The Ozempic Debate Continues...
The debate over GLP-1 agonists, such as Ozempic, Mounjaro, Wegovy, Semaglutide and Tirzepatide, is heating up. With a plethora of mixed opinions about whether or not they should be prescribed and a good amount of misinformation about side effects and risks, it can be a highly political and confusing landscape. I recently tuned into an enlightening podcast that featured both a proponent and a critic of these peptides on Dr. Hyman’s The Doctor’s Farmacy Podcast. It was one of the most well-rounded and engaging discussions I’ve heard on the topic. So, I want to talk about it.
If you don’t have two hours to dedicate to the full episode, don’t worry—I’ll summarize the key points below and share my own insights along the way.
The podcast is a must-listen for three main reasons. First, it highlights the obesity epidemic we have in this country. 42% of the population is obese, and almost 94% of the population is metabolically dysfunctional in some way. We have a serious issue that I we cannot deny or ignore. Second, it emphasizes the importance of integrating diverse viewpoints on the matter. Both speakers delivered compelling arguments, which made for a vibrant and layered conversation. This dialogue not only deepens the understanding of the peptides’ role in healthcare but also underscores the complexity of such issues. Finally, it outlines almost every argument made both for and against these peptides.
To get started, I’m going to discuss what GLP-1 agonists like Ozempic, Mounjaro, Wegovy, Semaglutide, and Tirzapetide are. If you already know what these peptides are, you can skip this and move straight down to the podcast debate by clicking here.
I’m also going to discuss all of the following arguments about these peptides (click on the question to go straight to my answer):
- Do I prescribe these peptides at my practice?
- Who should take a GLP-1 agonist?
- What is the difference between the brand names (Ozempic, Mounjaro, and Wegovy) versus the compounded formulas (Semaglutide and Tirzapetide)?
- What is the cost?
- What are the benefits beyond weight loss, if any?
- What are the side effects?
- Will I regain the Weight? / Is it a lifetime medication?
- What lifestyle modifications must be made alongside GLP-1 agonists?
- Do these peptides cause muscle loss or muscle wasting?
- How do they affect the gut microbiome?
What are Ozempic, Mounjaro, Wegovy, and other Weight Loss Peptides?
The name ‘Ozempic’ is often used as a catch-all for weight loss peptides, but it specifically refers to one of the GLP-1 agonists available today. GLP-1 agonists, including Ozempic, Wegovy (based on semaglutide), and Mounjaro (comprised of tirzepatide and is a GIP and GLP-1), are not just ordinary medications; they are peptides—a type of medication that mimics natural hormones.
These peptides help regulate appetite and insulin levels by increasing feelings of fullness, slowing stomach emptying, and promoting proper insulin release in response to meals. This makes them effective for weight management and treating conditions like type 2 diabetes and even autoimmune diseases.
The Difference Between Peptides and Medications
The distinction between peptides and other drugs is important. Pharmacological medications typically function by inhibiting, blocking, or altering normal physiological processes to manage symptoms or combat disease. For example, many drugs work by interfering with the natural pathways that cause inflammation, pain, or disease progression. In contrast, peptides such as GLP-1 agonists operate in a fundamentally different manner.
On the other hand, peptides are naturally-occurring or synthetically-produced molecules that the body recognizes and utilizes to regulate its own functions. Peptides enhance or mimic the actions of naturally produced hormones, facilitating normal physiological processes like appetite regulation and insulin secretion. This alignment with the body’s inherent mechanisms allows peptides to not only manage symptoms but also support the body’s natural regulatory capacities, promoting overall health and addressing the underlying causes of conditions.
However, there is a rich and ongoing debate about these peptides and whether or not they should be prescribed.
Dr. Hyman's Podcast Debate
Dr. Hyman’s Podcast episode featured Calley Means, co-author of the book Good Energy: The Surprising Connection Between Metabolism and Limitless Health and a harsh critic of Ozempic and other GLP-1 agonists, and Dr. Tyna Moore a naturopath and chiropractor who is a holistic expert in regenerative medicine and a big proponent of GLP-1 agonists. While they sit on opposite sides of this debate, they don’t completely disagree and have many moments of overlap and agreement that enrich both perspectives.
