In recent years, medical researchers and pharmaceutical companies have made remarkable progress in the area of diabetes management. Specifically, semaglutide (sold under the brand names Ozempic, Wegovy, Rybelsus, and others) has proven to be effective in helping people with Type 2 diabetes regulate their blood glucose (sugar) levels.

As an added bonus, semaglutide has also proven to be effective in promoting weight loss for many people. Likely you’ve heard or read all about that by now. And you certainly wouldn’t be the first to wonder if semaglutide could work that magic on you.

Here at PROVOKE Health, we too have observed some amazing results in our functional medicine and integrative health clinic, with people who have struggled for years to lose weight suddenly shedding pounds, feeling great, and looking better than they had in years.

However, recent reports of adverse side effects have begun to emerge — side effects such as nausea, diarrhea, vomiting, constipation, abdominal pain, fatigue, malnutrition, and “Ozempic face” (the rapid loss of facial fat, which can make the face look gaunt or droopy).

Scale and semaglutide

 

In this blog post, we review some of the arguments for and against semaglutide. But first, let’s take a look at what this medication is, how it works (its mechanism of action), and some of its common adverse side effects.

What Is Semaglutide?

Semaglutide is the generic name for a group of antidiabetic medications classified as glucagon-like peptide-1 receptor (GLP-1R) agonists. Some GLP-1R agonists, including Ozempic, can also be very effective in promoting weight loss and treating obesity. (For more about this, read our previous blog post, “Ozempic for Weight Loss: Too Good to Be True or an Effective Treatment,” here on the PROVOKE Health blog.)

Most of the medications in this class are injectable, meaning you inject a liquid form of the medication using a needle and syringe. Injections are delivered to the fatty tissues beneath the skin in certain areas of the body, including the belly, outer thighs, and upper buttocks.

Semaglutide has earned a great deal of positive press for its promising benefits, especially in respect to weight loss. However, like any medication, this class of medications carries potentially negative side effects. Prior to taking semaglutide or any of its brand-name equivalents, it is important to weigh the potential benefits against the possible adverse side effects before adding these medications to your diabetes management or weight loss plan.

How Semaglutide Works

Two thirds of people in the United States suffer, to some degree, from insulin resistance. That means their cells don’t respond properly to insulin — a hormone the body produces to stimulate the metabolism of sugar. Over time, the insulin receptors on cells become less and less responsive to insulin, especially when subjected to a high-sugar diet. So, even if your body produces a normal amount of insulin, it may not be enough to metabolize the amount of sugar in your diet. As a result, instead of burning off the sugar and using it as energy, the sugar is converted to fat and stored in the body.

Semaglutide launches a three-pronged attack to improve and restore healthy sugar metabolism, burn fat, and curb diet:

  • First, it stimulates insulin production to help regulate blood sugar levels.
  • Next, it inhibits the release of glucagon, slowing the release of sugar into the blood, which makes the body burn more fat.
  • Finally it reduces appetite by slowing the movement of food through the digestive system, so that you feel full longer.

Possible Negative Side Effects of Semaglutide

Conventional wisdom tells us any drug that’s effective in treating a health condition has the potential for causing negative side effects, and this is true for GLP-1R agonists like semaglutide, as well. Possible adverse side effects include the following:

  • Abdominal pain
  • Acid reflux
  • Constipation and increased risk of bowel obstruction
  • Decreased appetite (which is one of the benefits, as well)
  • Diarrhea
  • Dizziness
  • Fatigue
  • Gastroparesis (stomach paralysis)
  • Headache
  • Hypoglycemia
  • Malaise (not feeling well overall)
  • Nausea
  • Rapid heart rate
  • Urticaria (hives)
  • Vomiting
  • “Ozempic face”

The most common and severe adverse side effects seem to be related to the slowing of the movement of food through the digestive tract and the lowering of blood glucose, the latter of which can result in hypoglycemia(abnormally low blood glucose).

The Harvard Medical School Says

Ozempic Face As A Side Effect Of GLP-1 Drugs

You may have heard about “Ozempic face” as a side effect of GLP-1 drugs, though the term is misleading because this can be a side effect of any GLP-1 drug or any other cause of rapid weight loss.

The rapid loss of fat in the face can cause:

  • a hollowed look to the face
  • changes in the size of the lips, cheeks, and chin
  • wrinkles on the face
  • sunken eyes
  • sagging jowls around the jaw and neck.

If weight is lost in a more gradual way, these changes may not be as noticeable. It’s the faster pace of weight loss that occurs with GLP-1 drugs that can make facial changes more obvious.

~ Harvard Health Publishing — the consumer health information division of Harvard Medical School (Feb. 2024)

Arguments and Counterarguments Surrounding the Use of Semaglutide for Weight Loss

Before using any medication, doctors and their patients need to weigh the pros and cons and make a well-informed decision. Here are four key arguments that discourage the use of semaglutide for weight loss, each of which is followed by our perspective:

Big pharma and the media are merely seeking to capitalize on the huge demand for weight loss products.

