Semaglutide (Ozempic & Wegovy) Hype or Cure?
Statistics
According to the National Institute of Health, nearly 1 in 3 adults are overweight, which is (30.7%).
According to the CDC, Obesity in the USA affects 100.1 million (41.9%) adults and 14.7 million (19.7%) children and accounts for approximately $147 billion in annual health care costs.
Obesity is linked to 30-53% of new diabetes cases in the U.S. every year.
More than 1 billion people have obesity worldwide: 650 million adults, 340 million adolescents and 39 million children, according to the WHO.
The worldwide obesity rate has nearly doubled since 1980.
The World Obesity Federation predicts that by 2030, one in five women and one in seven men will have obesity.
Unfortunately, according to these statistics, many of us are either overweight or even fit into the obese category, according to Body Mass Index calculations. This is extremely concerning considering the health risks associated with being overweight and obese are significant. The health risks include: developing heart disease, strokes, hypertension, joint problems, sleep apnea, mental health issues like depression and anxiety and poor self-esteem, which are all concerning and are a public health concern (and even crisis).
Being overweight can limit physical activity, mobility and overall quality of life.
photo credit Kenny Eliason Unsplash
I have been working on finding weight loss tools for my clients for over 16 years and it is extremely challenging. When it comes to weight gain struggles, I have worked to balance hormones, supported thyroid optimization, rebalanced the gut microbiome, removed toxins, worked to reduce inflammatory foods in diet, recommended fasting and timed eating changes. I have helped people with dietary plans as best as I can, as well as referred many people to nutritionists for extra help. I also encourage people to look at emotional eating and stress as a layer too.
I have prescribed the HCG diet, Phentermine, MIC/B12 injections, Metformin and other medications, yet often this is still failing certain patients and our society.
Supporting my patients with healthy weight loss is one of the most challenging parts of my job.
Hello Semaglutide! This is one of the best tools I have come across so far that can help clients who struggle with other methods to lose weight and keep it off by retraining eating habits and engage in more intuitive eating.
I have wanted to write this newsletter for some time, but I wanted to wait until I had gained more clinical experience before writing it. Now is the time because not only is it blowing up in the media, but I have some real life patient results over the past year to draw from, which has been very exciting too!
So let’s explore this together and see how Semaglutide is promising solutions for those seeking to improve their health and longevity!
What is Semaglutide anyway?
Semaglutide is a peptide, which is a short chain of amino acids linked together by peptide bonds. This is specifically a glucagon-like peptide-1 receptor agonist “GLP-1 RA“, meaning that it mimics the GLP-1 hormone, which is secreted by the small intestines in response to eating. The pancreas will then make more insulin, which reduces blood sugar (glucose) in the body.
Additionally, GLP=1 slows down the emptying of the stomach, leading to a feeling of fullness, which helps control appetite and therefore promotes more weight loss.
A study of 2000 obese adults compared people using Semaglutide plus a diet/exercise program with people who made the same lifestyle changes without Semaglutide.
After 68 weeks, half of the participants using Semaglutide lost 15% of their body weight and nearly 1/3 lost 20%. Participants who incorporated only lifestyle changes lost about 2.4% of their weight. (see link below )
Key for effective weight loss
Key for Improving Insulin Sensitivity
Key for reducing Cardiovascular events, which is the #1 killer for men and women
Pharmaceutical FDA approved “drugs” as types of Semaglutide
What is Semaglutide approved for? Weight loss & Type 2 Diabetes
Semaglutide FDA approved “drugs” are below
Ozempic (approved for Type 2 Diabetes in 2017)
Rybelsus (approved for Type 2 Diabetes in 2019) oral form
Wegovy (approved for weight loss in 2021)
Type 2 Diabetes as defined as two occasions of a Fasting Glucose over 126 & HgA1C >=6.5%
Wegovy criteria for approval are adults with Body Mass Index (BMI) of 30kg/m2 or greater “obese” category” OR adults with a BMI of 27kg/m2 or greater AND at least one weight-related comorbidity such as HTN, Dyslipidemia or Type 2 Diabetes.
