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Why is Everyone So Wild for Ozempic?


 

Part I - What it Is and How it Works





Ozempic has been billed as a wonder drug for weight loss by influencers and the popular press. Recently, Barbara Streisand responded to an Instagram photo of Melissa McCarthy asking if she had used Ozempic. It’s not just celebrities and the media. You have probably heard about it from your aunt or neighbor too. When a seatmate on a recent Amtrak ride learned I was a Dietitian and Diabetes Educator, I spent 30 minutes reviewing the pros and cons of the medication with her. People are fascinated and scared by this latest craze in weight loss. Businesses across the globe are also taking note and changing their financial forecasts and fast food menus to address the wave of smaller portions demanded in the wake of Ozempic. Ozempic is likely here to stay, so let’s take a closer look at how it works, who it is meant for, if it is right for you, and what to expect if you take this medication. 


What Is This Medication?

Ozempic is part of a class of medications called GLP-1 receptor agonists (mimicking a hormone we have in the body) and is actually the brand name of Novo Nordisk’s drug indicated for use in patients with diabetes. “Ozempic” is to GLP-1s like “Kleenex” is to tissues. It’s a brand, but there are several GLP-1 receptor agonist medications on the market and a newer generation that targets GLP-1 and GIP.



Targets GLP-1

Targets GLP-1 and GIP

Approved for Diabetes

Ozempic (semaglutide)


Trulicity (dulaglutide)


Victoza (liraglutide)*


Rybelsus (semaglutide)**

Mounjaro (tirzepatide)

Approved for Weight Loss

WeGovy (semaglutide)


Saxenda (liraglutide)*

Zepbound (tirzepatide)

*Older generation daily injections. All others are once weekly injections.  

**Daily pill.


GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) are two of the main incretin hormones in the body released when we eat, and they play an important role in sugar metabolism and appetite. When food enters the gut, GLP-1 and GIP respond to stimulate the release of insulin from the pancreas. This in turn helps move sugar out of the bloodstream and into cells to provide energy to the body. There are many other mechanisms at play involving not just the gut and pancreas, but also the brain and liver, which will be further reviewed below. Only in recent times have we learned that these crucial hormones are severely low in people with type 2 diabetes and even those with prediabetes. GLP-1 medications can help make up for that deficit.1,2 


How Does it Work?

I teach my clients and students how GLP-1 medications work the same way I learned, with the mnemonic GLP: G for gut, L for liver, and P for pancreas. 


Gut: These medications work in part by slowing down digestion in the stomach. This achieves a few things. First, you will be full faster, because food does not move out of the stomach as quickly. You will also be full longer. This is advantageous for weight loss, because you will eat less throughout the day and eat smaller portions. Weight loss is beneficial for diabetes, as it helps reduce insulin resistance, allowing the body to better use the insulin it is already making. 


Slowed digestion has additional benefits for managing blood sugars in diabetes. Blood glucose will experience a slower and steadier rise and fall because of the slowed digestion, breakdown and absorption of sugar into the bloodstream. This means blood sugars won’t spike as high, which produces less wear-and-tear on blood vessels over time. Research is also looking at the impact GLP-1 medications have on the brain chemistry of hunger, fullness, cravings, and addiction. 


It is important to note that the delayed stomach emptying caused by the medication can lead to gastro-intestinal distress in some patients, especially when high fat foods like pizza and french fries are eaten. Fat naturally lingers in the stomach longer than carbohydrates and protein, but when it lingers too long or there is an excessive amount to be digested, it makes some people feel sick. Since these medications cause slower stomach emptying, that fat lingers in the stomach even longer, sometimes leading people to feel queasy.  


Liver: The liver acts as a storage reservoir for glucose in the form of glycogen. Glucose (aka sugar) is a useful quick energy supply for the body. In diabetes, the hormones regulating the release of glucose from the liver into the bloodstream can be faulty and put too much glucose into the blood, causing high blood sugars. Mimicking the hormone GLP-1, these medications help tell the liver not to release glucose into the bloodstream. This is another highly effective way these medications help reduce blood sugars in patients with diabetes. 


Pancreas: The pancreas produces many digestive enzymes and hormones, among them insulin. Insulin is released from the pancreas and signals cells to open to allow glucose to exit the bloodstream, enter cells, and provide energy to the body. Insulin in a healthy person works in concert with glucagon, GLP-1, GIP and many other signaling molecules to maintain glucose homeostasis, aka good blood sugars. 


However, in diabetes, there is sometimes insufficient insulin production. GLP-1 medications shine in this department. In response to food entering the stomach and small intestine, these medications help signal the pancreas to release more insulin in order to help manage the anticipated influx of glucose from the breakdown of carbohydrates. This allows for a lesser rise in blood sugars in response to food. 


Some of the GLP-1 medications also carry an indication for cardiovascular benefits. This means that in addition to benefits for blood sugar and weight, these medications also reduce risk for heart disease and stroke. Clinical trials are still underway for the newer generation of GLP-1/GIP medications, but I suspect they too will show cardiovascular benefits.3,4


Stay tuned for Part II (and maybe III) - Who Should Take It, What to Expect, and If It’s Right for You



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