The injection that removes hunger

Paula 1223. Saturday, April 8, 2017.

Every morning the Natalia routine (who asks to reserve his last name) follows the same order: shower, make up and dress.Before shewing the last buttons on her blouse, she goes to the kitchen and opens the refrigerator.She draws a little box that keeps what she calls the "Lord Pencil", an applicator similar to a pen, whose tip is a fine syringe that contains a medication that injected near her navel."It is a minimum peñizquito, nothing hurts. And its effect is immediate: I barely click on me for food," he has naturally on the peculiar method that has followed every day for 4 months, when he weighed 61 kilos.Today, with 1.60 m tall, Natalia is 54 kilos and proudly says that her jeans are size 36, although her self -imposed is to reach 51 kilos.

Natalia is 43 years old, two children and a successful career as a sales executive of an important company in the Alto neighborhood.She doesn't have time, she says, to acquire healthy eating habits or exercise."I live in meetings and events. Zero possibility of sitting to eat quiet or go to the gym. It happens to me that I finish pecking a sandwich or some sweet little thing to undone and that had me filling," she says.

A friend told her that a remedy was being injected that took hunger and sold without a recipe in the pharmacy."I left and bought it. Obviously that the injection gave me scare, but my friend told me that neither her nor her acquaintances had happened to them and she recommended seeing a tutorial on YouTube to learn to inject myself correctly. From thatDay The Lord Pencil has done his magic: I got hungry, "he says.

What Natalia is injected is called Liraglutida, an analogous 97% equal to LPG-1, a natural hormone of the organism that is secreted in the small intestine in response to food intake."Its main function is to act in the pancreas to stimulate insulin secretion (which lowers glycemia) and inhibiting glucagon liberation (which rises glycemia) and, thus, reduce blood sugar levels," he explainsDr. Gonzalo Godoy, German Clinic Diabetologist.Precisely because of this regulatory effect of glycemia, the medication was created for type 2 diabetics, those in which the pancreas does not produce enough insulin to control the blood sugar level or in which the organism is unable to use the insulin ofEffective form.

Launched in 2009 by the Danish laboratory Novo Nordisk under the commercial name of Victaza, a year later it was approved by the FDA –FOOD and DRUG Administration, the United States regulatory body - and since then its use was massified by the world. So much so that in Brazil, Mexico, the United States and Spain, true online black markets have been raised that sell it directly and not in the pharmacy with a medical recipe, such as the indication of the regulatory agencies. And it is that the fury for the victza - which comes in a pencil precarious with liraglutida, which is injected subcutaneously into abdomen, upper part of thighs or arms in adjustable and progressive doses of 0.6; 1.2 and 1.8 mg, and that are defined according to the response of each patient - has to do with a side effect that was observed during the drug investigations: the diabetics reported a drastic loss of appetite and a sense of permanent satiety , with what they managed to lose weight.

"An anorexigen effect occurs, since the medication also acts in the hypothalamus, where the hunger regulatory centers are located, decreasing the appetite. Next to it, the mechanism of lowering blood glucose levels also retards gastric emptying, which induces greater satiety. Something contrary to what happens when glycemia levels are high and that produce polyphagia or the imperative and unstoppable need to hunger, "says Dr. Julieta Klaassen, a nutritionist at the Obesity Treatment Treatment Center of the Obesity of the Obesity of theUC Christus Health Network.

