The buzz around weight loss drugs is at an all-time high thanks to celebrities and social media influencers touting their dramatic before and after results. Semaglutide, commonly known as Ozempic and Wegovy, is the primary suspect in these injectable weight loss medications. You’ve probably heard the “O-O-O-Ozempic” commercials and, if you’re like me, you can’t get that jingle out of your head.
Even though semaglutide has been on the market for a while as a diabetes medication, it just became approved by the FDA in 2021 as an anti-obesity medication. The buzz is real. According to a CNN article, it’s estimated that 1.7% of Americans were prescribed semaglutide in 2023, a 40-fold increase over the past five years [1].
In this article, you’ll learn what semaglutide is, the unwanted side effects, and ways to ease these potential concerns through diet, exercise, and dietary supplements.
What You Need to Know
- Semaglutide is a GLP-1 agonist, which is a class of medications used to treat type 2 diabetes and obesity. It’s become increasingly popular in the media as a miracle weight loss drug.
- As with any pharmaceutical medication, semaglutide comes with unwanted side effects, including a decrease in muscle mass and gastrointestinal issues.
- For people who are on semaglutide for weight loss, this should be coupled with healthy lifestyle changes, like diet and exercise. Certain supplements can complement your weight loss efforts or help combat the negative side effects, such as meal replacements, protein powders, multivitamins, probiotics, fiber, creatine, HMB, and bone-strengthening calcium and vitamin D.
- As always, talk with your physician before taking any supplements.
Semaglutide is a GLP-1 agonist, which is a class of non-insulin medications for the treatment of type 2 diabetes. They are used to help lower blood sugar levels and to aid in weight loss. According to the Cleveland Clinic, the following GLP-1 medications are available in the U.S. market [2]:
- Dulaglutide (Trulicity®)
- Exenatide (Byetta®) and exenatide extended-release (Bydureon®)
- Liraglutide (Victoza®)
- Lixisenatide (Adlyxin®)
- Semaglutide injection (Ozempic®, Wegovy®) and tablets (Rybelsus®)
In 2023, the FDA approved a similar class of medications to treat obesity, called tirzepatide (ZepboundTM). The same active ingredient, tirzepatide, is also in Mounjaro®, a medication approved for the treatment of type 2 diabetes. Tirzepatide is a dual combination of GLP-1 receptor agonists plus GIP receptor agonists (glucose-dependent insulinotropic polypeptide) [3].
The differences between these products are the dosage, administration (oral or injection), and indication (diabetes and/or weight loss). Currently, Wegovy is the only semaglutide injection approved for weight loss, whereas Ozempic is approved to lower blood sugar levels for those with type 2 diabetes [4]. These medications can be expensive, especially if insurance companies don’t cover the cost. The list price (or out-of-pocket cost) for Ozempic is over $900 and Wegovy is over $1,300 for a monthly supply.
While they may be expensive, the medications DO work for weight loss. In a clinical study, subjects had weekly injections of 2.4mg of semaglutide or a placebo in conjunction with diet and exercise for 68 weeks. Results showed the semaglutide group lost an average of 33 lbs (or 14.9% of their body weight) compared with 5.7 lbs and 2.4% in the placebo group [5].
In order to understand how these weight loss medications work, it’s important to discuss the role of GLP-1 in the body. GLP-1 stands for glucagon-like peptide-1, which is a hormone that’s produced by the small intestine. GLP-1 receptor agonist medications, like Ozempic and Wegovy, are designed to mimic this hormone. GLP-1 plays several biological roles, such as [2,6]:
- Increasing insulin secretion from the pancreas – Insulin is the hormone that allows glucose to get transported from the bloodstream and into your cells and tissues to be used as energy. I like to think of insulin as a key. The cells in your body need a specific key to open the door to allow glucose (aka energy) to get in. In type 2 diabetes, the body doesn’t respond properly to these keys, leading to high levels of glucose in the blood.
