I was given Ozempic and it truly does work! I noticed also that it helped me cut back on my wine consumption at night! However, after several days, the diarrhea started and it did nothing but get worse. It got to the point I was in the bathroom every five minutes and Imodium AD didn’t make a dent. I sadly had to stop it as I couldn’t go anywhere unless I wore pads. Also when I had to go off it, my hunger skyrocketed. It doesn’t work for everyone.
That is so true, Helen. There are some tools to help limit that side effect - and of course you could discuss that with your doctor if you haven't already :)
But as is true with any medical intervention, Ozempic only makes sense to employ if the total benefits > total harms.
Thanks for the positive yet balanced perspective on Ozempic. As usual, you bring lots of clarity by looking at weight-loss drugs in the broader context of health and wellness.
One concern I'd like to raise is the effect on GLP medications in tandem with SSRIs. I've been using Mounjaro with great success, however, noticing on the higher doses, that my SSRI feels almost ineffective with a return of panic attacks and depression. I've worked closely with my psychiatrist and prescribing obesity medicine doctor, and while unusual, there are reports coming in from patients about delayed effects of mental health medication. Since it does delay gastric emptying and reduce effectiveness of birth control, I'm hoping more attention will be paid to this concern in the future. I'm still using GLP medications but with a different perspective and strategy (scheduled intervals OFF the medication) of making sure while I reach my physical health goals, that my mental health stays on track as well :)
Great point, Alyssa. I am seeing this too. Just as our body and mind are in constant communication, so are our neurotransmitters (eg serotonin and dopamine) — and the meds that help regulate them. All the best for ongoing management of these important issues ❤️
Thank you for this great perspective. I’m trying to figure out how to articulate one small thing that’s nagging me about it, and I think it’s that it’s really hard to tease out cause and effect in a complex topic like weight loss.
I’m going to theorize (wildly - with no evidence but my own anecdotal experience) that being overweight is a symptom of a metabolic disorder that causes the body to have difficulty converting fat to energy. If a healthy person eats a meal, the body uses it for their immediate needs, then uses insulin to store the rest as fat which is then accessed throughout the day to supply constant energy. When the body is unable to access that stored energy, instead it gets hungry again, and then also stores any excess as fat, resulting in accumulation of fat over time, frequent hunger, cravings for carbs, and lack of energy due to the body being able to access its energy stores. Since people know they should eat less and exercise more to lose weight, but their body is telling them to eat more, this puts them into a constant battle with their biology, resulting in the mental health issues discussed in the article. The mental health issues don’t cause the weight issues, trying to restrict food causes the mental health issues.
As soon as the metabolic disorder is corrected, the person stops feeling an insatiable urge to eat, stops preferring carbs, stops having to focus on controlling their eating, stops beating themselves up. In other words, they experience eating the way people who don’t have metabolic disorders do, which is that food and weight are not preoccupations.
My hypothesis is that these drugs don’t directly affect the patient’s mental state, they operate strictly on the patient’s metabolism. It is the patient’s metabolic disorder that was causing the mental state.
The big question in my mind is what exactly is the nature of this metabolic disorder and what causes it? Clearly this class of drugs treats it, but it seems that the mechanism isn’t quite fully understood. To me the magic of the drug is that it means we are one step closer to figuring it out.
I say this as a person who, earlier in my life was effortlessly thin (meaning it wasn’t a focus - I ate mostly healthfully but didn’t count calories or deny myself an occasional treat, and I played sport for fun and health, not to lose weight) and have now crossed the line into obese (thanks, menopause! 😒). I’m the same person. I don’t think my willpower has changed. If I give up and don’t fight my hunger I’m not mental about it, it’s only when I try to lose weight that I become preoccupied and miserable. Clearly my body is different, and my hunger and energy levels are no longer accurate measures of how much food my body needs.
It feels like there's still a missing piece to this puzzle, but I think the success of this drug is a really interesting clue to what it might be.
I think we know already exactly how this drug works (see my description of mechanisms above) and why it helps people ...
