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The discussion surrounding GLP-1 agonists like Ozempic, Mounjaro, Wegovy, Semaglutide, and Tirzepatide continues to intensify. With a wide range of opinions on whether these medications should be prescribed and a significant amount of misinformation about potential side effects and risks, the conversation has become both political and confusing. I recently listened to an insightful podcast on this very topic, featuring Dr. Kimberly Anne Gudzune, MD, MPH, as a special guest on episode #405 of The Curbsiders Internal Medicine Podcast, titled “Obesity Medicine, GLP-1 Agonists, Weight Loss Management Tools and Tips.”

If you don’t have time to listen to the full episode, don’t worry. I’ll summarize the key points and provide my own take on the matter.

The podcast is worth tuning into for a few reasons. First, it sheds light on the growing obesity epidemic in the U.S. According to the most recent data from the Centers for Disease Control and Prevention (CDC), about 42% of adults in the United States are considered obese, defined by a body mass index (BMI) of 30 or higher. This is a critical issue, as untreated obesity can lead to various other health problems. Second, the episode highlights the need for diverse perspectives and approaches to address obesity effectively. A single strategy will not work for everyone; personalized treatments are necessary to achieve the best results.

The podcast featured some compelling arguments, making for an engaging and complex discussion. It not only provides a deeper understanding of the role these medications play in healthcare but also emphasizes the intricacies of managing obesity at a broader level.

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What are GLP-1 Agonist Medications?

Let’s begin by discussing what GLP-1 agonists like Ozempic, Mounjaro, Wegovy, Semaglutide, and Tirzepatide are. These medications are part of a class of drugs that work by mimicking the action of naturally occurring peptides in the body. They are becoming increasingly popular especially after celebrities like Oprah have come out and shared their experiences and weight-loss success with them. If you’re already familiar with these, feel free to jump ahead to the specific questions that our patients frequently ask

• Do we prescribe these weight loss medications at NovaGenix?

• Are there benefits beyond just weight loss for taking these medications?

• What are the potential side effects of GLP-1 medication?

• Who is a good candidate to consider taking a GLP-1 medication?

• Will these medications cause muscle loss or muscle wasting?

• How much does Wegovy, Ozempic or Mounjaro cost?

• How much does compounded Semaglutide or tirzepatide cost?

• What’s the difference between the brand name medications (like Ozempic, Mounjaro, and Wegovy) vs. the compounded versions (such as Semaglutide and Tirzepatide) from local pharmacies?

• Will the weight come back after stopping the medication and are these meds something you have to take for life?

• What lifestyle changes are necessary alongside these treatments?

• Neurological Benefits: One of the most promising developments in GLP-1 research is its potential role in neuroprotection. Studies suggest that GLP-1 agonists can reduce neuroinflammation and promote the growth of nerve cells, which may be beneficial in treating conditions like Alzheimer’s and Parkinson’s disease. This neuroprotective effect could potentially slow disease progression and provide more than just symptomatic relief, offering hope for new therapies in neurodegenerative disorders.

• Anti-inflammatory and Metabolic Regulation: GLP-1 agonists also possess strong anti-inflammatory properties, which can help individuals suffering from chronic inflammation related to metabolic disorders. Additionally, there is emerging evidence that GLP-1 agonists can modulate immune responses and impact tumor growth, opening new possibilities for cancer treatment and other diseases involving abnormal cell proliferation. Ongoing research is exploring how these drugs can influence the cellular pathways involved in tumor development and progression.

• Cardiovascular Health: GLP-1 agonists are proving to be powerful tools in the fight against cardiovascular disease, especially for individuals with type 2 diabetes who are at increased risk of heart issues. Research shows that these medications not only improve heart function but also lower the risk of major cardiovascular events. By improving lipid metabolism (such as lowering cholesterol) and reducing blood pressure, GLP-1 agonists contribute to better heart health and help prevent cardiovascular disease.

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What Are Ozempic, Mounjaro, Wegovy, and Other Weight Loss Medications?

