Safety, Side Effects, & Weight Gain After Ozempic - Insights from a Naturopath

Written By Dr Lana Content

In the health and wellness space, few phenomena have sparked as much intrigue, excitement, and controversy as the rise of Ozempic and similar GLP-1 medications. Nearly 75% of US adults are overweight or obese and 40% have pre-diabetes or diabetes, so it is no surprise that a simple weekly injection claiming to cause significant weight loss and improved glucose-control would have everyone from Oprah Winfrey to your average micro-influencer hopping on the bandwagon [1,2]. But do these medications really live up to the hype? And if so, at what cost to your health?

What is Ozempic and How Does it Work?

Ozempic, sometimes known by its generic name Semaglutide, belongs to a class of medications known as GLP-1 receptor agonists. These drugs mimic the action of Glucagon-Like Peptide-1 (GLP-1), a naturally occurring hormone in the body that regulates blood sugar levels by stimulating Insulin secretion and inhibiting Glucagon release. By activating GLP-1 receptors, Ozempic helps lower blood sugar levels, leading to improved glycemic control. Ozempic also slows down the digestive process, leading to increased feelings of fullness, thereby reducing overall caloric intake[3].

How Effective is Ozempic?

Efficacy rates for Ozempic vary from person to person. In clinical trials, individuals with Type 2 Diabetes lost an average of 14 pounds over 40 weeks while taking the 2mg weekly dose of Ozempic. However, 20% of participants experienced no weight loss or even gained weight [4]. This is likely due to the fact that while for many people Ozempic reduces appetite, for some individuals Ozempic may lead to blood sugar that is too low, a condition known as hypoglycemia, which can increase cravings for carbohydrates and sugar.

Are Ozempic and Similar GLP-1s Safe?

Ozempic was FDA approved in 2017 and is generally considered as safe when used as prescribed and under the guidance of a healthcare professional. However, treatment duration on Ozempic lasted only 30-68 weeks in studies, so safety for use beyond this timeframe has not been evaluated. It is also important to note that Ozempic is not FDA approved as weight loss medication; it is only approved as a treatment for Type 2 Diabetes.  Ozempic also comes with a list of important considerations and potential side effects. 

The following individuals may not be candidates for Ozempic:

  1. Over the age of 65. Ozempic may lead to reduction of muscle mass, which can be particularly problematic for those over the age of 65. Muscle mass is critical for the maintenance of strength and mobility, and muscle loss may increase the risk of falls and fractures, and other similarly associated injuries.

  2. Family history of thyroid tumors. Studies show an increased risk of thyroid tumors in individuals taking Ozempic [5].

  3. Personal medical history of kidney problems, gallstones, pancreatitis, Type 1 Diabetes, or diabetic retinopathy. 

  4. BMI under 30.

  5. Children under the age of 18.

Side Effects of Ozempic and How to Limit Them

The following side effects have been observed with Ozempic use:

  • Hypoglycemia. When blood sugar becomes too low, individuals may experience symptoms of hypoglycemia such as nausea, fatigue, irregular heart beat, extreme hunger / cravings, confusion, irritability, or loss of consciousness. It is important to continue to eat three balanced meals a day and avoid extended periods of fasting on Ozempic. Avoiding alcohol can also reduce the risk of developing hypoglycemia. 

  • Kidney damage. Ozempic is cleared from the body through the kidneys and has been shown to increase the risk of kidney damage [6]. Kidney function should be assessed regularly when taking Ozempic.

  • Gastroparesis. Ozempic works by slowing down digestion, but in some cases the stomach muscles may stop moving completely, a condition known as gastroparesis, or stomach paralysis. Food may form a solid mass in the stomach causing cramping, nausea, vomiting, and may potentially lead to Small Intestinal Bacterial Overgrowth (SIBO). Gastric motility can be enhanced with supplements such as magnesium citrate and ginger root.

  • Gallbladder issues (gallstones, cholecystitis, biliary diseases). Studies show that between one and five percent of individuals on Ozempic will experience gallbladder issues, 90% of whom had to remove their gallbladder completely [7]. Avoiding fried and fatty foods can optimize gallbladder function.

  • Sarcopenia (muscle loss). Studies show that nearly 40% of the weight lost on Ozempic isn’t the fat you’re hoping to bid adieu to - it’s muscle! [8]. This becomes particularly problematic when individuals gain weight back after coming off Ozempic, as this weight gain is usually all fat mass, meaning they could end up at a higher body fat percentage than they started with. This is why resistance training to prevent muscle loss is crucial for individuals taking and coming off of Ozempic.