Obesity BMI Qualification
Measuring a Body Mass Index is a common approach to assess body fat, however it does have many limitations.
It does not distinguish between excess fat, muscle or bone mass, nor does it provide any indication of the distribution of fat among individuals.
Body Mass Index may overestimate body fat in athletes and others who have a muscular build and it may underestimate body fat in older persons and others who have lost muscle.
More accurate, but expensive and more difficult to evaluate are below
TBW total body water
BIA bioelectrical impedance analysis
FFM fat free mass
The BMI calculator is however used as a simple and affordable tool and often used to gain quick insight into someone’s risk factors.
BMI calculator tool link
Obesity, overweight and body image concerns
The movement around body image, such as Lizzo platform, has done some wonderful things regarding practicing more self-love and letting go of the societal ‘ideal image of perfection’ that we’ve been sold to for 70+ years. We know those beauty magazines for both men and women are unrealistic, and have led to eating disorders and poor body image for far too long. So it’s refreshing to see a shift happening YET we know that fat cells do create their own inflammatory cytokine signaling. There are abundant studies around inflammation being the root of all disease.
So when we talk about health and wellness and longevity, we must reduce inflammation and with that reduce fat cells for a healthier body.
These human vessels we inhabit are important so that we can live our best selves and not be limited by a body with inflammation and disease.
Fat cells and inflammation
Adipose tissue (fat tissue) is not just a passive storage site for excess energy, it acts as an active endocrine organ that produces signaling molecules called adipokines. In excessive accumulation of fat tissue, the increased production of pro-inflammatory adipokines lead to chronic low -grade inflammation in the body. Surrounding tissue can become inflamed as well, leading to disease.
Fat cells- excess of macronutrients in the adipose tissues stimulates them to release inflammatory mediators such as tumor necrosis factor alpha and interleukin 7, and reduces production of adiponectin, predisposing to a pro-inflammatory state and oxidative stress.
Since we know inflammation is the “root of all disease”, this is a serious problem!
Luckily we are creative as humans and are continuously developing tools to help us with this epidemic. Hello peptides!! I want to be clear that this is not recommended for someone with a healthy BMI or who just wants to slim down or prepare for a beach vacation or role in a movie. This is instead a serious tool for people who seriously need it to mitigate health risk and prevent disease.
Of course, we know how important the basics are in keeping our bodies optimal, eating healthy organic balanced meals, avoiding refined sugars, moving the body every day and exerting ourselves with exercise and getting restful sleep. Despite the basics, I still hear every day “ I simply can’t lose this weight no matter what I do” and this is very frustrating. Using the available tools that modern medicine has developed is often necessary in help achieve success and optimal health.
What Patients are saying “I use to get hangry. I would have huge blood sugar fluctuations. Not anymore! Semaglutide has somehow changed my internal chemistry. I’ve lost 40lb since September (in 10 months). It has not been easy. I have had plenty of nausea and fatigue along the way, but as they say “pick your hard” It was also hard being heavy and I think this medication is incredibly powerful. I feel it has been quite successful for me”. -Merret M "I've struggled for decades to manage my weight. Carrie helped pinpoint my specific needs. With semaglitude and sermorelin, I was able to go from 174 to 138 pounds, develop an exercise routine and weight loss that has been lasting for almost one year now - even without the support of semaglitude. Thanks, Carrie!" - SM
photo credit Dima Solomin Unsplash
How to use
Most of my experiences is with the injectables, but if you are ‘shot shy’ the sublingual is available for compound as well. One pharmacy is compounding it from the brand name but in smaller doses to reduce side effects yet with still good efficacy. Another pharmacy is adding B12, Chromium and Pyridoxine to help efficacy, while reducing side effects of nausea and fatigue.
