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The Dark Side of Ozempic 

Updated: Jun 8


Woman using a scale





You can’t open a single social media app these days and not see headlines about Ozempic. 







FDA warns about Ozempic counterfeits, seizes thousands of fake drugs.” - CBS News 


“Dozens sue saying Ozempic, other weight loss and diabetes drugs cause harmful side effects.” - USA Today 


"Demand for Weight-Loss Drugs Spikes Despite Horror Stories." - Newsweek  


 

If you aren’t familiar with the terms ‘Ozempic’, ‘Wegovy’, ‘Mounjaro’, or ‘Zepbound’, you’ve likely been living under a rock. (No disrespect to you normal people who don’t have a TV or laptop – thumbs up, actually). All of these refer to medications called GLP-1s, or glucagon-like peptide-1 receptor agonists, a class of medications once used exclusively for treating type 2 diabetes. In recent years, however, the public has become acutely aware of an interesting side effect of these drugs: 


They cause profound, rapid weight loss. 


Historically, Americans have been the best at just about everything. Everything but losing weight. This country has been on one bad idea of a diet after another for decades. That’s led us successfully to a ‘two steps forward three steps back’ situation.  Twenty pounds down? Thirty pounds up. You play that game enough times and it’s best to just never step on the scale again. 


In the past, medications for weight loss haven’t been much better. Fen-Phen, Xenical – disasters. Weight loss surgery – ugh. Do I even need to comment on this? For years it looked like we’d best just embrace our expanding waistlines and buy bigger bras.  

That is, until Ozempic. 

Woman on a scale

"How a Diabetes Drug Became the Talk of Hollywood, Tech, and the Hamptons. Ozempic and other injections meant to treat chronic medical conditions are in high demand among elites looking to lose a little weight. ‘This is the Hollywood drug.’”

The Wall Street Journal, Oct. 12, 2022 

 

I’ll never forget the day that story came out. I had been helping patients lose weight with GLP-1s for years. The wheels didn’t come off that strategy until 2022, when the whole world learned about a drug called Ozempic. 


Let’s put the smear campaign aside for a moment. The GLP-1s are an extremely effective class of medications originally developed to treat diabetes. They lower blood sugar by mimicking the effects of a peptide that goes by the same name - GLP-1 - which is made by your gut. In a long, roundabout and convoluted kind of way, these medications ultimately work by correcting insulin resistance, which is the foundational problem in the development of diabetes.  


Insulin resistance causes many problems. First stop is weight gain. Central weight gain, to be exact. This is the weight gain that drives women to purchase painful ‘body sculpting’ undergarments from Instagram and men to wear their belts low enough you hope they never need to bend over. That’s just the beginning, though. That central fat deposition starts to accumulate in the organs and inside the liver. It drives inflammation and attracts more and more fat storage along the way.  Ultimately, insulin resistance shifts from being simply a muffin top or a dad bod, to the biggest driver of chronic disease as we know it today. Left untreated, insulin resistance leads to what we unaffectionately referred to in medicine as


The Four Horsemen’ 

  1. Diabetes 

  2. Heart Disease 

  3. Cancer  

  4. Dementia 


On the front end of things, the GLP-1s seemed to be God’s gift to the pharmaceutical industry. If they could correct insulin resistance, well, they could put a stop to a whole bunch of other bad things we wouldn’t need to contend with in the future – not just diabetes. In theory, GLP-1s looked like they might be the answer to chronic disease prevention across the board. 


But there’s always a problem with theories: We rarely understand the nuances, depth, or full scope of the data that support them. 


Byetta was the first GLP-1 approved by the FDA for use in treating type 2 diabetes. I didn’t have the same understanding of insulin resistance 20 years ago that I have today, but it was clear there was an association between Byetta and weight loss. It wasn’t much, but it was there. Since then, several other GLP-1s have been approved, each seeming to have more pronounced weight loss than the one before it. 


  • Exenatide (Byetta®), 2005. 

Up to 3% weight loss 


  • Liraglutide (Victoza®), 2010. 

Up to 8% weight loss 


  • Semaglutide  (Ozempic®), 2017. 

Up to 15% weight loss 


  • Tirzepatide (Mounjaro®), 2022. 

