Speaker A [00:00:00]:
Hi, everyone, and welcome to today’s episode. I’m really excited to talk to you guys about a very trendy topic that has been coming up all over. You’ve probably seen it on social media, may have read about it. It is Ozempic and Semaglutide, which is an injection for weight loss. So you probably have heard about it, but you probably haven’t heard anything about it for spinal cord injury. And so that is what we are going to talk about today. Let’s get to it. Welcome to the Pro Paralysis Nutrition Podcast, where changing your eating habits is the key to losing weight, improving bowel health, and feeling your best.
Speaker A [00:00:39]:
I’m your host, Fatima Fakouri. I’m a registered dietitian who’s married to a quadriplegic and specializes in nutrition for paralysis. Get ready to be inspired, educated, and motivated so you can take control of your health using the power of food. Let’s get started. This is the Paralysis Nutrition podcast. All right, so today we are going to talk about some of these weight loss medications that have gained massive popularity over the last few months. They’ve been out for a few years, but I feel like the last year or so it has really blown up. And of course, there are some pros and there’s some cons.
Speaker A [00:01:20]:
I will admit that there are more pros than I thought. Right. Because from my perspective, I’m just like, I’m a dietitian. You should learn to eat right and that is how you’re going to lose weight. But I looked into some of the research and educated myself a bit more about these drugs. And so I’m going to talk to you about it. Some of the pros, some of the cons. And of course, we’re going to be looking at all of this from the lens of having a spinal cord injury, living with paralysis, being a wheelchair user, having neurogenic bowel, because obviously that’s, that’s what we always do around here.
Speaker A [00:02:02]:
So if you haven’t heard, semaglutide is the big thing now, not just like in Hollywood, but I mean, I live in New York. I feel like a lot of people are on it and they are losing weight and they look pretty good for the most part. It’s quite a quick acting medication. So semaglutide is the active ingredient in these meds like Ozempic. That is the brand name of the medication, Mounjaro Wegavy. These are the brand names, but the active ingredient is semaglutide. So this is an injection that is for people with diabetes, type 2 diabetes. So not the kind that you’re born with, you know, that’s the type 1.
Speaker A [00:02:57]:
This is for type 2 diabetes, which is adult onset. And it’s been out, I think since 2000, I don’t know, but it’s been at least five years that it’s been out. And it is FDA approved for diabetes. So Mounjaro and Ozempic, those are FDA approved for diabetes. Wegovy is approved for weight loss as well. So that’s the only one that actually does have FDA approval to be used for weight loss. Now all of these semaglutide injections are for diabetes, but doctors are allowed to prescribe medications for what they call off label use. So that, what does that mean exactly? That means that even if a medication wasn’t created or designed for something, if we know that it helps with that thing, doctors are allowed to prescribe it.
Speaker A [00:04:05]:
So how does this semaglutide work? It works by mimicking a hormone that we have, which is called GLP1, that is glucagon, like peptide 1. So this is a hormone that we have. And the medication, when you inject yourself with it, usually once a week, I don’t know if you inject yourself with it or doctor supposed to inject you with it. Not really sure. But yeah, like once a week you would take this injection and it’s going to help manage your hunger. It will also lower your blood sugar. So again, it’s a diabetes medication. And another thing that it does.
Speaker A [00:04:46]:
So when I say it helps manage hunger, that doesn’t just mean that it makes you feel full. Right? Like that’s not the only thing. The other thing is that it slows down your stomach, so your stomach empties slower. When you are on one of these medications, that’s already, for me a red flag if you have spinal cord injury because you already have slow gut motility. So on top of that, taking a medication that is going to cause your stomach to empty slower on purpose, like this is already a red flag for me. But before we go into the red flags, I want to be fair. I want to be fair because I did find some information that was sort of surprising to me. You know, I don’t specialize in weight loss medications.
Speaker A [00:05:41]:
Like I’m the opposite of that. So I wanted to do this episode because Ozempic is everywhere and people have been asking about it. So is it appropriate for paralysis? Let’s, you know, we’ll get to that. But let’s talk about first some of the, some of the good stuff about it. So if you don’t already know, about 70% of people in the United States are currently overweight or obese. Obese means that you have a body mass index, a BMI over 30. Okay. And so we already know that a lot of people in this country, the vast majority, right, are overweight.
