Ozempic and other weight loss drugs - the headlines, the concerns, and *everything* you need to know

0:00This show is sponsored by Primidine, a clean, natural and science-based spermidine supplement that's been a long-time staple in my own longevity stack. Because studies suggest that through autophagy, spermidine increases healthspan and upregulates a range of health markers, from memory and cognitive function to heart health, hormone balance, fertility, and even hair growth. Plus, you can be assured that all ingredients undergo rigorous third-party testing. Buy Primadine now at OxfordHealthSpam.com and use the discount code DrSophie, that's D-R-Sophie for 20 % off. This show is sponsored by Microbes, an award-winning liquid probiotic that's now a staple for me because Microbes, with a Z on the end, is different.

0:47For one thing, they source directly from the soil on their Wiltshire farm, meaning more diversity with at least 15 strains of good bacteria in every single shot. It's brewed so it can survive in the stomach and a remarkable 92 % of customers say it makes a difference. Plus they offer micro-friendly cleaning, gardening and even microbes for dogs. Buy now at microbes.co.uk and use the discount code sophie20 for 20 % off. Hi I'm Sophie and this is Age Well with Dr Sophie Schotter, a space devoted to all things health, wellness and longevity. Because for me, aging well is about looking and feeling like the best possible version of ourselves inside as well as out.

1:31So together with my producer Fee, I'll be deep diving into the latest research sifting fact from fiction. I'll also be talking to all kinds of trusted experts tapping into their knowledge, along with bringing you conversations from a range of interesting women and men finding out how they age well. So this is my show. Welcome along. And as always, thank you so much for listening.

2:00Dr Sophie Shotter:So I think by now, so most of us have a baseline understanding that a Zen pick causes weight loss. But can you give us a super quick 101 on exactly what it is and how it works? And then we can talk about both any positives versus the controversy and the concerns. So yeah, Ozempic, what do we need to know? The first thing to say is that people here in the UK tend to talk about purely Ozempic, but there are actually other medications to talk about as well as Ozempic. And actually Ozempic is only NHS licensed as a type 2 diabetes treatment, whereas a medication, which is actually exactly the same medication but used slightly differently called Wigovi is the one licensed for weight loss.

2:45Basically if you're working through the NHS here in the UK doctors can't prescribe Ozempic for weight loss but a private doctor can prescribe Ozempic in what we call an off-label prescription and by private doctor we're not necessarily talking about an expensive private clinic. All of these drugs are surprisingly accessible both in pharmacies and from various online platforms, which for me is a concern and is something we can get into. I also want to talk about brand names versus the names of the actual medication. Ozempic is a brand name. The actual drug name is semaglutide. And Wigovi is also a brand name.

3:21And again, the drug is semaglutide. So they are exactly the same drug, but the difference is in the dosing. and this is where research has been done to find out what's effective for diabetes management and for weight loss and so the dosing protocols and regimes for the two are different. Then there's also Monjaro which again is another brand name but unlike Ozempic and Wigovi it's a different drug called Tisopeptide which we'll park for now. For the purpose of the podcast I'm going to use the brand names but I do want people to be aware of the intricacies of all of these drugs and bear in mind that as usual, this podcast isn't an endorsement or medical advice.

3:59It's purely a conversation. So all of these drugs are part of a class of drugs known as GLP-1 agonists. To break that down and explain it, GLP-1 is a hormone in your body, which is naturally made in the small intestine. And an agonist is something that mimics a substance in your body. So to put these two together, a GLP-1 agonist basically mimics this naturally occurring GLP-1 hormone. So what does this GLP-1 hormone do? It basically mimics one of the key hormone mechanisms that tells our brain that we're full. So it works to suppress our appetite, meaning we eat less food. This appetite suppression means we're therefore far less likely to snack.

4:41Semaglutide also slows down our digestion, So in other words, how quickly the stomach digests and empties so we don't get as hungry as quickly. It's important to mention the benefits for diabetes too, which is what these drugs were originally designed for. When we eat, our blood sugar goes up and this GLP-1 hormone encourages our body to create another hormone, and that's insulin. That's why these drugs were originally produced, to help people with diabetes by giving them enough insulin so that they can handle their blood sugar. This mechanism also means our body uses its fat stores for energy rather than simply storing it as fat.

5:16This is all a very simplified explanation, but it gives you an idea of how these drugs work. Munjaro, which is the other brand name I mentioned, is slightly different. Again, this contains tiers of peptide rather than semaglutide. And tiers of peptide mimics not only GLP-1, but a second appetite regulating hormone known as GIP. So Monjaro actually has a dual action weight loss purpose. There are various other drugs now associated with weight loss, but to keep it simple, these are the main three brand names that you will have heard of at present.