Ozempic is often used as a blanket term for weight loss drugs, but it’s just one of several GLP-1 agonists available today. GLP-1 agonists, including Ozempic, Wegovy (which contains semaglutide), and Mounjaro (which includes tirzepatide, a combination of GIP and GLP-1), are more than just standard medications. They are peptides, a category of treatments designed to replicate the function of natural hormones in the body.

These peptides/medications work by regulating appetite and insulin levels. They help people feel fuller for longer, slow down the rate at which the stomach empties, and support proper insulin release in response to meals. As a result, they are highly effective for weight management and are also used to treat conditions like type 2 diabetes and even autoimmune diseases.

Understanding the Difference Between GLP-1 Medications, Peptides and Traditional Weight loss Drugs

The primary difference between GLP-1 drugs and traditional weight loss medications lies in how they work in the body. GLP-1 drugs (like Ozempic, Wegovy, and Mounjaro) mimic the action of the naturally occurring GLP-1 hormone, which helps regulate appetite, insulin secretion, and blood sugar levels. These drugs promote a feeling of fullness, slow stomach emptying, and help the body respond better to insulin, making them effective for both weight loss and managing type 2 diabetes. They work by supporting natural physiological processes rather than forcing the body into a metabolic state that leads to weight loss.

Traditional weight loss medications, on the other hand, often work by altering the brain's chemistry or affecting metabolic functions. Some traditional drugs suppress appetite by influencing neurotransmitters (like phentermine), while others block fat absorption (like orlistat). These medications tend to focus on one specific function, like reducing calorie intake or preventing fat from being absorbed, often with more direct and sometimes aggressive effects on the body's systems. In other words, GLP-1 drugs regulate the body's natural processes related to hunger and glucose control, whereas traditional weight loss medications tend to target more isolated mechanisms like appetite suppression or fat absorption.

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The distinction between peptides and traditional medications is also significant, as some people consider GLP-1 drugs peptides. Most pharmacological drugs work by blocking, inhibiting, or altering natural processes in the body to manage symptoms or treat diseases. For example, many drugs interfere with pathways responsible for inflammation, pain, or disease progression. Peptides, like GLP-1 agonists, operate differently.

Peptides are either naturally occurring or synthetically produced molecules that the body recognizes and uses to regulate its own functions. These molecules mimic or enhance the actions of naturally produced hormones, facilitating normal processes such as regulating appetite or insulin secretion. Because peptides work in harmony with the body’s natural mechanisms, they not only address symptoms but also help the body maintain its natural balance and health.

GLP-1 agonists, which are glucagon-like peptide-1 receptor agonists, are synthetic compounds designed to mimic the action of the GLP-1 hormone. They help regulate blood sugar and appetite and are primarily used to treat conditions like type 2 diabetes and obesity. Though they are medications, they function similarly to natural peptides in the body. As GLP-1’s are man-made, they fall under the guidelines of the FDA and as such can be considered and treated as a medication.

The Debate Over Weight Loss Injections

Critics of GLP-1 agonists like Ozempic often point to potential side effects as a cause for concern. The approval of semaglutide, a GLP-1 receptor agonist, for weight management in January 2023 marked a new chapter in obesity treatment. However, in recent months, regulatory authorities have also highlighted rare but sometimes severe side effects associated with these drugs, particularly when used for diabetes treatment—side effects that some doctors may not have fully anticipated.

Susan Yanovski, MD, codirector of the Office of Obesity Research at the National Institute of Diabetes and Digestive and Kidney Diseases, noted in a JAMA news report, "When millions of people are treated with medications like semaglutide, even relatively rare side effects occur in a large number of individuals." Although these adverse events are infrequent, the benefits of these medications, especially for individuals with severe obesity, often outweigh the risks. The potential harm from untreated obesity is far greater than the low risk of side effects from GLP-1 drugs.

GLP-1 receptor agonists, such as semaglutide and liraglutide, work by mimicking intestinal hormones and typically cause gastrointestinal side effects like nausea, vomiting, constipation, and diarrhea. However, these common symptoms are not the rare, severe complications that have raised concerns recently.