The Critic: Calley Means criticizes Ozempic and other GLP-1 agonists because he’s looking at things from a wider angle. He thinks that, as a society, we need to focus on what has caused our obesity epidemic in the first place, namely: ultra-processed foods, big food corporations, modern farming practices, etc. He thinks big pharma is capitalizing on this crisis by pushing Ozempic as a standard of care for obesity (specifically in children), which ignores the need for wellness education and other lifestyle changes that could not only help on a patient-level, but could drive policy, acgriculture, and commerce in the United States more broadly. Calley believes that we should, instead, focus on a more functional approach to “clean up the fish tank first” (remove ultra-processed foods from kids’ diets, encourage exercise, etc), and if that doesn’t work, move toward more intensive interventions like weight loss medication. He argues that it should not be the standard of care.
He argues that we could use the $1500-$1800 cost of Ozempic each month per person (more on the cost below) we could overhaul our agricultural system to a regenerative model, and simultaneously instill wellness habits in children and our society as a whole. He then turns to a critique of the GLP-1 agonists themselves, citing severe side effects, muscle wasting, lifetime prescriptions, and cost.
My Take: I completely agree with Calley’s attack on ultra-processed foods, big pharma, and big “farma” (big agriculture). I think we can all agree that something is affecting obesity rates, and it is most likely our food and the toxins we are exposed to every single day. I agree with him here completely. I also think that the exorbitant cost of the brand name options is predatory (more on this below). Where he loses me (and also Dr. Tyna and Dr. Hyman) is when he disparages the GLP-1 agonists themselves. I prescribe them at my office, and there is a place for them in healthcare, including within a functional medicine approach. Keep reading to learn more.
The Proponent of GLP-1 Agonists: Dr. Tyna Moore also agrees that big food, big pharma, and corporate interest in our healthcare system is a larger problem in this country. However, she believes that criticizing these peptides is a mistake, as they are proving to be incredibly helpful for not only weight loss but multiple other medical issues. She breaks down the extensive medical research that has been done on GLP-1 agonist peptides and describes the long list of benefits, including (but not limited to) its regenerative, healing, and anti-inflammatory properties.
She agrees with Calley’s criticism of brand name peptides, attributing the side effects some people experience to high-dosing rather than the peptides themselves. She emphasizes that these issues often stem from high dosages and advocates for a ‘low and slow’ approach to achieve the best outcomes. She also clarifies to Calley that GLP-1s like Ozempic are peptides, not traditional medications, highlighting the difference between pharmacological and physiological treatments. Moreover, she prefers prescribing compounded peptides over name brands. These alternatives are not only more cost-effective but also offer adjustable dosages. She notes that the only aspect of Ozempic that is trademarked is its pre-dosed injectable pen, which administers a high dose that can lead to unpleasant side effects.
My Take: I highly agree with Dr. Tyna’s approach to GLP-1 peptides. I use these peptides as just one tool in a comprehensive approach to metabolic dysfunction, weight loss, and a variety of other issues. Low dosing is key and is many times just the thing that helps some (not all) patients get over the hump towards a healthier lifestyle. And, the benefits outside and above weight loss are becoming too great to ignore.
Do I Prescribe Weight Loss Peptides?
Yes, I do prescribe GLP-1 agonists like Ozempic in my practice. I do so for several reasons, chiefly because I’ve witnessed their remarkable benefits for certain patients firsthand. As a functional medicine professional committed to the holistic health of my patients, I’m always on the lookout for the most effective treatments for my toolbox to manage and reverse metabolic disorders—a major health concern affecting many people today. But, that is not all that these peptides do. As you will see below, GLP-1 agonists can help with gut microbiome diversity, neuroinflammation, cardiological benefits, and more.
Does this mean that all patients looking to lose weight should take a weight-loss peptide?
No, not all patients looking to lose weight need to take weight-loss peptides. There are many other ways to optimize your metabolism with a comprehensive, functional approach. Reducing inflammation, identifying food allergies, opening up detox pathways, bioidentical hormone replacement, treating the gut, and more can all help your body maintain a healthy weight.
Weight loss is generally one of the first benefits my patients see when they start implementing the tools I give them during a consultation. It’s the patients who have the weight to lose, have tried everything and nothing works who generally benefit most from GLP-1 agonists.
What are the Differences between the Brand Name and Compounded Versions?
