Old supplements prevail in the new age of Ozempic and AI

It’s now the 2020s, which sounds futuristic to begin with. We’ve got a supercomputer in every back pocket. And it’s the age of Ozempic and AI. 

We can reverse our metabolism in the same instant we can find an answer to any question. We’ve developed the technologies to snap our fingers, and boom! That magic injection. That one thing we needed to be happy, healthy and, of course, skinny. 

Yet some of these apparently lifesaving technologies (like GLP [glucagon-like peptide]-1 drugs and computer doctors) are still in the early stages of, let’s say, postmarket surveillance. That’s the FDA term for “work in progress.” Or as I describe it, “We’re starting to look at the drug’s side effects in real life and maybe we’ll tell you later what we found out.” 

New technology isn’t always the greatest, because we haven’t experienced the future that’s not arriving for a while. That’s why I’ve never been a first-mover. I’m patient. I’d rather watch the first versions succeed or fail before forming an opinion. So I’d rather stick with the supplements and ingredients that have stood the test of time on the market for decades and undergone the rigors of clinical studies and meta-analyses. 

Call me old-fashioned to prefer old supplements over new drugs. And my data’s right there on PubMed. 

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Berberine, meet TikTok

Let’s back up and explain. GLP-1 agonist drugs like semaglutide (Ozempic) are developed to bind to GLP-1 receptors in a relatively predictable way, stimulating adenylyl cyclase and cAMP (Cyclic adenosine monophosphate), which causes a number of metabolic benefits downstream. But you know what else stimulates adenylyl cyclase and cAMP? 

Lots of stuff in healthy diets, actually. Like caffeine. Alpha-lipoic acid. Catechins in tea. The adrenaline you get from riding a bicycle. 

But here we are. Calling supplements the wild west. And saying that only a drug — a magic injection — is the key. That’s capital-W Wild to me. Meanwhile, a black hole of attention and care in our health care system exists in that space between recommending oatmeal in the morning and prescribing the drugs whose eventual withdrawal ends up reversing the problems they treat. 

So we turn to TikTok. We’ve got red light. Cold water. Yellow sunglasses. And “nature’s Ozempic” (aka berberine). 

But the prescribers aren’t doctors — they’re yoga-mom influencers or tank-top muscleheads with self-certified degrees in videography and monetizing. In a tapestry of money- and power-driven misinformation woven with both truth and fiction, it’s a fool’s errand to tear at the seams. The gig influencer economy is tough enough without the truth. 

Related:Can gummies really deliver all the supplement nutrition kids require?

But hey, back to berberine — a really cool compound with actual potential to make an impact in well-designed studies. Clinical evidence is emerging, its mechanism on GLP pathways has been delineated and it appears to be relatively safe. Same with some others, like curcumin, gardenia, and even foods like soy and wheat. 

Yet, as your doctor would say, “These haven’t been studied like drugs are supposed to be studied.” And this, always followed with, “Who knows what’s in the bottle?” (This is an imaginary conversation based on millions of real ones.) 

Well, doctor. What does postmarket surveillance and adverse event reporting data mean to you? If berberine is so popular and so unsafe and of poor quality, wouldn’t we see more adverse event reports (AERs) than for your drug? (And by the way, are any of your patients experiencing a shortage or unaffordable costs of the drug you prescribe for them?) 

Many of us are old enough to remember the debacles of drugs once FDA approved before being later FDA rejected. Postmarket surveillance can be a real bitch. Some of the most famous cases involve drugs which acted so terrifically — and sometimes, irreversibly — on their targets that it tipped the homeostatic balance down the rabbit hole into dark inflammation-land. We didn’t pick up the signals in the premarket studies. (Or did we?) Sometimes Alice needs to put down the potion and crawl out of the hole, but the profit motive is too enticing. 

Back from Wonderland. Who’s to say that GLP-1 is the best target to hit on the head with a sledgehammer? Why not consider glucose transporter GLUT-4, the target for cinnamon and probiotics? Why not the GABA (gamma-aminobutyric acid) and dopamine receptors, which are targeted by, yes, GABA, lemon balm and others. Ancient Chinese herbs like astragalus and Panax ginseng are in play for GLP-1 activity, but with other activities as well. We’ve got enough options to look at. 

Between oatmeal and Ozempic

It all sounds easy. But obesity and metabolic syndromes are not easy problems to solve. And let’s not pretend that supplements can act alone or solve everyone’s problems. The good thing is, we do have a bunch of other herbs and nutrients that work on the same or similar pathways, with dosages and effects in humans demonstrated on a substantial level. They’re worth a try. (Although in many cases, they still need more investment to ensure they’re produced correctly, dosed appropriately and measured for their effects — but that means lots of opportunity.) 

Someone at some point before landmark research always has to say: “Hey, we have no idea if this will work, but let’s study it anyway.” But given the totality of science so far, we could soon consider a science-based combination of well-studied nutritional factors, with a sensible lifestyle plan to outweigh the benefit-risk calculation for GLP drugs. In fact, many are already working on this. 

Once we start to study this stuff with better analytical tools (and maybe even AI), we might accelerate our knowledge and develop ways to stay healthy during that time in between oatmeal-for-breakfast and Ozempic-for-lunch. 

Just maybe. And there I go with faith in technology on a whim. I’ll try to stop doing that. 

Clearly, making health a choice between one or the other — nutrition or drugs — is a false choice. Nutrition can’t quite replace medications for people who need them. In cases where a drug is medically necessary, proper nutrition can help to augment the positives, blunt the negatives and correct nutrient deficiency. Let’s just admit, at the very least, that neither oatmeal nor Ozempic alone are the answer.