Ozempic (and the similar drug Wegovy) has had more than its fair share of headlines and controversy. A global supply shortage, tweets about its use Elon Musk, approval for teenage weight loss in the United States. Oscars host Jimmy Kimmel even joked about it at last week’s movie night.
But how much do we really need drugs like Ozempic? Can we use food as medicine to replace it?
How does Ozempic work?
The active ingredient in Ozempic is semaglutide, which works by inducing satiety. This feeling of being satisfied, or “full”, suppresses hunger. That’s why it works for weight loss.
Semaglutide also helps the pancreas make insulin, which is how it helps control type 2 diabetes. Our bodies need insulin to move the glucose (or blood sugar) we get from food into our 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) that is normally produced in response to sensing nutrients when we eat. GLP-1 is part of the signaling pathway that tells your body that you’ve eaten and prepares it to use the energy from your food.
Read more: Ozempic helps people lose weight. But who should be able to use it?
Can food do that?
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 are usually foods high in fat or sugar with a low water content. There is evidence that by choosing foods rich in these nutrients, GLP-1 levels can be increased.
This means that a healthy diet, high in GLP-1 stimulating nutrients can increase GLP-1 levels. These could be foods with good fats, like avocado or nuts, or lean protein sources like eggs. And foods rich in fermentable fiber, such as vegetables and whole grains, feed our gut bacteria, which then produce short-chain fatty acids capable of triggering the secretion of GLP-1.
That’s why diets high in fat, fiber, and protein can help you feel fuller for longer. This is also why diet change is part of weight management and type 2 diabetes.
Read more: Considering bariatric surgery for weight loss? Here’s what to consider
Not too fast …
However, it is not necessarily that simple for everyone. This system also means that when we diet and restrict energy intake, we are more hungry. And for some people this “set point” for weight and hunger may be different.
Some studies have shown that GLP-1 levels, especially after meals, are lower in obese people. This could be due to reduced GLP-1 production or increased breakdown. The receptors that detect it may also be less sensitive or there may be fewer receptors. This could be due to 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 drugs can work, both have their challenges.
Medicines like Ozempic can have side effects like nausea, vomiting, diarrhea and problems in other organs. Also, when you stop taking it, the feelings of suppressed hunger will start to disappear and people will start to feel hungry at their old levels. If you’ve lost a lot of weight quickly, you may be even hungrier than before.
Dietary changes have much less risk in terms of side effects, but the answers take more time and effort.
In our busy modern society, costs, time, skills, accessibility and other pressures can also be barriers to healthy eating, satiety and insulin levels.
Dietary and medication solutions often focus on the individual making changes to improve health outcomes, but systemic changes, which reduce the pressures and barriers to healthy eating (such as shortening work weeks or raise the minimum wage) a difference.
It’s also important to remember that weight is only one part of the health equation. If you suppress your appetite but maintain a diet high in ultra-processed foods and low in micronutrients, you might lose weight but not increase your actual food intake. Therefore, support is needed to improve dietary choices, independent of medication use or weight loss, to improve real health.
Read more: Stop hating on pasta: it actually has a healthy ratio of carbs, protein and fat
The bottom line
The old quote: “Let food be thy medicine” is catchy and often based on science, 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 modify our health and our biological responses. But these effects occur against a background 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 path to success.
Although science is for populations, health care is individual and decisions about food and/or medication should be made with the considered advice of health professionals. GPs and dietitians can work with your individual situation and needs.