Speaker A [00:06:21]:
So having a medication that can help them lose weight, it’s, it’s out there. It’s. Could it be a good thing? Maybe, could it not? I don’t know. It really is up to the person. Now this is an, obviously this is a diabetes medication. And I, you know, makes sense because we have what, 35, 40 million people in just the United States who have diabetes and twice as many, you know, 90, 95 million people in the United States who are pre diabetic. And I don’t have a stat on how many of them don’t even know it, but it’s very, very high. So most people who are pre diabetic, again, this is like 90, 95 million people in the United States that are pre diabetic.
Speaker A [00:07:09]:
Most of them do not know that they are pre diabetic. I can’t tell you how many times I have had clients start with me and you know, they want to lose weight, they want to improve their bowels, they want to feel so much better. You know, we’re here for it. At some point during our time together, they may go to the doctor and get blood work and you know, find out like, oh, my hemoglobin A1C is borderline, meaning that I am pre diabetic. And what’s shocking to me is so many times the doctors don’t actually tell them that they are pre diabetic because it’s right on the border. But if we don’t address that pre diabetes early, it’s going to become diabetes type 2. So there’s obviously a need for medical intervention when it comes to diabetes and obesity in the United States. Okay.
Speaker A [00:08:10]:
So in that way I welcome, you know, pharmaceutical advances and things like that. Right? This medication helps manage hunger and appetite and it is going to lower your blood sugar. And you know, for people who are diabetic, this could really be a good blessing. Right? So here are some of the good new things that I learned about this semaglutide. So we have found, we, like, I’m, like, I’m a researcher. They, they have found that. Now again, this is for people who have diabetes, right? Like, all of the research, this is an important point. All of the research that is out about semaglutide is using people who have diabetes.
Speaker A [00:08:56]:
So we don’t really know how it works on people who don’t have diabetes, at least in a research sense. So when I say, oh, there’s some good stuff about it, I’m talking about these studies that were performed on people who have diabetes. So one thing, and I found this really interesting and positive, they have found that treatment with semaglutide improves your body composition. So that means that you are going to have less body fat, including abdominal fat, which is really stubborn, right. And also increasing lean body mass. So that’s like, wow, I had never heard that before. And you know, when we lose weight, we need to be in a calorie deficit, right? We need to be eating less calories than our body is using so that we can lose weight. But a risk of always a risk of being in a calorie deficit is that you’ll lose muscle.
Speaker A [00:09:57]:
Because most people when they cut calories aren’t doing it the right way. They’re not counting their macros, they’re not eating enough protein, right? So they are losing more lean body mass, meaning muscle, than they need to be because they’re not eating the right way. So they have found that if you take semaglutide and you have diabetes, you will have less body fat and an increase in lean body mass. So that’s a thumbs up. That’s a good thing. There was also a quite large study of like 12, 13,000 people. Again, all of these people had type 2 diabetes. And this study showed that there were some positive effects on the kidneys.
Speaker A [00:10:45]:
So if you’ve listened to my other podcast episodes or followed me on social media for a while, you know, I talk about protecting your kidneys because if you have a spinal cord injury or any type of diagnosis that leads to having a neurogenic bladder, you are at higher risk of kidney disease. So, like if you intermittent cath, if you have a suprapubic calf, whatever, we need to be careful about your kidneys. And so when I say eat more protein, I’m also saying be careful not to go nuts with the protein. Like pounding hundreds of grams of protein a day. Like some fitness people on social media tell you to don’t do that because it’s going to harm your kidneys. Now, what’s interesting is that this study showed that there was not, not that it was improvement, but that there was a reduced risk of losing kidney function and there were lower. It slows down your glomerular Filtration rate decline. So how do I say that in a very.
