GLP-1 Drugs: Between Hype, Hope, and a little Dose of Caution

In 1987, Dr Joel Habener and his team at Harvard Medical School identified GLP-1, a hormone produced in the gut that helps regulate blood sugar and appetite. They found that GLP-1 plays a vital role in boosting insulin secretion in response to meals. This discovery was significant because GLP-1 not only prompts the body to release insulin (which lowers blood sugar) after eating but also slows digestion, helping you feel full longer. This makes it highly beneficial for managing diabetes and obesity. But it doesn’t stop there—GLP-1 may also have positive effects on cardiovascular and liver diseases, Alzheimer’s, gout, and even addiction

So, how does GLP-1 work? After being injected, it circulates through the bloodstream, binds to GLP-1 receptors in the pancreas, and triggers a series of actions that prompt the pancreas to release more insulin to reduce blood sugar levels. It also suppresses glucagon, another hormone that would normally raise blood sugar, so the liver releases less glucose. Together, these effects help lower blood glucose and reduce appetite, leading to weight loss, especially in people with type 2 diabetes

However, like all medications, GLP-1s come with some risks. Since they slow digestion, there’s an increased chance of gallbladder issues, like gallstones and inflammation. They can also raise pancreatic enzyme levels (amylase and lipase), which can lead to pancreatitis. Thankfully, most side effects reported so far are mild to moderate and tend to improve over time

But have we been here before?

For those of us old enough to remember, the answer seems to be yes. The excitement around today’s obesity treatments, particularly GLP-1 medications, feels reminiscent of the Prozac frenzy of the late 1980s and 1990s. When Prozac came out in 1988, it was marketed as a groundbreaking antidepressant, sparking a cultural movement around biological solutions to mental health. The media celebrated Prozac as a miracle drug. By the early 1990s, the concept of "cosmetic psychopharmacology" emerged, with thought leaders suggesting that antidepressants could go beyond treating depression to enhance personality, boost confidence, and reduce anxiety. This "Prozac Nation" mindset led to widespread use, sometimes blurring the line between treating clinical conditions and seeking enhancement. Fast forward, and many who took Prozac and other SSRIs are now managing the complexities of long-term use and, for some, challenging withdrawals

Today’s enthusiasm around GLP-1s appears to echo that era. Like with Prozac, there’s a rush to position these new medications as a catch-all answer for, in this case, obesity and beyond, prompting concerns about long-term use, side effects, and potential unforeseen consequences

History has shown us the value of approaching these "miracle drugs" with cautious optimism, especially given how hard it can be to manage the repercussions if the initial promise fades