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- The Miracle Weight Loss Drug
This topic of the podcast/newsletter was a fun blend of science and pop culture. Over the last couple of years, semaglutide and other similar drugs have become perhaps the most widely talked about drugs on the planet. We get a fair amount of questions regarding these drugs so we thought it was a good time to dive in.
Semaglutide is a drug that is known as a GLP-1 agonist. This means it replicates the effect of a hormone called glucagon-like peptide 1. This is a hormone that is released from the gut. It stimulates the release of insulin and it stops the release of glucagon. These actions result in blood glucose going down as well as a reduction in appetite. These drugs were originally created to treat Type 2 Diabetes. However, the resulting weight loss was noticed and this led to studies showing semaglutide as being effective for weight loss without diabetes. This led to the approval of a new drug called Wegovy (which is the same thing as Ozempic, just with different branding and dosing) which has even been approved for kids aged 12 and up.
There is another class of drug known as tirzepatide (the actual drug name is Mounjaro). This is not the same as semiglutide. This drug is actually a co-agonist of two hormones. The first hormone is GLP-1 as mentioned above, but the second is called GIP (glucose-dependent insulinotropic polypeptide). The bottom line with this drug is that it has been shown to be superior to semaglutide in both weight loss and hemoglobin A1C reduction. Studies show that people were starting with an A1C of a little over 8.5% (full fledged diabetic) and within 6 months of being on tirzepatide every person got down below 6.5% (the cutoff for diabetes).
Does the weight stay off? From the studies we have now, it seems that if you stay on the drug, the weight loss remains (at least through 2 years). The general trend is you lose weight quickly in the beginning and it slows as the year goes on. The weight loss seems to plateau at about the end of year one and then holds through year two, as long as you stay on the drug. If you come off the drug, the weight comes back on. Again, the weight appears to come back on quickly initially and then slowly creep back on over time. Some people (usually the ones who only lost about 5% of their body weight) were actually heavier a year later after stopping the drug.
The side effects are basically all the common GI issues: nausea, vomiting, diarrhea, abdominal pain, and headaches. It does seem like a substantial number of people do experience these side effects. The other main issue we discussed on the podcast was the larger than normal loss of lean body mass. Typically when someone is dieting and losing weight, the average is you will lose 70% body fat and 30% lean body mass. If you strength train and get in enough protein, you may be able to shift this to more like 80-20 or possibly even 90-10. However, there is a study showing people on semaglutide lost more like 60% body fat and 40% lean mass. This is probably enough of a signal that people may want to at least consider getting a body scan to try and track what kind of weight is coming off. Losing too much lean body mass is never a good thing.
We end the podcast discussing the resulting shortage of Ozempic and Wegovy and the rise of the sales of off-label Ozempic being sold at med spas and other businesses across the country. Essentially compounding pharmacies are cooking up their own semaglutide compound and selling it. We discuss an article that basically just wonders where they are getting their semaglutide and how they are making it as it is a very complex molecule. The article also argues that unless you are getting brand name Ozempic or Wegovy, there really is no way to know what you are actually getting. Therefore, there is a bit of a “buyer beware” issue to the off-label semaglutide market.
Simplified Takeaways…
Semaglutide (Ozempic and Wegovy) and Tirzepatide (Mounjaro) work by replicating the effects of hormones released from the gut which decreases blood sugar and drives down your appetite.
Both are effective at reducing body weight and hemoglobin A1C.
Tirzepatide (Mounjaro) has been shown to be superior in both categories.
The side effects are very real and should be considered. One such side effect is a possible higher than normal loss of lean body mass.
The weight loss seems to be sustained as long as you stay on the drug. If you come off the drug, the weight will come back on.
Further Reading…
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