A Functional Take on Semaglutide Risks and Benefits

These medications are everywhere right now – let’s talk Semaglutide risks…

The question I get the most often lately is what do you think about Semaglutide medications – Ozempic, Mounjaro, Wegovy – these GLP-1 receptor agonist class of drugs that have taken the weight loss market by storm.

In this post I want to lay out the real semaglutide risks and benefits, how they work, why they’re effective, health considerations to factor when weighing them as a weight-loss option, and potential downstream effects you should be aware of.

Also what you can do to mitigate semaglutide risks and prevent any downstream dysfunction that may result from slowing down motility in the GI tract.

Let’s dive in…

How Semaglutide Works

The more technical name for these medications is GLP-1 receptor agonists as they mimic the effects of GLP-1, a hormone made in the gut.

So while we’re being technical… these drugs are actually peptides. Peptide drugs are made of amino acids and in a way work by supplementing the peptides your body naturally makes on it’s own.

Much like someone can take insulin in the treatment of diabetes, which was one of the first synthetic peptides to be made in a lab.

Like insulin, GLP-1 is something our bodies naturally make. So these types of medications are in a way enhancing processes the body would normally do on it’s own.

What is GLP-1?

GLP-1 is a hormone that gets released in the gut (called an incretin). Incretins are triggered whenever we eat and their job is to aid in digestion and help regulate blood sugar levels.

When GLP-1 gets released it triggers the pancreas to put out insulin, which helps glucose get out of the blood and into the cell, lowering blood sugar levels.

When we end up with lower levels of GLP-1 because of high blood sugar, or a metabolic health condition like type 2 diabetes that make our GLP-1 less effective, we don’t get that insulin release and blood sugar stays high.

So with a GLP-1 agonist, you’re making the body think there’s more GLP-1 than there actually is.

GLP-1:

  • slows down how quickly food leaves the stomach
  • helps you feel full longer
  • lowers stomach acid
  • lowers the level of glucose produced in the liver
  • raises post-meal insulin levels

This is how these medications decrease appetite and control food cravings which leads to lower food consumption overall and weight loss.

Affecting this process is also why these meds are associated with side effects like constipation, nausea, stomach pain, bloating, burping, loss of appetite, among others.

This shows us the rate of gastric emptying – a.k.a. how fast food is leaving the stomach and moving through the digestive tract – has a huge impact on glycemic control.

Semaglutide Risks – My Top Concerns 

Hyperinsulinemia 

Because GLP-1 triggers release of insulin from the pancreas, if someone with already elevated insulin levels were to use these medications their insulin levels could further elevate putting them at risk for hyperinsulinemia.

Insulin’s job is to help usher glucose into the cell where it can be turned into energy, but it’s also a fat storage hormone. So when it’s elevated, it’s signaling the body to store fat.

This is obviously the opposite of the intent with this medication.

Couple that with eating less, and you have a combo that can easily set someone up for muscle loss.

Muscle Loss 

The goal with semaglutide is to lower glycemic levels, reduce appetite toward the goal of weight loss.

Eating less food generally means decreasing protein intake, which is essential for muscle maintenance.

This becomes even more critical as we age.

If you’re not consuming adequate protein, muscle loss will result.

Combine that with hyperinsulinemia and you’re trading muscle for fat – over time shifting body composition to a weaker one that’s more frail and prone to dis-ease.

This is the opposite of what we need to be aiming for as we age.

Using these medications it’s essential to be intentional with protein intake. Ensuring that you’re consuming an adequate amount.

Generally this is 0.8 grams per kilogram of body weight, or 0.36 grams per pound. So for a 125 lb woman that would require at least 45 grams of protein. This requirement increases for adults (especially women) over age 40 to 1-2 grams per kilogram.

Aiming for about 20 grams of protein per meal is a good place to start to ensure sufficiency.

This is a fantastic tip for weight loss all by itself, BTW!

The challenge with GLP-1 agonists is nausea is a common side effect.

You know what you don’t want to eat when you’re nauseated?

Meat.

Crackers, breads, carbs, sound a lot better when you’re tummy’s off, right?

This is the pattern I see a lot of folks falling into and it can really set you up for the opposite of what you want.

Gut dysbiosis 

Semaglutide slows down the speed of what’s moving through the digestive tract causing dysmotility on purpose. When food moves more slowly through the intestines, it means more food for longer for the microbes that live there.

That means microbes can get overfed and out of balance and this can set up for all sorts of dysbiosis in the gut. Dysbiosis in the gut can further drive metabolic dysfunction, and can have wide reaching systemic effects throughout the body affecting the immune system as well as the brain and cognitive function.

Gallbladder disease 

When we talk about slowing things down in the digestive tract, we’re not just talking about food. It’s also slowing down all signaling happening throughout the entire course of digestion.

That includes signaling to release bile from the gallbladder.

The gallbladder concentrates bile that comes from the liver so that when we eat fat, an enzyme gets triggered to stimulate it’s release in order to help digest the fat.

With the slowing down, you can get an incomplete emptying of the gallbladder leaving bile behind.

As bile accumulates in the gallbladder it can contribute to stone formation.

What can really make this whole situation worse is remember – on these meds you’re likely losing weight.

Fat tissue is storage for toxins, so as you lose it, those toxins get freed up.

They end up in the bile, which is how they’ll eventually make their way out of the body. But with the increased toxin load more cholesterol gets added to the bile making it thicker – imagine a free flowing river getting gunked up with mud.

The bile is moving through more slowly, with more toxin debris – a double whammy contributing to gallstone formation and attracting inflammation at the gallbladder that can lead to disease.