Of course it is possible - as has always been true - that mental health can be improved in many ways at the same time - which, in the case of GLP1 agonist can stem from the combination of the increased sense agency, feelings of satiety, less food-related ruminations, and myriad other physical & social/emotional factors the accompany the improvement in one's health
In other words, I don't think there's much mystery here. :)
Made from the toxin of the Gila Monster lizard Ozempic paralysis your stomach, has thousands of reported serious adverse events and causes Thyroid cancer. Read the leaflet. Thyroid cancer is on there.
I'll put this under your post instead of main column:
Patients don't just lose fat. They lose 45% of their muscle. Which means strength, which is especially concerning for men.
But hey, if I wore, say, a 100lb lead suit 24/7, I suspect I'd gain 45% more strength over time. Heck, if Overweight & obese men have a tremendous, scary amount of burst strength, particularly when concentrated in one point. The younger ones even have some endurance to go along with it.
I've never seen a study on how much strength big men lose over time after a lot of natural weight loss from dieting. I imagine "If you don't use it, you'll lose it" applies the same to not carrying around extra weight as it does stopping any exercise program.
-My concern about GLP-1 is for others. (I've maintained my BMI between 23-25 for 43 years, my entire adult life.). But I've been harmed by several prescription drugs over the years, and stopped taking a 3 after a few doses that were later recalled because they killed people. The side effects of GLP-1 drugs are very serious, akin to that of many poisons. The horror stories are many, and the number of lawsuits are growing.
Originally, Ozempic was not designed to be an anti-obesity drug. Instead, when semaglutide was developed, it was intended as a diabetes therapy. IMO, it's use should have never expanded. Desperate people are easily taken advantage of, and overweight & obese people who've failed a diets and are suffering related health issues and and early grave are often desperate and looking for a quick fix. Desperation along with the fact that the drug alters their brain will affect their perception of side effects, possibly enough that they'll ignore the more serious, life threatening side effects, or rather, consequences, at their own peril, even not mentioning them to their own doctor for fear of losing access to the only thing they've ever tried that's reduced their weight.
I took a compounded version of semaglutide because I didn’t qualify at the time for Wegovy. I lost about 40lbs and felt great—all the highlights you articulated. I struggled with constipation a bit but managed that with teas or MiraLax.
Unfortunately what wasn’t included in my package was access to a nutritionist who could help me tweak my diet (which wasn’t awful but too carb heavy) or a trainer to create an exercise program I could deal with. I gained about 15 pounds back. Went back to the same clinic, but this time had abdominal cramps, immediate constipation, and generally felt bad. I stopped.
I’m back to where I was: frustrated with my weight, still battling carb cravings, and not happy with my appearance. I don’t exercise per se; I walk the dogs or take occasional walks. I have osteopenia so need to do weight-bearing exercise.
Thank you for the great article, and explaining how the GLP-1’s work.
I have been doing strength training using exercise bands for a couple of years. There is information online about how it all works. This should work as well as lifting weights. Also, I encourage you to give yourself credit for walking your dogs. I’m sure they appreciate you and really, any amount of moving our bodies is good. I am sorry you’ve struggled with GI symptoms, specifically constipation, to the point that you’ve found that you’ve had to discontinue taking semaglutide.
Great piece! Coming from the perspective of someone who has struggled with anorexia for a long time, I clearly know GLP-1s are not meant for me, BUT I do wish there was a way to have a drug like this (without the weight loss) for people with eating disorders because “food noise” with eating disorders is all too common. What I wouldn’t give to not think about food every day and all day, which is what it sounds like these drugs do. While recovery has helped me eliminate some of that noise, it’s been my constant friend for the past 25 years. Maybe someday they can figure out a use case for eating disorders (I realize this sounds strange, but it does fascinate me!)
I hear you - and I think that Ozempic's existence has furthered our understanding of disordered eating in such a way that I suspect something like it - but without the weight loss element - will come along some day. Here's hoping!
Thank you so much for this article and discussing the magic of this medication for the mind, body and soul. I have had Type 1 Diabetes for 27 years. I took Symlin, Victoza and now Ozempic. All three helped with reducing insulin requirements, satiation and stopping feelings of extreme hunger both from hypoglycemia and elevated blood sugar levels. The Type 1 autoimmune system kills beta cells in the pancreas that produce insulin. But, the autoimmune system also kills at least 4 other hormones that regulate the metabolism as it pertains to food absorption, insulin sensitivity, etc. These drugs have been an integral part of my ability to keep my A1Cs below 7 (for 27 years) and at 6.3 since taking Ozempic. Currently, Ozempic is not yet FDA approved for treatment of Type 1 diabetes.
