Uncategorized

• New research presented this week highlights a link between drugs like Ozempic and a condition known as gastroparesis, so-called stomach paralysis.
• The studies found that patients who take GLP-1 drugs were more likely to develop the condition.
• Despite the name, experts contacted by Healthline reiterated that gastroparesis is an expected and reversible effect of GLP-1 drugs.

Are you more likely to develop gastroparesis, so-called stomach paralysis, if you’re taking an obesity or diabetes medication like Wegovy or Ozempic?

A trio of studies presented at Digestive Disease Week 2024 examined real-world patient data to better understand the prevalence of certain gastrointestinal side effects, including gastroparesis, among patients taking popular weight loss and diabetes medications.

These include glucagon-like peptide-1 receptor agonists (GLP-1), a class of drugs that includes semaglutide (Ozempic and Wegovy), and twincretin drugs like tirzepatide (Mounjaro and Zepbound), which utilize both GLP-1 and GIP, a separate receptor agonist.

The gastrointestinal side effects of these drugs are well known; they include nausea, vomiting, and diarrhea. However, there are also less common events associated with them. These include gastroparesis, ileus, and acute pancreatitis.

Many of the rare events have only begun to get more attention because of real-world data coming out about them from patients and prescribers. For example, the FDA only added a warning about iIeus for Ozempic and Wegovy in October 2023.

With so many Americans taking GLP-1 and twincretin drugs — a recent survey found that number to be as high as 13% (about one in eight adults) — data about their side effects is mounting rapidly.

Researchers have consistently found that gastroparesis is more prevalent among people who take GLP-1s than those who don’t. However, the significance of that finding is still up for debate among experts contacted by Healthline.

New studies investigate association between gastroparesis and GLP-1 drugs

Researchers independently took up investigating the association between GLP-1s and GI side effects, especially gastroparesis, in three separate studies presented this week. The presentations have not been published in medical journals.

The first study, led by researchers at the University of Kansas, utilized records from TriNetX, a global electronic medical records database. It includes records from millions of patients across large healthcare organizations. Researchers used a tranche of data from patients who had been prescribed a GLP-1 for diabetes or obesity between 2021-2022.

Those patients were then compared with a control group of similar individuals, also with diabetes or obesity, but who were not treated with a GLP-1.

In total, close to 300,000 patients were included.

Researchers found that people taking GLP-1 drugs were 66% more likely to be diagnosed with gastroparesis than those who were not. Among patients taking the drugs, 0.53% were diagnosed with gastroparesis — about 750 out of nearly 150,000 patients.

“Patients need to be informed about these side effects before treatment is started. There is a lot of excitement and demand for these medications, but side effects are critical points for discussion,” Prateek Sharma, MD, a Professor of Medicine in the Department of Medical Oncology at the University of Kansas School of Medicine, and lead investigator of the study, told Healthline.

The  second study, this time from investigators at University Hospitals in Cleveland, also used the TriNetX database to examine the prevalence of gastroparesis in patients with type 2 diabetes who had been prescribed either a GLP-1 or a twincretin drug.

Researchers included 336,655 individuals for this cohort and then matched them one-to-one with a separate cohort that did not take a GLP-1 or twincretin medication.

They then looked at various time intervals between three months and two years since patients started their medication to track the progression of gastroparesis.

At three months, the incidence of gastroparesis was similar between the two groups. From six months onward, the GLP-1 group was more likely to experience gastroparesis than the control group. At eighteen months, the GLP-1 group was 25% more likely to develop the condition than those who didn’t take the drugs.

But, like the first study, the overall incidence of gastroparesis remained low: between 0.16-0.77% of cases over the two-year period.

A third study used records from the Mayo Clinic health system to look at patient records of about 80,000 people who had been prescribed a GLP-1. Within this group, researchers were interested in a small subset of patients, only 839 of them, who had shown and subsequently received a gastric emptying scintigraphy (GES) test.

GES tests are considered the “gold standard” for testing gastric emptying.

About one-third of this group, or 241 people, still had food in their stomachs four hours after eating, meeting the diagnosis criteria for gastroparesis. Within that group, 127 had preexisting GI symptoms, and 38 had prior documentation of delayed gastric emptying.

Experts weigh in on new research

Healthline spoke with two obesity experts who were not affiliated with the research to discuss the findings and ask them whether they were concerned about the potential risk of gastroparesis in patients taking GLP-1 drugs.

While they praised the research for helping to create a real-world snapshot of how the drugs are affecting patients, they said that there is a lot of misunderstanding about gastroparesis and its risk to patients.

“Even though there was an increased risk, the percentages were still fairly low. A lot of them were under 1%. Even though it was increased compared to no medication, there was still a very low risk. I think that’s something people need to remember,” said Dr. Beverly Tchang, MD, an endocrinologist, Spokesperson for the Obesity Society, and Assistant Professor of clinical medicine at Weill Cornell Medicine.

Dr. Dan Azagury, MD, section chief of Minimally Invasive and Bariatric Surgery and medical director for the Bariatric and Metabolic Interdisciplinary clinic at Stanford Medicine, told Healthline that while the data confirm the GI side effects, he is concerned about the narrative around gastroparesis.

“I think people don’t know what it is, so it’s scary. For us, gastroparesis is not worrisome. It’s a slowdown of the emptying of the stomach. This is a reversible condition. You take the drug, your stomach slows down. You stop the drug and things reverse back to normal,” he told Healthline.

Gastroparesis is, in fact, one of the mechanisms through which GLP-1s and similar drugs work.

“Gastroparesis is a fancy scientific term to indicate that the gut slows down in response to these medications. It’s an expected effect, and to some extent, it actually helps people feel fuller and experience more weight loss,” said Tchang.

“It’s not paralysis,” said Azagury.

“We need to better define this term in a way that is less scary for patients because it’s not that your stomach is going to be paralyzed,” he said.

The bottom line

A trio of new studies show that patients taking GLP-1 drugs are more likely to experience a condition known as gastroparesis.

