> Recellularization via electroporation therapy (ReCET) is a novel endoscopic procedure that uses electroporation to induce cellular apoptosis and subsequent reepithelization.
GLP-1s baseline eliminate insulin for about ~40% of people. This boosts that number to 86%.
Note that Tirzepatide also reduces the chance of developing type 2 in the first place by 94%, and I suspect that newer generation receptor agonists will see higher insulin discontinuation rates in general.
Very cool stuff all around. Might finally be able to put this whole obesity-and-diabetes thing to bed.
Make sure you are getting sufficient calories and you won't lose any weight.
The caveat is that it slows digestion down and this effectively reduces your capacity to eat a lot of food. So maintaining a high calorie diet may require some changes to increase the energy density of your food.
Folks should follow medical advice and do what works for them, but be aware that these guidelines were established prior to the obesity epidemic. I’d be highly surprised if someone weighing 300lbs vs. the same person weighing 190lbs should be losing weight at the same rate per week.
I imagine these will be updated to be body weight (or fat) adjusted as time goes on, like some doctors are already doing.
It is best described by me turning the volume down on your desire for a dopamine hit. You’ll eat what you need, vs going for the helping of comfort food. Many people see a more active libido, less alcohol desire and other factors.
We’ll see lots of other indications I’m sure. This drug is like the Keytruda of self control.
I am in a pretty close knit community of 100s of people on the subject and while the side effects should not be discounted, figuring out ways to properly take the medication more or less eliminates them completely for nearly everyone.
The current dosing and schedules of the drug (and all GLP-1s for that matter) are largely an effect of what was tested during trials and not what will end up being most effective a decade from now. The rest of it is patient compliance and liability from drug manufacturers.
The most obvious two things to point at are that the half life of Tirzepatide is 5 days while the prescriptions are for 7 day intervals for ease of use. The other would be the rather large jumps in dosing (2.5mg per step) available in injector pen forms and prescribed.
Some bleeding edge doctors are willing to take the risk to go outside dosing and schedule guidelines, but not many.
Even then, the side effects seem to be rather minor compared to obesity or T2D and few and are far between.
I also had similarly reactions to the topic before I started to really look into it and dig deeper. I firmly believe these medications will change society at a level only antibiotics have so far.
That said, there is nothing magic about aligning the half-life and interval. 50% isn't a minimum concentration threshold for efficacy. depending on the product, it can be anything. Sometimes area under the curve is the relevant parameter. Sometimes you want the product to go under a limit before redosing.
The one part I disagree with is about bleeding edge doctors. Maybe it is my field, but I find doctors to be readily willing to completely ignore the labeling. Statutory protections are high for clinicians operating off label. If someone is interested, I suggest they raise it with their doctor. For most medications, the dosing is far from the individual optimum.
Re: the half-life, I generally agree - however at low dosing, a half-life calculator seems to coincide with some folks experience with side effects - especially starting out initially. Once the dosing levels go up, the impact is much less - but even I at my peak weight loss at a mid-dosing level could tell a difference in hunger levels if I had to wait a few days due to travel or whatnot.
I was on Rybelsus for about a year and a half. It changed my life, and frankly, being able to skip a dose of I wasn’t feeling great eliminated bad belly side effects.
There was a promising example in China where Scientists cured a single woman who had T1D. It's n=1, but the first step to a cure is curing someone :)
No doubt, the current T1D market players will have created some legal moat, so it might be best for the patients if these companies are the ones to bring the treatment to the market. But we shall see - the current big pharma in diabetes space is heavily invested in drug production rather than implantation procedures. It is a very different business model requiring very different facilities, management, and technology.
[0] https://www.diabetes.org.uk/our-research/get-involved/take-p...
It's frustrating, as Type 2 diabetes is 100% manageable through diet. You don't even have to exercise, just eat healthy. Today, with the use of continuous glucose monitors, you have all the data you need to make informed diet decisions - you know exactly what "eat healthy" means for your body.
Why do you suspect it changes energy expenditure?
