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  • Writer's pictureDr. Megan Choy

So Let's Talk about Ozempic (and medications in general)

Ozempic, also known as Semaglutide, Wegovy, Rybelsus, and Mounjaro (and probably some other names that I didn't stumble across) is a drug intended for diabetics that is used off-label as a weight loss drug. There is a lot of talk about it right now on various social media platforms, as well as in the news. That on its own didn't trigger me to look into the medication, it took someone I know taking it and having issues to get me to research this drug. Once I started looking into it, I really wanted to share my thoughts and ideas about Ozempic.

In case you haven't been following, here's the quick overview of what is being talked about. Ozempic is making waves as a "weight loss" drug, apparently being used and applauded by many celebrities and influencers. In addition to the reported significant weight loss, two other things are being spoken about on social media, "Ozempic face" the gaunt, aging face that some users get from taking the drug, and the rebound weight gain that some are having when they stop taking it.

I want to take a step back and talk about what Ozempic is and what it does. Ozempic is a drug that was approved by the FDA for glucose control in diabetics. It is a glucagon-like-peptide (GLP-1) agonist. This means that it mimics the action of the human hormone GLP-1. GLP-1 is a hormone that regulates blood sugar and satiety by doing several things in the human body. It stimulates the production and release of insulin, slows the emptying of the stomach after eating, and does a few other things in the digestive system and the nervous system. When taken, Ozempic acts on the same receptors as GLP-1 and triggers these same functions.

When this drug is taken by diabetics, studies have shown that it lowers their blood sugar and assists in weight loss. When the drug is taken by a non-diabetic, but overweight, individual, it appears that the drug causes fast weight loss. I say "it appears" because at this point all we are relying mostly on anecdotal evidence. There are people out there saying that it does this, but the studies are in early stages still. And more importantly, the long-term safety of a non-diabetic taking the drug has also not been confirmed.

Now, I don't really doubt that the drug does result in weight loss in a non-diabetic. I think it's likely that it results in fast and dramatic weight loss. For me, the question is, at what cost does it do this? In reality, the cost is the similar in both the diabetic and the non-diabetic, but with a diabetic, there is already a disharmony in their physiology. While I do not see this drug as the solution for a diabetic, it at least serves a purpose.

So what is the cost of taking the drug to lower blood sugar and lose weight with Ozempic? It is the cost of taking any medication.

The body looses it's ability to self-regulate.

Let me explain this more. GLP-1 is a hormone. In a healthy body, GLP-1 is produced and secreted in response to the bodies needs. There are receptors to which this hormone attaches, and its connection to those receptors stimulates a cascade of actions in the body (in this case, primarily the production and release of insulin).

In a diabetic, the body isn't responding adequately to its own needs, it isn't making and releasing enough insulin. In this case Ozemic comes in and through the external supply of GLP-1-like substance, it forces the body to produce and release more insulin. This results in a normal or normal-ish level of insulin. I mentioned that the cost of a medication is loss of self-regulation. I see this as less problematic in a diabetic because their body was already failing to self-regulate. So by taking the drug they didn't loose self-regulation, but gained appropriate levels of the insulin through external regulation. As a physician who seeks healing, my goal is to re-establish optimal self-regulation, and so it is never my choice to resort to drugs unless I am unable to re-establish self-regulation quickly enough to prevent death or injury. But I can understand drugs like ozempic for this purpose, and if a person is unable to re-establish regulation for one reason or another, ozempic can fill an important role.

So what happens when a non-diabetic takes Ozempic? Presumably, their body is self-regulating its insulin production before they begin taking the drug. So they are already producing GLP-1 and it binds to receptors and triggers the cascade that results in the release of insulin. Then Ozempic provides an additional, external source of the GLP-1-like substance, and MORE insulin is made and released. Now there is an excess of insulin in the body. This results in lower blood sugar, and weight-loss.

For this next part, I don't have scientific data on this particular drug. What I do have is consistent evidence of how physiology works. Because there is excess insulin in the body, and this results at least occasionally, in hypoglycemia (low-blood sugar), the body begins to adapt. It decreases it's own production of GLP-1 and it decreases the number of receptors for GLP-1 and Ozempic to bind to in order to decrease insulin levels. The body may also decrease the number of insulin receptors (decreasing the effect of insulin) in response to high levels of hormone. So over time, the weight-loss effect of Ozempic decreases, and eventually stops altogether as the body seeks to restore its normal blood sugar levels.

Now that the drug is no longer having the desired weight-loss effect, and may be causing other adverse side effects, the user will generally choose to discontinue taking the drug. So now the external source of GLP-1-like substance is gone. But the body is still releasing less of it's own GLP-1 AND the receptors have been down-regulated, and if the insulin receptors were down-regulated as well, the insulin that is present also has a smaller effect. Suddenly, there is MUCH less of the stimulation to produce and release insulin and the insulin that is present is not as effective. Guess what happens now?

Best case scenario, the person experiences a slight weight gain as their body attempts to re-establish self-regulation of insulin. If everything goes well, they will begin to make more GLP-1 and they will produce more receptors for GLP-1 to bind to, and they will also make more insulin receptors, thus restoring optimal function. During this transition, they may only gain back a little of the weight they lost, they may gain all of it back, or they may even gain back more than they lost while taking the drug. This explains the "rebound weight gain" that is mentioned by some users.

Additionally, we sometimes see individuals who don't seem to regain optimal self-regulation. It's almost like their body says, "Nope, you told us we didn't have to do this anymore so we're not going to." This is a very sad outcome, as these individuals will struggle with insulin, blood sugar, and weight for a long time as a result of taking the drug. These individuals will not likely be the majority of people who have taken the drug, but they will, and probably already do, exist.

So what is the takeaway from all this? I hope to help people understand why drugs like Ozempic aren't really the miracle pills that they sometimes appear to be. They come with a cost. If you have diabetes and your body is already failing to self-regulate, Ozempic may be a tool for you. But if your body is currently self-regulating insulin, using Ozempic for weight loss comes at a high price, and in the long run, you may discover that it doesn't even provide the results you were looking for.

If you're looking to loose weight, or to optimize your blood sugar, I always recommend long-term, sustainable, life-style modifications that work WITH the body (instead of ON it) to optimize its self-regulation. This ensures that you not only achieve the desired outcome, but you also improve your overall health at the same time!!

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