Ozempic linked to stomach paralysis, other gastrointestinal issues: UBC study | Hacker News Reader

Ozempic linked to stomach paralysis, other gastrointestinal issues: UBC study

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61 pointsalibosworth83 comments

Anecdotal experience - Good friend of mine who struggles with weight was taking Ozempic for about two months.

He described nausea quite often when I saw him but the results were pretty astounding.

He then hit a wall where gastroparesis would happen quite often and I happened to be at his house when one of these bouts got very severe. He went from feeling bad, to hunched over in pain and started projectile vomiting in the span of 30 minutes. He said it was clearly the meal he had eaten several days ago...it was awful.

I believe this happened to him several more times - and AFAIK he stopped taking it, and promptly regained some weight back.

His doctor isn't monitoring correctly. They should drop the dose. Standard treatment is start with a really smart dose then you double it each month for 5 months. In reality, if you're losing weight, you should just keep on that dosage.

May be his pharmacy struggling with supply -- I hear lots of folks are titrating outside of the guidelines because they can't get the appropriate dosage.

I wish more folks would get comfortable crushing tablets and weighing out their own dosage on scales. It’s not that hard to cut tabs in half or crush two and make 3 doses out of those, then put them back into caps. Empty gelatin caps are cheap and easy to work with.

Should anyone have to do this? Of course not, but if the choice is between this or projectile vomit every waking hour, it’s not a hard choice IMO.

Lastly, I just wanted to take a moment to think about how useless pharmacies have become that they can’t actually do this for you anymore and literally just count out pills, or more realistically push a button on a machine that counts out the correct amount.

Ozempic is an injection administered weekly not a pill that can be split.

Even some pills cannot be split really easily. One example I like to give is Vyvanse. It uses extended release balls that are not evenly distributed in terms of what they contain (I’m no expert here, just going off a doctor’s summary). The only way to properly split it is to pour it into a glass of water and let it dissolve, then take the percentage of the dosage that you need and consume that percentage of water before the contents settle and while they still remain in a well mixed suspension. The remainder of the dosage is essentially no longer any good by virtue of being inactivated over time by being in the water and must be discarded.

Letting it dissolve like that will interrupt the time release mechanism. This is not recommended

My understanding of Vyvanse is that it uses metabolic mechanisms in order to time the release of the drug which helps to prevent abuse. I'm far from a doctor however.

I’m not sure about vyvanse specifically but for some medications the time release mechanism is the coating. my comment should have been more clear

vyvanse relies heavily on the second pass effect to activate, which is what makes it resistant to abuse. it also means if you don’t make sure to eat lunch the second half of the dose doesn’t kick in until supper and you end up being awake until 4-5am. ask me how i know…

Ozempic is a pen-style injector, not a pill.

I agree with your general point, although (and it may not be the same everywhere, but is certainly true in the UK) Ozempic is supplied as a pre-filled pen injector that handles the dose for you, and is taken once a week - there are no markings for a half-dose (and the patient info sheet seems to suggest that a partial dose isn't possible)

Having taken it, I can say that attempting a half-dose of Wegovy pens would have wildly varying results. The smaller Ozempic pens can easily titrate down, but Wegovy pens are not at all designed for it.

Yup, and this is mostly to protect profit for the pharma companies so people don't split doses.

don't some medicines have a time delay release mechanism that this would defeat? getting that much of a dose of some medicines all at once wouldn't be ideal I'd think. caveat emptor and all that.

Anecdotal sample of one here: since starting the treatment a year ago, I have hardly set foot in a fast food restaurant, and my visits to other food establishments have been reduced by 75% at minimum. Grocery shopping has been more mindful and smaller in size. The impact on my desire or even ability to consume food beyond the base metabolic necessity is real.

Why is that? For me, it was because I'd get severe symptoms after eating fatty foods.

Semaglutide made me feel more like I was full and simultaneously made me feel less like I was hungry. The stomach slowdown helped as well. I had some of the less desirable side effects of that, and those were really unpleasant but also showed me that I had no real idea when I was full or hungry and wasn’t eating for the right reasons. I’m hoping the insight sticks, at least.

I hope so too, good luck!

Out of curiosity, do you also drink Yakult or similar?

https://en.wikipedia.org/wiki/Yakult

may i ask why?