  • Nutrient deficiencies. Nutrient deficiencies may occur due to impaired digestion and severe caloric restriction. Individuals on Ozempic must ensure they are eating a nutrient-rich diet and consider a multivitamin supplement to prevent nutrient deficiencies which can lead to fatigue, hair loss, hormonal imbalances and more.

  • Digestive issues such as constipation, diarrhea, GERD (gastroesophageal reflux), and nausea. The delayed gastric emptying which helps individuals feel more full while on Ozempic can also lead to serious digestive issues. These digestive issues may be minimized by ensuring you are adequately chewing your food, avoiding eating too much in one sitting, and adding in supplements such as digestive enzymes. 

Do These Medications Work Long Term?

The long-term efficacy of GLP-1 receptor agonists like Ozempic has been a subject of interest in diabetes research. Studies have shown that these medications can sustain glycemic control over time, providing lasting benefits for individuals with Type 2 diabetes. However, research has not been extended beyond 68 weeks, and many individuals are told to remain on these drugs indefinitely due to the possibility of gaining all the weight back once they come off. As of now, we currently do not have sufficient data to say for sure whether these medications are safe for long-term use.

Why Do People Gain Weight After Being on Ozempic?

“Ozempic rebound” is a phrase often used to describe the rapid weight gain that can occur when individuals come off of Ozempic. Studies show that within a year of coming off Ozempic, ⅔ of people will regain all of the weight back that they lost, many of whom end up at a higher weight than when they started [9]. This rapid weight gain is likely due to a number of factors including:

  • Negative metabolic adaptations caused by severe caloric restriction. The human body has an innate wisdom that is always seeking homeostasis. When you drastically cut calories, your body senses a crisis and slows down metabolism to conserve energy, cannibalizing muscle tissue for fuel. Prolonged calorie restriction leads to a sluggish metabolic rate and muscle loss, making it harder to maintain weight loss. When you resume normal eating, your body hoards calories, fearing another famine, further disrupting metabolism. This negative adaptation can be limited by avoiding crash diets, prioritizing protein, and resistance training.

  • Reverting back to poor dietary and lifestyle choices. Because Ozempic can artificially manipulate appetite and hunger cues, individuals may be able to initially lose weight without having to learn how to properly manage cravings and implement self control. But here's the catch: without learning how to navigate those cravings and listen to your body's hunger cues properly, your chances at long-term, sustainable weight loss are slim to none. Without the “crutch” of Ozempic, most people will fall right back into old patterns. 

  • Reduction of muscle mass leading to a lowered metabolic rate. As previously mentioned, studies show that roughly 40% of the weight lost on Ozempic is actually muscle, not fat. Comparatively, studies show that weight lost following a high-protein diet and implementing regular exercise is only 11% muscle [11]. This appreciable difference in muscle loss means that those who lost weight on Ozempic will likely have a significantly lower metabolic rate than individuals who lost weight through diet and exercise alone, as muscle mass is a key factor for metabolism.

What Happens if You Take Ozempic and You Don’t Have Type 2 Diabetes?

As mentioned, Ozempic is not currently approved for weight loss for individuals who do not have Type 2 Diabetes. However, a similar GLP-1 medication called Wegovy is approved for weight loss in individuals with a BMI over 30 or a BMI over 27 if they have a weight-related health condition. Unfortunately, many doctors these days seem to be giving out Ozempic to almost anyone who asks for it! In fact, the increase in off-label Ozempic prescriptions for weight loss increased more than 500% in many cities across the country between 2021 and 2023. Over-prescribing GLP-1 medications like Ozempic for minor weight loss may be problematic for a number of reasons, including:

  • These medications have not been studied on individuals with BMIs below 27, so we do not know if side effects may be different or more severe for them. For instance, there is a possibility that instances of hypoglycemia and muscle loss (sarcopenia) may be more pronounced for these individuals.

  • The risk of serious side effects (pancreatitis, thyroid C-cell tumors, sarcopenia, kidney damage, gallstones, etc.) is likely not worth it for individuals who are not obese or do not have a serious weight-related health problem.  

  • The risk of metabolism damage and post-Ozempic weight gain may not be worth it  for individuals who are not obese or do not have a serious weight-related health problem.

