I am a physician who prescribes and follows this medication. I believe you significantly underplay the downsides. First of all, a life long drug is no joke at all; especially if my patient is not medicalized.
Starting a GLP-1 agonist on a late-life diabetic is a significantly easier chose than starting it on the hordes of 20 year olds asking for it. Why?
1) There are no studies that answer: ‘is this medication safe for 50 years?’ which is exactly what we’re offering here. Last time my field tried a ‘benign’ drug that made physiologic sense in an entire age group for decades (aspirin); it did not end well.
2) I can tell you from experience Mounjaro has significantly more discontinuation due to side effects than GLP-1 agonist. (Tirzepatide > Semaglutide > Dulaglutide). It causes severe acid reflux in many patients, one that only responds to high doses of PPIs (if it does)
3) And while your confidence in safe long term use of these drugs might be misplaced; there’s no evidence of harm yet. There IS evidence of harm for long term PPIs, which is what we’re being forced to do for people who want to stay on these drugs in a rapidly escalating cascade of medicalization
4) many Anesthesiologists have already started doing rapid sequence intubations on anyone using GLP-1s routinely because of the higher risk of aspiration. How many physicians tell patients starting these drugs ‘any future elective surgery you take will be slightly riskier’? How many discuss the lifetime use? The unsure risk of muscle mass? We at best discuss the risk of medullary thyroid cancer and gastroparesis/GERD.
5) I am seeing a lot of ‘GLP-1 gluttony’ that mimics the famous ‘statin gluttony’. No further words are needed.
There is too much positive spin on this and not enough caution. I am reasonably confident in saying when I revisit this in 5 years, the average American will not be much healthier but will definitely be much more medicalized.
I feel like "too little or too much can disrupt the 'intended' function" is kind of the norm for a LOT of the various compounds we're working with, no? Like several of the standard "vitamins" are poisonous if you get enough of them in your system. If GIP is serving some kind of regulatory role, with the "intended" (fitness-adapting) outcome of turning excess circulating glucose into triglycerides and then storing them in adipose tissue (so that you can store up energy in a feast year, to survive a future famine year), then potentially imbalancing it in either direction might mess with that process somehow... Though if that's right you potentially could have a situation where, say, you're still building triglycerides just as fast, or even faster, than normal; but then not storing them fast enough, which would mean a higher level of circulating triglycerides.... which might be a problem (High levels of circulating triglycerides are a heart attack risk, I think?)
Anyways, I'm just speculating... I suppose you'll address some of the possibilities in follow-up posts.
I am a physician who prescribes and follows this medication. I believe you significantly underplay the downsides. First of all, a life long drug is no joke at all; especially if my patient is not medicalized.
Starting a GLP-1 agonist on a late-life diabetic is a significantly easier chose than starting it on the hordes of 20 year olds asking for it. Why?
1) There are no studies that answer: ‘is this medication safe for 50 years?’ which is exactly what we’re offering here. Last time my field tried a ‘benign’ drug that made physiologic sense in an entire age group for decades (aspirin); it did not end well.
2) I can tell you from experience Mounjaro has significantly more discontinuation due to side effects than GLP-1 agonist. (Tirzepatide > Semaglutide > Dulaglutide). It causes severe acid reflux in many patients, one that only responds to high doses of PPIs (if it does)
3) And while your confidence in safe long term use of these drugs might be misplaced; there’s no evidence of harm yet. There IS evidence of harm for long term PPIs, which is what we’re being forced to do for people who want to stay on these drugs in a rapidly escalating cascade of medicalization
4) many Anesthesiologists have already started doing rapid sequence intubations on anyone using GLP-1s routinely because of the higher risk of aspiration. How many physicians tell patients starting these drugs ‘any future elective surgery you take will be slightly riskier’? How many discuss the lifetime use? The unsure risk of muscle mass? We at best discuss the risk of medullary thyroid cancer and gastroparesis/GERD.
5) I am seeing a lot of ‘GLP-1 gluttony’ that mimics the famous ‘statin gluttony’. No further words are needed.
There is too much positive spin on this and not enough caution. I am reasonably confident in saying when I revisit this in 5 years, the average American will not be much healthier but will definitely be much more medicalized.
I feel like "too little or too much can disrupt the 'intended' function" is kind of the norm for a LOT of the various compounds we're working with, no? Like several of the standard "vitamins" are poisonous if you get enough of them in your system. If GIP is serving some kind of regulatory role, with the "intended" (fitness-adapting) outcome of turning excess circulating glucose into triglycerides and then storing them in adipose tissue (so that you can store up energy in a feast year, to survive a future famine year), then potentially imbalancing it in either direction might mess with that process somehow... Though if that's right you potentially could have a situation where, say, you're still building triglycerides just as fast, or even faster, than normal; but then not storing them fast enough, which would mean a higher level of circulating triglycerides.... which might be a problem (High levels of circulating triglycerides are a heart attack risk, I think?)
Anyways, I'm just speculating... I suppose you'll address some of the possibilities in follow-up posts.
Where did you hear about BioAge being spooked?