Inject a small amount subcutaneously once per week, and then increase the dose every 1-2 weeks until finding a good dose that suppresses the appetite, balances the side effects and provides weight loss support.
On average, I have seen 8-40 pound weight loss over months to a year.
There are some ideas I have on how to work with the side effects which can be discussed if you consult with me on this medication.
Common side effects
Mostly GI symptoms: decreased appetite (a desired effect), nausea, headaches, dizziness, fatigue, vomiting, bloating, gassiness, constipation & diarrhea.
Often these symptoms improve over time as the body adjusts to the medication. This is also why the dose is started low and titrated up slowly to tolerance.
Hypoglycemia, especially if in combination with other Diabetic medications.
There may also be injection site redness/swelling/itching.
Risks
Gallbladder problems such as inflammation or gallstones can occur because the emptying of the gallbladder is slowed down. It is advised to take bitters, drink beet juice and or add Ox Bile to aid in gallbladder digestion
Release of toxins that are being stored in fat cells. Therefore, I recommend taking a binding agent if the weight loss is too fast or if patients are feeling sick.
Nutrient depletion if eating too few calories with simple carbs. Therefore adding a multivitamin and mineral would be supportive during this process.
Sagging or loose skin with rapid weight loss or loss of muscle strength. Therefore adding Branch Chain Amino Acids would be supportive for those patients.
Pancreatitis (low risk)
Thyroid C Cell Tumors found in animal studies only on other GLP-1 receptor agonists used for Diabetes when studied at high doses and with long-term use
Semaglutide should not be used in combination with other GLP-1 medications (see link below)
DO NOT USE IN PREGNANCY – discontinue the medication at least 2 months before planning pregnancy
DO NOT USE if you have Type I Diabetes
Cost
If you have diagnosed obesity or have Type 2 Diabetes, most insurances will pay for Wegovy, Rybelsus or Ozempic, with a prior authorization.
If you fall in the category of being overweight and have insulin resistance but you don’t qualify for the FDA approved drugs, you would need to get Semaglutide compounded at a different dose, which requires a prescription and the cost is out of pocket.
One 1ml vial of compounded Semaglutide is about $340
$300 with overnight shipping for $40 = $340
These last about 5 -6 weeks depending on dosing
Compounded sublingual Semaglutide is about $220 for 6 weeks
Prices do vary depending on pharmacies and availability.
What happens after you lose the weight?
If you regain the weight after stopping the medication, below are some of the most common reasons why this could happen.
Metabolic rate is too low from too little physical activity.
You are not exercising enough or with enough exertion. If you are exercising 3 days a week, that is simply not enough to lose weight, as it is barely enough to maintain weight. Ideally exercise at least 4x per week (daily is best) of cardiovascular exercise AND weight training 2-3x/week. (I will personally gain a few pounds in a week if I don’t get vigorous exercise at least 4x per week)
Walking is better than no exercise, but exercise that elevates your
heart rate is preferred.
The concept of walking 10,000 steps per day to achieve better health is thought to have been popularized by a Japanese pedometer manufacturer in the 1960s. This doesn’t seem to be backed up by studies, yet I endorse this for most people because it holds one accountable to moving their body.
Exercise Increases Metabolic Flexibility!!
Using our technology to our advantage can help us too, such as the Fitbit’s, the iPhone, Apple watches, Oura rings & Whoop devices, which are all great tools.
No, I do not love the electromagnetic frequencies with technology, yet they are here and if we can use these tools wisely, they can be a guide for us to live healthier lifestyles.
Too many calories in your diet for your metabolic rate
Too large of portions are often understated, especially in the U.S.
Once you establish your hunger signals and how much you really need to
eat to fuel your body, you can consciously remind yourself to
stop eating once you feel full.
Leptin resistance Leptin is a hormone produced by fat cells to help regulate appetite and body weight. It signals the brain when fat cells are saturated to “turn off hunger signals” so you stop eating. However if one has leptin resistance, that signal is not sounding and therefore people overeat.
