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 TikTookay2 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 a better 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 value. Not solely does Wegovy price greater than $1,000 a month,4 it could possibly additionally result in debilitating unwanted effects, together with abdomen paralysis.
‘I Wish I Never Touched It’
Joanie Knight took Ozempic for about two years, when she grew to become unable to swallow meals. The purpose? Her abdomen was filled with meals. Violent vomiting and fixed nausea adopted, together with a prognosis 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 medication made my life hell. So a lot hell. It has price me cash. It price me a whole lot of stress; it price me days and nights and journeys with my household. It’s price me lots, 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. However, gastroparesis additionally results in nausea, vomiting and, in extreme circumstances, dehydration and malnutrition. Diabetes is essentially the most generally recognized reason for gastroparesis, as a consequence of nerve injury within the abdomen.7
However, semaglutide and related medicine 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, advised CNN these unwanted effects are listed on the label:8
“Gastrointestinal (GI) occasions are well-known unwanted effects of the GLP-1 [glucagon-like peptide 1] class. For semaglutide, the vast majority of GI unwanted effects are gentle 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. Symptoms of delayed gastric emptying, nausea and vomiting are listed as unwanted effects.”
GLP-1s Dramatically Slow 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 once you eat to control insulin, together with many different features.9
Along with affecting insulin, GLP-1 could affect the nervous system, resulting in an appetite-reducing response. However, one in every of their mechanisms is, in truth, 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, not less than partly, by retardation of gastric emptying”10 — the hallmark of gastroparesis.
Meanwhile, in Wegovy scientific trials, 44% of these taking the drug skilled nausea whereas 24% had vomiting and 20% had belly ache,11 all widespread 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 load loss results grew to become. The delay in digestion was dramatic.
While meals sometimes 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. While 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 Obesity Drugs
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 drugs administration whereas offering high-touch help in navigating the insurance coverage approval course of.”14
In different phrases, WeightWatchers members will be capable to guide a digital session with a clinician and get a prescription for Wegovy or one other GLP-1. In reality, Sequence’s program is solely based mostly round weight reduction medicines. 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 a very good match.” In different phrases, you’re just about assured to get a prescription for those who enroll.
Skepticism is smart on this case, because the variety of vital unwanted effects tied to the medicine continues to extend. On social media, many members had been bowled over by the transfer, saying it “rubbed them the improper 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 shed some 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 Facebook and Reddit appear to have extra questions than selections.”
Case Reports Highlight Semaglutide-Induced Stomach Paralysis
Gastroparesis amongst these taking semaglutide isn’t remarkable. Case research of two girls who suffered from medication-induced gastroparesis had been revealed within the Journal of Investigative Medicine in 2021.18
The first concerned a 52-year-old lady who took semaglutide for one month earlier than signs, together with belly 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 belly 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 regularly resolved when the drug was stopped.
However, 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 because of the extreme gastroparesis, which left her in a position to “eat sufficient that I’m not malnourished.”19
Anesthesiologists Warn Not to Take Ozempic Before Surgery
Due to the 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 recommend stopping this and different GLP-1 receptor agonists earlier than the process, as they might improve the danger of issues related to anesthesia — specifically that you would regurgitate meals that’s nonetheless sitting in your abdomen, even for those who’ve fasted appropriately.
As a outcome, they advocate not taking the medicines for a day or per week previous to surgical procedure, and probably delaying the process if signs corresponding to nausea, vomiting, belly ache or bloating are current. In a information launch, Dr. Michael W. Champeau, ASA president, defined:21
“While there’s at present 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 obtained anecdotal stories that the delay in abdomen emptying may very well be related to an elevated danger of regurgitation and aspiration of meals into the airways and lungs throughout normal 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 traditional. If the abdomen is full or if the gastric ultrasound is inconclusive or not potential, take into account delaying the process or proceed utilizing full abdomen precautions. Discuss the potential danger of regurgitation and aspiration of gastric contents with the proceduralist or surgeon and the affected person.”
