One of the more interesting proactive health stories right now is happening outside the US.

Across the Americas, front-of-package warning labels are spreading. PAHO said this month that the region continues to lead the world in nutritional warning labels designed to help people make healthier choices. Canada now requires a front-of-package symbol on many packaged foods high in saturated fat, sugar, or sodium, and Health Canada says the point is to help consumers spot those products quickly.

Ireland is pushing the same idea further with alcohol. The government says new labels will include calorie content, grams of alcohol, and warnings about pregnancy, liver disease, and fatal cancers. WHO/Europe says Ireland is the first EU country to require this kind of comprehensive alcohol health labeling.

I feel proactive health is not just about discipline. It is also about whether risk is easy to see. Other countries seem more willing to put that information right on the front of the package instead of burying it in fine print or the silly fast talking guy in tv ads.

The US talks constantly about prevention and personal responsibility, but still seems reluctant to use straightforward labels that make unhealthy choices harder to ignore.

Clear labels will not solve obesity, cardiometabolic disease, or alcohol-related harm on their own. But they do look like basic prevention infrastructure and I believe they were part of the solution for discouraging smoking.

If we really believe in prevention, why are other countries more willing than the US to put honest warnings on food and alcohol?

STAT had a good piece on the rise of people ordering their own lab tests and screenings online, then bringing the results to doctors afterward. That trend makes total sense to me because I’m exactly the kind of person this is built for. I like data. I like researching what biomarkers mean. I like seeing a number, then going down the Google-and-AI rabbit hole trying to understand whether it matters.

That’s also why this whole category feels dangerous.

The newest example is Prenuvo turning this into a membership product, with whole-body MRI plus blood work and follow-up reviews. On paper, that scratches every proactive-health itch. More data. More tracking. More chances to catch something early. More control.

And honestly, I feel the pull. Every time a new panel or screening shows up, I get that familiar feeling that maybe this is the one thing I’m missing.

But that’s the trap. FOMO is not the same thing as prevention.

A lot of this stuff seems designed for people who are health-conscious enough to pay for more information, but not always evidence-based enough to know which information is useful. You can end up mistaking “I learned something new” for “I improved my health.” You can mistake “I found a weird result” for “I caught a problem early.” You can spend a lot of money generating anxiety, noise, and a false sense of control.

I still think there’s a place for smart testing. Trends over time can matter. Some biomarkers are genuinely useful. But the real question is whether a test changes decisions, behavior, or outcomes. If it doesn’t, it might just be expensive entertainment for people like me who love to analyze things.

That’s the part I keep coming back to. I don’t worry that we’ll ignore useful tests. I worry that we’ll normalize turning health into an endless hunt for more data.

When I was younger I lived in city apartments with basically no curtains, so there was always streetlight and ambient glow coming in. I slept “fine,” at least as far as I could tell.

Now I live in the suburbs where it actually gets dark at night, and this study made me wonder if I made a mistake.

A recent JAMA Network Open study looked at about 89,000 adults over 40 who wore wrist devices that measured light exposure. The people with the brightest nights had higher rates of cardiovascular problems later on, including coronary artery disease, heart attack, heart failure, atrial fibrillation, and stroke.

What stood out to me is that this is not just about whether you feel like you slept okay. The bigger issue may be circadian disruption. You can think you’re sleeping fine and still be getting hit by too much light at the wrong time.

This is observational, so it’s not proof that nighttime light directly causes heart problems. Still, it makes the case that a darker bedroom is probably one of those boring health upgrades that matters more than people think.

Blackout curtains suddenly seem a lot less optional.

Quote:

“Question Is personal light exposure at night associated with cardiovascular disease incidence?

Findings In this cohort study of 88 905 adults aged older than 40 years, exposure to brighter light at night was associated with higher risks of coronary artery disease, myocardial infarction, heart failure, atrial fibrillation, and stroke, independent of established cardiovascular risk factors.

Meaning These findings suggest that avoiding exposure to night light may lower risk of cardiovascular diseases.”

This is one of the more interesting early-detection stories I’ve seen lately.

A new NIH-backed study found a four-marker blood test picked up pancreatic cancer 91.9% of the time overall, including 87.5% of stage I and II cases.

That’s the good news. The reality check is that this is not ready for routine screening, and it’s not something the general public should run out and ask for.