Semaglutide can improve leptin sensitivity (study below) but studies lack
evidence if leptin resistance returns after stopping the peptide.
Hormones not being balanced Sex, hormones; low estrogen, progesterone, testosterone and DHEA will cause decreased metabolic rate. Alternativity, high stress hormones, such as cortisol will affect weight gain as well, especially in the belly (often called the “cortisol belly”.
5. Hypothyroidism or Subclinical Hypothyroidism
The thyroid hormone being low or sub optimal will affect metabolic rate.
Testing that is key to measure your thyroid are:
TSH, T3 free, T4 free & Reverse T3.
Balancing all of these hormones are key to losing weight and keeping at an optimal weight for health and longevity!
photo credit Siora photography on Unsplash
Tips on keeping weight optimal
Start the day with apple cider vinegar in water to help alkalize your body and decrease appetite. The more “alkaline” you are, the less inflammation you have and better detoxification.
Chew 32 times per bite and slow down and enjoy each meal. If you’re eating slower, you will respond to when your body says you’ve eaten enough and that will help you adjust your portion size.
Eat your vegetables on the plate first.
Don’t practice “clean your plate” rule. It is OKAY to not eat all of the food on your plate. Leftovers can save money and time!!! Considering serving half of what you would think you need and if you’re still hungry after you finished your meal and have rested a bit, you can go back for more.
Take a walk! Going for even a short walk (at least 10 minutes) to help you digest, decrease your glucose load from your meal and increase your metabolic burn rate, especially after dinner.
Practice Fasting (how many times have I talked about this! Sick of me talking about it yet?) 12 hours fast every night and then 3x/week try a 16-18 hour fast. Intermittent fasting best done is stopping at 5 PM and next day eating at 9 AM. Getting your metabolic rate going in the morning instead of waiting too long to eat is key to getting insulin sensitivity active.
Longer fasts such as the fasting mimicking diet by Prolon
can be helpful for a “reset” as well
7. Eat a Low carb diet (avoid corn, white potatoes, white rice,
dairy and refined sugars) and eat 8 servings of vegetables, healthy fats
and proteins daily to build lean mass. Watch your alcohol intake too, as
the calories add up quickly when they are in liquid form.
Eat fruit don’t drink it.
8. Eating organic, since toxins will be held inside fat cells and make it
more difficult for you to lose weight. Once patient lost 5lb and kept it off
after stopping using Clorox daily as a cleaner!
9. Work with a Nutritionist
I always recommended working with a nutritionist for meal planning if it
feels unrealistic with your family to work on these recommendations.
Nutritionists can support you with healthy meal planning and finding
ways to help the entire family eat healthier with enjoyment!
I personally follow all of these recommendations to keep myself at an optimal body weight (well except chewing 32x per bite, that is a hard one!!) And let me be clear, it does get more challenging when our hormones change as well. Ugh!
Is Semaglutide all Hype or a Cure?
Well now you know there is good reason for all of the hype. And as much as we can't say any weight loss tool is a cure, I believe this has given many people results that are changing the trajectory of their health in a positive way.
I hope you can all feel my enthusiasm for this incredible game-changing medication that has been helping change the lives of many people and for our societies as a whole.
If you qualify for Semaglutide based on your BMI or you have Type 2 Diabetes and want to see if it’s right for you, call the office and book a consult with Carrie at 303-459-4875.
As always, my goal is for you to feel healthy, youthful and energetic!
Yours in Health and Wellness,
Carrie
Studies
Once-Weekly Semaglutide and Lifestyle changes in Adults with Overweight or Obesity
Obesity in the USA
Obesity Worldwide
Influences on metabolism
Obesity and inflammation
Adipose Tissue, Inflammation and Cardiovascular Disease
Obesity and Inflammation: A Vicious Cycle
Adipose Tissue Inflammation and Metabolic Dysfunction: Role of Exercise
Semaglutide and Leptin Sensitivity
List of GLP-1 receptor agonist meds
