Ozempic (& other GLP-1 weight loss drugs) - are they the new frontier or something to fear?

Hello, Hello, Hello. Welcome back to another exclusive nutrition lesson inside the Body Fit Athletic Club. If you don't know who I am, my name is Vivian and I am the registered and licensed dietitian nutritionist here at Bodyfit by Amy. Today we're going to talk about Ozempic. You've probably seen headlines, heard people talk about it, or maybe you're wondering what all the buzz and hype is about. Today we're going to dive deep into what Ozempic is, how it works, its fascinating origins, benefits, side effects and, and my opinions on it. What is Ozempic? Ozempic is a once a week injectable drug that was initially tested and approved to improve blood sugar levels in patients with type 2 diabetes. By the way, the name Ozempic is a brand name for the drug semaglutide. Semaglutide is the active ingredient. It's the drug that makes Ozempic work. How does Ozempic work? Great question and I don't fully know. Researchers don't fully comprehend the mechanism for what makes these drugs work the way that they do. But. But here's what we do know. These semaglutide drugs are part of a larger group of medications that are called GLP1 agonists. Stick with me here. GLP1, which stands for glucagon, like peptide 1, is a hormone that your body naturally produces and one of its main roles is to regulate blood sugar levels. This hormone helps the pancreas release the right amount of insulin when blood sugar levels are high. And you may already know that insulin helps move sugar from the blood into other body tissues. This is a good thing. We want that sugar to be moved out of the blood and into our tissues to be used for energy. Besides helping us out with insulin, this hormone also slows digestion which can make you feel fuller for longer. And it can help send signals to the brain that say I'm full, causing you to eat less. Semaglutide drugs like OIC mimic the GLP1 hormone that our bodies naturally produce. You may hear these medications get referred to as GLP1 agonists. These the agonist part means that it mimics the human hormone GLP1. We know that many people, especially those with type 2 diabetes or obesity, do not produce enough GLP1 hormone. So it is likely that these drugs are correcting a deficiency and providing the portion of the hormone that your body is not naturally producing. When did Ozempic come on the market? Semaglutide has been on the market as a treatment for type 2 diabetes in the United States since 2018 under the name Ozempic. Yep, you heard that right. 2018. So it's pretty new. Oic is made by Novo Nordisk, which is a huge Danish pharmaceutical company. When did we discover OIC? Let me tell you. Let's go back to 1984 and head over to Canada, shall we? Oh, and let's talk about creepy and venomous lizards. In 1984, Dr. Daniel Drucker, an endocrinologist from the University of Toronto, discovered a hormone in the human gut in the small intestine. If we're being specific. This hormone, they discovered, is the GLP1 hormone that I told you about. I don't know about you, but I find this to be really fascinating. Sometimes it feels like we've known everything about the human body for centuries. And it's interesting to hear that this hormone was only discovered 40 years ago. So Dr. Drucker and his team started to study this hormone to understand what it does in the body and how it works. And they quickly realized that this hormone is super excellent at controlling blood sugar because it can tell the pancreas to drop some insulin. And remember, insulin is the hormone that brings blood sugar down because it moves it out of our blood. But they have a problem. This hormone is produced quickly by the body and it's also removed very quickly from the body. This quick removal made it really hard for Dr. Drucker and his team to study. Fast forward to the Bronx in the year 1990. Remember, Dr. Drucker in Toronto discovered this hormone in humans in 1984. He continued studying it, but other scientists also started investigating this new hormone. John Ang, an endocrinologist from the Bronze, decided to look into other animals that may produce this hormone, and ideally, an animal that doesn't clear the hormone as quickly as we humans do. And this brings us to a gill monster. What? Yeah, a Gila monster, which, if you are unfamiliar, is a thick and giant lizard. I'd like to never cross paths with. With that. Apparently they're shy, but if you make them mad, they will bite you. And their venom probably won't kill you. But it does hurt. So I hear. Anyways, Dr. Ang decides to get a hold of this hefty reptile and studies it. And what does he find? A hormone in the venom of the gila monster called extendant 4, which is remarkably similar to the human hormone GLP1. If you're wondering why they picked this lizard, it's because they're known to have A remarkable ability to go long periods of time without food and, and it also has an incredible ability to keep their blood sugars stable. Remember how I told you that GLP1 gets cleared from the body super quickly and that's why it was really hard to study? Well, to be specific, GLP1 remains active in the body for two minutes, but extend and four. That's the thing we found in the venom of the Gilla monster that remains active for hours, suggesting that it could be