Saxenda might be one of the best weight loss medications that exist on the market right now. But just because it might work doesnt mean its 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. Lets jump in: More... What is Saxenda & Does it Work? First, lets 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 twenty pounds if you weighed two hundred pounds. At first, that doesnt 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 thats 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. Why ? Because it can safely be combined with other therapies that even 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, lets discuss why Saxenda actually works... five Ways Saxenda Helps Boost Weight Loss Saxenda is a medication that falls into the GLP-1 agonist class of drugs. GLP-1 stands for Glucagon-like peptide one and thats 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 youve 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 wont 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, lets talk about HOW it works. # 1. Reduces Leptin blocking 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 twenty 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 foul 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 its also probably the most neglected. Until recently we didnt 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) : Reduces existing leptin resistance - meaning it helps to change the biochemistry of the body to ALLOW for weight loss to occur - meaning it helps to change the biochemistry of the body to ALLOW for weight loss to occur Attenuates (or reduces) the rise in leptin resistance once you start losing weight - meaning it helps you keep off the weight that you are losing 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: Bottom line : Saxenda helps reduce leptin levels and helps treat leptin resistance. Leptin is responsible for weight loss resistance. # 2. Improves Insulin Sensitivity 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. Its 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 its almost impossible for your body to burn fat (4) . Why? 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 doesnt 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. For instance: 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. Bottom line : GLP-1 agonists help reduce insulin resistance and lower blood sugar. This activates hormone-sensitive lipase and results in more fat burning over time. # 3. Acts as a Glucagon Suppressant 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. Bottom line : Saxenda helps reduce hyperglucagonemia (lower glucagon levels) which promotes normal glucose metabolism in the body and in the liver. # 4. Reduces Appetite Another benefit of using Saxenda is how it alters your appetite. Youve 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 heres 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 its 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. Bottom line : Saxenda helps reduce appetite by slowing down gastric motility. This reduction in calories is also coupled with a reduction in leptin levels which results in weight loss over time. # 5. Increases Metabolism 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. Why ? Because your basal metabolic rate, or resting energy expenditure, is responsible for the superiority of calories that you burn. This metric is also responsible for how likely you are for keeping off any weight that you lose. If you do any sort of diet that results in metabolic damaged (defined as reducing your metabolic rate) then your chances of regaining that weight back are VERY high. This is famously illustrated in the biggest loser study (7) which showed that contestants of this program suffered severe basal metabolic rate damage. These contestants were burning on average 600-700 calories LESS per day than a normal person, which means that almost all of them gained the weight back that they lost. This is why most calorie restricted diets fail and why we, as a nation, have such a difficult time with weight loss. We put all of our focus on calories instead of on hormones and basal metabolic rate. So how does Saxenda work? Saxenda helps naturally improve your metabolism, probably through its effects on leptin levels. Leptin feeds back to your hypothalamus and helps set your body set point - the number of calories your body burns which in terms alters your appetite. Your body is constantly trying to match the number of calories you burn to the number of calories that you consume. Bottom line : Saxenda helps improve your metabolism over time, probably through its effects on leptin levels. Saxenda vs Victoza You might be confused about these two medications, so let explain the difference. Let me be clear: Saxenda and Victoza are the exact same medication. Both medications use the same active ingredient which is Liraglutide. Liraglutide is the reason that these medications both work. Where they differ is in dosing and how they are FDA approved, but please note this doesnt mean that you cant use Victoza for weight loss. Victoza is FDA approved for type II diabetes in the following dosages: 0.6mg per day 1.2mg per day 1.8mg per day Saxenda is FDA approved for weight loss at the following dosages: 3.0mg per day You can see the main difference between the two is really just the dose and what they are approved to treat. Why have two medications to begin with? Doesnt it just cause confusion? Well... you arent wrong. The main reason for having two medications has to