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  • Writer's pictureDave Balzer

Is the Ozempic craze the new Opioid Crisis?


Ozempic is an amazing and fascinating drug. There is no denying that. But does it have a dark side? What do we actually understand about the drug and are we getting the full story? And most importantly… do we even need it?


Ozempic is a GLP1 agonist medication. You may be familiar with the generic name semaglutide or the other name-brand drugs – Trulicity, Wegovy, Mounjaro, and so on. These drugs have been around for nearly 20 years and have been effective in treating Type 2 Diabetes. GLP1 agonist drugs, like Ozempic, function by mimicking the effects of the naturally occurring hormone GLP1 in the body – specifically in the gut and brain. GLP1 is a hormone that signals the pancreas to release more insulin to assist in the uptake of glucose as we consume food. It also slows gastric emptying (food digestion) which helps in regulating blood glucose levels. This all sounds fine and dandy… what’s the fuss about helping people with diabetes manage their blood sugar? Well, the initial form of the drug created in the mid-2000s quickly began to evolve with appealing new research findings in the early 2010s – at higher doses, exogenous GLP1 is able to cross the blood-brain barrier and has a major impact on regulating the appetite and satiation centers of the brain.


I’ll speed up the physiology explanation for you… here’s the TLDR: it makes you feel full, decreases your interest in eating food, and subsequently leads to significant weight loss typically due to calorie restriction.


Half Dome, Yosemite National Park - Summer 2023


Let’s take a quick break from Ozempic and tell the story of how Oxycontin (the drug behind the opioid crisis) came into existence and how this relates to Ozempic. Oxycodone, the active medication in Oxycontin, was first synthesized in the early 1900s and rose to popularity as a battlefield drug to assist in treating traumatic wounds. The medication had significant pain-relieving capabilities without producing the sedation of other drugs like morphine or hydrocodone. It was a very effective medication when used for this short-term purpose. It was also well known at the time that opioids posed a high risk for addiction. Fast forward to the mid-1990s when Purdue Pharma claimed that if you add a slow-acting, time-release component to oxycodone it decreases the risk of addiction. And that’s how Oxycontin was born! We all know how this story ends… 


To compare Ozempic to the Opioid Crisis I’ll need to backtrack to the initial purpose of Oxycontin. Much like Ozempic, in the mid-1990s there was no denying that Oxycontin was an amazing and fascinating drug. At that time it was strictly being used on terminal patients with end-stage diseases like cancer. These patients had debilitating, unrelenting pain and were on the verge of dying. The problems with Oxycontin began to develop when it was repurposed in larger doses and urged to be used on conditions it was not meant to treat. Is this story starting to sound familiar yet? Cue the Ozempic catchy commercial… “Oh, oh, oh, Ozempic!”



Let me be clear…


  • Ozempic in the right dose is highly effective in managing Type 2 Diabetes. 


  • Oxycontin, in the right dose, can be hugely beneficial in providing comfort care to those nearing the end of life or in some post-surgical care cases.


I’m not here to argue whether Ozempic is good or bad. We’re completely missing the boat if the discussion is strictly focused on picking sides. My point is the pharmaceutical industry has a bad track record in attempting to treat chronic conditions. I take that back, let’s be honest, a “bad track record” description is being too nice. In fact, they’ve never been successful in treating chronic conditions if the measure of success is decreasing the prevalence of a condition in a population. Prozac and other SSRIs have been around for over a half-century, yet depression rates continue to rise. Anxiety-related disorders are increasing at an alarming rate even with the massive surge in benzodiazepine prescriptions – not to mention all the side effects that come with both those drugs. Chronic pain conditions and disability due to pain have never been higher and we all know Oxycontin and other opioids only made the problem worse. How about Metformin… that’s had success, right? Well, it’s been around since the mid-1990s, yet rates of diabetes have more than doubled since the year 2000.


