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The Case:

Hadley has been struggling with weight loss for years and is now in perimenopause.
She’s tried many diets but the results were temporary.
She eats mindfully avoiding gluten, processed foods, and sugar.
She was intrigued by the hype around Ozempic (semaglutide) but wanted to make sure it was safe and that there weren’t other issues at play in her weight mystery.

Weight Loss Struggles and Hormone Changes in Perimenopause

Hadley’s struggle is so common. Perhaps it’s familiar to you too? You hear about the latest trend in weight loss and wonder (hope) that it’s going to be what helps you get your metabolism working in your favor so you can drop those last few pounds and keep them off. Ozempic has put semaglutide in the news with so many people talking about its popular side effect of weight loss with ease. But, like Hadley, you may have wondered - is it safe and does semaglutide really work for weight loss? The Functional Medicine View of Ozempic for Weight Loss

Emily Sadri is a long-time friend of the show. She joined us on episode 107 to share all kinds of eye-opening information about birth control pills and thyroid.

Because of that informative episode, I knew she was just the person to talk to about Hadley’s case and this trend of using semaglutide for weight loss purposes.

Emily is a board-certified Women's Health Nurse Practitioner, and hormone and weight loss expert. She owns and operates a boutique women’s functional medicine practice in Cleveland, Ohio, and helps women everywhere live more balanced, healthier lives. What is Semaglutide (originally marketed as Ozempic)?

Semaglutide is a peptide drug that was initially marketed as a medication for diabetes. Developed by Novo Nordisk in 2012, semaglutide was later found to have the potential for weight loss. The drug is now available under the commercial name Wegovy and is prescribed for obesity. How does Semaglutide Work?

One of the most impressive things about semaglutide is its multi-faceted approach to weight loss. Unlike many weight loss medications that rely on appetite suppression or stimulants, semaglutide works by slowing down digestion and promoting a feeling of fullness.

In this episode, Emily explains that by slowing gastric emptying, semaglutide delays the movement of food from the stomach into the small intestines, which helps to control appetite and reduce food intake. The drug also acts on the hypothalamus, a part of the brain that regulates signaling for many different functions.

The hypothalamus controls sympathetic nervous system signaling, and semaglutide modulates and increases sympathetic output just enough to stimulate lipolysis or fat breakdown. This action raises people's basal metabolic rate slightly, which over time results in weight loss. What did the Clinical Studies on Semaglutide Find?

Clinical studies have shown that people treated with semaglutide for weight loss have an average of 15% body weight loss, which is a remarkable achievement. This weight loss was achieved without significant lifestyle or diet counseling, making semaglutide seem like exactly what the weight loss market has been waiting for.

But…

As a practitioner who primarily works with women aged 35 to 55 who often have a thyroid issue or Hashimoto’s, I'm sensitive to anything that stimulates stress pathways. Emily agrees with my caution but says semaglutide is an appealing option for women who are looking to lose weight but want to avoid the side effects of stimulant-based medications. Unlike stimulants, semaglutide doesn't suppress appetite in the same way, which is better for metabolism in the long term. However, sustainable weight loss isn’t just about eating less. Exploring the Emotional Component of Weight Loss

In this episode, we also discussed the emotional component of weight loss and how important it is to acknowledge and address it. We talked about how people need reassurance to feel confident about the weight loss process and how feedback can be a useful tool in achieving success.

She explained that extreme dieting can be deleterious for hormones, create stress, and cause women to feel like nothing will work. She emphasized that restoring balance is crucial and shared how semaglutide, can help stabilize glucose levels and create a sense of evenness, reducing anxiety around blood sugar irregularities. Understanding Semaglutide and Its Effects on Glucose Levels

Semaglutide works for type II diabetes because it raises insulin initially, which is contrary to anti-insulin theories. However, it also helps lower glucose levels. Stabilizing glucose levels can help women overcome the glucose rollercoaster that they often experience. When glucose levels stabilize, the anxiety and chemical dips in blood sugar that drive hunger disappear; leading to a sense of zen detachment from food. The Role of GLP-1 in Weight Loss

GLP-1 is a peptide hormone that signals satiety and fullness, which helps with weight loss. When we produce more GLP-1, it increases our sensitivity to leptin, our satiety hormone. Emily points out that we don't fully understand why some hormone signals get messed up along the way, but it's likely due to the abundance of food we have access to all the time. This abundance makes us eat as much as we can get our hands on, which causes us to ‘save up for a rainy day’ that doesn't come in modern America. It's one of the main drivers of the obesity epidemic, according to one theory. Using Semaglutide is Not a Silver Bullet

After our in-depth discussion about using semaglutide for weight loss purposes, Emily cautioned that it's not a silver bullet. While it can provide significant support, she emphasizes the importance of also adopting lifestyle changes, such as reducing processed foods and sugar, and increasing healthy fats and proteins. It's also important to find a sustainable way of eating that works for you and creates balance. She reminds us that weight loss is not just about looking good but about metabolic health, longevity, and overall well-being. Is Semaglutide for Weight Management a Long-Term or Short-Term Solution?

As a weight management medication, semaglutide was designed to be a long-term solution. But from the perspective of functional medicine, Emily explains, it is important to look at transitioning off the medication or moving to a small maintenance dose that may not even need to be given weekly. The goal is to promote healthy metabolic flexibility and the ability to burn fat easily, which can be achieved by working on all the other things that support weight loss and good health. What You Need to Know about Taking Semaglutide for Weight Loss

Before jumping on the Ozempic bandwagon, here are the key things you need to know about semaglutide:

Side Effects of Semaglutide

Generally, semaglutide is given as a weekly injection and is titrated slowly from a quarter of a milligram to the target dose of 2.4 milligrams to avoid side effects. The primary side effects that people experience are nausea, reduced appetite, anorexia, and initial fatigue. However, these side effects are usually transient, and most people can tolerate them well. Some people are more sensitive to the gastric peptides that the medication increases than others, which can cause nausea, stomach pain, or a feeling of being sick.

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