The Good, the Bad, and the Ugly of Ozempic Type Meds (GLP-1 Agonists)
Why health coaching is needed before, during, and after usage.
By Curt Dearing, Pharm.D
At a glance:
|
GLP-1 agonists like Ozempic have emerged as powerful tools in managing diabetes and promoting weight loss, but they come with a range of effects – some beneficial, some concerning, and some potentially dangerous. As a clinical pharmacist who has managed diabetes clinics for decades, I have seen firsthand the good, the bad, and the ugly of GLP-1 agonists.
The Good – Ozempic and GLP-1 Benefits
| GLP-1 agonists offer several significant benefits: |
|
|
|
|
|
I have used Ozempic and GLP-1’s in patients with diabetes with success. My goal has always been to use them as a “kick-start” to weight loss and diabetes control, with eventual discontinuation once lifestyle modifications have been implemented and the body has begun to heal itself of the damage caused by the toxic diet and sedentary lifestyle that led to the disease. GLP-1 agonists are medications that mimic the action of glucagon-like peptide-1 (GLP-1), a hormone naturally produced in the body. These drugs work through several mechanisms to regulate blood sugar levels and promote weight loss.
GLP-1 agonists work in the pancreas to produce more insulin, especially when blood sugar levels are high. These medications suppress the release of glucagon, a hormone that raises blood sugar. They also improve the body’s response to insulin. Though these are all beneficial in the treatment of diabetes, I give a lot of the credit to the effects they have on the GI system by slowing down the rate at which food leaves the stomach, leading to a prolonged feeling of fullness. They also activate GLP-1 receptors in the brain’s hypothalamus, reducing hunger and food intake. The combined effects of increased satiety, reduced appetite, and slowed gastric emptying often result in significant weight loss for many patients due to the decreased calorie intake, which also benefits blood sugar levels.
The Bad – Side Effects of Ozempic and GLP-1 Agonists
|
|
|
|
|
|
How the Side Effects Work
The most common side effects of GLP-1 receptor agonists are GI in nature, affecting up to 50% of patients. Nausea is the most frequently reported symptom, followed by vomiting, diarrhea, and constipation. These side effects are typically dose-dependent and more pronounced at the beginning of treatment or during dose increases. Other common, but less frequent, side effects include injection site reactions, headache, and nasopharyngitis. Many of these side effects can be minimized or better tolerated with proper education and coaching with the initiation of treatment.
What about Ozempic Face?
“Ozempic face” is an informal term describing facial changes that occur due to rapid weight loss associated with the use of GLP-1 agonists. This is characterized by a loss of facial fat, resulting in a more gaunt or hollowed appearance, particularly in the cheeks, temples, and under-eye areas. The sudden reduction in facial volume can lead to sagging skin, more pronounced wrinkles, and an overall aged look. These changes are not a direct side effect of the medication itself, but rather a consequence of significant weight loss occurring faster than the skin can adapt. The severity of “Ozempic face” can vary among individuals and may be more noticeable in those who lose a substantial amount of weight quickly. Once again, this effect can be potentially minimized with proper coaching to gradually lose weight and utilizing protein intake and building muscle. The majority of weight loss on these drugs is primarily muscle which sets the patient up for a poor future regarding the bodies appearance and the quickness of gaining fat back when the drug is ceased.
The Ugly – Severe Risks of Ozempic and GLP-1 Agonists
| More severe and concerning side effects, though less common, include: |
Inflammation of the pancreas causing severe abdominal pain. |
Animal studies have linked GLP-1 drugs to thyroid C-cell tumors, though not confirmed in humans. |
Potential impact on kidney function, especially in patients with pre-existing conditions. |
Severe stomach paralysis leading to ongoing nausea and digestive issues. |
Increased risk of gallstones and bile duct blockages. |
A rare but serious complication requiring immediate medical attention. |
Potential increased risk of certain cancers, including thyroid cancer. |
Vision problems, including risk of diabetic retinopathy and potential permanent vision loss. Recent study showing increased risk of ischemic optic neuropathy. |
Increased risks of suicide ideation. |
GLP-1 drugs can potentially cause serious side effects in some patients. The most significant concerns include gastrointestinal issues such as pancreatitis, bowel obstruction, and gastroparesis. Other serious side effects include gallbladder problems, acute kidney injury, hypoglycemia (particularly in diabetic patients), and rare allergic reactions. Pancreatitis, characterized by severe abdominal pain, is of particular concern and may require hospitalization. Patients using GLP-1 drugs should be vigilant for symptoms like intense abdominal pain, severe vomiting and diarrhea, inability to pass gas or move bowels, or yellowing of the skin (jaundice), and should seek immediate medical attention if these occur.
