“Ozempic side effects” has become an umbrella term for reactions to all GLP-1 medications. We used to think that there was a slight difference between some of these medications, but in head-to-head trials, many of the side effects from these weight-loss medications were very similar. Osama Hamdy, MD, PhD, medical director of the Obesity Clinical Program at Joslin Diabetes Center in Boston and associate professor of medicine at Harvard Medical School, explains what you can expect…
Side effects are most common when you first start the medication
This is true for most medications. Since we start GLP-1 drugs at a low dose, side effects often are often mild. Side effects are more likely to happen on Days 1, 2 and 3 after taking the medication and improve by Days 4, 5, 6 and 7. Best: Consider this when deciding which day of the week to take your shot. Some people pick Friday so that they’ll feel better at the start of the workweek…others choose Monday so they’ll feel their best for the upcoming weekend.
Side effects vary wildly from one person to the next
There is a scientific reason for this—because of a genetic mutation, some people don’t make any natural GLP-1 or make very little, so they are more sensitive to the medication and actually are the most responsive to it. Other people have side effects with the first dose and never again…for others, it’s with every dose…and it can be everything in between. Best: Be consistent about taking the medication. If you are off it for more than two weeks, the likelihood of side effects increases when you start again.
Side effects may increase when you increase the dose
GLP-1 drugs are so effective that you may not need the highest dose to have a great response. But if you aren’t getting results from a low dose and want to increase it, work with your doctor to find the right balance of weight loss and symptoms. Not everyone can increase the dosage at the same pace or tolerate the side effects at the maximum dose. With every step of escalation, or increase in dosage, you may get side effects. Side effects usually ease over time, but if they don’t, your doctor may suggest that you go back down to the previous lower dose. The sweet spot is when hunger, appetite and cravings that made it hard to stay on your nutritional plan are well-controlled…you’re losing weight in a moderate way…and you have few to no side effects and good quality of life. Best: Gradually escalate the dose. and if you feel mild side effects at any dose, remain on it until side effects disappear before moving to the higher dose.
What Are the Bad Side Effects of Ozempic and Other GLP-1s?
Gastrointestinal side effects take the top spots—nausea (sometimes with vomiting and/or reflux), constipation or diarrhea.
Nausea
Nausea is the most common side effect, affecting up to 80% of people. Most people are willing to put up with it because they understand that they’re losing weight because of the drug’s effect on appetite. That being said, there are things you can do to help minimize nausea. Solution: Try drinking ginger ale, eating small pieces of fresh ginger or eating a small piece of aged cheese like Romano or Parmigiano. If you need stronger relief, ask your doctor about an anti-emetic, or antinausea, medication—you won’t be able to stay on it indefinitely, but it may help as a bridge. Don’t force yourself to eat. While it’s important to consume protein to help maintain muscle, eating when nauseous can cause vomiting, and that can lead to dehydration. Nausea can also be triggered by the following scenarios…
Going too long without food. Some people experience nausea in the morning because it’s been so long since they last ate. If you don’t typically eat breakfast, your odds of nausea increase. Solution: Have a small meal when you first wake up.
Eating too large a meal. GLP-1 drugs are designed to make you feel full sooner, but you may be missing that signal out of habit. Think of Thanksgiving dinner when your brain tells you you’re no longer hungry, but there’s still that slice of pie coming so you eat it…and feel nauseated afterward. Solution: Cut your meal size in half, then take a moment to assess satiety—you may be satisfied on less now. Leave the table when the sensation of hunger disappears…don’t wait until you are full or stuffed.
Eating high-fat meals. Fatty meats, butter and deep-fried foods can trigger nausea. Solution: Limit or eliminate these foods and focus on lean protein.
Eating meals high in refined sugars. Fresh or frozen fruits with natural sugars are healthy. Solution: Avoid the added sugars in foods like cookies, cakes, candy, sweetened soft drinks or fruit juices and even crackers.
Constipation and diarrhea
Solution: Boost the fiber in your diet with whole grains, legumes and fruits and vegetables…and stay well hydrated for better control of both sides of that equation. Talk to your doctor before taking any anti-diarrheal medications.
If you’re having significant side effects: Reach out to your doctor. While health-care providers don’t like to prescribe one medication to help you stay on another, there are drugs that can help you through the introductory period until you can tolerate the side effects or they go away.
Is Ozempic Face a Real Thing?
