5 issues it is best to find out about Ozempic from a dietitian
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A registered dietitian’s deep dive into the reality about Ozempic. Let’s dive into the science to have a look at how efficient at weight reduction it truly is and simply how dangerous the unwanted effects truly are. We additionally cowl implications of the medicine scarcity and concerns for these with a historical past of an consuming dysfunction or disordered consuming. 
Set off warning: discussions of weight reduction numbers, consuming dysfunction behaviors
Ozempic and different weight reduction drugs like Wegovy, Mounjaro, Trulicity and Rybelsus are a scorching subject proper now.
Celebrities are publicly attributing their weight reduction to those drugs (Oprah being the most recent one as I’m penning this). Medical doctors are prescribing them left and proper for weight reduction (and every other ailment you may deliver to the physician that they suppose is correlated to your weight). Sufferers with diabetes (for whom these drugs have been initially developed) can’t entry these meds as a result of there are shortages throughout the nation and their well being is struggling consequently.
From information headlines to TV commercials to water cooler speak, Ozempic is in all places. As a non-diet, weight-inclusive dietitian, I wish to guarantee that I’m empowering my shoppers and my group with all of the evidence-based data we now have (and spotlight what we don’t have) as a way to make an knowledgeable resolution on whether or not or to not take these drugs. It’s not my function to influence you (as a result of I consider in your company and physique autonomy) however it’s my function to teach and inform, which I hope to do right here.
I’d by no means, ever disgrace or decide somebody who decides to take these drugs. It might make sense should you select to take them or are eager about taking them given the anti-fat tradition we dwell in and the strain from medical suppliers to “do one thing about your well being, aka your weight.”
So I compiled what I’ve discovered about these drugs on this publish and am highlighting what the analysis reveals us on weight reduction (how a lot weight you’re truly prone to lose – trace: it’s not as a lot as you may suppose), what the recognized unwanted effects are, and why you have to be cautious about the place you’re accessing these meds from.
What’s GLP-1?
These weight reduction drugs fall into a category of medicines known as GLP-1 agonists. GLP-1 is glucagon-like peptide, also referred to as an incretin. Incretins are secreted within the small gut and assist to extend insulin, lower glucagon and decelerate gastric emptying (i.e. digestion), all of which assist to handle blood sugar. With incretin, glucose can slowly enter the bloodstream as an alternative of being flooded with it.
It additionally stimulates satiety and fullness and helps you keep full longer, which is why the medicine is now getting used to regulate urge for food and produce weight reduction.
What’s semaglutide?
Semaglutide is the generic title for the lively ingredient in Ozempic and Wegovy. Ozempic and Wegovy are simply the model names. Ozempic is FDA-approved for the remedy of diabetes, and in 2021, Wegovy grew to become FDA-approved for the remedy of weight reduction. Each are basically the identical medicine solely Wegovy has greater doses of semaglutide.
As soon as Wegovy grew to become FDA-approved for weight reduction, it rapidly went into scarcity after which medical doctors started prescribing Ozempic off-label (that means prescribing it for one thing aside from what it’s FDA-approved for) for weight reduction. After which Ozempic shortages rapidly adopted swimsuit.
The issue with that is Ozempic and different GLP-1 and GIP agonists FDA-approved for diabetes remedy aren’t attending to the individuals who want them essentially the most and might have critical well being ramifications for these with diabetes.
Semaglutide continues to be in scarcity as of penning this weblog publish in December 2023.
How do GLP-1 agonists assist these with diabetes?
In of us with diabetes, incretin’s results are lowered (by about 30%), which ends up in greater blood sugars and poorer blood sugar management. GLP-1 agonists assist management blood sugar and decrease A1c ranges, which measure your common blood sugar ranges during the last three months. Research present these drugs can assist decrease A1c ranges by 1 – 2.4 share factors and might scale back the chance of cardiac occasions, no matter weight modifications.
