Oh, oh, oh, Ozempic

In last week’s column we spoke about intermittent fasting versus normal diet regimes, and the consensus was that the effects of both seem to be similar and it is really a matter of whatever works best for your metabolism and lifestyle.

A combination, though, of eating small meals, eating at least one salad or fruit smoothie or low-calorie meal per day, and doing some form of intermittent fasting—whether 16 hours fasting to eight hours normal eating, or 14 hours fasting to ten hours normal eating—may be the most effective. Depends on your lifestyle as to what time you arrive from work, whether you are single or married, and the number of children or younger relatives in your household.

But if you are serious about trying to have a more healthy lifestyle, you also have to stop making excuses and make at least some change, even if minor. Try to buy some lettuce every week so that you have to use it before it disintegrates. Have a fixed weekly budget for fruits so there would always be fruits available in the household as a replacement snack. Force the change. Start with a small change, and every three months add something further.

Of course, this all has to be combined with some regular consistent exercise and mindfulness or meditation or spiritual connection. Of course, also, one cannot be trying to lose weight and do binge eating or binge alcohol drinking multiple times a week. It has to be all in moderation.

You cannot be eating a salad a day, be proud of yourself, and combine that with cake and ice cream to counterbalance. You cannot be intermittent fasting, and then interrupt that with beers and cocktails—and then still expect to lose weight and be surprised when it has not happened. It does not work that way. It is all about how many calories you take in, how many you burn out and how fast your metabolism does such.

One thing that has become a factor in this weight-loss angst are the recent medications for type 2 diabetes that have the side effect of weight loss. I am talking about Ozempic and other similar versions. It seems Ozempic (semaglutide) is the original version, given subcutaneously once weekly. So, it is an injectable and not oral.

Mounjaro is also similar, but stronger. Wegovy, also given subcutaneously, is similar to Ozempic, but can be used for patients without diabetes. The tablet form, Rybelsus, can be given orally once daily. A similar oral version is Saxenda (liraglutide).

Ozempic is the most well-known and although Rybelsus is the oral version, Ozempic has remained more popular because it can be given in higher doses and has greater effects. Rybelsus is more of a hassle to take and is less convenient. You need to take it on an empty stomach, 30 minutes before eating, and you have to drink a certain amount of water during that 30 minutes.

All of the versions can cause nausea, abdominal pain, diarrhoea, vomiting and constipation. The side effects are worse if the person has a diet high in greasy, fatty foods or alcohol.

Another side effect is the “Ozempic face”, where those taking Ozempic lose healthy-looking fat from their faces and are left with a saggy, aged appearance. The Ozempic, et al, medications can also cause damage to the pancreas, gall bladder and kidney, and possibly an increased risk of thyroid cancer. Additionally, there can be changes in vision, and allergic reactions with skin rashes.

Ozempic works by mimicking a gut hormone called GLP-1. It seems GLP-1 hormones are produced by the intestines after a meal. GLP-1 stimulates your pancreas to produce more insulin. It then reduces glucagon. Glucagon causes your liver to release glucose.

Thus, the overall effect would be a reduction in the blood glucose level. GLP-1 slows down how fast food leaves your stomach, making you feel full for a longer period. Thus, you may eat less generally. It seems it also directly affects the appetite-control area in your brain so that your brain also thinks you are full for a longer period.

Ozempic and its versions should not be used for persons who are pregnant and breastfeeding, children under 18 years, those with kidney or pancreas issues, those with type 1 diabetes and those with a family history of thyroid cancer.

Should persons who are not diabetic take Ozempic, or one of its versions, for weight loss? Ozempic does cause weight loss but aside from the side effects already listed above, it can cause low blood glucose (which makes sense since it is used for persons with diabetes who have high blood sugar).

Even more significantly, most of the weight lost will be regained once you stop taking the medication—and this could happen within a few months.

Medications like Ozempic are for chronic long-term use, for chronic conditions. If tried for short periods, persons may just go back to square one.

I have never heard of a salad causing pancreatitis and kidney failure. My vote is for you, the non-diabetic, to ignore the hype. My vote is smaller meals, one salad per day, one fruit as a snack per day, mindfulness every day, intermittent fasting and exercise as many times per week.

No weight to regain. No Ozempic face. Just a Trini, looking good, feeling healthy.

—Dr Joanne F Paul is an emergency medicine lecturer with The UWI.

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