Gastroparesis, sometimes called stomach paralysis, refers to delayed or slowed emptying of stomach contents after eating.

Experts say that despite its name, gastroparesis doesn’t actually cause paralysis and is a reversible and expected part of taking a GLP-1 drug.

• A study has found that fish oil supplements are linked to increased first-time CVD risk.
• However, they were beneficial to those who already have CVD.
• It appears that the risks of fish oil supplements outweigh the benefits in healthy people.
• Experts advise against using fish oil supplements if you are currently healthy.
• Eating a heart-healthy diet containing omega-3 sources like fatty fish may be best.

Fish oil derived from fatty fish like salmon, mackerel, and trout is often recommended for its anti-inflammatory effects, especially in people with cardiovascular disease (CVD), high blood pressure, abnormal lipids, and rheumatoid arthritis.

Fatty fish are a great source of two omega-3 fatty acids that the human body needs but cannot make for itself: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).

However, while it might seem like a good idea for healthy people to also supplement with fish oil to help prevent disease, the results of a large, long-term study published on May 21, 2024, in the journal BMJ Medicine, indicate that this may not be the case.

The researchers found that using fish oil on a regular basis might actually increase the risk for healthy people to go on and develop first-time heart disease and stroke.

Regular use did, however, help slow the progression of existing CVD. It also helped reduce their risk of death.

Fish oil use linked to increased CVD risk in healthy people

The researchers included 415,737 people from the UK Biobank study.

Over half (55%) of the participants were women, and their ages ranged from 40 to 69.

The information collected about the individuals included their use of fish oil supplements and their dietary intake of oily and non-oily fish.

People’s health was tracked until either their death or the end of the study in March 2021.

About a third of people said they used fish oil supplements on a regular basis, with the majority of them being older, white, and female.

Among those who had no known CVD at the start of the study, regular usage of fish oil supplements was linked with a 13% increased risk of developing atrial fibrillation and a 5% greater risk of having a stroke.

However, those regular users of fish oil who had CVD at the beginning of the study saw a 15% lower risk of going from atrial fibrillation to a heart attack and a 9% lower risk of progressing from heart failure to death.

Why fish oil might affect healthy people differently

Dr. Michael O. McKinney, primary physician at Healthy Outlook in Jacksonville, Florida, explained that the omega-3 fatty acids found in fish oil supplements have been widely studied and found to have both anti-inflammatory and lipid-lowering effects.

“In individuals with established CVD, these properties can stabilize atherosclerotic plaques, lower levels of serum triglycerides, and improve endothelial function, thereby reducing cardiovascular adverse events,” he said.

McKinney noted, however, that the situation is not quite so straightforward when people are in good health.

“Their potential merits at high doses of omega-3s could enhance the risk of bleeding by their anticoagulant effects outweighing benefits in individuals lacking significant cardiovascular disease risks,” he stated.

Taking fish oil supplements when you are healthy could also result in fatty acid imbalances, perhaps inadvertently increasing a person’s risk for heart disease, according to McKinney.

Dr. Sarah Bonza, a board certified family physician and founder of Bonza Health in Columbus, Ohio, said another factor to consider is that some research has suggested that fish oil might increase healthy people’s risk for atrial fibrillation, a heart rhythm disturbance linked with greater stroke risk.

“However, for people with preexisting poor cardiovascular health, omega-3s indeed have anti-inflammatory and plaque-stabilizing effects,” she added, “which help in slowing the progression of cardiovascular disease and in reducing the chances of death from heart-related events.

“So, these advantages may be more than the hazards in patients with weakened cardiovascular systems,” said Bonza.

What experts recommend regarding fish oil supplements

“If you are healthy and you seek to use fish oil capsules for preventing heart disease, it might be better to think over your decision,” said Bonza.

She further stated that the American Heart Association does not advocate taking omega-3 supplements if you are at low risk for CVD because the effects are “far more enhanced” in those with the disease.

Instead, Bonza suggests eating a heart-healthy diet with plenty of natural omega-3 sources, such as fish.

In her opinion, this will be more beneficial to your health.

“On the other hand, personal health condition factors differ, so it is important to talk to a healthcare provider first before choosing to modify supplement consumption​,” she added. “Talk to your doctor first to be safe.”

Supplements that may offer similar benefits to fish oil

Bonza said she would recommend supplementing with flaxseed oil or chia seeds instead of fish oil due to their high alpha-linolenic acid (ALA) content. This is a plant-based omega-3 fatty acid, she explained.

She suggests augmenting your diet with this type of fatty acid because it might have anti-inflammatory properties that can benefit your cardiovascular health, but it is not associated with the risk of atrial fibrillation.

“Also, the diet that contains omega-3s in the form of nuts, soy products, and fortified food will provide the same benefits without high-dose supplements,” she added.

McKinney additionally suggests supplementing with other heart-supporting supplements, such as Coenzyme Q10 (CoQ10), and fiber supplements, such as psyllium husk.

“In addition, everyone has to consult their healthcare providers so that individual patients adjust their choices of supplementation corresponding to their health problems and peculiarities,” he concluded.

Takeaway

A new study has found that fish oil supplementation was associated with an increased risk of developing heart disease and stroke in healthy people.

However, people with existing CVD experienced protective effects against further progression of their disease.

This was an observational study. It does not prove causation.

Experts say the difference in how fish oil affects people’s risk might be due to the fact that in healthy people, the risks associated with fish oil supplementation — such as bleeding, fatty acid imbalance, or atrial fibrillation — might outweigh any potential benefits.

For healthy people, it may be best to get omega-3 fatty acids from foods like fatty fish.

Flaxseed oil, chia seeds, foods fortified with omega-3 fatty acids, CoQ10, and psyllium husk may be safer supplements for cardiovascular health.

Doug Jenkinson was a Midlands GP for 37 years, during which time he made a special study of whooping cough and documented over 700 cases. The thing about whooping cough is that anyone can diagnose it once they have heard …

• Step counts and minutes are both useful ways to measure physical activity, a new study suggests.
• A greater number of steps per day or minutes of exercise per week are both associated with lower health risks, researchers found.
• Move more, sit less is still a good overall goal, regardless of how you track the movement.

