How to Supercharge the New Weight Loss Drugs

As you likely know, the new GLP-1 agonist drugs for weight loss have taken the world by storm.  Both Wegovy and Saxenda are only approved for the treatment of obesity, whereas other GLP-1 agonists are approved for the treatment of type 2 diabetes, including:

• Adlyxin (lixisenatide)
• Bydureon BCise (exenatide extended release)
• Byetta (exenatide)
• Mounjaro (tirzepatide)
• Ozempic (semaglutide)
• Rybelsus (oral semaglutide)
• Saxenda (liraglutide)
• Trulicity (dulaglutide)
• Victoza (liraglutide)

Even though these drugs are only FDA approved for the treatment of type 2 diabetes, they are often prescribed off-label for obesity.

You Better Get in Line

Every Tom, Dick, and Harriet have lined up to obtain these drugs, leading to a shortage that likely won’t be corrected until mid-2024. Even if you win the lottery and gain access to one of these medications, don’t get your hopes too high. Yes, the drugs do suppress appetite and lead to weight loss in most individuals, but before you get out the pompoms, let’s review the data on these drugs. Here are the known facts:

1. When you stop using the drugs, most of the weight is regained, and sometimes the weight gain takes off like a rocket.
2. Remember that obesity is defined as excess body fat relative to other body components such as muscle, connective tissue, and organs. Humans evolved to have an ideal amount of body fat, and if you exceed this level, you’re heading into obesity. Men are obese if they have more than 25% body fat, and for women it’s more than 30% body fat. If you are obese you want to lose fat, not lean body mass. Studies have shown that up to 40% of the weight loss using these drugs is lean body mass. The is always due to excessive calorie restriction, and these drugs make it much easier to put your body in a starvation metabolic mode where lean body mass is consumed for basic energy needs. Clearly, that’s not where you want to go.
3. These drugs are associated with numerous side effects. They often cause gastrointestinal problems, and nausea is very frequent. Kidney damage and angioedema are rare side effects. A recent JAMA article reported an increased risk of the serious side effects of pancreatitis and bowel obstruction.
4. These drugs are very expensive, so patients without insurance can rarely afford them. Over 70% of insurance companies no longer cover this class of drugs, either for type 2 diabetes or obesity. The message is, unless you’re wealthy, forget about magical weight loss drugs!

A Revolutionary New Disease Model

The good news is that there is a way to makes these drugs more effective. To do so, you need to focus on diet-induced brain dysfunction. I term this disorder Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. This relatively new disease concept is driven by consumption of ultra-processed food. This food is neurotoxic, and over time can trigger this unique form of diet-induced brain dysfunction. It’s interesting to note that Sapien Labs just came out with a report titled “Ultra-processed food consumption and mental wellbeing outcomes”. This is exactly what I have been saying for many decades, so it’s reassuring to see that the research community is now up to speed!

I have identified 22 symptoms that are associated with CARB syndrome, and these symptoms overlap with many common brain and psychiatric disorders, creating massive diagnostic and therapeutic confusion. These unfortunate patients often end up being treated with medications that accelerate their health problems and increase fat storage.

Measure, Don’t Guess

At the beginning of our obesity epidemic, I started to measure the body composition of every patient at every visit. The so-called obesity experts recommended that we evaluate obesity using body mass index or BMI, which is essentially a size measure that tells you zippo about how much fat is in each patient. Over time I noticed a strong correlation between these brain dysfunction symptoms and changes in percent body fat. When the symptoms got worse, after a lag of several weeks their percent body fat would start to rise. If I managed to suppress their symptoms, within several weeks their percent body fat would start to fall. It was apparent that when it comes to fat storage, the brain calls the shots. From an evolutionary standpoint this makes perfect sense.

I concluded that the disease CARB syndrome is composed of two main components:

1. The development of up to 22 brain dysfunction symptoms that interfere with your ability to function, and often leading to being incorrectly diagnosed with common psychiatric disorders.
2. The storage of excess body fat at virtually any caloric intake, until you cross into early starvation, where loss of lean body mass takes place.

Voilà! We now have a concept that explains the origins of our current twin epidemics of common brain disorders and obesity! The 22 symptoms of CARB syndrome seem to be associated with depletion of key monoamine neurotransmitters like dopamine, serotonin, and norepinephrine. The glucose spikes from consuming ultra-processed food likely cause dumping and depletion of these critical chemical messengers. Years ago, I stumbled upon a supplement called Appe-Curb that contains the precursors the brain needs to make these neurotransmitters. It was being promoted as an appetite suppressant, because these precursors suppress hunger and cravings for sweet and starchy food—the lead symptom of CARB syndrome. I gave this supplement to some of my patients, and quickly realized that it is very effective for managing CARB syndrome. I rebranded the supplement as CARB-22.

The Six Magical Keys to Weight Loss

Understanding the CARB syndrome disease model also gives us good news on the obesity drug front. This class of popular drugs can be used effectively to treat obesity if they are a part of a comprehensive CARB syndrome treatment plan. This highly-effective plan should include Dr. Wilson’s Six Magical Keys to Weight Loss when using these drugs:

1. You need to follow a healthy diet with adequate protein at every meal. I like The Zone Diet promoted by my friend Barry Sears.
2. It’s critical to avoid ultra-processed food. This food is defined by having excess sugar, high glycemic carbohydrates, and excess omega-6 fatty acids relative to omega-3 fatty acids. These components are very neurotoxic, especially when combined.
3. I recommend exercising on a regular basis, including both aerobic and strength training.
4. I recommend taking a high-quality omega-3 supplement and a strong polyphenol to suppress inflammation. You should take enough omega-3 to keep your AA/EPA ratio between 1 and 3. This is a simple fingerstick test available from OmegaQuant or from the Zone site. I like OmegaRx2 and MaquiRx sold by Dr. Sears because of their unparalleled high quality.
5. I recommend taking CARB-22 to suppress cravings for sweet and starchy food, and the other symptoms associated with CARB syndrome. These weight loss drugs suppress appetite, but when individuals do eat, they still tend to consume sweet and starchy food, the very food that is driving their brain dysfunction. CARB-22 is very effective at suppressing these cravings.
6. I recommend limiting caloric intake within reason. In an ideal world you should have your body composition measured frequently, but this option is often not readily available. If you are rapidly losing weight, or have light-headedness, weakness, or nausea, you have likely over restricted your calorie intake, leading to loss of lean body mass. If so, you need to increase your intake of healthy food with adequate amounts of protein as outlined in the Zone Diet developed by Dr Sears.

If you are obese, feel free to use one of these new medications, but only use them in the context I have outlined. If you strictly follow my Six Magical Keys to Weight Loss, you likely won’t need to use this type of medication to achieve significant fat loss! As my wise grandfather used to say: “Keep it simple, stupid”.