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Semaglutide: The Pros and Cons of This Medicine
After Bariatric Surgery
A meta-analysis on the use of GLP-1 receptor agonists for weight gain or insufficient weight loss after bariatric surgery showed a mean weight loss of 4.15 kg greater for semaglutide compared to liraglutide (Saxenda).
The Downsides
Semaglutide use can cause gastrointestinal problems such as diarrhea, nausea, or vomiting. These side effects increase the risk of treatment discontinuation, raising safety concerns, particularly at high doses.
In addition to the effects on the digestive system mentioned above, the risk of gallbladder-related disorders, particularly cholelithiasis, may increase with semaglutide use.
Although the observed weight loss was mainly due to a decrease in adipose tissue, in some cases, the reduction in muscle mass was significant, accounting for up to 40% of the total weight loss. Despite this, the proportion of muscle mass to total body weight increased, suggesting an overall positive outcome in people who are overweight or obese. This reinforces the importance of incorporating physical activity while taking semaglutide, along with adequate protein intake. It should be noted that rapid weight loss with GLP-1 receptor agonists can also affect bone density. Significant (≥ 14%) and rapid (over 3 to 4 months) weight loss is associated with significant bone loss, while more moderate and slower weight loss may better preserve bone mass.
People using GLP-1 receptor agonists to treat obesity experience a significant reduction in appetite and energy intake, with observed calorie reductions of 16 to 39%. This significant and rapid reduction can lead to an insufficient intake of essential vitamins and minerals. Iron, calcium, magnesium, zinc, and vitamins A, D, E, K, B1, B12, and C are examples of nutrients that are at risk of deficiency. Signs of nutritional deficiencies may include fatigue beyond expected levels, excessive hair loss, itchy skin, muscle weakness, poor wound healing, and unusual bruising.
GLP-1 receptor agonists can have negative effects in otolaryngology. A systematic review highlights the occurrence of Eustachian tube dysfunction following the use of these molecules, such as hyperacusis, vertigo, deafness, tinnitus, ear pain, and motion sickness.
Finally, GLP-1 receptor agonists are generally not recommended for people with a history of eating disorders or certain specific pathologies, such as gastrointestinal diseases or kidney failure. Furthermore, they are contraindicated during pregnancy and breastfeeding.
Author
A University of Montreal graduate and holding a Master's Degree in Medical Research from Griffith University in Australia, Tracy is a Registered Dietitian and active member of the Ordre professionnel des Diététistes Nutritionnistes du Québec (ODNQ). With more than 15 years of experience, she likes to share her knowledge about food in a simple and illustrated way in order to support you in achieving your health goals. Her approach combines the pleasure of eating, intuitive eating and mindfulness. Tracy specializes in adapted nutrition for chronic diseases, weight loss, gastrointestinal health, vegetarianism and veganism.
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