentical hormones the drug companies have been trying to outlaw it – so far unsuccessfully. Also a previous compounded weight loss drug I used for women – HCG (which had good success) was removed from being classified as a drug and put into a class called biologics. Compounders are only allowed to make drugs – not biologics so that ended access to HCG from compounders.
The price of these medications is cheaper if you illegally (assuming you’re not a researcher) order them from what is called the GREY MARKET. The grey market could be a legitimate drug manufacturer that manufactures the drug for research purposes in animals (the drug comes labeled not for human consumption). The manufacturing process should be basically the same (depending on who you are dealing with) but it is not as tightly regulated. I would have concerns for things like is it sterile since these medications are injected into the body, is it the proper dose or does it contain contaminants. They could even be selling you no drug at all – it’s the Wild West. Certificates of Analysis that may be provided from these sellers can also be fake. I DONT ADVISE THIS ROUTE AT ALL! BE PICKY ABOUT WHAT YOU INVITE INTO YOUR BODY.
SIDE NOTE – I am someone who has seen fraud, fakes and poor quality in the supplement industry (fakes on AMAZON are rampant). I in fact actually visit supplement manufacturers to make sure they are following the best manufacturing standards and really do my research before using a supplement company. I am also very careful to avoid exposing supplements to high temperatures in storage or transport (such as being shipped on a boat from China!). To avoid this I order my supplements directly from the warehouse of a U.S. manufacturer. If you want to read an article I wrote that covers supplement quality (you can read it here).
BENEFITS –
If your goal is to lose weight – these medications will help you do that! They are almost equivalent to bariatric surgery (which historically has been the best method for losing weight) but obviously these injections are much less invasive. Basically- these injections give you the “GIFT” of not needing sheer willpower to eat less (due to supporting metabolic control of blood sugar, slowing the GI tract and affecting satiety centers in the brain that reduce appetite). On these medications – you simply won’t think about food as much! When you USE THIS GIFT wisely to break any addictions to unhealthy eating habits and when used with exercise they can be a win-win.
Weight loss injections have also been found to improve cardiovascular health and blood sugar control which is important for long-term health. Additional research also is showing benefits in multiple organs such as the kidneys, brain and joints due to the injections having anti-inflammatory effects. (See this article).
RISKS -Let’s look at the big picture. In my career I worked exclusively with women and I know how important weight is to most of us – mentally and physically (it’s like Viagra is so important to men!). All medications have their risks and as individuals we all have different risk tolerances. It’s important to know the risks of any medication -I will refer you to the articles I referenced previously that covers these medications in depth – including the risks. I trust women to decide what is best for them once they have evaluated the risks and benefits.
I do want to point out some things that I feel can reduce risk. It’s my opinion that you can reduce side effects such as nausea and reduce risks such as muscle and bone loss, pancreatitis and gastric paralysis by using the LOWEST DOSAGE THAT IS EFFECTIVE which is oftentimes MUCH LOWER than the drug companies recommendation. With a lower dose the weight loss is slower which helps preserve muscle mass especially if you’re also exercising (resistance training is really a must on these medications). Hair loss which is extremely common with rapid weight loss is also less likely to occur. The weight loss injections can also be effective longer (drug resistance is reduced) when lower doses are used.
Finally to reduce risks patients should be screened appropriately before starting these injections (instead of brief online questions) since the risks are higher in certain individuals (such as someone with a history of thyroid cancer or prior pancreatitis).
I do want to point out other things that I feel could potentially affect the safety of these weight loss injections. Since Semaglutide and Tirzepatide model peptides your own body produces, I am hopeful that their long term risk profile will be reasonable. However – the drug companies DID CHANGE THE CHEMICAL STRUCTURE of these peptides so that they would last longer in the body and not require frequent injections. These drugs are also MANY MULTITUDES STRONGER than the peptides your own body produces (large doses were required to get the results they wanted).
All of this I keep in the back of my mind since in my decades of working with hormones I have learned bio-identical hormones (exact copies of what the body would make) tend to be superior and I have learned that large doses can be problematic since they upset normal hormone balance by causing hormone resistance (example – we all know elevated levels of insulin can cause insulin resistance).
Finally I do want to point out these drugs do have a black box warning – due to increased medullary thyroid cancers in rodents. I am also concerned about the new data revealing their effects on the eyes including blindness (see this article). Carefully consider the risks before starting any medication.
HEALTH YOURSELF : DO YOUR RESEARCH! KNOW THE PRO’S AND CON’S OF THESE MEDICATIONS. GOING SLOW AND LOW – CAN REDUCE RISKS AND SIDE EFFECTS.
LAST WORDS OF ADVICE: YOU MAY NEED SUPPLEMENTS WHEN ON WEIGHT LOSS INJECTIONS:
When dieting – especially on these medications – it can be difficult to obtain all the nutrients your body needs (ONE REASON WOMEN EXPERIENCE HAIR LOSS). Most women need at least a multivitamin to avoid deficiencies. I like a MV from WholeScripts (log in to your account or create an account) called Xymogen”s Active Nutrients.
Since you don’t want to lose too much muscle it is important to obtain adequate protein. Since bulky protein is often not palatable to women on these medications you may need to supplement with a protein shake. I like from WholeScripts (log in or create an account) Orgain Organic Protein Powder.
Muscle loss can be very significant on these medications if you are not careful. MUSCLE IS YOUR METABOLIC CURRENCY – so to maintain weight loss you do not want to lose it!! As I have said -resistance exercise is a must on these medications to help retain muscle mass. This is especially important as we age since it can be extremely hard to rebuild muscle. If you are not able to exercise due to physical limitations or just want to be proactive – I recommend that you supplement from WholeScripts with Xymogen’s HMB Pro which has studies showing it helps maintain muscle even when inactive (read this).
Finally, if you are transitioning off these medications or just want to blunt your appetite consider a supplement that can elevate your own body’s production of GLP 1. Many supplements are now touting that they can do this but the supplement I have seen with the best data is Calocurb – you can read about it at calocurb.com This link will provide you with a 10% discount if you do want to try it.
Doctor Brenda Smith
Doctor. Brenda Smith, newsletter provides general health information for educational purposes only. The information in this newsletter is not to be used as a substitute for medical advice, can not diagnose or treat any health condition, and does not substitute for care from your own in person physician. Any questions regarding your own health should be addressed to your own primary care physician or other healthcare provider .