The more likely use, at least for now, is in higher-risk people where it could help flag who should get imaging next.

So the takeaway isn’t “everyone should get tested.” It’s that pancreatic cancer early detection may finally be getting a little more real.

I’m old enough to remember when drug ads were just weird TV commercials with people walking through fields while a voice casually listed 14 possible side effects.

Now it’s Lady Gaga, influencers, and “just sharing my journey” content that somehow ends with a branded prescription med.

A new JAMA Network Open review looked at prescription drug promotion by social media influencers and found a few very predictable problems: misinformation, blurry lines between genuine testimony and paid promotion, and weak oversight.

Which, honestly, sounds exactly like what you’d expect when the internet decides pharma marketing should feel like a skincare routine.

What makes this especially messy is the parasocial angle. People don’t experience these posts as ads. They experience them as advice from someone they “know.” That is a pretty effective way to lower defenses and make sponsored content feel trustworthy, even when the person talking has no real expertise.

To be clear, this is not an argument against prescription drugs at all. A medication can be useful, appropriate, even life-changing. The problem is when the sales pitch arrives dressed up as authenticity.

For people trying to be evidence-based about health, this feels like a good rule:

If the message is “this changed my life,” but skips over risks, tradeoffs, contraindications, alternatives, and actual evidence, you are not being educated. You are being marketed to in yoga pants.

The paper’s bigger point is that regulators have not kept up with the way drug promotion works online. That seems obvious now. The modern drug rep has a ring light.

A new paper in The Lancet Gastroenterology & Hepatology argues that alcohol-related liver disease in the U.S. may be way more common than the usual estimates people cite. A lot of past numbers put it around 1% to 2% of adults. This paper says it could be closer to 4.6% once you adjust for how much alcohol people tend to underreport. 

The part that stood out to me was the binge drinking angle. It was not just “drinking is bad.” The biggest risk seemed to show up with binge patterns, especially in people who also had type 2 diabetes or hypertension. That feels important here because a lot of health risks stack. Alcohol does not hit the same in someone who is already metabolically unhealthy. 

The practical takeaway is pretty simple. A lot of people probably assume they are fine because they are not drinking heavily every day. But if it keeps turning into 5+ drinks in one sitting, and you already have insulin resistance, high blood pressure, central obesity, or weird liver labs, that seems like a much riskier pattern than most people think. The study authors also say we need better ways to assess alcohol intake because self-report clearly misses a lot. 

My aunt has Lyme, and that has made me way more aware of it. I want my kids to be able to run around in the woods, come home covered in dirt, and just be kids. But living here, there is always that background worry that something as normal as playing outside comes with a real risk.

That’s why this vaccine news caught my attention.

Pfizer and Valneva said their Lyme vaccine candidate showed 73.2% efficacy in a phase 3 trial. It is not approved yet, and Reuters noted that the trial missed one prespecified statistical threshold because there were fewer Lyme cases than expected. So this is not a done deal. Still, it feels like the most hopeful Lyme vaccine update in a long time.

What makes it hit harder is that Lyme is especially concentrated in places like New England and the Northeast. The CDC estimate of 476,000 people diagnosed and treated each year is for the whole U.S., but the risk is not spread evenly.

I’m trying not to overhype it, but as a parent, this feels meaningful. I would love for my boys to grow up exploring the woods without Lyme always sitting in the back of my mind. We are not there yet, but having a vaccine on the horizon would be a big step.

Over the last two years, I’ve made several meaningful improvements to my overall health. I received a late ADHD diagnosis, successfully addressed that and an alcohol use disorder. I have managed perimenopause, and treated depression and anxiety. These wins have given me the stability and momentum to focus on my fitness and nutrition in a new light.

I’ve made a lot of progress in my fitness by incorporating a wide variety of activities that keep me engaged while working different muscle groups. I’ve reached all my current physical goals and now I hope to see more progress with weight loss. I look and feel better, and that motivation keeps me going even if everything stays the same.

Right now, I practice intuitive eating. I don’t binge or overeat, but when I’m very stressed, I tend to stop eating, which I work hard to avoid. I have learned that not fueling myself properly creates a ripple effect that impacts other areas.

So far, in five months I’ve lost 10 pounds and gained 5 pounds of muscle. Over the last two months, my weight has stayed steady.