Up to 22.5% weight loss 



Those numbers might not sound overly impressive to you, but they should. The numbers for Ozempic and Mounjaro are massive. This is real, live, statistically significant weight loss – and Ozempic was first on the scene. Blood sugars came down, lipids improved, patients were predictably losing weight. There was just one problem. 


People simply stopped eating. 


And they stopped eating for weeks. Ozempic didn’t come with a roll of duct tape that wrapped around the mouth portion of the face. It didn’t make all food look and taste like dog shit. No – it just made people so nauseous and full so quickly, that it was just easier not to eat. Ozempic was too strong. It worked too well. That wasn’t obvious in the beginning. Early on, all systems were a go. Numbers improved, the scale moved, but as the months and years went on, we started seeing other things too. Potentially concerning things. Some red flags. Just some case reports at first. Then came the studies. The rumors and speculation began to grow legs. Within just the past year, we learned what we now believe to be true.


There really was a dark side of Ozempic. 


  • People were lethargic. 

  • Their hair started falling out. 

  • The constipation was brutal. 

  • Stomach paralysis. 

  • "Ozempic face". 


Then came reports of body composition changes. And OMG. Sarcopenia – muscle wasting. Osteopenia and osteoporosis – bone loss. If we didn’t put the brakes on this train, the users of Ozempic were heading straight towards the waste land of the ‘Skinny Fat’ person.  


We can’t have this. 


We can’t accept swapping one medical problem for a handful of others. That makes no sense.  


The numbers that are good with Ozempic are excellent. But the recent numbers being published on the dark side of Ozempic are not acceptable. To be fair, there aren’t many. The studies we have are conflicting. There’s no consensus on this yet but we need to assume there’s potential for harm until proven otherwise. Period. 


In our practice, we’ve transitioned the overwhelming majority of patients previously on Ozempic over to Mounjaro. Mounjaro is similar to Ozempic but safer. I don’t want to get lost in the weeds on this but suffice it to say the makers of Mounjaro kept the good parts of Ozempic and removed the bad. Blood sugars, lipid parameters, weight loss – all superior on Mounjaro compared to Ozempic. They turned the volume of GLP-1 wayyy down on Mounjaro and added a second peptide called GIP (glucoinsulinotropic peptide, also made by your gut). Preliminary data suggests this likely circumvents the potential for negative changes in body composition. 


But only time will tell. 


There doesn’t seem to be an evil nanobot inserted into these medications that causes the Sharon Osbourne effect. 


Sharon Osbourne
Sharon Osbourne

“Sharon Osbourne, 70, reveals 30-pound Ozempic-aided weight loss after saying she

‘didn’t want to be this thin”- Metro News, Sept 29, 2023 

 

It seems to be the profound loss of appetite associated with Ozempic. When people lose weight, they lose fat, but they lose muscle too. We know this. The problem seems to be that the associated nausea seen with Ozempic (rarely seen with Mounjaro) causes people to snack like birds on oyster crackers – not almonds or eggs. They are simply getting absolutely no protein in their diet. Without adequate protein consumption, the body will break down muscle and bone to get the micronutrients it needs to keep systems operational.  


The end result is not good. Not good at all.  


You can rebuild muscle. It’s not easy, but it’s not impossible. Rebuilding bone on the other hand? Good lord. Once bone is demineralized – once it’s lost – it takes a feat of the supernatural to rebuild. We need to take this potential risk seriously. 


OK – so there’s the doom and gloom. Ozempic has been quietly, potentially, harming people who are using this medication since 2017. Current estimates indicate that 13% of the US population is taking this drug. It’s likely many more are using the infamous bootlegged generic version, ‘semaglutide’ from various reputable and black-market sources. Now what? 

Now we evaluate for harmful changes in body composition and get serious about reversing and preventing further damage. That looks like this: 



Measuring Body Composition & Bone Density 

We actually purchased our own DEXA scanner last fall for this very purpose. You can get a bone density scan through your regular doctor’s office, but only if you happen to be a female over the age of 65 or a female under the age of 65 with a history of something predisposing you to early bone loss (i.e. prolonged steroid use, previous atypical bone fracture, premature menopause, history of anorexia, smoker). Otherwise, you’re buying that scan yourself.  


