The rather sudden advent of a new class of weight loss drugs including Mounjaro, Ozempic and Wegovy is taking the world of obesity by storm. These new medications enhance a hormone called GLP-1, and that’s important because this amazing molecule is secreted by both the gut and certain areas of the brain in response to eating. In essence, GLP-1 suppresses appetite and increases insulin production and the metabolic rate. When this hormone is acting physiologically, it tells a person that they’re full and it’s time to stop eating and it ramps up the metabolic rate to burn more calories. When GLP-1 enhancing drugs are used as a treatment for obesity, they do the same, resulting in significant weight loss. They appear to be much more effective than other weight loss medications, so celebs and A-listers have lined up around the block to get these apparent miracle drugs, to the point where there is now a supply chain shortage.
One glaring problem with this class of medications is that once you stop taking them, the weight is almost always rapidly regained, putting you back at square one. These drugs are also very expensive. For example, Wegovy costs about $1,600 per month without insurance coverage, putting it out of reach for all but a small minority of patients. Beyond that, obese rats receiving Wegovy and similar drugs had an increased risk of benign and cancerous thyroid tumors, adding another concern about widespread use of this class of medications. So much for “miracle” drugs.
Understand the True Pathology
I believe the strongest argument against using this type of drug is the failure of the medical and scientific communities to understand the basic physiology and pathology of most forms of obesity. The traditional view is that it’s some type of “energy imbalance”—too many calories consumed, and not enough calories burned through metabolism and exercise. These excessive calories end up being stored as body fat. If this is true, the solution is straightforward—eat less food and increase your activity physical level. With today’s world-wife obesity epidemic, it’s obvious how this approach has worked out!
Drugs like Wegovy do suppress appetite and increase metabolism, but their physiological effects are much more complex than just these two mechanisms. Wegovy and similar drugs are known to enhance brain monoamine neurotransmitters like serotonin, dopamine, and norepinephrine, which on a theoretical basis should help reduce anxiety, depression, and other common brain disorders. These monoamines are also known to play a critical role in satiety and controlling hunger. Adding to the confusion, some of the clinical trials of this class of drugs have shown anxiety and depression to be uncommon side effects of the medications.
This is Your Brain on Highly Processed Food
To make sense of these contradictory trends, I need to walk you through the altered physiology in the brains of most folks with obesity. Based on decades of clinical experience, paying careful attention to my patients’ brain dysfunction symptoms, and measuring their body composition at every visit, I was able to develop a new disease model that better explains our current twin epidemics of psychiatric disorders and obesity. Years ago, I was fooling around with urine tests for monoamine neurotransmitters. Nobody really understood how to interpret these tests and at one point I ended up measuring urine neurotransmitter levels while patients underwent glucose tolerance tests. Shortly after they got their glucose load, their urine would suddenly fill up with large amounts of monoamines like serotonin, dopamine, and norepinephrine. This made no sense to me. Why would Mother Nature flush these valuable chemicals down the drain? It finally dawned on me that this is a pathological rather than a physiologic process.
Pee Away Your Monoamines
It soon became obvious to me that glucose spikes cause a dumping of neurotransmitters into the synaptic space, overwhelming the reuptake recycling system. These valuable chemicals are then taken up by the blood stream and excreted by the kidneys. This process is clearly pathological, because Mother Nature would never plan to throw aware these valuable chemicals. Over time I identified 22 symptoms that are associated with this process, and many of these symptoms overlap with traditional psychiatric disorders, creating massive diagnostic and therapeutic confusion. This seemed to fit the pattern of a disease, and I eventually coined the term Carbohydrate Associated Reversible Brain syndrome or CARB syndrome to describe this pathological process. The sudden drop in glucose after the glucose spike is interpreted by the brain as “it’s time to eat.” The brain thinks there is some serious starving going on, so it puts the body in a famine protective fat-storage mode, where excessive fat will be stored at virtually any caloric intake.
Because of their progressive brain dysfunction symptoms, individuals with CARB syndrome are often misdiagnosed with common psychiatric disorders, and they are subsequently treated with mood stabilizers, anti-psychotics, and anti-depressants. Weight gain is a common side effect of all these drugs. Does any of this seem familiar? Today clinicians are seeing a zillion patients with obesity and psychiatric disorders, who fail to respond well to traditional treatments. In other words, it’s a complete unmitigated disaster!
Feed Your Brain
If my view of the situation is correct, it’s obvious why just magnifying neurotransmitter effects using medications, and leaving the actual levels of these chemicals low, is a roadmap for disaster. Decades ago, I realized that the only way to increase monoamine neurotransmitter levels is to provide the precursor amino acids that the brain needs to make these chemicals. That would be L-tyrosine, L-phenylalanine, and L-tryptophan (which is converted to 5-htp). To boost neurotransmitter levels, you need to provide these precursors mixed in the proper ratio, along with certain co-factors. Richard and Judith Wurtman from Harvard were the first to use precursors for their clinical effects over 50 years ago. Over time I developed my own precursor supplement called CARB-22.
