Saxenda might be one of the best weight loss medications that exist on the market right now.
But just because it might work doesn't mean it's necessarily right for your body.
Saxenda works because it alters many hormone systems in your body that tend to interfere with your appetite, metabolism and even other hormones.
In this post, I will walk you through how Saxenda helps with weight loss and who should consider using this new medication.
Let's jump in:
First, let's start off by establishing that Saxenda does indeed work for weight loss.
The studies are clear on this matter (1):
Many studies have shown that patients using Saxenda lose significant amounts of weight over several weeks (usually around 10% body fat).
That means that using this medication might help you lose up to 20 pounds if you weighed 200 pounds.
At first, that doesn't sound very good, but it's actually quite impressive if you consider that this weight loss is achieved generally without any other therapies added.
And that's where things get interesting.
If you have an understanding of weight loss and how hormones influence your weight, you can benefit even more from using this medication.
Because it can safely be combined with other therapies that ALSO increase your weight loss efforts and together this can result in dramatic weight loss.
We will talk about those therapies in just a minute but for now, let's discuss why Saxenda actually works...
Saxenda is a medication that falls into the GLP-1 agonist class of drugs.
GLP-1 stands for Glucagon-like peptide 1 and that's where Saxenda has its primary action.
Saxenda (or Liraglutide which is another name for this medication) sits on this receptor and causes changes to very important hormones involved in regulating body weight: insulin, leptin, and glucagon.
Liraglutide was originally developed to treat type II diabetes because it can help reduce insulin resistance but was soon found to have a dramatic effect on weight.
Because of this, the makers of Liraglutide (or Victoza as it is called if used to treat type II diabetes) came out with a new name (saxenda) which is now FDA approved for weight loss.
If you've been following my blog you know that I am a big fan of GLP-1 agonists and that I use them effectively for weight loss (to help patients lose 50+ pounds).
You can read about the case studies here and here - which include before and after pictures.
So, naturally, I am a big fan of the GLP-1 agonists, but in order to get the kind of results you see in those case studies, it has to be used CORRECTLY and combined with other therapies.
Simply taking Saxenda will help you lose some weight by itself, but it won't get you back to your ideal or normal weight by itself (you will have to add other therapies to get there).
I will talk about the downside of using Saxenda below, but for now, let's talk about HOW it works.
First, and probably most important, is that GLP-1 agonists help lower leptin resistance.
You may not even realize it, but when it comes to weight loss leptin is probably the single most important hormone for determining if you will lose weight and how much weight you will lose.
Leptin is also responsible (at least in part) for the weight gain after rapid weight loss.
What happens is something like this:
You go on a calorie restricted diet which helps you lose 20 pounds or so within a matter of 30-60 days.
Your body senses this rapid weight loss and makes changes to your hormones to INCREASE your appetite and LOWER your metabolism to compensate.
The hormone responsible for this is Leptin.
Leptin levels then spike which causes your body to regain that weight that you previously lost (2), but in the process, you have damaged your metabolism slightly (not good).
Repeating this process over and over causes worsening leptin resistance and make it so that you are unable to lose weight even if you try excessive dieting or calorie restriction.
Leptin is probably one of the more important hormones involved in weight management and it's also probably the most neglected.
Until recently we didn't really have a way to treat leptin resistance even though most Doctors recognized that it was involved in many cases of obesity in the US.
So where does Saxenda fit in?
Studies have shown that Liraglutide (Saxenda or Victoza) does two important things related to Leptin and leptin resistance (3):
These effects seem to be mediated through receptor changes by the GLP-1 agonist and on the leptin receptor.
Either way, the result is the same:
This medication helps reduce leptin resistance and can help lower leptin levels.
This changes the biochemistry in your body and helps to naturally reduce your appetite, increase your metabolism and increase fat burning capacity.
This change alone is probably why GLP-1 agonists are so effective for weight loss, but they have more benefits beyond their effects on leptin.
You can find more information in my hormone and weight loss guide to find exactly how I use GLP-1 agonists, how to manage your diet to control leptin levels and much more here:
Saxenda also helps reduce insulin resistance.
Insulin resistance is the root cause of type II diabetes mellitus and insulin is responsible for the majority of the negative consequences associated with that disease.
What you may not realize is that insulin resistance is incredibly common in the US.
It's estimated that up to 50% of the population has some degree of insulin resistance and, by lab testing, show signs of diabetes or pre-diabetes.