Sure. Ozempic slows down stomach emptying, so food sits around longer in your stomach before continuing on the rest of the digestive process.

That seems like it could allow for some not-real-great bacteria to multiply, in an environment they're happy with.

Yakult would potentially head that off / stop those bacteria from doing that.

It's going to be very interesting to see how the people who insisted on getting off-label prescriptions fare in court.

All the non-diabetics using it will generate great data.. for the rest of us.

Unfortunately not really, because the infrastructure that allows us to glean insights from actual healthcare practices is abysmal/nonexistent, at least in the US.

It became clear during COVID that a lot of people seem to presume there's some way for researchers to just "look at what's happening," and there isn't.

There's no nationwide research infrastructure for gleaning insights like that. But large provider organizations have huge patient populations and do a lot of research. They have multiple studies underway for Ozempic and similar drugs.

Clinical research trials are a lot more useful as they get a lot more data points from far fewer patients. Not many people want to get blood drawn every week and keep a detailed daily journal about eating and exercise habits.

Totally. I didn’t say “it won’t be studied,” I’m saying the data won’t be “great,” as described above.

That's a really good point, and it seems to pervade the scientific establishment. There's an unfortunate tendency to study something, and (assuming a real effect is found & reproduced) say 'well we know about that now' and just move onto something else, instead of building out infrastructure to gather more longitudinal/geographic data. The efforts in the UK to build huge datasets for long-term diagnostics is a welcome exception.

Wegovy is incorrectly listed in the article as a diabetes medication, it is only approved for weight loss. It is also 30% more expensive.

https://www.wegovy.com/

Wegovy, Ozempic and Rybelsus are all brand names for the same underlying drug semaglitude that was approved first for diabetes in different dosages.

Wegovy and Ozempic are indication-specific brands, but the same product.

Mounjaro by Lilly is still diabetets only, wonder what their obesity-specific brand name will be.

When it comes to prescription drug liability claims, it doesn't really matter whether the use was off-label. The key factor is whether harmful side effects were properly disclosed on the product label. Where manufacturers really get hit with huge verdicts is when they knew (or should have known) about a side effect but failed to put it on the label.

Okay, it's 10x the rate. From 45 per 100k person-years to 450 per 100k person-years for the pancreatitis. That seems like it's worth taking the play on if you're fat and can't unfat yourself.

I was on it for 2 months, and felt no serious adverse gastrointestinal effects. A tiny bit of nausea, but no vomiting or stomach pains. I was conscious of things acting differently down there so I made sure to eat smaller meals, and avoided fatty foods. A lot of people keep eating just like before and that's where most problems stem from.

Initially my appetite almost completely went away, but then it came back to what felt like normal. There were days where I felt like I was eating too much or binging, but the weight kept coming off at about 2lbs per week. Also, being free from the food noise was incredibly liberating because I'm otherwise always thinking about food.

I ended up stopping because I would get incredibly sleepy at about 10pm to the point where staying up was almost impossible. I tried eating more thinking it was a blood sugar issue, but that didn't help. It just didn't work with my schedule.

I plan to get back on it, or an alternative like Mounjaro.

"Another issue he brought up with the study is that the researchers found that people on Ozempic were five times more likely to drink alcohol compared to the other medications."

Hm. May have located the problem.

This is considered to be the first generation of weight loss drugs that work. There will probably be better ones.

What's odd is that a common side effect with semaglutide medications is a severe reaction to alcohol. Anecdotally, I vomit any time I have alcohol in beer sized doses. In fact, semaglutide is being investigated as a potential treatment for Alcoholism. (https://www.npr.org/sections/health-shots/2023/08/28/1194526...)

So I think "other medications" is doing a lot of heavy lifting here. It depends on what medications they're talking about. I think since incretin mimetics are more "social" medications and taken usually by a younger crowd, it would make sense that more people are drinking than maybe other groups.

That’s a bit too judgy, I think. I don’t drink at all, and still had to stop using semaglutide because the nausea/stomach-slowing was very difficult to tolerate.

Well, one possible confounding factor here is that they were comparing it against buproprion-naltrexone. Buproprion is also known as Wellbutrin and is prescribed for, among other things, smoking cessation and ahedonia. Naltrexone is interestingly an opioid antagonist that is known to decrease alcohol desire and is often prescribed off label for that use case. So there may be some other factors at play here in this specific study.

