New weight loss drugs like Ozempic promise easy weight loss, but there’s a hidden danger—accelerated muscle loss and frailty over time.
The Dark Side of Weight Loss Drugs: Uncovering the Hidden Risk of Muscle Loss
New weight loss drugs like Ozempic promise easy weight loss, but there’s a hidden danger—accelerated muscle loss and frailty over time.
Maybe you’re contemplating hopping on the latest weight loss CRAZE, maybe you’ve already managed to snag a prescription and you’re enjoying the benefits of one of the new “Titans of Weight Loss”,
A quick introduction
The Titans of weight loss represent a new class of weight loss therapies, officially they are classed as incretin based therapies/mimetics. They mimic the endogenous hormones, collectively referred to as the incretins, these gut hormones help to signal to the body that you’ve just eaten and that it is time to “take care” of the groceries.
“Taking care” of the groceries includes
- Shooting a note to the beta cells of the pancreas to release insulin resulting in improved glycemic control
- Keeping the contents of the stomach whooshing for a tiny bit longer i.e. slowing gastric emptying
- And putting a stop to further grocery acquisition until such time as the current load has been processed so appetite is reduced and overall food intake is decreased.
The incretin mimetic family
The poster child is semaglutide, better known as Ozempic® and Wegovy®. Semaglutide’s pharmacological categorization is as a GLP-1 agonist (the GLP refers to glucagon-like peptide).
But the family is growing………
Add-ons include
- Tirzepatide (which is a dual agonist pinging both the GLP-1 and GIP receptor)
- Retratrutide ( is a GLP-1 + GIP + glucagon agonist) all rolled into one. FANCY FANCY !
The question is should you hop on the band wagon ?
If you google right now, the answer would be HELL YES. Even the “purists” in the functional medicine camp are singing their praises and the vast majority of research appearing in the big medical data base see the class of drugs as
“THE MIRACLE we’ve been waiting for”
and the thinking is…………let’s “ADD IT TO THE WATER”.
Hang on a minute
Well for the record…………… I am not a big fan. Trained as a pharmacologist (this is someone who specializes in studying drugs), I see some BIG red flags.
Efficacy is NOT the issue
If the goal is to lose weight………….. they deliver.
This is the data from the STEP trial which put these guys on the map.
Effect of Once-Weekly Semaglutide, as Compared with Placebo, on Body Weight. Copyright 2021 Massachusetts Medical Society
A caveat : they seem to work better in clinical trials than in the real world. In real world trials the weight loss is a little more moderate especially in people who are metabolically challenged. This is not a BIG SURPRISE, this often happens in clinical trials, the reason, who goes into a trial is carefully monitored.
A close to 5 % weight loss, while not the whopping 15 % since in clinical trials, is not too shabby and the very act of losing weight more often than not improves many aspects of body chemistry, especially health parameters that are related to “obesity”.
Selective BETTER BODY CHEMISTRY
They DO NOT improve body chemistry in terms of insulin levels.
In fact quite the opposite, because of timing issues, insulin levels are boosted morning, noon and night. And for me this is a concern, because a lot of the metabolic chaos that goes hand in hand with metabolic syndrome is rooted in insulin levels being high : morning, noon and NIGHT.
They’re FOREVER DRUGS
You don’t take them, lose the weight and then STOP and live as a skinny individual thereafter. If you STOP, the weight comes right back, here is data showing the extent of the weight gain.
Change from baseline in body weight by week in participants in the semaglutide arm, grouped by categorical weight loss from week 0 to week 68. © 2022 John P. H. Wilding et al Diabetes, Obesity and Metabolism
This data reveals a lot of the time people are NO BETTER off a year down the line. And for a few unlucky souls, they are worse off than when they started. Of course, this is not unusual – it is the fundamental problem with weight loss.
Losing the weight is relatively easy. Keeping it off is the REAL CHALLENGE.
Natural but NOT natural
They are not the same as endogenous incretins, incretins are gut hormones, the drugs are primarily acting outside of the gut.
High circulating levels are NOT natural.
The impact of high circulating levels 24/7 long-term is UNKOWN.
But it is unlikely to be completely BENIGN.
The UNKNOWN stems from the fact the drugs only came onto the market in 2021, so they just haven’t been around long enough to know what the long term impacts will be. There are hints of some serious adverse events e.g. pancreatitis.
They don’t fix body chemistry where it matters
What we do know….
They don’t FIX insulin resistance/hyperinsulinemia, actually they perpetuate it, because the way they lower sugar levels is by BUMPING UP insulin production, around the clock.
But the negative impact on metabolic health doesn’t stop here : let me explain.
Weight = fat and muscle
When it comes to DIETING, we talk about weight loss, but the real goal is fat loss. When you lose weight, you can and do lose fat, but you can also lose muscle.
It’s a problem with any “weight loss” strategy, including conventional dieting, but this class of drugs seems to AMPLIFY the problem. Head to head comparisons highlight the true extent of the problem.
So how much muscle loss are we talking about ?
Few studies have documented the extent of the muscle loss, one that did, suggested the muscle loss was in the order of 6 kg.
Relatively speaking, this is A LOT. You are losing muscle as you age, this loss clocks in at 1 – 3 kg per decade. PER DECADE !
So 6 kg in 72 weeks is SIGNIFICANT!
Lost muscle brings frailty
And remember it’s this muscle loss that drives GETTING OLD and when enough muscle is GONE, you fall into the category of frail. The medical terminology for this is sarcopenia (too little flesh).
When you’re frail : you’re vulnerable.
To falls, to infections, to EVERYTHING.
And low muscle mass is not just a problem for ninety two year olds, it is one of the first signs of metabolic troubles. Read more here.
So the weight loss induced by the TITANS of weight loss is TAINTED.
So should you avoid them ?
This is biology – it depends. You do need to weigh up the pros and cons and mitigate the risks.
Muscle loss is a thing, FOR EVERYONE.
This is not a case of adverse event that happens because you are somehow genetically disadvantaged, it’s going to happen.
The extent of the loss is impacted by
- genetics
- age,
- gender
- metabolic status
Muscle mass is adaptable
Fortunately muscle can be “built” – with sweat and tears. Okay, maybe the tears are optional, but the sweat isn’t.
To build muscle you need to WORK THEM.
The best way to work them is to make them LIFT/PUSH/PULL heavy things. The official name for this kind of exercise is resistance training. And research shows it does help mitigate the muscle loss.
Effects of Liraglutide combined with exercise on body composition . The blue shows the drug on its own, the yellow the drug + exercise. Mmmm, the green confirms exercise alone has legs.© 2024 by the American Diabetes Association
Of course…….. this is HARD WORK, but exercise plus a weight loss titan trumps the drug on it’s own.
Mitigating the risk
A win ? You bet, but it does challenge the idea of EASY WEIGHT LOSS thanks to drug therapy. Lol.
I think creating BETTER BODY CHEMISTRY without drugs is a better option and it is more do-able than you might think, especially if you use biological principles. If this is an option you want to explore……. sign up for a day of Voxer, let me help you figured out where to begin.
Further reading
Don’t let your pain medication put you in a wheelchair ?
When it comes to medications, what goes in, must come out, and it’s getting paracetamol “out”, that is it’s Achilles heal – putting you at risk of health problems
Eating protein saves your muscles while the fat cells burn
You’ve decided to go on diet to lose some of those extra pounds. You plan to lose the fat, which is creating the somewhat unsightly belly tyre, but will you ?.
Are You Losing Muscle Without Realizing It?
You might be losing muscle without realizing it even when you’re trying to improve your health by hitting the gym and lifting heavy.