Food Anxiety

Do you mentally punish yourself every time you eat food? Every bite, you debate with yourself about whether it’s “good” for you or not? Whether you deserve to eat that dessert after having been so good for the whole week? That one delicious croissant can’t be that bad for you right? That low level tension that pervades all your thoughts for every item of food and drink you put into your body. And maybe that feeling of resignation of hating yourself for doing it, but doing it anyway?

Last year, a specialist doctor pointed out that I had pre-diabetes. Unfortunate, as I had known for a year. And ignored it. And now my HbA1C had crept up. Enter worrying about every item of food I put into my mouth.

Prediabetes

But why? What is prediabetes? Good question. I grew up thinking diabetes wasn’t particularly terrible and that it only happened to people who ate too much sugar. I drink black coffee and had given up desserts the 3 years ago. So what on earth was happening? Why was I getting called out by my doctor now?

It turns out that your eating habits take a while to take a toll on your body. This explanation is very simplified as there are multiple types of diabetes, but it holds true in my case:

Prediabetes is the early stages of your body developing type 2 diabetes and for me it is due to a build up of visceral fat in my liver.

When this happens, it starts affecting your liver and pancreas’ abilities to adjust your insulin levels. When you eat carbohydrates, it enters your blood stream as glucose. Insulin is needed to pull that glucose out of the blood stream and store it as fat in your body. Now, with prediabetes, since your insulin control is starting to get messed up, your body lets the glucose sit around in your blood stream for a long time, and in the long run, this causes your blood vessels to stiffen and leads to heart disease.

So how do you get out of this viscious cycle? You have to get rid of that bad fat built up in your liver! How do you do that? Lose the visceral fat. How? Eat fewer carbohydrates.

Enter the low grade anxiety over food that dogged me for every item I put in my mouth. Now, constantly worrying about whether I was eating correctly was really frustrating and I was a lot unhappier than I had ever been in my life since it was impacting everything I was doing. So I dove in to GLP-1s to see what I could find there.

GLP-1s and prediabetes

There are a few major studies that prove the efficacy of GLP-1s on prediabetes:

1. The 2022 study Changes in Glucose Metabolism and Glycemic Status With Once-Weekly Subcutaneous Semaglutide 2.4 mg Among Participants With Prediabetes in the STEP Program showed that of 1,536 participants with baseline prediabetes, significantly more achieved normoglycaemia at week 68 with semaglutide compared to placebo with 36.3%, 34.5%, and 19.4% higher reversal rate with semaglutide compared to placebo in STEP 1, 3, and 4 respectively.
2. The 2023 study 71-LB: Tirzepatide Reduces the Predicted Risk of Developing Type 2 Diabetes in People With Overweight/Obesity With and Without Prediabetes demonstrated that the 10 year risk of developing type 2 diabetes went down significantly with tirzepatide, at 13%, 17% and 18% risk reductions at 5mg, 10mg, and 15 mg dosages respectively for 987 participants who had prediabetes. The risk reduction was 11%, 12%, and 12% for 1,552 participants who did not have prediabetes. So there was significant risk reduction of developing type 2 diabetes for all participants, regardless of prediabetes status.
3. The 2021 study Once-Weekly Semaglutide in Adults with Overweight or Obesity showed that “weight loss with semaglutide [at a dose of 2.4 mg] was accompanied by greater improvements than placebo [for] cardiometabolic risk factors, including reductions in waist circumference, blood pressure, glycated hemoglobin levels, and lipid levels; a greater decrease from baseline in C-reactive protein, a marker of inflammation; and a greater proportion of participants with normoglycemia. [...] Statistical superiority of semaglutide over placebo was achieved for all end points in the hierarchical testing procedure.”

These studies all show that using semaglutide or tirzepatide alongside the lifestyle interventions significantly reduces the risk of progressing to diabetes type 2.

Preventing the progression of prediabetes to type 2 diabetes should be taken seriously

I have prediabetes and so do 38% of all Americans. That’s 1 in 3 Americans. Scarily, 80% of people with prediabetes don’t know they have it.

Given that prediabetes is one of the precursors to heart disease, the biggest cause of death in the US and the world, we should take it seriously and prevent it if possible. GLP-1s and GIPs give us a way to do just that, and in a more effective way than through lifestyle interventions alone.