GLP1 medications. How we got here….

To understand why GLP-1 medications have begun to transform our healthcare system, we must go back to the beginning. In the early 1900s, scientists identified peptide hormones that are released in response to eating. These hormones stimulate the pancreas to produce insulin, enabling the body to utilize the energy from food.

Let’s simplify how we use energy from our food. After we eat, the food travels to the stomach, where it starts breaking down into basic nutrients—carbohydrates, fats, and proteins. Glucose, derived from carbohydrates, is the molecule we’re most familiar with, so let’s focus on it. Glucose is absorbed in the intestines where food is digested, then it travels through the bloodstream to the body’s cells for energy. Each cell has a membrane that regulates how glucose enters. Sometimes glucose can pass through the membrane on its own, but in many cases, open channels are needed. This is where insulin comes into play. Insulin acts like a key, opening these channels for glucose to enter the cells. If insulin levels are low or if the insulin receptors on the cells aren't functioning properly, glucose cannot easily enter, leading to a buildup that can cause problems. This is a broad overview of diabetes: Type 1 diabetes arises from insufficient insulin due to a non-functioning pancreas, while Type 2 diabetes typically involves dysfunctional insulin receptors combined with low insulin production. To treat diabetes, many times we provide patients with insulin or medications that enhance insulin receptor function.

In 1986, researchers identified the first GLP-1 peptide hormone, marking a significant advancement in understanding the naturally produced molecules that influence insulin release. Unexpectedly, these molecules were found to affect other aspects of metabolism, directly impacting the brain and gastrointestinal tract. GLP-1 peptides also slow down food movement through the intestines, leading to a faster and longer-lasting feeling of fullness. Initially thought to only affect appetite, it became evident that these peptides also create a sense of "satisfaction." This feeling is key to how our current medications influence consumption behaviors beyond food, including alcohol, tobacco, opioids, and even compulsive activities like gambling or shopping.

GLP-1 molecules are produced in our gut and released when we eat. They play a crucial role in enhancing insulin secretion, slowing gut motility, and inducing feelings of satisfaction. The critical question arises: why do we need medications to supplement what our bodies naturally produce? The answer is simple—we are not producing enough GLP-1 due to unhealthy guts, influenced by our diets (primarily processed foods) and a lack of fiber-rich whole foods, along with various environmental factors and genetics. In a future blog, I will explore gut health in greater detail, but understanding this basic concept will help you see that we can naturally increase GLP-1 production and repair our metabolism.

This is where GLP-1 receptor agonist (RA) medications come in, helping to level the playing field for repairing metabolic health. These medications mimic our natural GLP-1 molecules closely enough that our cells respond similarly. Developing these medications required both crafting a molecule resembling natural GLP-1 and adding a carrier to keep it circulating in our system longer. Normally, after eating, our bodies produce GLP-1, which does its job and then diminishes. The new medications remain in the system for a prolonged effect.

Ideally, we would all read this and immediately start improving our diets and habits to enhance our own GLP-1 production. While a small percentage of people may achieve this, it's not the reality for most of us. For years, society has made individuals feel at fault for not adopting healthy habits—imposing a sense of moral failing tied to gluttony and laziness. However, this narrative is misleading. We must recognize that many beliefs about weight, weight loss, willpower, and metabolism are rooted in misinformation propagated by a system that profits from these misconceptions. Our food sources, advertising, social pressures, and misunderstandings about metabolism have led many down a path that is overwhelmingly difficult to navigate alone.

I view these medications as essential tools. Patients taking them often experience reduced food cravings and increased ability to resist foods they know they shouldn't consume. Imagine feeling the satisfaction that nature intended around food—enjoying a cookie and being satisfied with just one. It’s likely our grandparents knew this instinctively, before processed foods like those from Nabisco changed the game.

To recap: we need food for energy for every cell in our body, and our metabolism orchestrates how this energy reaches those cells. Metabolism is a complex interplay of peptides and signals we're only beginning to understand, with GLP-1 molecules being significant players in energy utilization and appetite regulation. These molecules originate from our gut, and to produce them naturally, we must maintain gut health. However, shifting dietary and environmental trends over the past 50 years have contributed to unhealthy guts, leading to metabolic diseases such as obesity, diabetes, heart disease, autoimmune disorders, and even cancer and Alzheimer’s. Excitingly, many of these conditions appear to be responding to out new GLP-1 mediations. I am excited for where we go from here in correcting our health!