Semaglutide: A Weight Loss Breakthrough?
Anyone who reads medical news or follows Kim Kardashian on Twitter knows about the “miracle” weight loss shot that’s changing how people think of weight loss. The shot is called Ozempic and contains a substance called semaglutide. Semaglutide is a type of peptide called a glucagon-like peptide (GLP-1) receptor agonist. GLP-1 is naturally produced by the body after we eat. Metabolism is very complex, but basically it regulates our blood sugar, and gives us a feeling of being full, called “satiety”. Anything that increases the activity of the GLP-1 receptors (called an agonist) will increase the activity ofr GLP-1. So, semaglutide quite literally kills the appetite, so much so that people start to burn up their own body fat for energy. Voila: instant weight loss.
Medicines and supplements have existed for a long time that lessened appetites, mostly by preventing absorption of foods, leading to an uncomfortably full feeling in the stomach. Alli and Xenacal are fat blockers that work this way, and a number of carb blockers are on the market as well. What makes semaglutide different is that it actually works on the brain to stop the FEELING of hunger rather than preventing digestion and making people feel sick. There is evidence that obese people (a whopping 40% of Americans) don’t receive the same satiety signals as thinner people, leading to overeating.
Make no mistake, though, people can definitely feel sick on semaglutide, including nausea and vomiting, diarrhea, dehydration and low blood sugar. We’ve used semaglutide quite a bit in my clinic, and we’ve found that many of the side effects can be lessened by starting at a much lower dose than recommended, and slowly working up. The dose must be adjusted individually, and the patient comes in every week. The medication is given as a subcutaneous (under the skin) injection and this “check-in” is helpful in avoiding many of the side effects.
In addition, blood testing is required before administering the med the first time, and periodically after. This is because of rare but dangerous inflammation of the pancreas, gall bladder or kidneys that can occur with treatment. Blood sugar over time (called a glycohemoglobin test) is also done before initiating semaglutide treatment, to document abnormal blood sugars. The drug was invented and approved for Type 2 diabetics with weight issues, but since obesity and excess weight are associated with so many health risks (including cancer, liver disease and sleep apnea), semaglutide may have some broader applications (pun intended). This careful blood testing and monitoring are essential, in my opinion, to a safe and effective treatment.
There are some absolute contraindications to using the drug. Rats given the drug developed thyroid tumors, and even though this has not been found in humans, people with a history (including family history) of thyroid cancer or tumors are excluded from taking the drug. People with history of pancreatitis, gall bladder or kidney disease also cannot take the drug. Type 1 (insulin dependent) diabetics are not approved to be treated, and people should stop their existing diabetes medications when taking semaglutide. It is not approved for patients under 18, and obviously, patients who are underweight and have a distorted body image are excluded from treatment.
Ozempic and its sister drug, Wegovy, are quite expensive and sometimes in short supply. Compounding pharmacists, who are regulated to make sure they are producing medications to high standards, produce semaglutide in a less expensive form, and frequently combined with something else.. For instance, the semaglutide we use in our office is compounded with a form of Vitamin B6, a nutrient which is necessary for proper metabolism. We also require that patients take a multivitamin during their treatment course, since they are eating less and therefore taking in less nutrients in their food.
What to do after the weight is lost is still being determined. When you stop treatment, the appetite returns and the weight can come back. One school of thought is that semaglutide will eventually become like high blood pressure treatment, that is, always taken. However, it’s not clear whether there will be long term effects. It would seem that the most prudent course is to learn and develop good eating habits while simultaneously losing weight.