Aiming for 7,000 or 10,000 steps a day is an easy way to increase your physical activity, which can decrease your risk of cardiovascular disease, type 2 diabetes, and other conditions.

But the current U.S. physical activity guidelines recommend that people measure their physical activity in minutes, rather than steps — specifically, at least 150 minutes of moderate-intensity aerobic physical activity or 75 minutes of vigorous-intensity activity per week. 

So, is it really better to count the minutes you spend exercising instead of counting your steps? 

A new study suggests no. 

Step- and time-based targets were both associated with lower risks of death from any cause and from cardiovascular disease events in older women, researchers found. 

This suggests that finding what works for you may be the best way to meet your health goals.

“For some, especially for younger individuals, exercise may involve activities like tennis, soccer, walking or jogging, all of which can be easily tracked with steps. However, for others, it may consist of bike rides or swimming, where monitoring the duration of exercise is simpler,” study author Rikuta Hamaya, MD, PhD, a researcher in the Division of Preventive Medicine at Brigham and Women’s Hospital, said in a news release.

“That’s why it’s important for physical activity guidelines to offer multiple ways to reach goals,” she said. “Movement looks different for everyone, and nearly all forms of movement are beneficial to our health.”

The results were published May 20 in JAMA Internal Medicine.

Exercise duration vs. steps

For the study, researchers examined data from nearly 15,000 healthy women 62 years or older who participated in the Women’s Health Study.

Between 2011 and 2015, participants were asked to wear a research-grade activity monitor for 7 days in a row, removing it only for sleeping, showering or bathing, or swimming.

Women also completed annual questionnaires which asked about their health, including cardiovascular disease events such as heart attack and stroke. Deaths of participants were reported by family members or the postal service.

Researchers followed participants through the end of 2022.

Participants’ median physical activity time was 62 minutes of moderate-to-vigorous intensity physical activity per week, and they accumulated a median step count of 5,183 steps per day. In other words, half of the participants engaged in at least this amount of activity or daily steps.

As expected, higher levels of physical activity, measured by time or step count, were associated with a lower risk of death from any cause or cardiovascular disease events. The most active women — in the top quarter — had a 30% to 40% lower risk of these compared to the least active quarter of women.

In addition, at 9 years of follow-up, participants in the top three-quarters of physical activity time and step counts lived 2.22 and 2.36 months longer than women in the lowest quarter, respectively. This survival advantage remained even when researchers took into account participants’ body mass index (BMI).

The results for both analyses were similar for step counts and minutes.

The study adds to our understanding of different ways to track physical activity, but researchers point out that they only assessed participants’ physical activity at one time.

In addition, this is an observational study, so it cannot prove cause and effect. Researchers hope to carry out a randomized controlled trial later on to better understand the link between health and tracking exercise by minutes or step counts.

The best way to track your workouts

While step counts won’t work for every activity, you can use it for things like walking, hiking and running, not just during your workouts, but also throughout your day.

But that doesn’t mean step counts is the best way to track those types of activities.

Karly Mendez, a human performance specialist with Memorial Hermann, said choosing whether to use step counts or minutes is a matter of personal preference because higher levels of both have been linked to better health.

Sometimes, though, tracking steps can help people keep exercising, said James Rodgers, an expert coach and competitive runner for 20 years.

“Certain individuals respond well to setting a specific metric goal and keeping track of their progress, which helps them stay motivated in reaching a certain number,” he told Healthline. “As their fitness improves, they may aim to gradually increase the step goal.”

However, “expecting beginners to meet a step count goal might be too much pressure,” he said. “Instead, it might be easier for beginners to quantify their activity time,” such as walking for 30 minutes every day after lunch.

Step count also doesn’t take into account the terrain you are walking or running on, Rodgers pointed out. For example, doing 8,000 steps on a hilly or mountainous trail requires more effort than doing the same number of steps on a flat, paved road.

”While counting steps on an undulating trail could be excellent training for you, mirroring the number of steps you do on flat terrain may be too much,” he said, “and you risk overtraining.”

So if you are moving over different types of terrain, tracking your minutes, rather than steps, may be a better option. Also, “you will likely progress more steadily [by tracking time],” said Rodgers.

Personalizing your workouts

There are also other ways to measure your physical activity, such as tracking both duration and intensity. 

This approach is more personalized because an “intense” workout for one person may be a “moderate” workout for another. Aiming for what’s intense for you will help you progress over time.

Mendez suggests “training 80% of your weekly volume [time] in zone 2 and 20% of your weekly volume in zone 4/5. This can be done with any activity you love.”

Zone 2 workouts are easy enough that you can talk the entire time, whereas “zone 4/5 workouts consist of getting your heart rate high, holding it high, and letting it come back down to rest,” she told Healthline.

You can also measure intensity by tracking your heart rate, said Rodgers. “Training in a variety of heart rate zones for certain durations can help to ensure your performance does not plateau.”

Heart rate monitoring will also account for the terrain, because if you are walking or running up a steep hill, your heart will likely beat faster to compensate for the increased effort.

Rodgers cautions that while step counts or other workout metrics can be good motivational tools, it’s important to not become too focused on them.

”Maintaining a balanced approach to your training is crucial,” he said. “Incorporate other aspects of exercise that may not involve steps, such as strength work, for optimal benefits.”

It’s also okay to switch things up, said Mendez, tracking steps one day and duration on other days. The key, though, is to do something active every day — aka move more, sit less.

“Do what you truly enjoy doing, and find a schedule and workout that works for you,” she said. “This is the best way to make sure you stay consistent and coming back.”

Takeaway

Tracking physical activity using step counts is increasingly popular, especially with the availability of smartphone apps and wearable devices. However, U.S. physical activity guidelines are based on minutes per week, rather than steps.

A new study suggests that both step counts and minutes can be useful ways to track certain types of physical activity, such as walking, hiking, and running. Higher levels of either activity measure were associated with a lower risk of death from any cause and cardiovascular disease events among older women.