Side note I had never even heard of this combination of buproprion-naltrexone being prescribed for weight loss. I am not sure how common it is

Pancreatitis is already a listed side effect of GLP-1 agonists, right?

I'm not an expert, but from https://pubmed.ncbi.nlm.nih.gov/32103407/:

> Seven CVOTs enrolling 56,004 patients with T2DM were identified, with a median follow-up time ranging from 1.3 to 5.4 years. [...] Conclusion: Pooled analysis of CVOTs did not suggest any increased risk of either acute pancreatitis or pancreatic cancer with GLP-1RA treatment in T2DM patients.

Is this sort of thing higher the longer you use it? If it’s only for 3-6 months to get the ball rolling and getting you walking and eventually into a gym it’s probably worth the risk. It really shouldn’t be a long term thing should it?

I was gaining a lot of weight and simply walking for 30min was exercise (which sounds embarrassing in retrospect as I type it). So I did that daily around the neighborhood. That got easier, all I cared about was doing it daily not the outcomes, then I started going on a bike rides with slow increasing intensity, then got a gym membership, and now 2yrs later I’m in excellent shape, addicted to the feeling after working out, and do ~45min of fitness 5 days a week.

I know binge eating seems to be the issue with this one in particular but for me I naturally started to eat better on days I do fitness, I feel like eating things that give me energy. My body demands it. When I had relapses into not doing daily fitness I almost always eat poorly in a negative cycle just sitting on the couch drinking alcohol because I don’t have energy to go out.

Not to get preachy (everyone has a solution) but I think too many people do dramatic gym efforts or massively change diet with Keto (or w/e) then burn out quickly instead of starting small and focusing on routine/habit as the goal #1… not obsessing about how much calorie burn you can pack into x minutes before going back to nothing in 2 months. Fitness is a basic lifestyle routine like showering and brushing your teeth, it’s not a huge hard commitment when it’s paced properly and a natural daily thing.

I think people vary greatly in how much they enjoy exercise. I don’t, unfortunately, so it’s very hard for me to keep up any aerobic exercise program. I simply don’t form a habit, I have to push myself every time.

I don’t think it has anything to do with whether people do a massive change or not. I think the people that enjoy exercise usually never have to do a massive change because they are already doing it from natural enjoyment.

You’ve never felt a good after a short bit of cardio or lifting heavy weights?

Besides my point was that most overweight people would lose weight simply walking around the block every day. That’s not asking people to go for a run when they weigh 250lbs+ which will always suck unless you very slowly work up to being able to run more than a half a block and wear knee supports.

The thing about working out daily is that the first 10min always sucks bad after but after you’re done it feels great - for the rest of the morning. Being depressed is harder in that mind state which feeds into more physical activity.

Like I said though you have to start small.

From my understanding all that Ozempic does it kill your appetite. It doesn't burn fat or anthing else (except the side effects of course) or does it?

Seems to me that there must be a safer way to reduce someones appetite.

It can help you process glucose better. Semagultide can help lower A1C in multiple ways, mainly by regulating appetite but also by stimulating the receptors that cause insulin to be produced. By producing more insulin, you feel more satiated and also reap the benefits of moving farther away from prediabetes/diabetes

I've also heard that Ozempic was good for the GDP, so mixed bag.

Denmark gets rich, everyone else gets poor because they don't consume. Well played

If we ever found out that it cures peoples appetite for spending then it would be banned immediately.

I don't know to what extent this kind of perspective matters compared to the obviously more common usage of obese people with serious diet control problems, but I come at this more from a physique sport angle. I have no real interest in getting big and don't want to use steroids, so I don't actually compete, but I do lift nearly every day, run nearly every day, and have become extremely lean, probably currently somewhere in the area of 6-7%. My experience of using this myself and of seeing other people use it is from this perspective, people who were never all that fat to begin with and are just looking for it to be easier to be extremely not fat.

And in those communities and in my personal experience, this kind of thing virtually never happens. I've been in a calorie deficit since roughly mid May at this point, and have felt no nausea, haven't vomited, have felt nothing, really. I can barely tell I'm taking a drug. The only perceivable effect is I'm not hungry, and this seems to be the common takeaway from bodybuilders and models and what not doing this. My wife has been taking it for over a year and a half now and has had no side effects.