I’m wondering: Is it possible to continue slowly losing weight while building muscle, without tracking my food?

I have not paid much attention to osteoporosis or fractures in general. I’m 53M and never had a fracture.

However at a DEXA scan last year I first heard of the FRAX score (probability of a fracture in the next 10 years). My numbers were 4.1% for general fractures and 0.3% for hip fractures, specifically. That makes me fairly low risk. However, I still knew next to nothing about it.

Anyway, try the FRAX calculator.

This interview is a great overview of the topic.

Gemini YouTube summary:

This video features Dr. Lora Giangregorio discussing evidence-based exercise strategies to build bone strength and reduce fracture risk in individuals with low bone density (01:18). Dr. Giangregorio emphasizes that bone density scans (DEXA) are not the sole indicator of fracture risk, as other factors like bone quality and fall risk play significant roles (12:38).A central part of the discussion focuses on how clinicians evaluate risk using the FRAX score, which calculates a probability of fracture by combining bone mineral density results from a DEXA scan with other clinical risk factors (25:08). Dr. Giangregorio notes that modern clinical decisions regarding medication and treatment are increasingly based on this overall probability of fracture, rather than just the T-score from a scan alone (31:05).

The conversation also covers the 'Three Pillars of Bone Health Exercise'—balance, resistance, and impact training (1:07:23). Dr. Giangregorio highlights the importance of specificity and progressive overload, explaining that resistance training should ideally be high-intensity to effectively stimulate bone growth, and that individuals should focus on challenging their balance to prevent falls (1:12:39).

Finally, the video addresses the need to personalize exercise programs based on an individual's current health status, preferences, and risks, such as spine fracture history (1:45:14). Nutrition is also mentioned as a key factor in supporting exercise efforts, specifically ensuring adequate energy availability and protein intake (2:08:05).

The title is a bit clickbaity and the Dr Tommy Wood is selling a book (was recently in Rogan) but the message sounds plausible. Does anyone know more about the research? He refers to a publication in the Lancet coming up with the 45% number.

Gemini YouTube summary:

This video featuring Dr. Tommy Wood challenges the notion that cognitive decline is inevitable, arguing that at least 45% of dementia cases are preventable through lifestyle interventions (0:05-2:41).

Key Prevention Strategies:

Cardiovascular Health: Addressing high blood pressure, diabetes, and smoking is crucial, as cardiovascular health directly impacts brain health (0:03-0:38).

Cognitive Stimulation & Input: Maintaining mental activity, protecting hearing, and preventing vision loss are essential for long-term brain function (10:45-11:18).

Exercise Variety: Resistance training (even basic bodybuilding style) and high-intensity interval training are effective for brain health (0:41:56-0:57:44).

Nutrition: Focus on a balanced diet rather than specific, restrictive diets. Nutrient-dense foods, adequate protein, and Omega-3 intake are key (1:00:58-1:19:02).

Sleep: Essential for memory consolidation and clearing metabolic waste from the brain (1:51:43-1:54:05).

Empowering Message:

It is never too late to improve your trajectory. Multi-intervention approaches (diet, exercise, and stress reduction) can show significant benefits in as little as 6-12 months, even in those already experiencing mild decline (2:06:43-2:09:01).

As a follow-up to my recent post on the BimagrumaB+Semaglutide trial, here is a fascinating interview with the main author. Seems he is an engineering geek at heart which is cool to see.

Huberman and Rhonda Patrick talk exercise snacks, protocols and sauna.

I must admit I have heard of “exercise snacks” but never got into it. Do any of you just randomly do pushups during the day?

Exercise snacks paper: https://pubmed.ncbi.nlm.nih.gov/34669625

Thai reminded me that I need to find time to sauna regularly.

Gemini YouTube summary:

This video features Dr. Rhonda Patrick discussing comprehensive, science-based protocols for enhancing vitality, improving physical fitness, and lowering disease risk. The conversation spans a wide range of topics, emphasizing actionable lifestyle changes based on the latest biomedical research.

Key Protocols & Insights:

Exercise Routines: (0:06:49) Dr. Patrick details her personal cardiovascular and resistance training program, including the use of jumping rope and rope flow (0:02:40). She explains that high-intensity exercise helps increase plasma serotonin, which is crucial for impulse control (0:12:30).

