The demand for medicines promising simple weight reduction has skyrocketed, with prescriptions rising 2,082% from 2019 to 2022.1 Semaglutide, extra popularly generally known as Ozempic, is main the pack, with the hashtag #Ozempic having obtained 1.2 billion views on TikTok2 as of July 2023 — to present just a few indication of its recognition.
Semaglutide is bought underneath the identify Ozempic as a diabetes drug and, in a better dose, underneath the identify Wegovy as a weight reduction drug. It touts weight lack of 14.9% amongst adults with weight problems,3 nevertheless it comes at a steep value. Not solely does Wegovy price greater than $1,000 a month,4 it could additionally result in debilitating uncomfortable side effects, together with abdomen paralysis.
‘I Want I By no means Touched It’
Joanie Knight took Ozempic for about two years, when she turned unable to swallow meals. The explanation? Her abdomen was filled with meals. Violent vomiting and fixed nausea adopted, together with a analysis of extreme gastroparesis, or delayed gastric emptying.5
“I want I by no means touched it. I want I’d by no means heard of it in my life,” Knight informed CNN. “This drugs made my life hell. A lot hell. It has price me cash. It price me a variety of stress; it price me days and nights and journeys with my household. It’s price me so much, and it’s not value it. The value is simply too excessive.”6
Gastroparesis slows or stops the motion of meals out of your abdomen to your small gut. This ends in feeling full longer, which is one mechanism by which semaglutide ends in weight reduction. Nonetheless, gastroparesis additionally results in nausea, vomiting and, in extreme circumstances, dehydration and malnutrition. Diabetes is essentially the most generally recognized explanation for gastroparesis, as a result of nerve harm within the abdomen.7
Nonetheless, semaglutide and comparable medication are designed to delay gastric emptying, and nausea and vomiting — widespread signs of gastroparesis — are reported in lots of who take them. Even Novo Nordisk, which manufactures Ozempic and Wegovy, informed CNN these uncomfortable side effects are listed on the label:8
“Gastrointestinal (GI) occasions are well-known uncomfortable side effects of the GLP-1 [glucagon-like peptide 1] class. For semaglutide, nearly all of GI uncomfortable side effects are delicate to average in severity and of quick period. GLP-1’s are recognized to trigger a delay in gastric emptying, as famous within the label of every of our GLP-1 RA medicines. Signs of delayed gastric emptying, nausea and vomiting are listed as uncomfortable side effects.”
GLP-1s Dramatically Gradual Digestion
Semaglutide is a glucagon-like peptide 1 receptor agonists (GLP-1RAs). As a peptide hormone, GLP-1 is, amongst different issues, a part of a gaggle of incretin hormones, that are launched whenever you eat to manage insulin, together with many different features.9
Together with affecting insulin, GLP-1 could affect the nervous system, resulting in an appetite-reducing response. Nonetheless, one in every of their mechanisms is, actually, delayed gastric emptying — an impact many who take it aren’t conscious of. In 2021, Mayo Clinic researchers wrote that “their [GLP-1 agonists and analogs] results are mediated, a minimum of partially, by retardation of gastric emptying”10 — the hallmark of gastroparesis.
In the meantime, in Wegovy medical trials, 44% of these taking the drug skilled nausea whereas 24% had vomiting and 20% had stomach ache,11 all widespread signs of gastroparesis. Mayo Clinic researchers additionally appeared on the results of one other GLP-1 receptor agonist, known as liraglutide, in adults with weight problems.
They discovered the drug’s weight reduction results had been related to “delay in gastric emptying of solids,”12 and the longer meals sat within the abdomen, the larger the burden loss results turned. The delay in digestion was dramatic.
Whereas meals usually left the abdomen in simply 4 minutes amongst these within the placebo group, it took a median of 70 minutes in those that took liraglutide. For some, the delay was much more — as much as 151 minutes. Whereas this decreased considerably by 16 weeks, with meals leaving their stomachs in about half-hour, this was nonetheless for much longer than the seven minutes within the placebo group.13
WeightWatchers Plans to Promote Weight problems Medicine
WeightWatchers is shifting into the weight problems drug market through its acquisition of telehealth platform Sequence. In a press launch, WeightWatchers said, “Sequence seamlessly integrates the affected person and clinician expertise for ongoing, medical care and drugs administration whereas offering high-touch assist in navigating the insurance coverage approval course of.”14
In different phrases, WeightWatchers members will have the ability to e book a digital session with a clinician and get a prescription for Wegovy or one other GLP-1. In actual fact, Sequence’s program is fully primarily based round weight reduction medicines. Considered one of their FAQs is “What if my clinician determines a prescription will not be proper for me?”15
The reply is you’ll take an consumption quiz and have an preliminary session, however, “Your program solely begins in case your clinician determines that you just’re match.” In different phrases, you’re just about assured to get a prescription if you happen to enroll.