But I'm not out there trying to maintain my pizza and ice cream diet while outsourcing portion control to a drug. I'm also not trying to lose 80 pounds in a year. I don't eat out, weigh and measure and plan all of my food, and haven't had a dessert or a drop of alcohol since last Christmas. Likely won't have another until this Christmas.

It's just something to keep in mind depending on your specific goals. I feel like, at least until I stopped reading the news, I was getting bombarded almost daily with scare articles like this claiming you'll be miserable, sick, your face will sag and age prematurely, all kinds of ridiculous shit. I can't speak to what it's like to have lifelong problems with food habits and to be over a hundred pounds past the recommended BMI range, or what any means of changing that will do to you. But if you are a reasonably fit person who wants to be absolutely shredded, or someone who has been and can be shredded and has lost weight plenty of times before, but just want it to not be a miserable four months, these drugs are absolute gold. Not just bodybuilders, but dancers, gymnasts, climbers, weight class fighter, anyone with a strong incentive to be very lean most of the time. Maybe we don't matter as much to public health compared to fighting the obesity epidemic, and maybe we're not very common on a place like Hacker News where most readers are probably sedentary and have never been athletes, but we're still a demographic and the GLP-1 revolution has been a godsend for us. They're far safer than anything that existed previously. They just take what you were already doing and put it in easy mode.

I'd guess there are a few factors at play, but my assumption is that the drug is perceived as a cheat. We see obese people as weak and loathsome due to their own failings and now they're going to simply take a drug and think they can get away with it? Surely they must deserve some punishment. Surely this drug is too good to be true.

If it was available readily and cheap, I'd be curious to give it a try, though I have no desire to ever get below 10% body fat.

First, you're not "probably currently somewhere in the area of 6-7%" bodyfat--6-7% is a minicut away from 5-6%, which is stage-ready levels of bodyfat for natural bodybuilders, and they only drop to that a few times a year (because of muscle loss and the inability to build muscle). But the rest of your comment is worth taking in for those who are overweight or obese and still have reservations about these drugs, or about using drugs at all for weight management. The influencers selling you discipline, diet, exercise, and the rest as the ticket to achieve lasting weight loss are already on these drugs. If you have serious weight issues (which these people don't), why aren't you? (I say this as someone who has never used any drug for weight loss, except being a bit of a caffeine junkie.)

Well, that was quick.

Can we just let people be fat and happy

We can! But should we?

Being fat is similar to being a drug user. At first, you actually are fat and happy. Over time, being fat will absolutely reduce your happiness from the medical, societal, and physical issues that arise. Similar to how drug users build up a tolerance and instead of using the drug to be happy, they use the drug to feel normal.

And just to state a simple fact, I do not condone shaming people with weight control issues.

I have thought of this before.

But it isn't really the same. Drugs, the really bad ones will probably ruin your life or kill you in the space of two or three years.

Being fat unless it's super super severe often won't start impacting your health seriously until your 30's or 40's.

on the opposite side anorexia will kill you much faster than obesity

So what about smoking?

It's good that we discourage smoking, even aside from the secondhand smoke component.

Some drugs will kill you slowly also. Doesn't mean they're good for you.

At 30, you have more than half your life ahead of you. At 40, you are just about the halfway mark.

That's just the more serious longterm effects. The reversible short term ones are immediate.

I was at a birthday hike for a friend - up a short granite hill for good views, some slow meandering around a lake. Very relaxed stuff. One of her guests couldn't make it up the hill. Full on bawling, had to leave early. This woman could not participate in even a casual hike for a friends party and she clearly wanted to be able to.

I was fat but below the obesity level before I started my whole thing and the first "benefit" I noticed was that I could do any physical activity. I might be bad at it, but I could rock climb, and kayak, and play basketball with people. The "Oh, I can't do that" was simply _gone_.

> on the opposite side anorexia will kill you much faster than obesity

* Anorexia nervosa, about 5.1 deaths per 1000 person-years

* Obesity, about 200 deaths per 1000 person-years.

Being fat has numerous social penalties. I think they originate from instinctive reactions embedded deep in peoples’ brains, and those reactions are flat-out not going to go away from anything we can do today.