Argument

About 80 percent of people in the U.S. are considered overweight or obese. Instead of researching and addressing the root cause of obesity in the U.S., doctors and patients are looking for a quick fix. Pharmaceutical companies along with the media are making huge profits advertising and selling weigh loss medications. Selling a drug instead of whole-heartedly promoting the consumption of healthy foods and the pursuit of a healthy lifestyle is dubious and may even be unethical.

Our Perspective

We couldn’t agree more with this argument, and we will use all available medication and non-medication treatment options to help our patients achieve their health and fitness goals and objectives.

As a healthcare provider fighting against the “sick care” system, which has paid off and bullied members of the conventional medicine community into a pharmaceutical-only approach, we remain skeptical of any products marketed as “miracle cures,” and this includes GLP-1R agonists such as semaglutide.

These medications are not the perfect solution for every patient. We have had patients in our practice whom we have taken off GLP-1R agonists due to side effects or lack of efficacy. The medicine does not help every patient (nor does it cause adverse side effects in all patients).

People who have gained weight over the course of many years are likely to struggle with weight loss regardless of how hard they try. In addition, most people in the U.S. suffer from chronic systemic inflammation and metabolic disorders (due to diet, lifestyle, stress, exposure to environmental toxins, and other factors) and may have addictions to unhealthy foods — all of which promote weight gain, not weight loss.

When GLP-1R agonists like semaglutide are used in concert with positive, long-term diet and lifestyle changes and other treatments (such as detox and anti-inflammatory protocols), these medications can make the difference in restoring health, resiliency, confidence, and fitness, making it easier for patients to lose weight and transition to a healthier diet and lifestyle. A GLP-1R agonist may not be the silver bullet, but it can be a key component in a patient’s overall health and fitness plan.

No large-scale long-term studies on GLP-1R agonists for patients who are overweight but not diabetic have been conducted.

Argument

Studies on GLP-1R agonists have focused on their effectiveness in helping patients with Type-2 diabetes maintain their blood glucose levels. No large-scale long-term studies have shown its effectiveness in promoting weight loss. As a result, doctors and their patients do not have the data they need to perform the most well-informed risk-benefit analysis.

Our Perspective

Using a medicine appropriately, for its intended use or an off-label use is integral to a doctor’s art of medicine. The art of medicine includes a consultative approach with doctor and patient weighing the risks and benefits of starting a medication, followed by careful monitoring to optimize the benefits while reducing the risks.

“Art of Medicine” — The intentional blend of a doctor’s medical knowledge with empathy and understanding toward patients’ individual needs. Involves listening, empathizing, and thoughtfully solving health problems beyond textbook knowledge.

Many medicines are prescribed for off-label use simply because doctors know that the medications are effective, based on their clinical experience, reports from other doctors, and reports from patients. This is the case with GLP-1R agonists such as semaglutide. These medications can be effective in helping people lose weight when used with proper oversight, dosing, and timing.

Discontinuing the medication may result in weight gain.

Argument

Patients are being put on a medication that decreases appetite by slowing digestion, which results in rapid but not necessarily lasting weight loss. If the person has not made positive changes in their diet and lifestyle, including reducing consumption of junk food, soda, and excessive carbs, they will gain back the weight when the medication is discontinued. In addition, most people don’t want to stay on medication forever for a variety of reasons.

Our Perspective

This is a valid argument, which is why we motivate and work closely with our patients to use GLP-1R agonists as part of a holistic, personalized plan of care to restore health. Anyone using these medications without making lasting changes to their diet and lifestyle will experience rapid weight gain when they stop the medication. Additionally, eating less, but eating junk food is not going to reduce inflammation in any meaningful way. Inflammation is driven by poor food choices, environmental factors, and a sedentary lifestyle.

If a patient is unwilling to change their diet and lifestyle in ways that would help them reduce inflammation, lose weight, and reverse metabolic disorders, we will not consider providing therapy with GLP-1R agonists such as semaglutide.

At PROVOKE Health, we may use semaglutide as a tool to support patients who have been previously unsuccessful at weight loss, while we continue to carefully map out a plan to improve metabolic health, thus empowering them to come off the medicine in a prescribed period of time.

As a general rule, we believe 10 to 12 months is long enough to be on the medication. This period of time also enables us to increase the dosage gradually to provide a cushion of safety from potential side effects. If a person is strictly relying on semaglutide, they are likely missing other factors that contribute to weight gain including, diet, exercise, eating habits/timing, thyroid health, hormone balance, digestive issues, vitamin deficiencies, or stress-induced illness.

A comprehensive, integrative, and personalized approach to patient care is designed to individually support a patient in respect to each of the aforementioned factors, increasing the likelihood of enjoying benefits while minimizing the risks.

