Last week, we went beyond the headlines to explore what the emerging science actually tells us about the unexpected benefits of GLP-1s. 

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Catch Up

But when things are moving this quickly, there’s always more to unpack. So we took your questions to an expert.

Darshan Shah, MD, is a health and wellness specialist, board-certified surgeon, published author, entrepreneur, and founder of Next Health, the world's first and largest Health Optimization and Longevity clinic. With expertise in all body systems, he has performed over 20,000 surgical procedures, including trauma surgery and complex reconstructive procedures. 

As a Longevity Medicine specialist, he has advised thousands of patients on how to optimize their well-being and extend their healthspan and lifespan. Dr. Shah began his career at an accelerated MD program and earned his medical degree at the age of 21, becoming one of the youngest doctors in the United States. He continued his training at the Mayo Clinic, one of the most prestigious medical institutes in the country. After earning his board certification, he opened medical/surgical centers throughout California, started four other companies in the health and wellness space, and has published a book, authored numerous papers and patented medical devices. 

Dr. Shah's belief in continual education and self-improvement has earned him alumni status at Harvard Business School, Singularity University, and other prestigious institutions. His passion is speaking on the topics of longevity and health, having done over 100+ speaking engagements and appearances. 

And today, he’s tackling the questions you submitted about leaky gut. Let’s get into it.

Q. I’m excited about some of the potential benefits (of GLP-1s), but I’m also nervous because these drugs haven’t been around that long. How worried should we be about the long-term side effects?

GLP-1s were first approved actually way back in 2005. So they've been around for about 20 years. It's probably one of the best-studied drugs in medicine and the only thing new is that we now have new forms and new dosing algorithms. So there's a lot of long-run data that comes from diabetes dosing way before it was a weight loss drug.

There's a trial that was called SELECT that shows that people on semaglutide versus placebo actually had less serious adverse events. So it’s pretty interesting that placebo did worse than being on semaglutide as far as the most adverse events go. Longer-term trials that have been done show that pancreatitis and cancer concerns and thyroid concerns . . . they all came from rodent studies and really have not panned out in humans. So I feel really good about the safety of these drugs.

Now obviously if you have a tumor like a medullary thyroid carcinoma, which is exceedingly rare, you're not going to take them. But otherwise, there's really good safety. Now, a lot of the risk comes from taking too much too fast, and you can see people with GI side effects from that. However, the key here is using them responsibly and making sure that the drugs are not escalated to too high of a dose and definitely not too quickly.

A lot of the side effects also come from just rapid weight loss. We see this with gastric bypass surgery or anyone losing weight rapidly, and that could be gallstones or gastroparesis or nutrient deficiencies. And these are all just a product of rapid weight loss, not from the drugs themselves

Q. I’ve seen they’re even studying GLP 1s for Alzheimer’s, Parkinson’s, and addiction. Is there any real promise there?

So, the answer here is definitely a yes. But I think that you have to catch these earlier in the disease process, specifically around Alzheimer's and Parkinson's, to have the better metabolism, lower inflammation, and really affect the risk of actually developing Parkinson's and Alzheimer's.

There are some good studies around the biomarkers of Alzheimer's—they are called p-tau 217 and p-tau 181—that showed a 10% reduction in these biomarkers of Alzheimer's. So things are pretty promising, but still lots of studies need to be done. There's some studies that were done on later-stage Alzheimer's and Parkinson's where the drug did not have a benefit. So we just really don't know yet.

Addiction is a different story. There's a study that's being published in The Lancet that is a 26-week trial of semaglutide, and it really showed a great effect on people with moderate to severe alcohol use, where heavy drinking dropped 41%. And the big picture here is that the reward system—whether it be for food, alcohol, gambling, or any type of addiction—is really tuned down. 

And that's where you're going to see a lot of great benefits around GLP-1s for some addictive disorders. In my personal practice, I see this all the time; people have less of a craving for alcohol and for even smoking.

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Q. I remember seeing people say statins were so beneficial that one day they'd be in our water supply. Are GLP 1s like that? Will everyone be taking one someday?

So you know, statins do have a lot of benefits, but they're definitely not for everybody. Not everyone needs their cholesterol lowered and not everyone needs to lose weight or have inflammation lowered. So I don't think it's something that everyone should be taking.

But I do think that they do categorize in the same category of statins as far as usefulness goes for many people in the population with something that is a massive health issue, which is obesity, inflammation, and metabolic disease. We know 90% of Americans have some level of metabolic disease, and if that can't be turned around with diet, GLP-1s can definitely be a good part of the solution.

Q. Five years from now, what do you think we'll know about GLP 1s that we don't know today?

GLP-1s are called weight loss drugs, but really that's not what they're about. I think we're going to change them into a new category called metabolic health drugs. And metabolic health has so many more implications, such as not just avoidance of diabetes but also reduction of inflammation, better gut health, and prevention of disease in general.

There are also some great studies around using GLP-1s to help improve cartilage production. We can see that the benefits go way beyond just weight loss.

I do think that there is more research that needs to be done on where GLP-1 receptors are and on what type of cell types, because as we discover more cell types that have GLP-1 receptors, we can certainly expect to see some effect on those cell types as well. The joints are a perfect example of this where there are GLP-1 receptors in our joints and we can actually see cartilage regeneration.

The views expressed by our expert are entirely their own. There is no financial, professional, or organizational affiliation between the expert featured in this Q&A and our sponsor.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.