Speaker A [00:11:57]:
So the, the gfr, the glomerular filtration rate indicates how well your kidneys are functioning. And so basically the study showed that the semaglutide could actually offer some kidney protective effects, which is really interesting. And you know, that is something that is of interest to me as someone who works with people who have spinal cord injury. Right. I always want to make sure that we are keeping these things in mind. Right. Like I do weight loss, I do bowel and gut health. Yeah.
Speaker A [00:12:34]:
But I always thinking about these other paralysis related medical things like preserving kidney function at the same time that I’m talking about weight loss and bowel health. So we like that. Right. We like the kidney protective effects for people who have diabetes because people who have diabetes also have risk of kidney disease. So I guess, you know, that’s probably why they studied it too. Right. Another thing that I liked reading and learning was that people who used the semaglutide had lower levels of crp. So CRP is C reactive protein.
Speaker A [00:13:17]:
It is a lab that we can use to measure inflammation in the body. So the study that showed semaglutide reduces inflammation was really interesting to me because if you reduce inflammation, that kind of can be extrapolated to say that you’re reducing the risk for heart disease. And of course, this is in people who were in the study, all of which were obese, overweight and had diabetes. So that’s it for the good part. That’s it for the good part. I wanted to give a background on what is this medicine and all that before we talk about it in the context of having a spinal cord injury. Right. Because that’s what, that’s what this podcast is about and that’s what paralysis nutrition is about.
Speaker A [00:14:10]:
So again, there’s no research on non diabetic patients. Right. That’s not who the drugs are for. The drugs are for people who have diabetes. So we know the long term risks now of taking Ozempic or any of those other types of semaglutide. We know the long term risks for people who have diabetes. For example, they say that there’s a risk for damage to your thyroid. So when I say damage, not really damage, cancer.
Speaker A [00:14:42]:
So there’s a risk for thyroid cancer. And also they found thyroid tumors in some of the rat studies. Right. So that’s no good. There’s a potential risk that you will get cancer on your thyroid. Your thyroid is really important. Also pancreatitis. Right.
Speaker A [00:14:59]:
That’s not good. There’s also something called, I didn’t mention this before. There’s also something called Ozempic face. If you’ve seen it, you know what I mean? Basically, anyone who loses weight rapidly, there’s gonna be signs in the face, right? So Ozempic face means that you’re looking kind of gaunt, perhaps that you were looking older, right. It kind of looks like rapid aging and like sagging of the skin. And of course dermatologists have Botox and fillers for that. So ozempic face is a not good thing, Right? No one wants to lose weight and then look old. That’s no good.
Speaker A [00:15:41]:
There’s also like a lot of talk about how it can make you agitated, it can make you irritable, it can make you depressed. And one thing I looked up said that people do have thoughts of suicide. Now I will also say if you look up the side effects of lots of different drugs, they say similar things like which drug doesn’t cause side effects, right? They all cause side effects. But we’re being very fair, right? I’m giving you the whole scoop on what this is. So another thing, as a mom, this is very troubling to me and I know a lot of pediatric dietitians are not okay with this, but a few months ago the American Academy of Pediatrics or of pediatricians actually gave the thumbs up for using semaglutide for kids ages 12 and up for weight loss. I mean, and you know, and they say along with nutrition and lifestyle changes. And so I wonder what case a pediatrician would okay semaglutide for in a child, like a 12 year old child. I don’t know, maybe it’s like really, really like a specific situation.
Speaker A [00:16:59]:
But I don’t want to say anything ignorant, but I do want to say that’s troubling to me. And why is it troubling to me? Because they’re 12, they’re kids and they’re supposed to be growing. And when you take ozempic or you take any med, it doesn’t make you really change your habits. It makes you eat less while you’re on it because it’s delaying your stomach from emptying and because it’s working on your glucagon, right? Glucagon is your, is your hunger or your fullness hormone. But basically it’s acting on your hormones, it’s acting on your body in these big ways. And I’m going to assume that the pediatricians have a reason for saying that. But anyway, if you don’t have kids, you probably just. That’s like in one ear, out the other.