Experts emphasize that it’s important to find what works for you, and not become too focused on tracking. Balance is key, they say, including doing other types of exercise, such as strength work.

• U.S. spending on prescription drugs amassed $722 billion in 2023, a nearly 14% uptick from 2022, marking the largest increase in spending in 20 years, according to a new study.
• The diabetes and weight loss medication semaglutide (Ozempic, Wegovy, and Rybelsus) topped the list.
• While drug prices did rise, the data and experts point to other, more significant factors for the national increase in spending. 

According to a study published in the American Journal of Health-System Pharmacy on April 24, the U.S. spent more than $722 billion on prescription drugs in 2023, a 13.6% increase from 2022. This is the largest uptick in spending in 20 years. 

Semaglutide (sold under brand names Ozempic, Wegovy, and Rybelsus) ranked No. 1 on the list of the top 25 most popular drugs by U.S. spending.

The U.S. shelled out $38.58 billion on these medications, which can run a person around $1,000 without insurance. Numerous factors — not just the sticker price of a drug — are likely driving the surge, according to the report and experts not affiliated with it.

Though semaglutide tops the list, medications that treat other conditions round out the top three. Those are Adalimumab (Humira) and Apixaban (Eliquis).

Adalimumab treats autoimmune disorders, such as rheumatoid arthritis and Crohn’s disease. Apixaban is used to prevent and and treat blood clots for certain patients and also to help protect people with some heart rhythm problems.

Top 25 Most Popular Drugs By U.S. Spending

1. Semaglutide (Ozempic, Rybelsus, Wegovy):  $38.58 billion

2. Adalimumab (Humira): $35.33 billion

3. Apixaban (Eliquis): $22.11 billion

4. Dulaglutide (Trulicity): $16.28 billion

5. Empagliflozin (Jardiance): $15.89 billion

6. Ustekinumab (Stelara): $15.87 billion

7. Pembrolizumab (Keytruda): $15.40 billion

8. Tirzepatide (Mounjaro, Zepbound): $13.16 billion

9. Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy): $13.15 billion

10. Dupilumab (Dupixent): $11.49 billion

11. Risankizumab (Skyrizi): $10.10 billion

12. Etanercept (Enbrel): $9.55 billion

13. Insulin glargine (Lantus, Toujeo, Basaglar): $8.89 billion

14. Rivaroxaban (Xarelto): $8.26 billion

15. Dapagliflozin (Farxiga): $7.90 billion

16. Immune globulin (antibodies to make the immune system stronger): $6.27 billion

17. Insulin aspart (NovoLog): $5.79 billion

18. Secukinumab (Cosentyx): $5.72 billion

19. Sitagliptin (Januvia): $5.72 billion

20. Fluticasone/umeclidinium bromide/vilanterol (Trelegy Ellipta): $5.71 billion

21. Nivolumab (Opdivo): $5.39 billion

22. Lisdexamfetamine (Vyvanse): $5.36 billion

23. Insulin lispro (Humalog): $5.32 billion

24. Ixekizumab (Taltz): $5.31 billion

25. Ocrelizumab (Ocrevus): $5.30 billion

Why prescription drug spending is increasing 

Eric Tichy, Pharm.D., a pharmacist, author of the new study, and Mayo Clinic division chair, said the research turned up three primary reasons for the price increase: 

Utilization (6.5% increase)

Utilization increases when a drug already approved for one use is approved for another. Experts believe this trend will likely continue in 2024, especially since semaglutide (Wegovy) received FDA approval for heart attack risk reduction in March.

“This expanded indication is likely to increase both the utilization of Wegovy and its coverage by insurance providers,” said Kimberly Posey, PhD, DNP, an associate professor and the director of graduate nursing at Texas Christian University. “Significantly, this change means that Wegovy will now be covered under Medicare Part D.”

Medicare does not cover drugs specifically used for weight loss, and KFF analysis suggested the new approval for semaglutide could expand Wegovy coverage eligibility to around 3.6 million people.

New drugs (4.2% increase)

The FDA approved 55 new drugs in 2023.

“Nearly half of [these drugs] were classified as first-in-class due to employing novel mechanisms of action to treat various medical conditions,” Jennifer Bourgeois, Pharm.D of SingleCare said. “Biologic drugs like adalimumab, or Humira, and gene therapies for cancer are costly to manufacture, contributing significantly to drug spending.”

For instance, in November 2023, Zepbound received FDA approval for weight management and loss. The generic form of Zepbound, tirzepatide, was the eighth-most popular drug by U.S. spending in 2023.

“Ongoing innovation in the pharmaceutical industry leads to the development and approval of new drugs, which often command higher prices due to extensive research and development,” said Joy Liu, the CEO and founder at Plenful, a tech company that regularly works with pharmacies.

Price increases (2.9% increase)

Drug prices ticked up by about 3% in 2023. 

“This upward trend in drug prices contributes directly to the overall growth in prescription drug spending,” Bourgeois said. 

Still, Tichy stressed it’s not the most significant factor in the increase in price spending.

“While prices did increase, we know that most patients have some form of insurance, and they are likely to be insulated from the price changes,” he said.

And, while it’s challenging to predict whether spending will decrease in coming years, Tichy says the cost to at least some consumers could fall. The 2022 Inflation Reduction Act included several provisions regarding prescription drug prices. Tichy highlights three:

• Removing the cost share for vaccines, meaning patients with Medicare Part D no longer have out-of-pocket costs for vaccines
• Limiting the monthly insulin expense to $35
• Limiting out-of-pocket patient responsibilities for all prescriptions under Medicare D

Additionally, the study indicates that Medicare’s ability to negotiate drug prices under the 2022 law will likely lower costs. Medicare will negotiate prices for 10 drugs that will take effect in 2026, and new ones will be added annually. These should reduce cost-related obstacles for patients and could drive increased use of prescription drugs.