The differences between brand name and compounded versions of GLP-1 agonists are primarily found in their manufacturing, regulatory approval, and customization options. Brand name GLP-1 agonists, such as Ozempic, Wegovy, and Mounjaro, are produced by pharmaceutical companies and have undergone extensive clinical trials to ensure their safety, efficacy, and quality. They are approved by regulatory agencies like the FDA, which also monitors their production processes and ensures they meet strict standards.
Compounded GLP-1 agonists (tirzapetide and semaglutide), on the other hand, are mixed on-demand by compounding pharmacies according to a physician’s prescription. This allows for a degree of customization in dosage and formulation to better meet the specific needs of individual patients, such as adjusting the medication to avoid certain fillers or allergens that may be present in the brand name options. However, because compounded medications are not subject to the same rigorous FDA approval process as brand name drugs, their consistency, potency, and purity can vary. This is why, at my practice, we use FDA
While brand name GLP-1 agonists are reliable due to their stringent regulatory approval and consistent quality, they do come with limitations that might not make them the ideal choice for every patient. One significant issue is the lack of dosage flexibility. Brand name medications like Ozempic and Wegovy are typically available in only a few set doses, which may be too high for some patients, particularly those who are sensitive to the medication or who are just beginning treatment and may benefit from a more gradual dosage increase. This lack of flexibility can make it difficult to finely tune the treatment to reduce side effects and to consider individual patient needs.
These factors highlight why compounded versions of GLP-1 agonists might be a more suitable alternative for some individuals. Compounded versions allow for more precise control over dosages and can even be considerably more cost-effective.
The Brand Names are More Expensive
Brand name GLP-1 agonists like Ozempic and Wegovy are often significantly more expensive than compounded Semaglutide or Tirzepatide. The cost can be prohibitively high for patients who are uninsured or underinsured, as these medications are typically priced at a premium. This financial burden can make access to these potentially life-changing treatments difficult for a significant portion of the population.
These factors—rigid dosing options and high costs—highlight why compounded versions of GLP-1 agonists are a more suitable alternative for most individuals. Compounded versions allow for more precise control over dosages and can sometimes be more cost-effective, particularly if they are tailored to reduce waste or avoid unnecessary higher doses.
Compounded versions provide flexibility and personalization that may be necessary for patients with specific needs or sensitivities, while also providing the more cost-effective option.
Patients should discuss with their healthcare provider which option might be best for them based on their medical history and treatment goals.
What Are the Benefits Outside of Weight Loss?
Initially developed to manage diabetes, GLP-1 agonists like semaglutide and tirzepatide are gaining recognition for their potential in treating a range of other significant health conditions. Recent research findings highlight the broader therapeutic applications of GLP-1 agonists, including their cardiovascular, neuroprotective, and anti-inflammatory benefits.
- Cardiovascular Health GLP-1 agonists are proving to be a valuable tool in the fight against cardiovascular disease, especially for patients with type 2 diabetes who are at a higher risk of heart conditions. Research shows that these drugs not only improve cardiac function but also reduce the risk of major cardiovascular events. By improving lipid metabolism (lowering cholesterol) and lowering blood pressure, GLP-1 agonists contribute to cardiovascular health maintenance and disease prevention (Nature).
- Neurological Benefits One of the most exciting developments in GLP-1 research is their potential role in neuroprotection. Studies indicate that GLP-1 agonists can reduce neuroinflammation and promote the growth of nerve cells, which could be instrumental in treating diseases like Alzheimer’s and Parkinson’s. This neuroprotective effect offers hope for therapies that could alter the course of neurodegenerative diseases, providing not just symptomatic relief but also slowing disease progression (Frontiers in Endocrinology).
- Anti-inflammatory and Metabolic Regulation GLP-1 agonists also exhibit significant anti-inflammatory properties that may benefit individuals suffering from chronic inflammation associated with various metabolic disorders. Moreover, the potential of GLP-1 agonists to modulate immune responses and influence tumor growth opens new avenues in the treatment of cancer and other proliferative diseases. Ongoing research is exploring how these drugs affect cellular pathways that are crucial in the development and progression of tumors (Frontiers in Endocrinology).
The therapeutic potential of GLP-1 agonists extends well beyond their original purpose. With benefits ranging from improved heart health to potential roles in treating neurodegenerative diseases and reducing inflammation, these drugs represent a promising frontier in medical treatment. As research continues to uncover these diverse benefits, the role of GLP-1 agonists in medicine could expand significantly, offering new hope for patients with a variety of health conditions.
