You’ve probably heard about the drug Ozempic, which is used to manage type 2 diabetes and as a weight loss drug.
Ozempic has had more than its fair share of headlines and controversy. One global drug shortage, tweets about using Elon Musk, approval for teenage weight loss in the United States. Oscars host Jimmy Kimmel even joked about it on movie night last week.
But 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. That feeling of being satisfied or “full” suppresses the appetite. That’s why it works for weight loss.
Also semaglutide helps the pancreas produce insulinhelping to manage type 2 diabetes. Our body needs insulin to move the glucose (or blood sugar) we get from food into our cells so we can use it for energy.
Semaglutide works by mimicking the role of a natural hormone called GLP-1 (glucagon-like peptide-1), normally produced in response to nutrient sensing when we eat. GLP-1 is part of the signaling pathway that tells the body that it has eaten and prepares it to use energy from food.
Can food do this?
The nutrients that trigger 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 intestinal bacteria).
There are many of these macronutrients in energy-rich foods, which tend to be foods high in fat or sugars with low water content. There is evidence that by choosing foods rich in these nutrients, GLP-1 levels can be increased.
This means that a healthy diet rich in GLP-1 stimulating nutrients can increase your levels. They can be foods with good fats, such as avocado or nuts, or lean protein sources like eggs. And foods rich in fermentable fiber, such as vegetables and whole grainsfeed our gut bacteria, which then produce short-chain fatty acids capable of triggering GLP-1 secretion.
That’s why diets high in fat, fiber and protein can help you feel fuller for longer. This is also why changing your diet is part of managing your weight and type 2 diabetes.
Not so fast…
However, it’s not necessarily that simple for everyone. This system also means that when we diet and restrict energy intake, we become hungrier. And for some people this “set point” for weight and hunger can be different.
Some studies have shown that GLP-1 levels, particularly after meals, are lower in people with obesity. This could be due to reduced GLP-1 production or increased degradation.
The receptors that detect it may also be less sensitive or there may be fewer receptors. This could be due to differences in genes that encode GLP-1, the receptors or parts of the pathways that regulate production. These genetic differences are things we cannot change.
So are injections the easiest solution?
While diet and medication can work, both have their challenges.
Medicines like Ozempic can have side effects, including nausea, vomiting, diarrhea and problems in other organs. Furthermore, when you stop taking it, the feeling of pent-up appetite will start to disappear and people will start feeling hungry at the previous levels. If you’ve lost a lot of weight quickly, you may feel even hungrier than before.
Dietary changes are far less risky in terms of side effects, but the answers will take more time and effort.
In our hectic modern society, cost, time, skills, accessibility and other pressures can also be barriers to healthy eatingfeeling of fullness and insulin levels.
It’s also important to remember that weight is only one part of the health equation. If you suppress your appetite but stick to a diet high in ultra-processed foods that are low in micronutrients, you may lose weight, but you won’t increase your actual eating. Therefore, support is needed to improve food choicesregardless of medication use or weight loss, for true health improvements.