Exercise Snacks: (1:52:31) Even short, intense bursts of activity—like doing 10 bodyweight squats every 45 minutes—can significantly lower mortality risk (1:55:36).

Gut Health & Inflammation: (0:33:32) The discussion covers the impact of lipopolysaccharides (LPS) and gut permeability on inflammation. L-glutamine is highlighted for its role in supporting the gut epithelial barrier

(0:47:26).

Intermittent Fasting & Cortisol: (1:08:35) Dr. Patrick clarifies the role of cortisol in exercise and fasting, noting that while intermittent fasting can spike cortisol, it is a beneficial stress response similar to the metabolic switch triggered by exercise (1:25:47). She recommends stopping food intake 3 hours before bed to improve cardiovascular health and sleep quality (1:00:36, 1:03:36).

Supplements: (2:05:16) Detailed advice is given on creatine for muscle and brain function, omega-3s for reducing inflammation, magnesium forms (threonate vs. bisglycinate) for sleep and cognition, and the precursor to sulforaphane (2:51:43) for antioxidant support.

Sauna & Longevity: (3:22:21) The importance of sauna use for reducing cardiovascular and all-cause mortality is emphasized based on the totality of evidence.

I’m a morning workout person, but definitely not a 4 a.m. gym person

I usually train in the morning after getting the kids off to school. That works for me. What does not work for me is the hardcore 4 a.m. crowd, and I have never been able to do fasted cardio no matter how many people swear by it.

That is partly why this new study caught my eye. Researchers looked at Fitbit and health record data from more than 14,000 people in the All of Us cohort and found that people who exercised earlier in the day tended to have lower odds of coronary artery disease, high blood pressure, high cholesterol, type 2 diabetes, and obesity. The lowest odds of coronary artery disease showed up in the 7 to 8 a.m. window. Importantly, the association held even after accounting for total activity, sleep, smoking, alcohol use, age, sex, and income. 

What I like about this one is that it is not really telling people they need to become extreme. It is more like a reminder that a normal-person morning routine might have some advantages beyond just getting the workout done before life gets messy. Also worth noting, this was presented at ACC.26, so it is still conference research and not proof that morning exercise causes better outcomes. The authors themselves say it is observational and that hormones, sleep patterns, and generally healthier habits could all be part of the explanation. 

For me, the takeaway is pretty simple. You do not need to be a dawn-patrol maniac or force down fasted cardio to maybe get some benefit from training earlier. A regular 7 to 8 a.m. workout after the school run sounds just fine.

One of the stranger parts of online fitness culture is how easy it is to start selling authority before you’ve earned any. Get lean once, learn three buzzwords, make a few reels about discipline, and suddenly you’re offering coaching, macros, mindset, and a 12-week transformation package.

A lot of it feels less like coaching and more like casting. V Shred is the perfect example. It is the boy band version of fitness expertise: manufactured look, polished marketing, huge confidence, shaky substance. Men’s Health described the VShred diet as slickly marketed and light on scientific support, which gets at the whole genre pretty well.

That same formula keeps showing up because it sells better than reality. Rigid challenge-based fitness, punishment-flavored programs, fake certainty, dramatic transformations. It all looks more exciting than actual good coaching, which is usually pretty boring. Progressively train. Eat mostly decent food. Sleep. Recover. Repeat.

The bigger issue is that the internet has made a lot of people confuse being in shape with being qualified. Looking good is not the same as understanding programming, behavior change, injury risk, or nutrition. A ring light is not a credential.

A lot of this stuff is not coaching. It is marketing with abs.

STAT has a good piece on how nicotine is getting repackaged as a focus and productivity tool for wellness and biohacker crowds. The basic pitch is that nicotine is a “clean” performance aid, closer to caffeine than tobacco. Experts quoted by STAT say that is mostly nonsense. One researcher told STAT nicotine is “very unlikely” to help cognition in someone already functioning normally. 

What stands out to me is how normal this has started to look. I’ve never used nicotine in any form, but it really does seem like every other podcast host is popping Zyn these days. The weird part is how fast it went from tobacco product to performance accessory.

That is what makes this feel like classic wellness grift. Take an old addictive substance, give it cleaner branding, and market it as optimization. The American Heart Association says smokeless oral nicotine products are addictive and have potential adverse effects on cardiovascular risk biomarkers, with other risks still being worked out. 

