GLP-1- The Good, the Bad, and the Ugly!

In recent years, there has been a great deal of interest in GLP-1 medications and its potential to provide therapeutic benefit. GLP-1 for years had been used exclusively for the treatment of type 2 diabetes but has now been found to have multiple beneficial effects on glucose metabolism and has been FDA approved to treat obesity. GLP-1 works by binding to GLP-1 receptors, which are located in a variety of tissues throughout the body including pancreas, brain and fat cells. However, is GLP-1 all that it is made out to be? In this blog post we will discuss what makes GLP-1 so special by delving into its features and effects on our bodies; taking into consideration both the good and bad side of things when discussing each aspect about GLP-1.

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WHAT IS GLP-1?

GLP-1 stands for Glucagon Like Peptide-1 and it is a hormone released from the intestines in response to food intake. GLP-1 is an incretin hormone and its primary role is to stimulate the release of insulin from the pancreas. GLP-1 also increases glucose uptake in the muscle cells, inhibits glucagon secretion from the pancreas and decreases appetite and food intake. GLP-1 acts on specific receptors present in multiple tissues throughout the body, including pancreatic beta cells, brain areas involved in reward processing, and fat cells.

GLP-1 AND DIABETES

GLP-1 is used in diabetes treatment to stimulate the release of insulin from the pancreas and decrease glucagon secretion. GLP-1 agonists (synthetic GLP-1 molecules) are used in combination with other therapies to improve glycemic control and reduce risk of hypoglycemia. GLP-1 agonists are approved for use as injectable medications and GLP-1 receptor antagonists are approved for use as oral medications. GLP-1 agonists have been shown to reduce HbA1c levels, improve glycemic control and reduce risk of hypoglycemia in individuals with type 2 diabetes.

GLP-1 AND OBESITY

In addition to its effects on glucose metabolism, GLP-1 has been found to have beneficial effects on obesity. GLP-1 agonists reduce food intake by decreasing the reward associated with eating. GLP-1 receptors are present in brain areas involved in reward processing, so GLP-1 agonists can decrease the motivation and drive to eat by disrupting these reward pathways. GLP-1 agonists also increase energy expenditure and reduce fat storage in the body. GLP-1 agonists are approved for use as injectable medications to help individuals with obesity achieve weight loss goals.

THE GOOD, THE BAD & THE UGLY OF GLP-1

The “good” of GLP-1 is that GLP-1 agonists have been found to reduce HbA1c levels, improve glycemic control and reduce risk of hypoglycemia in individuals with type 2 diabetes. GLP-1 agonists also have beneficial effects on obesity, reducing food intake and increasing energy expenditure. In a recent study, GLP-1 agonists were found to lead to an average of 7% weight loss in the treatment group versus 2.3 % in the placebo group, with GLP-1 therapy leading to greater reductions in body fat.

The “bad” of GLP-1 is that GLP-1 agonists can be expensive and may not be covered by insurance plans. GLP-1 agonists are injectable medications, so this can be inconvenient for some individuals. GLP-1 receptor antagonists may cause fluid retention and weight gain in some individuals.

The “ugly” of GLP-1 is that GLP-1 agonists can cause gastrointestinal side effects, including nausea and vomiting. GLP-1 receptor antagonists have also been linked to lean mass loss and increased risk of fractures. In a recent study, GLP-1 receptor antagonist therapy was associated with a significantly higher risk of fracture in women compared to GLP-1 agonist therapy. Additionally, in two semaglutide trials , DEXA scans revealed  a significant decrease in lean muscle mass associated with GLP-1 receptor antagonist therapy.

NOT ALL WEIGHT LOSS IS CREATED EQUAL

GLP-1 agonists have been found to be effective for weight loss, but it is important to understand that not all weight loss is created equal. Losing weight in itself  is not a cure for obesity. GLP-1 agonists are only one piece of the puzzle when it comes to weight loss and should be used in combination with lifestyle changes, such as increased physical activity and improved nutrition, to promote long-term success. GLP-1 agonists reduce food intake and increase energy expenditure, but they do not address underlying issues with emotional eating or lifestyle factors such as diet and lack of physical activity.

Body Composition vs Body Weight

When trying to reach weight loss goals, it is important to measure body composition (lean mass and fat mass) rather than just focusing on body weight. GLP-1 agonists have been linked to lean mass loss, so monitoring body composition can help ensure that individuals are losing fat and not muscle. Muscle is important because it helps burn calories and maintain a healthy metabolism, so preserving lean mass is important for long-term weight loss success. Fat loss while increasing muscle mass is the ultimate goal! Before starting these medications, it’s recommended to have a form of body compositional analysis to assess your baseline, such as a DEXA scan.

BODY COMPOSITION AND LONGEVITY

Recently on the blog, we discussed how strength training is a critical piece of the puzzle for optimal longevity.  GLP-1 agonists can be helpful for weight loss, but it is important to understand that GLP-1 agonists cannot replace strength training for optimal longevity. Our body composition and muscle strength are important for maintaining our quality of life and independence as we age, so it is important to focus on building muscle mass and not just the number on the scale.