I would love to hear your perspective on if these drugs will eventually be approved or more widely recommended for their other health benefits? I’ve been reading and hearing a lot ( Dr. Mark Hyman recently had a podcast on this) about patients reduction in brain fog, arthritis and PCOS symptoms while taking GLP1. I’m interested in the research and ( if there is any) on GLP1 as a preventive for inflammatory disease and specifically Alzheimers as my mother has early onset. Do you know much about this?
I think we need a lot more data to begin recommending the GLP1 meds for people with other, "metabolic-adjacent" problems.. however we do know that there is a relationship btw obesity and arthritis, obesity and PCOS.. so to the extent that GLP1s help w obesity and its associated hormonal imbalances it makes intuitive sense that arthritis (aka wear and tear on the skeleton) and PCOS (hormonal imbalance) would improve as well. But intuition does not also match data.. so more studies need to be done.. and are already happening
To echo Peggy, this is a magnificent piece and the first I've seen to truly capture the unique benefits of these drugs. As someone who was hospitalized twice for ED as a teen but who also carried and birthed 3 babies and then hit perimenopause, I had struggled for decades doing everything I could to maintain a healthy body weight but still watched in misery as it continued to go up and my health issues associated with inflammation and body weight increased in kind. I obsessed over calories, over eating healthily but not depriving myself, constantly thinking about wanting to enjoy simple pleasures like birthday cake with my family but also loathing myself for not being able to lose more than a pound or two that was quickly regained no matter how hard I tried. Wegovy quieted the chatter and removed the rumination. I continued to do exactly what I'd already been doing (lots of fruits and veg and cooking at home, whole grains, etc, regular exercise) but I never had to think about what I would eat and how much I would eat and if I would regret it--I just eat when I am hungry and I stop when I'm full. I don't obsess over whether or not I "deserve" a food, I just can enjoy it with my family. I lost 35lb, 25% of my body weight. My migraines and arthritis are less severe and frequent and I just feel better in general. When I've had to go stretches without the meds because of drug shortages I have found that my perspective on eating, in absence of the drug, has been transformed, and my satiety awareness has returned. The narrative that these drugs are for lazy people who "don't want to do the work" is so toxic and formed from the same society that bombards people with diet culture and consumer culture and condemns individuals who were raised with unhealthy coping mechanisms for not having better "willpower." I am happy for anyone who is able gain relief and help from these meds, and I hope that there are further applications for those who struggle with addiction issues beyond food. Thank you again for sharing your thoughts about these medications, I appreciate you articulating the often unspoken benefit of emotional and behavioral wellness that these drugs provide.
Lisa, thank you so very much for articulating your experience so beautifully. I couldn’t agree w you more that the “laziness” narrative is so appallingly inaccurate that it’s thrilling to witness patients like yourself finally experience some emotional relief from Ozempic. I also appreciate the comment on how your perspective on eating has been transformed, even when you aren’t actively taking the medication. The psychological benefits of insight and self-compassion don’t disappear when the drug does. Thank you for that reminder to others!
Thank you for this clear explanation. I try to explain these things to friends and acquaintances, but your technical expertise is more convincing. I have long known that my weight was a result of genetics over "willpower", but our culture (and the very powerful diet cartels and pharmaceutical companies) have done a wonderful job of brainwashing. I do appreciate the "agency" that Ozempic has given me, although it was hiding there under the weight of my weight, if you will.
I was given Ozempic and it truly does work! I noticed also that it helped me cut back on my wine consumption at night! However, after several days, the diarrhea started and it did nothing but get worse. It got to the point I was in the bathroom every five minutes and Imodium AD didn’t make a dent. I sadly had to stop it as I couldn’t go anywhere unless I wore pads. Also when I had to go off it, my hunger skyrocketed. It doesn’t work for everyone.
That is so true, Helen. There are some tools to help limit that side effect - and of course you could discuss that with your doctor if you haven't already :)
But as is true with any medical intervention, Ozempic only makes sense to employ if the total benefits > total harms.
