Everyone's Talking About Ozempic / Wegovy ...

Semaglutide and its most well-known brand names Ozempic (a diabetes medication) and Wegovy (a weight-management medication) has been a bit of a hot topic for a while now.

Ozempic has been approved for use, initially in the USA and then more widely across the world, for around 8 years for type 2 diabetes patients, to help them better regulate their blood sugar levels, alongside diet and lifestyle measures.

In the last 2 or 3 years, the higher dose formulation of Wegovy, has also been approved for long-term weight management in adults with obesity or other weight-related issues.

So what is it and how does it work?

Well, it’s essentially a peptide. Peptides are short chains of amino acids, the building blocks of proteins. So far so harmless, I mean plenty of us pop a spoonful of collagen peptides in our tea to help support our joints, hair, skin, nails etc.

Peptides are clever little things. They act as signalling molecules and regulators of all sorts of biological processes, so they’re involved in all sorts of functions of the body and can influence these processes.

To get a bit science-y, semaglutide is a peptide that is fairly similar to the hormone Glucagon-like-Peptide-1 (GLP-1), but modified with a little side chain of amino acids. It’s what’s known as a GLP-1 receptor agonist, which means that it activates the GLP-1 receptor to release GLP-1, which is generally released after eating to signal satiety and regulate blood sugar. By doing this, it helps to reduce food intake and help keep blood sugar levels in check. That’s a slightly simplified version, but it’s about as science-y as I’m comfortable with!

You can see how it’s appealing. Who doesn’t want something else to do the heavy lifting for them when it comes to controlling appetite and food intake, especially if it’s something that you have always struggled with. Sweet relief, I don’t have to think about food all the damn time…

Never that simple though is it? Sadly there genuinely is no such thing as a free (small and healthy) lunch.

Like any medication, it comes with a list of side effects, some of which are common, such as nausea, dizziness, constipation, diarrhoea, and a few more serious, but rare side effects as well, such as a risk of gall bladder issues and pancreatitis.

But really the main issue with semaglutide is two-fold. Yes, once it kicks in, you do lose weight, and quickly in many cases, but if you’re not very careful with additional lifestyle changes, a lot of that weight loss is muscle loss rather than fat loss. That in itself is really problematic for longer term health, strength and mobility. There’s a well-publicised study published on PubMed here that looks at these effects in patients taking metformin (another semaglutide brand).

It seems to be well-accepted across both Western medicine and naturopathic / functional medicine, that the crucial lifestyle habits to either adopt or maintain or increase when taking a semaglutide, are a protein-rich diet and plenty of weight or resistance training. If your appetite is a bit flimsy, it can be hard to make yourself eat a lot of protein-dense food, so it’s not as easy as it sounds. And for some people, they also report a reduced desire to exercise, which is rather unhelpful (reported in a recent study by the University of Copenhagen).

Secondly, when patients stop taking the medication, on average, they tend to regain around two thirds of the weight that they gained, and it goes back on fairly quickly, and as fat, as weight gain tends to do. This doesn’t happen to everyone, and it’s less likely to happen if you keep up your additional lifestyle changes, but I’ve talked to people on discussion groups who have kept up all the lifestyle changes, and have put the weight back on regardless, which tends to suggest that there is some kind of more permanent change to the metabolic feedback loops in the body for some people, which should ring some alarm bells. Obviously I only have their word for that, so I’m not suggesting that it constitutes proof of this happening.

However, here’s the details of another study published on PubMed that demonstrates these results when patients stop taking the medication.

So, what do I think about all this? GLP-1 medications like semaglutide certainly have their place, and shouldn’t be dismissed out of hand. If you are morbidly obese and lose a lot of weight on them, it’s clear that you will improve your health outcomes across a range of body systems even if you are losing muscle. There’s a quid pro quo and you’re probably still on the winning side, especially if you can then implement some healthier lifestyles practices as your weight reduces.

And it is clear that these medications are also anti-inflammatory and help to regulate insulin levels, which is positive for longer term health.

But what does worry me is the  whole ‘robbing Peter to pay Paul’ approach that some people seem to be taking. They’ve got a stone to lose and they’ve got busy lives and they’re looking for a magic bullet. And there isn’t one.

Is it really worth taking the risk of losing a load of muscle and then putting it all back on as fat, for the sake of a stone?? I’ve seen people online considering taking it to drop 8 pounds!

Or panicking because you’re taking it and really struggling to keep your protein intake up, and not finding the time to go to the gym?

Muscle is a crucial organ of longevity and is essential for maintaining strength and mobility as we get older. Lean muscle is also fantastic at firing up your metabolism.

Unless semaglutide would be a lifesaver for you, would you not be better to put in place healthy lifestyle practices across the board, to help ensure your healthy longevity?

And if you do, frankly your weight will take care of itself over a sensible period of time…

Health isn’t just about the number on the scale. It’s about how well you’re nourishing and nurturing your body and brain generally, how well you’re managing your stress levels, how well you’re sleeping and moving your body.

Do you really want to risk permanent changes to the way your metabolism works, for the sake of a number?

And while we’re on the subject, I thought I’d woken up and it was April the first when I heard announced on the radio that the government wants to prescribe semaglutide to overweight out of work patients, to ‘help get them back into work’.

Seriously, they’d be better prescribing health coaching, patients will come out of it a lot healthier, and it will cost the health service considerably less in the long run……’scoots off to pen a letter to Wes Streeting to that effect…’