Speaker A [00:17:46]:
But I didn’t like that. It’s like, come on, 12 years old. You need to start taking this. When we know that there’s a risk that you could get a thyroid cancer, that you could get pancreatitis. And so now we’re on the bad part right now we’re on the. Should people with paralysis take this? And I’ll start by saying this history has not been kind to weight loss meds. Like, it hasn’t. I’m 40 now, and I remember we have had so many weight loss meds.
Speaker A [00:18:15]:
You know, every couple of years we get one, people use it, and then we find out something bad about it, and it sort of goes away. I forget the scientific name for it, but fen phen was a big one in the 90s. And this was like the miracle pill, right? That would make you lose weight. Fen phen. And then we found out that, like, it could kill you, right? And how it’s because it damages your heart valves. So history hasn’t been conned, right? And of course, tons of people took fen phen. I don’t know what the deal with it is now. I knew a few years ago there was another one that came out, and it’s like, they’re here today, gone tomorrow.
Speaker A [00:18:56]:
And why are they gone tomorrow? Because they find out something really bad about it. So we already know that it could give you thyroid cancer. We already know that it could cause pancreatitis. We already know that it might mess with your mood in terms of agitation and depression and things like that. And the other thing is, so I mentioned a few times that it slows your stomach from emptying, which also can affect your medication. So if you take any. Any medication, right? There’s, like, a lot of meds that people take for different reasons. Your medications are going to be absorbed differently because your stomach is slow, is more slow to empty.
Speaker A [00:19:44]:
Which brings me to the main reason why I’m giving semaglutide and all of its brand names. Manjaro, Wegavy, Ozempic. I’m giving them the seal of disapproval. So it’s a no from me. Your spinal cord injury dietitian. It’s a no from me. Why? Because the most common side effects. And this is not just from, like, reading research.
Speaker A [00:20:19]:
This is from. I mean, everybody’s talking about it, right? Everyone’s getting crazy diarrhea. You have neurogenic bowel. Do you want to have bowel issues worse than you have the Number one reason I am giving these a big fat no is because they cause diarrhea and constipation. They also cause nausea and vomiting. And it’s supposed to be, like, for, you know, a short time. But here’s the thing. There’s no research of these drugs on people who don’t have diabetes.
Speaker A [00:20:56]:
So if you are a wheelchair user who wants to lose weight and you do not have diabetes, it’s an absolute no. Because there’s no research on it. None. There’s no research. I just looked on semaglutide for people with spinal cord injury at all. What we do know is that it can help you lose weight. It can also have some protective effects for the kidneys. It’ll help you lose body fat.
Speaker A [00:21:28]:
It may reduce some of the inflammation in your body. However, there’s a lot of other things that can help you do that that are not going to give you crazy diarrhea and constipation. As somebody who has now worked with, like, hundreds of people throughout the past, paralysis. Nutrition is turning three this April. So for the past three years, I gotta say, bowel issues are probably the biggest. Weight is a big thing, too. But bowel issues come first in terms of things that disrupt people’s lives and make people really miserable and in many cases, depressed and unproductive. So if you are curious, right, like, oh, zempic.
Speaker A [00:22:13]:
Like, maybe I can get Ozempic. No, no, you should not take this. And I haven’t even gotten to, like, sort of the worst part of it. So. The worst part is that semaglutide works when you take it regularly. Most people are taking the shot once a week. What happens when you stop taking it? Even the pharmaceutical companies themselves have said this, that you gain back the weight within a year, your appetite comes back, and you gain it all back. So it’s a no.
Speaker A [00:22:48]:
It’s a no. I was happy to do this episode because people have really been talking about these meds for months now. Every other celebrity that you see is already, like, they’ve been on it for months. I’m not going to mention names because this is not a celebrity gossip podcast. But, you know, it’s almost sort of upsetting to me because I thought we were getting over it. I thought we were loving our bodies. I thought this new generation, like, wasn’t going to have it anymore with this, you know, thinness is the ideal body. Like, it’s not.