We initially offered and encouraged patients on GLP-1s to do this – now we are requiring it. Why? Because of the Oath: First Do No Harm. I am not going to continue to prescribe these medications for weight loss unless I am damn sure I’m not causing harm while doing so. I can’t tell if you have dangerously low muscle mass or bird bones by looking at you. We’re not going to guess. We’re going to test.  


We restructured this process to make it as affordable as humanly possible for patients on any form of Ozempic or Mounjaro. We’re going to offer it at no cost to our patients who are ordering these medications through our office. To continue to be treated with these medications, you can be assured we will monitor your bone density and body composition at least once yearly.  



Careful Calorie Consumption 

Protein. You need to eat protein. In order to build or maintain muscle, you need to eat roughly 1.2g of healthy protein per pound of ideal or goal weight per day. So, if your ideal or goal weight is 150 pounds, you should be consuming 75 to 125g of protein per day. Some estimates are much higher – at least 2g per day. So, the same person wanting to maintain a healthy body composition at 150 pounds might need to consume 125 to 150g of protein per day. There are lots of macronutrient app trackers available today: MyFitnessPal, Carb Manager, Cronometer, Lifesum. Pick one. Use it. 



Muscle Promoting Exercise 

Move your body. This is why aliens are just big heads with scrawny arms and legs. They just sit around in spaceships all day long thinking about how to take over the universe. If you want muscle, you need to move your ass. Resistance training, weight lifting, go for a walk with a weighted backpack. Running for miles on end is not the best way to build lean tissue.



Supplements 

In addition to the usual vitamin D, B complex, magnesium, omega-3, probiotic, and well balanced multivitamin we should all be taking, there are muscle and bone building supplements to consider. Creatine, protein powders, branched chain amino acids, Beta-Hydroxy-Beta-Methyl butyrate (HMB). You should also – you know – maybe get some sleep, drink some filtered water, and take some time for stress reduction occasionally. 



Conclusion 

Gaining weight is easy. You know this. You can do it in your sleep. Losing weight? Bahh. It remains one of life’s greatest mysteries – well, doing it safely and sustainably is anyway. Thankfully, we may have found the closest thing to an easy button for weight loss yet. The GLP-1s. But your parents were right. Again. Dammit. You don’t get something for nothing. OK – maybe not the best analogy as the GLP-1s may seem financially crushing, BUT they work. The tradeoff is diligent monitoring of diet, exercise, lifestyle, and body composition. I’ve got my ear to the ground on this. I don’t want to make your life more difficult; I want to make it better – the best it can possibly be. By all accounts, we can use these tools safely if we stick to our core principles:  


Treat every patient as a unique individual with their own set of genetic and environmental differences. Different resources, different life stressors, different goals. All the while being mindful that Pharma approaches healthcare with profits as their incentive. Remember, there is no money in wellness. Half-truths often come with lies. But the corporate machine that is conventional medicine, didn’t account for hackers like us that remembered how to think and take the good while leaving the bad. 


I’ve got you, friends. You can have it all. I do nothing but eat, drink, and sleep in this mess of sorting fact from fiction. The answers are right in front of us - of course mixed in with the thistle that also seems to have taken hold of my back yard. Fear not. I will not stop researching until I get answers. Regardless of obstacles, we can see through the lies and get to the truth. 



On A GLP1? Here Is Your To Do List

Click to Enlarge & Download



All patients using (Ozempic, Wegovy, Mounjaro, Zepbound, semaglutide, or tirzepatide) should be having a DEXA bone scan and body composition completed annually. We want to make you are losing weight in a healthy way, keeping bones strong, and maintaining muscle mass.


Note: If you are using a GLP1, a DEXA/Body Composition scan will be discussed by your provider at your next visit. Any questions can be answered at that time.



Resources 

The Impact of GLP1 Agonists on Bone Metabolism: A Systematic Review, 2022 


Sharon Osbourne, 70, reveals 30-pound Ozempic-aided weight loss after saying she ‘didn’t want to be this thin, 2023 


Once-weekly semaglutide versus placebo in adults with increased fracture risk: a randomized, double-blinded, two-center, phase 2 trial 


Narrative Review of Effects of Glucagon-Like Peptide-1 Receptor Agonists on Bone Health in People Living with Obesity 


Ozempic can cause major loss of muscle mass and reduced bone density 


Demand for weight loss drugs spikes – Despite horror stories – Newsweek, Apr 2, 2024 



 

 

 

 

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