Most people don't actually say it out loud, but this is all directly implied by the "personal responsibility" retort that is wildly popular among people who don't actually suffer from a given malady, in response to attempts to address it collectively.
However, I dont agree with your supposition following from that.
I think that obesity is a symptom of a cultural problem worth solving, not an individual moral failing, and there are better ways to learn than death.
There are lots of things in our culture that result in physical and mental sickness. It is good to treat the symptoms, but we should also pay attention to the cause.
Culture operates both at the individual and collective level. One can not exist without the other. One can not change without changing the other. Personal beliefs and actions shape collective culture, and culture shapes personal beliefs.
It is the natural consequence of the human body's strategy for finding enough sustenance to drive that big brain over an evolutionary timeline that was mostly dominated by scarcity.
We like to call it a disease because we want to live longer. But all of the consequences happen after most humans have procreated, so there is no evolutionary pressure[0] to change it.
[0] Yes, I understand evolution isn't quite that simple
> "when _you_ believe the solution is trivial" (emphasis mine)
> "But you could also consider..."
Travel to Italy or France and the difference is shocking — both in terms of the look of the people and the quality of the food.
The average American is 50% richer than the average French, and have access to everything they need to eat like one if they choose.
In fact, much of the difference is the French choosing not to eat - both in terms of frequency and quantity.
Healthy food attitudes can absolutely be learned and taught. If you see a 200lb 10 year old, the difference between them and their classmates isn't the contents of the supermarket. Its what is going on at home, the actions of their parents, and what they are learning.
I say this not to blame or pass judgement, but to demonstrate that induvial behavior and actions matter.
As programmers, we usually prefer to remove code to fix a bug than adding patches on top of buggy code. Let's not pretend that the same logic does not apply here.
That's clearly double unhealthy behavior and will bring unintended consequences. Which might be better than the current predicament but still let's not pretend this is not a "monkeypatch".
Semaglutide is ozempic. By itself it can be enough to help people get their A1C down through healthier diets.
For me to find the study especially interesting, I'd have to see a comparison between ReCET + semaglutide vs just semaglutide. And upon re-reading I see that's their plan.
> “We are currently conducting the EMINENT-2 trial with the same inclusion and exclusion criteria and administration of semaglutide, but with either a sham procedure or ReCET. This study will also include mechanistic assessments to evaluate the underlying mechanism of ReCET.”
You, sir, are a modern messiah. Well done.
Still popular opinion is that eating meat and fat is bad for you (heart attack) but no many understand that eating sugar and carbs is a highway to diabetes).
In fact many people who go on keto and reverse diabetes report that doctors instead of congratulating them and telling other patients to do the same, tell them that keto diet (i.e. eating lots of meat) will give them heart attacks.
Most people don't know how bad sugar and carbs are because no one tells them.
I point this out because I've gotten the impression that many seem to view keto and veganism as opposite sides of a "culture war", and use that to justify reacting to one or the other with hostility. In reality, they're entirely orthogonal. One is a range of macros while the other is an ethical philosophy, and they aren't in any way mutually exclusive.
*: To preempt the usual comments on this, my current LDL is 54 and HDL is 57. At its lowest point a few years ago, my total cholesterol was exactly 100. I don't buy that saturated fat is necessarily unhealthy at all.
Not Sarcasm:
1) We simply don't know. Effects seem durable while people take the drug, but we have limited long term data. We dont have large populations that have taken it for 10 or 20 years
2) When people go off GLP-1 drugs, about 50% of them bounce back to their original weight or gain more. about 50% of people hold steady or go on to lose more weight.
This demonstrates that individual behavior and actions play a critical role, even for people who have taken the drug.
If you catch type 2 diabetes before it gets so bad that it has killed off the beta cells, then your best treatment is to fast for a while. After a couple of days, you should notice a massive improvement in glucose control. A week of fasting a couple of times a year might be all it takes to give you a complete cure. YMMV, but in my opinion (and that of a whole load of people who know what they're talking about) it's better than filling yourself with drugs.
After the beta cells have been killed off by overwork, yeah, you need insulin. But you can still reduce the amount you need by losing weight.
