Latest news with #ZiyadAl-Aly
Medscape
29-05-2025
- Health
- Medscape
GLP-1s Treat and Even Reverse Some Forms of Liver Disease
In the past two decades, the global prevalence of metabolic dysfunction–associated steatohepatitis (MASH) has increased dramatically as a result of the obesity epidemic. Researchers project that by 2040, rates of MASH will increase by 55%. Prior to that most liver diseases were caused by alcohol use and hepatitis C, a viral infection that primarily affects the liver. MASH, a preventable form of liver disease previously called nonalcoholic fatty liver disease, is caused by a buildup of visceral fat cells that accumulate on top of the internal organs, in this case the liver, and keep it from functioning properly. The liver's primary role is to filter blood, nutrients, and bile used for digestion, as well as to remove toxins from the body. Excess fat cells blanket the liver and keep it from working at full capacity. Fat cells are also metabolically active and can cause a chronic state of inflammation in the part of the body where they reside. Over time, these fat cells can cause cirrhosis of the liver, or permanent scarring. Once patients reach this stage, the only option is a liver transplant. New Research on Glucagon-Like Peptide 1 (GLP-1) Agonists and MASH Until recently, the lone treatment for early-stage MASH was weight loss to reduce the number of fat cells that surround the internal organs. But new research has shown that GLP-1 agonists can reduce and even reverse the condition. In a study published last month in The New England Journal of Medicine , researchers were able to show that semaglutide resolved fatty liver and inflammation in over 60% of cases and decreased scar tissue in just over a third of patients. 'These findings suggest that semaglutide may prevent fatty liver disease from progressing to cirrhosis and can indeed reverse the course of the disease,' said Arun J. Sanyal, MD, study author and director of the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at Virginia Commonwealth University in Richmond, Virginia. Another study published last year in JAMA Internal Medicine had a similar finding, showing that GLP-1 agonists were associated with less progression of the disease and reduced mortality in patients with MASH and diabetes. Another large-scale observational study published in Nature Medicine found that GLP-1s reduced the risk for hepatic failure, which occurs when the liver is unable to perform basic functions, as well as liver cancer, both of which are downstream consequences of MASH. How GLP-1s Improve Liver Function 'These medications reduce fat burden, which results in fat loss everywhere, including around the liver,' said Ziyad Al-Aly, MD, an assistant professor in the Division of General Medicine & Geriatrics at Washington University School of Medicine in St. Louis and author of the recent study in Nature Medicine . 'When fat cells are reduced in size and volume, the normal liver cells have more room to grow and function.' Ziyad Al-Aly, MD These medications also seem to work on reducing the inflammation and oxidative stress caused by metabolic disease, which allows for a better environment for the liver to function. 'Fat is not an inert tissue, it's metabolically active, causing a slow burn to all the cells surrounding it,' said Al-Aly. These medications keep the disease from progressing and reduce scarring, which improves the damage that's already been done, he said. Changing How Primary Care Physicians Diagnose Liver Disease Primary care physicians are most often the first line of defense against liver disease, and as a result, they need to be vigilant in the way that they screen for the condition, said Charu Sawhney, DO, MPH, an internal medicine physician with Harbor Health in Round Rock, Texas. Physicians need to be aware that even if liver enzymes appear even slightly elevated, there still could be a reason to utilize these medications to prevent later-stage MASH. Charu Sawhney, DO, MPH 'Normal levels for liver enzymes in some patients can be lower than what labs show,' said Sawhney. This is especially true if a patient has other metabolic risk factors such as diabetes, obesity, or high cholesterol. If liver enzymes continue to go up even after diet and lifestyle changes, patients might require liver imaging, specifically a wave-based ultrasound called elastography, which measures the elasticity or stiffness of tissues on the liver and can judge if certain portions of it have scarred or hardened. When liver cells change texture and become harder, the scan can estimate levels of fibrosis and, therefore, the stage of MASH that a patient is in. Additionally, the severity of fatty liver disease depends on other factors besides weight and can sometimes be surprising. 