I think this quote is misattributed to Einstein, but I’ll mention it anyway…

“The definition of insanity is doing the same thing over and over and expecting different results.”

I understand my measure of success differs significantly from traditional biomedical models and Big Pharma. Their measure of success or “solution” is to manage chronic conditions and create a culture where these chronic conditions are viewed as inevitable. My wife sometimes gets annoyed with me for being too optimistic, but in my eyes, Big Medicine's/Big Pharma's measure of success should be viewed as flat-out not good enough. It’s deceptive and lacks true informed consent. But that’s a whole other conversation.


As I said, the argument shouldn’t be “is Ozempic good or bad”. The real discussion is whether these medications truly do anything to address the root cause of illness or dysfunction. In my opinion, Ozempic does appear to be a useful medication for managing Type 2 Diabetes (keyword: managing), but it does little to nothing to address the root cause of obesity (although I can see an argument for utilizing Ozempic as an additive treatment -- short term -- in conjunction with strength training, walking, and nutritional education for those with BMI over 40). Did you know that Ozempic isn’t even indicated as a medication to treat obesity or to be used as a weight loss medication? Actually, none of the GLP1 agonist drugs are approved for treatment of obesity. They are all currently being prescribed off-label as a weight loss medication**.


**Wegovy and Zepbound are derivatives drugs of Ozempic

which acts on GLP1 and a few other hormone receptors.

They are the only approved drugs for weight loss.


I am not claiming that medications being prescribed off-label is always a bad thing. There are dozens of medications prescribed off-label that end up being extremely effective in those uses. Plus, the most successful innovation in pharmaceuticals is made by tinkering with current uses. But for the sake of comparison, the story arc of Ozempic follows the same Big Pharma success narrative of Oxycontin. In the early stages of Oxycontin, it was also being prescribed primarily off-label as its initial approval was for conditions like terminal illness pain relief mostly in hospice and palliative care settings (not the most lucrative client population right there). That quickly devolved into being prescribed off-label for various aches and pains.


This all sounds like a lot of bashing of Ozempic, without providing any alternative solutions. And from my standpoint, if you aren’t providing solutions then you’ll end up being part of the problem. So, let’s talk solutions:


Knowledge is Power - True “Informed Consent”


The pharmaceuticals hold the power if you don’t gain an understanding of what is truly going on within your body when you ingest these drugs. For instance, did you know GLP1 is naturally released in our body when we eat food? Yup! And another fun fact… ingesting protein specifically increases the amount of GLP1 in our gut and signaling to our brain. Sadly, the vast majority of Western cultures on the Standard American Diet (SAD!) are not meeting their protein requirements (depending on the person protein intake should be at least 60-75% of your ideal body weight in grams of protein per day). 

It’s abundantly clear that food is a sensory input to the body and guides every cell in the body on how it should function. If the sensory input is constant ultra-processed food then it quickly becomes dysregulated and dysfunctional (disease, poor mood, poor energy, pain, etc). Ultra-processed food quite literally steals your body’s ability to feel full. We must provide the body with the nutrients it requires to provide satiation (aka adequate amounts of micro and macronutrients) or it will drive us to eat more and more.


True “informed consent” is absent in healthcare today. And there isn’t one person or clinician or insurance to blame. It is a systemic problem. Sadly, many view informed consent as just agreeing to go along with a procedure, medication, or treatment. In reality, time needs to be taken to inform the patient of the full nature of the pathology and the possible treatments available – both pharmaceutical and non-pharma lifestyle behavioral options. That is true informed consent. It’s a difficult, time-consuming task. There’s no denying that, but I hope this article provides more insight as there is still so much unknown on this topic.


Naturally improve levels and signaling capacity of GLP1


  • Eat quality sources of protein, fiber, and healthy fats


  • Improve the gut microbiome by eating fermented foods. This creates an optimal environment in which GLP1 can easily be signaled.


  • Prioritize sleep, regular exercise, and manage stress.