do with money. The makers of Victoza wanted to make more money presumably by increasing their patent on Liraglutide and charging more money for the change in the dose. This means that it will be very difficult to get either of these medications for probably at least 10+ years. But do they both work the same? Absolutely, so dont let that confuse you. Studies have been done using both medications and they do indeed show similar results. Whats important here is HOW you dose the medication, how often you increase the dose and when to increase your dose. The benefits listed above are only achieved at a certain minimum dose and this dose is different for each person. In my weight loss guide, I talk about how to appropriately use GLP-1 agonists including Victoza and Saxenda. I also talk about when you should increase your dose and how to titrate your existing medication to help with your weight loss. The worst thing you can do is take the maximum dose and lose twenty pounds quickly, but then stay at a weight loss plateau when you have 30+ more pounds to lose. How much does Saxenda Cost? One of the biggest drawbacks of using this medication is the cost. Saxenda (without a coupon or discount card) costs upwards of about $1,500 per month. Even using websites such as goodrx.com which has coupon codes for medications the price only lowers to around $1,100 to $1,200 per month. This is obviously an issue because even though Saxenda works this makes the medication unavailable to most people who could actually benefit from it . Whats worse is that insurance does not cover the medication generally. Even though there would be a huge benefit to reducing your weight by fifty pounds versus the risk of maintaining fifty pounds of weight gain over 2-3 decades. Despite this issue, there are some other options... Saxenda coupon & Savings card Like many other medications, Saxenda does have a coupon code or savings card that may work for some people. The only problem is that it doesnt work for everyone. You can find more information on how to get the savings card for saxenda here. How do you use the coupon? You must first get a prescription from your Doctor for Saxenda, then you have to apply for the savings card and then have your pharmacy apply the discount to the medication. The process isnt difficult but it doesnt alWays work. This leaves a fair amount of patients without the medication or having to pay the high price. Luckily there are some Ways that you can get Victoza covered by insurance if you know a few tricks. Saxenda Side Effects Even though Saxenda works doesnt mean it comes without any side effects. While this medication does have many side effects, most of them can be avoided if you use the proper titration schedule. In addition, the goal of using Saxenda in the way that I recommend results in only using the medication during weight loss phases. This means that the use of Saxenda is only temporary and doesnt have to be continued once you lose all of your weight. Even when used appropriately sometimes patients do experience some side effects, the most common being: Nausea Headache Vomiting Muscle cramps Dizziness These side effects tend to go away over time, but saxenda can also cause more serious side effects as well: Inflammation of the pancreas Gallbladder problems Low blood sugar Increased heart rate Kidney problems Depression Chronic pain In my personal experience of using Saxenda and Victoza, I have never had a patient endorse any of the more serious side effects listed above, but they have been documented in some patients. As alWays make sure to address any issues with your medication with your Doctor. And just remember that most of the symptoms associated with Saxenda can be mitigated if you use it correctly. In addition, any risk of serious side effects can generally be mitigated further by the fact that if you use Saxenda correctly you will NOT be on it long term. How to use Saxenda Effectively with other Therapies and to Boost Weight Loss Results After reading this post it may be tempting to think that Saxenda is the answer to your weight loss problems. While it is helpful I dont want to leave you with the wrong impression . Saxenda really shouldnt be used as monotherapy for weight loss. Meaning that it shouldnt be used without making other changes to your diet, lifestyle, exercise routine, supplements, and hormones. To get the kind of lasting weight loss that you are looking for it will require a more comprehensive approach that includes ALL of those things. Saxenda, or Victoza, can be combined with other therapies that multiply the effects of the medication. This results in more weight loss that is sustained. You can find more information about therapies that compliment Saxenda or Victoza here. Back to you Saxenda is a powerful medication that can seriously help treat weight loss in most patients. It does this through its effects on various hormones in the body including leptin, insulin, and glucagon. These powerful hormones are responsible for your metabolism, how much energy you burn at rest and how your body stores and burns fat . Using Saxenda can help bring these hormones back into normal balance and help you lose weight in the process. In order to get the best possible results (with weight loss), Saxenda should be used as part of a more comprehensive treatment plan instead of being used alone. Now its your turn: Have you used Saxenda? Did it work for you? Why or why not? Leave your comments below!
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