'How bad fatty liver disease is in a patient isn't always related to how much weight someone has gained,' said Carolynn Francavilla, MD, a nationally recognized obesity physician who owns and operates Green Mountain Partners for Health and Colorado Weight Care, both in Denver. It's important for physicians to realize that some patients with fatty liver disease might not have obesity as would be expected. For these patients, adipose tissue seems to accumulate on the liver before it does on other parts of the body. This could be related to the quality of our food system, including the use of sugar substitutes like high fructose corn syrup, which research has shown is even harder on the liver. There might also be a genetic propensity toward fat storage around the organs. A New Way to Treat MASH If indeed GLP-1s are a potential treatment in those with MASH, this might also change the way that primary care physicians treat these patients and how the medication is prescribed in those with earlier stages of the disease, said Francavilla. Right now, there's not an official approval from the US Food and Drug Administration (FDA) for prescribing GLP-1s in patients with MASH, but Francavilla hopes that it's forthcoming. 'It will be really exciting to have these medications as a treatment option because right now there's only one medication, and it's for people who have pretty advanced fatty liver disease,' said Francavilla. This medication, called resmetirom , is approved by the FDA to target a protein in the liver to reduce fat and inflammation and scarring. But GLP-1s can be used much earlier to prevent the condition. 'With so many cases of MASH happening so much younger, it's a disease that physicians really need to take seriously,' said Sawhney. 'If we want to catch this disease at the early stages when we can still do something about it, it's most likely going to be primary care physicians who see it.'
New York Times
10-03-2025
- Health
- New York Times
A Clearer Picture of Covid's Lasting Effects on the Body
Five years — and hundreds of millions of cases — after the World Health Organization declared the Covid-19 pandemic, scientists are getting a clearer picture of how the virus can affect the body long after an infection seems to pass. Some of Covid's effects became apparent soon after the virus began spreading. We quickly understood how deadly an infection could be, especially for those with underlying conditions like diabetes and heart disease. But it has taken years of research to start making sense of how a bout of Covid can lead to lasting, sometimes invisible changes in different parts of the body. Some of these effects, such as chronic fatigue and brain fog, are considered long Covid, defined as symptoms from an infection that persist for at least three months. By some estimates, 400 million people worldwide have been diagnosed with some form of long Covid. But an infection can also lead to other issues, including lung and heart damage and microbiome changes in the gut, that may not always be recognized as long Covid but can still have a lasting effect on our health. We now have a better sense of what might be behind those changes, including the role of the widespread inflammation that Covid can cause. For most people, inflammation will subside once the virus clears. But for some, if it 'rages' too intensely or persists as a 'slow burn' for too long, it can wreak havoc around the body, said Dr. Braden Kuo, a neurogastroenterologist at Massachusetts General Hospital. Here's what scientists have learned so far about inflammation and the other factors driving these effects. The Lungs Covid irritates the lungs and can cause long-term issues, like persistent shortness of breath and coughing. In rare cases, Covid can lead patients to develop pneumonia and leave scarring and small masses of tissue, called nodules, throughout the lungs. Those scars can make it harder to breathe. Small studies have suggested that over 10 percent of people hospitalized with a Covid infection had lung scarring and other issues two years later. The cause: The virus invades cells along the airways, causing inflammation that can attack and sometimes destroy healthy lung tissue. This can impair the lungs' ability to deliver oxygen throughout the body, said Dr. Ziyad Al-Aly, a senior clinical epidemiologist at Washington University in St. Louis. As the lungs try to recover and repair, they form scars. But scar tissue itself can stiffen the lungs and reduce lung capacity, leading to lasting symptoms such as a cough and shortness of breath. The Gut Covid can cause short-term symptoms like nausea, vomiting and diarrhea. But in some people, Covid can lead to chronic gastrointestinal problems, like reflux, constipation, diarrhea and abdominal pain. These issues can last for months or even years. In a 2024 study, researchers estimated that bouts with Covid had left as many as 10 percent of people with lasting abdominal pain and 13 percent with gastrointestinal issues a year later. The cause: Scientists don't know why, exactly, Covid can throw off normal gut function so much — but they're getting a better understanding of what might be at play. For example, it's now clear that the virus can disrupt the gut microbiome, reducing beneficial microbes and increasing the numbers of harmful ones. 