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Serious Gastrointestinal Issues

A study published in JAMA revealed that GLP-1 receptor agonists are linked to a ninefold increase in the risk of pancreatitis compared to older weight-loss medications like bupropion. Additionally, patients taking GLP-1 agonists had four times the incidence of intestinal obstruction and more than three times the rate of gastroparesis. While these risks remain low—less than 1% annually—they are important considerations, particularly for patients requiring long-term use of these medications. Therefore, it’s essential for doctors to discuss these risks with their patients.

The Critic's Perspective: A Different View on Ozempic and GLP-1 Agonists

Many critics of Ozempic and other GLP-1 agonists argue that we need to address the root causes of the obesity epidemic rather than relying on medications. These critics point to issues like ultra-processed foods, big food corporations, and modern farming practices as major contributors to the problem. They believe that pharmaceutical companies are taking advantage of the crisis by promoting drugs like Ozempic as a standard treatment for obesity, including in children, while neglecting the importance of education about wellness and lifestyle changes that could have a broader, more lasting impact.

Critics suggest that the priority should be on more functional approaches to health, such as reducing the consumption of ultra-processed foods, promoting exercise, and encouraging overall healthier lifestyles. These steps, they argue, should come before turning to medications like Ozempic. Medications should be seen as a secondary option, used only after lifestyle interventions have been attempted.

Many also highlight the high cost of Ozempic, which ranges from $1,000 to $1,800 per month, depending on treatment and dosage, suggesting that these funds could be better invested in initiatives that improve access to nutritious foods and support sustainable agriculture. By focusing on wellness programs, particularly for children, and fostering healthier habits, we could see long-term benefits that reduce the strain on the healthcare system, lower the prevalence of chronic diseases like diabetes and heart disease, and ultimately lower healthcare costs. The critics' argument centers on the idea that lifestyle changes, rather than medication, should be the foundation of obesity prevention and treatment, particularly for children and younger adults.

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Proponents of GLP-1 Agonists: A Case for These Medications

Supporters of GLP-1 agonists often agree that issues like corporate influence from big food, big pharma, and other interests in the healthcare system are major concerns in the U.S. However, they argue that criticizing these medications is a misstep, as GLP-1 agonists have proven to be highly beneficial, not just for weight loss, but for treating a range of other medical conditions. Extensive research has shown the peptides in GLP-1 agonists offer a variety of benefits, including regenerative, healing, and anti-inflammatory effects.

Some experts who favor medical intervention suggest that many of the side effects reported with GLP-1 agonists stem from high doses rather than the drugs themselves. Experienced physicians often recommend a gradual increase in dosing approach to minimize side effects and optimize patient outcomes. Additionally, many doctors are turning to compounded versions of these peptides, such as semaglutide and tirzepatide, as a cost-effective alternative to brand-name drugs. These compounded forms offer the added benefit of customizable dosages, improving both affordability and patient-specific treatment.

Do We Prescribe Weight Loss Medications at NovaGenix ?

Yes, Dr. Mackey prescribes GLP-1 agonists like Ozempic at NovaGenix, and for good reason. We’ve seen firsthand the incredible benefits these medications provide for certain patients. As a functional medicine practitioner experienced in anti-aging and weight-loss, Dr. Mackey strives to offer the most effective treatments to manage and reverse metabolic disorders, which are a significant health issue for many individuals today. However, GLP-1 agonists offer more than just weight loss. They can also support gut microbiome diversity, reduce neuroinflammation, improve cardiovascular health, and much more.

Does this mean that every patient looking to lose weight should take a weight-loss medication? No, not at all. Weight loss drugs are not necessary for everyone. There are numerous other ways to optimize metabolism through a comprehensive, functional approach. Addressing inflammation, identifying food sensitivities, supporting detox pathways, bioidentical hormone replacement, and gut health treatments can all help maintain a healthy weight.

In fact, weight loss is often one of the first benefits our patients experience when they begin implementing the strategies we discuss during a consultation. GLP-1 agonists tend to be most effective for patients who have struggled with weight loss despite trying multiple methods and need an extra level of support.

