Weighing up the pros and cons of weight loss jabs

How the ketogenic diet works in a similar way, but without the risk of pancreatitis, among others.

Sometimes, when it comes to pharmaceuticals, you have to weigh up the benefits and the side effects, and see which way the scales tip. That’s clearly been the thought process of the many people who have opted for the irresistible promise of easy weight loss offered by Mounjaro, Ozempic et al.

In exchange for no effort, combined perhaps with a little nausea, diarrhoea, constipation, the odd headache and regular fatigue, you get to watch the numbers on the scales tumble downwards. The pleasure must be immeasurable, compared to the inconvenience of an adverse reaction or two.

Except that those adverse reactions may be rather more serious than previously imagined, or properly evaluated through long-term trials.

Once hailed as the magic bullet that would turn the tide on obesity, weight loss jabs are starting to look more like a poisoned chalice, because of the serious side-effects being reported.

People taking them are turning up at hospital and being diagnosed with acute pancreatitis. Other people have developed chronic pancreatitis. Acute or chronic; you don’t want either.

So alarming is this phenomenon that a new study has been launched by the UK Medicines and Healthcare Regulatory Agency to investigate the link.

Pancreatitis is inflammation of the pancreas. Acute pancreatitis means it comes on quite suddenly, and symptoms include severe pain, nausea and vomiting. If chronic, the inflammation is ongoing, usually with repeated episodes of severe pain that can leave the pancreas permanently damaged.

In the UK, around 400 people so far have presented at hospital, out of an unknown number of people on the drugs. That figure is unknown because the drugs are available from so many different sources, regulated and unregulated, prescribed or privately purchased.

Weight loss injections (GLP-1 agonists) were originally launched to lower blood sugar levels in people with type 2 diabetes. They worked, and lo! Turned out they also reduced appetite, and this led to weight loss. Many type 2 diabetics are overweight or obese, so this was seen as an exciting outcome.

The golden egg had hatched.

GLP-1 agonists stimulate the pancreas to make insulin, a hormone that responds to and manages glucose in the blood. They mimic the action of natural GLP-1, which also suppresses secretion of glucagon, a hormone that increases blood sugar levels when they are low.

In other words, GLP-1 agonists assume part of the role of the pancreas in the regulation of blood sugar, appetite and cravings.

Other serious issues are appearing in connection with the drugs, such as gallbladder and kidney problems. Just this year, Pfizer scrapped its experimental version of the jab because of liver damage in one of its trial participants.

Then there’s the one potential adverse reaction that probably scares people the most: ‘Ozempic face’. This drug-induced look includes hollow appearance, wrinkles, sunken eyes, saggy jowls and changes to the size of lips, cheeks and chin.

Not to worry, there’s always the option of plastic surgery after the desired weight loss has been achieved.

In another twist of unintended consequences, these drugs are creating worrying side effects for the food industry. Recent headlines, including Food industry scrambles to respond to GLP-1 craze, highlight this concern. People have reduced appetites, and reduced cravings for the very products that were making them fat in the first place.

What a nightmare.

The food industry always rises to a challenge, and it will surely respond by inventing new ways to increase the addictive nature of their products.

Meanwhile, and more fortuitously for human health, March this year also saw the timely publication in the journal Nutrients of an extensive review of studies that compared the effectiveness of the ketogenic diet with other weight loss strategies, such as low-fat diets.

The ketogenic diet is a low carbohydrate diet, based on fat and protein. There is no standard definition, other than the low carb aspect, usually set at 50 g daily, or less. Having said that, the less carb content the more effective it is.

When carbohydrates and the glucose they release are not available, your body switches to burning ketones for fuel. These ketones are made from your body fat. As well as providing fuel, they suppress secretion of the hunger hormone, ghrelin, and raise levels of the satiety hormone, leptin.

The ketogenic diet regulates blood sugar and eliminates the glucose fluctuations caused by carb-rich meals. Therefore, there is much less insulin secretion.

The conclusion of the review was that the ketogenic diet is a highly effective, possibly the most effective, weight loss strategy.

What’s more, it also reduces need for pharmacological obesity control.

The superiority of the ketogenic diet over the low-fat diet in terms of glycaemic control has also been demonstrated in a number of meta-analyses.

The diet works, but for many people the scales do not tip in its favour. Some sacrifice is required.

That’s a pity, because another health benefit of the diet is the breakdown of blood fats (triglycerides) into free fatty acids, in a process called lipolysis. These fatty acids create ketones and keep blood fats low. Doing so reduces your chances of developing pancreatitis, because high triglycerides - hypertriglyceridemia - is the third most common cause of acute pancreatitis.

The ketogenic diet can often achieve the same results but arguably with fewer and less serious side effects.

Stay off the carbs and you can keep your weight stable. But if you choose the meds method, you’ll have to stay on them. An analysis of the consequences of coming off the drugs has found that people regain everything they lost within a year.

The scales of effort and reward now suggest that you either stay on the drugs for life and deal with the consequences, or you change your diet, lose weight and enhance your chances of prolonged good health.

Not so fast!

Put that on pause, because the pharmaceutical fightback has begun.

A new study, published in the journal Nature by three scientists, two of whom are ‘uncompensated consultants for Pfizer’ has found that weight loss injections may lower the risk of a heart attack or stroke, even if they do increase the risk of pancreatitis.

The scales are set to tip back in favour of the meds. Before you know it, weight loss jabs will become the new statins, and we’ll all be issued with prescriptions after the age of 50.

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There are so many conflicts of interest involved in this debacle that it is easy to forget that the only interests that truly matter are yours. You decide which way the balance of effort and reward should go.

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