The BMI Disaster
By measuring body composition on every patient at every visit, I also learned that when patients use any type of diet drug without precursors, the weight they lose tends to be more lean body mass rather than fat. Remember, obesity is defined as “excessive body fat”. The so-called experts screwed things up when they decided to use body mass index (BMI), to diagnose and treat obesity. BMI is a size measure and tells you nothing about the amount of fat in your body. Even though body fat and BMI tend to correlate in populations, that isn’t true when it comes to individuals, and you are an individual, not a population!
Clinicians and researchers quicky lost interest in precursors when drugs like Prozac hit the scene. That was a huge mistake, because sooner or later low levels of neurotransmitters will result in significant pathology even when taking drugs to boost levels of these chemicals. After all, a Zillion x Zero = Zero!
Pick Your Poison
It is true that drugs like Wegovy suppress cravings and excessive hunger, leading to temporary weight loss. Yet the same is true of the infamous fen-phen combination. These medications usually resulted in significant weight loss, and initially everyone and their grandmother wanted access to them to lose a few pounds. It’s estimated that over six million people took this combination, but fenfluramine and dexfenfluramine were quickly withdrawn from the market when this class of drugs was associated with extremely rare pulmonary valve malformations. This action was based on the idea that we shouldn’t accept any risk from medications for weight loss when all you need to do is eat less and exercise more! Once the drugs were discontinued, people almost always regained the weight. Wegovy and similar drugs also suppress cravings and excessive hunger resulting in weight loss, but the weight is quickly regained when the drugs are stopped. This class of drugs are also associated with possible thyroid cancer. Let me think—what seems to be worse, a silent heart valve problem or thyroid cancer? Despite this glaring issue, to date nobody has suggested ripping Wegovy and similar drugs off the market.
Know and Understand Your Disease
It’s also extremely important to focus on the differences between classical psychiatric disorders and CARB syndrome with nearly identical symptoms. Patients with traditional disorders often do well with just medications, in many cases mitigating the need for neurotransmitter precursors. These folks have some type of hereditary condition affecting the function of their neurotransmitters, so boosting the effects of the monoamines makes perfect sense. Most of these folks do just fine without adding monoamine precursors, although a few patients may experience minimal benefits. This difference is key to understanding how to manage these. Patients:
Traditional Psych Disorder = monoamine dysfunction and dysregulation
Treatment: Boost monoamine function with drugs
CARB syndrome = low levels of all monoamines
Treatment: First use drugs to control symptoms along with precursors to normalize levels
It’s also critical to understand that most people currently diagnosed with a mental disorder actually have a different disease: CARB syndrome. Throughout history traditional psychiatric disorders have always been rare, and they are still rare today. If you have strong cravings for sweet and starchy food along with some of the 22 symptoms of CARB syndrome, you have CARB syndrome rather than a classic psychiatric disorder, or perhaps you have both disorders. It’s important to understand that many people with traditional psychiatric disorders also have some degree of CARB syndrome, further complicating the clinical picture and treatment protocols. Talk about a modern medical mess!
Follow the Money
So why was fen-phen suddenly ripped from the market, while Wegovy and similar drugs remain on the market despite the potential for serious side effects. I have a theory why this is so, and it has to do with greed and money. Phentermine and fenfluramine were cheap generic drugs when they were used for weight loss, so pharmaceutical companies didn’t have much to gain. Thus, it was wham, bam, thank you ma’am—the drugs were immediately ripped from the market. Drugs like Wegovy are extremely expensive, branded drugs that are making a ton of money for pharmaceutical companies. The pharmaceutical companies concluded that a touch of thyroid cancer isn’t a problem when their bank accounts are going through the roof. As the say, follow the money!
Ditch the Drugs
To effectively treat CARB syndrome, you first need to suppress the symptoms of the disease so you will be able to follow a healthy, whole foods diet with minimal amounts of highly processed food. You need to pull your brain out of the famine protective metabolic mode that’s driving excessive fat storage. Remember, when it comes to fat storage, the brain calls the shots. The combination of low dose drugs like fen-phen or GLP-1 inhibitors along with a monoamine neurotransmitter precursor product will result in markedly improved brain function and a slow loss of excessive body fat. Once you are headed in the right direction, ditch the drugs, continue the precursor supplement like CARB-22, and continue to follow a healthy eating and exercise program. When used with precursors, the older drugs like fen-phen are much safer choices, and they are nearly as effective as Wegovy and similar drugs when it comes to fat loss. Currently available combinations of older drugs include phentermine and fluoxetine or a similar SSRI anti-depressant medication, or bupropion combined with an SSRI.
The best game plan is obvious. When medications are indicated to initially suppress the symptoms of CARB syndrome and lose excessive body fat, combine the older drugs with a precursor supplement. It’s clearly time to “wave goodbye to Wegovy”.