What Are the Side Effects of Ozempic and Other GLP-1s?
Based on recent research and clinical insights, while GLP-1 agonists are associated with side effects, these are generally manageable and not overly common. The most frequently reported side effects are gastrointestinal, including nausea, vomiting, diarrhea, and constipation. These symptoms are usually mild and tend to decrease over time as patients adjust to the medication (Gastroenterology Insights) (Journal of Clinical Medicine).
Serious side effects like pancreatitis and renal impairment are rare, and when side effects occur, they are often linked to dosing strategies. A “low-and-slow” approach to dosing is widely recommended to minimize side effects. This involves starting with a lower dose of the medication and gradually increasing it, which allows patients to adjust more comfortably and reduces the incidence of gastrointestinal issues (Gastroenterology Insights) (Journal of Clinical Medicine).
Furthermore, clinical guidelines emphasize the importance of healthcare providers being well-informed about the use, action, and dosing of GLP-1 agonists, as well as being proactive in managing any complications that arise. This careful management helps ensure that patients can continue treatment with GLP-1 agonists without severe discomfort or the need to discontinue due to adverse effects (Journal of Clinical Medicine).
These findings highlight that with careful management and appropriate dosing strategies, the side effects of GLP-1 agonists can be effectively managed, making them a viable option for many patients seeking treatment for type 2 diabetes and obesity.
Is GLP-1 Agonist Therapy a Lifetime Commitment?
One of the common questions surrounding GLP-1 agonist therapy is whether these medications need to be taken for a lifetime. The answer is nuanced and largely depends on individual health goals, responses to the medication, and the ability to sustain lifestyle modifications.
Studies show that GLP-1 agonists can lead to significant weight loss, with some patients experiencing a decrease in body weight that allows for the gradual phasing out of the medication. The efficacy of GLP-1 agonists in reducing weight and improving metabolic health can provide a window of opportunity for patients to implement long-term lifestyle changes, such as improved diet and increased physical activity. Over time, these lifestyle modifications can sustain the benefits achieved during GLP-1 therapy, potentially reducing the need for continued medication (BMJ) (Cleveland Clinic). As you lose weight, you become less insulin-resistant,
However, there is a concern about weight regain once the medication is discontinued. Research indicates that maintaining the weight loss achieved with GLP-1 agonists is largely dependent on continuing the lifestyle habits developed during treatment. A gradual reduction in the medication, under medical supervision, can help assess the body’s response and make necessary adjustments to stabilize the new weight and maintain health improvements (Cleveland Clinic).
Ultimately, while GLP-1 agonists provide significant benefits for weight management and diabetes control, they are best used as part of a comprehensive approach that includes dietary changes, regular physical activity, and possibly psychological support. With the right strategies in place, it is feasible for some patients to wean off these medications and maintain their health gains long-term.
What the Research Says About Regaining the Weight:
An electronic health records company conducted a study of 20,274 patients who lost at least five pounds on semaglutide. Researchers followed up one year after they stopped taking the medication to assess weight changes. They discovered that 17.7% of these patients had regained all the weight they initially lost or even gained more. However, the majority (56.2%) managed to maintain their weight close to what it was when they stopped the medication or continued to lose additional weight (Epic Research).
the majority (56.2%) managed to maintain their weight close to what it was when they stopped the medication or continued to lose additional weight (Epic Research, 2024)
This approach emphasizes the importance of a holistic strategy in the treatment of obesity and diabetes, where GLP-1 agonists are one of several tools used to achieve and maintain health improvements.
Which Lifestyle Modifications Must be Implemented Alongside GLP-1 Agonists?
To maximize the benefits of GLP-1 agonists for weight loss and overall health, it is crucial to combine these medications with specific lifestyle modifications. Key recommendations include:
- Increased Protein Intake: A diet high in protein supports muscle repair and growth, which is crucial when using GLP-1 agonists. Protein helps maintain muscle mass during weight loss, promotes satiety, and can enhance the metabolic rate. Include sources like lean meats, fish, eggs, and legumes in your meals to ensure adequate protein levels (NIH).
