Ozempic; also called semaglutide, Wegovy, Rybelsus; is used to help patients lose weight when other options fail or take too much time. You may also have heard of another semaglutide for weight loss called Mounjaro (tirzepatide), which is gaining popularity. It’s a newer medication type called GLP-1/GIP agonists, which has a similar action to semaglutide.
Semaglutide for Weight Loss: A Hot Topic
Semaglutide for weight loss and GLP-1 (glucagon-like peptide 1) agonist medications have been discussed on a typical day over the last year, especially as they are easier to get. Most patients using or thinking about using this medication may not be grasping the need for counsel and guidance to keep them medically safe.
These are conversations that we often have in our practice. They need to be supported before, during, and after using a drug like this to monitor negative effects. There is often a mental-emotional piece that needs to be addressed as well. For example, there may be years of trying to lose weight and trying to get their metabolism to function. Patients often need validation and help with their mindset to transition from desperation and frustration to education and instilling hope, confidence, and a sense of well-being.
How Do GLP-1 Agonists Work?
Let’s talk about how semaglutide for weight loss works in the body and the risks associated with these long-acting medications. GLP-1 agonist medications mimic our body’s natural GLP, but it stays in the body for a longer time (up to five weeks). GLP-1 is found in our body naturally as a peptide hormone, specifically made in the small intestine to support the normal response of insulin and blood sugar control. It breaks down within one to five minutes.
What Effects Does Semaglutide for Weight Loss Have?
Its effects include:
Improves insulin secretion: It simulates the pancreas to produce insulin, which lowers blood sugar and suppresses the release of glucagon (which raises blood sugar). This forces the body to generate more glucose by breaking down fat and protein.
Reduces appetite and cravings: It goes into the brain and regulates the appetite, decreases cravings, but not just for food.
Slows digestion: It also slows gastric emptying, how long food stays in the digestive system, so you feel full longer. Diabetics have deficiencies of GLP, and we think it is related to the health of the lining of the small intestine.
Most GLP-1 agonists for weight loss we are using are injectables. However, some people are using pills or under-the-tongue versions of these medications. Historically, these drugs are used to treat diabetes and have some cardiovascular benefits as well. GLP-1 receptors are found in the brain, arteries, heart ventricles, and the atrium, as well as the kidneys, lungs, nervous system, and lymphatic system, helping to heal these tissues. We don’t have clarity on whether cardiometabolic markers are improving because of the drug itself or because of weight loss. We will know more as more patients discontinue the drug.
Side Effects of GLP-1 Agonists
The most common side effects of Ozempic reported by patients are digestive issues and feeling uncomfortable.
Things like:
- Nausea, vomiting, diarrhea, and constipation are the most common. These side effects are usually mild to moderate and can last for several days.
- More serious but less common side effects include pancreatitis, bowel obstruction, gallstone attack, bile duct block, and kidney failure.
- We are also seeing gastroparesis, where the stomach stops digesting food, and food does not leave the stomach. It is unclear if this is reversible after stopping the medications.
- Another problem is muscle wasting because the body has to burn fat and protein to make glucose, people can lose muscle mass, and their metabolism decreases.
- If you have a history of Irritable Bowel Syndrome caused by SIBO (small intestine bacteria overgrowth), acid reflux, or constipation, it could make these conditions worse, but moreresearch is needed.
The Challenges of Weight Loss with GLP-1 Agonists
Patients looking to Ozempic for help are overweight and often undernourished since their metabolic processes are already not working properly. Since Ozempic reduces appetite, it can worsen the undernourishment of minerals, vitamins, fiber, and plant antioxidants. With these medications being so strong on forcing the body to lose both fat and muscle, it can result in someone who is both underweight and undernourished.
After the forced slowdown of the metabolism, the muscle won’t come back after it is lost, but the fat will often come back quickly. So now we have a disproportion of muscle to fat loss. This is why the recommendation is to get on the medication and stay on them for a lifetime. The reality is that patients get tired of taking it. If you don’t make lifestyle changes along with the medication, it is not sustainable, really, and the side effects are greater.
There is a real problem with stopping the drug suddenly or too fast, but there are some possibilities to get off it. Some research is showing that lower doses over months can prevent some of the weight returning, but most people do gain weight if they stop the drug suddenly. Some doctors have decided to get compounded medications and try these drugs at lower doses to match the microdoses of the body instead of the commercial dosage amount taken weekly. These smaller doses increase the chance of successfully getting off the commercial dosing. But this is done while working on lifestyle changes and increasing your own natural production of GLP-1 in the body.
Lifestyle Challenges for Weight Loss
Particularly, a balanced diet of nutrient-dense, whole foods is key:
- Whole grains: Oats, barley, and whole wheat are high in soluble fiber, which slows digestion
- Fruits and vegetables: Water-rich fruits and vegetables can increase GLP-1
- Lean proteins: Poultry, meat, fish, beans, legumes, nuts, and tofu are all good sources of
- protein
- Avocados, nuts, and seeds: Contain fiber and monounsaturated fats
- Olive oil: Contains unsaturated fats
- Muscle building, like resistance or strength training, is another important strategy. Muscle mass and strength are very efficient at using up fuel, such as fat, and keeping your metabolism up.
- Things that interrupt normal sleep, such as sleep apnea, insomnia, and stress, are linked to being overweight. Sleeping appropriately helps to restore and repair cells.
- Supplementing the diet with some plant-based interventions can be used, too.
- Some small studies show that supplements like berberine, curcumin, and ginseng can boost GLP-1 levels. Consuming resveratrol, a natural compound found in grapes, red wine, and certain berries. Research suggests it may increase GLP-1 secretion.
- Taking probiotics or foods supporting Akkermansia mucinphila, Lactobacillus rhamnosus GG, and Clostridium butyricum may help promote the production of GLP-1.
Taking a naturopathic medical approach is key if you are considering taking these weight-loss medications or want to lose weight. Lab markers, monitoring muscle loss, addressing metabolism, elimination pathways, hormones, and lifestyle and dietary change are all critically important for weight loss and to keep it off. Working with a naturopathic doctor becomes even more important if you start these medications.
Co-Authors:
Dr Shannyn Fowl, ND runs Journey of Health Medical Clinic in Southern California and Arizona where she enjoys helping patients find answers to their health challenges so they can be empowered to thrive in their own world. As adjunct faculty, she spent a decade teaching ‘Introduction to Naturopathic Medicine’ to the general public and as continuing education to nurses. She has been a principal investigator for research projects during her career and recently co-authored a peer-reviewed article on the effects of drumming. Drawn to travel, she is looking forward to more exploring and experiencing the diversity of culture as time allows during her husband’s retirement. There is no end to the tools that can be used for healing in a naturopathic practice.
Learn more about her here.
Dr. Laurence Freitas ND LAc is a licensed naturopathic doctor and acupuncturist who owns Realm Naturopathic & Integrative Medicine clinic in Coronado, CA. With over seven years of experience practicing naturopathic medicine and acupuncture, Dr. Freitas brings a wealth of knowledge to his patients. Prior to opening his clinic, he spent 12 years working in public health and health policy, giving him a unique perspective on integrative healthcare.
At Realm, Dr. Laurence takes a holistic approach, blending traditional natural therapies with modern scientific advancements to develop personalized treatment plans for each patient. His goal is to address the underlying causes of illness and promote overall wellness rather than just treating symptoms. With his extensive training and patient-focused care, Dr. Freitas is dedicated to helping his patients achieve optimal health and vitality through naturopathic and integrative medicine.
Learn more about him here:
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