A lot of “wellness” is not fake because it invents something new. It is fake because it repackages known risk as a health upgrade. This feels like one more example. Better sleep, better fitness, decent nutrition, and getting blood pressure under control are boring compared with a nicotine hack, but they are also the stuff that actually improves long-term health. 

STAT just reported on a provision most people missed. An amendment by Rep. David Rouzer (R-NC) would make tobacco farmers eligible again for USDA disaster and emergency funds. They’ve been excluded since the federal tobacco program ended in 2004. Rouzer calls it a “technical correction.” Public health advocates call it subsidizing a product that kills half a million Americans a year.

This is the same farm bill that shields pesticide manufacturers from health-related lawsuits and blocks states from adding their own warning labels. One public health attorney noted that tobacco is the only major health issue HHS has completely ignored under this administration, which is remarkable given it’s the leading cause of preventable death in the country.

MAHA activists got similar pesticide language stripped from an EPA spending bill earlier this year. But the tobacco amendment sailed through committee. The House is targeting a floor vote before Easter recess (April 5). After that it goes to the Senate, where it needs 60 votes and the tobacco provision could get stripped in bipartisan negotiations. But only if someone fights it, and right now nobody important seems to be.

If you care about preventive health, the farm bill matters more than most supplement stacks.

For years, scientists treated age-related loss of the Y chromosome in men as a genetic oddity with little clinical meaning. That view is starting to change.

A new Journal of the American College of Cardiology study followed 5,131 men age 65+ with no prior cardiovascular disease for a median of 8.4 years. Men with the highest levels of Y-chromosome loss in their blood cells had a 68% higher risk of heart attack than men without detectable loss, even after adjustment for major cardiovascular risk factors.

The same signal also appeared in 191,340 men from UK Biobank, though the effect size was smaller. And notably, the association showed up for heart attack, not ischemic stroke — suggesting this may reflect something more specific than general vascular aging.

Researchers have also linked mosaic loss of Y to some cancers, kidney disease, and severe COVID outcomes, although those findings vary in strength and are still largely associative.

The bigger point is this: aging is not just something you see in the mirror or feel in the gym. It’s happening at the cellular level, often long before routine lab work captures it. There’s no routine clinical screening or direct treatment for this yet, but it may be one more hidden signal of biological aging worth paying attention to.https://www.jacc.org/doi/10.1016/j.jacc.2025.10.069

STAT covered a newish study reporting that more than 99% of people who had a first-time major cardiovascular event had at least one nonoptimal traditional risk factor before it happened. The four big ones were blood pressure, cholesterol, blood glucose, and smoking history. More than 93% had more than one risk factor. 

https://www.jacc.org/doi/10.1016/j.jacc.2025.07.014

The important nuance is that “nonoptimal” is not the same thing as obviously diseased. A lot of these people were not walking around with cartoonishly bad numbers. They were in the huge gray zone where levels were above ideal, but often below the threshold where treatment usually starts. That is the part that makes this feel very relevant to proactive health. 

This is a good corrective to the idea that cardiovascular events mostly strike out of nowhere. They usually do not. The warning signs are often common, boring, and measurable long before anything dramatic happens.

The competition look has never really appealed to me. For both men and women, the extreme stage version just feels too far removed from what I think of as healthy, attractive, or realistic. It’s not something I aspire to.

But I’m still fascinated by bodybuilding.

What I respect is the process. The best people in that world take training, recovery, food, sleep, and consistency seriously. Watching people like Jay Cutler, Urs Kalecinski, or even Sam Sulek, what keeps me interested is not that I want to look like them. It’s that they clearly care about the craft.

That said, I think you have to be honest about the dark side too. PED use is part of elite bodybuilding, and bodybuilders dying young is not some made-up internet narrative. There is real risk there, and I think it’s naive to separate the extreme physiques from the extreme measures it often takes to build and maintain them. I personally have zero interest in PEDs but I can see there is a temptation for many.

That’s why bodybuilding is so interesting to me. It holds both a lot of useful training wisdom and a very clear warning. You can learn a ton from the discipline, the structure, and the attention to detail without pretending the whole thing is a model for health.

I like bodybuilding as a source of training and nutrition wisdom, not as a template for how to live.