5:48Dr Sophie Shotter:Okay, brilliant. Thank you. And how are these taken and are they safe to take long term? Even though Ozempic and Wigovia are the same drug, you take them in slightly different doses. So Wigovia is actually in higher doses, so you could say it's stronger. both are taken as an injection usually into your belly thigh or upper arm and the big advantage here is that they're once a week and roughly at the same time every week you start both at a lower dose and work your way up to higher doses on a monthly basis they are designed to be taken long term but at the moment that's kind of limited to two years under the guidance of a doctor and when you reach your weight loss goals doctors should in theory recommend stopping treatment but the jury is actually out here based on the relapse weight of the weight going back on.

6:37The research has shown that if you stop taking either Ozempic or Wigofi, it's highly likely that you're going to gain back all of the weight you lost, which for me reinforces that lifestyle changes while taking the drugs are crucial. So make good food choices, which is the primary indicator for maintaining a healthy weight. It's an important message that often gets lost in all the marketing hype because the weight loss data is really impressive but the pharmaceutical companies typically stop tracking people's weight loss once they stop taking the medicine and the relapse rate is pretty strong which we'll get into.

7:11It's also important to note that if you start taking either of these drugs your body may get used to it, establish a new normal and this can cause your weight to plateau.

7:19Dr Sophie Shotter:Interesting and how long do they take to work? You may actually find that your appetite is lower after your very first dose but it can take a few weeks to notice a meaningful difference. Therefore, when it comes to actually losing weight, this isn't an overnight thing, nor should it be. Weight loss on Ozempic may take longer than Wigovi because again, Wigovi has a higher maximum dosage. And with Monjaro, there may be even more weight loss because of, as I said, that dual action effect. But none of these drugs are without risk or side effects. And the idea is to build up slowly on lower doses, which should help mitigate or reduce the side effects.

7:54And when you start feeling full, moderate the amount of food you're eating, but don't skip meals.

8:00Dr Sophie Shotter:Okay, so should we talk about the side effects? Sure. About one in 10 people experience either nausea, so feeling sick, or diarrhoea. Other common side effects include constipation, dizziness, and tiredness. Compared to Ozempic, Wigovi comes with a longer list of common side effects. And again, this is because of that higher dosage. There are also more serious side effects which are less common but not exactly rare. So one of them is pancreatitis which is an inflammation of the pancreas which is associated with severe abdominal pain and in some cases can even warrant hospital admission and intensive care.

8:36Dr Sophie Shotter:Yeah I've seen this on various newspaper headlines very recently. What is going on with this? So hundreds of people have reported problems with their pancreas linking it to these jabs and and this has prompted health officials to launch a study into these side effects. To date, Wigovia and Ozempic have been linked with 113 reports of pancreatitis and one death. This isn't intended to scaremonger, it's purely reporting on the facts, and we could get into some of the reported positives in a moment. But in case you aren't aware, pancreatitis is a sudden inflammation of the pancreas, which is a gland sitting behind the stomach that helps us to digest food.

9:11Symptoms include severe abdominal pain plus feeling sick and having a fever. And pancreatitis can be either acute, so comes on suddenly and goes away potentially more quickly, or chronic, which means it can grumble on for a very long period of time. Pancreatitis isn't a common side effect, but it's said to affect around one in 100 patients, so I also wouldn't call it rare. It's also worth noticing that nearly half of these cases have actually involved Monjaro. The MHRA has encouraged anyone hospitalized with acute pancreatitis to report it if they've been having these injections to the yellow card scheme.

9:49The MHRA will then invite those patients to take part in what's called the yellow card biobank study. So further research is happening and scientists are also looking to understand whether there are any genetic factors at play in terms of who gets this pancreatic reaction. Certainly the Munjaro patient information leaflet advises patients to talk to their doctor before using it if they've ever had pancreatitis before.

10:12Dr Sophie Shotter:OK, so so far I'm not overly convinced, but then again, I'm not overweight. So what's the flip side to all of this? I mean, you said there were positives with these jabs. Yeah, the most obvious one is weight loss, which can be life changing for so many people, both physically and emotionally. And beyond weight loss, there's also some really interesting new research. One study published in January suggested these drugs could actually reduce the risk of 42 diseases. including heart disease, various obesity-related cancers, kidney disease, plus Alzheimer's and a range of psychiatric conditions. There's early evidence that this is because of the drug's metabolic effects.

10:45The analysis, which involved about 2 million people, so not a small number, also linked the drugs to a noted reduction in bacterial infections and fever. So, for example, people using these weight loss drugs were actually just as likely to catch COVID, but they were less likely to die from it. They also apparently cut the risk of substance abuse as well as schizophrenia, suicidal thoughts and seizures. So, you know, at this point it's sounding like some sort of panacea, which worries me a little bit. Despite the study being short, with people taking the drugs for only three and a half years, it reported a 12 % reduction in Alzheimer's disease, which is again quite something.

