Semaglutide And Tirzepatide - What's All The Hype? 

Dr. Deborah Bowers, with Yorkville Pharmacy and Wellness, is a functional medicine wellness pharmacist. She uses pharmaceuticals when patients need them, but also looks for the root cause to address why they're taking those medicines. Unlike traditional or conventional medicine, hopefully they will discontinue those medicines as their body heals. The medicines simply cover up the symptoms.

Semaglutide is administered as a weekly injection or as an oral tablet. It's available as a: compounded product, Ozempic pen injector, Wegovy auto-injector and Rybelsus tablet.

Tirzepatide is administered as a weekly injection. And it is also available as a: compounded product, Mounjaro pen injector and Zepbound auto-injector.

How do these medications work? What makes them desirable?

GLP-1 stands for glucagon like peptide one, which mimics a hormone. And that hormone enhances insulin secretion when blood sugar levels are high. This occurs in the pancreas.

And it reduces glucagon, which is the sugar release that naturally occurs in our body whenever we need it from the liver. It slows gastric emptying in the stomach, and it increases satiety in the brain, which makes you feel full.

Tirzepatide has an added action with another peptide called GIP, which is a glucose dependent insulinotropic polypeptide. It also works in the intestines. It results in added insulin creation and a greater sensation of fullness. Instead of just having one hormone that's in Semaglutide, you have two hormones working in Tirzepatide.

Studies have shown that GLP-1 increases cardiac protection, glucose utilization, cardiac output, vasodilation, as well as decreases fatty acid metabolism. Vasodilation causes the blood vessels to open more. That's usually a positive thing.

Cardiac output is usually positive because as you age, your cardiac output starts to decrease.

Inflammation is decreased in our immune system.

In our skeletal muscle, it increases the uptake of glucose. Glucose fuels cells and increases perfusion, which means it increases blood flow. This is important, especially in diabetics and people who are insulin resistant - who have not been diagnosed with diabetes yet, but may be pre-diabetic.

The issue with diabetes is there's excess glucose sitting around, and your body has nowhere to put it. Then, it starts wreaking havoc on the organs.

In the kidneys, it also increases diuresis, which is a fancy way of saying it increases your urine output.

In the adipose tissue, it increases the breakdown of fat and increases the glucose uptake. That's another positive.

GLP-1 medications like Semaglutide and Tirzepatide control blood sugar, which is why they're used for Type 2 Diabetes. They also help with weight loss, which is why it's become so popular.

Just because someone's not labeled diabetic, we usually can see that they're headed in that direction about 10 to 15 years before they've got lab values and symptoms that would label them with that diagnosis. It's really important to realize that you don't just wake up one day diabetic, unless you have Type 1, which does happen. For the majority of diabetics that have Type 2, this has been coming for over 10 to 15 years. Doctors typically watch the numbers until you become diagnosable.

These medications also have cardiovascular benefits, such as reducing heart attack and strokes in the patients with diabetes and cardiovascular disease.

The media has given these medications a lot of attention. Actors, actresses and movie stars have used them and touted them. They can change people's lives when some other things haven't worked.

There's also been a huge shortage, which always makes news.

People are getting results. They're improving their quality of life, and they're giving them health outcomes that they have not been able to get otherwise. Again, in comparison with other traditional treatments.

With every medication that you take, there are risks versus benefits. And the side effects of these medications are pretty significant. You need to know about them.

The most common side effects are: nausea, vomiting, constipation, diarrhea and appetite reduction. Since you may want appetite reduction, it may seem like a benefit, not a side effect. We're going to discuss why that can be an issue too.

Besides constipation, diarrhea and vomiting making you feel unwell, these medications can have even more serious side effects. This is why you definitely have to have regular check-ins with your practitioner, to make sure these things aren't happening and that you are pooping regularly every single day. That's important, even if you're not on these medications.

If you don't remember anything else from this article, remember that pooping every single day is really important for your overall health. And it should look like a banana or a sausage.

