It’s being called a miracle drug, a weight-loss revolution, and at the same time, a potential nightmare. Ozempic has changed lives almost overnight, helping people shed pounds without diets or workouts. But behind the headlines and TikTok hype lies a darker side, one that raises serious questions about how far science should go to change our bodies. Here’s why Ozempic is both amazing and terrifying at the same time.
Effect 1: Blood Sugar Fluctuation and Rapid Weight Loss Consequences:
Along with the presumably desired weight loss, unwanted effects like hair loss, the gaunt appearance of the so-called Ozempic face, and even Ozempic feet have made their rounds online. But the drug itself isn’t to blame for those headline-grabbing side effects. A fast drop in weight is known to cause visible changes when the skin doesn’t keep up with fat loss, and hair is known to fall out in response to inadequate nutrition or rapid weight loss. So instead, today we’re going to be talking about actual side effects, some of which are pretty surprising.
First up, there’s what semaglutide is supposed to do. Humans have many different types of so-called receptors embedded in cell membranes or inside cells. Each type of receptor is like a unique, complex switch in an extremely intricate switchboard. And each one responds to the binding of one or more signaling molecules. Any time you want to start, stop, or change a biological process, signaling molecules and receptors are out there directing traffic.
GLP-1 is a signaling molecule naturally produced by the body, mostly in the intestine, in response to eating food. It binds to the corresponding receptors in different parts of the body, influencing processes that govern blood sugar, fat mass, insulin secretion, fullness, and more. GLP-1 drugs basically pretend to be GLP-1, letting us take control of those processes.
So here’s how that works. Insulin is often compared to a key that unlocks the body’s cells, allowing sugar in for energy. People with diabetes may not be able to process sugar adequately on their own. Semaglutide stimulates pancreatic cells to produce insulin far more efficiently than natural human GLP-1, which helps lower blood sugar. Semaglutide also seems highly effective at reducing glucagon, which has the opposite effect of insulin, it raises blood sugar when the cells need more energy. Glucagon levels can be too high in some people with diabetes or a higher body fat percentage, allowing too much sugar to hang out in the bloodstream.
Semaglutide dials up insulin and reduces glucagon, pulling blood sugar levels down overall. This can protect against the harmful effects of higher blood sugar over time. In the long run, reduced blood sugar levels may lead to reduced conversion of glucose to fat. And this plays one role in the weight loss that occurs with this drug. But blood sugar reduction can also be a mixed bag. Semaglutide and other GLP-1 drugs can cause blood sugar to drop too low, especially when the dosage is off or when it’s used with other glucose-lowering drugs.
Known effects of low blood sugar include cognitive issues and anxiety, which is one reason that doctors closely monitor patients on these drugs. It’s also why you should take these drugs under the supervision of a qualified healthcare team and avoid sketchy websites. Some doctors also advise against taking them purely to drop a few pounds for cosmetic reasons.
Effect 2: Slowed Digestion and Surgical Risks:
Semaglutide has a lot of effects on how we process and break down our meals. So maybe it’s not surprising that it can also affect our actual digestive organs. For one, it slows the movement of the digestive system. One way this happens is through the activation of nerves that reduce smooth muscle contractions in the stomach. Semaglutide also seems to act on the pyloric sphincter, the muscular ring between the stomach and the small intestine, which may play a role in slowing down stomach contents from moving on. This can be helpful, keeping contents in the stomach for longer means sugar getting into the bloodstream more slowly.
But it can also contribute to undesirable side effects. One of those is a condition called gastroparesis, or stomach paralysis. This is reported to be as unpleasant as you would imagine. It’s worth noting that diabetes itself is known to cause gastroparesis, so diabetics risk developing it whether or not they use semaglutide.
But here’s one fun consequence: It could affect you if you need surgery. Anesthesiologists have noticed that slow stomach emptying means stuff could stay in your stomach, even if you were very good and followed their instructions on when to stop eating. And that increases the risk of aspiration, or stuff coming back up into your airway from your stomach during an operation.
There is disagreement among experts on what to do about this. For a while, major professional organizations in anesthesiology recommended stopping semaglutide one to two weeks before surgery. Though some have walked this back, many hospitals may still require stopping the drug before a scheduled procedure.
Effect 3: Unexpected Pregnancies and Drug Interactions:
Even stranger, there have also been reports of unexpected pregnancies, leading to so-called “Ozempic babies.” The cause? Some have hypothesized that slow stomach movement decreases the effectiveness of the birth control pill. There is evidence that delayed gastric emptying may affect the way the body processes other drugs, especially those that rely on speed of digestion or other time-related internal logistics for their efficacy. These include some over-the-counter drugs like Tylenol, or prescriptions like certain statins. But it varies from drug to drug.
Some medications seem to be processed fine with slower stomach emptying. One small study suggests that birth control pills are among those that should be effective, even with the slowed GI movement. Instead, some of these surprise pregnancies could result from an increase in fertility that can come with reduced body fat and blood sugar.
More studies are needed to confirm the effects of these drugs on oral contraceptives, though, so some experts, including regulators in the UK, recommend caution in those seeking to avoid pregnancy.
