The demand for medicines promising simple weight reduction has skyrocketed, with prescriptions rising 2,082% from 2019 to 2022.1 Semaglutide, extra popularly often known as Ozempic, is main the pack, with the hashtag #Ozempic having obtained 1.2 billion views on TikTok2 as of July 2023 — to offer just a few indication of its recognition.
Semaglutide is bought beneath the identify Ozempic as a diabetes drug and, in the next dose, beneath the identify Wegovy as a weight reduction drug. It touts weight lack of 14.9% amongst adults with weight problems,3 however it 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 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 rationale? Her abdomen was stuffed 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 instructed CNN. “This drugs made my life hell. A lot hell. It has value me cash. It value me a variety of stress; it value me days and nights and journeys with my household. It’s value me so much, and it’s not value it. The worth is just too excessive.”6
Gastroparesis slows or stops the motion of meals out of your abdomen to your small gut. This leads to feeling full longer, which is one mechanism by which semaglutide leads to weight reduction. Nonetheless, gastroparesis additionally results in nausea, vomiting and, in extreme instances, dehydration and malnutrition. Diabetes is essentially the most generally recognized reason behind gastroparesis, as a result of nerve harm within the abdomen.7
Nonetheless, 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, instructed 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 reasonable 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 unwanted 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 bunch of incretin hormones, that are launched once you eat to manage 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 among their mechanisms is, the truth is, 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 belly ache,11 all widespread signs of gastroparesis. Mayo Clinic researchers additionally regarded 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 better 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 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, medical care and medicine administration whereas offering high-touch help 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. The truth is, Sequence’s program is solely based mostly round weight reduction medicines. Certainly one of their FAQs is “What if my clinician determines a prescription just 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 an excellent match.” In different phrases, you’re nearly 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 shocked by the transfer, saying it “rubbed them the unsuitable 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 selections.”
Case Experiences Spotlight Semaglutide-Induced Abdomen Paralysis
Gastroparesis amongst these taking semaglutide isn’t unparalleled. 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 girl 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 girl affected by belly 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 regularly 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 as a result of 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
Because of 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 counsel stopping this and different GLP-1 receptor agonists earlier than the process, as they might enhance the chance of problems related to anesthesia — particularly that you would regurgitate meals that’s nonetheless sitting in your abdomen, even for those who’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 akin to nausea, vomiting, belly ache or bloating are current. In a information launch, Dr. Michael W. Champeau, ASA president, defined:21
“Whereas there may be at the moment 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 danger of regurgitation and aspiration of meals into the airways and lungs throughout basic anesthesia and deep sedation.
These problems may be critical, so we’re offering steering on when GLP-1 agonists needs 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 guage 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 typical. 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. Talk about the potential danger of regurgitation and aspiration of gastric contents with the proceduralist or surgeon and the affected person.”
Intestinal Obstruction Threat Rises 3.5-Fold on Semaglutide
These fashionable weight reduction medicines trigger different vital dangers as effectively and should even trigger a doubtlessly deadly intestinal obstruction. Diabetic sufferers who use the medicine have a 4.5 instances greater danger 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 medicine had been additionally discovered to extend the size and weight of the small gut in animal research, whereas in people they might enhance 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 significantly have an effect on intestinal perform, rising obstruction danger:24
“As a result of GLP-1RAs might trigger steady will increase within the intestinal size and villus peak, the small gut could change into as inelastic and fibrotic as a free spring, resulting in long-term higher intestinal obstruction …”
Thus far, medical trials haven’t revealed such adjustments within the human intestine, seemingly as a result of it’s troublesome to measure small gut size. Additional, the most typical symptom of those adjustments is constipation, which may be attributed to many causes — to not point out, the crew famous, research usually aren’t lengthy sufficient to disclose intestinal obstruction dangers:25
“The chance of power intestinal obstruction in people cumulates over time, with the very best incidence showing 1.6 years following GLP-1RA therapy. Nonetheless, medical trials on GLP-1RAs often 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 Hostile Occasions Reporting System additionally regarded into “rising information on the potential danger 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 exhibiting acute kidney damage in individuals taking semaglutide. Each sufferers had power kidney illness on account of diabetes and “skilled speedy worsening of kidney perform and elevated proteinuria after being prescribed the GLP-1 receptor agonist semaglutide.”30 Wegovy’s prescribing data additionally has a sizeable record 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 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 treatment” medicine for weight reduction in our lifetime. Utilizing medicine to drop pounds might result in everlasting, debilitating well being issues — and if we do, it’s seemingly you’ll regain the burden for those who ever cease taking them.
Fortuitously, there are answers that we all know right this moment that deal with 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 reason behind 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 yr after stopping semaglutide.32 Fortuitously, there are higher methods to drop pounds that don’t put your well being in danger. Prime 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 chubby 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
Take into account chopping LA right down to under 5 grams per day, which is near what our ancestors used to devour earlier than power well being situations, together with weight problems, turned widespread.
Ideally the precise quantity although is healthier outlined as a share of day by day energy. LA needs to be lower than 2% of your day by day energy. I used to be in a position to get my share right down to 0.8%. You don’t want costly lab assessments, as all you could do is rigorously enter your meals information into Cronometer and it’ll let you know your %.
• 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 arrange the vast majority of your meals at residence so you already know 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. While you eat each few hours for months, years or many years, by no means lacking a meal, your physique forgets the way to burn fats as a gasoline.
Most individuals who observe 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 stress and temper, than those that used a 12-hour or extra consuming window.34
Though TRE is a tremendous device initially for most individuals, when you regain insulin sensitivity you need to enhance your meals window to 10 to 12 hours.