Thanks for the positive yet balanced perspective on Ozempic. As usual, you bring lots of clarity by looking at weight-loss drugs in the broader context of health and wellness.
Thanks, Shmuel!
One concern I'd like to raise is the effect on GLP medications in tandem with SSRIs. I've been using Mounjaro with great success, however, noticing on the higher doses, that my SSRI feels almost ineffective with a return of panic attacks and depression. I've worked closely with my psychiatrist and prescribing obesity medicine doctor, and while unusual, there are reports coming in from patients about delayed effects of mental health medication. Since it does delay gastric emptying and reduce effectiveness of birth control, I'm hoping more attention will be paid to this concern in the future. I'm still using GLP medications but with a different perspective and strategy (scheduled intervals OFF the medication) of making sure while I reach my physical health goals, that my mental health stays on track as well :)
Great point, Alyssa. I am seeing this too. Just as our body and mind are in constant communication, so are our neurotransmitters (eg serotonin and dopamine) — and the meds that help regulate them. All the best for ongoing management of these important issues ❤️
Magnificent piece, Lucy!!! So helpful and thoughtfully presented. Magic, indeed, or maybe just the future if we can open our minds to it!
Thanks, Peggy. I agree- Maintaining an open mind is so important for health!
Thank you for this great perspective. I’m trying to figure out how to articulate one small thing that’s nagging me about it, and I think it’s that it’s really hard to tease out cause and effect in a complex topic like weight loss.
I’m going to theorize (wildly - with no evidence but my own anecdotal experience) that being overweight is a symptom of a metabolic disorder that causes the body to have difficulty converting fat to energy. If a healthy person eats a meal, the body uses it for their immediate needs, then uses insulin to store the rest as fat which is then accessed throughout the day to supply constant energy. When the body is unable to access that stored energy, instead it gets hungry again, and then also stores any excess as fat, resulting in accumulation of fat over time, frequent hunger, cravings for carbs, and lack of energy due to the body being able to access its energy stores. Since people know they should eat less and exercise more to lose weight, but their body is telling them to eat more, this puts them into a constant battle with their biology, resulting in the mental health issues discussed in the article. The mental health issues don’t cause the weight issues, trying to restrict food causes the mental health issues.
As soon as the metabolic disorder is corrected, the person stops feeling an insatiable urge to eat, stops preferring carbs, stops having to focus on controlling their eating, stops beating themselves up. In other words, they experience eating the way people who don’t have metabolic disorders do, which is that food and weight are not preoccupations.
My hypothesis is that these drugs don’t directly affect the patient’s mental state, they operate strictly on the patient’s metabolism. It is the patient’s metabolic disorder that was causing the mental state.
The big question in my mind is what exactly is the nature of this metabolic disorder and what causes it? Clearly this class of drugs treats it, but it seems that the mechanism isn’t quite fully understood. To me the magic of the drug is that it means we are one step closer to figuring it out.
I say this as a person who, earlier in my life was effortlessly thin (meaning it wasn’t a focus - I ate mostly healthfully but didn’t count calories or deny myself an occasional treat, and I played sport for fun and health, not to lose weight) and have now crossed the line into obese (thanks, menopause! 😒). I’m the same person. I don’t think my willpower has changed. If I give up and don’t fight my hunger I’m not mental about it, it’s only when I try to lose weight that I become preoccupied and miserable. Clearly my body is different, and my hunger and energy levels are no longer accurate measures of how much food my body needs.
It feels like there's still a missing piece to this puzzle, but I think the success of this drug is a really interesting clue to what it might be.
I think we know already exactly how this drug works (see my description of mechanisms above) and why it helps people ...
Of course it is possible - as has always been true - that mental health can be improved in many ways at the same time - which, in the case of GLP1 agonist can stem from the combination of the increased sense agency, feelings of satiety, less food-related ruminations, and myriad other physical & social/emotional factors the accompany the improvement in one's health
In other words, I don't think there's much mystery here. :)
Made from the toxin of the Gila Monster lizard Ozempic paralysis your stomach, has thousands of reported serious adverse events and causes Thyroid cancer. Read the leaflet. Thyroid cancer is on there.