Demographic shifts may be expanding the need for prescription drugs

Bourgeois said that demographic shifts could also be widening the need for prescription drugs as the U.S. population ages.

Sahily Paoline, the chief clinical officer at Xevant, agreed, saying the current state of prescription drug spending also “suggests a higher prevalence of chronic diseases that require ongoing medication management, such as diabetes and cardiovascular conditions.”

Bourgeois pointed to PEW Research published in 2024 indicating that 62 million people in the U.S. are 65 and older as a significant contributor to the use of prescription drugs for chronic conditions like heart disease, diabetes, and arthritis.

She also cited Merck data that about 80% of older adults take at least two prescription drugs regularly, and 36% take at least five prescription drugs.  

“As this segment of the population continues to grow, the demand for prescription medications is expected to rise, leading to an overall increase in drug spending nationwide,” Bourgeois says.

How can the cost of prescription drugs be reduced?

Unlike, say, exercising to reduce heart disease risk, there’s not much people can do to lower the costs of prescription drugs. The heaviest burden falls on the government.

“To reduce drug prices, a key strategy is government regulation,” Posey said. “By enabling programs like Medicare to negotiate directly with pharmaceutical companies, significant purchasing power can be leveraged to secure more reasonable prices.”

Posey says the Inflation Reduction Act could serve as a model for future legislation. However, Paoline is pessimistic that significant change will happen in the short term.

“Progress in legislative efforts to rein in soaring drug prices faces resistance from pharmaceutical companies, who argue that high prices fuel innovation,” Paoline said. “Market forces, such as the constant influx of new expensive drugs and regular price hikes on existing medications, continue to increase spending.”

However, Wegovy prices fell in the first quarter of 2024, with experts pointing to increased competition. 

“Heightened competition and expanded access could drive further decreases in anti-obesity drug prices,” Bourgeois says.

Yet, whether that trend continues remains a significant question mark.

“It’s a challenging question whether the competition among anti-obesity drugs will lead to significant reductions in out-of-pocket costs for consumers,” Posey said.

Shifting the approach from treating conditions to preventing them could also help decrease spending, something more in control of consumers and the providers caring for them.

“While medications are essential for many conditions, this [spending] trend also underscores the importance of integrating preventive healthcare practices to address underlying health issues and improve overall health outcomes,” Paoline said. “By balancing medical treatments with preventive strategies like healthy lifestyle changes, we can aim for a more holistic approach to healthcare.”

Takeaway

Prescription drug spending ballooned by nearly 14% from 2022 to 2023, the largest increase in the U.S. in two decades, per a new study.

Expanded utilization of drugs, 55 new FDA-approved medications, and a small (less than 3%) increase in drug prices are behind the trend.

Semaglutide, including Ozempic, topped the list of the top 25 most popular drugs by U.S. spending.

The U.S. population is also getting older when the risk of chronic conditions increases.

Experts say that the most significant way to reduce drug spending is through legislation and that the 2022 Inflation Reduction Act, which included prescription medicine stipulations, is a start.

Focusing on lifestyle changes and preventative care can also help reduce reliance on prescription drugs and associated spending.

• The Centers for Disease Control and Prevention has begun publishing wastewater data to help track the bird flu in the U.S.
• The disease is primarily spreading among birds, but has been detected in cattle as well.
• Wastewater testing is a vital early warning system designed to spot emerging viral outbreaks.
• The current threat to people is considered low.

Bird flu, also known as the H5N1 virus, has infected cattle in nine states, according to data from the Centers for Disease Control and Prevention (CDC).

To track the spread of the disease, the CDC has begun reporting wastewater data.

Although it has affected millions of birds and other animals in the last 2 years, its risk to humans is still considered low. Just one person in the U.S. has developed H5N1 in recent months.

Bird flu can have a 50% fatality rate, but has not spread widely to humans

Since January 2022 in the U.S., the H5N1 virus has killed over 90 million birds across 48 states.

It also sporadically jumped into mammal species in the U.S., including mountain lions, bears, bobcats, coyotes, raccoons, minks, and skunks.

More recently, the virus has moved into a new host: cattle. Although cattle are less seriously affected than other species, this can make it harder to track where the disease is spreading.

Because the virus rarely kills cows, infected animals can continue to live among their herd, providing more opportunities for the virus to pass to other cattle and species.

In April 2024, the United States recorded its first cow-to-human transmission of H5N1 in a dairy farm worker in Texas. This is only the second human case of H5N1 to be identified in the U.S. ever; the first was in 2022.

So far, there has been no recorded human-to-human transmission of the virus.

Krzysztof Pyrć, PhD, a professor of biological sciences and leader of the Virology Laboratory at the Malopolska Centre of Biotechnology at the Jagiellonian University in Poland said that the first human cases of H5N1 were discovered in the 1990s.

“Since then,” he explained, “roughly 1,000 cases have been recorded in humans, approximately 50% of which were fatal.”

“Since 2020, we have a new subtype that is much more transmissible, causing a pandemic in birds with multiple outbreaks recorded worldwide,” he said.

This includes infections in mammals, including marine mammals in South America, farmed foxes in Finland, and cats in Poland.

Where are H5N1 levels highest?

The CDC considers the threat posed to people by H5N1 to be “low,” but they are closely monitoring the outbreak. They have launched a new dashboard monitoring wastewater.

Their National Wastewater Surveillance System (NWSS) takes data from more than 600 sites across the U.S. and compares current levels of the virus with those from 2023.

According to the CDC, most wastewater monitoring cannot tell the difference between H5N1 and other types of influenza A viruses. However, detecting large differences between this year’s levels and the levels from 2023 is a signal that H5N1 is involved.

Compared with last year’s data, during the week ending the 4th of May, levels of influenza A viruses were “above average” in 10 sampling regions out of 230:

• Pinellas County FL,
• Randall/Potter County TX,
• Montgomery County TX,
• Sonoma County CA,
• Webb County TX,
• Marin County CA,
• Oswego County NY,
• San Francisco/San Mateo County CA,
• Placer County CA,
• Santa Clara County CA.