Really bad drugs kill through overdose, whether from low quality supply or some users' inability to manage their addiction. I think there are more 'functional addicts' around than most realize. It seems to me that a good comparison to morbid obesity is tobacco smoking; you can keep at that for a long time but the odds of cumulative damage becoming disabling rise inexorably.

Yes, to a certain degree. But now we are in an obesity epidemic. It is just as bad as people smoking in the previous generations. Loads of people are MORBIDLY obese.

Good for them?

Why? Have you seen the medical outcomes for people in that group who develop acute medical problems? I don't mean just the statistical outcomes, but the qualitative individual ones. Other than 'possibly survive a sudden famine' I cannot think of a single thing morbid obesity makes better.

Better than being stripped of their human agency and choice.

Better to be fat and happy than skinny with someone controlling your life

Being controlled by the corn/sugar industry doesn't sound great to me but you do you.

I can say no to the corn industry. I can't say no to the government.

Anyone is welcome to be fat and happy, but don't put down those who want to un-fat to be happy. Don't come back with that fatness is a social construct stuff either; your fat and happy idea is just as much a social construct.

And please don't ask me to pay for your healthcare because you chose to be fat and happy.

I hate this sentiment. It can be used about, well, anything at all that might cause your risk of anything to go up as far as science understands it today (which might be different tomorrow, they're always learning).

Accident while biking? Nope - too risky, no care for you. Eat red meat and get cancer? Too bad, no treatment for you. Same for drinking wine, or doing any of the thousands of things "they" say MAY raise your cancer risk.

Joint problems happen to all manner of people, thin or fat, but we'll only pay for treatment for the thin ones.

It just goes on.

That mostly seems reasonable. Get in a car crash? Your car premiums go up. Get in a bike accident and need medical care? Your medical premiums go up. Have too high a body fat? Higher premiums. Smoke? Higher premiums.

With a single payer system you could also price it into things like red meat and alcohol through a sales tax that goes to insurance.

To extend your examples: why aren't we coupling this to incentives? Car crashes are much more debilitating than bicycle crashes, and most bicycling in the world is done for transport, yet we heavily incentivize car culture.

As a casual bicycle user, you're far more likely to have a serious bicycle collision from being hit by a car driver.

Not sure what you mean by "Car crashes are much more debilitating than bicycle crashes."

If a cyclist gets hit by a car at any significant speed, he's likely seriously injured or dead, while the car driver is likely unscathed, at least physically.

If two cars collide, unless they are traveling at quite high speeds or are particularly unlucky, everyone will probably walk away, as they are surrounded by a steel structure that has been specifically engineered to protect vehicle occupants in the most common crash scenarios, in addition to the protection provided by safety belts and airbags. The cyclist has none of this.

If two bicycles collide, well it depends but scrapes and possibly broken bones are likely, along with possible concussion or worse head injury.

We know that bicycle usage in places like the Netherlands doesn't result in frequent serious accidents like you describe. The safety culture is totally different, and injuries like that are low despite a much more casual approach to helmets. There are people on cargo bikes transporting goods and going shopping with their children.

This is an infrastructure problem, not a bicycle problem. The infrastructure problem exists because places like the USA prioritize cars.

Even the two bicycle collision you describe is quite rare outside of competitive sports. People casually bicycling to work aren't going at such speeds, don't go closely in opposite directions, and really have no reason to do so.

Bicycling is very safe when you remove car interaction from the equation.

Check out this YT channel for more info backed by data: https://youtube.com/c/notjustbikes

I agree it's something of a slippery slope and a lot of arguments would be had about where the lines are, but already done for some things. I have to sign a "smoke free affidavit" at work or else pay more for my health insurance.

It kind of really puts a load on the healthcare system and makes everyone’s rates go up. Plus it’s terrible for the individual themselves. Societal pressure is a fantastic motivator.

Shame is a terrible motivator for weight loss. It just doesn't really work. Nobody gets fat because they think being fat is okay. Fat people tend to be struggling with other things that they largely need to tackle before they have the emotional bandwidth to do the un-fat thing.

Fat shaming doesn't help anyone lose weight, it just makes you feel superior.

It works very well. If they’re struggling with other things societal shame will make sure losing weight becomes their major struggle.

The thing about claiming things like this is they require a strong scientific consensus. Otherwise, if they're wrong, its just hurting people, sometimes even killing them. Many girls die every year from EDs, and societal shame is a strong candidate for their cause.

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