- Decreasing glucagon secretion – Glucagon is another hormone that raises blood sugar levels. To help me remember it, I think of it as “glucose gone” since it allows glucose to go out of the cells and into the blood.
- Slowing gastric emptying – Slowing the time it takes for your food to digest helps to slow the rate at which blood glucose levels spike after a meal. This can also help in feelings of fullness and satiety, a beneficial feature for those trying to lose weight.
There are several reported side effects of semaglutide weight loss drugs, including:
- Gastrointestinal issues – According to the labels for Wegovy and Ozempic, the most common side effects are nausea, diarrhea, vomiting, constipation, and abdominal pain. There have also been reports of more serious, but rare, GI complications such as gastroenteritis. [7,8] These GI issues tend to occur when the medication is first started and as the dosage is increased. In clinical trials, around 15-30% experience nausea, 10-15% experience diarrhea, and 5-10% of folks had vomiting [9].
- Loss of muscle mass – Studies have shown that Semaglutide can result in a decrease of fat free mass, which is an indicator of muscle mass [10]. Maintaining muscle mass is especially important for those trying to lose weight because muscle is more metabolically active than fat (aka. it burns more calories).
- Loss of bone density – There has been some buzz in the news about GLP-1 agonists leading to decreased bone density. While there’s an association between diabetes and increased bone fracture risk, recent studies have not confirmed a connection between semaglutide and decreased bone mineral density [11]. It seems like more research is needed in this area. However, bone health is still an important factor to consider because bone mineral density tends to decrease after people lose a substantial amount of weight [12].
- Decreased nutrient intake – Because semaglutide slows gastric emptying and reduces appetite, that means people tend to eat less throughout the day (hello, weight loss). In fact, studies have shown it can reduce total calorie intake anywhere from 24-35% daily [13,14]. Even though decreased calorie intake is desirable for weight loss, it means there’s a potential for suboptimal intake of key vitamins and minerals as well.
- Weight regain – After the medication is stopped, most people regain most of the weight they’ve lost. In a follow-up study, subjects regained two-thirds of their prior weight loss in one year after they stopped semaglutide [15].
There is currently no official “diet plan” that is recommended for those on Ozempic or Wegovy. However, there are important nutrition, exercise, and lifestyle changes that can help along the way.
Protein to Maintain Muscle Mass
Protein to Maintain Muscle Mass
Protein powders usually provide 25 grams of protein per serving and protein-fortified bars and snacks can range from 10-20 grams. Use them in between meals or post-workout as a way to boost your daily protein intake.
READ MORE: BEST PROTEIN POWDERS OF 2024
HMB & Creatine to Improve Exercise Performance
To prevent the loss of muscle mass, it’s imperative to start a resistance training routine. Two key supplements can help maximize your exercise efforts, HMB and Creatine. HMB, a metabolite of the amino acid leucine, plays a role in decreasing protein breakdown and maintaining muscle mass during resistance exercise. Creatine fuels muscles during resistance exercise and gives your workout performance a boost. Aim for 3g of HMB and 5g of creatine daily.
Multivitamins to Fill Nutrient Gaps
Multivitamins are a staple for overall health. Most of us aren’t consuming adequate amounts of vitamins and minerals through food alone, especially when we’re cutting back on calories, so multivitamins are a way to ensure you’re meeting your daily micronutrient needs.
Supplements for Gut Health
Depending on your GI concern, different types of supplements can help.
Fiber supports digestive regularity and helps relieve occasional constipation. It’s recommended to consume 28 grams of fiber per day, but most people aren’t getting enough of it through food alone. Not only can fiber help with gut issues, but it also helps with weight management by helping you to feel full and keep blood glucose levels steady. Make sure to drink plenty of water as you up your fiber intake.
Probiotics supply the gut with “good” bacteria, which can help with overall gut flora, gut health, and immunity.
Digestive enzymes help with the breakdown of macronutrients (carbs, fat, and protein) and help release vital nutrients and support healthy digestive function.