'Good' microbes can help tamp down inflammation while 'bad' ones can increase it. Inflammation from the infection itself, as well as from the altered gut microbes, might harm the lining of the intestine. This can allow toxins and the broken-down components of food to escape from the gut into other tissues of the body. Immune cells might then mount an allergy-like response to certain foods, leading to food intolerances. Inflammation may also 'chew away' at the nerves that signal pain in the gut or that control the intestinal contractions that keep food moving along, Dr. Kuo said. This can cause stomach or intestinal pain or make food move too fast or too slow through the digestive tract, resulting in symptoms like diarrhea or constipation. The Brain At the height of an infection, patients often develop headaches and can feel dizzy and confused. They sometimes struggle to find the right words, have difficulty concentrating or following a conversation or find they have gaps in their memory. These symptoms can linger: Studies have found that roughly 20 to 30 percent of people infected with Covid experienced brain fog at least three months after an initial infection. Research also shows that Covid can lead to conditions like anxiety or depression, or exacerbate existing mental health issues. The cause: Scientists are still working to identify all the factors that contribute to lasting neurological issues after Covid. But one culprit seems clear: persistent inflammation, which damages neurons and inhibits the creation of key connections between synapses. All of this may cause symptoms like those described above. Some researchers also think that areas of the brain involved in cognition and emotion are particularly vulnerable to inflammation, which helps explain why an infection can induce or worsen mental health issues. Another theory is that the virus disrupts the blood-brain barrier, which protects brain tissue and is vital for cognitive function. Fragments of the virus may also linger in the brain long-term, which could explain why some cognitive symptoms last beyond the initial infection. The Heart A Covid-19 infection increases the risk of heart problems, including heart attacks, strokes, damage to the heart muscle and an irregular heart beat, known as an arrhythmia. One large study found that having Covid doubled the risk of a major cardiovascular event for up to three years. The cause: When you have an acute Covid infection, the stresses of fever and inflammation can place excess demand on the heart. In someone who already has plaque buildup in the arteries or heart muscle that's started to become stiff, that demand can lead to an irregular heartbeat or heart attack. But more common, scientists think, is that the virus provokes inflammation that injures the heart muscle. The virus may also damage the cells lining the blood vessels, leading to inflammation there. This could cause a new clot to form or make existing plaque break off and clog a blood vessel. That type of blockage can cause sudden death from a heart attack or lead to downstream damage to heart muscles and other tissue, which can result in heart failure or an arrhythmia. People who have been hospitalized for Covid have the highest short- and long-term risk of heart complications. Some research suggests that people with a non-O blood type — A, B or AB — have a particularly increased risk, perhaps because blood type may be linked to how the blood clots. The Circulatory System Studies of patients with long Covid show that their bodies have trouble moving blood out of the legs and abdomen and back up to the heart. That can reduce the amount of blood the heart pumps out, causing fatigue, shortness of breath and a feeling of being unwell after exercise. The cause: It's not clear why these circulatory problems happen, but scientists hypothesize that in some patients, inflammation harms certain nerve fibers outside the brain and spinal cord that regulate the squeezing ability of blood vessels. This could result in impaired blood flow, said Dr. David Systrom, a pulmonary and critical care physician at Brigham and Women's Hospital in Boston. In some patients with long Covid, it also appears that the muscles are less able to extract oxygen from the blood than normal, hampering their ability to keep up with exercise, Dr. Systrom said. In addition, the mitochondria — the energy-producing powerhouses of cells — may not work properly or at full capacity, delivering another hit to muscle tissue.
