Tag: GLP-1 Agonist
GLP-1 (again !)
April 30, 2025 8:22 pm
In 1986, GLP-1 was identified (Mojsov et al., 1986). In 2005, the FDA approved a compound similar to GLP-1 (exenatide) for diabetes. It took nearly three decades of technological advancement in genetic research, tissue culturing (Saccharomyces cerevisiae), genetic sequencing, purification, and stabilization of the product for GLP-1 to become commercially available.
GLP-1 is a potent stimulator of insulin release (lowers blood sugar) while decreasing Glucagon secretion (think of it as anti-insulin). GLP-1 also slows GI motility and stomach emptying. It reduces the appetite at the brain level. GLP-1 medication stimulates insulin release from the Beta cell, which produces insulin in the pancreas. GLP-1 intercepts signals in the Vagus nerve to slow gastric emptying.
There are built-in safety mechanisms to prevent the human body from self-destructive, runaway chemical imbalances. For example, osteoclasts and osteoblasts are cells that break down and build bones, as we read in this blog. This balance is closely regulated against outside interferences to prevent osteoporosis or bone thickening (low vitamin D, menopause, or growth hormone injections).
When a patient takes thyroid medication, the TSH goes down because it senses enough thyroid in the bloodstream to stop ordering thyroid gland from secreting (even though none was being secreted as to why the thyroid medication was started)
These are all examples of where I am going with this: What is not adequately explained and discussed is that other chemical pathways are being affected in ways that we do not recognize. We already know it can cause pancreatitis because GLP-1 can overstimulate the beta cells. We also know that it can cause certain rare types of thyroid cancer.
Yes, I am a surgeon, but I could help my patients. I would have started prescribing these medications long ago before we started seeing a patient who is now coming to have surgery after trying GLP-1 medications and gaining weight back after they stopped because they had significant complications and side effects, or they could not afford it. The complication profile and the side effects cause significant portion of the medication discontinuation.
I have already stated before that GLP-1 medications offer no off-ramp for the patients. Once you start it, you must stay on it for a long time. The published data provides dismal long-term outcomes for patients who stop the medication.
The literature also has shown that Sleeve gastrectomy and the duodenal switch have far better long term outcome than the GLP-1 medications.A patient story: Lap Band complication and Wegovy
October 24, 2024 4:30 pm
Not too long ago, I saw an old patient who had seen me years ago after having had a lap band placed for weight loss. At the time, I recommended that the lap band be removed and that alternative plans be made. I suspected a slipped band. We discussed the reality that after the band removal, weight gain is to be expected. Several surgical options were discussed, and the patient dismissed them as “too radical.” The patient decided to “deal” with the ongoing nausea and vomiting since it was a small price to pay for the weight loss. I warned the patient that elective removal of the band is much safer than an emergency procedure in the middle of the night when it is least convenient. The patient did end up with an emergency lap band removal and was started on GLP-1 Agonists (Wegovy) because of the weight gain that followed the band removal. The side effects of the medication were debilitating, with nausea, dizziness, and fainting due to low blood sugar. The drug has all been stopped, and most, not all, of the side effects are resolved. The plan is to get this patient in a better shape and, reevaluate the esophagus and the stomach, and formulate a strategy based on the blood work, upper endoscopy, upper GI study findings and decide if the patient will be a good candidate for the Laparoscopic sleeve or the duodenal switch operation.
Here are my recommendations:
- Patients should avoid lap bands. Those with lap bands, regardless of how they feel and whether they are having issues with them, should have the lap band removed immediately before they end up in the emergency room or have irreversible changes to the cells or function of the stomach and esophagus.
- Patients who have the lap band removed will have less weight loss with the sleeve than those who have the sleeve as the primary procedure (the lesson here is that a less invasive, seemingly easy solution is much worse long term; more on this below). Lap Band patients should be revised to the duodenal switch, SPIS, SADI, or Gastric bypass if they have substantial weight to lose.
- GLP-1 agonist medication should be avoided. It is not a solution to the underlying problem but a band-aid covering the metabolic derangement.
- GLP-1 agonist medication needs to be taken long term, and there is no exit strategy– when the patients stop taking the drug, the weight comes back, in addition to the complication associated with it.
- I have also heard that “if it were bad, then the FDA would not approve it.” well, let’s think about it: the FDA approved the Lap band and Phen-Fen, and we all know how these worked out.
- There are no shortcuts, simple injections, or a pill for the complex, multifaceted condition of obesity. Advocating solutions with no long-term outcome, significant complications, and safety concerns is irresponsible.
- A diabetic patient should take the medication LIFELONG to control their blood sugars, including the GLP-1 agonist class of drugs. The concerns are for these medications being used for the treatment of obesity
Radiology film of normal position and a slipped LapBand
SUMMARY: Buyers beware- those who choose to embark on the dangerous load of GLP-1 agonist medications should be prepared to deal with the short and long-term complications of the medication and its withdrawal. This is like the problems that are being seen with patients who choose to have a lap band because it was advocated as simple, reversible, and the Phen fen medication for weight loss with the associated cardiac complication.
https://www.dssurgery.com/wp-content/uploads/2024/09/P000008S017b.pdf
https://www.dssurgery.com/wp-content/uploads/2024/09/20-year-all-procdure-metaanalysis.pdf
https://www.dssurgery.com/weight-loss-injection/
https://www.dssurgery.com/glp-1/
https://www.dssurgery.com/weight-loss-medications-compared-to-surgery/
https://www.dssurgery.com/articles/glp-1-agonists-a…agency-clinicians/
https://www.dssurgery.com/articles/managing-the-gas…clinical-practice/