  • Practice mindful eating. Take your time, savor the food!


  • What's the common denominator on this list? They're all virtually FREE! Who doesn't love that?! It may be difficult and a big lifestyle change, but if it's simple, yet difficult... then you should probably be doing it.


 

I’ll let you be the judge as the jury is still out on GLP1 agonist drugs, but here are a few of my concerns about Ozempic and the new culture of “weight loss drugs”:


  • Muscle loss


Muscle degradation over the lifespan (sarcopenia) is a massive issue in our aging population. Muscle loss as we age leads to frailty, disability, severe risk for falls/fractures, and even possible signs of neurocognitive decline. Sarcopenia is already a huge problem for many over the age of 55. Early studies on GLP1 agonist medications show individuals are not just losing fat, but also huge amounts of muscle mass. Now, to not straw-man this finding, it must be said that anyone who does an aggressive calorie-restricted diet may see a similar proportion of muscle and fat loss. This can easily be counteracted by maintaining a proper strength training program while taking GLP1 agonists, but something tells me most people are not doing this. In summary, when it comes to body composition and dieting, there’s no such thing as a free lunch.


  • Highly Expensive – $12-20K per year!


Big Pharma is currently lobbying insurance companies to cover these drugs as a weight loss medication. They are hiring scientists to manufacture claims that obesity is 100% genetic and incurable; therefore insurance should cover these expensive drugs at full price. Claiming obesity to be solely genetic is a slippery slope to go down. Deceiving individuals by telling them they have no autonomy or sense of control over their well-being is not healthcare in my opinion. And I’m no expert on finances, but someone will have to pay for this and I’m willing to bet it’ll be through higher premiums and deductibles.


  • All or Nothing? Ozempic for life


Once you’re on Ozempic you may never come off. All signs point to it being extremely challenging to come off these drugs without having significant weight gain. Once again proving this is not a solution, just a bandaid… much like the other chronic conditions listed above that Big Pharma has unsuccessfully tried to tackle.


  • Side Effects


Nausea, vomiting, depression, headache, diarrhea, constipation... the list goes on. I know through personal experience that many people have minimal to no side effects with Ozempic and other GLP1 drugs, but I also have personal experience with clients who have horror stories of significant depression, anxiety, and “Ozempic Flu”. I wish I could give credit to who said this, but I just can’t remember, “There are two types of drugs… drugs that don’t work and drugs that have side effects”.


  • Orthorexia and Eating Disorders

Our culture praises extreme thinness, and we all know that eating disorders are on the rise, especially in young females. Let’s say everything I wrote above is completely wrong or you just disagree with it (and you may be right), but I think we can all agree that individuals who are already a “healthy” weight or only slightly overweight should not be taking Ozempic. Nobody is gaslighted more by the medical field and cultural phenomena than females. This frustrates and worries me as it makes for a difficult climate for young females to grow up healthy and happy.


  • Thyroid Dysfunction


Substantial evidence shows those with thyroid dysfunction may want to take precautions when using Ozempic. This makes sense as the thyroid gland functions to regulate many hormonal systems in our body, specifically metabolism, cellular growth, and body temperature. Even the Ozempic commercial mentions these thyroid issues. There’s still much to be explored on Ozempic and its effect on the thyroid gland.


 

I always try to end on a positive… the body has an incredible, innate capacity to heal and thrive. The food we ingest directly impacts the body's ability to create high-quality cells and stave off chronic disease. Lastly, and most importantly, don’t let ANYONE tell you all chronic disease is genetic! Don’t let them steal your sense of agency and autonomy over your body and health!


 

If you're looking for some interesting resources on Ozempic and GLP1 agonists I highly recommend checking out the following podcasts:



  • Two doctors and a former pharmaceutical consultant debate the benefits and risks of Ozempic.





  • A new series by the podcast The Journal discusses the past, present, and future of Ozempic and other GLP1 agonist drugs.



Thanks for reading!

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