Understanding Metabolic Health and Pharmacological Options: Improving metabolic health is crucial in preventing and managing interconnected diseases. Lifestyle changes and medications such as SGLT2 inhibitors can play a significant role in achieving optimal metabolic health.
Metabolic disease is interconnected with other types of diseases like cardiovascular disease, neurodegenerative disease, and cancer. It is crucial to improve metabolic health to prevent and manage these conditions. Lifestyle changes play a significant role in improving metabolic health. However, there are also pharmacological options available. SGLT2 inhibitors, Metformin, and GLP1 are some medications that can be used to improve metabolic health. SGLT2 inhibitors specifically target Sodium Glucose Co transporter Protein 2 (SGLT2) in the kidneys, helping to regulate glucose levels. Understanding the basics of these medications and their development can be complex, but visual aids can be helpful. Maintaining good metabolic health and exploring pharmacological options can provide potential benefits for overall well-being.
Kidney's Role in Glucose Regulation and Potential Solutions for High Blood Glucose Levels in Type 2 Diabetes: The kidney plays a crucial role in selectively retaining necessary substances but can also prevent reabsorption of filtered glucose, making it a potential target for managing high blood glucose levels in type 2 diabetes.
The kidney's primary role is not to eliminate bad things from the body, but rather to understand what is good and retain it. As plasma passes through the kidney, it selectively pulls back into circulation the necessary substances like glucose, sodium, potassium, and chloride. However, there is an interesting opportunity here regarding glucose. Although the kidney's main task is not to regulate glucose concentration, it does have the ability to prevent the reabsorption of filtered glucose. By blocking a protein called SGLT 2, more glucose can be excreted in the urine, making it an attractive solution for high blood glucose levels in individuals with type 2 diabetes. This approach is focused on lowering glucose levels and can be used alongside other strategies such as increasing insulin sensitivity or managing insulin itself. Additionally, some drugs are developed based on naturally occurring substances, like fluorescein found in apples, which initially demonstrated glucosuria and became an important diagnostic tool for diabetes in the past.
The Relationship Between Natural Compounds and Drug Development: Nature serves as a valuable resource for pharmacologists, providing a foundation for drug development. Natural compounds like fluorescein and drugs derived from them, such as SGLT 2 inhibitors, offer effective treatments for diabetes.
There is a similarity between naturally occurring compounds and the drugs derived from them. For example, fluorescein, a naturally occurring substance, has a similar structure to SGLT 2 inhibitors, which are used to treat diabetes. These inhibitors have different versions with varying potency and dosing. Furthermore, it is worth noting that some widely used drugs like statins and metformin are also derived from natural sources. This suggests that nature has provided a foundation for pharmacologists in drug development. Additionally, in the discussion of SGLT 2 inhibitors, it is mentioned that a higher dose leads to a greater reduction in hemoglobin A1c, indicating their effectiveness in managing diabetes.
SGLT 2 inhibitors: Beyond Blood Sugar Regulation: SGLT 2 inhibitors have shown potential in reducing risks for heart failure patients, improving cardiovascular outcomes, and possibly reducing blood pressure.
SGLT 2 inhibitors, such as Metformin and Conegaflozin, show promising benefits beyond just regulating blood sugar levels. While Metformin is commonly used for early intervention in type 2 diabetes, SGLT 2 inhibitors have shown greater potential in the scientific community. These inhibitors have been found to decrease the risk of hospitalization and death for heart failure patients, as well as improve cardiovascular outcomes for patients with reduced ejection fraction and preserved EF. Additionally, there may be a correlation between the use of SGLT 2 inhibitors and a reduction in blood pressure, possibly due to the impact on sodium excretion. Although the complex names of these drugs may be confusing, pharmaceutical companies deliberately choose catchy trade names to ensure brand association and prolonged sales.
SGLT 2 inhibitors offer potential benefits beyond diabetes treatment, particularly in heart failure patients.: SGLT 2 inhibitors may have positive outcomes for heart failure patients, even without diabetes, and there is growing interest in their potential cardioprotective effects.
SGLT 2 inhibitors, often used to treat type 2 diabetes, have shown positive outcomes in patients with heart failure, even if they do not have diabetes. The reduction in blood pressure may be one potential reason for this, but there may be other factors at play as well. Additionally, there is growing interest in the potential cardioprotective effects of SGLT 2 inhibitors. Many individuals who are not diabetic are curious about these benefits, similar to the interest in Metformin for its potential protective properties. By becoming a premium member, you can access the complete AMA episode, as well as enjoy exclusive member benefits like comprehensive show notes, monthly AMA episodes, premium newsletters, a private podcast feed, and more. Remember, the information provided in this podcast is for general informational purposes only, and it is essential to consult with healthcare professionals for personalized advice and treatment.
#279 - AMA #53: Metabolic health & pharmacologic interventions: SGLT-2 inhibitors, metformin, GLP-1 agonists, and the impact of statins
Peter explores various pharmacologic tools for improving metabolic health and treating diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines their comparative effectiveness and potential in lifestyle interventions.