Skepticism is smart on this case, because the variety of vital uncomfortable side effects tied to the medication continues to extend. On social media, many members had been stunned by the transfer, saying it “rubbed them the fallacious approach.”16 As Rolling Stone reported:17
“The transfer appears to be at odds with the longstanding tenets of this system. WeightWatchers, which was first began in 1963 and instituted in strip malls throughout America, has lengthy been touted by its supporters (together with Oprah Winfrey herself, who owns stake within the firm) as a neater technique to drop pounds, whereas avoiding the stigma and temptation of crash diets and weight reduction drugs.
… Some Weight Watchers customers feeling caught or plateaued of their weight reduction have welcomed the change, whereas a majority in on-line chat rooms on websites like Fb and Reddit appear to have extra questions than choices.”
Case Studies Spotlight Semaglutide-Induced Abdomen Paralysis
Gastroparesis amongst these taking semaglutide isn’t extraordinary. Case research of two girls who suffered from medication-induced gastroparesis had been revealed within the Journal of Investigative Drugs in 2021.18
The primary concerned a 52-year-old lady who took semaglutide for one month earlier than signs, together with stomach ache, bloating and nausea, started. Testing revealed delayed gastric emptying, which resolved after she stopped taking the drug. The second case concerned a 57-year-old lady affected by stomach bloating, nausea and vomiting for a yr.
She had began taking dulaglutide, model identify Trulicity, one other GLP-1 receptor agonist, 15 months prior. Testing revealed she had extreme delayed gastric emptying, which steadily resolved when the drug was stopped.
Nonetheless, this isn’t all the time the case. In Knight’s case and one other described by CNN, signs didn’t get higher even after they stopped taking the drug. Knight ended up having abdomen bypass surgical procedure as a result of extreme gastroparesis, which left her capable of “eat sufficient that I’m not malnourished.”19
Anesthesiologists Warn To not Take Ozempic Earlier than Surgical procedure
Because of the delayed abdomen emptying that happens with semaglutide, the American Society of Anesthesiologists (ASA) launched a warning for these taking the medication earlier than elective surgical procedure.20
They counsel stopping this and different GLP-1 receptor agonists earlier than the process, as they may enhance the danger of issues related to anesthesia — specifically that you might regurgitate meals that’s nonetheless sitting in your abdomen, even if you happen to’ve fasted appropriately.
Because of this, they advocate not taking the medicines for a day or every week previous to surgical procedure, and probably delaying the process if signs equivalent to nausea, vomiting, stomach ache or bloating are current. In a information launch, Dr. Michael W. Champeau, ASA president, defined:21
“Whereas there’s at present an absence of scientific information on how GLP-1 receptor agonists have an effect on sufferers having surgical procedure and work together with anesthesia, we’ve obtained anecdotal reviews that the delay in abdomen emptying could possibly be related to an elevated threat of regurgitation and aspiration of meals into the airways and lungs throughout basic anesthesia and deep sedation.
These issues could be severe, so we’re offering steering on when GLP-1 agonists needs to be stopped upfront of an elective process.”
The chance of these utilizing semaglutide having a full abdomen is so excessive that the ASA suggests utilizing ultrasound to judge the abdomen contents previous to surgical procedure if a affected person hasn’t withheld the drug, stating:22
“If the abdomen is empty, proceed as standard. If the abdomen is full or if the gastric ultrasound is inconclusive or not attainable, take into account delaying the process or proceed utilizing full abdomen precautions. Focus on the potential threat of regurgitation and aspiration of gastric contents with the proceduralist or surgeon and the affected person.”
