Aaron Hartman, MD explains how GLP-1 drugs like Ozempic work and why slow dosing matters to avoid muscle loss and "Ozempic face." Common side effects include nausea and constipation; rare risks include intestinal obstruction. He covers emerging uses in cardiovascular health and renal protection, plus how resistance training and lifestyle changes preserve muscle alongside medication.
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Around 2006–2007.
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GLP1s are all the rage. Ozempic, Wegovy, Bayeta, Victoza, whatever the thing you're taking for weight loss. These are all the craze. They're miraculous for weight loss, miraculous for a whole bunch of things. Or they can kill you, you know, or they can give you intestinal obstruction or parathyroid cancer. So what is the skinny? What's the real truth about GLP1s, Brazimbic, Wegovy, these medications and why is that important to you? So first question you might ask is like where am I coming from with this? I'm a medical doctor. I first started using Vieta was actually the first GLP on the market. I remember using it was twice a week back in 2006, 2007. I've been using these medications ever since then my clinical research company, VA Research center also did clinical research with these for weight loss as well as for cardiovascular risk reduction. And just this past month in the medical letter they came out now FDA approved to use GLP1s to actually help patients with kidney issues. So pharmacologically the GLP1s are used for preventing heart disease, treating diabetes, weight loss and now kidney renal protection. But what's kind of also interesting is a bunch of different groups. I see a lot of patients with mast cell activation syndrome, polypsis, autonomia, a lot of things. And what's happened is we're realizing that these GLP1s are also anti inflammatories in the MCAS world. We're actually using microdosing to actually help treat some patients with MCAS or mast cell activation syndrome, which might explain why some people get these medications and like there's aches and pains and other things go away because you're actually treating dysfunctional mast cells. I've also had some interesting effects with it in some of my middle aged women who've actually gone through menopause, actually helping regulate hormones because of the impact on their metabolism of GLP1s as well as the impact on hormone sensitivity. So these medications have a lot of interesting uses. So what is a glucon, like peptide? It's actually something your body actually naturally makes, Butyrate, which is a short chain fatty acid made in your GI tract, it's made in fermented dairy, is nature's butyrate. There is some stuff out there talking about berberine as a nature's ozempic quote unquote. It's more of a berberine actually acts more like metformin as far as its effect on insulin sensitivity. There are some probiotics out there. Pendulum has a group of them and actually have certain strains of bacteria that actually will create GLP1s in your GI tract. But the gist is that your body's supposed to naturally make these to help regulate your metabolism, something your body naturally makes. So what's the skinny? Well, the problem is is that if you use this too fast, too quick, too strong, you can have people lose weight really fast. Your healthy weight loss is one or two pounds a week, four to eight pounds a month. If you lose 20 pounds in a month, you're going to lose muscle mass. And now people are talking about ozempic face. You may have seen people whose faces kind of hollow out, they actually lose fat, not sipital fat, they'll lose fat in their cheeks. And what happens is you look hollow that you lose muscle and fat as well. You lose muscle in the face as well. And so if you lose the weight too quickly, you can actually use muscle mass. And that's one of the things that happens with GLP1s as well is people will lose muscle mass. And so you need to combat that with hit training, some kind of muscle training, muscle mass building as well as using. There is a peptide called BPC157 that can help prevent the side effect of muscle mass loss with your GLP1s. But where people get into problems with the GLP1s is they start it too quick, too fast, they don't realize having side effects. The biggest side effects that I personally have seen have been nausea, reflux, constipation. I've seen some anxiety. I had one individual develop horrible panic attacks. I have not seen the parathyroid cancer in my career. I've been using this drug again since about 2006, 2007, had thousands of patients use it. So I've got pretty good experience with it. I've not seen that it's actually a pretty safe medication if you use it in the right situation. What's also really interesting to me is because of its impact on metabolism, there's interesting research showing it as a neuroprotective and there's some interesting research looking at it for prevention of Alzheimer's as well as Parkinson's progression. So this class of medications has a lot of really great potential use in the right hands. Dosing is tricky. The there are some now some oral by mouth versions of semaclutide as well as tazeplatide. Making me dumb my mouth. I've not had as much clinical experience with Those to know if they're as effective as the injectables just cost. It's cheaper to do the injection versus the pills but they are helpful medication. Berberine you know is it's more acts like, more like metformin which interesting thing with metformin which actually comes from French Lilac, it is a diabetes medication which actually is an anti aging drug. It actually helps with senescent cells and it actually changes your gut microbiome. It actually increases the counts of Akkermansium mucinophylla which actually certain probiotics do that as well which affect GLP1. So it's one of those interactions we see that's really interesting and we're learning basically if we can change the gut bacteria and use these medications or herbs in the right way, we can actually improve your metabolism. So if that information is helpful about GLP1s again when you get stuck where you get tricked into, we have issues where you use them too. You go up too fast, too quick, you lose too much weight. If you have side effects like nausea, g upset reflex, you don't pay attention, you advance the dose. That's where people get into trouble. But using the right hands, skill for hand, people have used this a lot. They're actually a pretty safe medication. Of course I always recommend to talk with your personal healthcare provider first but they can be pretty impactful. I've had a couple of patients come to me actually for consults for getting gastric bypass surgery. And they and they had to come see me, meet with me once a month for three months before the insurance would pay for it. And a few of them I actually was able to get on a GLP1 medication. And the data is really interesting. You can lose almost as much weight on GLP1 as you can with a gastric sleeve procedure which is a type of bypass procedure. So they can be very profound for weight loss. It's just not too quick, not too fast. And because of their mast cell effects, if you have inflammation, there's five kinds. I tell patients there's five cons of obesity. There's caloric which is, you know, inverses out, you just eat too much, there's inflammation, there's metabolic, which is like metabolic syndrome kind of stuff. There's your microbiome, there's toxins which a lot of people don't realize. These things called obesogens which are chemicals that make you obese, whether it's phthalates, benzenes, you know, a lot of things. And then there's a neurologic component, which is your nervous system, is like a talk, like a trauma response. If your nervous system is wound up in sympathetic overdrive, you can't really feel like you're safe for your body to kick in and arrest and digest and lose weight. Interesting thing is that the GLP ones address three or four of these, so actually it's like an easy blind way to hit a lot of different types of causes for obesity, so hopefully this information was helpful. If so, share your comments below. 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