Levels of the virus were deemed “high” in one region:

• Saline County, KS

Regions where cattle have been infected

To date, nine states have identified H5N1 outbreaks in cattle:

• Michigan: 14 herds
• Texas: 13 herds
• New Mexico: eight herds
• Idaho: five herds
• Kansas: four herds
• Colorado: two herds
• Ohio: one herd
• North Carolina: one herd
• South Dakota: one herd

The importance of wastewater monitoring

A recent paper from the Texas Epidemic Public Health Institute identified nine cities in Texas where H5N1 was detected in the wastewater between March 4th and April 25th. The paper is a pre-print and has yet to be published in a peer-reviewed journal.

The research used data from the Texas Wastewater Environmental Biomonitoring Network (TexWEB network) which focuses on the early detection of pathogens.

“For approximately 2 years, TexWEB has been monitoring the wastewater of multiple municipalities across Texas,” the study authors said in an emailed statement.

Using genetic information, the researchers can “monitor the levels and sequence of hundreds or even thousands of viruses in a single sample.”

The study authors told Healthline that, until March 2024, they had not identified any H5N1 viruses. However, “After early March,” they explained, “we have seen H5N1 in multiple sites and we continue to see H5N1 up until the most recent sampling.” 

How can wastewater monitoring help?

The Texas-based researchers told Healthline that data from wastewater acts “as an early sentinel signal of where known or emerging viruses are present within the catchment area of a wastewater treatment plant.”

They then pass this information to local and state public health departments, which can begin planning and increasing their surveillance efforts.

Although wastewater monitoring is a vital part of detecting emerging viral outbreaks, it does have certain limitations.

For instance, the researchers explain that TexWEB cannot identify where the virus is coming from, so it could be from “wild birds, agriculture, food processing, or mammals, including humans.”

Should people be worried about a bird flu outbreak?

“At this point, there is no evidence for human-to-human transmission, and pasteurized milk has been shown to be safe,” the researchers from Texas told Healthline. 

However, they also said that “TexWEB continues to monitor for emerging mutations that may increase virulence or transmissibility to mammalian hosts.”

We asked Pyrć whether the H5N1 virus could spark a new pandemic. “Unfortunately, the answer is yes.”

“Luckily,” he continued, “for now, the virus does not thrive in the human body, and only a few cases have been reported globally. Can this change? Yes, it can, but we cannot predict when it will happen and how severe the disease caused by a new variant will be in humans.”

We also asked what global health organizations should do to slow transmission. He answered our question with a question:

“Are individual countries and politicians prepared to brace for the next threat and follow the advice given by international agencies? Are they ready to allow professional agencies to operate without political pressure?”

While bird flu certainly is a serious threat, Pyrć believes we should “prepare for it, but we should not panic.”

The takeaway

The H5N1 virus has infected millions of birds and other mammals. Recently, it has “jumped” into cattle in nine states. So far, there has only been one case of cattle-to-human transmission and no human-to-human transmission.

The CDC is closely monitoring the situation, and wastewater analysis is just one of their tools. Although we do not know the virus’ next move, for now, we do not need to worry.

• The FDA has approved two new self-screening tests for HPV.
• Patients would be able to access the self-screening test at a physician’s office.
• While these tests can act as a supplement, the pelvic exam may still be necessary in some cases.

The U.S. Food and Drug Administration approved two new self-tests to detect HPV. These new tests would allow people to take their own sample to test for HPV, instead of having a physician perform a pelvic exam to take a sample.

Detecting HPV can help physicians determine if a person is at risk for cervical cancer.

The tests are made by Roche and BD.

A better way to test for HPV?

HPV is the most common sexually transmitted infection, with more than 42 million cases in the U.S., according to the CDC.

“The introduction of self-screening tests for cervical cancer is a fascinating development,” said Matthew Casavant, MD, OB/GYN and founder of South Lake Obstetrics & Gynecology. “These tests can potentially increase screening rates by reducing the discomfort and anxiety associated with pelvic exams.” 

The HPV test can detect signs of the virus in the cervix. These viruses can be precursors to cervical cancer.

To test for HPV, a physician would traditionally take a swab while doing a pelvic exam of a patient. That swab would then be tested for HPV.

With these new tests, patients themselves can use the swab to take a sample. The sample is taken at the physician’s office, similar to how a urine sample might be taken at a medical office.

However, the FDA may soon allow these tests to be conducted at home, according to the Washington Post.

Dr. June Hou is an associate professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons, and also a specialist in treating gynecologic cancers, said that these types of tests may help remove barriers for women to get HPV testing especially if they are approved for at-home use.

“I am excited about these new tests overall,” Hou said. “Cervical cancer is one of the few preventable cancers by ways of vaccination and screening. To receive screening however, women currently will need to carve time out of their day to make an appointment…These new tests will remove some of these barriers that are time consuming,and will broaden access to cervical cancer screening to more women, in a more convenient way.”

Reasons pelvic exams may still be necessary

However, while these new tests may serve as a supplementary tool, they should not completely replace pelvic exams, Casavant noted. Pelvic exams are crucial for detecting other gynecological issues beyond cervical cancer, such as ovarian cysts, endometriosis, and sexually transmitted infections.

Signs of cervical cancer

Symptoms include:

• irregular bleeding
• unusual vaginal discharge
• pelvic pain
• pain during intercourse 

“These symptoms often appear in advanced stages, which is why regular screening through Pap smears and HPV tests are critical for early detection,” Casavant stated.

How to reduce your risk of developing cervical cancer

When it comes to preventing cervical cancer, there are several approaches that can be effective. Being proactive is essential, say medical experts.

“Preventing cervical cancer primarily involves regular screening, getting the HPV vaccine, and practicing safe sex to reduce HPV transmission,” said Casavant.

“Treating cervical cancer might include surgical interventions, radiation therapy, and chemotherapy, depending on the stage at diagnosis. Staying informed about your health, attending regular check-ups, and discussing any concerns with your doctor are the best proactive measures.”

