You’ve probably heard of the drug Ozempic, used to manage type 2 diabetes and as a weight-loss drug.
Ozempic (and similar drug Wegovy) has had more than its fair share of headlines and controversy. A global supply shortage, tweets about its use Elon Musk’s Endorsement for Teen Weight Loss in the USA. Oscars host Jimmy Kimmel even joked about it on film’s night of nights last week.
But how badly 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 semaglutideWho works by inducing satiety. This feeling of being full or “full” suppresses the appetite. That’s why it works for weight loss.
Semaglutide also helps the pancreas produce insulinwhich is how it helps manage type 2 diabetes. Our body needs insulin to move the glucose (or blood sugar) we get from food inside 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 energy from your 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 gut bacteria). There are many of these macronutrients in energy-dense foods, which tend to be high-fat or high-sugar foods with low water content. There is evidence that by choosing foods high in these nutrients, GLP-1 levels can be increased.
This means that a healthy diet rich in GLP-1 boosting nutrients can increase GLP-1 levels. It could be food with good fats, like avocado or nuts, or lean protein sources like eggs. And foods high in fermentable fiber, like vegetables and whole grains, feed our gut bacteria, which then produce short-chain fatty acids that can trigger GLP-1 secretion.
That is why high in fat, rich in fiber And high protein diets can all help you feel full longer. This is also why diet change is part of both weight management and type 2 diabetes.
Not so fast…
However, it is not necessarily so simple for everyone. This system also means that when we diet and restrict energy intake, we are no longer hungry. And for some people that “order” for weight and hunger could be different.
Some studies have shown levels of GLP-1, especially after meals, are lower in obese people. This could be from reduced GLP-1 production or increased degradation. The receptors that detect it could also be less sensitive or there could be fewer receivers. It could be because of differences in the genes that code for 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 both work, both have their challenges.
Medicines like Ozempic may have Side effects including nausea, vomiting, diarrhea and problems in other organs. Moreover, when you stop taking it feelings of suppressed appetite will begin to subside and people will begin to feel hungry at their former level. If you’ve lost a lot of weight quickly, you may feel even hungrier than before.
Dietary changes carry much less risk in terms of side effects, but the answers will take more time and effort.
In our busy modern society, costs, deadlines, skills, accessibility and other pressures can also be barriers to healthy eatingsatiety and insulin levels.
Diet and drug solutions often focus on the individual making changes to improve health outcomes, but systemic changesthat reduce the pressures and barriers that make healthy eating difficult (like reducing work weeks or increasing the minimum wage) are much more likely to make a difference.
It is also important to remember that the weight is only a part of the health equation. If you suppress your appetite but maintain a diet high in ultra-processed foods low in micronutrients, you might lose weight but not increase your actual diet. Thus, support to improve food choices is needed, independent of medication use or weight loss, for true health improvements.
The bottom line
The old quote:Let food be your medicineis catchy and often science-based, especially when drugs are deliberately chosen or designed to mimic hormones and compounds already found naturally in the body. Changing our diet is a way to alter our health and our biological responses. But these effects occur in the context of our personal biology and unique life circumstances.
For some people, medication will be a tool to improve weight and insulin-related outcomes. For others, food alone is a reasonable route to success.
Although science is about populations, healthcare is individual and decisions about food and/or medication should be made with the sound advice of healthcare professionals. General practitioners and dieticians can work with your individual situation and needs.