Three patients in my practice recently illustrated the broad psychiatric and medical effects of a single medication.
A 35-year-old woman using semaglutide observed within a week that her craving for alcohol decreased and the constant "food noise" in her mind nearly vanished. Standing at five feet five inches, her weight dropped from 210 pounds to 145 pounds. She launched her own business, instructing infants and mothers in a swimming pool. She now confidently wears a swimsuit.
A 69-year-old woman taking tirzepatide lost 60 pounds and saw her blood pressure return to normal. "I now have a sense of freedom around eating, and I feel really good. I feel fabulous."
A 60-year-old man who was given a minimal dose of tirzepatide noticed an improvement in his arthritis and chronic inflammatory bowel disease. He could now enjoy foods that used to cause diarrhea.
Semaglutide (Wegovy) and tirzepatide (Zepbound) were developed for diabetes and obesity. How can these medications positively influence alcohol use, food cravings, blood pressure, arthritis, and bowel disease?
These medications imitate a group of molecules called incretins. Every chemical structure in your body is made up of molecules. Incretins act as hormones, which your body uses for internal communication. These hormones are generated in your gastrointestinal tract, often referred to as the second brain, and in your brainstem, also known as the reptilian brain.
Incretins signal and modulate your gastrointestinal tract, cardiovascular system, kidneys, and immune system. They influence at least a half dozen areas in your brain.
How can a single type of signal lead to such diverse effects? Evolution offers a comprehensive framework for understanding this phenomenon. In his remarkable book Life Ascending, Nick Lane, a biochemist and Professor of Evolutionary Biochemistry at University College London, states, "The deepest question of all is why complex life emerged just once in the entire history of life on our planet." Once complexity emerged, it encompassed simplicity.
When complex life first emerged billions of years ago, evolution embarked on intricate paths with innumerable detours. However, simplicity offered advantages in conserving energy, adapting swiftly, and maintaining structural stability. Evolution continually employs effective signaling systems for diverse purposes.
The exploration of the brain remains in its nascent phase, with neuroscientists leading the way in new discoveries. Roger McIntyre, a psychiatrist and Professor of Psychiatry and Pharmacology at the University of Toronto, is a trailblazer in incretin research. In an article published this year in Psychiatry and Clinical Psychopharmacology, he states:
"...preclinical, neuroimaging, observational, and emergent contr0lled trial data evidence suggests that incretin receptor agonists may exert direct central nervous effects - augmenting neurogenesis, neuroplasticity, and functional connectivity..."
Dr. McIntyre proposes that incretins might enhance the growth of new neurons in the human brain and boost the interaction among the brain's eighty-six billion neurons. Neurons play the pivotal role in communication within the brain.
We categorize the human body into organs to aid in understanding. Similarly, we understand the brain as nodes and circuits to improve comprehension. However, the body does not acknowledge these divisions. Essentially, the body functions as an integrated whole.
Your body is composed of about thirty trillion cells arranged into numerous organs. There is continuous communication. Despite your complexity, there is simplicity. Ancient biological systems, maintained over millennia, use the same molecules to signal throughout your body.
Semaglutide and tirzepatide represent the beginning. Many new incretin analogues or mimics are actively being researched. The next decade will provide much deeper understanding of both the simplicity and complexity of the human body.
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