More details from the brilliant Geoff Pain here;
https://geoffpain.substack.com/p/ozempic-semaglutide-deaths-endotoxin?
:)
I'll put this under your post instead of main column:
Patients don't just lose fat. They lose 45% of their muscle. Which means strength, which is especially concerning for men.
But hey, if I wore, say, a 100lb lead suit 24/7, I suspect I'd gain 45% more strength over time. Heck, if Overweight & obese men have a tremendous, scary amount of burst strength, particularly when concentrated in one point. The younger ones even have some endurance to go along with it.
I've never seen a study on how much strength big men lose over time after a lot of natural weight loss from dieting. I imagine "If you don't use it, you'll lose it" applies the same to not carrying around extra weight as it does stopping any exercise program.
-My concern about GLP-1 is for others. (I've maintained my BMI between 23-25 for 43 years, my entire adult life.). But I've been harmed by several prescription drugs over the years, and stopped taking a 3 after a few doses that were later recalled because they killed people. The side effects of GLP-1 drugs are very serious, akin to that of many poisons. The horror stories are many, and the number of lawsuits are growing.
Originally, Ozempic was not designed to be an anti-obesity drug. Instead, when semaglutide was developed, it was intended as a diabetes therapy. IMO, it's use should have never expanded. Desperate people are easily taken advantage of, and overweight & obese people who've failed a diets and are suffering related health issues and and early grave are often desperate and looking for a quick fix. Desperation along with the fact that the drug alters their brain will affect their perception of side effects, possibly enough that they'll ignore the more serious, life threatening side effects, or rather, consequences, at their own peril, even not mentioning them to their own doctor for fear of losing access to the only thing they've ever tried that's reduced their weight.
I took a compounded version of semaglutide because I didn’t qualify at the time for Wegovy. I lost about 40lbs and felt great—all the highlights you articulated. I struggled with constipation a bit but managed that with teas or MiraLax.
Unfortunately what wasn’t included in my package was access to a nutritionist who could help me tweak my diet (which wasn’t awful but too carb heavy) or a trainer to create an exercise program I could deal with. I gained about 15 pounds back. Went back to the same clinic, but this time had abdominal cramps, immediate constipation, and generally felt bad. I stopped.
I’m back to where I was: frustrated with my weight, still battling carb cravings, and not happy with my appearance. I don’t exercise per se; I walk the dogs or take occasional walks. I have osteopenia so need to do weight-bearing exercise.
Thank you for the great article, and explaining how the GLP-1’s work.
I have been doing strength training using exercise bands for a couple of years. There is information online about how it all works. This should work as well as lifting weights. Also, I encourage you to give yourself credit for walking your dogs. I’m sure they appreciate you and really, any amount of moving our bodies is good. I am sorry you’ve struggled with GI symptoms, specifically constipation, to the point that you’ve found that you’ve had to discontinue taking semaglutide.
Great piece! Coming from the perspective of someone who has struggled with anorexia for a long time, I clearly know GLP-1s are not meant for me, BUT I do wish there was a way to have a drug like this (without the weight loss) for people with eating disorders because “food noise” with eating disorders is all too common. What I wouldn’t give to not think about food every day and all day, which is what it sounds like these drugs do. While recovery has helped me eliminate some of that noise, it’s been my constant friend for the past 25 years. Maybe someday they can figure out a use case for eating disorders (I realize this sounds strange, but it does fascinate me!)
I hear you - and I think that Ozempic's existence has furthered our understanding of disordered eating in such a way that I suspect something like it - but without the weight loss element - will come along some day. Here's hoping!
Very insightful and educational article. I wish more physicians researched obesity as you have.
Thank you so much for this article and discussing the magic of this medication for the mind, body and soul. I have had Type 1 Diabetes for 27 years. I took Symlin, Victoza and now Ozempic. All three helped with reducing insulin requirements, satiation and stopping feelings of extreme hunger both from hypoglycemia and elevated blood sugar levels. The Type 1 autoimmune system kills beta cells in the pancreas that produce insulin. But, the autoimmune system also kills at least 4 other hormones that regulate the metabolism as it pertains to food absorption, insulin sensitivity, etc. These drugs have been an integral part of my ability to keep my A1Cs below 7 (for 27 years) and at 6.3 since taking Ozempic. Currently, Ozempic is not yet FDA approved for treatment of Type 1 diabetes.