5 issues it is best to find out about Ozempic and Wegovy (and different GLP-1 agonists)
1. It’s possible you’ll or could not shed extra pounds with Ozempic and when you cease taking it, you’ll doubtless achieve the burden proper again.
Not everybody loses weight taking these drugs, which is vital to notice, in any other case individuals who don’t shed extra pounds on these meds are left feeling like failures.
The analysis on semaglutide for weight reduction largely comes from the STEP trials, randomized managed trials (RCTs) that are funded by, you guessed it, the pharmaceutical firm that makes this drug, Novo Nordisk.
When wanting solely on the STEP trials, outcomes present that 85% of individuals taking these drugs lose some quantity of weight. So about 15% of oldsters who take these meds received’t lose any weight. For individuals who do shed extra pounds, on the very least, they’re shedding about 5% of their physique weight (that’s about 10 lbs for somebody who weighs 200 lbs).
Roughly half of the oldsters who took this medicine noticed a extra average weight reduction, about 10-15% of physique weight (about 20-30 lbs for somebody weighing 200 lbs) and roughly one third of oldsters taking this medicine noticed a reasonably substantial weight lack of 20% or extra physique weight (about 40 lbs weight reduction for somebody weighing 200 lbs). This extra substantial weight reduction is in fact what’s driving all of the hype and media protection on these drugs.
However let’s needless to say these trials weren’t solely funded by the maker of the drugs but additionally had a whole lot of exclusion standards. Folks couldn’t be part of these research in the event that they have been depressed, had any current cardiovascular points, and in the event that they have been females of childbearing age with no extremely efficient contraception methodology, simply to say a couple of.
While you take a look at different trials on semaglutide, with out the pharma funding and in depth exclusion standards, the outcomes are much less spectacular. Solely 40% of oldsters are shedding at the very least 5% of physique weight. a meta-analysis (evaluation) of RCTs, most weight reduction totals hovered round a mean of 8-10 lbs, with a couple of research displaying extra vital weight reduction, round 25-40 lbs.
In case your purpose is to lose about 5-10% of your physique weight then these drugs may aid you get there however in case you are on the lookout for extra dramatic weight reduction, these meds most likely received’t aid you meet your targets.
It’s additionally vital to acknowledge what occurs while you cease taking the drugs. As a result of perhaps your insurance coverage will cease masking it, or you possibly can now not afford it, or there’s a scarcity, and so on.
Research have checked out what occurs while you take somebody off semaglutide and exchange it with a placebo and located that weight regain occurs in a short time. Inside a yr, folks regain virtually all of their weight misplaced, even whereas nonetheless doing behavioral interventions like vitamin, train, and cooking courses.
Sounds similar to all of the analysis on what occurs to your weight when you cease doing a weight loss plan (you achieve it again).
2. Ozempic comes with very disagreeable unwanted effects.
Research present {that a} vary of 60% as much as 93% of individuals taking these drugs will expertise some unwanted effects – the most typical being gastrointestinal misery. These unwanted effects could embody nausea, vomiting, diarrhea, constipation, GERD, and stomach ache. For most individuals, extreme GI signs ought to resolve inside a couple of days and extra gentle GI unwanted effects often resolve inside 8-12 weeks.
These drugs additionally include a black field warning that they’ll improve the chance of thyroid tumors. That is based mostly purely on research completed in rodents so we don’t know the way that extrapolates to people, but. There are human research being performed now however we received’t know the outcomes till 2035 on the earliest. Due to this these drugs are contraindicated for these with a household historical past of thyroid tumors.
There are different very uncommon unwanted effects like pancreatitis, gallbladder illness, kidney harm, and suicidal ideation. The FDA additionally lately added ileus to the checklist of unwanted effects on the label, which is when your bowel stops functioning and you’ll’t take away waste – it might solely be handled with surgical procedure and may be deadly.
After which there’s the aesthetic reported facet impact individuals are speaking about, “Ozempic face”. Because of fast weight reduction (for some) and certain not getting satisfactory vitamin, folks report having unfastened pores and skin on their face and a hollowing beneath the eyes and close to the temples. This look can also be seen in these affected by malnutrition.
