Fat Cell Scientist Reveals Unpopular Truth About Ozempic for Fat Loss - Dr. Bikman

Weight Regain after Ozempic

• When individuals stop taking Ozempic for fat loss, they immediately begin to regain weight, and within two years, they are often within a few pounds of their original weight, having gained back around 25 pounds of the 30 pounds they initially lost (12s).
• However, not all of the weight lost is regained, as 40% of the lost weight is lean mass and 60% is fat mass, which can be a concern for older individuals who may struggle to regain lost muscle and bone mass (18s).
• Research on GLP-1 (glucagon-like peptide-1) was pioneered at East Carolina University, where scientists studied the effects of gastric bypass surgery on obese and diabetic individuals, leading to the discovery of the incretin hormones (42s).
• The incretin hormones, including GLP-1, have an effect on blood glucose and insulin signaling, and GLP-1 is particularly powerful in inhibiting glucagon production from the alpha cells of the pancreas (2m27s).

GLP-1 and Incretin Hormones

• GLP-1 has a yin and yang relationship with insulin, as it counteracts the effects of glucagon, which increases blood glucose levels, and high glucagon levels are often seen in individuals with type 1 or type 2 diabetes (3m24s).
• The discovery of GLP-1 and the incretin hormones was a result of research into the effects of gastric bypass surgery, which led to a deeper understanding of the mechanisms behind glucose control and metabolism (2m10s).
• The gut is now recognized as one of the busiest endocrine organs in the body, producing dozens of hormones, including the incretin hormones, which play a crucial role in metabolism and glucose control (2m17s).
• Experimental models of type 1 diabetes have shown that blocking glucagon without administering insulin can lead to normal blood sugar levels (4m5s).

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GLP-1 and Diabetes

• Diabetes is not only a problem of too little or non-functioning insulin but also of too much glucagon (5m29s).
• GLP-1 reduces glucagon production, making it easier for people with diabetes to control their blood sugar levels (5m37s).
• GLP-1 based drugs do not contain the exact hormone but instead a molecule that acts like GLP-1, stimulating the same receptors and inhibiting glucagon production (6m9s).
• Initially, GLP-1 based drugs were used at lower doses to inhibit glucagon and control glucose levels, primarily for type 2 diabetes (6m31s).
• At higher doses, GLP-1 based drugs were found to be effective in controlling weight, leading to their marketing as weight loss drugs (7m25s).
• The diabetes drug Ozempic is primarily an anti-diabetic, and the only difference between it and other similar drugs is the dose, with the same exact molecule being used but at different doses (7m36s).

Ozempic's Mechanism and Side Effects

• The higher doses of Ozempic have a twofold primary mechanism: activating satiety centers in the brain to reduce hunger and slowing peristalsis, which slows the rate at which food moves through the intestines (8m13s).
• GLP-1, a peptide hormone that comes from the gut, is mimicked by Ozempic, and one of its effects is to tell the brain that it's not necessary to eat, resulting in reduced hunger (8m23s).
• The slowing of peristalsis can become a problem, as it can cause the intestines to become paralyzed, with documented cases of people experiencing full-on paralysis of their intestines due to the use of these drugs (8m49s).
• Even at normal doses, Ozempic can slow down the intestines too much, leading to issues such as putrid breath and noxious fumes due to food staying in the stomach for extended periods (9m37s).
• People taking Ozempic may need to stop taking the drug before undergoing surgery to allow their stomach to fully empty, as the slowed digestion can increase the risk of complications during anesthesia (10m19s).
• The reduced hunger experienced by people taking Ozempic may be due to feeling slightly sick to the stomach, rather than a genuine reduction in cravings (10m54s).

Additional Effects of GLP-1

• GLP-1 has other noteworthy effects that should be mentioned, although they are not specified in this section (11m15s).
• GLP-1 can aid in weight loss by activating lipolysis, fat mobilization, and fat burning, as well as stimulating the activity of brown adipose tissue, which has a high metabolic rate to create heat and can help individuals stay lean and reduce the risk of diabetes (11m22s).
• Activating brown fat more often can lead to a greater chance of staying lean and a lower risk of becoming diabetic (11m57s).
• GLP-1 has multiple favorable metabolic effects, including stimulating brown adipose tissue (12m4s).

Consequences of GLP-1-Based Weight Loss Drugs

• However, GLP-1-based weight loss drugs have consequences, such as the composition of weight loss, with up to 40% of lost weight coming from fat-free mass, including water, muscle, and bone (12m38s).
• For every 10 pounds of weight loss, only six pounds are fat, while four pounds come from non-fat sources like muscle and bone (12m59s).
• Approximately 70% of people on GLP-1-based drugs choose to stop taking them after 24 months, and weight regain begins immediately, with most regaining weight within two years (13m10s).
• When individuals regain weight, they do not regain the same composition of weight lost, with muscle and bone mass not being restored like fat mass, particularly in older individuals (13m48s).
• This can result in individuals being fatter than before they started taking the drug, even if they have regained less weight overall (14m51s).
• There is a potential tolerance or feedback loop disrupted by using GLP-1-based weight loss drugs, which is an area of ongoing research and interest (14m58s).
• When taking a particular drug that acts like a hormone, the body's endogenous production of that same hormone may decrease, but there is no evidence that GLP-1 receptor agonist drugs prevent the intestine's ability to produce GLP-1 (15m8s).
• However, there is some evidence to show that the use of GLP-1-based drugs reduces the sensitivity to GLP-1, which was observed in an in vitro study, but it is unclear if this applies to humans (15m41s).
• Chronic exposure to these drugs may lead to a reduction in sensitivity to GLP-1, which is a fundamental biological principle where too much of something can result in resistance to that something (16m7s).
• This reduced sensitivity to GLP-1 could be problematic for individuals who have lost weight and already have a decreased metabolic rate, as they may experience less satiety from their normal diet and potentially eat more (16m36s).
• The use of GLP-1-based drugs can lead to a vicious cycle of weight gain and decreased metabolic rate, which needs to be considered when using these drugs (17m6s).
• % of people choose to stop taking these drugs, and while the reasons are unclear, it is essential to weigh the benefits and drawbacks of using these medications (17m10s).
• GLP-1-based drugs were initially considered favorable at lower doses, as they helped control blood sugar levels and cravings, but the increased doses have made it harder to view them favorably (17m59s).
• The trend of increasing doses and combining drugs to offset effects is concerning, and it is essential to consider the consequences of using these medications (18m33s).
• Using the lowest possible dose of Ozempic for fat loss, particularly when combined with a low-carb diet, may have some value for individuals trying to break deep-seated habits, but it is not a recommended long-term solution (18m51s).