Hou said that the most effective way to prevent cervical cancer is still getting vaccinated against HPV.

“HPV vaccines are extremely effective at preventing HPV infection, the precursor to the vast majority of cervical cancer,” Hou said. “While vaccination is typically recommended before age 12, it is also recommended for everyone up to age 26 if they were not already vaccinated.   Additionally, cervical cancer screening is very effective at diagnosing pre-cancer cells of the cervix.  Removing the pre-cancer cells will prevent cancer.”

The CDC notes people aged 27 to 45 may also get the HPV vaccine if they were not adequately vaccinated when they were younger.

Takeaway

The FDA has approved two new tests that allow women to perform a self-test to detect signs of HPV. These new tests may help cut out some uncomfortable pelvic exams at the gynecologist.

• A new study has found that plant-based diets are linked with better health.
• People eating vegetarian and vegan diets had a lower risk for heart disease and cancer.
• They were also less likely to die from cardiovascular disease.
• Plant-based diets are low in cholesterol and saturated fat, but high in nutrients.
• A flexitarian diet composed of whole foods may be the best plant-based diet.

A new scientific literature review has found that vegetarian and vegan diets help improve cardiometabolic risk factors, such as elevated lipids, blood sugar, body weight, BMI, and inflammation.

The individuals studied also had a lower risk of ischemic heart disease and gastrointestinal and prostate cancers.

The authors of the study, which was published on May 15, 2024, in the journal PLOS ONE, further stated that people who ate vegetarian diets were at reduced risk for dying from cardiovascular disease.

They did note, however, that pregnant people eating vegetarian diets did not appear to have any difference in their risk of developing gestational diabetes and high blood pressure.

Over 20 years of research highlight the health benefits of plant-based diets

The authors wrote that prior studies have shown that diets low in plant foods and high in meat, refined grains, sugar, and salt are associated with a greater risk of death.

They said this suggests that eating a more plant-based diet should have the opposite effect, reducing the risk of cardiovascular disease and cancer.

To see whether this assumption held up, the researchers examined 48 papers published over a 23-year span.

They selected papers that dealt with plant-based diets and their effects on cardiovascular health and cancer risk.

They used an umbrella review approach, taking data from all the studies and analyzing it.

This method is unique in that it only uses the highest-level evidence, which is other systematic reviews and meta-analyses.

When they analyzed the two decades of compiled data, they found that the association between vegetarian and vegan diets and reduced cardiometabolic risk factors was quite strong.

The research team conceded, however, that the study had some limitations, such as variations in the exact diet followed, patient demographics, and study length.

Why plant-based diets help reduce health risks

Dr. Libbat Shaham, a board certified family physician with Medical Offices of Manhattan and contributor to LabFinder.com, who was not involved in the study, commented on the study, explaining that the observed improvements in health may come down to what plant-based diets don’t contain: cholesterol and high levels of saturated fat.

“Cholesterol and saturated fat over time are what lead to damage to, and obstruction in, blood vessels — the cause of heart attacks and strokes,” she explained.

Shaham went on to say that saturated fat is mostly found in animal foods and is solid at room temperature.

“Cholesterol is made in the liver,” she added. “Plants don’t have livers. Animals do.”

Dr. Sarah Bonza, a board certified physician specializing in family medicine and lifestyle medicine, who was not involved in the study, added that plant-based diets also may help reduce the risk of chronic diseases because of what they do contain, which are vitamins, antioxidants, and fiber.

“Fruits, vegetables, whole grain, legumes, nuts, and seeds … all contain vitamins, minerals, and phytonutrients that benefit people’s health,” she said. “With these meal plans, one may expect fewer inflammations and improved heart and immune health.”

Bonza additionally pointed out that the fiber in plant foods helps speed up the digestion process and keeps the gut microbiome healthy.

What’s the best plant-based diet?

While the study looked at vegetarian and vegan diets, Faith Krisht, a Registered Dietitian Nutritionist who was not involved in the study, advises that the best way to eat plant-based is to follow a flexitarian diet.

“Research shows that vegan and vegetarian diets are often deficient in essential fatty acids such as EPA and DHA, Vitamin B12, Vitamin D, and iodine,” she said. “These are all important nutrients for human health.”

A flexitarian diet — which focuses on eating mainly plant-based proteins while occasionally adding animal-based proteins — helps ensure that you are getting all the vital nutrients that you need.

Krisht also recommends eating a diet that is high in whole foods rather than one that is high in refined and ultra-processed foods.

“This means a diet that is rich in whole grains, beans, lentils, vegetables, fruit, seeds, nuts, minimally processed animal proteins,” she said.

According to Krisht, this ensures that you get plenty of healthy fiber and antioxidants while also avoiding added sugars, which can increase your risk of chronic disease.

How to incorporate more plant-based foods into your diet

Krisht said a simple way to add more plant-based foods to your diet is to incorporate them into meals you already enjoy.

“Add black beans to your taco meat or in a quesadilla, add chickpeas to your curry, throw some edamame into your stir-fry, add pumpkin seeds to your morning oatmeal,” she suggested. You can start small and work your way up to more.

Krisht said that one thing she likes to do is keep a variety of seeds on hand, such as sesame, sunflower, chia, flax, hemp, and pumpkin.

These can easily be added to yogurt, smoothies, oatmeal, salads, baked goods, and even regular meals.

“You can also try adding various whole grains to your white rice such as farro, quinoa, or wild rice,” she said.

Takeaway

Over 20 years of studies have found that plant-based diets can improve cardiometabolic health and help prevent cancer.

Experts say this is because plant foods are low in cholesterol and saturated fats while being high in other desirable nutrients like vitamins, antioxidants, and fiber.

The best plant-based diet may be one that is well-rounded in nutrients due to occasional meat intake. It should also be filled with whole foods.

To start eating more plant-based foods, start slowly and try incorporating them into your current diet.

