The demand for drugs promising straightforward 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 acquired 1.2 billion views on TikTok2 as of July 2023 — to present just a few indication of its reputation.
Semaglutide is offered 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 however it comes at a steep worth. Not solely does Wegovy price greater than $1,000 a month,4 it may possibly 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 grew to become 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 informed CNN. “This medication made my life hell. A lot hell. It has price me cash. It price me lots of stress; it price me days and nights and journeys with my household. It’s price me loads, and it’s not price it. The worth is simply 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 identified reason behind gastroparesis, because of nerve injury 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, informed 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 delicate to reasonable in severity and of brief length. GLP-1’s are identified 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 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 gaggle of incretin hormones, that are launched if you eat to manage insulin, together with many different features.9
Together with affecting insulin, GLP-1 might affect the nervous system, resulting in an appetite-reducing response. Nonetheless, one among their mechanisms is, in reality, 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 partly, 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 widespread signs of gastroparesis. Mayo Clinic researchers additionally seemed 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 have been related to “delay in gastric emptying of solids,”12 and the longer meals sat within the abdomen, the higher the load loss results grew to become. 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 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 be capable of e book a digital session with a clinician and get a prescription for Wegovy or one other GLP-1. Actually, Sequence’s program is totally based mostly round weight reduction drugs. One in all their FAQs is “What if my clinician determines a prescription shouldn’t 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 in case you enroll.
Skepticism is sensible on this case, because the variety of important unwanted effects tied to the medicine continues to extend. On social media, many members have been shocked by the transfer, saying it “rubbed them the mistaken method.”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 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 Experiences Spotlight Semaglutide-Induced Abdomen Paralysis
Gastroparesis amongst these taking semaglutide isn’t unprecedented. Case research of two girls who suffered from medication-induced gastroparesis have been printed 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 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 girl 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 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 may improve the danger of problems related to anesthesia — specifically that you would regurgitate meals that’s nonetheless sitting in your abdomen, even in case you’ve fasted appropriately.
In consequence, they advocate not taking the drugs for a day or every week previous to surgical procedure, and probably delaying the process if signs akin to nausea, vomiting, stomach ache or bloating are current. In a information launch, Dr. Michael W. Champeau, ASA president, defined:21
“Whereas there’s presently 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 acquired anecdotal stories 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 common anesthesia and deep sedation.
These problems might be severe, so we’re offering steerage 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 common. If the abdomen is full or if the gastric ultrasound is inconclusive or not doable, take into account delaying the process or proceed utilizing full abdomen precautions. Focus on the potential danger 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 drugs trigger different important dangers as properly and will even trigger a probably deadly intestinal obstruction. Diabetic sufferers who use the medicine have a 4.5 instances increased danger of intestinal obstruction than these utilizing different drugs. 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 have 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 critically have an effect on intestinal operate, rising obstruction danger:24
“As a result of GLP-1RAs might trigger steady will increase within the intestinal size and villus top, the small gut might change into as inelastic and fibrotic as a free spring, resulting in long-term higher intestinal obstruction …”
Up to now, scientific trials haven’t revealed such modifications within the human intestine, probably as a result of it’s troublesome to measure small gut size. Additional, the commonest symptom of those modifications is constipation, which might be attributed to many causes — to not point out, the workforce 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 very best incidence showing 1.6 years following GLP-1RA remedy. Nonetheless, scientific 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 examine utilizing the FDA Hostile Occasions Reporting System additionally seemed into “rising information on the potential danger of pancreatic carcinoma related” with GLP-1Ras, together with semaglutide, discovering a transparent affiliation.28
“Primarily based on this pharmacovigilance examine, GLP-1RAs, besides albiglutide, are related to pancreatic carcinoma,” researchers famous, including, “Primarily 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 damage in individuals taking semaglutide. Each sufferers had continual 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 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 load in case you ever cease taking them.
Luckily, there are answers that we all know right this moment that deal with the basic 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 examine regained two-thirds of their prior weight reduction, and many of the modifications in cardiometabolic variables additionally reverted again to pretreatment ranges one yr after stopping semaglutide.32 Luckily, there are higher methods to drop some pounds that don’t put your well being in danger. High methods embrace:
• 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 kind of omega-6 fats present in seed oils like soybean, cottonseed, sunflower, rapeseed (canola), corn and safflower.33
Take into account slicing LA all the way down to under 5 grams per day, which is near what our ancestors used to eat earlier than continual well being situations, together with weight problems, grew to become widespread.
Ideally the precise quantity although is healthier outlined as a share 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 share all the way 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 %.
• Avoiding practically all ultraprocessed meals, quick meals and restaurant meals — Just about all of them include seed oils. The simplest method to do that is to organize the vast majority 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. Once you eat each few hours for months, years or a long time, by no means lacking a meal, your physique forgets methods to burn fats as a gas.
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 examine, 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 device initially for most individuals, when you regain insulin sensitivity you need to improve your meals window to 10 to 12 hours.