Carbohydrate Addiction and Ozempic

• Humans show addictive behaviors towards carbohydrates, whether alone or with fat, which can lead to insulin resistance and contribute to chronic disorders (19m25s).
• Implementing principles of controlling carbs, prioritizing protein, and not fearing fat can be challenging, especially when it comes to controlling carbs (19m18s).
• Some individuals may benefit from taking a low dose of Ozempic for a limited period to learn how to eat differently, but even then, 71% of people get off the drug on their own after 24 months due to side effects (20m35s).
• At 24 months, most people find that their sweet cravings have returned to pre-treatment levels, despite continued use of the drug, indicating diminishing returns and resistance to the treatment (21m11s).
• The effect of GLP-1 drugs like Ozempic is to control sweet cravings, but it is not a substitute for learning how to eat differently and developing self-discipline (21m29s).
• A more favorable approach would be to use lower doses of Ozempic, coupled with a low-carb diet, to help individuals learn how to eat differently and develop sustainable habits (21m49s).

GLP-1 and Food

• GLP1 (glucagon-like peptide-1) is affected by different types of food, with protein, saturated fats, and monounsaturated fats having a strong GLP1 effect, while polyunsaturated fats have a modest effect, and carbohydrates have varying effects depending on the type (22m25s).
• Certain foods, such as a baked potato, have a minuscule effect on GLP1, while others, like sweet potatoes and allulose, have a notable effect (22m43s).
• The GLP1 effect of natural foods can be measured on a scale of 1 to 10, with a mix of saturated fats and proteins being the most potent, but the GLP1 effect of certain drugs cannot be measured on the same scale, as it is much stronger (23m5s).
• The consumption of industrialized oils, such as oxidized and cruddy oils, may contribute to a reduced GLP1 response, but the extent of this effect is unclear (23m59s).
• Linolic acid, a primary polyunsaturated fatty acid in refined oils, is problematic and may contribute to insulin resistance, but there is debate about its effects within the seed oil community (24m46s).
• The effect of linolic acid on GLP1 is likely modest compared to its effects on insulin resistance, and the differences between fats are more significant in the context of insulin resistance (25m34s).

Saturated vs. Unsaturated Fats

• A study published about 20 years ago found that saturated and monounsaturated fats increase GLP-1 levels, while polyunsaturated fat has a lesser effect, with a statistically significant but potentially meaningless difference at the scale (25m46s).
• Animal studies have shown that when calorie intake is controlled, animals that consume most of their fat from coconut oil or refined seed oils tend to gain more fat, indicating that factors beyond calories are at play (26m10s).
• Thermodynamics, a principle of physics, does not apply to living organisms, which are open systems with energy moving in complex ways that cannot be readily quantified (26m36s).
• The invocation of thermodynamics in biology has led to the misconception that obesity is purely a function of calories in and calories out (27m16s).
• Animal studies have found that animals that get their fat isocalorically from seed oils tend to gain more fat than those that consume other types of fat, although the mechanism behind this is unclear (27m28s).
• Linolic acid, a type of polyunsaturated fat, can undergo oxidation for energy purposes, but it is also prone to peroxidation, a process that can lead to cell damage (28m56s).
• Peroxidation of linolic acid can result in the formation of a reactive molecule called 4-HNE, which can force fat cells to grow through hypertrophy (29m16s).
• Dr. Steven Kain's research has shown that the brain is capable of metabolizing linolic acid, including oxidizing it for energy purposes (28m34s).
• Restricting hyperplasia may cause fat cell growth that promotes insulin resistance, and linolic acid and polyunsaturated fats from refined seed oils are problematic due to their direct cellular metabolism and abundance in the human diet (29m27s).
• Soybean oil is now the single most consumed fat in the human diet, and people eat more of their fat calories from soybean oil than any other source (30m0s).
• Despite the common idea that saturated fats are the primary cause of diabetes and heart disease, consumption of saturated fat in the US diet peaked in the 1940s and has since decreased, while rates of heart disease and diabetes continue to rise (30m27s).
• The fear of saturated fat has led to a decrease in consumption, but heart disease and diabetes have still skyrocketed, indicating that saturated fat is not the primary cause (30m56s).
• Refined starches, sugars, and seed oils are consumed in larger quantities, and seed oils often come with refined starches in packaged foods (31m11s).
• It is challenging to find processed foods without seed oils, and even foods like potato chips, crackers, and cereal typically contain seed oils (31m26s).
• Some companies, like Masa, are making products with alternative fats like tallow, which used to be commonly used in foods like french fries (31m43s).
• Animal fats, including tallow, can provide a better mouthfeel and texture in foods compared to seed oils (32m15s).
• Dr. Bikman is a big advocate of animal fats and can be found on his website insulin iq.com or his YouTube channel Insulin IQ (32m37s).