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 present just a few indication of its recognition.
Semaglutide is offered beneath the title Ozempic as a diabetes drug and, in a better dose, beneath 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 rationale? 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 instructed CNN. “This medication made my life hell. A lot hell. It has value me cash. It value me plenty 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 worth 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. Nevertheless, gastroparesis additionally results in nausea, vomiting and, in extreme instances, dehydration and malnutrition. Diabetes is probably the most generally identified explanation for gastroparesis, as a consequence of nerve harm within the abdomen.7
Nevertheless, 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, instructed 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, nearly all of GI unwanted side effects are delicate to average in severity and of quick period. 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 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 if you eat to control insulin, together with many different capabilities.9
Together with affecting insulin, GLP-1 might affect the nervous system, resulting in an appetite-reducing response. Nevertheless, one in all 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 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 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 better 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 shifting 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 assist 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. 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 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 simply’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 vital unwanted side effects tied to the medication continues to extend. On social media, many members had 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 strategy to shed 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 Experiences Spotlight Semaglutide-Induced Abdomen Paralysis
Gastroparesis amongst these taking semaglutide isn’t exceptional. Case research of two girls who suffered from medication-induced gastroparesis had been printed 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 title 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.
Nevertheless, 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 capable of “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 medication 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 issues related to anesthesia — specifically that you can regurgitate meals that’s nonetheless sitting in your abdomen, even in case you’ve fasted appropriately.
Consequently, they advocate not taking the drugs for a day or per week previous to surgical procedure, and probably delaying the process if signs resembling nausea, vomiting, stomach ache or bloating are current. In a information launch, Dr. Michael W. Champeau, ASA president, defined:21
“Whereas there’s 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 acquired anecdotal experiences 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 issues might be critical, so we’re offering steerage on when GLP-1 agonists needs to be stopped upfront of an elective process.”
The probability 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, think about 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 Danger Rises 3.5-Fold on Semaglutide
These stylish weight reduction drugs trigger different vital dangers as properly and will even trigger a probably deadly intestinal obstruction. Diabetic sufferers who use the medication have a 4.5 occasions larger danger of intestinal obstruction than these utilizing different drugs. A examine of 25,617 folks 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 peak; villi are the hairlike projections contained in the small gut that assist soak up vitamins. Writing in Acta Pharmaceutica Sinica B, researchers defined how this might severely 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 might develop 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, seemingly as a result of it’s tough 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 danger of continual intestinal obstruction in people cumulates over time, with the best incidence showing 1.6 years following GLP-1RA therapy. Nevertheless, scientific 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 examine utilizing the FDA Antagonistic Occasions 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
“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 harm in folks taking semaglutide. Each sufferers had continual 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 info additionally has a sizeable listing of warnings and precautions, together with for:31
Acute gallbladder illness
Acute kidney harm
Hypersensitivity reactions, together with anaphylactic reactions and angioedema
Diabetic retinopathy issues
Coronary heart charge enhance
Suicidal conduct and ideation
Higher Choices for Weight Loss
It’s my robust perception that we’ll by no means see the “miracle remedy” medication for weight reduction in our lifetime. Utilizing medication to shed pounds might result in everlasting, debilitating well being issues — and if we do, it’s seemingly you’ll regain the load in case you ever cease taking them.
Luckily, there are answers that we all know immediately that deal with the basic cause 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.
Members in a single examine regained two-thirds of their prior weight reduction, and a lot of the modifications in cardiometabolic variables additionally reverted again to pretreatment ranges one yr after stopping semaglutide.32 Luckily, there are higher methods to shed pounds that don’t put your well being in danger. High methods embody:
• Lowering 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 kind of omega-6 fats present in seed oils like soybean, cottonseed, sunflower, rapeseed (canola), corn and safflower.33
Contemplate reducing LA right down to beneath 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 best outlined as a proportion of each day energy. LA needs to be lower than 2% of your each day energy. I used to be capable of get my proportion right down to 0.8%. You don’t want costly lab exams, as all it is advisable to do is rigorously enter your meals information into Cronometer and it’ll let you know your %.
• Avoiding almost all ultraprocessed meals, quick meals and restaurant meals — Nearly all of them comprise seed oils. The simplest method to do that is to organize nearly all of your meals at house so you realize 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. If you eat each few hours for months, years or many years, by no means lacking a meal, your physique forgets how you can burn fats as a gas.
Most individuals who follow 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 enhance your meals window to 10 to 12 hours.