Can Weight Loss Drugs Be A Mind Tool?

Obesity and type 2 diabetes mellitus (T2DM) are two of the most pressing public health threats facing the United States today. This should come as no surprise, as these related conditions have been affecting an increasing number of Americans for decades.

One of the exciting news has been the development of drugs such as glucagon-like peptide 1 (GLP-1) receptor agonists. This class of drugs includes semaglutide (Ozempic, Wegovy), liraglutide (Victoza), and dulaglutide (Trulicity), and they have proven to be incredibly effective in helping overweight patients, often allowing them to lose weight even if the treatment is not combined with lifestyle. They are also frequently prescribed, with one in five people with T2DM using these drugs as of 2022.

Reducing obesity can reduce the risk of high blood pressure, heart disease and many other complications associated with T2DM. However, it seems that these drugs can also help to treat pathologies that do not seem to be closely related to obesity. Early research suggests that it can reduce the severity of symptoms of COVID-19 (although it does not reduce the risk of infection), and that it can help treat mental conditions and even prevent disease progression. mental disorders such as Alzheimer’s disease and Parkinson’s disease. .

How GLP-1 Agonists Work: Insulin, T2DM, and Obesity

Synthetic GLP-1 agonists mimic the GLP-1 hormone, which is produced in the gastrointestinal (GI) tract after eating. GLP-1 produces insulin, which helps control blood sugar levels by encouraging cells to absorb glucose and use it for energy.

Patients with T2DM either do not make enough insulin to properly control their blood sugar levels or have developed insulin resistance (meaning their cells are less responsive to insulin signaling). Because this doesn’t happen all at once, most people have years of prediabetes (usually caused by genetics, a long-term lifestyle, or a diet high in sugar and saturated fat). made in bulk), as their cells develop greater insulin tolerance, and eventually become insulin resistant. . It is only after their pancreas is unable to produce enough insulin to maintain a healthy blood sugar level that a patient develops diabetes.

By promoting the release of insulin, GLP-1 agonists can help people with T2DM better control blood sugar levels and avoid complications associated with the disease, such as chronic inflammation, damage of nerves and diseases affecting the kidneys, eyes and cardiovascular system.

Fortunately, researchers realized early on that the benefits of GLP-1 agonists were not limited to the treatment of T2DM; they also helped patients lose weight. As a result, over the years, these findings have led many medical professionals to use GLP-1 agonists as a way to control weight. However, recently, the Food and Drug Administration (FDA) approved their use in the treatment of obesity, as it not only helps stimulate the release of insulin but also slows down digestion, which is leading to a longer feeling of satiety.

GLP-1 Agonists and alcoholism

But that doesn’t seem to be the whole story.

GLP-1 agonists also appear to act on certain parts of the central nervous system (CNS), particularly the parts of the brain that control appetite and eating patterns, as well as the brain’s reward centers. (especially known as). mesolimbic reward pathway). In other words, these drugs do not only affect the organs of the GI tract; they also appear to act in CNS areas closely related to emotion and motivation, altering people’s psychological relationships with rewarding activities and altering reward behavior accordingly.

This change is something that patients carefully notice and report. After starting treatment with GLP-1 agonists, many describe not only a reduction in appetite, but also a psychological change in their relationship with food. Most importantly, they describe not being overwhelmed by the obsession with food. Examples of what is known as “food cravings,” include binge eating (especially high-energy and highly palatable foods), the temptation to repeatedly check requests for food, and thinking about food. which they will eat while they are eating. food GLP-1 agonists make these concerns or “noise” quiet and easier to ignore.

Researchers have found that this type of “noise” also affects people with substance abuse problems. Although preliminary, several studies have found that GLP-1 agonists can promote abstinence in patients with alcohol use disorder, cannabis use disorder, and opioid use disorder. . They even seem to help individuals quit smoking.

GLP-1 Agonists and Dementia

Recently, a published study found that GLP-1 agonists can help reduce cognitive decline in patients with Alzheimer’s disease (AD). According to study leader Paul Edison of Imperial College London, who presented at the Alzheimer’s Association International Conference on July 30, 2024, patients with AD who were given liraglutide had almost half the volume loss in brain areas related to memory, language and. executive function, as measured by MRI. Over 12 months, the liraglutide group also reported an 18 percent slower weight loss compared to the placebo group in the study.

What remains an open question is how these drugs exert their neuroprotective properties in AD patients. Although it is believed that the cause of AD lies in the abnormal accumulation of plaques and proteins around neurons that eventually become toxic and suffocate brain cells, research has found that GLP- 1 does not directly provide for the deletion of these buildups. It is likely that GLP-1 agonists reduce neuroinflammation by reducing insulin resistance in the brain, as they reduce insulin resistance in the periphery, and that lowering blood glucose levels prevents inflammation and slow down the progression of diseases.

If this research is confirmed, GLP-1 agonists could improve the course of the disease for many neurological and psychological problems related to inflammation, providing relief to millions of patients.