- Weight Resistance Exercise: Resistance training is essential for building and maintaining muscle mass, which can be particularly beneficial for those on GLP-1 agonists aiming for weight loss. Muscle tissue burns more calories at rest compared to fat tissue, thus increasing overall metabolic rate. Incorporate exercises such as weightlifting, using resistance bands, or body-weight exercises like push-ups and squats into your routine at least two to three times per week (Mayo Clinic Diet).
Regular Monitoring: Working closely with a healthcare provider to monitor progress and adjust the treatment plan as necessary is advised. This ensures that any potential side effects are managed promptly and that dietary and exercise plans are effectively contributing to weight loss and health goals (Premium Health).
Combining these dietary and exercise strategies with GLP-1 agonist therapy creates a robust framework for achieving and maintaining significant weight loss while improving overall metabolic health. This holistic approach is vital for long-term success in managing both weight and related health conditions.
Do GLP-1 Agonists like Ozempic Cause Muscle Loss/Wasting?
It’s important to note that muscle loss in weight reduction scenarios isn’t exclusive to GLP-1 agonist use and can occur with any weight loss regimen. Ensuring an adequate intake of protein and engaging in resistance training can help preserve muscle mass during weight loss efforts, irrespective of the methods used.
The debate about GLP-1 agonists like Ozempic causing muscle loss or muscle wasting is a vibrant discussion. The research, however, is murkier. The Step 1 trial in 2021 is an oft-cited study, as it was the first to demonstrate the efficacy of semaglutide as a treatment for adult obesity. A subset of 140 patients underwent body composition analysis, which showed that lean mass (muscle) accounted for 39% of total weight loss. This is a significant percentage. However, these trials were conducted in obese adults, with far more weight to lose. In fact, the ratio of lean mass actually increased by 3%, so the loss of muscle was not a factor and still showed beneficial results in this population.
Overall, while there is a potential for muscle mass changes, the effects of GLP-1 agonists on muscle are influenced by several factors, including the patient’s overall health, diet, and exercise habits. Continuous research and personalized medical guidance are essential to navigate these aspects effectively. This is why weight resistance exercise and protein intake is a must with ANY weight loss therapy.
Do GLP-1 Agonists Affect the Gut Microbiome?
Although research in this area is still developing, GLP-1 agonists also appear to influence the gut microbiome. The interaction between GLP-1 agonists and the gut microbiome may impact overall metabolic health and glucose metabolism.
Research suggests that GLP-1 agonists can alter the composition and function of the gut microbiota. For instance, changes in the gut microbiome have been associated with improved insulin sensitivity and increased energy expenditure, which are linked to the effects of GLP-1 on gut hormone secretion and appetite regulation. This interaction highlights the potential of GLP-1 agonists not only in managing blood sugar levels but also in affecting the gut microbiota, which could contribute to their metabolic benefits (Microorganisms) (Frontiers in Endocrinology).
Further exploration is needed to fully understand the extent and nature of these interactions and how they contribute to the therapeutic effects of GLP-1 agonists. As research continues, it will be important to consider these factors when evaluating the overall impact of GLP-1 based therapies on health beyond glucose control.
The Final Word on GLP-1 Agonists Like Ozempic
This isn’t my final word on these peptide therapies, as I’ll be excited to keep sharing the important research that continues. I hope that I’ve addressed most of your concerns, regarding GLP-1 agonists, and I’ve demystified the Ozempic debate in some way.
The decision to begin treatment with a GLP-1 agonist is a personal one, made in consultation with your healthcare provider. Given their significant benefits—which include not just weight loss but also potential improvements in gut microbiome diversity, reduction in neuroinflammation, and enhanced heart health—the appeal of these treatments is difficult to ignore.
Compounded versions of GLP-1 agonists present a particularly attractive option. They are not only more cost-effective but also allow for greater personalization of treatment, helping to reduce side effects more effectively than their brand-name counterparts. This tailoring of medication to individual needs underscores the pivotal role of personalized medicine in contemporary healthcare.
If this discussion has sparked your interest, or if you have experiences and thoughts you’d like to share, please leave your comments below. For a more in-depth conversation or to explore how these treatments might benefit you personally, do not hesitate to call my office to set up a consultation. Your journey towards optimal, VIBRANT health is a collaborative effort, and we’re here for you!
In Vibrant Health,
Elizabeth Tringali, PA-C