GLP-1R agonists may have a negative impact on mental health.

Argument

Early evidence suggests that a small number of patients on GLP-1R agonists may be having more suicidal ideation. Why this is occurring is unclear at this time. However, it stands to reason that it’s certainly a possible side effect because GLP-1R agonists do have an impact on the gut-brain axis (the communication between your digestive tract and brain).

Our Perspective

GLP-1R agonists are not a black-and-white proposition for mental health. For many, the weight-loss benefits seem to improve a person’s mental health. In addition, weight loss is often a huge motivator that drives positive changes in both diet and exercise, and all of those improvements boost a person’s overall mood and happiness.

Studies show that GLP-1 receptors (GLP-1Rs) are distributed across various organs including the pancreas, lung, stomach, intestines, kidney, heart, and diverse brain regions. In one such study — Combination of Insulin with a GLP1 Agonist Is Associated with Better Memory and Normal Expression of Insulin Receptor Pathway Genes in a Mouse Model of Alzheimer’s Disease (Journal of Molecular Neuroscience, Jan. 2019) — researchers demonstrated that a mixture of GLP-1R agonists “boosts memory and improves insulin action in the brain.” Animal studies have shown that serotonin, dopamine, and GABA are all positively influenced by the addition of GLP-1R agonists.

All that said, we cannot yet know with certainty the impact that GLP-1R agonists have on an individual’s brain. We may never have that fully answered because each person’s reaction to any medication is unique. This again requires patients be monitored for changes in moods, the affect (how a person experiences an emotion), and any other signs and symptoms of mental health deterioration while on GLP-1R agonists.

Semaglutide Use Requires a Comprehensive, Integrative, and Personalized Approach

We believe that the most effective approach to evaluating the pros and cons of any treatment option, including the use of prescription medications, is best handled on an individual basis between doctor and patient. We would love to see an end to pharmaceutical advertising and an increase in open and honest discussion among the most highly qualified doctors and researchers around all health-related topics, including prescription medications, vaccines, and other medical interventions.

Some of our patients who struggled the most with weight management and have failed to lose weight despite their Herculean efforts to do so have experienced amazing results with the addition of a GLP-1R agonist like semaglutide with minimal to no side effects. And they have been able to come off the medication without gaining weight.

Risks of side effects when using semaglutide can be reduced by using the lowest effective dose and slowly increasing the dose over your personalized plan of care. Additionally, injections of B vitamins have been found to be helpful in reducing any nausea resulting from treatment.

If you are struggling to lose weight and are motivated to make lasting positive changes to your diet and lifestyle, we encourage you to discuss with your doctor the possibility of adding a GLP-1R agonist like semaglutide to your treatment plan. If you’re in need of a doctor who understands the complexities of weight management and you’re interested in a functional medicine approach to your healthcare, contact us to schedule an evaluation.

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Frequently Asked Questions about Semaglutide and Weight Loss

Can Semaglutide or Ozempic be used safely over the long term for weight management, and if so, what are the guidelines for long-term use?

According to the U.S. Food & Drug Administration (FDA), studies have shown that when taken as prescribed, Semaglutide is a safe medication, has low risks of severe adverse events, and can be taken by most individuals. That said, the safety of Semaglutide or Ozempic for long-term use in weight management is still being researched by pharmaceutical companies and medical researchers at colleges and universities. Generally, their use should always follow a healthcare provider’s guidance, considering potential benefits and risks and each individual patient’s plan of care and health-related objectives.

Are there any dietary or lifestyle modifications that enhance the effectiveness of Semaglutide or Ozempic in weight loss efforts?

Combining Semaglutide or Ozempic with dietary changes and increased physical activity can enhance weight loss efforts. A balanced diet and regular exercise are often recommended alongside these medications, as part of your doctor’s plan of care for you and your desired health outcomes.

How do Semaglutide and Ozempic compare with other weight loss medications in terms of effectiveness and safety profile?

Semaglutide and Ozempic have shown effectiveness in weight loss and have a specific safety profile. However, comparing them directly to other weight loss medications or approaches requires considering individual factors such as health conditions, effectiveness, side effects, and personal health goals. Discuss these matters with your healthcare provider before starting a new or enhanced plan of care.

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About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing at PROKOVE Health in Tampa, Fla. Dr. Lewis has 20 years of experience practicing nutritional and holistic medicine. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), Dr. Lewis has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa and elsewhere.

Disclaimer: The information in this blog post about semaglutide is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this blog post should be construed as medical advice from Dr. Matthew Lewis, Functional Healthcare Group, PLLC, or PROVOKE Health, nor is this blog post intended to be a substitute for medical counsel on any subject matter. No reader of this blog post should act or refrain from acting on the basis of any information included in, or accessible through, this blog post without seeking the appropriate medical advice on the part