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Semaglutide - Is it safe?


Semaglutide (brand name Ozempic, Wegovy, Rybelsus) was originally developed to treat Type 2 Diabetes. Originally released in 2012, this weekly injection is a type of medication known as a GLP-1 Receptor Agonist and it increases your natural production of insulin. By increasing insulin, it decreases the levels of glucose in the bloodstream which decreases fat accumulation in the liver and improves cholesterol.


Over time, such significant health benefits were seen in people using semaglutide that it underwent additional testing for use solely as a weight loss medication, and was first approved for this use in 2017. The FDA studies demonstrated that individuals without diabetes who used semaglutide weekly for 68 weeks lost on average 12.4% body weight. Semaglutide has been found to reduce liver function tests (ALT) and inflammation (hsCRP) by 6-12% and 25-43% respectively in people at risk for nonalcoholic fatty liver disease.


In addition to making huge improvements in blood sugar levels, semaglutide decreases appetite and makes you feel full longer. By decreasing appetite, it helps individuals establish a change in eating patterns and behavior. These lifestyle changes initially occur due to the effects of the medication, but with health coaching and additional support, it is possible to continue these lifestyle changes once the weight has been lost and the medication slowly stopped.


What to know before starting this medication.


There are some conditions which may require additional monitoring or be contraindications to semaglutide therapy. These conditions include:

  • Endocrine tumors (in you or a close relative)

  • Eye disease

  • Gall bladder disease

  • Depression or mental health disorders

  • Personal history of pancreatitis

  • Kidney disease

  • Stomach or intestine problems

  • Suicidal thoughts

  • Thyroid cancer (in you or close family member)

  • Allergy to semaglutide

  • Pregnant or actively trying to get pregnant

  • Breastfeeding


This medication can not be used in individuals with Type 1 diabetes. Type 1 diabetes means your pancreas does not produce insulin, therefore, this medication will simply not work.


Common side effects.


As with all medications, there are side effects that can be experienced with semaglutide. These side effects can be lessened with slow increase in dosing and by monitoring diet and lifestyle. Common side effects include:

  • Diarrhea

  • Loss of appetite

  • Nausea

  • Stomach pain

  • Vomiting

Many of these symptoms can be improved by eating high quality foods including lean meat that is baked or boiled, cooked vegetables, small amounts of fatty vegetables, nuts. It is best to avoid alcohol, fried foods, sweets, baked goods, breads, rice and pasta. Maintaining a daily movement routine and good sleep habits also improve overall health outcomes while on this medication. It is important to maintain muscle mass, so high quality protein is essential, and supplementation with organic whey protein and vitamins may be beneficial.


Concerning side effects … when to call your provider.


There are more concerning side effects from this medication that may require more urgent evaluation. If you experience any of the following issues, it is important to be seen quickly.


  • Allergic reactions: these can include symptoms such as hives, rash, swelling of the face, lips, tongue or throat

  • Sudden visual changes

  • Heart palpitations

  • Severe stomach pain, nausea, vomiting or fever

  • Dehydration: symptoms such as dry mouth, increased thirst, dark or brown urine

  • Kidney injury: look for decreased urine, swelling in hands, ankles, feet

  • Pancreatitis: severe stomach pain that radiates to back, fever, nausea, vomiting

  • Increased suicidal thoughts


It is important to note that the above symptoms are “worst case scenarios” and are rare. Staying in touch with your healthcare provider, increasing your medication slowly and maintaining appropriate nutrient and fluid intake can help you make the most out of this treatment.


It works but is it safe?


When reading the potential “call your doctor” side effects, it can seem as though risk of semaglutide is more than the potential benefit. However, the reality of these side effects and the frequency in which they are observed in the population at large is mild to moderate. The most common symptoms that are seen in real life include the gastrointestinal symptoms of nausea, vomiting and diarrhea. These symptoms are more pronounced during the first 8-12 weeks of therapy and when the dose is increased more rapidly than monthly.


Some recent research has found that there may not be a link between semaglutide and pancreatitis/pancreatic cancer. Additionally, there is a black box warning on semaglutide for possible C-cell thyroid cancer, but these findings were in mouse studies where the mice were given significantly higher doses than humans. At this time, evidence has not been conclusive that semaglutide is indeed linked to increased thyroid cancer in humans with no previous history.


Studies do show that semaglutide may increase the risk of developing stones in the gall bladder. However, it is unclear how this happens and the incidence is about 1.4%. Speaking with your care provider routinely during treatment is an important consideration for maintaining positive outcomes.


Conclusion


Semaglutide benefits include:

  • improves blood sugar

  • promotes weight loss

  • decreases cardiovascular risk

  • decreases cholesterol

  • decreases fatty liver disease

  • decreases inflammation

  • decreases risk of stroke, heart attack

  • reduces excess body fat

In general, this medication is very well tolerated. Our gentle semaglutide program increases medication dosage slowly over 12 weeks allowing the body to make adjustments and decreasing unwanted side effects.


Our program allows individuals to achieve their weight loss goals while slowly making lifestyle adjustments to maintain their weight once medications are stopped. Because we take a full body approach to overall health and well being, our medical guided weight loss solutions are available to our established patients only.


References




https://my-bmi.co.uk/advice-education-history-of-semaglutide/



https://www.frontiersin.org/articles/10.3389/fendo.2021.645563/full


https://www.endocrine.org/news-and-advocacy/news-room/featured-science-from-endo-2021/semaglutide-reduces-excess-body-fat-in-people-with-obesity


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