PCOS and GLP1: Ozempic and Wegovy
Hello everyone,
How was your week? We are officially in February 🎉. This means warmer temperatures and longer days are coming! I am also reaching my 30s this month.
Let’s start February with a hot topic. Ozempic and weight-loss injections have been a topic of discussion for the past year or so. As some of you might consider it for weight loss and PCOS management, let’s dive into how it works and what the research says.
I want to tell you that I do not support quick and easy solutions for weight loss. For me is a moral value. I have spoken to too many women who have been through cycles of quick wins just so they are back to where they started or worse, feeling like a failure and leaving them with low self-esteem. However, I do support medication as an aid for our body as long as it’s clearly labelled so and we know that the foundations are our eating and movement habits.
In this newsletter:
Our natural GLP1 Hormone
GLP1 for Type 2 Diabetes
How did it start being used for weight loss?
GLP1 for Weight loss
GLP1 for PCOS
Should you take it?
Some words of precaution
How do GLP1 medication work?
The GLP1 Hormone
Ozempic and other injections on the market (e.g. Wegovy) are called GLP-1s agonists. An agonist is a substance that mimics the actions of a natural compound. These medications mimic the effect of the GLP-1 hormone.
The natural GLP-1 hormone in our body gets released as soon we eat. We see this hormone increasing 10–15 minutes after starting to eat and staying raised in the blood for several hours afterwards.
This hormone is released mainly by our gut but can also be secreted by the pancreas and the brain. In short it:
Increases insulin levels: it does so by encouraging the release of insulin from the pancreas and increasing the volume of cells in the pancreas that produce insulin. This is because it signals that there is food coming, and as a result, it prepares the most important carrier of glucose: insulin.
Reduces the glucose that is released from our liver. The liver has no reason to release the stored glucose when food is incoming. New glucose is coming 🎉
It reduces appetite. Given you are eating, there is no reason to keep you hungry.
Slows the emptying of the stomach. Food travels from the stomach to the intensities when it’s ready to be digested. Just so not all food gets released at once, GLP1 helps ensure the right cadence, leaving food in the stomach for longer. This gives us the feeling that we are full.
This hormone signals to our body that food is incoming and prepares the road for the arrival of glucose.
GLP1 for Type 2 Diabetes
Given its effect on decreasing appetite and insulin stimulation, this hormone has appealed to scientists for the management of type 2 diabetes. In this condition, insulin can’t keep up with the glucose levels, which leads to hyperglycaemia and damage to the pancreatic cells. If we manage to make people eat less ( ⬇️ glucose) and stimulate the pancreas (⬆️ insulin), people with type 2 diabetes can manage their condition better. And.. that was true. The synthetic version of GLP1 semaglutide does just that.
In 2017, Ozempic (the commercial name for semaglutide) was FDA-approved for the management of type 2 diabetes in the US.
How did it start being used for weight loss?
Besides helping with glucose management, these medications were also causing weight loss. This is often desirable in type 2 diabetes management.
Our natural GLP1 doesn’t have a long life as a hormone. It gets released when we eat and then broken down. The synthetic GLP1s found in medication have a much longer life so it’s able to act for pre-longed times. This means decreased appetite giving you a feeling of fullness for longer. Over time, you eat much less than you would normally do. By eating less, you experience weight loss.
Due to the fact that our society is obsessed with skinny, people started taking Ozempic for weight loss even though this medication was not, and it is still not FDA-approved for weight loss.
However, ever since, other GLP1 medications have been studied purely for weight loss.
GLP1 for Weight loss
In 2021, another brand name, Wegovy, got the FDA's approval to treat obesity or overweight individuals with at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol). The approval came with the condition to be used in addition to a reduced calorie diet and increased physical activity. Please bear in mind that even this medication comes with the foundations of nutrition and exercise.
GLP1 for PCOS
These injections are attractive for the management of PCOS because of their effect on glucose metabolism and weight loss. We know that reduced levels of weight mean lower levels of insulin and inflammation, which in turn lowers Testosterone and LH levels. This means that GLP1 could positively impact PCOS symptoms.
In terms of research, there is some research on other types of GLP1 medication which have been on the market for a while (e.g. exenatide, liraglutide), and they show promising effects on body weight for PCOS.
In terms of the actual type of GLP1 found in Wegovy, I have only found one study looking at twenty-seven obese patients with a diagnosis of PCOS. Results show improvements in weight, regularity of the cycle and insulin resistance. I am sure much more research will be on its way as many experts are proposing it for the management of PCOS.
Should you take it?
This is something that only you can decide. If you go for it, please do it with a recommendation from your doctor.
My take on this is that these medications can be incredibly beneficial for those with high levels of obesity. The decreased appetite can give them a breathing window to focus on nutrition and exercise. If they don’t make the right lifestyle change, they will put the weight back on as soon as they stop taking the medication.
For those who have lower levels of excess weight, I don’t personally think it’s necessary. But what you deem necessary is not for me to decide, and there is no judgment on using the fruits of modern technology to help us out.
Some words of precaution
These are some of the things that worry me with this drug:
Long-term data. Please bear in mind that we don’t have data on the long-term effects of taking this drug, and there have been examples of weight loss drugs in the past which have had to be removed from the market. GLP1 is safe in the short and medium term, but we don’t know the long-term consequences.
Muscle loss. Part of the weight people lose is muscle, which is key to supporting our bones and incredibly powerful for insulin resistance. Once you stop the medication, starting with a lower muscle mass is worrying.
Nutrient Deficencies. We know that food is much more than energy. It gives us the vitamins and minerals for our body to function well. I am worried that the decreased food intake will also come with deficiencies, which can affect our long-term health.
Quick fixes. I am very worried about this causing yet another vicious cycle of people going on it, losing the weight they require, coming off it and putting it all back. Whilst this is recommended to be done in conjunction with lifestyle change, we know how hard it is to change our behaviours. Will people engage in those behaviours if the weight comes off without much effort? Some will; some won’t.
Side effects. Every medication comes with side effects. We need to accept them as soon as we start taking them. I am more worried about the lack of long-term data on side effects.
This topic is super vast and there a lot of other offerings on the market and different type of syntethic GLP1s. If this interests you, let me know, and I will delve deeper into this subject.
Have a lovely Sunday,
Francesca
1 Sources
Carmina, E., & Longo, R. A. (2023). Semaglutide treatment of excessive body weight in obese PCOS patients unresponsive to lifestyle programs. Journal of Clinical Medicine, 12(18), 5921. https://doi.org/10.3390/jcm12185921
FDA approves new drug treatment for chronic weight management, first since 2014. (2021, June 21). U.S. Food and Drug Administration; FDA. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014
Glucagon-like peptide 1. (n.d.). Yourhormones.Info. Retrieved January 20, 2024, from https://www.yourhormones.info/hormones/glucagon-like-peptide-1/
Siamashvili, M., & Davis, S. N. (2021). Update on the effects of GLP-1 receptor agonists for the treatment of polycystic ovary syndrome. Expert Review of Clinical Pharmacology, 14(9), 1081–1089. https://doi.org/10.1080/17512433.2021.1933433
Srinivasan, D., & Lofton, H. F. (2022). Effect of GLP-1 agonists on weight loss in patients with polycystic ovary syndrome and obesity: A single-center study. Obesity Pillars, 2(100016), 100016. https://doi.org/10.1016/j.obpill.2022.100016
Disclaimer: We are all unique in our ways, so this information is for educational purposes only. In my communications, I summarise research data and bring my experience. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs