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by dyauspitr 5 hours ago
What’s the downside to this magical drug. There has to be a downside…
7 comments

Why does there have to be a downside?

What was the downside of washing hands before surgery?

One argument would be that Ozempic doesn't give your body any additional resources. It just triggers your body to behave in a different way. But if the changes it causes are universally good, why didn't evolution already make your body work that way?

I suppose the counterargument would be that modern life is different from the evolutionary environment, and so it's possible for a change to be beneficial now that wasn't beneficial then. But it would still be good to understand better the mechanism of the effect of Ozempic on things like addiction.

> But if the changes it causes are universally good, why didn't evolution already make your body work that way?

That’s not how evolution works.

Because our bodies are delicate systems of networks, and inputs in one area can have complex/unpredictable outputs elsewhere, it seems.

Typically, if something "works", there often appear to be side effects. A free lunch is rare.

https://www.uclahealth.org/news/article/understanding-medica...

> Typically, if something "works", there often appear to be side effects

Unless it’s literally a deficit. There isn’t a downside to treating vitamin C deficiency with vitamin C.

The fact that GLP-1 seems to have roles not just in satiety but that agonists seem to reduce other types of impulsiveness (e.g. gambling, shopping) is interesting. That's not something you'd predict as a consequence, and perhaps is downstream of some gut-brain connection.

Of course we already manipulate brain chemistry in other more direct ways with antidepressants so perhaps any unwanted second-order effects could be minor in comparison to the profile of existing antidepressants .

Yeah, that's a good point. I hadn't heard about impulsiveness. I had read that taste preferences changed - e.g., salty, sweet, savory, fatty:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7105351/

I've been watching developments on how GLP1s seem to go beyond just hunger/insulin response, even how they may affect symptoms of polycystic ovarian syndrome (PCOS), which is difficult on women who have it:

https://academic.oup.com/ejendo/article/194/3/S25/8488941

Some downsides:

1. They make you stop eating, which for most of human history kills you.

2. They are a life-long treatment and kind of expensive unless you go gray market.

3. Gastrointestinal issues especially when titrating up.

1. They don't make you stop altogether, they just make you feel full on less calories, which is good when you are in a calorie dense environment like modern society.

2. Not necessary here either if dietary habits are permanently altered, which can happen more easily after several months on GLPs.

3. Perhaps!

Even if there are zero effects other than the advertised weight reduction, one downside is obvious from the comments here - some people will stop exercising.

While exercise has many positive effects, which I'd argue are more important than the weight loss, the latter is the primary reason many people exercise and likely to stop when given the weight loss by other means.

Most people are achieving weight loss by dietary changes. It takes a massive amount of exercise to significantly alter your calorie balance. Definitely good for you either way but most people who exercise also want to be toned or muscular.
We should stop telling people that exercise is a primary driver of weight loss.

That said, exercise has a direct impact on metabolic health which is pretty necessary to maintain a healthy weight.

Nothing in this world is free, GLP-1s have their downsides (excluding cost).

Mostly it's nausea and gastrointestinal distress side effects. These tend to cool down over time, but it'll put a ceiling on how big a dose you can tolerate. Some people can't tolerate a dose at any level.

And downsides of penicilin? There are some but they are massively offset by not having alt consequences
There are massive downsides to any antibiotic. A single dose of a broad-spectrum antibiotic can permanently alter a kid's gut microbiome and make them more likely to develop a variety of mental health issues like depression

https://theconversation.com/how-childhood-infections-requiri...

https://www.scientificamerican.com/article/a-single-course-o...

Penicillin resistant bacteria?
Don't they age your face pretty badly?
The downside is that they make you eat less thereby taking away one of the few things that make life worth living.
That is the silliest take ever. I am on GLP-1s, and I still enjoy my food..maybe more than ever before.