Intestinal Obstruction Danger Rises 3.5-Fold on Semaglutide
These fashionable weight reduction medicines trigger different vital dangers as properly and should even trigger a probably deadly intestinal obstruction. Diabetic sufferers who use the medication have a 4.5 occasions larger threat of intestinal obstruction than these utilizing different medicines. A research of 25,617 individuals additionally discovered use of GLP-1Ras will increase the speed of intestinal obstruction by 3.5-fold.23
The medication had been additionally discovered to extend the size and weight of the small gut in animal research, whereas in people they could enhance intestinal size and villus top; villi are the hairlike projections contained in the small gut that assist take in vitamins. Writing in Acta Pharmaceutica Sinica B, researchers defined how this might critically have an effect on intestinal operate, growing obstruction threat:24
“As a result of GLP-1RAs may trigger steady will increase within the intestinal size and villus top, the small gut could turn out to be as inelastic and fibrotic as a unfastened spring, resulting in long-term higher intestinal obstruction …”
To this point, medical trials haven’t revealed such adjustments within the human intestine, seemingly as a result of it’s tough to measure small gut size. Additional, the most typical symptom of those adjustments is constipation, which could be attributed to many causes — to not point out, the staff famous, research usually aren’t lengthy sufficient to disclose intestinal obstruction dangers:25
“The chance of continual intestinal obstruction in people cumulates over time, with the best incidence showing 1.6 years following GLP-1RA therapy. Nonetheless, medical trials on GLP-1RAs normally don’t final for greater than a yr …”
Kidney, Most cancers Dangers Are Additionally Regarding
The long-term dangers of semaglutide are unknown, however already the drug carries a black field warning as a result of rodent research discovered semaglutide causes thyroid C-cell tumors “at clinically related exposures.”26 Pancreatic most cancers is one other concern. One affected person within the Maintain 5 trial developed metastatic pancreatic carcinoma about 65 days post-treatment.27
A pharmacovigilance research utilizing the FDA Adversarial Occasions Reporting System additionally appeared into “growing information on the potential threat of pancreatic carcinoma related” with GLP-1Ras, together with semaglutide, discovering a transparent affiliation.28
“Based mostly on this pharmacovigilance research, GLP-1RAs, besides albiglutide, are related to pancreatic carcinoma,” researchers famous, including, “Based mostly on the bibliometric investigation, cAMP/protein-kinase, Ca2+ channel, endoplasmic-reticulum stress, and oxidative stress are potential pathogenesis of pancreatic carcinoma ensuing from GLP-1RAs.”29
The kidneys additionally appear to be negatively affected, with two case research displaying acute kidney damage in individuals taking semaglutide. Each sufferers had continual kidney illness on account of diabetes and “skilled speedy worsening of kidney operate and elevated proteinuria after being prescribed the GLP-1 receptor agonist semaglutide.”30 Wegovy’s prescribing info additionally has a sizeable checklist of warnings and precautions, together with for:31
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Acute pancreatitis |
Acute gallbladder illness |
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Hypoglycemia |
Acute kidney damage |
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Hypersensitivity reactions, together with anaphylactic reactions and angioedema |
Diabetic retinopathy issues |
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Coronary heart fee enhance |
Suicidal conduct and ideation |
Higher Choices for Weight Loss
It’s my sturdy perception that we’ll by no means see the “miracle remedy” medication for weight reduction in our lifetime. Utilizing medication to drop pounds may result in everlasting, debilitating well being issues — and if we do, it’s seemingly you’ll regain the burden if you happen to ever cease taking them.
Happily, there are answers that we all know right this moment that tackle the basic purpose why most individuals achieve weight, which is insulin resistance secondary to mitochondrial dysfunction from extra reductive stress. Extra linoleic acid (LA) from seed oils is the first explanation for mitochondrial reductive stress.
Individuals in a single research regained two-thirds of their prior weight reduction, and many of the adjustments in cardiometabolic variables additionally reverted again to pretreatment ranges one yr after stopping semaglutide.32 Happily, there are higher methods to drop pounds that don’t put your well being in danger. High methods embrace:
• Decreasing your consumption of seed oils whereas growing your consumption of wholesome fat — Consuming an excessive amount of linoleic acid is the first issue driving the chubby and weight problems epidemics. LA is a kind of omega-6 fats present in seed oils like soybean, cottonseed, sunflower, rapeseed (canola), corn and safflower.33
Take into account chopping LA right down to beneath 5 grams per day, which is near what our ancestors used to devour earlier than continual well being situations, together with weight problems, turned widespread.
Ideally the precise quantity although is healthier outlined as a share of every day energy. LA needs to be lower than 2% of your every day energy. I used to be capable of get my share right down to 0.8%. You don’t want costly lab assessments, as all you might want to do is rigorously enter your meals information into Cronometer and it’ll let you know your p.c.
• Avoiding practically all ultraprocessed meals, quick meals and restaurant meals — Nearly all of them include seed oils. The simplest approach to do that is to organize nearly all of your meals at residence so you recognize what you might be consuming.
• Utilizing time restricted consuming (TRE) — Our historic ancestors didn’t have entry to meals 24/7, so our genetics are optimized to having meals at variable intervals, not each few hours. If you eat each few hours for months, years or many years, by no means lacking a meal, your physique forgets the right way to burn fats as a gas.
Most individuals who follow TRE restrict the time they devour meals to eight to 10 hours or much less on most days of every week. In a single research, adults with weight problems who used an eight-hour consuming window misplaced extra weight, and had higher enhancements in diastolic blood strain and temper, than those that used a 12-hour or extra consuming window.34
Though TRE is an incredible instrument initially for most individuals, when you regain insulin sensitivity you wish to enhance your meals window to 10 to 12 hours.