Effect 4: Protection for the Heart and Brain:
So, let’s get to some good news to balance out the bad. Semaglutide is well-known for blood sugar reduction and weight loss, but it turns out that it may also help keep certain organs healthy. Like the heart. People with diabetes have a higher risk of heart attack, stroke, and other dangerous cardiovascular events, and semaglutide has been known to have a protective effect against them. But it can also help people without diabetes.
One major trial of over 17 thousand patients with existing heart disease and higher body fat found that those taking the drug had a lower incidence of acutely life-threatening heart problems compared to those on a placebo. That one was funded by the drug company, so grain of salt.
In 2024, the FDA approved Wegovy to reduce the risk of these heart problems in people who may not be diabetic, but do have other risk factors. Researchers are still unraveling how semaglutide does this. It could largely be a result of blood sugar control, or weight loss, including the reduction of fat around the heart itself, and associated health benefits.
Scientists are also looking into how the drug may protect the heart beyond just blood sugar and weight loss. For instance, GLP-1s seem to lower molecules associated with inflammation, which is known to increase cardiovascular risk. And also a bunch of other risks. It’s also a bunch of, it’s like cancer… Heart disease.
Those are the big ones. But they’re the two big ones. Evidence from mouse studies suggests that it may also reduce what’s called heart remodeling. This is basically structural changes to the heart’s muscle and blood vessel tissue in response to cumulative damage, which leads to an enlarged heart. An enlarged heart is essentially overcompensating for its inefficiency, also contributing to cardiovascular risk.
And then there are potential perks for the brain. Semaglutide seems to improve cognition, protect against nerve-related disorders associated with diabetes, and protect against Alzheimer’s and Parkinson’s disease. Those are two bad ones! No joke, one 2024 study found a 40 to 70% decrease in risk for a first-time Alzheimer’s disease diagnosis in patients with type 2 diabetes taking semaglutide, compared to other diabetes meds.
Again, scientists suspect that several physiological mechanisms are likely at play in the brain. Like in the heart, protection against inflammation in the brain probably plays a role. Evidence also suggests that the drug may improve the function of synapses, which are the structures located between neurons that enable the transmission of cell signals. Early days for this research, but fantastic if true. Like, we did not mean to make an Alzheimer’s drug here, but we may have!
Effect 5: Eye Damage and Bone Density Concerns:
For another potential undesirable effect, a large 2024 trial showed that patients on semaglutide are at higher risk of developing irreversible blindness in one eye due to a halt in blood flow to the optic nerve, again compared to other treatments. Now, the overall risk of this condition is low. The study also didn’t present evidence to show a causal link, just a correlation between the use of semaglutide and the increased risk.
In addition, some studies suggest that semaglutide increases the risk of diabetic retinopathy. This is a disease of the retina that can develop in patients with diabetes due to cumulative damage to blood vessels inside the eyes. Scientists have observed that the disease is more likely in semaglutide users who experience more rapid drops in blood sugar. There is a noted phenomenon in which this eye condition paradoxically worsens when blood sugar drops quickly, before potentially getting better.
So, vision problems are another case of weighing the risks of taking semaglutide with the risk of not taking it, and that varies widely from person to person. So, we’ve talked about semaglutide’s effect on the blood, stomach, and GI tract, other organs, and eyes. It turns out that semaglutide may directly or indirectly affect your bones. Some studies suggest it could help protect joints and increase bone cell growth.
There’s conflicting evidence here, other studies suggest that it could also increase bone loss in certain populations, especially older adults. And that could be because bones are always undergoing a natural push-and-pull, with gain and loss of bone tissue happening in balance with each other. So that balance could be thrown out of whack.
Here, too, ensuring adequate nutrition and exercise to maintain bone-supporting muscle mass can help keep bones as healthy as possible while taking the drug. Wildly enough, we could keep going, but as is often the case, we’ve had to boil this down to an abridged list of effects of semaglutide. All in all, semaglutide is a super-powerful drug, and power comes with risk.
Like practically any other drug… or like other life choices, there’s a lot to understand about semaglutide’s risks and benefits. It comes down to weighing these pros and cons with the guidance of a dedicated care team and based on each individual’s needs and health profile. Ideally, each patient should be empowered with access to nutrition, physical activity, and dedicated doctors to maximize good effects and minimize the not-so-good.
Conclusion:
Ozempic has proven to be both a scientific marvel and a medical warning sign. It’s helped countless people control blood sugar, lose weight, and even protect their hearts and brains, but it also comes with side effects that remind us how delicate our biology really is. Like most breakthroughs, it’s a tool that can change lives or cause harm depending on how it’s used. The real challenge isn’t just what Ozempic can do, it’s how wisely we decide to use it.
FAQs:
1. What is Ozempic used for?
It’s mainly prescribed to manage type 2 diabetes and help with weight loss.
2. How does Ozempic make you lose weight?
It mimics a natural hormone that controls appetite and slows digestion.
3. What are the most common side effects?
Nausea, stomach issues, fatigue, and dizziness are the most frequent.
4. Can Ozempic cause serious health problems?
In rare cases, it can affect vision, digestion, or blood sugar levels too strongly.
5. Is Ozempic safe for non-diabetic use?
It’s approved for weight loss in some forms, but only under medical supervision.
6. Can you stop taking Ozempic anytime?
No, stopping suddenly can cause blood sugar spikes or rapid weight regain.