Hey there. It's Dr. Susan Peirce Thompson, and I want to talk to you about the five things that it's likely no one's telling you about GLP-1 medications, including your doctor. I want to start off with a story here. In the last week, I've talked with two different people on the phone who I've talked with six months ago. They're both on GLP-1 medications and they're these classic examples of people who are loving them. They've lost their weight, they feel great, they're able to eat whatever they want. The medication is totally working for them. They feel amazing on it. It's a lifesaver. And this week when I talked with them, both of them, they were both like, "Yeah, I'm now thinking, I don't know that I want to be on these medications forever. I kind of wish there was a way to get off of them." I was gobsmacked.
Now, let me tell you the five things that people aren't talking about, about these medications, because it's really interesting that about 85% of people within two years decide that they want to get off the medications and actually get off of them. That's a finding that came out from a pharmaceutical company that took a look at sales patterns. It wasn't a pharmaceutical, it was a distribution company that took a look at sales patterns and that's what it showed is within two years, 85% of people are off them.
The first thing that people aren't talking about is what GLP-1 actually is. Most people understand that it's a hormone that's naturally made in your body anyway. Your body makes it. Now, the medication doesn't deliver that exact hormone. It delivers an agonist, which means a copycat version, because GLP-1 itself is incredibly fast acting. It's there and it's gone in a flash. As a matter of fact, GLP-1 in your body spikes for only about two minutes just at the end of your meal. If you've seen people, and maybe you are one of these people, I'm not, but the people who they eat a meal and at the end of it, they push their plate away and they're like, "Oh, I'm done." There may be food left on their plate, but after that point, they can't eat another bite. They're really, truly done, full, sated. It's over. The meal is done. That happens because of a GLP-1 spike that lasts about two minutes. It's just the you're absolutely done eating signal. So, if you eat three, four, five times a day, you're actually getting six, eight, 10 minutes of GLP-1 exposure through the day. Suddenly expanding that out to twenty four seven, 365 exposure to GLP-1 medication is a complete change for the brain and the body.
You can naturally increase your GLP-1 signal, the one that your body makes on its own. You can eat more fiber at a meal. You can eat more protein at a meal. You can chew your food or I guess really eat food that requires chewing, like real mastication as opposed to fast food is notorious for being produced so that it can just slither right down your throat and not require hardly any chewing at all. That's one of the features of fast food typically. So, chewing salads, chewing apples, chewing carrot sticks, that kind of chewing, the mastication itself releases a greater GLP-1 signal. But the significance of the fact that GLP-1 is this hormone that's released so briefly in the brain and the body is that you're now exposing GLP-1 receptors all through your brain and your body to a signal that they really aren't accustomed to receiving in that kind of intensity, that kind of duration and frequency.
What that means is that there's all kinds of side effects. It's not just about the digestive system. It's all these other systems. I'm going to talk about some of that in this video here in a second. But what most people don't understand is that GLP-1 actually is not the body weight regulation hormone. It's not the hormone whose job it is to make sure you stay at the right weight. That's actually the job of a different hormone called leptin.
I talk about leptin a lot. Leptin is the hormone that keeps mammals at the right weight. Leptin is the reason that you never see deer in the wild fat. It just doesn't happen because as soon as a mammal eats too much food and puts on a bit of weight, the fat cells themselves release leptin into the bloodstream. That leptin circles back to the brain and shuts off the desire to eat and it stays shut off until the body weight goes back to the right level. Leptin's job is actually to keep body weight at the right level. So, why isn't it working in humans? Because obviously humans are not staying trimmed like deer in the wild. It's broken in us and it is broken. That leptin signal is broken and it's called leptin resistance. The reason that it's broken is because high triglycerides, high baseline insulin levels, and inflammation, those three things block leptin at the brain stem and the hypothalamus. So, the brain can't see the leptin that's circulating so freely through the bloodstream saying, "We're overweight now. We're overweight now. Hello, hello. We need to eat less." The brain can't see that signal anymore because it's being blocked by unwell blood, like a system that is now toxic and diseased and stressed, inflammation, high triglycerides, high baseline insulin levels. These things are the hallmark of eating a crappy diet in modern society and that's actually what's keeping a body too heavy. What that means is that really, if you want your whole brain and body to get back into balance, you actually have to eat well. You actually have to eat foods that we were designed to eat, fruits, vegetables, proteins, nuts, grains, seeds, like actual real food as opposed to ultra-processed food, as opposed to sugar and flour. So, there's that.