TOO MUCH OF A GOOD THING

While GLP-1 can be an excellent way to improve glycemic control and reduce risk of hypoglycemia, GLP-1 agonists should not be taken indefinitely. GLP-1 agonists can have serious side effects in some individuals and long-term use of GLP-1 agonists is associated with an increased risk of fractures. Thus, GLP-1 agonists should be used responsibly under the supervision of a healthcare provider after weighing out risks and benefits.

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STRENGTH TRAINING FOR LONGEVITY

If you have ever been on a call with Dr. Bajnath, you may hear what sounds like a treadmill in the background. “Sitting is the new smoking” is phrase Dr. Bajnath tells all his patients when they ask him about the treadmill. In fact, the average American spends 6-7 hours a day sitting. We all know that aerobic exercise can be beneficial for the heart muscles and overall health. But what about muscle strength? Recent research has found that muscle strength may be just as important for longevity as aerobic exercise, and is often overlooked. In this week’s blog, we’ll be discussing the importance of muscle strength for longevity and why it has become increasingly important with our sedentary lifestyles. We’ll also look at some strategies for incorporating more muscle-strengthening activities into your daily routine. So, if you’re looking to live a longer, healthier life, don’t forget about strength training!

WHAT IS STRENGTH TRAINING?

Strength training, also known as resistance training, is any exercise that uses your own body weight or external weights like dumbbells to increase muscle strength and endurance. Strength training can be done in a variety of ways including lifting weights, using machines, and doing bodyweight exercises like push-ups or squats. Research shows that the average 30 year old starts to lose muscle mass at a rate of 1-2% per year, so incorporating strength training into your routine can help slow down this process.

BENEFITS OF STRENGTH TRAINING

Strength training is an important component in maintaining health as we age. It can help:

• Reduce body fat and improve body composition

• Improve cardiovascular health and lower risk of stroke and heart disease

• Strengthen bones, joints and connective tissues

• Increase muscle strength, flexibility, power and endurance

• Improve balance and coordination

• Boost energy levels and reduce fatigue

• Help manage stress, depression and anxiety

STRENGTH TRAINING & LONGEVITY

In Longevity Medicine, we are constantly looking for ways to optimize healthspan and extend life expectancy. Research has shown that strength training can be beneficial for longevity, as it helps to slow down the process of age-related muscle loss, reduce body fat, increase bone strength and improve overall health. Additionally, reports have suggested that intense exercise and strength training may lead to a longer lifespan due to the anti-inflammatory and antioxidant benefits of exercise.

The British Journal of Sports Medicine in a meta-analysis of 28 studies concluded that there is a correlation between muscle strength and longevity. The study found that increased muscle strength was associated with a 22% decrease in mortality risk, while aerobic activity was associated with an 11% reduction in mortality risk. Research shows that having strong muscles significantly decreases the risk of premature death from any cause. Building muscle strength through resistance training helps you not only to age more gracefully, but also to combat chronic illnesses like diabetes and heart disease. Strength training does not need to be intimidating or overly time consuming. You can use your own body weight for resistance, or you can use hand weights and resistance bands. Even a few minutes of strength training a day can make a difference in your health outcomes.

Creating an exercise program that combines both aerobic exercise and strength training is the key to enjoying the benefits of both types of physical activity. The American Heart Association recommends at least 30 minutes of moderate-intensity aerobic exercise at least five days a week, plus two or more days of strength training.

HOW TO GET STARTED WITH STRENGTH TRAINING

If you are new to strength training, it can seem overwhelming at first. Here are some simple tips to help get you started:

-Start slow and focus on proper form

-Find a program that works for you

-Begin with bodyweight exercises and work your way up

-Incorporate different types of strength training (free weights, weight machines, resistance bands, etc.)

-Listen to your body – rest when needed and choose lighter weights if necessary

STRENGTH EXERCISES TO INCORPORATE FOR LONGEVITY

SQUATS

As we age, our ability to effectively move decreases. Squats help to improve our mobility and reduce the risk of falls. Regular squats can also strengthen your lower body, specifically your glutes and legs. This comes in handy especially when we age as this helps preserve our ability to pick things up from the floor and use the restroom without assistance.

PUSHUPS

We all know that pushups are great for building upper body strength. But pushups can help you live longer too, as they are good for your heart health and reduce the risk of injury due to falls. Pushups also engage core muscles which helps in maintaining balance and coordination.

BENT-OVER ROWS

Rows target multiple major muscle groups, including the back muscles, shoulders, and arms. Strengthening these areas provides improved posture and balance, which can reduce the risk of falls. The bent-over row is particularly great for improving stability, posture, and flexibility.

PLANKS

Planks are an efficient exercise that works multiple muscle groups at the same time. Planks help to build core strength, which is essential for a healthy back and improved balance. They also improve posture, which helps decrease the risk of injury due to falls.

BRIDGES

Bridges target your glutes and hamstrings and help with lower back pain. This exercise supports the spine, strengthens the abdomen, and increases range of motion in the hips. Bridges also help to reduce inflammation in the joints, which can help keep them healthy as we age.

The evidence is clear: strength training is key for living a longer, healthier life. Incorporating a variety of exercises into your routine will help you build muscle strength and improve balance, posture, flexibility, and circulation. Start today and reap the benefits for years to come!

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