When you lose a lot of weight, regardless of how, you’ll lose fatty tissue all over your body. If you are older and have struggled with obesity for a long time, you might not have noticed the natural signs of aging in your face because of extra subcutaneous fat. But as we age, we lose elasticity and collagen, so you may be surprised by the change in your appearance when you lose fat in your face. Though the effect has been labeled “Ozempic face,” the same thing can happen after bariatric surgery and other forms of weight loss.
Long-Term Side Effects of Ozempic and Other GLP-1s
It’s important to understand all the areas of concern surrounding the use of GLP-1 drugs. Some are rare but can be serious. Best: Don’t get a prescription from an online or virtual doctor visit. Instead see a real, in-person doctor who has first given you a thorough examination.
Loss of muscle
This is the major side effect from GLP-1 drugs, and it isn’t spoken about enough. In general, independent of weight loss, people lose around 8% of their muscle mass every 10 years starting at age 40. The speed of that loss increases with age. After age 70, you lose about 15% of muscle mass every 10 years. Result: During your lifetime, you lose around 40% of your muscle mass. When you lose weight by conventional means, 15% to 25% of the total weight lost is muscle mass, so, if you lose 10 pounds, 1.5 to 2.5 pounds will be muscle.
Problem: With GLP-1 medications, the amount of muscle loss is 40% of the total weight loss…or for every 10 pounds lost, four pounds are muscle. And you will not regain the muscle easily. The amount of muscle mass lost in one year on a GLP-1 medication is the equivalent of age-related muscle mass loss over eight to 10 years. When muscle mass declines, so does muscle performance—that is when people start to develop mobility issues such as not being able to stand up from a chair.
Solution: Increase protein intake significantly and do strength-training exercises every day. Pay attention especially to the large muscles—quadriceps, hamstrings, gluteal muscle, core muscles and shoulder muscles.
Thyroid cancer
All GLP-1 medication labels carry a warning box about medullary thyroid carcinoma. That data comes mostly from preclinical studies on rodents. Keep in mind: While Zepbound has been available for only a year and a half and Wegovy for three years, Ozempic and other GLP-1 drugs have been prescribed for diabetes for at least eight years. Bottom line: If we were going to see a link to thyroid cancer, we likely would have seen it already. But if you have a personal or family history of this rare type of cancer or have the rare genetic disorder called multiple endocrine adenoma type 2 (MEN-2),which puts you at greater risk for medullary thyroid cancer, you should not take a GLP-1 drug.
Pancreatitis
The numbers are very small—about 0.34 per thousand—but there is an increased risk for pancreatitis in people taking a GLP-1 compared with people who are not, especially among those with diabetes…very high triglycerides…or gallstones…or who drink a lot of alcohol. Watch for signs such as severe pain in the middle of your stomach along with persistent vomiting. Report this to your physician right away—he/she can order a blood test to measure the digestive enzymes amylase and lipase. If they are elevated, an ultrasound can make a diagnosis. Having had pancreatitis for any reason in the past could put you at higher risk of having it again when starting a GLP-1 drug. Best: A GLP-1 medication should not be prescribed to people with any history of pancreatitis.
Gallbladder disease
Weight loss in general can increase risk for gallstones , and that risk is slightly increased when the weight loss comes from being on a GLP-1 drug. We don’t know the mechanism behind this, and it happens in a very small minority of GLP-1 users. But women in their 40s and 50s seem to be at higher risk in general after weight loss and should be monitored. Report any upper right quadrant colicky abdominal pain, especially after a fatty meal, a common sign of gallstones.
Depression
GLP-1 medications also can have a psychological impact. Weight loss in general has been linked to depression. Some people feel better after losing weight, but some feel worse because of changes in the brain’s reward center, which keeps people addicted to substances, including food. GLP-1 medications help counter food addiction, but the brain can get disrupted neurotransmitter signals, and dopamine and serotonin levels can plummet, setting the stage for depression. It’s rare, but people taking these medications should be aware of the possibility and get help if they see any signs. An antidepressant such as a serotonin uptake inhibitor might be prescribed.
If you are having surgery: Always pause GLP-1s before any type of surgery. GLP-1 drugs delay gastric emptying, so your stomach might not be fully empty just from not eating after midnight before the procedure and you could aspirate that remaining food while under anesthesia. Work with your doctor on whether you need to stop the drug one or two weeks in advance. Depending on the type of surgery you’re having, you might need to wait a certain period—until you’re back on solid foods, for instance—to restart the GLP-1. And if it’s been longer than two weeks since your last GLP-1 dose, you may need to restart at a lower dose to avoid side effects.