a long acting effective diabetes treatment. Almost immediately, scientists started using it in pharmaceutical research to see if they could develop a drug that would help people with their blood sugars and also appetite regulation. As you can imagine, a lot of people felt a little funny about the idea of a medication coming from the venom of a reptile. But the results this drug was having while being studied in clinical trials were pretty incredible. People were reversing their diabetes, losing some weight, and people taking the drug had less of a protein that causes Alzheimer's disease. Based on the positive results and minor side effects, this drug was approved in 2005 and called Etide. You can still find it today under the brand name Byeta or Bidurian. Beside, of course, like most for profit industries, if one thing seems to work, competitors are going to try to replicate it and see if they can come up with their own version and join in on the money earning train. And in fact, take a look at how many versions of GLP1 medications are out there today. In 2012, Novo Nordisk finally figured out how to make their own version of the GLP1 medication inspired by the Gillimonster Venom Hormone Hexendin 4 and they call it Semaglutide. For six years they tested and researched this medication and the results were even more mind blowing than the medication that was approved in 2005. In fact, it is rumored that when the results of this medication were presented to attendees at the American Diabetes association conference, people gave it a standing ovation and were crying at the power this medication could have in improving people's lives with diabetes. Clinical trials continued showing that this drug was good, like really good. People's diabetes were improving dramatically. Their heart health was also getting better. Heck, even their kidney function improved. Oh, and they were losing weight. They were losing serious weight. In fact, one study showed that a higher dose of semaglutide led to a loss of 5% of body weight in people, which is clinically significant. In 2018, the drug gets officially approved for public use to treat people's diabetes and nothing more. How did Ozempic, a drug for diabetes, become the end all and be all for weight loss? When people started taking these medications for diabetes, their blood sugars improved significantly, but also they lost weight, like a lot of weight. Even before the medication was approved for public use, the rumors were circulating that this medication that helps people with diabetes has weight loss effects too. As soon as it was approved, sketchy doctors started offering it to the rich clients who had no diabetes but wanted to lose weight. What makes me angry here is that many of these people wanting to lose weight wanted to lose 5 to 10 vanity pounds, not 100 pounds. In 2022, Ozempic went viral on TikTok, and now here I am telling you all about it. Famous people like Elon Musk and Chelsea Handler endorsed it and sang the praises of the drug. Next thing you know, we start to hear that all sorts of celebrities and wealthy people, many of whom are already thin, are taking Ozempic and paying for it out of pocket to be the thinnest version of themselves. Between going viral on TikTok and the fact that the rich and famous were hoarding a large portion of the drug for vanity reasons, a shortage was officially declared in 2023. So this wonderful drug that can help people with diabetes is now not available to treat people with diabetes because a big chunk of people taking the drug are taking it for a different purpose, weight loss. Due to the shortage of oic, people began asking about other alternatives, like the sister drug of OIC, which is WeGovi and and other GLP1 medications like SEP Bound, Mounjaro, Revelsis, and Victoza. And next thing you know, there's a shortage of all of these. This shortage situation was not only problematic for people who relied on these medications to control their diabetes, but it also created another massive mess. It seems that anytime we have a situation in which demand far exceeds supply, scam artists come out to play to see if they can cash in on the craze. You may have noticed that while there was a shortage of these drugs, they were also somehow being advertised as available for $99 a month at your local weight loss clinic. These versions are essentially knockoff versions of semaglutide, and they were likely made by compounding pharmacies. Compounding pharmacies do good work, and they are legal. But some health experts, including the Food and Drug Administration, raised concerns about how some compounding pharmacists were producing semaglutide. Some compounding pharmacies used the salt forms of semaglutide. To meet the surge in demand. And this, my friends, is not safe and it's just not the same thing. This ordeal prompted the Food and Drug Administration to issue a warning on May 31st of this year to tell people to stop taking these versions of semaglutide, as many people were having bad side effects and ended up in the hospital. Noordis, which still holds the patent on OIC and wovi, has also stepped in and sued various medical spas, weight loss clinics and compounding pharmacies who are selling unapproved versions of semaglutide. So take this as a warning. The real version of Semaglutide, AKA OIC and many of