The demand for drugs promising simple weight reduction has skyrocketed, with prescriptions rising 2,082% from 2019 to 2022.1 Semaglutide, extra popularly referred to as Ozempic, is main the pack, with the hashtag #Ozempic having acquired 1.2 billion views on TikTok2 as of July 2023 — to offer just a few indication of its recognition.
Semaglutide is offered underneath the title Ozempic as a diabetes drug and, in the next dose, underneath the title Wegovy as a weight reduction drug. It touts weight lack of 14.9% amongst adults with weight problems,3 but it surely comes at a steep worth. Not solely does Wegovy value greater than $1,000 a month,4 it could actually additionally result in debilitating unwanted side effects, together with abdomen paralysis.
‘I Want I By no means Touched It’
Joanie Knight took Ozempic for about two years, when she grew to become 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 advised CNN. “This drugs made my life hell. A lot hell. It has value me cash. It value me loads of stress; it value me days and nights and journeys with my household. It’s value me loads, and it’s not price it. The value is just 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 injury within the abdomen.7
Nonetheless, semaglutide and related medicine are designed to delay gastric emptying, and nausea and vomiting — frequent signs of gastroparesis — are reported in lots of who take them. Even Novo Nordisk, which manufactures Ozempic and Wegovy, advised CNN these unwanted side effects are listed on the label:8
“Gastrointestinal (GI) occasions are well-known unwanted side effects of the GLP-1 [glucagon-like peptide 1] class. For semaglutide, the vast majority of GI unwanted side effects are delicate to average in severity and of quick length. GLP-1’s are recognized to trigger a delay in gastric emptying, as famous within the label of every of our GLP-1 RA drugs. Signs of delayed gastric emptying, nausea and vomiting are listed as unwanted side effects.”
GLP-1s Dramatically Sluggish 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 bunch of incretin hormones, that are launched whenever you eat to control insulin, together with many different capabilities.9
Together with affecting insulin, GLP-1 could affect the nervous system, resulting in an appetite-reducing response. Nonetheless, one in all their mechanisms is, in actual fact, 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, at the very least partially, by retardation of gastric emptying”10 — the hallmark of gastroparesis.
In the meantime, in Wegovy scientific trials, 44% of these taking the drug skilled nausea whereas 24% had vomiting and 20% had stomach ache,11 all frequent signs of gastroparesis. Mayo Clinic researchers additionally appeared on the results of one other GLP-1 receptor agonist, referred to 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 grew to become. The delay in digestion was dramatic.
Whereas meals sometimes left the abdomen in simply 4 minutes amongst these within the placebo group, it took a mean 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 30 minutes, this was nonetheless for much longer than the seven minutes within the placebo group.13
WeightWatchers Plans to Promote Weight problems Medication
WeightWatchers is transferring into the weight problems drug market through its acquisition of telehealth platform Sequence. In a press launch, WeightWatchers acknowledged, “Sequence seamlessly integrates the affected person and clinician expertise for ongoing, scientific care and medicine 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 ebook a digital session with a clinician and get a prescription for Wegovy or one other GLP-1. In truth, Sequence’s program is totally primarily based round weight reduction drugs. One among their FAQs is “What if my clinician determines a prescription isn’t 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 a very good match.” In different phrases, you’re nearly assured to get a prescription when you join.
Skepticism is smart on this case, because the variety of important unwanted side effects tied to the medicine continues to extend. On social media, many members had been shocked by the transfer, saying it “rubbed them the flawed manner.”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 strategy to drop some pounds, whereas avoiding the stigma and temptation of crash diets and weight reduction tablets.
… 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 Reviews Spotlight Semaglutide-Induced Stomach Paralysis
Gastroparesis amongst these taking semaglutide isn’t unparalleled. Case research of two ladies who suffered from medication-induced gastroparesis had been revealed within the Journal of Investigative Medication 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 12 months.
She had began taking dulaglutide, model title Trulicity, one other GLP-1 receptor agonist, 15 months prior. Testing revealed she had extreme delayed gastric emptying, which progressively resolved when the drug was stopped.