The Peter Attia Drive
367 Episodes
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#317 ‒ Reforming medicine: uncovering blind spots, challenging the norm, and embracing innovation | Marty Makary, M.D., M.P.H.
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Is Ozempic a Weight Loss Miracle?
Unless you’ve been living off-grid for the last few months, chances are you’ve heard of Ozempic (or semaglutide)– the newest FDA approved miracle injection for weight loss. Social media has ignited feeds across the world with weight loss transformation posts from semaglutide injections- and 812 million views on TikTok to be exact.
Tailored to diabetes, this drug works by stimulating insulin secretion and therefore lowering fasting and postprandial glucose levels in four mechanisms. During the Ozempic drug trials, it was noted that weight loss was such a consistent and dramatic side effect that the FDA approved semaglutide for weight loss under the brand name Wegovy in 2021.
In this episode, I discuss:
- The four mechanisms of Ozempic
- Changes in insulin sensitivity
- Increased energy expenditure by encouraging stored fat to turn into energy.
- Slows gastric emptying
- The impact on appetite.
- And what current research is finding. (Hint: It might not be a long-term weight loss miracle!)
To sum it up, weight loss medications like Ozempic cannot have substantial results without compromise (i.e. losing lean muscle mass). Most importantly, NONE of the weight loss medications are fixing the root cause of the problem. The purpose of this podcast is to help you make an informed decision about your options for weight loss. If you are considering semaglutide injections for weight loss, talk to your doctor about the pros and cons!
Love it? Hate it? We’d love to hear your feedback!
References used for this episode:
1. https://pubmed.ncbi.nlm.nih.gov/30122305/
O'Neil PM, Birkenfeld AL, McGowan B, et al. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. Lancet. 2018;392(10148):637-649. doi:10.1016/S0140-6736(18)31773-2
2. https://pubmed.ncbi.nlm.nih.gov/33755728/
Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.322
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769337/
Sargeant JA, Henson J, King JA, Yates T, Khunti K, Davies MJ. A Review of the Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors on Lean Body Mass in Humans. Endocrinol Metab (Seoul). 2019 Sep;34(3):247-262. doi: 10.3803/EnM.2019.34.3.247. PMID: 31565876; PMCID: PMC6769337.
4. https://pubmed.ncbi.nlm.nih.gov/35441470/
Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. doi:10.1111/dom.14725
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139. JASON PHILLIPS: How to make success inevitable.
This week’s badass guest is Jason Phillips.
Jason is an impactful entrepreneur who has established immense reverence + authority in the health + fitness industry through his incredible knowledge in nutrition, fitness, as well as his experience in creating + up-leveling, health/fitness businesses into multi-million businesses.
Jason is the Founder + CEO of the Nutritional Coaching Institute, an institute that certifies health coaches + arms them with invaluable tools that help them to become leaders in the field + turn their business models into a 6-7 figure business.
Jason is largely contributing as one of the most profound thought leaders in the industry.
From coaching world-class athletes to contributing his high-level expertise to monster brands like GOOGLE to writing for major publications like Men’s Fitness & Entrepreneur Weekly, and writing his own books; he continues to lead from his heartbeat philosophy that is: “Impact over everything.”
In this inspiring conversation, Jason & I take you through:
- What + why Jason leads himself + all aspects of his business with his core principle: “Impact over everything.”
- Jason’s journey of battling anorexia + why he left his corporate $200k job in a flash moment, to pursue his passion for empowering others through the optimization of nutrition + fitness for increased performance, body composition + overall health.
- How to assess your biofeedback to know when to push + when to recovery.
-
Stress and its impact on your health + fitness goals that you may be unaware of.
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Essential recovery to accelerate the progress that most people don’t recognize
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Jason’s Self-Mastery formula that helps you create your ultimate business success
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Cultivating a “why not me?” mindset to conquer fear + achieve your ultimate potential in life.
This episode is so empowering + exudes what I call “the heart of an underdog + the mindset of a champion.” Jason’s journey is truly just that. He is living a LEGENDARY path. I'm proud to share his genius + amazing energy in this talk with you.
Enjoy!
xRx
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Gary Fettke - Why the Push for Veganism is so Strong: Ep26
We caught up with Dr. Gary Fettke and his wife Belinda during the 2019 San Diego conference and I put the question a question to him asking where he planned to go from here now that he had been absolved of all the trumped up charges levelled at him by his governing body, AHPRA. He promptly ignored me and started talking about the discovery his wife has made over the last few years about the influence the Seventh Day Adventist Church has hod on our current dietary guidelines. Apparently he is pretty fired up about all that and very proud of the enormous amount of work his wife Belinda has put into uncovering this whole story.
I did put the question to him again later and we have posted that response in an earlier podcast but we decided to post this response now too as it is very interesting. You can find the earlier podcasts of his and of Belinda's at the links below.
https://www.lowcarbusa.org/plant-based-diet-episode-10/
https://www.lowcarbusa.org/gary-fettke-exoneration-episode-8/