Ginger and peppermint are good ones to try if you’re looking to soothe and comfort an upset stomach.
READ MORE: WHAT IS FIBER AND WHY IS IT IMPORTANT?
Vitamin D and Calcium for Bone Health
If bone density is top of mind, especially if you’re older or post-menopausal, check out supplements designed for bone health. These are typically combinations of Vitamin D, Calcium, Vitamin K, and Magnesium.
Meal Replacements to Control Calorie Intake
Meal replacement shakes are a convenient way to control calorie intake during weight loss (or even after weight loss when you’re just trying to maintain your weight). They’re packed with muscle-protecting protein as well as vitamins and minerals you may be lacking. Meal replacements are also a way to eat smaller meals with less volume (rather than large meals that can trigger some of those nasty GI side effects like nausea).
Incorporate Resistance Training
Exercise regularly to stay in a calorie deficit. Aim for 150 minutes of moderate-intensity exercise per week, with resistance training activities at least two days per week. It’s important to incorporate weight training to help prevent muscle and bone loss. Visit the GNC Learning Center for beginner, intermediate, and advanced workout plans.
Eat Small, Frequent Meals
Eating less in one sitting can help avoid occaisional nausea, heartburn, and other GI effects. It’s important to be mindful and to stop eating once full and avoid eating when you’re not hungry [9]. For those with diabetes, this is also an important strategy in maintaining consistent blood sugar levels and avoiding the highs and lows between large meals. Click here for an example of a 1,500-calorie, two-week meal plan.
Consume Adequate Protein
Research shows that high protein intake during a calorie-restricted diet helps to maintain lean body mass, especially in older adults [16]. Muscle mass is more metabolically active than fat mass, making it an important part of trying to lose weight. While protein needs vary depending on weight, age, gender, and level of physical activity, I’d generally recommend 0.5 grams of protein per pound of body weight. For example, if you weigh 200 lbs, you’d want to consume 100 grams of protein per day.
Limit High–Fat Foods
Since semaglutide slows digestion and many experience GI discomfort, it’s a good idea to limit high-fat foods (which are slow digesting in and of themselves). If you’re feeling nauseous, you may also want to avoid spicy foods and carbonated beverages.
Stay Hydrated
Because semaglutide delays gastric emptying and GI transit time, it’s important to stay hydrated and drink plenty of water to keep things moving, especially if you’re increasing your fiber intake.
Get Adequate Sleep
Getting adequate sleep is important for overall health as well as your waistline. There is evidence that people who don’t get enough sleep have a greater chance of obesity. This could be due to many factors. Lack of sleep can alter hormones that control hunger which can lead to overeating and unhealthy food choices. Not to mention the more tired you are, the less energy you have to exercise [17].
Take Home Message
Semaglutide weight loss injections are popular pharmaceutical interventions due to their impressive weight loss results. However, many unwanted side effects are commonly reported, like GI upset and muscle loss. Long-term weight loss isn’t as simple as a magic pill (or syringe). It takes consistency, motivation, a support system, and a wellness-first approach to your daily lifestyle. GNC is here to help along the way, with meal plans, exercise plans, and supplements that can complement your medical weight loss journey. As always, speak with your healthcare provider before taking any supplements or starting an exercise routine.
References
- CNN Exclusive: Prescriptions for popular diabetes and weight-loss drugs soared, but access is limited for some patients. Deidre McPhillips, CNN. Prescriptions for popular diabetes and weight-loss drugs soared, but access is limited for some patients | CNN Accessed Jan 31, 2024.
- GLP-1 Agonists. The Cleveland Clinic. Access Jan 29, 2024. GLP-1 Agonists: What They Are, How They Work & Side Effects (clevelandclinic.org) 3
- FDA Approves New Medication for Chronic Weight Management. FDA Approves New Medication for Chronic Weight Management | FDA Access Feb 2024. 4.