Natural Ozempic Alternatives & Preventing Post-Ozempic Weight Gain

For those seeking natural alternatives to Ozempic, or looking to prevent post-Ozempic weight gain, lifestyle modifications play a pivotal role in diabetes and weight management. In fact, there are natural ways to boost GLP-1 without medication. These include:

  1. A regular exercise routine (3-4 times per week for 30-60 minutes) that places an emphasis on strength training.

  2. Increasing dietary protein (0.8-1.0 g/lb of lean body mass per day) and fiber (minimum 25g per day) intake. 

  3. Keeping Cortisol levels in check by managing stress and prioritizing sleep (7-9 hours per night).

  4. Eating fermented foods (kimchi, sauerkraut, yogurt, kombucha, etc.) or taking a probiotic supplement

  5. Incorporating GLP-1 boosting supplements such as L-Glutamine, Berberine, Magnesium, and Resveratrol [10].

In summary, the decision as to whether or not the risks outweigh the potential reward in regard to Ozempic is a personal choice that should be made with careful consideration under the guidance of a trusted medical professional. There are no quick fixes or shortcuts when it comes to achieving a healthy weight, and diet and lifestyle modification is equally as important whether or not you choose to take Ozempic. Regular testing of kidney function, blood sugar, and thyroid function is highly recommended for anyone on Ozempic or similar GLP-1 medications. If you are interested in creating a personalized weight loss / blood sugar management plan, you can click here to get in touch with a member of the Dr. Lana Wellness team.

References

  1. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015;314(10):1021–1029. doi:10.1001/jama.2015.10029

  2. Li, M., Gong, W., Wang, S., & Li, Z. (2022). Trends in body mass index, overweight and obesity among adults in the USA, the NHANES from 2003 to 2018: a repeat cross-sectional survey. BMJ open, 12(12), e065425. https://doi.org/10.1136/bmjopen-2022-065425

  3. Wojtara, M., Mazumder, A., Syeda, Y., & Mozgała, N. (2023). Glucagon-Like Peptide-1 Receptor Agonists for Chronic Weight Management. Advances in medicine, 2023, 9946924. https://doi.org/10.1155/2023/9946924

  4. Frías, J. P., Auerbach, P., Bajaj, H. S., Fukushima, Y., Lingvay, I., Macura, S., Søndergaard, A. L., Tankova, T. I., Tentolouris, N., & Buse, J. B. (2021). Efficacy and safety of once-weekly semaglutide 2·0 mg versus 1·0 mg in patients with type 2 diabetes (SUSTAIN FORTE): a double-blind, randomised, phase 3B trial. The lancet. Diabetes & endocrinology, 9(9), 563–574. https://doi.org/10.1016/S2213-8587(21)00174-1

  5. Bezin, J., Gouverneur, A., Pénichon, M., Mathieu, C., Garrel, R., Hillaire-Buys, D., Pariente, A., & Faillie, J. L. (2023). GLP-1 Receptor Agonists and the Risk of Thyroid Cancer. Diabetes care, 46(2), 384–390. https://doi.org/10.2337/dc22-1148

  6. Leehey, D. J., Rahman, M. A., Borys, E., Picken, M. M., & Clise, C. E. (2021). Acute Kidney Injury Associated With Semaglutide. Kidney medicine, 3(2), 282–285. https://doi.org/10.1016/j.xkme.2020.10.008

  7. Trujillo J. (2020). Safety and tolerability of once-weekly GLP-1 receptor agonists in type 2 diabetes. Journal of clinical pharmacy and therapeutics, 45 Suppl 1(Suppl 1), 43–60. https://doi.org/10.1111/jcpt.13225

  8. Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., Kushner, R. F., & STEP 1 Study Group (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England journal of medicine, 384(11), 989–1002. https://doi.org/10.1056/NEJMoa2032183

  9. Wilding, J. P. H., Batterham, R. L., Davies, M., Van Gaal, L. F., Kandler, K., Konakli, K., Lingvay, I., McGowan, B. M., Oral, T. K., Rosenstock, J., Wadden, T. A., Wharton, S., Yokote, K., Kushner, R. F., & STEP 1 Study Group (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, obesity & metabolism, 24(8), 1553–1564. https://doi.org/10.1111/dom.14725

  10. Yaribeygi, H., Jamialahmadi, T., Moallem, S. A., & Sahebkar, A. (2021). Boosting GLP-1 by Natural Products. Advances in experimental medicine and biology, 1328, 513–522. https://doi.org/10.1007/978-3-030-73234-9_36

  11. Willoughby, D., Hewlings, S., & Kalman, D. (2018). Body Composition Changes in Weight Loss: Strategies and Supplementation for Maintaining Lean Body Mass, a Brief Review. Nutrients, 10(12), 1876. https://doi.org/10.3390/nu10121876

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