Lo anterior motivó a Novo Nordisk a experimentar con mayores dosis de liraglutida para el tratamiento exclusivo de la obesidad. Y en 2014 el laboratorio lanzó Saxenda, el mismo fármaco solo que en una dosis mayor, de 3 mg. Su indicación es clara: se usa en obesos cuyo Índice de Masa Corporal (IMC) sea superior a 30 y, excepcionalmente, en personas con sobrepeso que exhiban un IMC superior a 27 y que en sus exámenes se observe al menos una comorbilidad relacionada con el peso, como pre diabetes, hipertensión, dislipidemia –niveles altos de colesterol, triglicéridos o ambos– y apneas del sueño. "Liraglutide (Saxenda^R) es un tratamiento coadyuvante para reducir el peso, siempre y cuando se incluya un abordaje integral de la enfermedad, vale decir, cambios en el estilo de vida con una dieta sana y ejercicio", enfatiza el doctor Rodrigo Alonso, nutriólogo jefe de Clínica Las Condes, quien agrega: "La liraglutida tiene un efecto inhibidor del apetito, y la sensación de saciedad dura alrededor de 24 horas y por eso se debe inyectar a diario, idealmente a la misma hora. El objetivo es aprovechar su efecto anorexígeno para que al paciente le sea más fácil acoplarse al plan de alimentación propuesto por el médico tratante con tal de que, en un año aproximadamente, este pueda perder alrededor de 10% de su peso inicial y reducir así el riesgo de enfermedades asociadas", explica el especialista.

But while Saxenda was not yet launched into the market, the mouth of the promising effect of the victza to lose weight without great sufferings, expanded at the speed of light and on the Internet abound Facebook groups and international forums with testimonies - theMost female - accounting for the good results they have obtained using the medication.Even there some diabetics recognize having recommended the remedy to friends who did not have the disease but needed to lose weight.Others, self -medicated and others share the doctor of the doctor who prescribed Victoza, having a minimum overweight and associated comorbidity."Although in Chile this does not happen yet, I would not surprise that the phenomenon begins to spread through social networks, as has already happened with other fashion methods to lose weight," says Dr. Godoy.

Coca light and cigarettes

Sandra (55) is a commercial engineer and colleague in Natalia and, like her, she wanted to lower the 8 other kilos that were impossible to lose with the spinning classes she practiced three times a week, even eating only salads."On the right time, then I stop exercising a week and fat immediately. At 20 years I would have gone down fast weight, but I am entering menopause and everything has slowed down and I stuck in a weight that I do notIdentify and bothers me. So when Natalia told me about this easy shortcut, I did not hesitate to take it, "says Sandra, who is a mother of 4 children and two months ago Victoza is injected.With 1.65 m high, it started with 68 kilos and its goal is to reach 60. Today it goes at 65. "It has not been as fast as I expected, but I am taking advantage of its removal-shrewride effect. In addition, I have maintainedthe diet

that the majority of my ultra skinny and great colleagues follow: I take about five cans of Coca Light per day and smoke like

Cartonera, "says Sandra on the peculiar regime that follows.

For its part, Natalia has restricted her diet."The injection is so powerful that you really have to remember to eat, because if you could not pass by. So green leaves and a small protein is what like all days because it is the least calories. Obviously notI can leave Coca Light because I have as an addiction, "he jokes.And he adds: "Injecting this reminds me of the sibtramine that I also took a couple of years ago. My husband tells me that how I am able to inject myself to be skinny, but anyway he is happy to see me like this. In addition, I alsoI move in a world where being skinny is a value as important as being intelligent. It sounds very banal, but it is reality, "he reflects.

In Chile, Victoza and Saxenda are relatively new. The first was approved by the Institute of Public Health (ISP) in February 2012 and circulated in the market in the middle of that year. Saxenda, meanwhile, enrolled in the ISP in May 2016 and only since February this year is available in pharmacies. Although they are sold with a medical recipe, it is possible to buy them without demanding one. Thus, Natalia and Sandra declare it. And this report verified it. It was asked to buy both medications in 10 pharmacies of the three largest chains in the country, located in Santiago Centro, Providencia and Las Condes and in no one demanded to see the medical recipe. Victoza costs between 65 thousand and 75 thousand pesos, and Saxenda between 180 and 198 thousand pesos, in addition you have to buy the needle pack for a month that costs around 7 thousand pesos. And, according to the dose that is administered, both last between 15 days and one month. Sandra, for example, has bought indistinctly Victoza and Saxenda and, in two months she has spent about 300 thousand pesos. "It's expensive and it's not available to everyone, but more laser hair removal cost me," she justifies.

"Before there were analog molecules of LPG-1 and, like the liraglutide, when the women who used it came out in the United States, they were called 'fat women, but rich', because this is a expensive treatment and today it is stillThe same. It is a very valid tool to lose weight but the contrast makes noise: while there are patients on the waiting list to get an endoscopy, there are people willing to inject for more than one hundred thousand pesos and expose their health, instead of changing theirhabits, "says Dr. Klaassen.

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That in some pharmacies you can buy without a recipe generates problems: every day more women like Natalia and Sandra could be injected without medical supervision.The specialists consulted for this article observe with concern that the self -medication of Victaza and Saxenda can be triggered as a consequence of the few pharmacological tools available to control food intake, such as fenthmine, anorexigen of the amphetamine family;The Orlistat, which inhibits the absorption of fats and the fenproporex, which also has lipolytic effect."This can lead to inappropriate use of Victaza and Saxenda. They believe that the drug is enough and are not restricted in the foods they consume or carry a hypocaloric diet that only makes them lose water and muscle mass, instead of fat. WithoutDue medical supervisors, this is bread for today and hunger for tomorrow, "warns Dr. Godoy.

Although Natalia is missing 3 kilos to get to her 51st goal, she says that she has often felt weak, cold, reluctant and has even fainted twice."As I eliminated the carbohydrates, I know that this annoying sensation is more for my hypocaloric diet than for the VictazGetting to my goal is afraid to stop clicking because I don't want to suffer the rebound. I really hope that at this time my body has become accustomed to lettuce and coca light. "

Dr. Julieta Klaassen is emphatic in pointing out that the treatment of nothing serves in women who self -medicate."They take advantage of the anorexigen effect without calculating whether the contribution of nutrients, such as vitamins and proteins is adequate for the operation of the organism. In this way they are not taking the most of the medication because it is most likely that they initially go down a lot, but, but, but,As soon as they stop clicking they will register. People want immediacy, but if they are not willing to change, then that things do not begin to inject things, "he says.

OFF LABEL INDICATION

María Luisa is 42 years old, she owns the house and has 6 children between 17 and one average year. She with that last bus she rose 25 kilos of the 54 kilos that she has always weighed and that with the 1.68 m height of her have always defined her as a thin woman. "I weighed the body of how fat I was and I did not get a gram, as I had happened to my other buses when I was younger," she says. She determined to get her figure always from her, she didn't even bought bigger clothes to not feel comfortable and she forced to enter the same jeans before pregnancy to feel squeezed and force her to go down. "I was where the nutritionist and the classic told me: 'You have to eat healthy, in small portions and several times a day. portions and I spent 4 months with that regime that left me in 73 kilos. There I stamped and I still had 18 kilos to go down. So the doctor suggested to try Victoza, which was the last generation of medicines to lose weight in the United States I had never heard about this treatment and gave me that of the punctures, "he says.

María Luisa was overweight with an BMI close to 26. And, although the indication is an BMI greater than 27, the specialists consulted in this report agree that there are many times drugs that fight overweight and obesity, but that were not necessarily createdfor that end."It is the case of some antidepressants and antiepileptics that function as effective tools for treatment in some people with excess weight. This is called off -Label indication," explains Dr. Alonso.And he adds: "For example, Victoza is not indicated for discreet overweight people, however, that some colleagues indicate it has to do that there is a good medical-patient interaction, who explains the pros and cons and establishes defined periods of treatment, time during which there is an accompaniment and monitoring of its evolution because, like every drug, it is not exempt from side effects that the patient must know, "he clarifies.

Before starting to puncture, the doctor of María Luisa explained the treatment and how to inject. "And she sent me to do millions of exams, such as the classic biochemical profiles, thyroid, liver, blood sugar levels and even vitamin D. None threw anything, I am a super healthy person," she says. In October she began the treatment. "The effect was really immediate. The first days I felt a headache, which passed me with Paracetamol. No other discomfort," says María Luisa who today is in 56 kilos and lacks two to reach the goal agreed with her doctor. Together, they defined the dose of Victoza that was going to be injected. "I use a dose of 0.9, very short. I tried a higher but the anorexigen effect is so powerful that I felt that I was not in control. With the dose of now I do not go hungry, but I still feel a little and so I can control Instead of eating a plate full of lentils, now I can only eat half and, although I could continue eating a little more, I am the one to say 'enough' and not the victory, "he says. The success of her treatment is due to how ordered she has been in the feeding pattern that gave her nutritionist and, about to finish the treatment, she is not afraid to gain weight. "Weight loss has been very gradual. As I am finishing, there are days when I do not inject and as just as well as the days I do. That shows me that during this time I have managed to train to continue, without the help of injection, with healthy habits and stay in my long -term weight, "says María Luisa, who has recommended the treatment of 5 of her friends. To all of them the word "injection" scares them. "But the puncture does not hurt," she assures them.