Yahoo
15-02-2025
- Health
- Yahoo
Weight-loss, diabetes drugs linked to vision problems in small study
Popular drugs for diabetes and weight loss could have an unexpected side effect. Glucagon-like peptide 1 (GLP-1) receptor agonists, which are used to treat type 2 diabetes and/or obesity, were linked to vision problems in a small study at the University of British Columbia. Some common GLP-1 drugs include Ozempic and Wegovy, which contain semaglutide as the active ingredient, and Mounjaro and Zepbound, which contain tirzepatide. Weight Loss May Be Helped By Drinking This, Study Suggests In the study, nine patients who were using a GLP-1 developed "ophthalmic complications," according to the researchers. The average age of the patients was 57.4 years, according to the study findings. Seven of the patients had nonarteritic anterior ischemic optic neuropathy (NAION), which causes vision loss in one eye. Read On The Fox News App One patient developed bilateral papillitis, which involves swollen optic nerves that can cause impaired vision, and another had paracentral acute middle maculopathy, which leads to a blind spot in the retina. Ozempic's Health Benefits Keep Growing, But Are The Risks Worth It? All the patients had a history of type 2 diabetes, hyperlipidemia (high lipids or fats in the blood), hypertension and/or sleep apnea. The findings were published in JAMA Ophthalmology. "In one of the cases presented, the patient was taking the drugs for weight loss and did not have a prior history of diabetes (which can also be linked to the condition)," lead author Mahyar Etminan associate professor of medicine at the University of British Columbia told Fox News Digital. "In another case, when the drug was stopped and reintroduced, the condition reappeared, strengthening a causal link." Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis, was not involved in the study but shared his comments on the findings. "This is a very small study and it was uncontrolled — meaning it did not include people who were not using GLP-1 drugs," he told Fox News Digital. "This makes it impossible to know whether the reported eye problems are caused by these drugs." Nevertheless, the doctor noted, "the story of GLP-1 is still being written — and we are learning something new about these drugs every day. The findings in this study should be pursued further." Etminan, lead study author, also acknowledged the study's limitations. "This data was derived from a series of individual cases and was not an epidemiologic study," he noted. "However, another recent epidemiologic study also confirmed an increase in risk." Bmi Is Wrong Way To Measure Obesity, Researchers Say — Here's What They Recommend Instead Al-Aly called for large, controlled studies — including people who take the drug and a control group of people who are not using the drug — to evaluate the long-term health effects of these medications, including eye problems. "In the meantime, for people who may be at risk of vision problems, or who already have vision problems, caution is advised," he added. "People should discuss with their doctors to determine if GLP-1 is the right medication for them." Etminan echoed that cautionary guidance. "Those taking these drugs for diabetes should probably continue taking them for their cardiovascular benefits, but be aware of the signs of NAION," he advised. "Healthy individuals taking them to lose a few pounds for an event might want to more carefully weigh the risks versus the benefits of taking these drugs." Dr. Seth Kipnis, medical director of bariatric and robotic surgery at Hackensack Meridian Jersey Shore University Medical Center, noted that there have been "rare and unusual side effects" from this class of medications, but he believes the vision changes seem to be more related to the rapid blood sugar changes caused by the medications than to the medications themselves. "We have encouraged any patients who are on these types of medications to report any unusual symptoms to their prescribing doctors," Kipnis, who also was not involved in the research, told Fox News Digital. "Most of the vision side effects appear to resolve when the medication is stopped." Click Here To Sign Up For Our Health Newsletter Kipnis emphasized that these drugs should only be taken under the care of a healthcare professional and that "good and consistent follow-up for dose adjustments with monitoring for side effects" is critical. When contacted by Fox News Digital, Novo Nordisk (maker of Ozempic and Wegovy) provided the following statement. "NAION is a very rare eye disease, and it is not an adverse drug reaction for the marketed formulations of semaglutide (Ozempic®, Rybelsus®and Wegovy®) as per the approved labels. After a thorough evaluation of studies from the University of Southern Denmark and Novo Nordisk's internal safety assessment, Novo Nordisk is of the opinion that the benefit-risk profile of semaglutide remains unchanged." The company also noted that eye conditions are "well-known comorbidities" for people living with diabetes. For more Health articles, visit "Any decision to start treatment with prescription-only medicines should be made in consultation with a healthcare professional who should do a benefit-risk evaluation for the patient in question, weighing up the benefits of treatment with the potential risks," Novo Nordisk article source: Weight-loss, diabetes drugs linked to vision problems in small study
New York Times
31-01-2025
- Health
- New York Times
Ozempic May Protect Against Alzheimer's
