Weight loss drugs for liver and kidney disease

Wegovy and Ozempic are drugs manufactured by the Danish company, Novo Nordisk, to treat diabetes. Within the past year or so they have been approved as weight loss drugs. The sales skyrocketed to the point that the GDP of Denmark soared. Novo Nordisk’s sales accounted for approximately 9.9% of Denmark’s GDP in 2024.

That’s pretty unbelievable. But the best news for any pharmaceutical company is that their drug has been approved for another common chronic disease. They already have the sunk cost of drug development and manufacturing. All they need to do is run a clinical trial on a new disease.

https://www.nytimes.com/2025/08/18/well/fda-approves-wegovy-mash-liver-disease-fibrosis.html

A Common Weight Loss Drug Can Treat Severe Liver Disease, F.D.A. Says

Wegovy has been approved for use among the growing number of Americans who have MASH.

By Dani Blum, The New York Times, Aug. 18, 2025

The Food and Drug Administration approved the weight loss drug Wegovy to treat an increasingly prevalent liver disease on Friday.

Roughly 15 million people — six percent of adults in the United States — have metabolic dysfunction-associated steatohepatitis, known as MASH. Rates of the disease are rising….

The list of conditions for which scientists are studying these drugs keeps growing. The F.D.A. approved Wegovy last year to reduce the risk of heart attacks and strokes in people who are overweight or obese; in January, the agency cleared Ozempic — which contains the same compound as Wegovy — to treat kidney disease in people with diabetes. Zepbound, a similar obesity medication from competitor Eli Lilly, won approval for people with obesity and sleep apnea in December. [end quote]

My dear, sweet mother-in-law died of MASH, which used to be called “non-alcoholic fatty liver disease.” She never touched a drop of alcohol but ate every meal at the family’s American-style diner which served the Standard American Diet (SAD). She wasn’t obese but had a typical overweight American woman’s soft body since she never worked out.

@captainccs has told us over the years how he reversed his chronic illnesses by improving his diet. But the CDC has told us that obesity in the U.S. is only increasing.

Novo Nordisk stock has collapsed from its 2024 peak since Eli Lilly now has a competing drug. The profiles of these stocks are completely different. But both of them are leading pharma companies and their products’ uses are growing.

Wendy

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Denmark’s GDP is a bit larger than that of Connecticut. Cigna, headquartered in Connecticut, has annual sales that are over 70% of the state’s GDP. That’s the result of international companies.

DB2

The internal fat around the organs seems to be the really bad fat.

You have to improve your diet to lose weight. Over the last year or so I have lost an additional 5 to 10 pounds with intermittent fasting. It happened accidentally. The body only has enough resources to either exercise or digest food, the reason they tell you not to go swimming right after eating. Not having much to do I go on long walks, the exercise prevents getting hungry effectively skipping lunch. Two meals a day is a mild form of intermittent fasting.

The Captain

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It’s true that fat around the organs is bad.

But the fat in MASH (metabolic dysfunction-associated steatohepatitis) is actually inside the liver, not around it. Without treatment, MASH can cause serious and potentially life-threatening complications by scarring the liver and/or causing liver cancer. MASH can be fatal.

MASH can also cause dementia by the buildup of poisons in the blood that poison the brain because the liver fails to remove the poisons. (Hepatic encephalopathy.) This happened to my mother-in-law. Knowing in advance that she had MASH helped us to recognize it when it happened and not be blindsided by her sudden dementia.

Wendy

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Here you go, Wendy….you might be interested in this…

The effect of obeticholic acid on hepatic blood flow in isolated, perfused porcine liver: Correction of oxygen‐nutrient mismatch might be a putative mechanism of action in NASH - Lake‐Bakaar - 2022 - Clinical and Translational Discovery - Wiley Online Library https://share.google/9C5c5SzdnYtwtuGbX

It’s really a series of proof (testing) of concept studies that’s sort of taken over from HepC with dh’s research…

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It’s another one of those serendipitous, “Now, that’s peculiar…..I wonder if???” moments.

He’d been working remotely with some people at Virginia Tech back when he was at Harvard to develop a true cardio-mimetic pump. The better to study sick, explant livers.

When we moved here to Colorado and he got tempted back into harness, he noticed…..and happened to mention…. that folk with alcoholic liver disease and NAFLD were developing cirrhosis much earlier/younger age than he’d see before. “Bloody altitude”, sez I (I blameeverything on it!) He got to wondering, lo….a project was born

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Not the full story, of course, so adding synchronicity to serendipity…..

