Breaking Down The Latest Sensationalism About Ozempic

The Dr. Tyna Show Episode 183

GLP-1s like semaglutide (commonly marketed as Ozempic and Wegovy) have gained immense popularity for their effects on weight loss and diabetes management. However, with popularity comes misinformation. Claims such as GLP-1s shrinking the heart, causing blindness, or contributing to erectile dysfunction (ED) have spread across media platforms, creating unnecessary fear.

In this podcast, I’ll break down these sensational claims by examining the studies behind them, addressing their limitations, and highlighting the nuanced truth.

Key Points We’ll Cover:

• Debunking the claim that GLP-1s cause blindness
• Understanding the supposed link between GLP-1s and erectile dysfunction
• Analyzing the “heart shrinkage” claim from recent research

Let’s dive into the details.

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Do GLP-1s Cause Blindness? The Truth About Retinal Risks

A recent study in Denmark and Norway analyzed the relationship between semaglutide use and non-arteritic anterior ischemic optic neuropathy (NAION), a rare condition affecting the optic nerve.

• Participants: 424,152 individuals with Type 2 diabetes, of which 61,377 used semaglutide.
• Findings: Semaglutide users had a 2.8x relative risk increase of NAION compared to users of another diabetes medication, SGLT2 inhibitors.
• Absolute Risk: The real-world risk translated to just one to two additional cases per 10,000 person-years.

Key Limitations:

• No Control Group: The study only compared two drug groups without a placebo or untreated cohort.
• Correlation, Not Causation: The study design cannot confirm semaglutide directly caused NAION. Other factors (like Type 2 diabetes or obesity) independently increase NAION risk.
• Lack of Dosage Data: Without knowing the dose or duration of semaglutide use, it’s difficult to draw meaningful conclusions.

Bottom Line:

The data suggests that the reported association between GLP-1 use and blindness is rare and influenced by underlying health conditions, such as Type 2 diabetes and obesity, rather than directly caused by the medication itself.

Erectile Dysfunction and GLP-1s

Another observational study suggested a potential link between semaglutide use and erectile dysfunction (ED) or low testosterone.

• Participants: Men with obesity or overweight conditions, many with Type 2 diabetes.
• Findings: The study observed an association between semaglutide and ED but did not establish causation.

Key Limitations:

• Confounding Factors: Men in the study often had pre-existing risk factors for ED, such as obesity, a sedentary lifestyle, and poor metabolic health.
• Rapid Weight Loss: Extreme weight loss caused by semaglutide could lead to reduced muscle mass, nutritional deficiencies, and hormonal imbalances, all of which may temporarily impact testosterone levels and sexual health.
• Self-Reported Data: Relying on participants’ self-reports can skew accuracy.

Bottom Line:

The available data indicates that factors such as rapid weight loss and pre-existing conditions may contribute to observed cases of ED, rather than semaglutide directly causing these effects. This underscores the importance of working with a healthcare provider to support metabolic and hormonal health while on GLP-1 therapy. This also highlights the importance of pairing GLP-1 therapy with strength training and a high-protein diet to maintain muscle mass and hormonal balance.

Does Semaglutide Shrink the Heart?

A recent mouse study suggested semaglutide reduced cardiomyocyte (heart muscle cell) size and overall cardiac mass. This finding, combined with results from cultured human heart cells, sparked concerns about “heart shrinkage.”

• Findings in Mice: Obese mice treated with semaglutide experienced a 30% reduction in body weight and a 65% drop in fat mass.
• Cultured Human Cells: The study observed reduced cardiomyocyte size when heart cells were exposed to semaglutide.

Key Limitations:

• Extreme Dosing: Mice were given doses far exceeding typical human levels, leading to rapid weight loss. This shock to the system likely caused atrophy across various tissues, including the heart.
• No Real Human Data: The human findings were based on cultured cells, not actual patients, making it impossible to draw concrete conclusions about clinical effects.

On the flip side, robust human trials like the SELECT study have shown semaglutide can reduce major cardiovascular events by 20%. Improvements in lipid profiles and inflammation further demonstrate its cardiovascular benefits.

Bottom Line:

Current evidence regarding GLP-1s and changes in heart structure is limited to animal studies with high-dose interventions and laboratory cell models. Real-world data in humans, such as the SELECT trial, demonstrates cardiovascular benefits, including reduced risk of major events. Proper dosing and gradual weight loss could potentially mitigate any theoretical risks to heart health.

Practical Takeaways: Using GLP-1s More Effectively

Avoid Rapid Weight Loss 

Extreme weight loss can cause hormonal imbalances, muscle loss, and vascular complications. Work with a healthcare provider to establish a gradual, sustainable plan.

Pair GLP-1s with Lifestyle Changes

• Incorporate strength training to preserve muscle mass.
• Follow a high-protein diet to support metabolic and hormonal health.
• Optimize sleep, stress management, and overall metabolic health.

Individualized Dosing is Key

• Start with low doses and titrate up slowly.
• Avoid using GLP-1s as a stand-alone therapy. Pair them with other supportive measures like peptides, hormones, or metabolic boosters as needed.

GLP1 Clinical Trials: Facts Vs. Fiction

While sensational claims about GLP-1s causing blindness, erectile dysfunction, or heart shrinkage make headlines, they often lack solid evidence and context. When used correctly and with medical supervision, GLP-1s are powerful tools for weight loss and metabolic health. Their benefits, including improved cardiovascular outcomes and reduced inflammation, potentially outweigh their risks when administered responsibly.

For those interested in diving deeper into GLP-1 use, be sure to check out my GLP-1s Done Right University for comprehensive guidance for both practitioners and the general public.

Remember, education and empowerment are your best defenses against misinformation. Research wisely, consult qualified professionals, and embrace a holistic approach to health and well-being.

Show Links: 

Once-weekly semaglutide doubles the five-year risk of nonarteritic anterior ischemic optic neuropathy in a Danish cohort of 424,152 persons with type 2 diabetes: https://pubmed.ncbi.nlm.nih.gov/39696569/#:~:text=type%202%20diabetes-,Once%2Dweekly%20semaglutide%20doubles%20the%20five%2Dyear%20risk%20of%20nonarteritic,Int%20J%20Retina%20Vitreous.

Semaglutide Reduces Cardiomyocyte Size and Cardiac Mass in Lean and Obese Mice: https://www.sciencedirect.com/science/article/pii/S2452302X24002869 

Prescribing Ozempic and Wegovy for Weight Loss is Associated with an Increased Risk of Erectile Dysfunction and Hypogonadism in Non-Diabetic Males: https://academic.oup.com/jsm/article/21/Supplement_1/qdae001.148/7600659 

GLP1 Done Right University 

Ozempic Uncovered 

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