Semaglutide is the active pharmaceutical ingredient in the brand-name drugs, Ozempic, Wegovy and Rybelsus. It is a GLP-1 agonist, which means it binds to the GLP-1 receptor within our cells and stimulates it. GLP-1 stands for glucagon-like peptide-1. Stimulation of this intracellular receptor increases insulin release, reduces glucagon release, slows gastric emptying, and reduces appetite via enhancement of satiety signals within the brain. These mechanisms together lower blood sugar levels and lead to weight loss. By the way, insulin is the primary hormone that causes sugar to leave the blood and enter the cell, while glucagon is an important hormone that causes sugar to leave the cell and enter the blood. Another important hormone that causes sugar to leave the cell and enter the blood is cortisol, the stress hormone.
Semaglutide has been out for some time, and initially, I was quite hesitant to prescribe it. As far as I’m concerned, doctors are supposed to focus on “first do no harm.” So, a good doctor should be more focused on not harming you than on helping you. Throughout my career, I’ve never “jumped on the bandwagon” with any new drugs. I have always thought to let other people be the “guinea pig” and not my own patients. Only when and if a drug would prove itself safe in the general population over many years would I ever consider using it in my own patients.
As time has passed, I have used these drugs on certain of my patients, and have found them to be safe and effective. Again, I focus first on safety and tolerability, and only then secondarily on effectiveness. Any treatment must be tolerated and safe as well as effective. If the treatment is not tolerated, we stop it. If the treatment causes any problems or seems unsafe in any way, we stop it. And, obviously, if the treatment is not effective, we stop it.
There are individuals who should not take these drugs. There is a connection between these drugs and an increase in the likelihood of certain thyroid cancers. This obviously proves these drugs interact with the thyroid gland in some potentially harmful way.This shouldn’t be surprising, since all hormones are interconnected. Thyroid hormone, insulin and glucagon are very connected since they are all energy hormones. Another important energy hormone is cortisol.
So, please make sure if you’re going to take semaglutide, you are working with a physician who is very well-trained in all these hormone systems, especially all the energy hormones. I would strongly recommend against going to any of these “health spas” to get these drugs. You’re asking for big problems if you do so, as far as I’m concerned.What I will do before starting these drugs is get baseline testing in all related hormone systems, insulin, thyroid and cortisol, as well as growth hormone and sex hormones. The patient will be closely monitored during treatment to ensure that no abnormalities are occurring anywhere within their metabolism, especially in any of these interconnected hormone systems.If such a thoughtful approach is undertaken, I believe these drugs can safely be used.
The next issue is effectiveness. In my experience, the weight loss happens because of an associated reduction of caloric intake, not because of any other “magical” pharmaceutical benefit. When people take these drugs, they experience a definite reduction in appetite. Because of this, it’s much easier to consume less calories day by day, and that’s why people end up losing weight.I do have a few patients who haven’t lost much weight on these drugs, and the reason, whether they want to admit it or not, is that they “out eat” them. If you take these drugs and don’t dramatically change your behavior in terms of decreased intake of food, not much good will happen.
Another issue with these drugs is their extreme cost. The brand name products are incredibly expensive. All you end up paying for is the brand-name and a fancy injecting device, as far as I’m concerned. In my practice, I offer a safe and effective compounded semaglutide product at a dramatically lower price than the brand-name products. I keep track of all the associated hormones to make sure nothing abnormal is happening within the body. I don’t just wait around like most doctors and hope nothing bad happens in the future, such as thyroid cancer. I also work closely with my patients in terms of dietary modification to ensure that they end up losing a great deal of weight.The plan I make with my patients is to use semaglutide to assist them in losing weight to achieve a goal bodyweight. At that point, we slowly get off the drug while we continue with the learned behaviors related to reduced daily caloric intake. This should ensure that the patient remains at their goal bodyweight while being off the drug.
In closing, semaglutide can be very helpful in losing weight and achieving a healthy goal bodyweight. But, you really need to work with a physician who truly understands insulin and its relationship and interconnections with all the other hormone systems of the body.
