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Chapter 1: What is the main topic of GLP-1s and their impact on addiction?
You are listening to TED Talks Daily, where we bring you new ideas and conversations to spark your curiosity every day. I'm Manoush Zomorodi, sitting in for Elise Hu this week with a special series of episodes all about how you can live a healthier life in our high-tech era. You may know my voice from the TED Radio Hour podcast over at NPR.
I'm also an author, two-time TED speaker, and this past April, a guest curator for the TED 2026 conference. My session was all about my obsession with technology, the human body, and what is keeping us human in this digital age. And that included the speaker you're going to get to know today, Dr. Dhruv Kular. is a practicing physician and associate professor at Weill Cornell Medical College.
He also writes for The New Yorker where he investigates all kinds of topics at the intersection of medicine, policy, and being human in this hyper accelerating world. I love reading his articles and I love his measured take on hot topics in health. He brings the perfect mix of science and just kindness and empathy. You'd want him to be your doctor, you know?
Anyway, his talk is about a hot topic in medical innovation, GLP-1s, drugs like Ozempic and Wegovy that millions of people are taking to treat diabetes and, more controversially, to jumpstart their weight loss journeys. And while these drugs have been around for a while, we are still learning a lot about how they work and the many ways that they can impact us beyond the number on a scale.
Now, for a long time, GLP-1 was thought to be mainly about digestion. But it's now clear that the medications affect much more than eating. They might have some of their most surprising effects not in the gut. but in the brain.
As Dhruv explains, GLP-1s are starting to show real signs of treating addictions, all kinds of addictions, from alcoholism to gambling. And the way that these drugs work is changing how physicians and researchers think about how they treat people with addictions. But also, as you'll hear, for some people, it's more.
Taking a GLP-1 can change the way that they think about themselves and how they actually live their life.
There's still a lot of stigma that's preventing people from coming forward when they have an addiction. I don't want to say that, you know, our behavior, our will has no role in these conditions. Of course, we need to encourage and help people make decisions that are in line with their health.
But I think that needs to be paired with an understanding that a lot of these processes are neurobiological and shaming people because they have these conditions is not going to be a productive way to go about it.
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Chapter 2: How did GLP-1s transition from diabetes medication to addiction treatment?
We might not even recognize it when we first see it. But now, GLP-1s are forcing us to reconsider not just the modern science of addiction, but ancient wisdom about restraint. For thousands of years, we have seen moderation as a moral achievement. Aristotle argued that the path to a life well lived runs through moderation.
Courage rests somewhere between cowardice and recklessness, generosity between stinginess and extravagance. He's often quoted as saying, it is best to rise from life as though from a banquet, neither drunken nor thirsty. Well, Aristotle never had a Dorito. He didn't have Krispy Kreme or McDonald's. He couldn't flip open TikTok and Instagram.
There weren't algorithms that were fracking his attention. And ancient Greece was not beset by fentanyl and oxycodone. We have a society today in which the fundamental problem for many people has shifted from scarcity and boredom to excess and distraction. Our technology often seems purpose-built to tap into our most basic vulnerabilities.
And the question now is how to bring our minds and our bodies and our environments into a more natural balance. GLP-1s They suggest that Aristotle's moderation is not just a virtue, it is a physiological state.
Chapter 3: What surprising effects do GLP-1s have on cravings and behavior?
It isn't just about character. It is about biology. And none of this is to suggest that we should somehow give up on the struggle to bring about a more healthful society, that we shouldn't do the hard cultural and political work to bring about a better world. in which we can address the drivers of addiction and other social problems, things like loneliness and trauma, pain, poverty, exploitation.
But it does suggest that we should welcome a promising new tool into our toolkit. Now, over the years, I have cared for many patients in the moments when an addiction has taken almost everything. the young woman whose post-surgery opioid use turned into a heroin addiction, and then into the heart infection that took her life.
The father, whose liver failed after decades of alcohol use, who was slowly dying on a transplant list. Every morning, I entered his room and was greeted by his children, age six and eight. And they would ask me when their dad could go home. Those were some of the hardest conversations I have ever had. In recent months, I have returned again and again to something that Mary told me.
She said that GLP-1s enabled her to act not just on her immediate desire to stop drinking, but on her deeper desire to reinvent the person she wanted to be, to change her habits, her relationships, even how she saw herself. She gained a kind of freedom to live alongside her desires instead of being ruled by them.
Because alcohol was no longer an issue, she told me, I finally had the chance to think, what type of life do I want? And that is a question that every person deserves a chance to ask. Thank you.
That was New Yorker writer Dr. Dhruv Kular. When we come back, Dhruv and I discuss why there's still a stigma around addiction, even though we have been talking about the genetic and biological reasons behind addiction for decades. Will GLP-1s finally change that? And what about the people for whom GLP-1s don't work? What are their options? Be back in a sec.
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Hi, I'm Molly Graham, host of Work Life, a podcast from TED. The most important lessons about work usually aren't the ones anyone teaches you. They come from experience, from uncertainty, from figuring things out as you go. On this show, my expert guests and I explore how careers really unfold through change, through doubt, through the decisions that shape who we become over time.
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Chapter 4: What is the significance of Mary's story in understanding addiction?
But I think there's still a lot of stigma that's preventing people from coming forward when they have an addiction. We have, as you said, made a lot of strides towards recognizing that a lot of this is biological, that it's happening even unconsciously, and that people really struggle in ways that they shouldn't be blamed for what's happening here. And so we've known that for many decades.
And for me, some of this really came home during my reporting for this piece. You know, I underwent an MRI scan, similar to what trial participants would have gone through. And, you know, I went into this MRI. They were showing me photographs of all sorts of things, whether it's Big Macs or... you know, mountains or alcohol like beer, wine, whiskey.
And they were basically seeing how my brain reacted to these various images. And afterwards, they showed me in response to photographs of alcohol, there was very little activity in kind of the relevant centers of my brain. And they compared them to people who are struggling with alcohol use disorder. And those areas just lit up in those people. And for me, it kind of drove home this point that
so much of our behaviors downstream of these processes that are happening inside of our brains before we even have an opportunity to make a kind of a reasoned decision about what we're going to do. And so I don't want to say that, you know, our behavior, our will has no role in these conditions. Of course, we need to encourage and help people make decisions that are in line with their health. But
I think that needs to be paired with an understanding that a lot of these processes are neurobiological and shaming people because they have these conditions is not going to be a productive way to go about it.
I mean, I'm trying to picture as we go forward, you're saying one out of eight people is starting to take this drug and many of them are off label, right? Like for all kinds of different things as well.
That's right. So diabetes, obesity, addiction, these are just a few of the conditions for which this class of medications is being studied. I mean, people seem to have beneficial effects for cardiovascular health or stroke risk.
There have been studies published that individuals with fatty liver disease or chronic kidney disease, those things either slow down or even reverse on GLP-1 medications. Interestingly, even osteoarthritis seems to have some evidence. So things that we would not have anticipated... seem to be amenable to treatment with GLP-1 medications. And some of that is independent of the weight loss.
One reason might be that GLP-1s are having some type of anti-inflammatory effect. So there's a change in the amount of inflammation in the body, and that's what's contributing here. You know, I don't want to come off as a total booster of these medications.
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Chapter 5: How do GLP-1s affect the brain's reward system?
Yeah, I mean, I think...
People are excited about the potential to take advantage of new technologies or interventions. They want to lean more into health and longevity. And I think that, in a way, is a great thing. I think if we're going to have a market in which people are accessing medicines in the way that they are today, then there's going to be any number of claims that are made about these types of things.
And I think it's incumbent on us to make sure that people have the information that they need to make those decisions about their health.
So how does it change the patient-physician relationship, all of these new technologies? Like, I can see it both ways. Like, on the one hand, great, we have AI to make more rapid diagnoses. This means that doctors can be more hands-on and do the human part of the job.
Or I could also see that it goes the opposite way, is that everything gets outsourced to tech and the humans get extracted from the equation entirely. Where do you think things are going now?
I think both are going to happen. I mean, I think there's going to be a lot more insistence that people are able to access these things even outside of the traditional medical system. I think one thing that it drives home for me is that as doctors or other clinicians, it's no longer going to be effective simply to state the evidence or to state a recommendation.
That really has to come paired with a rationale, a perspective, you know, demonstration of why it is that the recommendation that we are giving is what it is. Storytelling, I think, is going to be a really important part of the future.
I mean, it sounds old-fashioned, but really, because there's so much information out there, there's so much disparate information, it's very hard for people to sift through it all. It's also possible, you to get abstract in your thinking and not tie it back to real people's lives. When I'm in the hospital, I am interacting with the challenges that people are facing in a very real way.
And in a way, so many of the challenges that are in society, not just medical, but more general, they find their way into the emergency room. They find their way into the hospital, whether it's misinformation or homelessness, whatever it might be.
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