the similar drugs out there should be prescribed by your doctor. OIC and WOVI seem to be the most effective effective of these drugs, but they are also wildly expensive and rarely covered by insurance. And what do I mean by expensive? We're talking 900 to $1300 per month for these medications out of pocket how do you take Ozempic? Ozempic is an injectable drug that is administered once a week. The best places on your body to inject Ozempic are the front of your thighs, the front of your waist, abdomen, so your abdomen area, or your upper arms. So if you feel funny about needles and injections, this may be really tough for you. In terms of doses, the dosages typically vary, but they will usually start you at a small dose for the first four weeks and then increase your dose. If that dose works for you after four weeks, they will keep you there. If it's sort of working but like sort of not, then they're going to increase that dose again, give it a shot for another four weeks and then see how you do until eventually you reach that dose. That really manages your blood sugar very nicely. What are the side effects of Ozempic? Some of the most common, very common side effects are nausea, vomiting, diarrhea, constipation and abdominal pain. Now this isn't that surprising as one of the rules of this medication is to slow down the digestion process. So most of the common side effects are expected to be digest digestive related. There have been scarier side effects too. In October 2023, the Food and Drug Administration here in the United States added a warning about ileus to the Ozempic label after receiving complaints from 16 patients taking the drug. If you don't know what Ilias is, it's not fun. Ilias is a medical term for temporary paralysis of the intestines. Healthy intestines use muscle Contractions that move in a wave like motion. These muscle contractions move your digested food through the intestines and eventually out your booty hole. If you have ilas, your intestines are not contracting. They're not moving. If the intestines are not contracting and moving food forward as they should, digested food and stool can build up in the intestines and cause severe constipation. The worst case scenario, if left untreated, the contents can get so built up in the intestines that it can perforate or tear the intestines. This causes bowel contents, which have high levels of bacteria and to leak into areas of your body where they do not belong. And it is a real and serious and potentially fatal condition. Now, 16 people is not a lot of people. When talking about millions of people who take this medication, and hopefully if people are taking this medication, they have been educated about the side effects so they can monitor their digestive patterns and seek help if something seems off. We know constipation can be a sign of ileus. So if you have constipation that seems to be particularly severe, it's good to discuss with your provider whether the medication is right for you or if you require a lower dose to prevent a more serious complication like ileus. There have also been reports of gastroparesis, a condition that can occur when the muscles of the stomach are slowed or paralyzed. But a warning label has not been added like they did with Alias, at least not yet. OIC is notorious for digestive side effects. Again, if a medication is going to slow down the natural process of digestion, things can get a little out of whack. What we don't know are the long term side effects of taking a medication that slows down your digestion. Do the stomach and intestines forget how to contract at normal speed over time? Hopefully not, but who knows? Did you hear me say that the FDA added a warning label for Ileus in 2023? 2023. That was just last year. This medication first became available in 2018. So it's only been available to people for about five years. That's not that long. So we are literally watching to see what happens to people who take this medication. In 20 years, we'll have a better idea and understanding of the long term effects of taking a medication like this. Now, I know that can feel a little scary. Who's interested in being a laboratory rat? And let's see what happens to you. You maybe great things or maybe not so great things. The Key with medications. And yes, I know I'm not a pharmacist or a physician, but the key with medications is assessing the cost to benefit ratio. Are the side effects worth the benefit? Sometimes the answer is yes and sometimes the answer is no. Ideally, you have a wonderful provider to discuss what we know about the drug, what we don't know about the drug, and how it all ties to your medical history and whether the benefit of taking taking the medication far outweighs the side effects. So you might be wondering how I feel about Ozempic or other similar drugs. Well, as a dietitian who specializes in weight management, I knew I had to get pretty savvy about these medications quickly because I knew my patients were going to ask or possibly take these drugs for weight loss. My stand on taking medications for weight loss is right in the middle. I'm not all for it and I'm definitely not entirely against it. I'm right in the middle. I recently went back to assess data on my private clients. 