A funny thing happened on the way to treating diabetes—a welcome side effect became evident: weight loss. The medication, liraglutide, was originally approved in 20101 for assisting in the management of Type 2 diabetes. This was due to something called the incretin effect, which is an increase in insulin when glucose rises—something that is natural in most people but is faulty in diabetics. (Insulin is the body’s way of taking sugar into the system for the creation of energy or energy storage.) The normal incretin effect is caused by the body’s GLP-1 (glucagon-like peptide), which is the mechanism by which it helps control blood sugar. Liraglutide, which mimics the actions of GLP-1 (GLP-1 agonist), does the same thing, helping in the control of diabets.
GLP-1’s multitasking abilities
GLP-1, however, also serves as the body’s “fed” signal,2 which comes in handy before tackling the second half of that roast beef sub. Added to that is GLP-1’s causing a delay in stomach emptying, by which it decreases absorption from the intestines down the line, where most calories are in-processed.
Thus, it delivers a double-whammy for weight control. This was a raised-eyebrow moment for the Danish pharmaceutical company Novo Nordisk, Inc. when patients in studies reported weight loss as a side effect. It wasn’t a complaint, though.
Delusions or anal leakage—take your pick!
Until now, anorexants (appetite-suppressants) were limited to amphetamine-like preparations that had very nasty baggage in the way of mental changes and addiction when it came to side effects. The other “breakthrough” was 1996’s fat-blocking preparation, olestra (even used by Frito-Lay in potato chips!), deemed one of the 50 worst inventions by Time magazine.3
It is hard to say which side effect is worse—the paranoid psychosis from chronic amphetamine use or the dripping of yellow-orange gradu from the anus, impervious to even the tightest sphincter tone and impeccable continence. I think I’d rather be psychotic, but that’s just me.
An entirely different approach to weight loss
Four years after liraglutide hit the marketplace for diabetics, its spinoff, Saxenda, was approved for weight loss.2 Taking amphetamines was a bureaucratic nightmare due to regulatory concerns over controlled drugs, and those damn potato chips were too costly when factoring in the purchase of new undergarments. The liraglutide, doubled in dose from its original version, was announced as Saxenda, the new “blockbuster”4 anti-obesity drug.
The truth behind the hoopla
Blockbuster is a word thrown around too casually. Its original meaning of “game-changing new world order money-maker” has been diluted into just a marketing buzzword. In judging Saxenda as a drug for obesity and weight loss, it is useful to put it through the blockbuster filter:
According to Saxenda’s own website,
- weight loss was increased by two-and-a-half times with Saxenda as without it (with the usual diet and exercise). That’s a Star Wars (#3 highest gross);
- 60% of people lost more than 5% of their body weight; a third lost over 10%. This may not be impressive for a 110-lb runway model, but if someone weighs 250 pounds, we’re talking 12-13 and 25 pounds, respectively, in a year. That’s a Titanic (#4 highest gross);
- 80% of those who lost weight using Saxenda maintained their weight loss.
That’s a Gone with the Wind (#1 highest all-time gross movie of all time). This is most important, hence its blockbuster rating, since most diet failures are not in actually losing weight, but in keeping it off. The yo-yo diet is the overweight person’s typical downfall.
What do Saxenda’s users say?
According to Drugs.com, the average ratings are overwhelmingly favorable. 8/10 for weight loss (269 reviews); 7.9/10 for obesity (466 reviews). (This actually corresponds with the Rotten Tomato reviews for the blockbusters used in the blockbuster scale above.)
What do the actual studies say?
According to scientifically accepted study data, weight loss with liraglutide, across the board, was significant and reliable. Primarily studied for control of diabetes, the conclusion was “Weight loss is common with GLP-1 receptor agonists,” based on 17 randomized trials, then this was confirmed in a meta-analysis of 21 trials.5
What are the side effects to Saxenda?
- Increased heart rate
- Low blood sugar
- Nausea, vomiting
- Diarrhea and constipation
In animal studies, there was an increased risk of thyroid cancer. In humans, this is theoretical only and being studied.
All of the drug interactions revolve around Saxenda’s enhancing the hypoglycemic (blood sugar lowering) actions of many other drugs, from aspirin to anti-depressants. This is not a contraindication, but just a red flag that prompts extra vigilance for hypoglycemia.
How is Saxenda taken?
It is an injection, subcutaneously (not deep), once a day.
Can it be used long-term?
Yes. That’s why the long-term results show elimination of rebound weight gain in the dreaded yo-yo pattern.
Who can take it, according to the FDA’s indications?
People with a BMI 30 or above, who have failed to lose weight with standard approaches.
People with BMI 27 or above with associated obesity-related conditions, such as hypertension or type 2 diabetes, who have failed to lose weight with standard approaches.
Note “who have failed to lose weight with standard approaches,” because it is not a first-choice drug—for either diabetes or weight loss. The cost will have a patient’s insurance company forcing them through loops—loops on fire—before it’ll pay for it. (“Fat people” are the bastard step-children in the insurance industry’s database).
Who shouldn’t use Saxenda?
People allergic to it (of course) and people with a family history of thyroid cancer (due to its theoretical risk—see above).
Obesity is the scourge of the 21st Century, now considered the most important public health problem. It contributes or causes hypertension, diabetes, lower back pain, coronary heart disease—the world’s biggest killer, sleep disturbances (such as apnea), and chronic fatigue; and treating it eliminates or mitigates these problems. It costs billions in lost productivity each year.
And…it’s getting worse. Walk into any Wal-Mart and look around. If someone is a candidate for Saxenda for obesity PLUS an obesity-related medical condition, that criterion won’t be difficult to satisfy.
- Shyangdan DS, Royle P, Clar C, et al. Glucagon-like peptide analogues for type 2 diabetes mellitus. Cochrane Database Syst Rev 2011; :CD006423.
- Koliaki C, Doupis J. Incretin-based therapy: a powerful and promising weapon in the treatment of type 2 diabetes mellitus. Diabetes Ther 2011; 2:101.
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