E90: Obesity Medicine: GLP-1 Contraindications, Adverse Effects, and What To Do About It

Let's start off with contraindications.

So contraindications is something that the drug's label puts out.

Let's go over what they are.

First one is a personal medical history or a family medical history in a first degree relative of medullary thyroid cancer or MEN2A or MEN2B.

MEN is multiple endocrine neoplasm.

that is an exceptionally rare disorder.

I've never seen it before.

And I wonder if even how many, how many endocrinologists have seen it? Like, I don't know, have they all seen it at least once? It's pretty rare.

Um, there was a, there's a theory that Abraham Lincoln may have had.

I don't even know if it was men to A or B there's, there's other, there's a, there's a, there's like three, there's a third men, I believe.

And, uh, you know, he, he had the, uh, I guess they think that he may have had his body habitus was indicative of one of the symptoms of and i can't remember what it's called it's the one where you're you have the caved in chest and you're tall and lanky um they think that he had that and he may have had that as a part of one of these men disorders so but we can't know because no we didn't know that the disorder existed when he was alive but It's not a very common disorder, but the reason why MEN2A and MEN2B are mentioned is because medullary thyroid cancer is one of the cancers that is seen in those disorders.

So, or it's...

You may not have had medullary thyroid cancer.

The multiple multiple endocrine neoplasm means lots of different cancers.

And so you may have had, you know, you may have this disorder, but you haven't had medullary thyroid cancer.

But that's one of the cancers you can get with this disorder.

So you're like exceptionally high increased risk of getting that.

And so.

there's a black box warning on this.

So if you've had medullary thyroid cancer, MN2AB, or a first degree relative has, can't take a GLP-1.

This is the only black box warning.

And it's also, I'd say a little bit contra, sorry, the word, but it's not necessarily that this would even be a risk, okay? So let's see why we think it might be a risk.

Why is it a black box warning? so when they were testing these medications on rodents specifically the rag the liraglutide which is sex center or victosa when this was being tested on rodents back before you know these drugs didn't even really exist um they got this kind of cancer and it was at increased risk versus you know the ones that didn't get it so Rodents actually have GLP-1 receptors on C cells in their thyroid.

And humans, I was actually, I listened to a lecture by the person who discovered GLP-1s in the Gila Monster.

It's a Danish scientist, I think, that worked for Novo Nordisk, who came up with the first medications, because Novo Nordisk is a Danish company.

Let's start off with contraindications.

So contraindications is something that the drug's label puts out.

Let's go over what they are.

First one is a personal medical history or a family medical history in a first degree relative of medullary thyroid cancer or MEN2A or MEN2B.

MEN is multiple endocrine neoplasm.

that is an exceptionally rare disorder.

I've never seen it before.

And I wonder if even how many, how many endocrinologists have seen it? Like, I don't know, have they all seen it at least once? It's pretty rare.

Um, there was a, there's a theory that Abraham Lincoln may have had.

I don't even know if it was men to A or B there's, there's other, there's a, there's a, there's like three, there's a third men, I believe.

And, uh, you know, he, he had the, uh, I guess they think that he may have had his body habitus was indicative of one of the symptoms of and i can't remember what it's called it's the one where you're you have the caved in chest and you're tall and lanky um they think that he had that and he may have had that as a part of one of these men disorders so but we can't know because no we didn't know that the disorder existed when he was alive but It's not a very common disorder, but the reason why MEN2A and MEN2B are mentioned is because medullary thyroid cancer is one of the cancers that is seen in those disorders.

So, or it's...

You may not have had medullary thyroid cancer.

The multiple multiple endocrine neoplasm means lots of different cancers.

And so you may have had, you know, you may have this disorder, but you haven't had medullary thyroid cancer.

But that's one of the cancers you can get with this disorder.

So you're like exceptionally high increased risk of getting that.

And so.

there's a black box warning on this.

So if you've had medullary thyroid cancer, MN2AB, or a first degree relative has, can't take a GLP-1.

This is the only black box warning.

And it's also, I'd say a little bit contra, sorry, the word, but it's not necessarily that this would even be a risk, okay? So let's see why we think it might be a risk.

Why is it a black box warning? so when they were testing these medications on rodents specifically the rag the liraglutide which is sex center or victosa when this was being tested on rodents back before you know these drugs didn't even really exist um they got this kind of cancer and it was at increased risk versus you know the ones that didn't get it so Rodents actually have GLP-1 receptors on C cells in their thyroid.

And humans, I was actually, I listened to a lecture by the person who discovered GLP-1s in the Gila Monster.

It's a Danish scientist, I think, that worked for Novo Nordisk, who came up with the first medications, because Novo Nordisk is a Danish company.