- Medications Containing Semaglutide Marketed for Type 2 Diabetes or Weight Loss. FDA. Accessed Jan 30, 2024. Medications Containing Semaglutide Marketed for Type 2 Diabetes or Weight Loss | FDA
- Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002. doi: 10.1056/NEJMoa2032183. Epub 2021 Feb 10. PMID: 33567185. Once-Weekly Semaglutide in Adults with Overweight or Obesity – PubMed (nih.gov)
- Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs Context. 2015 Jul 9;4:212283. doi: 10.7573/dic.212283. PMID: 26213556; PMCID: PMC4509428. A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond – PubMed (nih.gov)
- Wegovy prescribing information. Accessed Jan 31, 2024. label (fda.gov)
- Ozempic prescribing information. Accessed Jan 31, 2024. OZEMPIC (semaglutide) injection, for subcutaneous use (fda.gov)
- Wharton S, Davies M, Dicker D, Lingvay I, Mosenzon O, Rubino DM, Pedersen SD. Managing the gastrointestinal side effects of GLP-1 receptor agonists in obesity: recommendations for clinical practice. Postgrad Med. 2022 Jan;134(1):14-19. doi: 10.1080/00325481.2021.2002616. Epub 2021 Nov 29. PMID: 34775881. Managing the gastrointestinal side effects of GLP-1 receptor agonists in obesity: recommendations for clinical practice – PubMed (nih.gov)
- Ida S, Kaneko R, Imataka K, Okubo K, Shirakura Y, Azuma K, Fujiwara R, Murata K. Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus. Curr Diabetes Rev. 2021;17(3):293-303. doi: 10.2174/1573399816666200705210006. PMID: 32628589. Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus – PubMed (nih.gov)
- Daniilopoulou I, Vlachou E, Lambrou GI, Ntikoudi A, Dokoutsidou E, Fasoi G, Govina O, Kavga A, Tsartsalis AN. The Impact of GLP1 Agonists on Bone Metabolism: A Systematic Review. Medicina (Kaunas). 2022 Feb 2;58(2):224. doi: 10.3390/medicina58020224. PMID: 35208548; PMCID: PMC8878541. The Impact of GLP1 Agonists on Bone Metabolism: A Systematic Review – PMC (nih.gov)
- Jensen VFH, Mølck AM, Dalgaard M, McGuigan FE, Akesson KE. Changes in bone mass associated with obesity and weight loss in humans: Applicability of animal models. Bone. 2021 Apr;145:115781. doi: 10.1016/j.bone.2020.115781. Epub 2020 Dec 4. PMID: 33285255. Changes in bone mass associated with obesity and weight loss in humans: Applicability of animal models – PubMed (nih.gov)
- Blundell J, Finlayson G, Axelsen M, Flint A, Gibbons C, Kvist T, Hjerpsted JB. Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes Obes Metab. 2017 Sep;19(9):1242-1251. doi: 10.1111/dom.12932. Epub 2017 May 5. PMID: 28266779; PMCID: PMC5573908. Effects of once‐weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity – PMC (nih.gov)
- Friedrichsen M, Breitschaft A, Tadayon S, Wizert A, Skovgaard D. The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity. Diabetes Obes Metab. 2021 Mar;23(3):754-762. doi: 10.1111/dom.14280. Epub 2021 Jan 3. PMID: 33269530; PMCID: PMC7898914. The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity – PubMed (nih.gov)
- Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA, Wharton S, Yokote K, Kushner RF; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725. Epub 2022 May 19. PMID: 35441470; PMCID: PMC9542252. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension – PubMed (nih.gov)
- Kim JE, O’Connor LE, Sands LP, Slebodnik MB, Campbell WW. Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis. Nutr Rev. 2016 Mar;74(3):210-24. doi: 10.1093/nutrit/nuv065. Epub 2016 Feb 16. PMID: 26883880; PMCID: PMC4892287. Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis – PubMed (nih.gov)
- Sleep and Obesity. Harvard School of Public Health. Sleep | Obesity Prevention Source | Harvard T.H. Chan School of Public Health. Accessed Feb 1, 2024.