本期AMA节目中，Peter深入探讨了备受关注的两个主题。首先，他详细介绍了GLP-1激动剂，特别是司美格鲁肽和替尔泊肽，这两种药物最初作为糖尿病药物上市，现在正被研究和用于减肥。Peter分析了相关数据，比较了这两种药物的有效性、副作用，以及他对广泛使用这些药物的保留意见，并探讨了哪些人可能适合使用它们。其次，Peter讨论了二甲双胍，另一种最初用于糖尿病管理的药物，是如何作为潜在的延寿药物而受到欢迎的，即使对于非糖尿病患者也是如此。Peter就这种可能性发表了他的看法，并回顾了一项关于二甲双胍是否应用于一般“老年保护”的最新研究数据。

💊GLP-1激动剂备受关注，主要用于减肥：司美格鲁肽和替尔泊肽作为GLP-1激动剂，最初用于治疗糖尿病，但现在因其减肥效果而备受关注。Peter深入探讨了这些药物的有效性、副作用，以及潜在的适用人群。

💉司美格鲁肽与替尔泊肽的比较：Peter比较了这两种药物在减肥和其他代谢健康指标方面的疗效。他分析了超过一年使用司美格鲁肽和替尔泊肽后，体重持续减轻和代谢指标改善的数据。

⚖️停药后的体重变化：Peter探讨了患者停止使用这些药物后，体重会发生什么变化，这对于长期用药的考量至关重要。

⚠️GLP-1激动剂的副作用：节目中提到了GLP-1激动剂和其他类似药物的一些显著副作用，例如静息心率增加等问题，需要引起重视。

💰药物的经济成本：Peter还讨论了这类药物的高昂费用，这对于患者的经济负担是一个重要的考虑因素。

🔬二甲双胍的“老年保护”潜力：节目探讨了二甲双胍作为一种潜在的延寿药物的可能性，即使对于非糖尿病患者也是如此。Peter回顾了一项研究，该研究调查了二甲双胍是否应该用于非糖尿病患者的“老年保护”。

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In this “Ask Me Anything” (AMA) episode, Peter focuses the discussion on two topics getting a lot of attention recently. He first dives deep into GLP-1 agonists, most notably semaglutide and tirzepatide, which originally came to market as diabetes drugs but are now being studied and prescribed for weight loss. He walks through the data and compares the effectiveness of the two drugs, the side effects, and perhaps more importantly, his reservations around wide use of these drugs and who he would consider to be a candidate for them. Next, Peter discusses how metformin, another drug originally brought to market for diabetes management, gained popularity as a potential longevity drug even for non-diabetics. Peter gives his take on this possibility and reviews data from a more recent study investigating the question of whether metformin should be used for general “geroprotection.”

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #45 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The hype around semaglutide, tirzepatide, and other GLP-1 agonists for weight loss [2:30]; Overview of GLP-1 agonists and why these drugs are getting so much attention [6:15]; Defining the term “geroprotective” [13:30]; Semaglutide: background, brand names, indications, and more [15:15]; Tirzepatide: background, brand names, indications, and more [19:15]; How semaglutide and tirzepatide compare in their efficacy in terms of weight loss and other metabolic health metrics [23:45]; Data showing sustained weight loss and improved metabolic metrics with after more than a year of using semaglutide and tirzepatide [29:00]; What happens to body weight when a patient discontinues the medication? [34:45]; Noteworthy side effects of GLP-1 agonists and similar classes of drugs [40:45]; Increased resting heart rate and other concerning trends in patients using GLP-1 agonists [45:15]; Changes in body composition (body fat and lean muscle) in patients on GLP-1 agonists [50:45]; Possible reasons for the loss of lean muscle mass and tips for protecting lean mass [59:00]; GLP-1 agonists and thyroid cancer [1:01:30]; Who might be a candidate for GLP-1 agonists? [1:03:45]; The large financial cost of this class of drugs [1:08:30]; Metformin as a geroprotective drug: origin of the idea that metformin could be a longevity agent even for non-diabetic patients [1:11:30]; A 2022 study on metformin sheds more light on the question of whether metformin should be used for “geroprotection” in non-diabetics [1:21:00]; Peter’s current approach with metformin for his patients [1:25:15]; and More.

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