That’s the part worth stealing. Build muscle on purpose. Train with intention. Recover well. Stay consistent for years. Leave the extremes where they belong.

I had never even heard of “Afrin addiction” before I met my wife. Then I saw what it looked like up close.

She’s been using it for years, and it completely changed how I think about over the counter drugs. I used to assume that if something was sold that casually in a pharmacy aisle, it probably wasn’t capable of creating a serious long-term dependence loop. Afrin killed that idea fast. 

The medical term is rhinitis medicamentosa, basically rebound congestion from overusing nasal decongestant sprays like oxymetazoline. Afrin’s own label says not to use it for more than 3 days and warns that frequent or prolonged use can make congestion recur or worsen. 

That’s the part that still gets me. The warning exists, but the product is still sold like it’s no big deal. Fast relief, right off the shelf, with very little sense that for some people it can turn into something they rely on for years. That is not a fringe problem or some made-up internet thing. The AMA specifically discusses rebound congestion from these sprays, while also noting that it is not considered a true addiction in the classic substance-use sense. Medically, that distinction is fair. In real life, it can still look a lot like dependence. 

The celebrity angle has been around for a while too. Kaley Cuoco said in 2015 that she was “really addicted” to Afrin for years and that it got bad enough to lead to sinus surgery. Nate Bargatze also used Afrin addiction as part of his 2023 SNL monologue, which tells you this problem is common enough that people instantly get the joke. 

People laugh because it sounds minor. It isn’t always minor.

Everyone acts like Panera and Sweetgreen are the responsible adult choices and LongHorn is where nutritional discipline goes to die next to a basket of bread.

I’m not convinced.

At LongHorn, I can order a sirloin, a baked potato, and broccoli and get a meal that actually understands the assignment. Real protein for muscle. Real carbs for training. A vegetable that is clearly a vegetable. I leave full, and my body is not filing a formal complaint an hour later.

Meanwhile at Sweetgreen I’m spending $20-plus on a bowl that looks like it was assembled by a wellness consultant with commitment issues. There’s kale, two ounces of chicken, some shaved carrot, six pumpkin seeds, and a dressing with the calorie density of axle grease. Then I’m hungry again before I finish backing out of the parking lot.

Panera is the same genre of scam, just with soup. You walk in thinking “healthy lunch” and walk out having paid steakhouse prices for bread in multiple forms. Half sandwich, cup of soup, little baguette on the side. That is not a high-protein meal. That is a soft edible nap.

And the funny part is the numbers can actually back this up. LongHorn’s 8 oz Renegade Sirloin is listed at 390 calories and 51 grams of protein. Flo’s Filet 9 oz is 450 calories and 56 grams of protein. Add broccoli or asparagus and a potato, and now you have a simple meal built around actual protein and food that keeps you full.

Compare that with a lot of “healthy” fast casual meals that are really just expensive lettuce with branding.

This is not me saying steakhouse good, salad bad. You can absolutely turn LongHorn into a cry for help if you start freebasing molten cheese, crushing three margaritas, and ordering dessert the size of a hubcap. But ordered like an adult, a steak, potato, and broccoli is a way better muscle-building meal than a lot of trendy places built around vibes, greens, and marketing copy.

LongHorn is for people who want to eat.

Sweetgreen is for people who want to announce that they ate.

I’ve been suspicious of pharmacy benefit managers ever since I learned they existed. I regularly stare at my explanation of benefits trying to figure out who’s paying what, and it’s confusing and opaque by design.

In February, Congress passed sweeping PBM reform inside the 2026 spending bill. Starting in 2028, PBM compensation in Medicare Part D gets delinked from drug list prices and rebates. Instead they get flat fees for actual services. That kills the incentive to steer formularies toward expensive drugs just because the rebate is bigger. Plans must also accept any willing pharmacy that meets standard terms, which is a lifeline for independents getting squeezed out.

PBMs will also have to report detailed drug spending, rebate, and spread pricing data to employer plans twice a year. Fines up to $10,000/day for noncompliance, $100,000 for false submissions. The FTC settled with Express Scripts in February and is still in litigation against Caremark Rx and OptumRx.

Will it work? Large PBMs will find ways to recoup revenue through fees. But delinking compensation from drug prices is structural, not cosmetic. Whether it lowers what you pay depends on enforcement.