Nonetheless, this isn’t at all times 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 because of the extreme gastroparesis, which left her in a position to “eat sufficient that I’m not malnourished.”19
Anesthesiologists Warn To not Take Ozempic Earlier than Surgical procedure
As a result of delayed abdomen emptying that happens with semaglutide, the American Society of Anesthesiologists (ASA) launched a warning for these taking the medicine earlier than elective surgical procedure.20
They counsel stopping this and different GLP-1 receptor agonists earlier than the process, as they might improve the danger of problems related to anesthesia — specifically that you would regurgitate meals that’s nonetheless sitting in your abdomen, even when you’ve fasted appropriately.
Consequently, they suggest not taking the drugs for a day or per week previous to surgical procedure, and presumably 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 may be presently a scarcity of scientific information on how GLP-1 receptor agonists have an effect on sufferers having surgical procedure and work together with anesthesia, we’ve acquired anecdotal stories that the delay in abdomen emptying may very well be related to an elevated threat of regurgitation and aspiration of meals into the airways and lungs throughout common anesthesia and deep sedation.
These problems will be severe, so we’re offering steering on when GLP-1 agonists ought to be stopped prematurely 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 common. 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 stylish weight reduction drugs trigger different important dangers as properly and will even trigger a doubtlessly deadly intestinal obstruction. Diabetic sufferers who use the medicine have a 4.5 occasions greater threat of intestinal obstruction than these utilizing different drugs. A research of 25,617 folks additionally discovered use of GLP-1Ras will increase the speed of intestinal obstruction by 3.5-fold.23
The medicine had been additionally discovered to extend the size and weight of the small gut in animal research, whereas in people they might improve 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 severely have an effect on intestinal perform, rising obstruction threat:24
“As a result of GLP-1RAs might 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 free spring, resulting in long-term higher intestinal obstruction …”
To this point, scientific trials haven’t revealed such adjustments within the human intestine, probably as a result of it’s troublesome to measure small gut size. Additional, the commonest symptom of those adjustments is constipation, which will be attributed to many causes — to not point out, the staff famous, research sometimes 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, scientific trials on GLP-1RAs often don’t final for greater than a 12 months …”
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 Opposed Occasions Reporting System additionally appeared into “rising 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 folks taking semaglutide. Each sufferers had continual kidney illness because of diabetes and “skilled fast worsening of kidney perform 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 problems |
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Coronary heart price improve |
Suicidal conduct and ideation |
Higher Choices for Weight Loss
It’s my sturdy perception that we are going to by no means see the “miracle treatment” medicine for weight reduction in our lifetime. Utilizing medicine to drop some pounds might result in everlasting, debilitating well being issues — and if we do, it’s probably you’ll regain the burden when you ever cease taking them.
Happily, there are answers that we all know at this time that handle the elemental cause why most individuals acquire 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.
Members 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 12 months after stopping semaglutide.32 Happily, there are higher methods to drop some pounds that don’t put your well being in danger. High methods embody:
• Decreasing your consumption of seed oils whereas rising your consumption of wholesome fat — Consuming an excessive amount of linoleic acid is the first issue driving the obese and weight problems epidemics. LA is a sort of omega-6 fats present in seed oils like soybean, cottonseed, sunflower, rapeseed (canola), corn and safflower.33
Contemplate chopping LA right down to beneath 5 grams per day, which is near what our ancestors used to eat earlier than continual well being circumstances, together with weight problems, grew to become widespread.
Ideally the precise quantity although is healthier outlined as a share of every day energy. LA ought to be lower than 2% of your every day energy. I used to be in a position to get my share right down to 0.8%. You don’t want costly lab checks, as all you might want to do is rigorously enter your meals information into Cronometer and it’ll inform you your p.c.
• Avoiding almost all ultraprocessed meals, quick meals and restaurant meals — Nearly all of them comprise seed oils. The simplest manner to do that is to organize the vast majority of your meals at house so what you’re consuming.
• Utilizing time restricted consuming (TRE) — Our historical ancestors didn’t have entry to meals 24/7, so our genetics are optimized to having meals at variable intervals, not each few hours. Once you eat each few hours for months, years or many years, by no means lacking a meal, your physique forgets methods to burn fats as a gasoline.
Most individuals who observe TRE restrict the time they eat 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 a tremendous instrument initially for most individuals, when you regain insulin sensitivity you need to improve your meals window to 10 to 12 hours.