Semaglutide (aka Wegovy/Ozempic)

Semaglutide is the same medication prescribed under the brand names of Ozempic and Wegovy, FDA approved for weight loss.

So, how does it work?

The short version is that it decreases appetite by making you feel full sooner and stay feeling full longer, so you eat less and you lose weight. You consume fewer calories. It has been proven effective in clinical trials and we have seen amazing results in our patients!

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What is Semaglutide and how exactly does it work

Semaglutide was originally developed to treat Type 2 Diabetes. Ozempic and Wegovy are the same medication, sold under brand names. They all contain the same active drug. Semaglutide is a GLP-1 (Glucagon-like peptide) receptor agonist. GLP-1 is a hormone produced in the small intestine after you eat that tells your brain you are full and don’t need to eat any more. Semaglutide works the same way as your body’s GLP-1 with one significant difference – it lasts longer than the body’s natural hormone – so you feel satisfied for longer. You eat less and are also much less likely to snack and feel hungry between meals. Semaglutide also helps to keep your glucose and insulin levels balanced. Your cravings for sugars, carbs, the foods that get many of us in trouble are decreased. What we have seen in our patients is that you just no longer want these foods. It isn’t a struggle to give them up, you don’t want them. It really is a game changer since it works in the part of the brain that controls our hunger. Combined with a healthy diet and exercise you will lose weight. 

If I'm not diabetic will Semaglutide cause low blood sugar?

No, it will not make your blood sugar drop if you are not diabetic. GLP-1 can increase the production IF your glucose level is too high, as in a diabetic. When glucose levels are too high, there are receptors in the pancreas that are then activated and the GLP-1 can then and only then cause increased production of insulin. So if the sugar level isn’t too high, your body won’t let more insulin be made. The human body really is pretty amazing. 

What are the side effects of Semaglutide?

It is important to remember that every medication can have side effects and that not everyone who takes a medication experiences side effects. With Semaglutide those who do experience side effects usually find that they are GI related and go away within a few weeks once their body gets used to the medication.  

Another important point to remember is that through our experience we have found the key is in dosing. Patients started at low dose and titrated up have tolerated Semaglutide very well with few side effects. Those we have heard about, not treated by us, who have had a lot of GI complaints, were started immediately on higher doses or titrated up too quickly.  

The most common side effects of Semaglutide include:

  • Nausea/vomiting
  • Diarrhea/constipation
  • Bloating
  • Abdominal discomfort
  • Heartburn/Indigestion

It is important to remember that Semaglutide does slow down the digestive process you need to monitor for constipation and increase your water and fiber intake (fruits and vegetables) and even take a fiber supplement. Any bowel issues you experience when starting Semaglutide usually taper off within a few weeks once your body has some time to adjust. 

The side effects, IF you experience any, are usually self-limited, meaning they will go away on their own, within a few weeks as your body gets used to the medication.

Is Semaglutide safe for me?

Semaglutide is safe for most people. Wegovy is FDA approved for weight loss and well tolerated. 

If you have a history of any of the following you may not be able to take Semaglutide and need to be sure to discuss with your provider:

  • History of thyroid cancer or Multiple Endocrine Neoplasia
  • Allergy to Semaglutide, Ozempic, Wegovy
  • Type 1 Diabetes
  • Diabetic eye disease
  • Gallbladder disease or history of pancreatitis

There are some medications that may interact with Semaglutide and you should discuss with your provider before starting to decide if this will be a safe treatment for you including:

  • Warfarin or other blood thinners
  • Insulin
  • Other diabetes medications

Tirzepatide (aka Mounjaro)

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Tirzepatide is the same active drug prescribed under the brand name of Mounjaro. 

How does it work?

Tirzepatide decreases appetite by making you feel full sooner and stay feeling full longer so you eat less lose weight. It has also been shown to increase insulin sensitivity and improve Triglyceride clearance which may prevent fat deposition. 

How is Tirzepatide different?

Tirzepatide was developed to treat Type 2 Diabetes and is sold under the brand name Mounjaro. Like Semaglutide, Tirzepatide is also a GLP-1 receptor agonist. It works to suppress appetite and increase satiety – feeling full. After you eat and blood sugar levels rise, GLP-1 also stimulates your body to produce more insulin and suppresses the production of glucagon, keeping your body in balance. In addition to the GLP-1 action, Tirzepatide also contains a GIP (glucose-dependent insulinotropic polypeptide) receptor agonist. GIP also helps to suppress hunger, stimulate insulin release and increase insulin sensitivity which may prevent fat deposition. Ectopic fat deposition, deposits in the liver, in muscles, visceral fat (in the abdomen), even around the heart and blood vessels, can increase risk of cardiovascular disease. 

If I'm not diabetic will Tirzepatide cause low blood sugar?

No, it usually does not cause low blood sugar. GLP-1 can increase the production IF your glucose level is too high, as in a diabetic or after you eat. When glucose levels are too high, there are receptors in the pancreas that are then activated and the GLP-1 can then and only then cause increased production of insulin. So if the sugar level isn’t too high, your body won’t let more insulin be made. GIP also protects against low blood sugar and helps keep you balanced. 

Are the side effects for Tirzepatide the same?

It is important to remember that every medication can have side effects and that not everyone who takes a medication experiences side effects. With either medication those who do experience side effects usually find that they are GI related and go away within a few weeks once their body gets used to the medication.  

Just like Semaglutide, with Tirzepatide we have found that appropriate dosing and titration is key to success and to minimizing side effects. Those we have heard about, not treated by us, who have had a lot of GI complaints, were started immediately on higher doses or titrated up too quickly. 

The most common side effects of Tirzepatide include:

  • Nausea/vomiting
  • Diarrhea/constipation
  • Bloating
  • Gas
  • Abdominal discomfort
  • Heartburn/Indigestion

It is important to remember that Tirzepatide also slows down the digestive process and you need to monitor for constipation and increase your water and fiber intake (fruits and vegetables). I usually recommend a fiber supplement at least for the first month. Constipation/diarrhea, if experienced, usually taper off over the first few weeks. 

The side effects, IF you experience any, are usually self-limited, meaning they will go away on their own, within a few weeks as your body gets used to the medication.

Is Tirzepatide safe for me?

Tirzepatide is safe for most people.  

If you have a history of any of the following you may not be able to take Tirzepatide and need to be sure to discuss with your provider:

  • History of thyroid cancer or Multiple Endocrine Neoplasia
  • Allergy to Tirzepatide
  • Type 1 Diabetes
  • Diabetic eye disease
  • Gallbladder disease or a history of pancreatitis

There are some medications that may interact with Semaglutide and you should discuss with your provider before starting to decide if this will be a safe treatment for you including:

  • Insulin
  • Other diabetes medications

How long will I need to take medication? Will I regain once I stop?

There are different thoughts about this. Our belief is that medication is only part of the solution to long term success. While taking the medication you are also changing the way you eat, live and think about food. There are experts in the field of obesity medicine that recommend long term continuation of Semaglutide, stating that obesity is a chronic disease and requires chronic treatment and Semaglutide is believed to be safe long term. There are also experts in the field who believe that you can maintain your weight with sustained diet and lifestyle changes. 

We will individualize a plan for you. You will start at a low dose and titrate up. This doesn’t always look the same for everyone. Once you achieve your goal weight you will start to titrate back down while maintaining your goal weight. One option would be that once you titrate back to the lowest dose and have maintained your goal weight for 3 months we discontinue the Semaglutide. You continue with a healthy lifestyle, diet and exercise and maintain your healthy new weight. 

Again, everyone is different and this is something we would need to discuss with you individually.