Coming up this week, I’ll share what I found doing a study in Rhode Island on the use of buses vs. cars to access healthy food. If you haven’t had to do it, and I’m glad I have never had to, it might be a little hard to imagine how hard it is to shop for groceries relying on the bus.
Medicare says yes to Ozempic and Zepbound
But first, there are a couple of big GLP-1 things to talk about. Beginning July 1, people who have Medicare Part D and qualify medically will be able to get GLP-1s to treat unhealthy weight with only a $50 monthly copay, much less than available discounted prices. Currently, Medicare does not cover any weight loss treatment.
The benefit is being offered by the Centers for Medicare and Medicaid Services, or CMS, as a pilot program that will end after a year and a half, on December 31, 2027. At that time CMS hopes a permanent program will be in place to continue benefit coverage.
A body mass index, or BMI, of 35 provides automatic medical qualification. A BMI of at least 30 in combination with diastolic heart failure, uncontrolled hypertension, or Stage 3a chronic kidney disease also qualifies. Finally, a combination of a BMI of at least 27 and either cardiovascular disease or prediabetes reaches the threshold of medical qualification.
To receive the prescribed GLP-1, patients with these conditions must receive prior authorization through Humana, the CMS contractor who will administer the pilot program.
Possible and and proven GLP-1 benefits grow and grow
While the inclusion of GLP-1s in Medicare benefits will reduce the risk from unhealthy weight for many, the bigger, long term GLP-1 story is that many of these newly covered Americans will experience other GLP-1 associated health benefits, as might anyone using GLP-1s.
At first scientists had it wrong. GLP-1 is a hormone that is produced in the gut in response to eating. The initial belief was that drugs like Ozempic worked for weight loss by supercharging our natural gut GLP-1, and the abundance of GLP-1in the gut made us feel satiated with less food than normal. Turns out that appetite suppression through signaling with GLP-1s seems to happen mainly in the brainstem, which produces GLP-1 in addition to the gut.
Also, GLP-1s slow the pace of stomach emptying and that contributes to a reduced desire to keep eating and also helps slow down metabolism. Carbohydrates are digested slower, turning into sugar less rapidly, tamping down glycemic spikes. So, by contributing weight loss and a reduction in blood sugar spiking, GLP-1s are good for control of prediabetes and diabetes.
The science and the public embrace of GLP-1s for conditions beyond unhealthy weight and diabetes are unfolding quickly. The benefit of GLP-1s to reduce the risk of cardiovascular events like heart attacks and strokes and for the treatment of sleep apnea is well documented, to the degree these are standard conditions qualifying patients with unhealthy weight but not obesity to receive GLP-1s under many health insurance plans.
Losing unhealthy weight is good for your heart health, but, as you may have heard, GLP-1s are good for your cardiovascular system independent of any weight loss.
GLP-1s are in love with cytokines. It’s complicated.
Cytokines are chemical messengers in our body involved in regulating our immune system. Too much cytokine production is associated with autoimmune disease like rheumatoid arthritis. On the other hand, doctors sometimes inject cytokines to fight cancer or serious infection.
The actions of the many cytokines, and their interactions with GLP-1s, are complex, but we know that the way that GLP-1s, working through cytokines, tamp down immune reactions in the body that are causing inflammation is key to benefits GLP-1s provide beyond weight loss.
Inflammation can save our life but is also involved in so many of our health problems.
To put this in plainer English, GLP-1s can reduce bad levels of inflammation in our organs without turning off immune reactions entirely. Liver and kidney disease and immune system dysfunction can benefit. Arthritis and female and male fertility are being researched in connection with GLP-1s.
Nervous system disorders are being investigated, although evidence has been disappointing or mixed in Parkinson’s and Alzheimer’s trials. However, dementia treatment research will continue with GLP-1s and newer, related drugs.
Meanwhile promising research has begun on the use of GLP-1s to treat traumatic brain injury. The availability of pill versions of GLP-1s offer additional hope for treatment in this regard. Orforglipron from Eli Lilly, which just came on the market, uses a small molecule structure which can penetrate the blood-brain barrier more easily than injectable versions that use full peptide proteins that are much larger. This not only means better transport of the medicine to the site of trauma but more availability to GLP-1 receptors deep in the brain, so potentially these oral medicines could have more effectiveness for controlling satiety.
A very interesting area of research is the often observed effect of GLP-1s on the reduction of addicted or disordered behavior. Many GLP-1 users report a sudden disinterest in drinking alcohol. Disordered gambling, shopping, sex behavior, and eating can be reduced, including simple food addiction and binge and anorexic behaviors. GLP-1s can be associated with reductions in the use of nicotine, opioids, cannabis, and cocaine.
Addictions are not a choice we make
I have to pause here because I just listed a number of what we think of as “bad things.” I always like to remind myself that these are just “things.” While all of these things can be bad for us, they are things I and other people are given by genetics, environment, and happenstance, and don’t choose. It’s good to remember that every one of these obsessions comes to us a product for sale, so someone stands to profit from our obsession.
We are fortunate to have an increasing arsenal of medical and behavioral treatments, now including GLP-1s, to rid ourselves of these things, and it may be that our society is making some progress in ridding itself of some of the stigma around these things.
A tremendous amount of research needs to be done to understand how GLP-1s work and to invent new ones and understand them as well. We are yet to sort out how much of a miracle these drugs are and to discover any risks to using them that may still be hidden.
But we may be at the start of a new era with regard to GLP-1s. The health benefits are so evident, and for some people the body image changes are important and apparent. Popular interest in GLP-1s has been extremely high. One in eight American adults is on or has tried a GLP-1. What’s more, dieting and medical treatments are both areas in which Americans as a group have repeatedly shown a willingness to try anything, and that is certainly the case with GLP-1s, be they compounded off-brand GLP-1s made in America or even much, much sketchier next generation GLP-1s like the experimental retatrutide compounded under unknown conditions in China and available on the gray market online.
It’s important that RFK, Jr., the FDA, and Trump take an aggressive approach to keep up with the American public, not just with approving new GLP-1s, as they seem intent on doing as fast as possible, but with ensuring GLP-1 safety and clamping down on sources of unregulated substitutes. And with making these medicines affordable to all Americans.
What do you think about what might be the awakening of the age of GLP-1s in America? Let us know!
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