Many years ago, while wandering around the Old City of Jerusalem, I was at the Dung Gate, an ancient break in the walls, named as such because it was the original route for garbage to be dumped. As I approached, I saw a camel, and a question that had bugged me for years came to mind. “Excuse me,” quoth I to the chap standing near the stately ship of the desert, “do you speak English?” He responded that he did, so I asked him, “Why do camels spit?” He looked at me, quite baffled, and announced with passion, “My camel does not spit!” I told him that my question referred to camels in general, whereupon he repeated angrily, “My camel does not spit!” At that point, the camel hocked an almighty loogie in my face, whereupon the fellow sheepishly said, “That’s not my camel!” True story.
But today we are going to talk about another creature’s saliva, specifically that of the Gila monster, found in North American deserts. It is now over 100 years since the discovery of insulin, a hormone produced by the pancreas that controls glucose levels. Subsequent discoveries showed that glucose control in diabetes was more complex than merely not producing enough insulin or human cells not responding to it. Eventually “GLP-1” (glucagon-like peptide 1) was found as well as the “receptors” on cells; the locks that the GLP-1 key could slot into. This held promise as a new way to treat diabetes, but for the fact that it was a very transient chemical in the body, so could not be turned into a drug. Enter the humble Gila monster, whose salivary venom contained a chemical that did the same as human GLP-1 but lasted much longer. After many twists and turns, in 2005 the first drug came to market to treat diabetes using this breakthrough. The GLP-1 Receptor Agonists (GLP-1RA) are molecules that mimic the action of human GLP-1, lock into cell receptors, and stimulate the cells to do as they are told!
As often happens in medicine, other effects were noticed, rather like the high blood pressure medicine that helped men sustain erections or the prostate enlargement drug that caused one’s hair to regrow. Here, the observation was that patients taking the medicine (Byetta) lost weight. News spread and people started obtaining the medicine to shed pounds. Knowing that GLP-1RA stimulates insulin release, further research revealed that brain receptors are stimulated by GLP-1RA suppressing hunger; stomach emptying slows, increasing a sense of fullness. One drug, tirzepatide (Mounjaro and Zepbound), contains another hormone found in the early days of research and it also stimulates metabolism, particularly fat burning.
Data now show that all of these are highly effective at controlling diabetes and inducing weight loss, but are all injections, as the chemicals cannot be readily made into pill form, although this is being evaluated.
Let’s be clear; although there were many treatments available before the GLP-1RA, diabetes is a wretched disease that shortens life and health span, causing kidney failure, stroke, blindness, and other sequelae. And obesity kills. It used to be that famine was the world’s greatest food emergency; now it is the opposite. There are other methods to slim down (Fifty Weighs to Lose Your Blubber: https://www.aopa.org/news-and-media/all-news/2013/december/pilot/fly-well-fifty-ways-to-lose-your-blubber) and already GLP-1RA meds are impacting these. For instance, as a surgeon, I would perform procedures to reduce stomach capacity and bypass gut absorption. The advent of laparoscopic techniques helped this become very popular with nearly 300,000 operations for obesity being performed in the USA in 2022, but these numbers decreased 25.6% from 2022–2023 according to a report in the Journal of the American Medical Association (JAMA). Conversely, in 2022, around 2 million Americans were taking semaglutide GLP-1RA-type medications, more than triple the number in 2019. Last year, a KFF Health Tracking Poll indicated that 12% of U.S. adults have used GLP-1 drugs, with 6% currently using them.
BMI (body mass index) is a calculation based on weight and height; if <18.5 one is underweight,18.5–24.9 is healthy, 25–29.9 overweight, 30–39.9 obese, and above 40, morbidly obese. Using a BMI greater than 30, JAMA reported that obesity rates increased every year in America until 2022 when it started to drop, likely due to the GLP-1RA, most dramatically in the American South, where obesity rates are higher.
There is no doubt that controlling diabetes and achieving, then maintaining, a healthy weight has profound short-, medium-, and long-term benefits and GLP-1RA can definitely help, but it needs to be used in a measured and proper fashion. First, discuss with your doctor whether this class of medications is suitable for you, and I strongly advise against just obtaining a prescription after an online “consultation.” Second, understand that getting weight under control long term demands a commitment to lifestyle changes, learning to eat a healthy diet, exercising regularly, and not slipping back into old habits. And while diabetes and obesity cause all manner of downstream issues, so do drugs. GLP-1RA commonly but temporarily causes heartburn, nausea, vomiting, diarrhea, and stomach discomfort. Other effects include altered or heightened skin sensation, increased sensitivity to cold, and more rarely serious side effects like thyroid problems, pancreatitis (inflammation of the pancreas), or visual disturbances. This is why a proper and thorough evaluation by a doctor who knows your history prior to starting treatment is wise.
From an aeromedical perspective, the FAA has specific guidelines for pilots taking GLP-1 drugs, including medications like liraglutide, semaglutide, and tirzepatide.
Primarily, the reason for taking the medication will be considered. AMEs can issue for a diabetic patient based on their history, an HbA1C, a report from the treating doctor, an affirmation of no serious side effects, and noting the indication for use. A 14-day observation period is needed when starting the medication with a 72-hour no-fly warning applying to any dosage (this typically ramps up month-by-month). Some of the compounded drugs may be an issue and merit a more detailed conversation as each component may affect certification differently. And obviously if taking one of these drugs and feeling unwell due to side effects, one should self-ground immediately.
I enjoy comedian Nikki Glaser’s acerbic wit, and at the 2025 Golden Globes she said that it was “Ozempic’s biggest night” after celebrities on the red carpet admitted to taking it without explaining the medical need. She also said from the stage, “If you lose tonight, please just keep in mind that the point of making art is not to win an award. The point of making art is to start a tequila brand so popular that you never have to make art again!”
The development of the GLP-1 drugs represents a huge step forward in helping people living with serious and life-threatening diseases, and the point of taking them is to cure or control these ills. It is not to massage one’s vanity. Avoid spitting camels, venomous lizards, and inappropriate advertising. And fly well!
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