As more and more people get on GLP-1 medication (Ozempic/semaglutide or Mounjaro/Zepbound/tirzepatide), I want to take a moment to give you the safety guidelines that will keep you out of trouble as much as possible.  There are some serious side-effects that are emerging and most of these are in your control!!

READ ON to learn key things you need to be doing, new side-effects reported and what tests to have followed while taking these medications….

Some of the biggest side-effects are due to life-style choices.

  1. Malnutrition is REAL especially when these medications take away your appetite and next thing you know you are eating 500 calories a day consistently. Skin becomes even more lax, hair starts falling out, unusual bloating occurs, fatigue, delayed healing, swelling and more all occur.  Do I really need to continue to list all the symptoms that can happen with malnutrition?

LIFESTYLE CHANGE:

  • EAT healthy, regular meals. If you make the necessary changes to your diet, you can probably lower your dose (with your doctor’s advice, obviously).
  • Consume enough protein for your height and weight (often a minimum of 60 grams up to 120 grams daily)
  • Consume enough good fats (fatty fish, avocados, nuts/seeds and olive oil for example)- this should be around 30% of your daily intake
  1. Constipation continues to be an issue and people have been hospitalized for this!

LIFESTYLE CHANGE:

  • Hydrate – drink ½ your body weight in ounces of water (ex: 160 pound person needs 80 ounces of water daily)
  • Fiber – you need between 30 grams to 60 grams daily depending on your size. A general rule of thumb is to take an additional 20 grams of protein daily in ADDITION to a healthy diet.  If you aren’t eating lots of fiber in your food choices then you will need more.  Think of simple ways of adding fiber like eating chia seeds daily, adding fiber like Sunfiber which has a unique guar gum base for the fiber which is often tolerated better than psyllium.
  1. Pancreatitis has been reported and I have seen pancreatic enzymes increase in a few people even after being on it for quite a bit of time. We adjusted the dose and frequency and these did come down but you have to pay attention.  Symptoms can be increased nausea after injection or pain on the left side of your abdomen.
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LIFESTYLE CHANGE:

  • Limit alcohol intake while taking these medications. Alcohol by itself can induce pancreatitis so adding these together is often asking for trouble!
  • If you are doing intermittent dosing (for example, once a month). You must use the starter dose rather than the higher doses you have increased up to.  There is a reason doctors start with the lowest dose and titrate you up every 4 weeks.  Coming in at a higher dose without titrating up can make your pancreas very angry.
  1. Vision loss. A specific type of vision loss called non-arteritic ischemic optic neuropathy (NAION) is starting to be reported.  This causes blurring of the vision, typically in one eye and guess what…it may improve but typically doesn’t go away!  The rapid drop of the blood sugar seems to create this issue especially in people who already have vascular disease.  Diabetics seem to be at higher risk but not always.  Higher doses of the medication may also have a higher risk.

LIFESTYLE CHANGE:

  • Don’t hurry and increase the dose. Recommendations are staying at each dose for at least 4 weeks before going up.
  • Don’t automatically increase the dose unless you really need it and use the lowest dose possible. If you are losing a pound a week then just continue what you are doing and don’t increase just because you have been told you can.  More is not always better!
  • If you experience any vision loss go see your ophthalmologist immediately.

Follow your blood work.  It is alarming how many clinics (especially the online ones) are not requiring this.  Changes can often be seen prior to major issues.  I recommend following labs every 4 months.  Check the blood counts, liver, kidney, pancreas and thyroglobulin antibodies each time at a minimum.

These medications have been important for so many conditions way beyond weight loss so regardless of why you are taking them be sure and follow these guidelines to continue a safer journey.

To your health,

Laura