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I don’t think so. That’s why none of them are approved outside T2D or obesity/overweight (contrary to SGLT2i). The fact that the benefits are independent of weight loss is a different question.
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Not true in the US.
GLP1s have approval for CVD and OSA (semaglutide and tirzepatide respectively).
We have the special circumstance in the US of being the most profitable market and a law stating that Medicare can’t cover weight loss medication.
So the manufacturers went hard and early in obvious common weight related diseases. So Medicare covers for these 2 other indications.
Now I have always credited the benefits to weight loss or calorie restriction as my bias but I could be wrong. The CVD benefits start before weight loss but not before calorie restriction. It will be challenging (and not financially beneficial) to prove any results independent of calorie restriction. I mean you would have to actively search out people who didn’t reduce calories or induce them to not reduce.
None of this means there are going to be benefits for thin people. Or what we might call - already calorie restricted people. But in the longevity space we use things that are going to be hard to prove but have reasonable evidence.
I go with the theory that almost all in the developed world could benefit from calorie restriction and GLP1s help with that.
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Wrong:
- Semaglutide is approved for CVD “and either obesity or overweight”
- Tirzepatide is approved for OSA “in adults with obesity” (not even overweight!)
Surely if semaglutide and tirzepatide could be approved for CVD and OSA in people with a lower BMI (18.5? 20?) that would be a way larger markets for pharmaceutical companies and they would have tried to get it.
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Exactly right. Evidence for SGLT2i, none for GLP-1RA. Which is why I take empagliflozin and have not gone for any glp-1 so far. The evidence is not there (so far).
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Ah. I stand corrected.
At least obesity and overweight are lower thresholds. Just about 70% of Americans are overweight so it seemed universal. And probably 80% of those with CVD.
But for thin people, no indication.
At the same time, there is no indication for SGL2I other than diabetics or people with end organ failure. Right?
And OSA and CVD are earlier in the process than end organ failure - by a lot. Probably a lot harder to prove a difference even if weight is a huge confounder.
I just don’t see a significant difference in the overall protection between the 2 classes. GLP1s do better for calorie restriction which still has the best evidence for longevity. GLP1s help people stick to IF which has a decent amount of data behind it.
I am on a SGL2I because I don’t want to lose more weight. But that would a minority problem.
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SGLT2 have T2D OR heart failure OR CKD. Those are sick population of course but kidney function inevitably declines from age 30 so the case to stop that decline early with SGLT2 is strong to me.
On top of that, we have Mendelian randomization showing that SGLT2 causally extends lifespan in men.
And the ITP in rodents.
GLP-1RAs have none of the above.
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Just a thought, the number of people dying of kidney failure who don’t have diabetes or uncontrolled hypertension is very small. Those that do have a disease process that is not slow decline except perhaps chronic stones, lupus and gout but very defined populations. I’m sure there are others I m not thinking of.
I stand completely unconcerned about my long term kidney function. I’ve never had a stone, my uric acid is normal, my sugars and blood pressure are fine. If I get Multiple Myeloma, an SGLT2 is not helping.
I was never one to take care of 90 year old healthy people often but I did do dialysis access for years. Everyone had an identifiable reason or was some fast disease process.
Heart failure is similarly, but not as consistently, a result of CAD, HTN, unfixed valve disease etc. All sort of idiopathic causes but not generally a long slow process that would be helped by SGLT2’s.
I am open to the debate but this idea that healthy thin people die of either kidney or heart failure often is just not something I ever heard of before this forum. Cancer, infection, dementia - these are what I worry about. Kind of like how I don’t worry too much about liver disease without having hepatitis, being overweight, or without drinking (too much). Despite it being a top 10 cause of death.
Everything declines after 30 like kidney function. Doesn’t mean it kills thin healthy people without identifiable causes.
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You’ll be glad to know then, that SGLT2i have repeatedly been associated with lower dementia rates 
!
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Where would you buy nasal NAD+
Which is the primary reason I take it. Bit the issue comes up more with women, like my wife, given the higher incidence of UTi and the lack of a longevity benefit in Mendelian randomization study.
She wants to lose 10 but once she does that, is the benefit over GLP1s enough to outweigh the UTI issue.
All Day Chemist
You can buy liquid retrutide, at The Wellness Company now, in the US. Their product is called Drops, taken daily
OK, though this looks intriguing:
The Effect of SGLT2 Inhibition on Brain-related Phenotypes and Aging: A Drug Target Mendelian Randomization Study
“SGLT2 inhibition was associated with longer father’s attained age (years of life increase per SD (6.75 mmol/mol) reduction in HbA1c levels = 6.21, 95%CI 1.95 to 11.15), better cognitive function (beta = 0.17, 95%CI 0.03 to 0.31) and higher intelligence (beta = 0.47, 95%CI 0.19 to 0.75).”
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I’m new here, what is SGLT2? And can you also give advice on how one takes Acarbose without experiencing terrible GI distress? I’ve tried breaking the 100mg tabs in half? TY
@DavidCary
N=1 here.
FWIW, I’ve been taking dapligloflozin and glp1’s for aprox a year and a half. I have not had a UTI. I know there is a risk but I’m not sure how many people are actually getting them?
Having said that, I’m also taking methylene blue a few times per week. I started taking it for the potential brain benefits, but it also might be helping to prevent UTIs as a bonus. I’ve been thinking of quitting MB, but I’m not sure I should due the possible UTI prevention?
Also, I’m very thin and take low dose glps. I’ve always fluctuated 3-4 pounds. When I started glp1’s I was on my high side and I lost the 4, which I would have eventually lost it anyway but this made it super easy. Over time I lost a little more and am 2-3 pounds lower than my normal range. I’m actually a little too thin based on my face not looking as good.
I share this detail as background to say I have been at my current weight for over a year and have not lost even an extra ounce. I just make sure my dose is low enough that I can eat through it.
Now, the question is if you are not using enough glp1 to get weight loss, are you getting enough for the other benefits… I certainly hope so!
@Amiz66 I also take acarbose and commonly take 100 -150mg. I have no issues. I think I recall hearing that your body adjusts, but also that you are more likely to have GI issues if you are eating high carbs foods. Fwiw, I did start on 25mg and raised my dose over time. I only went higher because I was getting crazy glucose spikes, but I have recently lowered my doses to 50-100mg.
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SGLT2 = Empagliflozin (Jardiance), Dapagliflozin, and Canagliflozin
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Yes, I started Jardiance about 4 months ago. Great for pulling extra sugar and salt from the blood. No issues or side-effects.
Can get from the company cheap… $10 per month.
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It affects maximum lifespan if you manage to avoid the other diseases, which is hard, of course. It also significantly increases risk for other diseases like CVD.
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See this thread to learn about why many of us take SGLT2 inhibitors: Canagliflozin - Another Top Longevity Drug
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