I was diagnosed with type 2 diabetes about two and a half years ago. After doing some research, I put myself on a strict keto diet. Within about a month, my A1C went from over 13 to hovering around 6 and has stayed there. Never took any diabetes medication.
I do give myself a "vacation" from the diet about once a month, which I usually reserve for a special occasion.
Eating out isn't as bad as you think when in that position. Get a steak with some low-carb vegetables on the side. You can still have blackberries and raspberries and if you really need to "cheat" you can find some deserts that are no carb. Although best to limit those types of sugars. Use an app / website to track carbs for the first few months.
Just remember you're either in ketosis or not. There's no such thing as a "cheat" day on Keto as going over carb amount can kick you out.
Also the binary nature of either being in ketosis or not is somewhat disappointing. I unfortunately find it impossible to be on a keto diet for long periods of time due to social situations and eating out. Do you have any advice?
Societal pressures can be challenging but it's really not that bad. We ate out quite a bit because of birthdays and such. If you're at a nice restaurant, get a steak and a low-carb vegetable. At Ruth's Chris we did Tomahawk steak with mushrooms. Drink club soda with lime or lemon. Chipotle is a good meal. Chicken steak, guac, cheese, salsa (check their site)
Wingstop was also goto for us. They have quite a few sauces that have no carbs. Eating out is planning. Check the menu; if it's not a chain, you might have to call. We did that a few times. Ask if they put sugar in certain things. Burger with bacon and cheese no bun is also an option. You have to be careful with chicken dishes because they might put a sauce on it.
Remember, it's low-carb, not no-carb, so if you accidentally eat a few pieces of bacon with sugar in it, it's not the end of the world. It's probably not going to be enough to kick you out.
And maybe the secret is the no sugar nor simple carbs
Try a book like "fiber fueled". That's a diet that is actually sustainable.
Because that’s accurate. Someone following this treatment plan is still at elevated risk of recurrence. Once you’re cured of the flu, your ex ante chances of catching it again are no higher. (We don’t have a cure for diabetes per se. Insulin controls but doesn’t cure it.)
By “a week of fasting” you mean a week of intermittent fasting or something else? Can you give an example of such a regime (and are there different ways?)?
Don’t have type 2 yet but has family history and it spiked to 6.1 one right after a hospitalisation so I have been spooked since (been 2 years). I get super stressed even at the thought of sugar related tests.
You don’t have to try for 7 days on the first attempt, though for most people the first two days are the most difficult so riding it out past the third actually gets easier.
Can confirm. My wife had surgery ~3 years ago. I supported her by eating the same things she was for prep and throughout the surgery. We lost about the same amount of weight, through ~1600cal a day and exercise. I wanted to get down about 25lbs lower than my lowest during that time. But, a year ago my wife was diagnosed with cancer, and that process totally screwed with our plans, and we both gained weight, her quite a bit less than me.
The last ~6 weeks I've been restricting calories again, and have started the journey back to where I want to be. I will say that the surgery really impacted her hair badly, which she didn't love. Despite taking all the best vitamins, her hair went from thick to somewhat thin.
If you can get rid of the things that trigger you and stick to low calories and exercise, you'll lose weight. The surgery helps, but committing to low calories is going to get the results. And a friend who got bariatric surgery but wasn't committed to lifestyle changes, within a year was back to her original weight.
What we put in our bodies means everything!
Another thing is consumption. All of my metrics start moving immediately in the positive direction when I'm on a calorie restricted diet, even before I start seeing results on the scale.
I could be unique but I doubt it.
The problem, of course, is that just like CICO, observing the relationship between weight and health is educational but useless as a strategy. If it were that easy there would be no overweight people in the world.
Is type 2 a permanent disease? Or is like when you lifestyle is bad and your sugar remains high/etc you are suffering from type 2 diabetes, but when your lifestyle and weight and great and sugar is well under control you don’t have type 2 diabetes, but if that changes you can get it again? Or it’s like - once “marked with type 2” no matter the sugar marker results you are a type 2 patient forever?