Over a decade ago, a smattering of studies suggested that early cousins of drugs like Ozempic and Mounjaro could prevent, or even reverse, signs of Alzheimer's disease in mice. Now, as the next generation of these medications has soared in popularity, and scientists discover they may have wide-ranging health benefits, research is revving up to investigate whether the drugs that upended diabetes and obesity care could also revolutionize Alzheimer's treatment. Emerging evidence seems encouraging — but questions and caveats abound. 'I think they're definitely promising,' said Karolina Skibicka, a neuroscientist and the chair in metabolic physiology at Pennsylvania State University. 'And that's sort of how far I would go with the currently available evidence.' The Early Findings Research in rodents has largely shown that these types of diabetes and obesity drugs, which mimic metabolic hormones, can improve several hallmarks of Alzheimer's disease in the brain, as well as boost the animals' ability to learn and remember. However, there is a long history of all sorts of drugs treating Alzheimer's in mice but not providing the same benefits for humans. There are only a few studies so far examining whether these medications can reduce the risk for dementia in people. One recent analysis found that, over the course of three years, people taking semaglutide (the compound in Ozempic and the weight loss drug Wegovy) were about 40 to 70 percent less likely to be diagnosed with Alzheimer's disease compared with people on other diabetes medications. A paper published this month reviewing a Veterans Affairs database similarly found that people prescribed these drugs were less likely to develop dementia compared with those who took other diabetes drugs. The benefit was more modest, though, with a roughly 10 percent decreased risk. The findings seem promising. But because these studies are observational, 'it's really hard to tell' whether the drugs are directly causing that benefit, or whether that lower risk is more of a coincidence, said Dr. Ziyad Al-Aly, the chief of research and development at the Veterans Affairs St. Louis Healthcare System and an author on the study. There are also clinical trials testing whether the drugs can treat people already diagnosed with dementia. Preliminary findings from one study of about 200 patients were presented at an Alzheimer's Association meeting last summer. They showed that patients with mild Alzheimer's disease who received an older, similar medication (liraglutide, sold under the brand name Victoza), had slower declines in both their cognition and brain volume compared with patients who received a placebo. The benefits were modest, and the researchers couldn't say whether they would meaningfully change a patient's condition. But Dr. Paul Edison, a professor of neuroscience at Imperial College London who led the trial, said that he was 'encouraged' by the results. Other trials testing whether semaglutide can delay the progression of Alzheimer's disease are ongoing. How the Drugs Might Work Researchers don't know how drugs like Ozempic might protect against neurodegenerative diseases — in fact, they're still trying to understand how these drugs impact the brain overall. But they have a couple theories: Diabetes and obesity both increase a person's odds of developing dementia, so it's possible that the drugs reduce that risk by improving metabolic health. The two conditions are associated with increased inflammation in the body, and many scientists think that reducing inflammation is at least partly how the drugs improve other health conditions, including heart and kidney disease. The same dynamic may be happening in the brain: Inflammation can kill cells and contribute to neurodegenerative disease, and these drugs may help by reducing it. There is some evidence from animal studies that the drugs can suppress brain inflammation, Dr. Skibicka said. But, she added, scientists can't directly link that to the improvements in Alzheimer's disease. The medications can also curb insulin resistance, a hallmark of diabetes. Healthy insulin functioning is important for memory formation, and insulin resistance has been linked to Alzheimer's disease. Research in animals suggests that because these drugs may improve insulin signaling in the brain, they could protect against neurodegeneration, said Nigel Greig, a senior investigator at the National Institutes of Health who has studied these drugs for neurodegenerative disorders. Scientists know that these medications target certain receptors in the brain, particularly in areas that are important for hunger and metabolism. Whether they can also meaningfully act on regions involved in learning and memory is an open question. Research has found that an older and less common drug, exenatide (sold under the brand name Byetta), can access deeper parts of the brain, Dr. Skibicka said. That includes the hippocampus, an area that is damaged early on in Alzheimer's disease. The data for other medications, including semaglutide and liraglutide, are more mixed. Some experts think that the molecules in those drugs have difficulty passing through the blood-brain barrier, preventing them from penetrating effectively. Researchers are hopeful that drugs currently under development could better access those deeper brain structures. Finally, a few studies in mice have found that the medications can reduce the buildup of the protein tau in the brain, which is a key contributor to Alzheimer's disease. Scaling back tau buildup could potentially help stave off cognitive decline in humans, Dr. Greig said, although a variety of medications have tried to target tau and had mixed results. In all likelihood, the drugs' potential benefits would stem from not just one factor, but a combination of many. 'The drug is not only working on the insulin resistance,' Dr. Edison said. 'It's clearly working on the other mechanisms. We know that for sure.' And regardless of how they work, if weight loss and diabetes drugs can be repurposed to prevent or treat dementia, experts will call that a win. 'The landscape of therapeutics for Alzheimer's disease is very, very thin,' Dr. Al-Aly said. 'There's not a whole lot of things that work, so any addition to this repertoire would be certainly welcome.'