11:24It's also been found that in patients with fatty liver disease, a Zempic could halt or even reverse the condition. Again, impressive. But just to return back to this reported reduction in obesity-related cancers, so things like thyroid, pancreatic, colon, breast and liver, I would ask, is it the drug link that's mitigating cancer risk or is it the weight loss? Because so many cancers are linked to obesity, and I've noticed other researchers asking the same question. It's also important to add that these researchers have warned that these drugs are not without risk. For example, they seem to increase joint pain, and again, this inflammation in the pancreas.

11:59People on the drugs are also more likely to have problems in their digestive system. So feeling sick, tummy pain, hemorrhoids, just three symptoms. The data also showed an issue with low blood pressure. So fainting, headaches, disturbed sleep, plus kidney stones, inflammation in the kidneys, and again, a range of joint pains, including cases of arthritis that became more frequent. And this was apparently the most surprising part of the study, as weight loss theoretically should reduce pressure on the joints.

12:28Dr Sophie Shotter:All really interesting and how come it's giving positive impacts on mental health? That's surprising. Yeah this is definitely interesting. The drugs appear to act on the brain's reward system which is why these neurological effects could be happening. Scientists think these drugs suppress reward mechanisms in the brain and therefore inhibits that urge to seek out for example alcohol or cigarettes. But bear in mind that weight loss can create a huge boost in self-esteem and self-confidence as well which can in turn improve mental health outcomes. And another interesting thing is that while the drug is associated with inflammation of the pancreas it's associated with less inflammation elsewhere in the body.

13:07So this synthetic version of the GLP-1 hormone is released by the gut after eating then travels through the blood and sticks to little receptors on the surface of brain cells and this tells the brain there's food in the stomach and is why people feel less hungry after eating. But these GLP-1 receptors are actually found throughout the body, including in some parts of the immune system. So it's a real mixed bag here of potentially huge benefits and yet potentially also very dangerous outcomes. I was reading comments of Professor Susan Jebb, a public health nutrition scientist at the University of Oxford, who's been researching obesity treatment since the 1980s, and I would agree with her that almost every aspect of health is better if you're a healthy weight.

13:50So again, is it simply the weight loss creating these benefits? One final point is that this big study was done in America on war veterans and the participants were primarily white men, meaning yet another study that excludes women and people of colour, which as a doctor and healthcare professional makes me really cross. Plus I've run through the side effects, but I do have more broad concerns too.

14:12Dr Sophie Shotter:Okay, so I agree with you on the study and should we run through some of your broader concerns? So I guess firstly nutrition. Because of the fact that these drugs significantly reduce appetite and the amount of food we eat, they therefore also increase the risk of nutrient deficiencies. So ensuring people know how to support their health whilst on these drugs is vital. If, for example, we revisit our Dr. Will Balsievitz podcast on the critical importance of fibre, surely there's an issue in that if people's appetite is so diminished, the last thing they want to do is have huge servings of fibre-rich food.

14:45and this all relates back to gut health which is a key pillar of health. The other issue is that people who want to control their weight typically exercise a lot and if weight loss occurs via these drugs it stands to reason that the motivation to exercise could be diminished and there's now so much data around the health benefits of exercise above and beyond the obvious fitness and lean muscle benefits. You could listen to our brain health episode just as one example. A third issue for me is that these drugs are relatively new. It's not yet clear how they'll affect our health over the course of many years.

15:19A lot of people are saying we need more time to review their impacts. For example, they're primarily indicated to treat type 2 diabetes but haven't been studied in people who've had pancreatitis. Fourthly, these drugs could have a really negative impact on people with eating disorders and my concern is could they even create an eating disorder? I was reading an article where a psychiatrist called Dr. Kimberley Dennis is quoted as saying these drugs are rocket fuel for people with eating disorders and certainly the ease of access causes alarm for me. I've heard stories of people popping into Superdrug and requesting their own dose or people using fat filters on photographs in order to be able to access doses or carrying full bottles of water while they stand on the scales and take a photograph so that they can access doses.

16:06I've also seen so many people using it as a tool to not eat enough to deliberately reduce

16:12Dr Sophie Shotter:their food intake below what is healthy that's not what these drugs are intended for and again it goes back to the cult of skinny rather than healthy because it is possible to have higher BMIs and be healthy and it's possible to have normal BMIs and be unhealthy so for me again the motivation here should be health rather than skinniness to my mind a good doctor would ensure that they take all steps to be aware of a patient's history including eating disorders but unfortunately there are so many stories already of people having very basic online consultations and as I said using these tricks or even just over-reporting their actual weight to get higher doses.

