本期AMA节目中，Peter讨论了最近备受关注的两个话题：GLP-1激动剂（如司美格鲁肽和替尔泊肽）和二甲双胍。GLP-1激动剂最初作为糖尿病药物上市，但现在正在被研究和用于减肥。Peter分析了这些药物的有效性、副作用，并重点讨论了他对广泛使用这些药物的保留意见以及他认为适合使用这些药物的人群。他还探讨了二甲双胍作为一种潜在的抗衰老药物的可能性，即使对于非糖尿病患者也是如此。Peter回顾了最近一项研究的数据，该研究调查了二甲双胍是否应该用于一般性的“抗衰老”。

🤔 GLP-1激动剂（如司美格鲁肽和替尔泊肽）最初作为糖尿病药物上市，但现在正在被研究和用于减肥。它们通过模拟GLP-1激素的作用来抑制食欲，从而帮助人们减重。这些药物已被证明在帮助人们减重和改善代谢健康方面非常有效，但它们也有一些副作用，例如恶心、呕吐和腹泻。Peter认为，这些药物可能不适合所有人，尤其是那些有胃肠道疾病或其他健康问题的人。

🤔 二甲双胍最初作为一种治疗2型糖尿病的药物上市，但近年来，它被认为可能具有抗衰老作用，即使对于非糖尿病患者也是如此。一些研究表明，二甲双胍可以延长寿命，并改善与年龄相关的疾病，如癌症和心血管疾病。然而，这些研究大多是在动物身上进行的，还需要更多的人体研究来证实这些发现。Peter认为，二甲双胍是一个很有希望的抗衰老药物，但还需要更多研究来确定它是否安全有效地用于非糖尿病患者。

🤔 Peter认为，在决定是否使用GLP-1激动剂或二甲双胍来减肥或抗衰老时，患者应该与医生进行讨论，以权衡利弊并确定这些药物是否适合他们。重要的是，要了解这些药物的潜在副作用，并采取措施来降低风险。

🤔 Peter强调，健康的生活方式，包括健康的饮食和规律的运动，对于减肥和抗衰老至关重要。药物可以帮助人们实现这些目标，但它们不应该取代健康的生活方式。

🤔 Peter还讨论了GLP-1激动剂和二甲双胍的一些其他重要信息，例如它们的使用成本、药物相互作用和长期效果。他建议患者在开始使用这些药物之前，应与医生进行详细的讨论。

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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.”

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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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