Gulf Insider
30-01-2025
- Health
- Gulf Insider
United States: Weight-Loss Drugs Linked To Increased Risk Of 19 Health Conditions
Popular weight-loss drugs like semaglutides (Ozempic and Wegovy) may help protect against over 40 conditions, including Alzheimer's disease, drug addiction, and seizures, a new review has found. However, researchers warn that these benefits come with an increased risk of 19 health conditions, such as syncope (fainting), arthritic disorders, and kidney and pancreatic problems. In a study published in Nature Medicine on Jan. 20, researchers from Washington University's WashU Medicine in St. Louis systematically evaluated health outcomes among roughly 2 million veterans with diabetes who were taking the popular weight-loss medications known as glucagon-like peptide-1 receptor agonists (GLP-1RAs) for about 3.5 years. The media, patients, and even some doctors have dubbed the medications 'miracle drugs' due to their profound weight-loss effects. Administered weekly via injection, GLP-1RAs simulate naturally produced hormones that suppress appetite and slow digestion, allowing people to feel full longer. However, data on these medications' comprehensive effects across the body's organ systems have been sparse. Health Benefits and Risks Disorders affecting the heart, blood vessels, liver, and respiratory system (such as pneumonia) were among the risks GLP-1RA use reduced the most. Studies have shown that GLP-1RAs may improve the health of cells lining the blood vessels. Improved endothelial function can lead to better regulation of blood flow and reduced platelet clumping, which could lower the risk of coagulation disorders and cardiovascular events. The research team also found that GLP-1RAs were linked to improved neurological and behavioral health outcomes. There was a reduced risk of seizures and addiction to substances such as alcohol, cannabis, stimulants, and opioids. This may be linked to how the drug affects neurological pathways related to reward and impulse control. Additionally, findings indicated a reduction in the risk of schizophrenia and suicidal thoughts, although it remains unknown why this is so. The study noted fewer instances of liver cancer, muscle pain, chronic kidney disease, bacterial infections, and fever. The risk of cognitive disorders such as Alzheimer's disease and dementia also decreased with GLP-1RA use. Insulin resistance has been associated with cognitive decline. By improving insulin sensitivity, GLP-1RAs may help support better cognitive functioning and emotional regulation in those taking them. While Alzheimer's pathology can begin over a decade before clinical symptoms emerge, the study suggested that a few years of treatment with semaglutide is enough to show a protective effect. Two large, phase 3 clinical trials (Evoke and Evoke+) are already being conducted to determine whether this effect is real. 'GLP-1RA drugs can have broad health benefits,' Dr. Ziyad Al-Aly, study co-author, clinical epidemiologist, and nephrologist at the WashU Medicine-affiliated John J. Cochran Veterans Hospital, stated in a press release. 'However, they are not without risks.' 'Our findings underscore the possibility for wider applications for these medications but also highlight important risks that should be carefully monitored in people taking these drugs,' he added. Known health risks associated with this drug class include low blood pressure, brief loss of consciousness that occurs when the brain doesn't receive enough blood (syncope), arthritic disorders, and kidney stones. A potentially severe side effect of GLP-1RAs is drug-induced swelling of the pancreas (pancreatitis) caused by the stimulation of the pancreas to produce insulin. This can lead to overstimulation of pancreatic cells, causing inflammation that could trigger the condition. In one out of five cases, pancreatitis could become life-threatening.