With any type of hypomotility – a.k.a. slowing down of movement in the GI tract – it’s only a matter of time until you start to see downstream dysfunction, dysbiosis and disease.

I don’t share these risks with the intent to scare or dissuade you from using them. My goal is to arm you with information  so you can make an informed decision if and how these may be a solution for you.

It takes time for these dynamics to develop.

Breaking the Cycle of Dysfunction

On the flip side using this type of medication as a tool to break the cycle of dysfunction at the GLP-1 level to regulate blood glucose levels in support of weight loss while simultaneously addressing root causes, changing diet, habits, lifestyle over several months, I can absolutely see where these drugs have their place.

Especially for someone with entrenched type 2 diabetes or other metabolic conditions that may be hard to break the cycle without more overt intervention.

Using a medication like this for a period of a few – 3 months or so – while working on diet and lifestyle factors could be a game changer for getting someone out of a hole and on their way to a much healthier life.

What I don’t see helpful and actually quite risky, is starting a medication when it’s not necessary (eg. to drop a quick 5 lbs before a wedding) or with no plan or intent to come off of it.

You have to assume that downstream there will be consequences. And that the likelihood of those consequences only increases with longer and longer term use.

Minimizing Semaglutide Risk

When we know the risks, we can do things to mitigate them.

Here’s what I’d do to support the body if it were me… Plus specific lab markers I’d check and keep and eye on to ensure optimal health and functionality.

Note – below includes some of my go-to products I personally use to support these areas of my own health, as well as links to where you can find and purchase these products online. Some require an account. Once set up with access you can navigate within the distributor’s site to find the product.

Please note these are personal suggestions and the content in this post is for educational purposes only and is not medical advice. Always consult with your primary care provider before starting a new supplement.

Support healthy weight loss and detoxification 

Recommended lab work: B12, folate, B6, homocysteine, total protein, albumin, sodium, potassium, chloride

Support the liver

  • Increase intake of bitter foods – greens, dandelion root, artichoke, citrus
  • Avoid or reduce things that are hard on the liver – toxins, pesticides, alcohol, caffeine

Recommended lab work: AST, ALT, GGT, alkaline phosphatase

Support healthy bile flow, clear bile congestion

Recommended Labwork: AST, ALT, alkaline phosphatase, bilirubin

Support the gut 

  • Eat a variety of plant fibers to support microbiome diversity
  • Keep sugar, processed carbohydrate intake to a minimum
  • Avoid antibiotics unless absolutely necessary
  • Eat probiotic foods (saurkraut, miso, kimchee)

Recommended/Optional Specialty Lab: GI Map or GI Effects

Support Muscle Maintenance 

  • Eat 20 grams of protein at every meal
  • Do weight bearing exercise 3-4x/week
  • Do squats

Conclusions on Semaglutide Risks

Just like any medication, there are Semaglutide risks and benefits. It’s a matter of weighing those two against each other and for your unique circumstances, determining if the benefits outweigh the risks.

The challenge with any new drug is the risks may not be clear yet. Especially long term.

I do think a good case can be made for using these medications in the short term as part of a comprehensive, holistic weight loss approach that encompasses diet and lifestyle changes to make it sustainable.

In many cases I can see where these can be an effective intervention that breaks a cycle keeping someone stuck in hyperglycemia.

And it’s a welcome alternative to the much more invasive bariatric surgeries that were the previous go-to.

The danger I see from a functional perspective on semaglutide risks is related to the downstream effects of hypomotility: dysfunction, dysbiosis, disease – which has already been seen and I’m afraid we’ll only continue to see more of.

I do think many of these risks can be mitigated with attention to those at risk areas (liver, bile, gallbladder, muscle wasting, etc.). And with some intention around supporting these areas while using a medication, there’s possibility for prevention.  At the least supporting these organs and functions can buy someone more time to continue to work on diet and lifestyle toward the goal of getting off the medication.

Support with Semaglutide

I often say, a functional approach and a conventional medicine approach each have its place, its strengths and weaknesses.

What over and over again I see work most beautifully, is when both approaches are used together, simultaneously.

That’s truly what I believe serves most people the best.

When it comes to these medications and avoiding semaglutide risks, I think this especially applies.

If you’re considering using a medication like this for weight loss, or management of a condition like type 2 diabetes, I’d encourage you to pair that with health coaching, ideally from a functional health perspective.

If someone I love was considering this route for themselves, that’s the advice I’d give them.

So I share it with you too.

I’m not a prescribing practitioner, but what I can help with is everything else – supporting your body overall to minimize semaglutide risks and any downside, optimize functionality so you’re getting even more of the benefit of the medication, changing your diet and lifestyle in a sustainable way that will last and serve you for years to come.

Up to this point, it’s been the case that I hear from folks after they’ve used one of these meds and they’re suffering the consequences with nasty side effects they can’t get rid of.

My hope is that will change. That folks will enlist my help earlier on in the process so they can have a better experience, fewer side effects and downstream consequences, a shorter duration of use, and possibly make the intervention unnecessary to begin with.

If you’d like support or just want to learn more about how I can help, best thing to do is schedule some time for a chat here.

Thoughts? Questions? Comments?

I’d love to hear from you on this. What’s your experience been with GLP-1s, semaglutide, Ozempic, etc.?

Share with us in the comments, will you?

Megan Adams Brown

 

 

The content in this email is for educational and informational purposes only and is not medical advice. Always consult with your primary care physician regarding any decision regarding medication use and check with your PCP before starting a new supplement or protocol. 

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