June 12, 2023 – Johnna Mendenall was never “the skinny friend,” she said, however the demands of motherhood – together with a sedentary office job – made weight control even harder. Fearing that type 2 diabetes within the family might catch up along with her, she decided to start out taking Wegovy weight-loss shots.
Nervous about possible unwanted side effects, she stared on the Wegovy pen for five days before mustering the courage to present herself her first 0.25-milligram injection. And sure enough, the unwanted side effects were severe.
“The nausea started,” she said. “When I increased my dose to 1 milligram, I was vomiting all night long from 10 p.m. to 5 a.m. I almost quit that day.”
Mendenall is certainly one of a growing number of individuals sharing personal stories online in regards to the weight-loss drug Wegovy — and similar drugs — and discussing their sometimes unpleasant and potentially heartbreaking unwanted side effects.
While gastrointestinal (GI) symptoms appear to be probably the most common, a protracted list of other symptoms have been discussed within the news, on TikTok and in online forums. These include the “Ozempian face,” or gaunt look some get after taking the drug, in addition to hair loss, anxiety, depression and debilitating fatigue.
Mendenall's predominant unwanted side effects were vomiting, fatigue and severe constipation, but she has also noticed some positive changes: The “eating sound,” or the urge to eat when she's not hungry, has disappeared. Since her first dose 12 weeks ago, she has lost weight from 236 kilos to 215 kilos.
Warning
The energetic ingredient in Wegovy, semaglutide, mimics the function of a natural hormone called glucagon-like peptide, or GLP-1making you are feeling full. Semaglutide is utilized in lower doses under the brand name Ozempic, which is approved for type 2 diabetes and is used off-label for weight reduction.
Both Ozempic and Wegovy contain a Warning for possible unwanted side effects. The commonest are nausea, diarrhea, stomach pain and vomiting.
With the increasing popularity of semaglutide, increasingly more individuals are receiving prescriptions through telemedicine firms and foregoing
more extensive consultations, which ends up in more unwanted side effects, says Caroline Apovian, MD, professor of medication at Harvard Medical School and co-director of the Center for Weight Management and Wellness at Brigham and Women's Hospital.
Experts say it's helpful to start out with low doses and progressively increase them over time to avoid unwanted side effects, but insurance firms often require a faster timeline to proceed covering the drugs, Apovian said.
“Insurance companies are practicing medicine for us by requiring patients to increase their dose [too quickly],” she explained.
Mendenall's insurance has paid for her Wegovy vaccinations, but without that coverage, she said it would cost her $1,200 a month.
There are similar drugs on the market, such as liraglutide, sold under the name Saxenda. However, it is injected daily rather than weekly and also has side effects and has been shown to be less effective. a clinical studyIn the subjects studied, the average body weight decreased by 15.8% with semaglutide and by 6.4% with liraglutide over 68 weeks.
Tirzepatide, sold under the brand name Mounjaro – a type 2 diabetes drug from Eli Lilly that may soon receive FDA approval for weight loss – may have fewer side effects. In clinical trials, 44% of patients who took Semaglutide had nausea and 31% reported diarrhea, compared to 33% and 23% of those who Tirzepatidealthough no study has directly compared the two active ingredients.
Loss of bowel control
Wegovy and Saxenda are currently the only GLP-1 agonists approved for weight loss. Their manufacturer, Danish pharmaceutical company Novo Nordisk, is facing a second Wegovy shortage due to increasing demand.
Personal stories online about semaglutide range from overwhelmingly positive—just what some need to win a lifelong battle with obesity—to harsh scenarios with potentially long-term health consequences, and everything in between.
One private community on Reddit is dedicated to a particularly unpleasant side effect: Loss of bowel control while sleeping. Others reported uncontrollable vomiting.
Kimberly Carew of Clearwater, FL, started taking 0.5 milligrams of Ozempic last year after her rheumatologist and endocrinologist recommended it to treat her type 2 diabetes. She was told it would help her lose weight, which she hoped would also ease her joint and back pain.
But after increasing the dose to one milligram, her initially mild gastrointestinal symptoms became unbearable. She couldn't keep food down, and when she vomited, the food often came back up whole, she said.
“One night I ate ramen before I went to bed. And the next morning it came out the same way it went in,” said Carew, 42, a registered counseling mental health intern. “I had severe heartburn and couldn't eat a few bites without feeling nauseous.”
She also suffered from “sulfur burps,” a side effect reported by some Ozempic users that caused her to sometimes taste like rotten eggs.
She was diagnosed Gastroparesisthe weakening and paralysis of stomach muscle contractions, making it difficult to digest food. Some types of gastroparesis can be resolved by stopping GLP-1 medications, as mentioned in two case reports in the Journal of Investigative Medicine.
Good Hormones
GI symptoms are most common with semaglutide because the hormone GLP-1 it mimics is secreted by cells in the stomach, small intestine and pancreas, said Anne Peters, MD, director of USC Clinical Diabetes Programs.
“That's the purpose: The unwanted side effects are real since it's a gut hormone. It increases the degrees of something your body already has,” she said.
But like Apovian, Peters said these side effects could likely be avoided by starting with the lowest dose and then gradually increasing the dose.
While the average starting dose is 0.25 milligrams, Peters says she often starts her patients with about an eighth of that — just “a tiny dose.”
“It will take months for them to reach the initial dose, but why the rush?”
Peters said she also avoids giving diabetes patients the maximum dose, which is 2 milligrams per week for Ozempic (and 2.4 milligrams for Wegovy for weight loss).
When asked about the side effects of the drugs, Novo Nordisk replied: “GLP-1 receptor agonists are a well-established class of medicine which have demonstrated long-term safety in clinical trials. The commonest unwanted side effects, as with all GLP-1 [agonists]are gastrointestinal in nature.”
Is it the medication or the burden loss?
Nonetheless, non-gastrointestinal unwanted side effects similar to hair loss, mood swings and sunken facial expression are reported online by semaglutide users. While these cases are sometimes what the medical world calls “anecdotal,” that's, personal but not at all times easily verifiable clinical experiences, they will have very profound consequences.
Celina Horvath Myers, also generally known as CelinaSpookyBoo, a Canadian YouTuber who took Ozempic for type 2 diabetes said she experienced severe panic attacks and depression after starting taking the drug.
“Who I have been for the past few weeks has probably been the scariest time of my life,” she said on her YouTube channel.
While severe depression and anxiety should not known unwanted side effects of the drug, some people experience anhedonia, or a “diminished ability to feel pleasure,” says W. Scott Butsch, MD, MSc, director of obesity medicine on the Cleveland Clinic's Bariatric and Metabolic Institute. But this will be a natural consequence of the lower appetite, he says, since eating brings most individuals pleasure within the moment.
Many other reported changes were attributable to the burden loss itself and never the medication, Butsch said.
“These are drugs that alter the body’s own weight regulation system,” he said. “If When someone loses weight, fat cells shrink and muscles atrophy. This rapid weight reduction could cause the face to alter.”
For some people, like Mendenall, the side effects are worth it. For others, like Carew, they are unbearable.
Carew said she stopped taking the medication after about seven months and gradually began to get used to eating solid foods again.
“That's the American way, all of us need to be slim and delightful,” she said. “But I feel like that's very unsafe because we just don't understand how much our bodies react to these items in the long run. People see it as a fast fix, but it surely carries risks.”