As Ponce understood them, it was “La fuente de la juventud” or as locals called their magical discovery, “the fountain of youth.” It seems that ancient navigation was a little imprecise by modern standards and the expedition actually landed on the coast of my home state, Florida, where he established the oldest city in America, St. Augustine. He named his discovery Florida, not only because they landed around the time of Easter (Pascua Florida), but also because of the region’s lush, florid vegetation. The exact circumstances of what happened next are a bit sketchy, but it appears that after a little while locals attacked the settlers, leaving Ponce de León fatally wounded. So much for the fountain of youth.
The obvious lesson from old Ponce is that there is no fountain of youth, so don’t get too hopeful about finding a magic formula or LA Fitness in a pill or test tube. Nevertheless, the dire statistics from the last few months do shed some insight into how we can live longer, healthier lives. Those articles highlighted a number of important factors derived from our review of diet, cancer rates, and obesity. The fountain of youth lies in a healthy lifestyle, proper diet, and controlling obesity. The obvious question is “How?” and we left off the discussion last month with the unanswered question posed by one of my readers asking, “OK, so now what?”
Controlling obesity is really hard for many people and has become a multibillion-dollar industry. Just check the emails in your spam folder, but any real help from all these potions, concoctions, and medications depends on the etiology of your weight gain. As I said right from the start, human genetics haven’t changed. Still, the rate of obesity in America has risen over the last few decades from about 50% of the population to over 75%, and that comes from life choices and ultra-processed food. For those of you whose weight is related to dietary and life choices, your fountain of youth is to turn things around and make healthier choices. But for the minority who have true genetically determined obesity, the problem is much more complex and comes down to attempts to change your basic weight point, which was detailed in our last discussion.
There are FDA-approved medications on the market to aid in weight loss, and they do have some real value for overweight people. Everyone has heard about a new use for an old Type II diabetes treatment out there sold under a bunch of different trade names like Ozempic, Trulicity, and Mounjaro. These meds boost production of a peptide hormone involved in glucose metabolism and satiety called glucagon-like peptide-1 (GLP-1). GPL-1 was first synthesized back in the mid-1980s by a Yugoslavian biochemist, Svetlana Mojsov, who found that the chemical stimulated pancreatic insulin secretion, lowering blood sugar (that’s why it helps to treat diabetics). The feedback loops that manage insulin production and satiety are complicated. The class of GPL-1 agonists works in several different ways. Among these pathways, this peptide blocks an anti-insulin chemical your body makes called glucagon that encourages glucose production leading to fat storage. They also interact in the metabolic chain with another hormone called incretin that enhances insulin effects, lowering blood sugar and glucose production. In combination, these meds also delay gastric emptying so food stays in the stomach longer, promoting the feeling of satiety, and shuts down caloric intake sooner.
All these effects combine to help patients effectively lose weight; that’s why the FDA has approved this class of meds to aid in weight loss and there’s good data out there that these medications are very effective. As far as a modern fountain of youth, the class of GLP-1 drugs seems to be the new up-and-coming miracle drug to fight a number of different conditions that can lead to ill health and shortened life expectancy. One recent journal article went so far as to call these meds “the gift that keeps on giving.” We know that the second highest concentration after the GI tract for GLP receptors is in the lungs, and there’s good evidence that these meds decrease respiratory tract inflammation and can treat asthma. There is also data that GLP-1s treat renal failure and cancer, improve cognitive function, and slow brain aging. Along with all that, recent data shows this class of meds can reduce the incidence of Alzheimer’s disease by an incredible 40-70%.
Summing all this up, a medical publication just this week reviewed the current state-of-the-art with the GLP-1 class of meds and touted them as showing “whole body promise with more to come.” Multiple trials and studies indicate benefits to heart health, renal, liver, cognitive, and bone health, as well as those “full body benefits.” Medscape published a study recently that reported data on 17,604 patients age ≥ 45 years that the GLP-1 class of meds decreases all-cause hospital admissions, further supporting its use in this population. There is also recent evidence that the GLP-1 class of drugs is also the newest fertility drug, helping couples who have had problems starting a family.
It’s not all rosy, as these meds have side effects and also require attention to diet to achieve and maintain weight loss goals. You also have to pay attention, since these meds can deplete vitamin stores and several nutrient supplements that are required to maintain health while you’re taking them. If you don’t want to follow the dietary restrictions, take injections, and deal with any side effects of these meds, there are several surgical options for severe obesity. Most involve making the stomach smaller by various methods and also bypassing some of the intestines. These operations go under the general heading of “bariatric surgery,” and all carry risks both short term and long term but generally have good short-term results. Unfortunately, many patients can regain the weight they lost over time in spite of the procedures.
In the end, there’s no fountain of youth, and the modern equivalent is hugely complex, but part of that complicated equation is healthy eating and weight loss, and GLP-1 meds are likely to turn out to be an important part of those lifesaving waters. Just how critical this is to all of us was highlighted by the conclusions in that article in The Lancet I quoted last month: “Trends in cancer incidence in recent birth cohorts largely reflect changes in exposures during early life and foreshadow the future disease burden.” So, that is “what’s next,” sort of a “fountain of youth,” unfortunately 500 years too late for Ponce de León, but not for us. Get up off the couch, eat NOVA type I foods, and make a real effort to exercise. If you have a genetic propensity to weight gain, your task is harder and involves genuine effort to try to “reset” your weight point, but you can also talk to your doc about some of the newer GLP-1 meds out there that will help. Regardless of how you control your weight, the consequences of not doing so are grave—quite literally—for you and all of our following generations. My new motto has to be “Eat healthy to fly safe.”