I would love to hear your perspective on if these drugs will eventually be approved or more widely recommended for their other health benefits? I’ve been reading and hearing a lot ( Dr. Mark Hyman recently had a podcast on this) about patients reduction in brain fog, arthritis and PCOS symptoms while taking GLP1. I’m interested in the research and ( if there is any) on GLP1 as a preventive for inflammatory disease and specifically Alzheimers as my mother has early onset. Do you know much about this?
Thank you!
I think we need a lot more data to begin recommending the GLP1 meds for people with other, "metabolic-adjacent" problems.. however we do know that there is a relationship btw obesity and arthritis, obesity and PCOS.. so to the extent that GLP1s help w obesity and its associated hormonal imbalances it makes intuitive sense that arthritis (aka wear and tear on the skeleton) and PCOS (hormonal imbalance) would improve as well. But intuition does not also match data.. so more studies need to be done.. and are already happening
“… ability to reduce the risk of diabetes, stroke, heart disease and dementia …” I can think of no possible way this can be proven fact.
okay then! :)
Thank you, appreciate the info!
Once again, the Marvelour McBride has put out all the puzzle pieces and combined them into a readable, comprehensible, p[icture of holistic healh
🙏
To echo Peggy, this is a magnificent piece and the first I've seen to truly capture the unique benefits of these drugs. As someone who was hospitalized twice for ED as a teen but who also carried and birthed 3 babies and then hit perimenopause, I had struggled for decades doing everything I could to maintain a healthy body weight but still watched in misery as it continued to go up and my health issues associated with inflammation and body weight increased in kind. I obsessed over calories, over eating healthily but not depriving myself, constantly thinking about wanting to enjoy simple pleasures like birthday cake with my family but also loathing myself for not being able to lose more than a pound or two that was quickly regained no matter how hard I tried. Wegovy quieted the chatter and removed the rumination. I continued to do exactly what I'd already been doing (lots of fruits and veg and cooking at home, whole grains, etc, regular exercise) but I never had to think about what I would eat and how much I would eat and if I would regret it--I just eat when I am hungry and I stop when I'm full. I don't obsess over whether or not I "deserve" a food, I just can enjoy it with my family. I lost 35lb, 25% of my body weight. My migraines and arthritis are less severe and frequent and I just feel better in general. When I've had to go stretches without the meds because of drug shortages I have found that my perspective on eating, in absence of the drug, has been transformed, and my satiety awareness has returned. The narrative that these drugs are for lazy people who "don't want to do the work" is so toxic and formed from the same society that bombards people with diet culture and consumer culture and condemns individuals who were raised with unhealthy coping mechanisms for not having better "willpower." I am happy for anyone who is able gain relief and help from these meds, and I hope that there are further applications for those who struggle with addiction issues beyond food. Thank you again for sharing your thoughts about these medications, I appreciate you articulating the often unspoken benefit of emotional and behavioral wellness that these drugs provide.
Lisa, thank you so very much for articulating your experience so beautifully. I couldn’t agree w you more that the “laziness” narrative is so appallingly inaccurate that it’s thrilling to witness patients like yourself finally experience some emotional relief from Ozempic. I also appreciate the comment on how your perspective on eating has been transformed, even when you aren’t actively taking the medication. The psychological benefits of insight and self-compassion don’t disappear when the drug does. Thank you for that reminder to others!
I know of several people, who are Ozempic. Thank you for clarifying everything there is to know about the drug.
I’m so glad that I receive your newsletter. I find it so informative.
Annie M’s parents are friends of ours. Her mom suggested I check out your website!
So glad I did!!
Thank you for this clear explanation. I try to explain these things to friends and acquaintances, but your technical expertise is more convincing. I have long known that my weight was a result of genetics over "willpower", but our culture (and the very powerful diet cartels and pharmaceutical companies) have done a wonderful job of brainwashing. I do appreciate the "agency" that Ozempic has given me, although it was hiding there under the weight of my weight, if you will.
Thank you for this. I agree with everything you said. Agency is so important for health.. glad you have been able to find more of it!