Husband’s open heart surgery (bio-Bentall) was in early 2019 and the apparent earlier development of cirrhosis, hepatocellular carcinoma etc secondary to NAFLD (as it was back then) at altitude had been buzzing around in his head for a year or more. With open heart surgery, and with procedures such as he and @WendyBG underwent, there’s a period on cardio pulmonary bypass that frequently leads to a spell of cognitive dysfunction (Pump Head) because the pumps don’t completely emulate the true action of the heart…..the primary reason, ironically, for the development of that set up husband was working with. Studying explant livers was just his interest ……. being a transplant hepatologist.

Although I satisfied myself that he still had all his faculties immediately after extubation, it’s almost like any grey cells that were knocked off were inhibitory ones, as the nuts and bolts of a putative mechanism for the actual cellular damage started to fall into place. …. along with a potential for treatment, which is more important. Not your classical signs and symptoms of Pump Head.

Signed: Mrs. Lake-Bakaar

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@VeeEnn I don’t think I had Pump Head this time but I was terribly weak for months. Could that be the reason?

Wendy

I doubt it. That weakness is a reflection of just how many of the body’s resources get harnessed for the healing process…..and for how long. Happened to my husband big time…..although he was going into work at the 6 week mark (actually with a sort of encouragement from his cardiothoracic surgeon who’s done something similar after his CABG)

Even my lapiplasty. Although I had to stay off my feet…..essentially in bed with “toes above the nose”…. immediately afterwards for a few weeks, I was so poleaxed in a whole body way that I was actually quite content to do just that. Such anesthesia that I had wouldn’t have affected my cardiovascular system much. It was much more structural

FWIW….you can see radiographic evidence of bony damage….surgery, tooth extraction etc….at the 18 month mark

BTW, the way I decided that dh was functioning reasonably well after his surgery, I used one of the questions he used with patients in his cognitive dysfunction testing…..”Who is the prime minister of Bangladesh?”

That might seem a bit off the wall (it is) There is a standard set of questions to ask patients who present with hepatic encephalopathy. It’s very disheartening for family members who’re accompanying them to hear how badly their loved ones seem to perform. So, at some point he took to throwing random questions like that into the mix….to break the tension a bit. 9 times out of 10, at follow up when he’d sorted them out, everyone returned knowing the answer.

So, immediately he was extubated (and that was super nerve wracking for me) I asked him that very question. I didn’t think he was aware but a little smile appeared along with a thumbs up….and I shed a few tears of relief and happiness. Everyone else in the room except the daughter probably wondered which of us was the craziest!!

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Amazing!

Immediately after I was extubated I was in the Intensive Care Unit. I tried to drink some water but aspirated it and almost choked. It was a nightmare. Far from smiling.

On about the third day after my surgery I was able to recite “Father William” from memory for my sister (or at least most of it). That’s why I said I didn’t have brain fog.

I think your husband wasn’t as sick as I was since he didn’t have the pleural effusion and atalectasis.

Wendy

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Oh he definitely fared better than you in the post op period. I imagine the procedure was a bit more complex with the coronary artery dissection and whatnot, but no post op complications. He needed supplemental oxygen for a few days….but that’s probably to be expected in the Mile High City. No bicuspid valve either, but he did have a bovine aorta. No idea if this had any significance beyond allowing me to point out I always say he’s full of B-S…..now I’ve got proof.

Complications don’t help any, but I really do think it’s dead easy to underestimate how demanding the healing phase with these big procedures is likely to be. I don’t know how actual sick people manage.

More Life imitating TMF…

I’m cautiously easing into my Z2/MAF/Low Lactate/ASCVD mitigation training and playing catchup with my podcasts. Started this on Sunday and added to it today. Some interesting insights from self experimenters with divergent views on the GLP-1 agonists. Presumably behind the usual paywall. Posting this because I can’t tell exactly where the cut off kicks in. Definitely plenty to think about…..at this rate, it’ll be a while before I can form enough of an opinion to decide whether it’s worth giving or not.

#359 ‒ How metabolic and immune system dysfunction drive the aging process, the role of NAD, promising interventions, aging clocks, and more | Eric Verdin, M.D. - Peter Attia #359 ‒ How metabolic and immune system dysfunction drive the aging process, the role of NAD, promising interventions, aging clocks, and more | Eric Verdin, M.D. - Peter Attia

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