Ozempic, the brand name for the popular weight-loss drug semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has gained a lot of popularity. It helps some people lose weight that they have struggled for years to get rid of. It helps with blood sugar management for type 2 diabetes. After all, weight loss is the key to reversing type 2 diabetes. However, there are emerging reports, including a published case report on PubMed, that suggests there is a potential link between sumaglutide and the occurrence of small intestinal bacterial overgrowth (SIBO). In the case published on PubMed, a 35-year old man developed worsened lactose intolerance and a new gluten intolerance while he was taking semaglutide. He did lose a ton of weight, 50 pounds in 120 days. So that part was great. But the new food intolerances–not so great.
The mechanism behind this potential risk lies in semaglutide’s impact on gut motility. Semaglutide slows down how fast the stomach empties and slows down how fast food moves through the gut, so that you feel full longer. Doctors have noted that this is a perfect setup for SIBO, as it allows bacteria to proliferate in the small intestine where they normally wouldn’t grow. The patient’s symptoms of bloating, diarrhea, and food intolerances align with SIBO’s clinical presentation. And his methane-positive SIBO test from Geneva Diagnostics confirmed the SIBO diagnosis. The SIBO showed up months after discontinuing the semaglutide. This guy took up strength training, watched his diet more carefully, had some coaching, and was able to maintain his BMI near 25 kg/m^2. And he did say he had some mild symptoms of lactose intolerance more than a year before getting on semaglutide.
What can we learn from this case report?
First, if you have gut issues, like food intolerances or allergies, semaglutide may not be a good idea for you. It may make these food reactions worse. This case report isn’t the only one showing that slowing down the gut motility could be a bad idea, leading to SIBO. And I wouldn’t wish SIBO on anyone, as I know a few people who have struggled with it for years and live on a very restricted diet just to manage a sense of normalcy in life. SIBO is not easy to reverse. I would rather tackle T2D any day.
Second, with all of the other side effects of semaglutide, and the weight-loss plateau, and the risk of gaining it all back when you get off of the drug, why do we think this drug is a great idea? It is a crutch, and you still have to learn all of the lifestyle changes and diet modifications that make any weight loss permanent. And we are now learning that it is a crutch that can really hurt you long term. So, I would carefully weight my options before thinking about using it.
Where to Go From Here?
If you were counting on Ozempic as your secret weapon to overcome type 2 diabetes, you may want to rethink that strategy. Instead, take a look at this article about goal setting and see if that might be helpful for you.
It could be you can do this on your own and you can take the information that I provided for you and reverse your type 2 diabetes. You’re not stuck with it—it is quite reversible. Or you may want to consider coaching with me.
So consider your options and figure out what works best for you now. I’m here to help in whichever way works best for you.