The more serious side effects are:

• Pancreatitis
• Gastroparesis
• Bowel obstruction
• Gallbladder dysfunction, such as congestion and gallstone attack

Pancreatitis is inflammation of the pancreas. It causes abdominal pain, which shouldn't be surprising, because these medications increase insulin production from the pancreas. If you use something too much, it can cause some problems.

And then you have gastroparesis, which is when movement of food out of the stomach is either slowed or stopped. And that can cause some serious issues.

Bowel obstruction basically means that a blockage that keeps food from passing through the intestines.

Gallbladder issues can cause gallbladder congestion and gallstone attack. This is why you may want to take d-limonene, phosphatidylcholine or a combination of those to help break up those congestion bile ducts.

Even though people can live without a gallbladder, it really does serve a purpose. It holds all the bile. After you eat, it allows this big bolus of bile to go through your intestinal tract and actually act like a soap, so to speak, to cleanse everything out. If you don't have your gallbladder, then there's nothing to hold that bile. You get a steady drip, drip, drip, and you don't get that cleansing effect.

Gallbladder congestion can be cause for many different things.

People who experience these more serious side effects likely had some underlying problems to begin with - the pancreatitis and the gallbladder situations for sure. You are probably going to have those whether you took the medicine or not. In my opinion, it's just the medicine probably sped that up a few years. So, keep that in mind.

The side effects are one of the reasons why we start with very low doses, and you increase gradually. You don't increase quickly. Also, eat smaller, more frequent meals.

Again, you also need to be checking in with your practitioner and having an exam to make sure the side effects aren't occurring.

Dr. Bowers had a patient who wanted to lose the weight fast. The body is not going to adjust well to starting on a higher dose. These medications are a hormone type of product. It takes the body time to adjust and regulate. We don't want to set patients up for failure. That's why we go low and slow.

We always want to use the least amount of medication to get the job done. If you're losing weight at a low dose, then there's no reason to increase it. Think about that.

There are considerations and precautions. People who are breastfeeding and pregnant women should definitely not be on these medications.

And you know, they have a black box warning for a history of thyroid tumors and multiple endocrine neoplasia syndrome type two. We have to weigh the benefits and the risks of being on these medications.

There are drug interactions that could occur.

If you have diarrhea, then you are not absorbing nutrients. Also, your medication could pass much quicker, resulting in not getting the benefit.

If you have constipation, the opposite could be true in that you're just absorbing a lot of toxins. Your body has taken the time to get those things ready to be moved out of your body from the GI tract. Since you're constipated, it just sits there and you reabsorb all that gunk, like a cesspool.

There are definitely things that impact drugs and nutrition. We want to make sure that we're monitoring your blood sugar levels and the side effects too.

Since the medications increase insulin, that will impact your glucose level.

Alright, let's say you decide that you're going to be on these medications. Remember, you may want to take some phosphatidylcholine and d-limonene to help you break up any bowel congestion or gallstones that you might not even know you have, which could rear its ugly head.

Another consideration is that you are going to be eating a lot less, which means it is very important that what you're eating is good, whole, nutritious and water-rich.

What I see in my practice most often is people with nutritional deficiencies. That's why they are experiencing the symptoms. And this goes way beyond weight loss; this is just in general. We definitely do not want to set you up to have other issues. Eating fiber-rich foods like vegetables, as well as lean proteins, is important. Protein can help you feel full and sustain you longer in between meals.

Make sure you're eating mindfully - not eating in front of the TV or in bed. Listen to your hunger cues. When you are full, stop eating. Eat slow enough that you know when you are full.

Do weight-bearing exercise because a lot of the weight that people tend to lose is their lean muscle mass. And that creates a whole other dynamic. Some of the frailty we see as people age is that they lose the muscle mass in their larger muscles. They start wasting away, so to speak. We don't want to get a jump on that.