Number two. Number two has to do with the fact that GLP-1 medications are hitting two different systems entirely. They're hitting the appetite system, which has to do with what people usually talk about with GLP-1s, that it's slowing down gastric emptying. It's playing a role with insulin, which is why it's prescribed for diabetics and so forth. This is the system that makes you not hungry. But GLP-1s are also hitting the dopamine receptors and the mesolimbic reward pathway. Maybe you have heard of this and this is the reason that GLP-1 medications are reducing food noise and also reducing addictive cravings of all sorts, cravings for caffeine and alcohol and nicotine and swiping right and all those things.
Now, what's interesting about this is that the way GLP-1s are doing the reward work that they do in the addiction pathways of the brain is they're blunting the dopamine spike that happens there. That is great in some ways. It takes away food noise, it takes away cravings for alcohol and for other things. But have you heard that some people are getting anhedonia from these medications? Anhedonia meaning lack of interest or pleasure in things, sort of a flat feeling? Well, check this out. People who go into using these medications with dopamine downregulation to begin with, meaning they have an addictive relationship with something already, sugar, flour, pornography, alcohol, whatever it is. They've been using something to such an excess that it's blown out the dopamine receptors in the nucleus accumbens and then those dopamine receptors have gotten gimpy. They've gotten less numerous, less responsive, and that's called dopamine down regulation. And now when you take away their dopamine spikes with the medication, the GLP-1 medication, they don't have enough dopamine just to sort of feel okay. And they experience a state of malaise, lack of motivation, lack of interest in things, lack of desire, lack of oomph. That anhedonia is likely related to the dopamine downregulation that they started the medication on in the first place.
Number three is that they don't just reduce appetite, they skew what you eat. Appetite gets so blunted with these medications that it's not just that you don't want to eat, it's also that healthier foods seem less palatable or appetizing. You're less likely to eat vegetables, you're less likely to eat lean protein, but also it sets up what's called a compensation effect. Psychologists have studied this a lot when it comes to exercise and eating, that people who've hit the gym a bunch of times during the week are more likely to drive through a fast food drive through and order fries and a shake. What they're telling themselves is it's okay because I've worked out five times this week. That's the compensation effect is, well, I worked out a lot, so therefore I can go eat some fast food.
GLP-1s set up that same compensation effect because when you haven't eaten anything all day, suddenly it sort of feels like, well, I'd better just get some calories in me, so I'll eat a few M&Ms. They skew the types of calories that you're likely to get into you. That is one of the main things that's causing the muscle loss, the hair loss that people are experiencing is actually not a direct effect of the medication itself. It's an indirect effect based on both the caloric deprivation, but also the skewing of the calories of what people are eating. So, even people who, for example, used to eat more healthy protein sources on this medication, they're far more likely to eat a highly processed protein shake that's heavily sweetened, either artificially sweetened or with sugar, either way. But a protein shake with a list of ingredients that's a paragraph long of tiny, tiny letters and things you can't pronounce, and that's likely to be their source of protein as opposed to a tuna fish sandwich or something like that. It profoundly skews the type of calories that the brain is going to seek out.
Number four is something that's seen often as life goes on while on a GLP-1 medication where the medication seems to be working miraculously. I have to say there are aspects of the medication that feel truly miraculous for people, taking away food noise, curbing appetite, releasing so much self-compassion for people who have thought that their overeating was a gluttony that was their flaw. Suddenly they realize, "Oh my gosh, it really just is biology." That awareness can release so much self-compassion. People are in this state of, "It's a miracle. I feel so grateful." And then days go by, weeks go by, months go by, weight loss is happening, everything's cool and the gang. And then a massive emotional stressor happens, something really upsetting, devastating, as happens in life. You got to expect it's going to happen. Then they find themselves eating, especially old favorite binge foods, like whole pizza, a pint of ice cream, whatever it is, eating foods really intensely. And as they're mowing down the food wondering, why is the medication letting me do this? They're thinking, last week I ate some ice cream. I had a few bites and I was done and I didn't even think about it again for the rest of the week. The ice cream was still in the freezer, which back in the old days never would have happened. But the emotional upset overrode the medication, and they find themselves eating just as if they weren't on the medication at all.
