Mechanism of Action

I am a big believer in understanding the WHY. When I understand the WHY, the better equipped I am to troubleshoot when a problem or new insight arises. 

For example, consider bad drivers, especially the ones that fail to match the speed of traffic as they merge onto a highway, and expect the tractor-trailer that is fully loaded to slow from 110km/h to 80km/h. So WHY are they there? 

We could list off a variety of reasons, many of which would likely involve swear words. However, the real reason I believe they are there is to help me practice my anger management skills and that is what I will continue to tell myself until everyone is in self-driving vehicles.   

So with that in mind, I have been meaning to write an article specifically on the WHY and how GLP-1 medications such as Wegovy, Saxenda, and Mounjaro work! How do these drugs help us lose weight and help us to manage our blood sugars?

When you are equipped with this information, hopefully, you will have a better understanding of potential side effects, and if you feel the medication may or may not be working! 

Great – so what can you tell me??

Wegovy, Saxenda, Ozempic, Trulicity, Victoza and kind of Mounjaro (Mounjaro is slightly different, which I will address in a future blog), all fall under the class of medications called Glucagon-like Peptide 1 agonist, or GLP-1 for short. 

GLP-1 is actually a hormone that is naturally produced within the body when you eat. When it comes to GLP-1 medications, what people much smarter than I have done is learned how to create nearly identical copies of our naturally produced GLP-1 hormone.

With the exception of concentrating the molecule and a few small tweaks that allow the GLP-1 medications to hang out longer and continuously exert the same effects of our naturally occurring GLP-1 hormone. 

The first GLP-1 medication Byetta (Exenatide), came to market in 2005 for the management of Type 2 Diabetes. If we include all the pre-approval research and data up to this point, we have over 20 years of experience in studying these medications. 

Unfortunately, as with most things involving the human body, we don’t know everything about GLP-1 in terms of its mechanism of action, but we have a solid body of knowledge as to what it does, therefore, what GLP-1 medications do in terms of weight loss and diabetes. 

So what do GLP-1s do?

Let’s start with blood sugar management: 

  • Massages the Pancreas 
    • Think of a nice relaxing massage at a tropical destination. Not a painful and soul-crushing deep tissue massage that my massage therapist inflicts on me every few months to ensure my body doesn’t fall apart entirely. Anywho, the pancreas produces insulin. Insulin lowers blood sugar levels. When the pancreas is given a nice massage, it produces more insulin which helps to reduce blood sugar levels. 
  • Chats with the Liver 
    • The liver creates sugar. In cases of diabetes and insulin resistance, the liver can get a little carried away with sugar production. Increased sugar leads to increased blood sugar. The liver means well and is doing the best it can, but sometimes it needs to have a chat with GLP-1. GLP-1 convinces the liver to shut down unnecessary sugar production, which helps to bring down blood sugar. 

Ok – what about weight loss?! 

Of course, I saved the best for last: 

  • Slows Digestion 
    • Like a bad driver that does not know how to merge, GLP-1 slows down the process of digestion. Therefore, the food you eat moves through the GI tract more slowly and food tends to sit in the stomach or intestine for a longer period of time.
    • On the one hand, this seems great as it provides the sensation of fullness, but on the other hand, it also contributes to side effects such as nausea, vomiting, and constipation. This makes sense, if the usual path is blocked off, well whatever it is will have to backtrack the way it came in. I have talked about how to manage these side effects in previous posts (nausea and vomiting, and constipation).
  • One thing I want to highlight is that, like the bad driver, eventually, things will return to normal speed and flow for most people. The slowing of digestion is technically a side effect that will dissipate over time. 
  • Brain Power 
    • Fun fact: When it comes to managing our weight, ie. appetite, most of the signalling and action comes from the brain. This is the main area that GLP-1 acts upon to help you regulate your appetite, satiety, or your wanting/liking of food, and your feeling of fullness. Overall, GLP-1 decreases your appetite and increases your satiety. Therefore, you will be less driven to stop at the drive-through or have a cookie from the break room. All of these will likely lead to a reduction in your calorie intake and, voila, weight loss!

Seems simple enough?! 

For clinicians and the nerdy types, there is a lot more intricate detail. I could write an article on every aspect, which I might still do but, for now this overview will hopefully suffice! 

So there is your brief rundown on the GLP-1 medications – specifically the general mechanism of action and how they work! 

Overall it is a cool little hormone that has a plethora of effects both on blood sugars and weight management. More research is in the works and new actions and effects are being discovered all the time. 

I will do my best to keep you updated on all of it, however, for today if you have any questions feel free to drop me a line on any of my social media platforms @theofficialdrdan.  

Until next time my friends! 

Always remember small tweaks lead to massive peaks! 

Dr. Dan

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