There was a big splash in blood sugar management for diabetics with the addition of the drug semaglutide. Not too long after, semaglutide was approved by the Food and Drug Administration to also be used for “overweight” individuals 12 years and older to help them lose weight. According to the drug company SingleCare, semaglutide was so popular from 2021 to 2022 that prescriptions for one brand name of it tripled.
How it Works
In technical terms, semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist and occupies the GLP-1 receptor in the brain that regulates appetite. Basically, it mimics a natural hormone in the body called incretin, which is made primarily in your digestive tract, to help you eat less, reduce your hunger and cravings, and feel fuller for longer.
The issue for many integrative healthcare practitioners is that semaglutide also slows gastric emptying and can have a multitude of side effects. These may include nausea, fatigue, headaches, constipation, diarrhea, belching, passing gas, vomiting, hair loss, recurrent fever, stomach paralysis, kidney damage, pancreatitis, gallbladder disease, and thyroid tumors.
Cost Conscious
Then there’s the financial cost of semaglutide. According to Peterson KFF Health System Tracker, a not-for-profit online monitoring hub for healthcare cost and quality, a one-month supply of the four brand-name semaglutide drugs costs between $936 and $1,349. When being used for weight loss in patients who are not significantly overweight, insurance may not cover this cost. Semaglutide is a long-term treatment for obesity, and most patients will stay on it for a year or more and then slowly wean off. However, Diabetes, Obesity and Metabolism reports that two-thirds of people regain the weight they lost one year after they stop taking semaglutide.
So, is taking semaglutide just to shed a few pounds a good idea? Who shouldn’t take it? What kind of diet should you follow while taking semaglutide? What do we know about the long-term effects of the drug? Are there natural alternatives to semaglutide? Read on to find out how different healthcare practitioners answer these questions.
The Good, The Bad, and the Old
Cara Phillipo, ND, at Natural Path Medicine in Portland, says semaglutide can be a useful tool for both obese and overweight patients trying to lose weight but that patients should also be prepared to change their diets while on semaglutide. She states that patients using semaglutide should avoid fatty, sugary, spicy, and fried foods. She recommends eating a bland whole-food diet and drinking plenty of water to help reduce any of semaglutide’s adverse side effects, particularly nausea, vomiting, bloating, constipation, and abdominal pain. Dr. Phillipo reminds patients that semaglutide is a long-term treatment, and this diet should be followed for the duration of its use.
Nicole Sundene, ND, of Scottsdale Naturopathic Clinic, says that semaglutide stimulates receptors in the hormone system and can negatively impact your hormone balance. “Is it worth risking thyroid and hormone health? Not yet, in my humble biochemistry opinion,” she says. “Also, we don’t know the long-term consequences beyond a few years.”
Dr. Sundene is correct. Most peer-reviewed, published studies of semaglutide are approximately two years long most of these studies also report that once a patient stops taking semaglutide, the weight often returns.
NHD Regenerative Medicine’s Sara Jo Walton, ND, discusses an overlooked issue regarding using semaglutide for weight loss. She calls it “semaglutide face,” where people lose weight so quickly that their facial skin begins to sag, wrinkle, and they appear older-looking. Dr. Walton says that patients with this problem may then turn to plastic surgery to help rejuvenate their appearance, which comes with a whole slew of other risks.
Who Should Use It?
Dr. Diana Thiara, the medical director of the University of California, San Francisco (UCSF) Weight Management program and the program director of UCSF Obesity Medicine Fellowship, makes it clear that semaglutide should only be used by people with diabetes, those who are obese or dealing with comorbidities associated with a high BMI.
“It’s not about how people look it’s about their health. If you’re a [healthy] weight or even in an overweight category but not showing signs of the risk of having elevated cardiometabolic disease, you don’t need to be taking this medication for weight loss. That’s not the goal, and it’s not safe,” Dr. Thiara says.
In a 2023 California Institute of Behavioral Neurosciences and Psychology review, both bariatric surgery and semaglutide treatment were found to be useful for those with a BMI of 30 or greater. The review suggested that bariatric surgery had a higher efficacy but carried more risk of complications over semaglutide treatment, which offered notable weight reduction benefits with a lower risk profile but also required continued treatment in order to maintain that weight loss.
Reproductive Risks
With known side effects ranging from nausea to possible thyroid cancer, semaglutide has another hidden risk that may not be top of mind for some patients.
According to the Centers for Disease Control and Prevention, nearly 45% of pregnancies in the US are unplanned. That’s why some doctors recommend that women of child-bearing age taking semaglutide also use birth control. There are no data on the effects of semaglutide on human fetuses. However, animal studies suggest the possibility of harm to offspring. Owing to its long half-life, manufacturers of semaglutide include a warning that semaglutide should not be taken by pregnant or nursing women and should be discontinued at least two months before a planned pregnancy.
Other Alternatives
Because semaglutide is a synthetic version of incretin, no natural sources are an exact reproduction. With that in mind, Videhi Patel, MD, an internist in Pensacola, mentions a few alternative supplements and/or herbs that may support healthy blood sugar and glucose metabolism, which may promote weight loss.
Berberine is a natural compound found in different plant species. Dr. Patel says that clinical research studies have demonstrated the role of berberine in supporting healthy blood glucose and lipid metabolism. Although the mechanisms underlying these beneficial effects are not entirely clear, it has been hypothesized that the modulation of gut microbes may be one mechanism by which berberine affects blood glucose metabolism.
Dr. Patel says that people with type 2 diabetes tend to have lower magnesium levels in their blood compared with other people. Because magnesium participates in metabolizing blood glucose, magnesium supplementation may support healthy blood glucose in such individuals.
Dr. Patel also suggests that aloe vera gel complex may support weight loss by boosting metabolism, lowering blood sugar levels, and reducing insulin resistance in prediabetic and obese patients.
Dr. Patel warns that magnesium and aloe vera can have a laxative effect, so patients should consult their healthcare practitioner before taking any natural product for weight loss.
Lastly, studies have found that cinnamon’s insulin-mimicking effect may support weight loss and healthy cholesterol and glucose levels.
Patient Beware
As with many weight loss trends, there are scores of healthcare providers, websites, and other sources available for people to get semaglutide. Dr. Sundene says patients should be cautious of getting a new drug they’ve never taken before without an in-person medical visit and be especially wary of getting it without a prescription.
Because Ozempic®, Wegovy®, and Reybelsus® are patented medicines only available by prescription and there are no generic versions of these drugs available yet, what some websites or clinics are offering customers may not be semaglutide at all. They could be selling the salt forms of it, which are usually only used for research purposes, may not be safe, and may not provide the desired effects.
Another possibility is that what is labeled “generic” semaglutide may actually be a compounded version. While regulated and licensed compounding pharmacies are able to produce semaglutide-compounded drugs under certain instances, they don’t go through the same rigorous testing and approval process as patented semaglutide drugs. The FDA has stated that it has received reports of safety problems in people using compounded semaglutide.
Dr. Sundene suggests the safer, most cost-effective alternative to semaglutide: thorough health testing and evaluation by a licensed healthcare practitioner, healthy eating, exercise, herbal and nutritional supplements as needed, and, in some cases, hormone balancing.