Why does this happen? Well, like I said, the medication is blunting the dopamine spike in the reward centers of the brain. There's no spike there happening, but this is creating a dopamine deficit situation in an emotional crisis. What happens is in an emotional crisis, the amygdala, the fear center of the brain, the threat center of the brain gets wildly triggered. I don't know if you're aware of this, but the amygdala used to get triggered by saber tooth tigers. Today it's more emotional things that happen at work or in the family or whatever. It's a bad conversation. It's whatever. That's the threat response that we have in modern society. The threats have totally changed.
So, the emotional thing happens, the amygdala sounds the alarm, cortisol floods into the system, and cortisol historically meant saber-toothed tiger, which meant we're going to need a lot of calories on board because this is going to be a calorically expensive emergency. The brain prioritizes eating sugar, fast calories like, "Oh my gosh, we got to eat a bunch of food." So, this emergency happens and then all of a sudden, because there's no dopamine spike, the dopamine system tries to marshal itself and it's profoundly suppressed. The cortisol busts right through and all of a sudden the medication gets completely overridden. At the same time, the prefrontal cortex is blunted in an emotional emergency like that. You don't have the risk calculation sort of, "Is this a good idea?" All that's completely taken offline. The prefrontal cortex is not able to get involved to reign it in. People find themselves binging right over these medications. And it's interesting because when things are going well, the medication feels like it holds. Then whenever someone's emotionally upset, the medication can seem to completely disappear on them, and they find themselves eating beyond the beyond. That's something that doctors often aren't saying in their doctor's office.
Now, that could be a sign that a conversation with a doctor is warranted to maybe up the dose of the medication, have that conversation with your doctor. I'm not sure. But this is something that people are experiencing. I've talked to eating disorder specialists who are confirming, absolutely, my patients, my binge-eating patients are binging right over this medication. What that indicates is using the medication as a stand-alone solution is likely not a good idea long-term or likely not a sufficient solution for the long-term.
The fifth and final thing that probably your doctor and nobody else is telling you about GLP-1 medications is because there's GLP-1 receptors all through the brain and the body, there's all these side effects. Or you just might call them effects. This is true of other medications too. When you take Prozac, which is an SSRI, there's serotonin receptors all through the brain and the body. So, you don't just get effects on mood, you get effects on sex and sleep and appetite and all kinds of other things. GLP-1s are the same. There's GLP-1 receptors specifically in the brain stem and the hypothalamus on the autonomic nervous system. So, we're talking sympathetic and parasympathetic nervous system. You know the ones, fight or flight, and rest and digest. Those nervous systems have GLP-1 receptors all through the nerves. What that means is that specifically GLP-1s stimulate the sympathetic nervous system. This is the stress nervous system, the fight or flight nervous system. GLP-1s directly stimulate it and they also directly dampen the parasympathetic nervous system. So, they suppress the rest and digest, they activate the fight or flight. What does that mean in practical terms? Well, it means heart rate goes up. How much? Well, on average, two, three, four, five, six, seven beats per minute. In some people, 10, 20 beats a minute. What percentage of the people have that extreme elevated heart rate reaction? Five to 10% of the population. It's not that common, but five to 10%. There's a lot of people on GLP-1s now. That's, I don't know, a million people. It's a lot of people having that response. I don't know how many. I just made up that number. Ignore that number, but it's a lot of people around the world. Heart rate goes up.