16:55One A &E doctor also recently reported young girls taking the drug in order to and I quote get beach body ready before their holiday taking too high dose and having dangerous side effects and I also worked with The Sun on an expose similar to this where it was being dispensed out of some dodgy knock-off designer clothes shop with the reported motivation of the patient who had a healthy weight to lose a stone before their holiday in a month. Because these drugs are still so new there's no what we call longitudinal data on how they affect eating disorders in the long term. There's also some evidence emerging that these drugs could trigger a relapse in someone who has already suffered from disordered eating.

17:38So medics are monitoring all of this closely. Another concern is private pharmacies creating off-brand versions of Ozempic and Wig-Ovi. I think this is more of an issue in the US where the FDA has received reports of adverse events after patients have used generic versions of semaglutide, the active ingredient, but needless to say please don't buy unregulated drugs online.

18:01Dr Sophie Shotter:So much there and part of the issue as you've alluded to is how easily accessed these drugs are. You can go online to very well-known retailers and get a prescription for as little as around£70 a month. There's very little doctor oversight if any and therefore a lot of people don't understand how these drugs work or their side effects. And what about this weird phenomenon of improved fertility and a Zempic baby as I appreciate this is a bit of a sidebar but I was reading about this. Yeah this is very strange and mostly anecdotal so I really would proceed with caution. The theory is that these jabs can indirectly improve fertility by promoting weight loss which can regulate menstrual cycles and improve ovulation particularly in women with PCOS or obesity.

18:46It can also improve insulin resistance and hormone levels again helping fertility but there are also potential negative effects such as reduced levels of LH and FSH, which are crucial for ovulation. And doctors have certainly advised against getting pregnant while on these drugs due to a lack of studies on Ozempic's use during human pregnancy and some pretty worrying outcomes observed in studies among rats. So pregnant rats who were given Ozempic had increased rates of fetal death, structural abnormalities and growth alterations, none of which sounds good. Bear in mind it can take up to six weeks for these types of medication to be gone from the body.

19:24So someone who's planning to conceive should stop them at least two months prior to conception.

19:29Dr Sophie Shotter:And what about these weight loss pills? Yeah so the tablets you might have heard of are Xenocal, Orlistat and Ally. Again these are all brand names. They're taken orally usually with food and they work differently to Ozempic and Wigovi. They basically stop your body from absorbing the fat from food you eat. It's important to say they're most effective when used alongside positive diet and lifestyle. There's another tablet called MySimba which is more similar to Ozempic and Wegovy as this also reduces your appetite and the dosage is gradually increased over time. But MySimba's active ingredients work in the brain to increase feelings of fullness whereas Ozempic and Wegovy work mostly on the digestive system to achieve the same outcome.

20:15All of that, Xenocal and MySimba are prescription only, whereas ally is available over the counter. Again, I have personal reservations about that. This could easily derail someone with an eating disorder or someone who's just not suitable for it. And I've also heard worrying stories about under 18s accessing and taking it. And I guess last but not least, another concern I have is sarcopenia, which has been shown to be an issue after use of these medications. It's an issue potentially with all weight loss, but seems to be particularly so with these weight loss injections and that means a loss of muscle mass not just fat mass so for anyone who is taking it or thinking about taking it exercise is crucial protein intake is crucial but even then i would expect you to be losing muscle mass as well as

21:03Dr Sophie Shotter:fat mass and i've been reading that for a lot of people as soon as they come off the drugs the weight piles back on which again you sort of touched on earlier should we talk a little bit more about that. Yeah, this is a bigger issue than people realise. And I'm going to quote from the expert. Professor Jeb, who I already mentioned, has found that people regain all of the weight lost within 10 months. And another obesity expert, Professor Alexandra Miras, has said, we estimate that around 95 % of people put all the weight back on once they stop taking the jabs. Dr. Martin White, a consultant in diabetes at King's College Hospital NHS Trust, has said, I haven't seen a single person who got down to a weight on GLP-1 drug, stopped it and then stayed at exactly the same weight when coming off the drug.

21:47This all makes sense from a pharmaceutical stance. So if you have somebody on a statin for their cholesterol, you stop the statin, almost inevitably their cholesterol rises. If you have somebody on a blood pressure tablet and they stop the tablet, almost inevitably the blood pressure rises. It's the same principle.

22:04Dr Sophie Shotter:I've also heard that people are now microdosing a Zenpik. What's the story here? Yes, this is about taking smaller than the recommended prescribed doses of Zenpik in order to lose weight more gradually while trying to minimise unpleasant side effects. Microdosing apparently helps reduce any nausea, constipation or reflux. And anecdotally, people have also said that smaller doses have helped them avoid other less common symptoms like brain fog. There's also a potential interest in this microdosing concept as a way of reducing systemic inflammation, which from a longevity standpoint is really interesting.