Semaglutide
Semaglutide for Weight Loss and Decreasing Cardiovascular Disease
Losing weight and keeping weight off is challenging for many in this world of environmental toxins, genetically modified foods, addictive food additives, and preservatives.
The bottom line is weight gain can commonly be caused by toxins indirectly as they stress our bodies causing imbalances in blood sugar. High blood sugar causes inflammation leading to an increase in cardiovascular disease and stroke, as well as pushing us to eat too much. It becomes a vicious cycle. Even when you are not overeating, our foods can cause inflammation. Alcohol consumption, can help tip the scales even more.
Last year the FDA approved a peptide called Semaglutide for weight loss. It is being heralded as a breakthrough treatment for many people who struggle with chronic weight management. This blog post will review Semaglutide clinical trial results, potential benefits, and side effects.
What is Semaglutide?
Semaglutide is an incretin hormone peptide known as a glucagon-like peptide or GLP-1, which is naturally produced in the body after consuming a meal to decrease blood sugars. It also slows stomach emptying which translates into a decreased appetite as you feel full longer. Because of its ability to decrease blood sugars, it was approved for the treatment of type II diabetes, long before approval for weight loss. Weight loss was observed as an outcome of type II diabetics taking the peptide.
How does Semaglutide work?
- Increases insulin to lower blood sugar levels in response to food or stress.
- Decreases glucagon to decrease blood sugar. (Glucagon stimulates the liver to produce more glucose.)
- Stimulates the feeling you are full.
- Suppresses food cravings and appetite by its decrease in gastric emptying and decreasing blood sugar. It may also have a direct effect on the brain.
The weight loss effects of Semaglutide are enhanced with lifestyle modifications such as increased nutrition and increased exercise. Semaglutide can also be used with intermittent fasting for a greater effect on decreasing fat. (previous blog post)
One of the main perks with Semaglutide use at RMC is the decrease in food cravings and decreased appetite. One person summed it up by saying, “It is so nice to not be thinking about food all day. I didn’t realize how much time that took out of my day!” Semaglutide could certainly be the answer to high blood sugars and weight gain caused by stressful lives and unhealthy foods.
Clinical Trials
When Semaglutide was injected subcutaneously once a week for 68 weeks, trial participants achieved significant weight loss and other health benefits summarized here:
- 86% of people achieved at least 5% weight loss, 70% at least 10%, over 50% at least 15%, and one-third at least 20% at 68 weeks
- 3.7-inch reduction in waist circumference
- 4.6 decrease in BMI
- 5 mmHg decrease in systolic blood pressure
- Lowered fasting blood glucose levels
- Reduced total cholesterol, VLDL, triglycerides and free fatty acids
- Lowered C-reactive protein levels (marker of inflammation)
- Reduced risk of heart attack and stroke
- Weight loss plateaued at 60 weeks
Depicted in the following chart is the observed weight change from the trial:
Cardiovascular Benefits
In a 3297 type II diabetic patient trial, 83% of participants having cardiovascular disease and/or chronic kidney disease, showed an improvement of kidney function and a decrease in adverse events as follows: 6
Disease Placebo Semaglutide
Stroke 2.7% 1.6%
Heart attack 3.9% 2.9%
CV death 8.9% 6.6%
Side Effects and Safety
The most common side effects include nausea, vomiting, diarrhea, and constipation. Other common side effects include anxiety, depression, fast pulse (increase of 2.7 beats/min average), skin rash, and nervousness. Most side effects are reported to be mild and most often occur when first initiating Semaglutide. Over time the body adapts to the Semaglutide and these side effects can decrease or resolve with decreased dosing and/or continued use.
Noticed in my practice are some people without diabetes, being more sensitive than others to the effects of Semaglutide. Therefore, we start people at ½ the initial dose and increase accordingly. There are people who do well injecting 0.05 mg a week of Semaglutide and others that do well injecting .50 mg twice a week, which is a huge difference in effects between people. Most do well on a 0.25 mg starting dose of Semaglutide once a week.
The prevalence of mild gastrointestinal side effects with Semaglutide was 74% vs Placebo 48%. It is assumed there would be a high percent of GI side effects as it affects gastric emptying. Only 7% of people stopped therapy because of these side effects vs 3% in the placebo group.3
The prevalence of serious adverse events was reported to be 9.8% in the semaglutide group vs 6.4% in placebo group.2 These events include hepatobiliary disorder and gallbladder disorders, most commonly cholelithiasis. Not seen in particular were pancreatitis, cardiovascular events, or kidney damage.
You should not take Semaglutide if you have diabetic retinopathy, personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia type 2, trying to get pregnant or are pregnant, breast-feeding, or have depression with a history of suicidal thoughts. To date no tumors have been reported in humans. “No unexpected safety issues have arisen to date, and the established safety profile for semaglutide is similar to that of other GLP-1RAs where definitive conclusions for pancreatic and thyroid cancer cannot be drawn at this point due to low incidence of these conditions.”4
Conclusion
Semaglutide has shown significant weight reduction of up to 20%, as well as other significant health benefits seen in cardiovascular disease, stroke, and kidney function in clinical trials over long term use. Safety issues are as stated above and overall have not been a big concern especially when considering the risk-benefit ratio.
The addition of Semaglutide to dietary changes and increased exercise may turn out to be a breakthrough for many in their quest to lose and maintain weight loss. It is also promising as an adjuvant in decreasing cardiovascular disease, stroke, and maintaining good kidney function in everyone whether they have type II diabetes or not.
Have an awesome day! Dr. D