25 pharmaceutical anti-obesity drugs have been recalled from 1964 to 2009. All of these failed long term in their promise of easy weight loss. Never forget these drugs were recalled because patients had significant side effects. The goal of weight loss drugs should not be to be able to buy a skinny casket!
Consult a Healthcare Professional
It’s crucial for patients to discuss these potential risks with their healthcare providers and weigh them against the benefits before starting GLP-1 agonist treatment. Close monitoring and proper management can help mitigate many of these side effects, ensuring that the “good” outweighs the “bad” and the “ugly” for most patients. I believe the success of GLP-1’s, and any treatment for that matter, is directly tied to the motivation of the users. Also important is proper education on use and expectations, as well as other support measures like supplements and coaching.
I believe that most people can attain weight loss goals with lifestyle measures and supplement use. This approach should always be utilized first. For those who may still need further assistance, perhaps the use of a GLP-1 can be the additional boost one needs to move towards their weight loss goals.
Why Not Partner With a Health Coach?
The assistance of a quality health coach during the entire process is crucial to the success of attaining weight loss goals. A health coach can individualize a game plan to include the best motivational tools, lifestyle measures, and supplements. Once actions are implemented, the coach can be there to make appropriate modifications, maintain motivation, and help with accountability.
Data shows that many GLP-1 users, especially when it comes to weight loss, will only stay adherent to treatment for less than a year. It is reported that only about one in three patients will still be taking GLP-1’s after one year. Some of the reasons for discontinuing include adverse effects, cost, perceived goals reached, and other unknown reasons.
At some point, there will be numerous more ex-GLP-1 users than current users and they will be searching for ways to keep the weight off. Many will be looking for supplements that focus on healthy weight maintenance and all the lifestyle changes that go with that, and not looking for a quick-fix drug. This is where an involved health coach can be instrumental.
Supplements for Ozempic and GLP-1 Users
GLP-1 users need to be supplemented with micronutrients, protein, multivitamins, and probiotics. For unknown reasons, many of the people who discontinue GLP-1’s will also stop using supplements. Perhaps due to frustration they simply give up trying. Post-GLP-1 needs like weight maintenance and muscle recovery will require the addition of supplements, fiber, and protein. Therefore, having the addition of a health coach onboard at each phase, including when pharmaceuticals are discontinued, is extremely important to make sure not all measures are stopped. Without coaching in all phases of weight loss, success rates will diminish. Besides the regaining of their weight, this has the potential to further worsen health outcomes.
Only when you know better can you do better:
Nutrition World is here to be your health coach on your health journey, guiding you along each phase to improve your healthspan.
References:
- Ozempic® [package insert]. Plainsboro, NJ: Novo Nordisk Inc.
- What to know about “Ozempic Face”. Medically reviewed by Ami Patel PharmD, BCPS — Written by Oladimeji Ewumi — MedicalNewsToday. Updated on October 24, 2023
- Grauslund, J, Taha, A.A., Molander, L.D. et al. Once-weekly semaglutide doubles the five-year risk of nonarthritic anterior ischemic optic neuropathy in a Danish cohort of 424,152 persons with type 2 diabetes. Int J Retin Vitr 10, 97 (2024).
https://journalretinavitreous.biomedcentral.com/articles/10.1186/s40942-024-00620-x - Keeping supplement customers after Ozempic use. Rick Polito. NBJ. December 5, 2024.
- Trending ingredients not the biggest opportunity of the “Ozempic Age”. Rick Polito. NBJ. November 14, 2024.