A lot of the food that we eat isn't nutritious, even if you make good choices. A stock of broccoli and an apple, for example, are 25%-50% less nutritious than they were before 1974-1975, whenever our farming practices changed.

I recommend supplements, even for people who are making really great choices just because our demand on life. Our stress levels are higher than they used to be. We're not sweating at the levels that we used to be to get rid of toxins, and we are exposed to toxins everywhere we turn. I have another video that talks specifically about supplements and what you should be evaluating for your unique situation.

We need to drink lots of water with clean electrolytes in it. You don't want electrolytes with a lot of sweeteners and artificial flavors or dyes. I personally like Ultima. That's what we sell at the pharmacy. Sole water is great too. Simply add some Himalayan salt to your water. (Get the recipe here.) It adds minerals and potassium to my water if I've run out of Ultima. You want to absorb that water into your cells. You don't want to just continue to pee it out.

If we don't address the root cause of the weight gain and figure out what got us there, then when we stop the medicine, the weight will come right back. Typically, people gain more weight.

I always recommend using some binders because weight is the body's way of protecting us from something. Is it protecting us from a toxin? Is it protecting us from emotions? Since it's protecting us, what's it protecting us from? When you start to lose that weight, then you're basically opening up a floodgate of toxins. And your body has the oxidative stress of dealing with that again. So, you definitely want something that's going to bind that up, and get it in your stool so that your body can remove it. And we already talked about how important pooping is.

Let's touch on the compounding of these medications. Yes, they are commercially available. They don't have a generic. So, how are all these different versions available? Well, the FDA has a list of commercially available products that can be compounded. And usually that is due to the manufacturer not being able to keep up with the demand for whatever reason. We experience this almost every year with pediatric Tamiflu. The manufacturer doesn't make enough. Then, you can't get it, and you've got kids that are miserable.

We have permission to make the compounded product. Compounded products are not the same as brand-name products. Realize that the compounded product does have an active pharmaceutical ingredient in it. So, you know, the pharmacy will buy the active pharmaceutical ingredient, just like the makers of Wegovy buy that ingredient, or Ozempic buy that ingredient. So you're not actually buying that ingredient. When you buy the brand names, you buy that delivery system. You buy that auto-injector or pen injector, for example.

And you buy that specific formulation, but the active pharmaceutical ingredient could be the same. The compounded products allow for more dosing adjustments and flexibility. So we mentioned people who are having side effects. Maybe you don't need to step up to the next full dose that is commercially available; maybe you need a dose and a half or a dose and a third.

503b facilities, which a lot of the pharmacies that are making the sterile (injectible) products, they are regulated by the FDA. The FDA is the same entity that regulates drug manufacturers. If you didn't know, pharmacy is a very regulated field. And the products that are being compounded that are not sterile, those pharmacies are using good manufacturing practices that are regulated by their pharmacy boards. There's about 20 different organizations that can come in my pharmacy to inspect and cite us for anything. Keep that in mind when you're looking at those options.

In some cases, the compounded product could be cheaper.

What is right for you may not be right for someone else. As with any drug, the usage benefits definitely need to outweigh the risks for a given individual. For example, if someone is morbidly obese, and has tried to lose weight, they may have some serious cardiovascular issues and have sugars that are uncontrolled, it may behoove them to take the risk of the side effects and precautions mentioned to see if these medications work for them.

Realize, too, that these medications don't work for everybody. And that's another layer that has to be addressed.

For the people that it works for, they have some good results along with the side effects. Dr. Deborah Bowers has not known anyone who's taken these medications and not experienced the side effects. That's really important to realize.

Now, there are a lot of people who don't experience the serious side effects. Dr. Bowers can't think of anybody who hasn't experienced the GI (gastrointestinal) side effects.

Hopefully this article gave you more information than you knew before to help you make an informed decision on what might be right for you.

If you'd like to discuss your situation with Dr. Deborah Bowers, Functional Pharmacist, to see if these medications are right for you and what your root causes of weight gain could be, schedule a complimentary discovery call here.