Insulin is also a very important hormone involved in the weight loss equation.
When insulin levels are high it's almost impossible for your body to burn fat (4).
Because insulin blocks the action of an enzyme called hormone-sensitive lipase.
This hormone is responsible for turning on "fat burning mode" and in the presence of high insulin, this enzyme is always on the "off" setting.
This is obviously a big problem if you are trying to lose weight.
In addition to preventing your body from burning fat as an energy source insulin also has the added problem of promoting fat storage.
This means that if you consume calories (from any source) these calories will be stored as fat in the presence of high levels of circulating insulin.
This is true even if you are consuming a low-calorie diet.
Insulin doesn't care how many calories you are consuming, it cares about storing whatever you eat as fat.
So how does Saxenda work?
Saxenda helps sensitize the body to insulin levels and helps to lower blood glucose levels in the process.
Using Victoza (especially when combined with the right diet, exercise, and supplements) can dramatically reduce fasting insulin levels and also fasting blood glucose levels.
The positive effects of reducing insulin also significantly help to improve other hormones in the body.
Insulin resistance can cause low testosterone (in men) and high testosterone (in women).
When you treat insulin levels these hormone imbalances tend to improve which will naturally result in weight loss and a reduction in symptoms associated with THOSE imbalances.
Glucagon is another hormone which is important for weight loss, but one that is less understood than insulin or leptin.
Over the next 5-10 years we will see a lot more research done on this hormone and how it relates to weight loss, but for now, we can talk about what we already know.
Glucagon is basically the exact opposite of insulin - in terms of how it alters blood glucose levels.
Insulin lowers blood sugar levels while glucagon helps increase blood sugar levels.
How does this relate to weight loss?
It turns out that in order to help burn fat in the body, your body must naturally deplete liver glycogen stores and have low enough insulin levels to promote hormone-sensitive lipase to activate.
In states that cause insulin resistance, there is also some degree of hyperglucagonemia - and this states promotes consistently high levels of glucose.
High glucagon also seems to interfere with normal glucose control which alters how your body burns energy.
Saxenda and other GLP-1 agonists help reduce glucagon levels(5) while simultaneously reducing insulin resistance.
Both of these changes promote more normal blood glucose levels and help promote proper liver metabolism of glucose and help adipose tissue burn fat.
This is also why GLP-1 agonists are so helpful for patients with type II diabetes.
Glucagon is just as important (if not more important) in the regulation of glucose levels in the body.
Our current focus is on insulin and how it manages glucose levels and we generally completely ignore glucagon and its effects.
But if you treat both insulin AND glucagon levels, you can get a much more normal glucose level and finally promote weight loss and fat burn.
Another benefit of using Saxenda is how it alters your appetite.
You've been conditioned to believe that your weight is the product of how many calories you burn minus the number of calories you consume.
Conventional wisdom would have you believe that reducing your total calories will always result in weight loss, provided you burn more calories than you consume.
Weight loss, in general, happens to be much more complex than this seriously oversimplified and inaccurate equation, but, nonetheless, here we are.
So here's the deal with appetite and Saxenda...
One of the side effects of Saxenda is slight nausea, and this is felt to occur due to how GLP-1 agonists alter gastric motility (6).
These medications slow down the gastrointestinal motility which means that your gastric contents empty more slowly.
This can result in symptoms such as reflux, and distention of the stomach which manifests as nausea.
Pretty much anything that tells your body that your stomach is full will also promote a reduction in appetite - this is natural and normal.
But, how does appetite impact weight loss?
Well, you do need SOME degree of calorie restriction to result in weight loss (but this should NOT be constant calorie restriction) and this calorie restriction from the loss in appetite is actually welcomed in this case.
The reason this appetite suppression is GOOD, is because it's also accompanied by the attenuation of leptin levels.
What this means is that you can lose the weight by reducing your appetite, and instead of your body responding with increased leptin levels, the saxenda actually blocks that rise.
So you get the benefit of both worlds:
Appetite suppression that does NOT result in your weight being regained AND suppression of leptin levels at the same time.
THIS is why appetite suppression is good in this case.
Saxenda also seems to have an effect on increasing your basal metabolic rate.
Your metabolism is probably one of the most important aspects involved in weight loss.
Because your basal metabolic rate, or resting energy expenditure, is responsible for the MAJORITY of calories that you burn.
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