Ozempic (and the similar drug Wegovy) has had plenty of headlines and controversy. A global supply shortage, tweets about its use from Elon Musk, approval for adolescent weight loss in the United States. Oscars host Jimmy Kimmel even joked about it during movie night last week.
But how much do we really need drugs like Ozempic? Can we use food as medicine to replace them?
How does Ozempic work?
The active ingredient in Ozempic is semaglutide, which works by inducing satiety. This feeling of satiety or being “full” suppresses appetite. This is why it works for weight loss.
Semaglutide also helps the pancreas produce insulin, which is how it helps manage type 2 diabetes. Our bodies need insulin to move the glucose (or blood sugar) we get from food into cells so we can use it as energy.
Semaglutide works by mimicking the role of a natural hormone called GLP-1 (glucagon-like peptide-1), normally produced in response to sensing nutrients when we eat. GLP-1 is part of the signaling pathway that tells your body you’ve eaten and prepares it to use the energy that comes from your food.
Read more: Ozempic helps people lose weight. But who should be able to use it?
Can eat that?
The nutrients that drive GLP-1 secretion are macronutrients – simple sugars (monosaccharides), peptides and amino acids (from proteins), and short-chain fatty acids (from fats and also produced by good gut bacteria). There are many of these macronutrients in high-energy foods, usually foods high in fat or sugars with low water content. There is some evidence that choosing foods rich in these nutrients can increase GLP-1 levels.
This means that a healthy diet high in GLP-1-stimulating nutrients can increase GLP-1 levels. These can be foods with good fats, such as avocado or nuts, or lean sources of protein such as eggs. And foods high in fermentable fiber, such as vegetables and whole grains, feed our gut bacteria, which then produce short-chain fatty acids that can trigger GLP-1 secretion.
This is why diets high in fat, fiber and protein can all help you feel fuller for longer. It’s also why diet change is part of both weight and type 2 diabetes management.
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Not so fast …
However, it is not necessarily that simple for everyone. This system also means that if we diet and limit energy intake, we get more hungry. And for some people, that “set point” for weight and hunger may be different.
Some studies have shown that GLP-1 levels, especially after meals, are lower in obese people. This may be due to decreased production of GLP-1 or increased degradation. The receptors that detect it may also be less sensitive or there may be fewer receptors. This may be due to differences in the genes that code for GLP-1, the receptors, or parts of the pathways that regulate its production. These genetic differences are things we cannot change.
So, are injections the easier solution?
While diet and medicine can both work, both have their challenges.
Medications such as Ozempic can have side effects such as nausea, vomiting, diarrhea and problems with other organs. In addition, the feelings of suppressed appetite will disappear when you stop taking it and people will feel hungry at their old level. If you have lost a lot of weight quickly, you may feel even hungrier than before.
Dietary changes have much less risk in terms of side effects, but the responses will take more time and effort.
In our busy modern society, cost, times, skills, accessibility and other factors can also be barriers to healthy eating, feeling full and insulin levels.
Diet and medication solutions often focus on the individual making changes to improve health outcomes, but systemic changes that reduce the pressures and barriers that make healthy eating difficult (such as shortening workweeks or raising the minimum wage) are likely to have a difference.
It’s also important to remember that weight is only one part of the health equation. If you suppress your appetite but maintain a diet high in ultra-processed foods and low in micronutrients, you may lose weight but not increase your actual nutrition. So support is needed to improve food choices, regardless of medication use or weight loss, for real health improvements.
Read more: Stop hating on pasta – it actually has a healthy ratio of carbs, protein and fat
it comes down to
The old quote, “Let food be thy medicine” is catchy and often grounded in science, especially when drugs are deliberately chosen or designed to mimic hormones and compounds that already occur naturally in the body. Changing our diet is a way to adjust our health and our biological responses. But these effects occur against a backdrop of our personal biology and our unique living conditions.
For some people, medication will be a tool to improve weight and insulin-related outcomes. For others, eating alone is a reasonable path to success.
While science is for the population, health care is individual and food and/or drug decisions should be made with the informed advice of health care professionals. General practitioners and dieticians can work with your individual situation and wishes.