Speaker A [00:23:25]:
I have so many. Well, I’m not going to get into it, but before, I worked with people who have Spinal cord injury. I worked with a lot of people who had eating disorders. And so to me, the pursuit of thinness, I have seen it become deadly. I have seen it become the thing that destroys your life. And so to me, being healthy and being thin, being skinny are not the same thing, right? So many people look thin but are not in good health, right? Like, inside their bodies, their hormones, their heart, their everything is not in good shape. So I’m never going to promote, like, the pursuit of thinness. And I’ll tell you this, too.
Speaker A [00:24:10]:
When I first started paralysis nutrition, I was like, huh? I don’t really want to talk about weight loss because you don’t have to lose weight to be healthy. That’s true. Weight and health are oftentimes used interchangeably, and that is not really accurate because you could have someone like me. I’ll share. So I’m five foot three. I’m about 120 pounds. I am at a healthy weight, right? If you saw me 20 pounds heavier at the same height, right? You would say, oh, now she’s overweight. But what if the weight that I put on was actually mostly muscle? And what if right now, you know, my blood sugar is poor because I’m not eating? I mean, I’m making this up.
Speaker A [00:24:58]:
What if in the thinner body, my labs weren’t as good as If I gained 10 pounds and, like, fueled my body in the right way? Like, you just don’t know, right? You just don’t know until you draw labs and you find out, like, hey, is this person having good cardiovascular health? Is this person’s thyroid in good shape? Is this person’s heart in good shape? Is their blood glucose in a good range? These are things that you cannot tell by looking at a person. So I didn’t even want to do weight loss in the beginning because I was like, oh, you know, I don’t want to make people feel bad. And then I realized when you’re a wheelchair user that you literally cannot live your life the way that you want to if you’re carrying a lot of excess weight. So now I feel really aligned talking about weight loss, because it makes people feel better in my community. It makes that easier to transfer. It makes it, you know, possible to do things independently, right? It makes physical therapy easier. It makes a lot of things a lot easier. So I think there’s a big difference between losing weight for the sake of feeling good, right? And of course, there are some health things involved as well.
Speaker A [00:26:13]:
Like extra fat tissue is correlated with inflammation. Inflammation is correlated with nerve pain. Like, all these things. Definitely. It’s one body, right? Everything works together. So losing weight when you’re a wheelchair user is going to make your life better. Becoming skinny because you’re injecting yourself with a diabetes medication is not the same thing. It’s not.
Speaker A [00:26:39]:
And so I got to say I was surprised to hear some of these kind of extra, I don’t want to say benefits, but, like, you know, I didn’t know about, like, the muscle mass thing and the adipose thing. Like, all right, that’s cool. But end of the day, it’s a big fat no for me. For people who have spinal cord injury and paralysis, because not only are you taking a medication that has not been studied in your population, you’re also taking a medicine that is designed to only work when you take it if your insurance does not cover it. I heard it’s like 900 or $1,000 a month. So this is expensive, right? Your appetite is going to come back when you stop taking it. You’re going to lose weight when you’re on it, and then you’re going to also poop your pants like crazy because everybody gets diarrhea. Everybody gets diarrhea and constipation from these medications.
Speaker A [00:27:30]:
So it’s a no. It’s a no. We don’t want to wreck our bowel health for the pursuit of weight loss. We want to learn to eat right, eat in a moderate calorie deficit, eat nutritious foods. Enjoy, enjoy, enjoy. Enjoy our favorite foods at the right times in the, you know, mindful portions. That’s what we want to do. So anyway, you guys, this was kind of a different episode for me.
Speaker A [00:27:58]:
It was cool, I think, you know, getting into the research and finding out more about this big trend. So until next time, I’ll see you on the next episode. That’s our episode for today. Thanks for listening. I hope you enjoyed it and that you learned something new. Remember, if you want to lose weight with paralysis, improve your bowel health and feel your best you can. It’s possible. You just have to change your eating habits.
Speaker A [00:28:23]:
If you need inspiration on how to get started, check out the paralysis Nutrition Cookbook 101 recipes to help you lose weight and improve bowel health. The cookbook comes with a bonus 30 day meal plan and is the perfect way to start eating healthier. You can find it online@paralysisnutrition.com cookbook. I’ll talk to you again soon.