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Are There Differences Between Brand Name and Compounded Versions of GLP-1 Medications?

The primary differences between brand name and compounded GLP-1 agonists lie in their manufacturing process, regulatory oversight, and customization options. Brand name GLP-1 agonists, like Ozempic, Wegovy, and Mounjaro, are produced by pharmaceutical companies and have gone through rigorous clinical trials to verify their safety, efficacy, and quality. These medications are approved by regulatory bodies such as the FDA, which ensures they meet strict production and safety standards.

Compounded GLP-1 agonists, such as tirzepatide and semaglutide, are prepared by compounding pharmacies based on a physician’s prescription. This process allows for greater customization in terms of dosage and formulation, enabling adjustments to meet individual patient needs—like avoiding certain fillers or allergens found in the brand name versions. However, compounded medications don’t undergo the same extensive FDA approval process as their branded counterparts, which can result in variations in consistency, potency, and purity. For this reason, at NovaGenix, we only work with licensed pharmacies who pass rigorous inspections and that have a proven track record of quality and reliability.

While brand name GLP-1 agonists are known for their consistent quality due to strict regulatory approval, they can have limitations. One common drawback is the lack of dosage flexibility. Medications like Ozempic and Wegovy are available in only a few pre-set doses, which may be too high for some patients, especially those just starting treatment or those sensitive to the drug. This limited flexibility can make it harder to tailor the treatment to each individual and reduce the risk of side effects.

These considerations underscore why compounded versions of GLP-1 agonists may be a better option for certain patients. They offer greater control over dosage and can often be more cost-effective, making them a suitable alternative in many cases.

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Brand Name GLP-1 Agonists Are More Expensive

Brand name GLP-1 agonists, such as Mounjaro, Ozempic and Wegovy, are often much more expensive than compounded versions of Semaglutide or Tirzepatide. For patients who are uninsured or underinsured, these medications can be cost-prohibitive, as they come with a premium price tag. This financial burden can make it difficult for many people to access these potentially life-changing treatments.

The combination of high costs and limited dosing flexibility is why compounded GLP-1 agonists are often a better option for many individuals. Compounded versions offer more precise dosage control, allowing for adjustments that can help reduce waste or avoid unnecessarily high doses, making them more affordable.

With the added benefits of flexibility and personalization, compounded medications are particularly useful for patients with specific needs or sensitivities. However, it's essential for patients to discuss their options with a healthcare provider to determine which form, brand name or compounded, is best suited for their medical history and treatment goals.

What Are the Benefits Beyond Weight Loss?

GLP-1 agonists, like semaglutide and tirzepatide, were originally developed to help manage diabetes, but they are now gaining attention for their potential to treat a wide range of other health conditions. Recent studies highlight several broader therapeutic benefits of GLP-1 agonists, including improvements in cardiovascular health, neuroprotection, and anti-inflammatory effects.

The therapeutic potential of GLP-1 agonists extends far beyond their initial use. With benefits that include improved cardiovascular health, possible roles in treating neurodegenerative diseases, and reducing inflammation, these drugs represent a new and exciting frontier in medical treatment. As ongoing research reveals more about their diverse advantages, the use of GLP-1 agonists in medicine may grow, offering fresh hope for patients with a wide range of health conditions.

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What Are the Side Effects of Ozempic and Other GLP-1 Agonists?

Recent research and clinical data indicate that while GLP-1 agonists can cause side effects, these are typically manageable and relatively uncommon. The most frequently reported issues are gastrointestinal, including nausea, vomiting, diarrhea, and constipation. These symptoms are generally mild and tend to diminish as patients adjust to the medication over time.

More serious side effects, such as pancreatitis or kidney impairment, are rare. In most cases, side effects are associated with dosing strategies, which is why a gradual, low-dose approach is recommended. This strategy involves starting with a lower dose and slowly increasing it, allowing patients to acclimate more easily and reducing the likelihood of gastrointestinal discomfort.