Cryptosporidium is a microscopic parasite that can cause an unpleasant – and sometimes dangerous – illness called cryptosporidiosis. This nasty bug lives in the intestines of infected humans and animals and is passed out in their poo. It can then …

• People receiving weight-loss drug Wegovy (semaglutide) lost an average of 10% of their body weight after four years, a clinical trial found.
• Study participants lost weight during the first year and three months of the study, after which their weight plateaued.
• A new analysis of data from the study found that people saw cardiac benefits of semaglutide regardless of how much weight they lost.

People receiving weight-loss drug Wegovy (semaglutide) sustained weight loss for up to four years, shedding an average of 10% of their body weight during that time, a new study found.

This is the longest clinical trial to date of this drug, which belongs to a class of medications known as GLP-1 receptor agonists.

The study, known as the SELECT trial, included over 17,000 adults who had obesity or overweight but did not have diabetes. People stayed on the medicine throughout the clinical trial.

The findings also suggest that there are heart health benefits in addition to those related to weight loss.

“At four years, we see ongoing benefits [of semaglutide],” said Cheng-Han Chen, MD, interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, Calif., who was not involved in the research.

Not only do “patients continue to have a reduction in weight, but also, more importantly, they continue to have a reduction in cardiovascular outcomes,” he told Healthline.

The study was published May 13 in Nature Medicine.

Weight loss lasted for at least 4 years

Overall, people who received once-weekly injections of semaglutide lost on average 10.2% of their body weight over the course of four years. Study participants continued to lose weight for about 65 weeks — a year and three months — and then their weight remained at a stable level.

However, people’s experience with the medication varied.

Of the people on the highest dose of Wegovy, 68% lost at least 5% of their body weight. This compared to 21% of people on the placebo.

Additionally, of the total people on Wegovy about 23% lost at least 15% of their body weight. For those in the placebo group, only 1.7% lost that much body weight.

An earlier clinical trial showed that people receiving semaglutide lost on average almost 15% of their body weight over 68 weeks, compared to only 2.4% in people who got a placebo. That trial was designed to test the drug’s effect on weight loss, and it also included structured diet and exercise interventions. 

In contrast, the SELECT trial was designed to see whether semaglutide prevented cardiovascular events such as heart attack and stroke, and did not include lifestyle interventions. This may explain the lower amount of weight loss in the SELECT trial.

No unexpected side effects found

Mir Ali, MD, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif., said the new trial verified the safety profile of semaglutide, showing “fewer side effects” of the drug than originally thought.

Researchers found no unexpected safety issues with the drug during the trial. 

In addition, the most common reasons that people receiving semaglutide withdrew from the trial were gastrointestinal symptoms such as nausea and diarrhea, which are known side effects of the drug. This occurred mainly during the beginning of the study, as the dose of the medicine is increased to a maximally tolerated dose.

The rate of serious adverse events was lower among people receiving semaglutide (33%) compared to the placebo group (36%). This was mainly due to lower rates of major cardiovascular events among people in the semaglutide group.

Rates of inflammation of the pancreas (pancreatitis) were similar in both groups, but rates of gallstones were higher in the semaglutide group. Both of these have been seen in earlier trials, and are included as a warning in the medication’s prescribing information.

Wegovy helped heart health even without weight loss

An analysis last year of the SELECT trial data found that semaglutide significantly reduced the risk of heart attack, stroke, and cardiovascular-related death in adults with obesity or who are overweight. 

This led to the Food and Drug Administration approving Novo Nordisk’s Wegovy for reducing the risk of heart-related events in this group of people.

A new analysis of trial data suggests that the heart-related benefits of the drug extend beyond weight loss — even people who didn’t lose weight while on the drug had a lower risk of heart attack, stroke, and other events, researchers found.

That analysis, which was presented May 13 at the European Congress on Obesity, shows that “patients may benefit from [semaglutide] even if they are not significantly overweight,” Ali told Healthline.

“Some of the possible mechanisms [for this] are that the drug may be better [at] controlling blood glucose, improving cardiovascular status, or perhaps it’s reducing inflammation,” he said.

However, more research is needed to understand the mechanisms behind the heart-related benefits of the drug. Additionally, more research will be needed to see if people who have had a previous heart attack or stroke, but don’t have obesity, might also benefit from taking semaglutide.

Will new study affect Wegovy price?

Given the strong safety profile, the benefits of weight loss, and the heart-related benefits, now insurers have more reasons to cover GLP-1 drugs which have a list price of approximately $1,349 for a one-month supply. 

Although this is the cost before insurance coverage, coupons or rebates, around half of people with insurance coverage still struggle to pay for GLP-1 drugs such as Wegovy, a recent KFF survey found.

The benefits may be worth the price, though.

“While this medicine is expensive, you’re preventing a lot of complications from cardiovascular disease down the road,” said Chen. “So from a public health perspective, it is very important that we provide this medication for patients.”

One question insurers may be wondering is whether they will have to continue paying for the drug indefinitely once people start taking it, as they often do with medications for lowering cholesterol and high blood pressure.

There is some research to suggest that ongoing treatment with GLP-1 drugs may be needed. Some studies have found that people regain some weight after they stop treatment. However, researchers have not yet examined whether any of the heart-related benefits persist if people go off the drug.

Ali said obesity is better thought of as “a chronic disease, like diabetes or high blood pressure, that may need long-term treatment,” rather than something that could be treated and then you’re done.”

And “with any treatment — whether it’s medication or surgery — the goal is to help the patient change to a healthier diet and lifestyle,” he said, “and then their weight loss results can be more sustainable.”

Takeaway

In a study of over 17,000 adults, researchers found that people receiving Wegovy (semaglutide) lost an average of 10% of their body weight after four years. People lost weight for the first 65 weeks of the study, after which their weight plateaued.

An earlier analysis of data from this trial found that semaglutide reduced the risk of heart attack, stroke and cardiovascular death in people with obesity or who are overweight. A new analysis found that these heart-related benefits occurred regardless of how much weight people lost.

This suggests that the benefits of semaglutide extend beyond weight loss. Researchers say the benefits may be due to the positive effects of the drug on blood sugar, blood pressure, inflammation or other factors.