Q&A: Zepbound vs. Ozempic; lung nodules; Hashimoto's hypothyroidism; & reintroducing alcohol after a break

Mar 28, 2025

ICYMI 👉

I’m taking Friday 3/28 off, but I’ll resume our weekly LIVE Q&As on Friday 4/4 at 3 pm ET. I hope you are enjoying them like I am!

Paid subscribers can submit their questions for me to answer live, right here.

In this week’s reader-submitted Q&A, we’re tackling these questions:

What is the difference between Zepbound and Ozempic?
Should I be concerned about a lung nodule?
Why do I still feel exhausted even though I’m taking a thyroid medication?
Can I safely reintroduce alcohol after not drinking it for a while?

📣 Send me your questions for future Q&As! Click here to write me. ✍️

red apple beside clear glass bottle — Photo by Diana Polekhina on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: ZEPBOUND VS. OZEMPIC

I would like to know the effects of Zepbound. You always talk about Ozempic, that I know it works. What about the difference between those two?
-MC

Great question, MC. You’re right—Ozempic tends to get the most airtime, but Zepbound is another powerful tool in the same class of medications and is worth understanding, especially as these drugs become more widely used for both diabetes, weight management, metabolic issues and cardiovascular health.

Ozempic is the brand name for semaglutide, a GLP-1 receptor agonist. It mimics a naturally occurring hormone that helps regulate blood sugar, slow digestion, and signal fullness to the brain. Originally approved for type 2 diabetes, it’s also prescribed under the name Wegovy for weight loss. For many people, it leads to significant reductions in appetite, improved metabolic markers, and substantial weight loss.

Zepbound, on the other hand, is the brand name for tirzepatide. It’s in the same family as Ozempic but has a dual mechanism—it targets both the GLP-1 receptor and a second hormone receptor called GIP (glucose-dependent insulinotropic polypeptide). The idea is that by activating both pathways, Zepbound may have a more potent effect on appetite regulation, blood sugar control, and weight loss. Early data suggest that Zepbound can lead to even greater weight loss than semaglutide in some people.

That said, both drugs can have side effects—most commonly nausea, constipation, or diarrhea—and they need to be taken consistently over the long term to maintain benefits. They’re also not magic bullets; they work best when combined with lifestyle changes like mindful eating, regular movement, and emotional support.

The right choice depends on your health goals, history, and how your body responds. Some people do better on one than the other, and it often comes down to tolerability, access, and personal preference. It’s always a good idea to discuss options with your doctor and make sure the bigger picture of your health—not just the number on the scale—is guiding the plan.

(I spoke about healthy weight loss on my live “show” here.)

I recently had a full-body MRI as part of an executive physical, and it found a small lung nodule. My doctor says it’s probably nothing and just wants to re-scan in six months, but I’m anxious about waiting. Should I push for more testing or trust the watch-and-wait approach?
–Mark

Hi Mark,

Finding a small lung nodule on an MRI or CT scan is understandably nerve-wracking, but in most cases, these nodules are harmless and benign. They often caused by past infections or scar tissue. The reason your doctor is recommending a follow-up scan in six months is that most small nodules don’t require immediate action unless they show concerning features, such as rapid growth or irregular shape.

The watch-and-wait approach is the standard recommendation for small nodules (less than 6mm in low-risk individuals) because most do not turn into anything serious. The goal of the follow-up scan is to check for any changes over time. If the nodule remains the same size or disappears, no further action is needed. If it grows or develops suspicious characteristics, then additional testing may be considered.

Your level of risk also matters. If you have a history of smoking, significant secondhand smoke exposure, or a strong family history of lung cancer, you might want to discuss whether additional imaging sooner—such as a low-dose CT scan or PET scan—would be reasonable. If you have no risk factors, then your doctor’s approach is consistent with current guidelines.

While waiting can feel stressful, it’s important to remember that most lung nodules do not turn into cancer. If your anxiety about it is affecting your well-being, be sure to ask your doctor for more information about the specific characteristics of the nodule and why they believe waiting is appropriate. That might help you feel more reassured about the plan. If you’re still uneasy, getting a second opinion is always an option!

I hope that helps.

QUESTION #3: HASHIMOTO’S HYPOTHYROIDISM

I was diagnosed with Hashimoto’s last year. I’m on thyroid meds - generic Synthroid - but I still feel exhausted and bloated too. Am I missing something, or is this just what life looks like now?
-Alyssa

Alyssa,

It’s common to feel frustrated when you’re taking thyroid medication for Hashimoto’s and still don’t feel like yourself. While thyroid hormone replacement (like levothyroxine) is essential for managing Hashimoto’s, many people continue to experience fatigue and other symptoms even when their lab numbers look “normal.”

First, it’s worth checking whether your thyroid levels—particularly TSH and free T4—are truly optimized, not just within the standard reference range. Some people feel better when their TSH is on the lower end of normal. In some cases, adding or switching to a combination therapy that includes T3 (the active form of thyroid hormone) can make a difference, though this approach isn’t right for everyone and should be guided by a knowledgeable provider.

Beyond the thyroid itself, other factors could be contributing to your fatigue. Hashimoto’s is an autoimmune condition, and people with one autoimmune disease are more likely to have others. It may be worth checking for issues like low ferritin, vitamin D deficiency, B12 deficiency, or adrenal dysfunction. Sleep quality, stress levels, and gut health can also impact how you feel, even if your thyroid is well-managed on paper.

If you’re doing “everything right” and still feel off, it’s not all in your head—and you deserve a provider who takes your symptoms seriously. Sometimes it takes trial and error to find the right medication dose or uncover additional contributors to fatigue. Life with well-managed Hashimoto’s shouldn’t leave you feeling perpetually exhausted. With a thoughtful, whole-body approach, most people are able to feel well again. I hope you get the medical attention you need!

QUESTION #4: REINTRODUCING ALCOHOL AFTER A BREAK

I stopped drinking for six weeks and felt incredible—better sleep, clearer skin, less anxiety. But I’m struggling to reintroduce alcohol in moderation without sliding back. How do I navigate the middle ground?
-Rob

Rob,

This is such a common and honest struggle—many people find that taking a break from alcohol brings unexpected clarity, both physically and emotionally. The challenge often lies in reintroducing it without slipping back into old habits that don’t serve you. Navigating that middle ground takes awareness, intention, and a bit of trial and error.

First, it helps to reflect on what you liked about not drinking. Was it better sleep? Less anxiety? Feeling more in control? Keeping those benefits front and center can guide your decisions about when, why, and how much you want to drink. It’s not about rigid rules, but about protecting the well-being you worked hard to reclaim.

Try setting clear intentions around alcohol. For example: “I’ll enjoy a glass of wine on the weekend with friends, but not use it to unwind after work.” Or “If I don’t feel great the next day, I’ll take that as feedback.” Staying connected to how alcohol makes you feel—not just in the moment, but the next day—can help you stay grounded in your choices.

It also helps to experiment with alternatives: non-alcoholic cocktails, sparkling waters, or just saying no without explanation. Having a plan going into social situations makes it easier to stick to your intentions.

If moderation continues to feel murky or like a slippery slope, it’s okay to consider whether life is actually better without alcohol. There’s no one-size-fits-all answer, and choosing not to drink (or to drink less) doesn’t have to be framed as deprivation—it can be a powerful act of self-care.

The goal isn’t perfection; it’s staying aligned with what helps you feel your best. And that clarity is something to celebrate.