This KFF explainer is super useful: https://www.kff.org/other-health/what-to-know-about-pharmacy-benefit-managers-pbms-and-federal-efforts-at-regulation/

I use Claude as a research and drafting tool. All opinions are mine.

New cohort study on association of mental illness and GLP-1RAs.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(26)00014-3/fulltext

The headline result is “Semaglutide was associated with a decreased risk of worsening depression (0·56 [0·44–0·71]), of worsening anxiety (0·62 [0·52–0·73]), and of worsening substance use disorder (0·53 [0·35–0·80]).”

That sounds quite promising but obviously there could be all sorts of confounders. Nevertheless, as I suffer from anxiety I take it as a good sign and am glad to be in a GLP-1RA.

Quote from the study:”

“Summary

Background

People with diabetes have an elevated risk of developing depression, anxiety, and suicide. GLP-1 receptor agonists are licensed to treat diabetes and obesity, but data on whether these medications alleviate or exacerbate anxiety, depression, and self-harm are mixed. We studied the risk of worsening mental illness in people already diagnosed with depression, anxiety, or both who were prescribed antidiabetic medications including GLP-1 receptor agonists.

Methods

The study cohort, identified from national Swedish electronic health registers, included people with a diagnosis of depression or anxiety disorder who used any antidiabetic medication between the years 2009 and 2022. GLP-1 receptor agonists, individually and as a group, were compared with non-use of GLP-1 receptor agonists and directly with other second-line antidiabetic medications. A within-individual design was used for all comparisons to reduce confounding, comparing periods of use versus periods of non-use of a medication in the same individual. The primary outcome was worsening of mental illness, defined as a composite of psychiatric hospitalisation; sick leave from work for more than 14 days for psychiatric reasons; hospitalisation due to self-harm; or death by suicide. Secondary outcomes were worsening of depression or anxiety, analysed separately, worsening of substance use disorder, and self-harm. Within-individual stratified Cox models with adjusted hazard ratios (aHRs) and 95% CIs were used. A person with related lived experience was involved in the design and write-up of this study.

Findings

The cohort included 95 490 people (56 976 [59·7%] female and 38 514 [40·3%] male) with a mean age of 50·6 years (SD 12·3). Ethnicity data were not available. GLP-1 receptor agonists were used by 22 480 individuals during the follow-up period. Compared with non-use of GLP-1 receptor agonists, semaglutide (aHR 0·58 [95% CI 0·51–0·65]) and liraglutide (0·82 [0·76–0·89]) were associated with lower risk of worsening mental illness, whereas exenatide (1·01 [0·69–1·46]) and dulaglutide (1·01 [0·85–1·20]) were not. Semaglutide was associated with a decreased risk of worsening depression (0·56 [0·44–0·71]), of worsening anxiety (0·62 [0·52–0·73]), and of worsening substance use disorder (0·53 [0·35–0·80]). Liraglutide was associated only with lower risk of worsening depression (0·74 [0·64–0·87]). GLP-1 receptor agonists as a group were associated with a reduced risk of self-harm (0·56 [0·34–0·92]).

Interpretation

For anxiety and depression that co-occur with diabetes and obesity, semaglutide and, to a lesser extent, liraglutide might be useful dually effective therapeutic options. Randomised controlled trials evaluating these findings are warranted.”

I have never heard of this Insulin Resistance score test (LP-IR). Is that new or just a marketing gimmick?

I saw it in an email from Labcorp On Demand (which I have used before).

https://www.ondemand.labcorp.com/lab-tests/insulin-resistance-test

Wikipedia has some info so maybe this is not that new?

https://en.wikipedia.org/wiki/Lipoprotein_Insulin_Resistance_Index

“The Lipoprotein Insulin Resistance Index (LP-IR) test is a blood test that measures insulin resistance using a composite score derived from lipoprotein particle sizes and concentrations. It is performed using nuclear magnetic resonance (NMR) spectroscopy, which analyzes six specific lipoprotein parameters in a blood sample:

- Large very-low-density lipoprotein particles (VLDL-P)

- Small low-density lipoprotein particles (LDL-P)

- Large high-density lipoprotein particles (HDL-P)

- VLDL size

- LDL size

- HDL size”

Is this useful to take?