04/18/2024
Did you know the trending diabetes medications, GLP-1 agonists, which are also used for weight loss, can have detrimental side effects? Examples of GLP-1 agonists include semaglutide (Brand name Ozempic, Wegovy) liraglutide (Victoza, , Saxenda), tirzepatide (Mounjaro), dulaglutide (Truliicty), and exenatide (Byetta).
GLP-1 agonists may lead to lean muscle loss. In a 2020 randomized, double-blind trial, individuals with diabetes mellitus taking once-weekly semaglutide injections lost an average of only 11 lbs in one year, of which 40% was lean muscle mass. The researchers noted that despite the significant amount of lean muscle mass loss, the overall proportion of lean muscle mass relative to other tissue increased. (McCrimmon et al., 2020) A 2021 randomized, double-blind, placebo-controlled trial involving individuals with a body mass index ≥ 30 also found similar results. (Wilding et al., 2021).
In other words, a GLP-1 agonist may help you lose 11 lbs, of which only 6 lbs is fat and 4 lbs is muscle. This means that in exchange for a small amount of undesirable fat loss, a loss of desirable muscle that increases your metabolism will also occur. With aging, loss of muscle mass is associated with osteoporosis, falls, and fractures, so this adverse effect is not insignificant. This is worth taking into consideration especially with the cost of the medication, and the amount of time required to achieve the small amount of average weight loss.
Although body composition improved overall, semaglutide may not be appropriate for all patients looking to lose weight (e.g., individuals with sarcopenic obesity). Efforts should be made to reduce the risk of lean muscle mass loss as much as possible.
Other undesirable side effects include triggering the immune system to form antibodies against the medication, which means your body rejects the medication. How common is this? The incidence of antibody formation was up to nearly 70% of patients with some GLP-1 agonists. We do not understand this well at this time, and what the long term implications are.
Pancreatitis is another common side effect which may require hospitalization. In one study, the risk of developing pancreatitis was 32 times higher for patients taking a GLP-1 medication compared to patients who did not. The risk of pancreatic cancer increased by 1.7 in one study, which means you are almost twice as likely to get pancreatic cancer with GLP-1 agonists than if you did not take the medication.
Lastly, there is ¨Ozempic face¨, a side effect referring to significant facial fat pad loss in the head, which includes sunken eyes, wrinkles on the face, a hollowed look, and changes in the size of lips and cheeks. This unsightly side effect may be due to a faster pace of weight loss in the face compared to the rest of the body, and may require plastic surgery for aesthetic enhancement.
However, the most benign and common side effect was nausea, which occurs in about 50% of patients. It may be no wonder you would lose weight!
It´s good to know this and understand that the decision to begin a GLP-1 agonist requires a personalized discussion with your physician that should include both the benefits in addition to risks.
Dr. Long was asked recently what she thought of these medications. While they can be useful in the treatment of obesity and diabetes, in her real life experience the weight loss has not been significant and does not justify the cost. Typically when one is dealing with weight struggles, there are multiple underlying causes that also need to be addressed, and the solution is not as simple as prescribing a medication. There are excellent holistic strategic approaches to weight loss that are cheaper and less risky. Schedule your consultation with Dr. Long today to begin your weight loss journey.