That the liraglutide is injectable and that there is no simile of oral intake has a reason: "LiraglutidIts effect, "explains Dr. Mónica Manrique, Nutrióloga, coordinator of the Meds Clinic Obesity Program.

Specialists agree that cases like María Luisa's are increasingly frequent. Dr. Alonso says: "Patients asking for Victoza. They are men and women - which are in a normal range - but they have risen in recent times and that, after having followed many feeding guidelines, they want to lose some additional kilos because it has cost them a lot to get rid of them. Of course, women are the most consultation. They are usually between 40 and 55 years. They cost them much more to go down, "says the specialist. In all of them the treatment is evaluated case by case. "You have to remember that to treat overweight and obesity there are 5 pillars. The former are personalized diet, exercises and changes in lifestyle. Only after this and check that the results are not the desired ones, medications are indicated and subsequently , bariatric surgery to patients who require it, "adds Dr. Manrique.

The call is that the indication of this medicine is evaluated case by case."Those who prescribe it without the specific indication, such as a BMI greater than 27 are committing imprudence, because there is no long -term evidence of their interactions in healthy patients, since the medication is still very new," Dr. Godoy is alarmed.

Adverse effects

According to the ISP Liraglutida is considered a medication with a favorable security profile.It is even indicated to be used prolonged while diabetes and obesity are chronic ill."It is an excellent drug that, in addition to inducing weight loss, decreases cardiovascular risk," says Dr. Jaime Díaz, a diabetologist and nutritionist at Santa María Clinic.But, like any medication, it has risks that Natalia and Sandra ignore.

In the first place, liraglutide can cause serious adverse reactions such as possible tumors in the thyroid - including cancer -, inflammation of the pancreas (pancreatitis), calculations to the gallbladder, hypoglycemia in type 2 diabetics that take other medications to be treated, acceleration of the heart rate, kidney and liver problems, severe allergic reactions and even depression or suicidal thoughts. And, in no case, is indicated for pregnant women and children. People with a history of any of these adverse reactions neither can the medication be administered. "Those who self -medicate do not know if they have any liver damage, for example. Victoza is administered without the corresponding exams prior to treatment could produce gallstones or pancreatitis that, if not treated in time, could result in major surgery," warns Doctor Díaz . Although rare, he himself had a case of a diabetic patient with Victoza treatment whom he gave pancreatitis. "In cases like these the suspension of the medication is immediate," he says.

More frequent are its mild adverse events such as nausea, diarrhea, constipation, vomiting, headache and dizziness.Some patients have even declared allergies in the puncture zone.That happened to Sandra, who watched a rash around her navel."The area burned me and I stopped injected there. Now I do it in my arm. Some ranch have also appeared, but nothing annoying," she says.

Between 2013 and 2016, the ISP has registered 35 notifications for adverse reactions with Victoza. "19 of them correspond to skin reactions on the injection site, 3 other problems in the injection site such as bruises or pain, 4 digestive problems, 2 pancreatitis. There are also hypoglycemia reports, thyroid, headaches and drowsiness problems , articular discomfort and even a case of cardiac infarction in which it could not be ruled out if it was due to this medicine or other hypoglycemients that the patient received, "says Juan Roldán, head of the ISP Pharmacovigilance Subdepartment, who clarifies that the notification of an adverse reaction suspicion does not constitute a complaint. "These effects are known. What we monitor is if any unidentified to evaluate and guarantee the safety of the product. Therefore, Victoza and Saxenda and all medications approved by the ISP are safe whenever they are used with the correct medical indication "He concludes.