3. There’s a scarcity of those weight reduction medicine, which is main compounding pharmacies to create variations that aren’t accepted or regulated.
When a drug goes on the FDA drug scarcity checklist, the FDA permits compounding pharmacies to combine up their very own model of the drug with none FDA approval or screening.
However, right here’s the catch. Novo Nordisk has a has a patent on the semaglutide molecule and solely they’ll produce it till 2032 so compounding pharmacies don’t have entry to this lively ingredient.
If you wish to take a weight reduction medicine, get a prescription out of your physician and safe it from a licensed pharmacy. Keep far-off from wellness facilities, spas, or telehealth suppliers touting these drugs at a low value.
4. There’s no long-term knowledge on Ozempic.
Let’s not overlook that we now have NO long run knowledge on these medicine. Semaglutide was accepted by the FDA for diabetes remedy in 2017 and the longest research I discovered was follow-up with a little bit over two years. We simply don’t know if there are any long-term unwanted effects. We additionally don’t know should you keep your weight reduction while you keep on this drug long-term.
It’s an eerily related image to previous weight reduction meds like Fen-Phen and Ephedra, each of which have been hailed as miracle weight reduction medicine with no long-term knowledge and have been finally taken off the market due to irreversible critical opposed unwanted effects like deadly hypertension, coronary heart valve issues, coronary heart assault, stroke, and demise.
It’s vital to weigh this when deciding to take the medicine – you merely can’t know what the protection or efficacy is of taking Ozempic long-term. What we do know is that if you wish to have a shot at sustaining your weight reduction, you’ll have to keep on it long-term.
5. Ozempic may be harmful for these with a historical past of an consuming dysfunction or disordered consuming.
This medicine in the end places you out of contact together with your physique’s pure starvation and fullness cues, which is counterproductive to consuming dysfunction restoration and the intuitive consuming framework. It causes you to eat much less, which may exacerbate and gas already restrictive consuming patterns, and result in potential nutrient deficiencies.
For these with binge consuming dysfunction or who wrestle with episodes of binging, coming off the medicine can lead to vital upswings in starvation, which can make you extra inclined to binges.
After which there’s the influence of weight modifications in your psychological well being. In the event you don’t shed extra pounds taking the medicine, you might go to extremes to limit your meals consumption. Or shedding weight could set off you to wish to lose much more, fueling extra restriction. Or should you lose vital weight after which achieve all of it again when you come off the medicine, that change in physique look could trigger emotional misery and result in disordered consuming.
In the identical approach I wouldn’t advocate a weight loss plan or intentional weight reduction to of us with an lively consuming dysfunction, a historical past of an consuming dysfunction, or disordered consuming, I wouldn’t advocate these weight reduction drugs both. It reinforces the concept skinny is finest and leads to insufficient nourishment and vitamin.
If you’re struggling to get satisfactory vitamin whereas taking one in every of these drugs or are debating on taking one in every of these drugs and would love extra individualized vitamin help, our group would love that can assist you. Guide a vitamin evaluation right this moment.
References:
https://pubmed.ncbi.nlm.nih.gov/32441473/
https://pubmed.ncbi.nlm.nih.gov/33567185/
https://dom-pubs.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dom.14863
https://pubmed.ncbi.nlm.nih.gov/35441470/
https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic
https://www.frontiersin.org/articles/10.3389/fendo.2021.645563/full
Consuming Issues & Diabetes: A Deal with Diabetes Medicines Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Professional
For extra weblog posts like this take a look at:
The way to Set Sustainable Well being Targets For the New 12 months that Are Really Sustainable
Am I Consuming Sufficient? 8 Indicators You’re Undereating
Is Intuitive Fasting Actually Intuitive or Is It Simply One other Weight loss plan?
What Is Orthorexia? When Wholesome Consuming Turns into Obsessive
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