Clinical guidelines also stress the importance of healthcare providers being well-versed in the proper use, action, and dosing of GLP-1 agonists, as well as actively managing any complications that may arise. This proactive approach ensures that patients can continue treatment with minimal discomfort and lowers the chances of needing to stop the medication due to adverse effects.

Overall, with careful management and appropriate dosing, the side effects of GLP-1 agonists can be effectively controlled, making these medications a viable and beneficial option for many patients dealing with type 2 diabetes or obesity.

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Is GLP-1 Agonist Therapy a Lifetime Commitment?

A common question regarding GLP-1 agonist therapy is whether it needs to be a lifelong treatment. The answer varies depending on each individual's health goals, how they respond to the medication, and their ability to maintain lifestyle changes.

Studies indicate that GLP-1 agonists can lead to significant weight loss, with some patients losing enough weight to eventually phase out the medication. These drugs not only aid in weight loss but also improve metabolic health, offering patients a chance to make lasting lifestyle changes, such as improving their diet and increasing physical activity. Over time, these habits can help maintain the weight loss achieved during therapy, potentially reducing the need for continued use of the medication. As weight is lost, insulin resistance typically decreases.

However, there is a concern about regaining weight after stopping the medication. Research suggests that maintaining the weight loss achieved with GLP-1 agonists largely depends on continuing the lifestyle changes developed during treatment. A slow tapering of the medication, under medical supervision, allows the body to adjust and helps stabilize weight while maintaining health improvements.

In conclusion, while GLP-1 agonists offer substantial benefits for managing weight and diabetes, they work best as part of a holistic approach that includes diet, regular physical activity, and possibly psychological support. With the right strategies, some patients may be able to reduce or stop medication while still preserving their health gains over the long term.

What the Research Says About Weight Regain:

A study conducted tracked 20,274 patients who lost at least five pounds while taking semaglutide. Researchers followed up one year after the patients had stopped taking the medication to monitor any changes in their weight. The findings revealed that 17.7% of the patients had regained all the weight they had initially lost or even gained more. However, the majority—56.2%—were able to maintain their weight close to what it was when they stopped the medication, or they continued to lose additional weight.

These results highlight the importance of a comprehensive approach to obesity and diabetes treatment. GLP-1 agonists are just one of several tools that can be used to achieve and maintain long-term health improvements, emphasizing the need for a balanced strategy that includes lifestyle changes alongside medical interventions.

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What Lifestyle Modifications Should Accompany GLP-1 Agonists?

To fully optimize the benefits of GLP-1 agonists for weight loss and overall health, it is essential to pair these medications with targeted lifestyle changes. Key recommendations include:

1.   Increase Protein Intake: A protein-rich diet is crucial for muscle repair and growth, especially when using GLP-1 agonists. Protein helps preserve muscle mass during weight loss, promotes a feeling of fullness, and boosts metabolism. Incorporate lean meats, fish, eggs, and legumes into your meals to ensure adequate protein intake.

2.   Engage in Resistance Training: Building and maintaining muscle mass is key for those aiming to lose weight on GLP-1 agonists. Since muscle tissue burns more calories at rest than fat, resistance exercises can increase your overall metabolic rate. Aim to include exercises like weightlifting, resistance bands, or body-weight movements (such as squats and push-ups) at least two to three times per week.

3.   Regular Monitoring: Collaborating closely with your healthcare provider to track progress and adjust your treatment plan as needed is essential. This helps manage any side effects and ensures that your diet and exercise regimen are supporting your weight loss and health goals.

Combining these dietary and exercise habits with GLP-1 agonist therapy creates a comprehensive approach for achieving and sustaining significant weight loss. This holistic strategy is crucial for long-term success in managing weight and improving overall metabolic health.

Do GLP-1 Agonists Like Ozempic Cause Muscle Loss or Wasting?

It’s important to understand that muscle loss during weight reduction isn’t unique to GLP-1 agonists like Ozempic; it can happen with any weight loss regimen. To prevent muscle loss, maintaining adequate protein intake and incorporating resistance training into your routine is crucial, regardless of the weight loss method used.