Now, the other thing that happens is heart rate variability goes down. Heart rate variability is the measure of the variance, the variability, the degree of difference between heartbeats. In other words, is your heart beating steady, steady, steady, steady, or kind of more now and a little less later? Interestingly, the variation is healthy specifically because you want your heart and your lungs to be paying attention to each other and you actually want the heart to be beating faster on the inhalation when there's all this oxygen to pump out to the body, and you want your heart to be taking an intelligent rest on the exhalation when there's no fresh oxygen coming in. Why should the heart be beating hard then? There's no oxygenated blood to pump out. Those differences might seem minute, but over the course of a day and a whole bunch of heartbeats, it actually adds up and a smart heart is resting on the exhalation.
The information about how the heart would know what the lungs are doing is being conveyed through the vagus nerve. This is the nerve that goes from the heart and the lungs and the gut and the other organs up to the brain and back down. It's a two-way highway, that vagus nerve. But you know what else travels through the vagus nerve? Is your gut feelings. Gut feelings actually are a thing and there's a nervous system in your gut and that information goes up to the brain and GLP-1 medications dampen that signal. They decrease heart rate variability and they dampen intuition, the actual signal of intuition that travels on the vagus nerve from the gut and the heart up to the brain. So, people who are highly spiritual, people who do chakra work, people who do cranial sacral work, people who pray, people who get a flutter of intuition and listen to it, they're noticing that on a GLP-1 medication, they can't hear themselves as well. It all feels muted. So, that's something your doctor's not telling you. Interesting, right?
Now, what your doctor's also probably not telling you is that none of the relevant research on GLP-1 medications is being sorted by people who have an addictive relationship with food. Presumably a lot of the people who are going for these medications do, but not everybody, and certainly there's gradations. In Bright Line Eating®, we have the Food Addiction Susceptibility Quiz™ where you can learn how susceptible you are to the pull of addictive foods. You can take that quiz at foodaddictionquiz.com. The import, the significance of the fact that they're not doing research based on food addiction susceptibility is that we won't know how these medications are selectively affecting people who used to have profound cravings, who used to binge a lot, who used to spend all their time thinking about what they've eaten or not eaten, whether they're on their plan or off their plan, how many miles, how many calories, how many pounds, all of that obsession. We know that these medications are taking away a lot of that food noise. What we don't know is when people get off the medications, does the food noise come back worse, or the same, or less? We don't know because they're not collecting that data. We don't know whether the medications are actually reducing body dissatisfaction or if people are still experiencing the same level of body dissatisfaction as they used to have.
What we are experiencing is the medications are giving us a different vantage point from which to explore weight loss in this new day and age. Because if you want to be on a GLP-1 medication, and I think that that can make a lot of sense, if you've really tried plans like Bright Line Eating or other approaches and you found that you can't stick with them, maybe with a GLP-1 medication you can. If you're not willing to work a program like Bright Line Eating or some other approach, then if you're willing to take a shot, if you're willing to take a pill because they're available in pill form now, maybe that's a good approach. But what if you're like one of the two people I talked about at the beginning of this video and you actually decide you want to get off the medication, then what are your options?
We live in a new weight loss reality and I'm doing an event this week to talk about how all of these things play into the person who wants to lose their weight and keep it off for good finally in this new landscape. It's not all about GLP-1s, it's also about what about the rest of the picture, and how do GLP-1s fit in? But how are you going to lose your weight and keep it off given what we know about weight loss now? I would say that the last five years have been the most productive, exciting time of weight-loss research that I've ever seen. It's fascinating, for example, just to see the concept of food noise be codified and measured now. I've been talking about food noise, I called it food chatter., I've been talking about that for 25 years and they're finally measuring it and it's finally a variable in studies. It's exciting stuff.
If you want to partake of the event that I'm hosting this week on The New Weight-Loss Reality, you can click below. I think we also have a direct link. You can go to ble.life/reality for The New Weight-Loss Reality. I'm giving some webinars. I'm doing some YouTube lives and a Q&A, just a bunch of stuff to be there with you live in real time and to answer your questions. The Q&As will be after the webinars. It's just going to be a lovely time to be together and to learn a bunch of new stuff. Those are some things that probably your doctor isn't telling you about GLP-1 medications. I'm Dr. Susan Peirce Thompson. Click below if you want to join me for these events, and it's been wonderful being with you. I will see you next week on the weekly vlog.