37 of them have taken drugs like Ozempic. A note. A larger number of my patients have been interested in the drug but have not been able to access it because of shortages or because their insurance would not cover it and they could not afford it out of pocket. Out of the 37 patients, 12 people disappeared off my radar. It's possible that they felt they didn't really need to work with a dietitian since they were losing weight with relative ease thanks to the medication. The rest are still working with me in some capacity. Every single one of them, every single one of them has experienced loss of appetite and nausea. Think about it. Who wants to eat when they're nauseous? Who wants food if they have no appetite? Not me and not most people. So a big reason why this medication works. People eat less. A lot less. Why? Because they don't feel as hungry as they used to before the medication. Again, there may be some other magical properties that help with weight loss that we don't fully understand understand, but eating less is a big part of it since digestion is slowed down as a result of these medications. Food hangs out in your stomach for a longer period of time. The full stomach sends signals to the brain that says, no food please, we are good. And it does so for a lot longer than before the medication. This quiets down that food noise that many people deal with when dieting. Have you ever gone on a diet and all you think about is when you get to eat again and eventually you lose the battle and give in and Eat everything because the constant thinking about food got too loud. That's food noise. And these medications help quiet down that noise since your stomach is remaining full for a lot longer than it used to, so it's not sending hunger signals to the brain like it used to. So less food noise. These medications are amazing. They really are. And I think they are a useful tool for people who struggle with severe obesity, who have tried everything under the sun to lose weight and yet cannot seem to do so successfully. And let it be known that taking these medications is not the easy way out. It's a hard decision to make and taking them isn't always easy and the side effects can really make you feel blah. These medications are a tool that can be incredibly helpful for individuals who have struggled with blood sugar control or weight loss on their own, despite them making positive health changes. One of my patients is 343 pounds and taking ozempic. This was a hard decision for her as she felt afraid to try something so new. But after years of various weight loss attempts organically with little success, she's finally seeing progress and she's also focused on the behaviors and not just using medication as a crutch. In this instance. I believe the medication is appropriate for this person and I fully support her using it. Let's take me for example. Let's say I want to lose 10 pounds because I think I would look better. I'm not overweight or obese and I do not have diabetes. Taking this medication would be ridiculous for me and it would be me taking away precious and life saving medication from someone who really needs it for vanity reasons. This type of use is annoying as heck and really makes me angry if you can't tell. Unfortunately, a lot of wealthy and famous people do this and that helped fuel the shortage, which is just oh, and a very important thing I want to bring up because this comes up a lot. Many people think that they can take this medication for like six months or three months, lose a bunch of weight and then get off the medication and then continue maintaining their weight loss. A few research studies have looked into this and when the medication is discontinued, the weight comes back. Every single one of my patients who have discontinued the medication have regained all the weight back. So it's important to note that this is a lifelong commitment, which again is a really hard decision to make. Another thing I want to mention is that while most people that take these medication do lose weight, what I have seen working with clients is that so some people do lose a nice amount of fat while maintaining their muscle mass. But unfortunately, some people also lose a significant amount of muscle mass and very little fat. A lot of this can be attributed to the fact that if you're eating less, but if you're eating, like, a little too little, then it can cause your body to have to start tapping into your muscle mass for energy. So this is really important to pay attention to because while you may lose your appetite or you may not feel so hungry or kind of nauseous and just kind of like, blah, I don't want to eat. It can be easy to be like, well, perfect. I'm just not going to eat, and maybe I'll end up eating, like, 100 calories today. That's not going to be helpful. That can really start to backfire because your body still requires energy, and it's going to start tapping into your muscle mass for energy. So even though we don't have a ton of appetite, even though we're not super hungry and definitely we don't want to eat in the way that we were eating before, we do still want to make sure that we're paying attention to eating enough, at least enough to preserve your muscle mass. Okay, I think that covers it. What did I miss? Any questions about this medication? Please leave me a comment and let me know what you thought of this video. See you next time.