The question of whether GLP-1 agonists cause muscle loss is a topic of debate, but the research is not definitive. A 2021 study on semaglutide, which was the first to show its effectiveness in treating adult obesity, analyzed body composition in 140 patients. The results revealed that lean muscle mass accounted for 39% of the total weight loss, which is a considerable percentage. However, these trials were conducted in obese individuals with much more weight to lose. Interestingly, the ratio of lean mass actually increased by 3%, indicating that muscle loss was not a major concern in this population, and the overall results were still positive.

In summary, while muscle mass changes are possible with GLP-1 agonists, their impact depends on factors like a patient’s overall health, diet, and exercise habits. This is why resistance training and sufficient protein intake are essential components of any weight loss program, including those involving GLP-1 agonists. Ongoing research and individualized medical guidance are important to effectively manage these concerns.

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The Final Take on GLP-1 Agonists Like Ozempic

Deciding to start treatment with a GLP-1 agonist is a personal choice that should be made in consultation with your healthcare provider. These medications offer significant benefits, including not only weight loss but also potential improvements in gut health, reduced neuroinflammation, and enhanced cardiovascular health, making them an appealing option for many.

Compounded GLP-1 agonists are an especially attractive alternative. They tend to be more cost-effective and offer greater customization, allowing treatments to be tailored to individual needs. This can lead to fewer side effects and highlights the importance of personalized medicine in modern healthcare.

If this discussion has piqued your interest, or if you have thoughts or experiences to share, feel free to leave a comment. For a deeper conversation or to explore how these weight-loss treatments might work for you, don't hesitate to contact our office for a consultation. At NOVAGENIX, your journey to optimal health is a partnership, and we're here to support you every step of the way!

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Here’s a list of 10 online resources and studies to help you learn more about GLP-1 medications:

1. Mayo Clinic - GLP-1 Agonists Overview
   Mayo Clinic’s website offers an overview of GLP-1 agonists, how they work, and their potential side effects.
2. National Institutes of Health (NIH) - GLP-1 Research
   The NIH provides a variety of research articles and clinical trial data on the effects of GLP-1 agonists in diabetes and weight loss.
   NIH GLP-1 Research
3. American Diabetes Association (ADA)
   The ADA website has valuable information and clinical studies on the use of GLP-1 medications for managing type 2 diabetes and weight loss.
   American Diabetes Association - GLP-1 Agonists
4. Endocrine Society - Guidelines on GLP-1 Agonists
   The Endocrine Society provides professional guidelines and treatment protocols for the use of GLP-1 agonists in clinical practice.
   Endocrine Society GLP-1 Guidelines
5. WebMD - GLP-1 Agonists Overview
   WebMD offers patient-friendly articles and expert commentary on how GLP-1 agonists are used for diabetes and weight management.
   WebMD GLP-1 Medications
6. PubMed - Study on Semaglutide and Weight Loss
   A clinical study on semaglutide’s effectiveness in promoting weight loss, one of the more detailed peer-reviewed resources available.
   Study on Semaglutide and Weight Loss
7. Journal of the American Medical Association (JAMA) - GLP-1 Agonist Studies
   JAMA has numerous articles and clinical studies on the long-term effects of GLP-1 medications in managing chronic conditions.
   JAMA GLP-1 Studies
8. National Institute for Health and Care Excellence (NICE) - GLP-1 Guidelines
   NICE offers evidence-based guidelines for the use of GLP-1 agonists in the UK healthcare system.
   NICE GLP-1 Guidelines
9. ClinicalTrials.gov - GLP-1 Clinical Trials
   ClinicalTrials.gov provides a list of ongoing and completed trials for GLP-1 agonists, including their applications for diabetes and obesity.
   GLP-1 Clinical Trials
10. American Association of Clinical Endocrinology (AACE) - GLP-1 Therapy Guidelines
    AACE provides guidelines and educational resources for clinicians using GLP-1 agonists in practice.
    AACE GLP-1 Guidelines

These resources provide valuable insights for both healthcare professionals and patients interested in GLP-1 medications.

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