Intestinal Obstruction Risk Rises 3.5-Fold on Semaglutide
These fashionable weight reduction medicines trigger different vital dangers as nicely and should even trigger a doubtlessly deadly intestinal obstruction. Diabetic sufferers who use the medicine have a 4.5 instances larger danger of intestinal obstruction than these utilizing different medicines. A examine of 25,617 individuals 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 peak; villi are the hairlike projections contained in the small gut that assist take up vitamins. Writing in Acta Pharmaceutica Sinica B, researchers defined how this might critically have an effect on intestinal operate, rising obstruction danger:24
“Because GLP-1RAs may trigger steady will increase within the intestinal size and villus peak, the small gut could change into as inelastic and fibrotic as a unfastened spring, resulting in long-term higher intestinal obstruction …”
To date, scientific trials haven’t revealed such adjustments within the human intestine, possible as a result of it’s troublesome to measure small gut size. Further, the most typical symptom of those adjustments is constipation, which could be attributed to many causes — to not point out, the workforce famous, research sometimes aren’t lengthy sufficient to disclose intestinal obstruction dangers:25
“The danger of persistent intestinal obstruction in people cumulates over time, with the best incidence showing 1.6 years following GLP-1RA therapy. However, scientific trials on GLP-1RAs normally don’t final for greater than a 12 months …”
Kidney, Cancer Risks Are Also Concerning
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 Sustain 5 trial developed metastatic pancreatic carcinoma about 65 days post-treatment.27
A pharmacovigilance examine utilizing the FDA Adverse Events Reporting System additionally appeared into “rising information on the potential danger of pancreatic carcinoma related” with GLP-1Ras, together with semaglutide, discovering a transparent affiliation.28
“Based on this pharmacovigilance examine, GLP-1RAs, besides albiglutide, are related to pancreatic carcinoma,” researchers famous, including, “Based 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 exhibiting acute kidney harm in individuals taking semaglutide. Both sufferers had persistent kidney illness because of diabetes and “skilled fast worsening of kidney operate and elevated proteinuria after being prescribed the GLP-1 receptor agonist semaglutide.”30 Wegovy’s prescribing data additionally has a sizeable listing of warnings and precautions, together with for:31
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Acute pancreatitis |
Acute gallbladder illness |
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Hypoglycemia |
Acute kidney harm |
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Hypersensitivity reactions, together with anaphylactic reactions and angioedema |
Diabetic retinopathy issues |
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Heart price improve |
Suicidal habits and ideation |
Better Options for Weight Loss
It is my robust perception that we are going to by no means see the “miracle remedy” medicine for weight reduction in our lifetime. Using medicine to shed some pounds may result in everlasting, debilitating well being issues — and if we do, it’s possible you’ll regain the load for those who ever cease taking them.
Fortunately, there are answers that we all know at this time that handle the basic purpose why most individuals acquire weight, which is insulin resistance secondary to mitochondrial dysfunction from extra reductive stress. Excess linoleic acid (LA) from seed oils is the first reason for mitochondrial reductive stress.
Participants in a single examine regained two-thirds of their prior weight reduction, and a lot of the adjustments in cardiometabolic variables additionally reverted again to pretreatment ranges one 12 months after stopping semaglutide.32 Fortunately, there are higher methods to shed some pounds that don’t put your well being in danger. Top methods embrace:
• Reducing 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
Consider chopping LA right down to under 5 grams per day, which is near what our ancestors used to eat earlier than persistent well being situations, together with weight problems, grew to become widespread.
Ideally the precise quantity although is healthier outlined as a proportion of each day energy. LA needs to be lower than 2% of your each day energy. I used to be in a position to get my proportion right down to 0.8%. You don’t want costly lab assessments, as all you want to do is fastidiously enter your meals information into Cronometer and it’ll let you know your %.
• Avoiding almost all ultraprocessed meals, quick meals and restaurant meals — Virtually all of them include seed oils. The easiest method to do that is to organize the vast majority of your meals at dwelling so you recognize what you’re consuming.
• Using 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. When you eat each few hours for months, years or a long time, by no means lacking a meal, your physique forgets find out how to burn fats as a gasoline.
Most individuals who apply TRE restrict the time they eat meals to eight to 10 hours or much less on most days of every week. In one examine, adults with weight problems who used an eight-hour consuming window misplaced extra weight, and had higher enhancements in diastolic blood stress and temper, than those that used a 12-hour or extra consuming window.34
Although 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.