Ozempic® is a prescription drug that is given to some adults who have type-2 diabetes1-3. It is the second-line treatment. It is given when the first-line treatment (metformin) does not control blood glucose sufficiently. Currently, it is given as an injection of 0.5, 1.0 or 2.0 mg of the active ingredient (semaglutide). It is injected once every week. In addition, an oral dosage form has been developed and shown promise in controlling hypoglycemia and glycated hemoglobin (HbA1C) in adults with inadequately controlled type-2 diabetes 4. When combined with proper diet and exercise, it can lower blood glucose and reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes with known heart disease. The most common side effects of Ozempic® may include nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation. Less common but sometimes severe side effects include thyroid tumors, pancreatitis (inflamed pancreas), changes in vision, hypoglycemia (low blood sugar), kidney failure, allergic reactions, and gallbladder problems.

Semaglutide influences blood glucose levels by binding to a specific receptor on cells in the lining of the small intestines (L-cells), as well as the liver, pancreas, central nervous system and kidneys. This receptor binds the hormone called glucagon-like peptide-1 (GLP-1). GLP-1 is produced in the gut and is released in response to food consumption. It reduces appetite and increases the secretion of insulin when it binds to its receptor. When the body does not produce sufficient GLP-1, agonists such as semaglutide can bind to the receptor and have the same effect. This is different from the way that metformin acts. So, Ozempic® can be given as a monotherapy or in combination with metformin or insulin. It is highly advisable in people who have cardiovascular disease, especially atherosclerosis.

However, both metformin and semaglutide cause severe adverse side effects in the gastrointestinal tract of some people. This includes vomiting, diarrhea, constipation and dyspepsia. There are also some other infrequent side effects. These include nasopharyngitis, headache, infections in the urinary tract and upper respiratory tract, as well as increased pancreatic enzyme (amylase and lipase) levels. Occasional cases of acute pancreatitis have been reported. In those cases, semaglutide treatment was discontinued.

More recently, much publicity has been given to the ability of Ozempic® to reduce one’s weight 5-6. The FDA approved Ozempic® in 2017 for treating adults with type-2 diabetes. In June 2021, they approved a higher dose of semaglutide in a drug called Wegovy® for weight management. However, there is now a shortage of Wegovy®, causing many physicians to prescribe Ozempic® for off-label use for weight loss. As of June 2023, the hashtag #ozempic on TikTok had 931.8 million views. It is becoming a vanity medication rather than a critical treatment for individuals with diabetes. Moreover, when people stop taking Ozempic®, they gain back most of the weight that they lost.

Still, some very influential people have recommended Ozempic® for weight loss. These patient influencers work with pharmaceutical companies to help promote their products. As demand rose rapidly, several insurance companies imposed restrictions on access for both Ozempic® and Wegovy®. Many insurers are denying prior authorization requests for patients unless they have completed diet and exercise programs or tried other lower-cost drugs first. Still, pharmaceutical companies know that many patients are still willing to pay approximately $13,000 USD/yr out-of-pocket if a weight loss drug is not covered by their insurance plans.

Also, TikTok and Reddit influencers are spreading the idea that the plant-based chemical called berberine can be a replacement for such popular diabetes and weight loss drugs as Ozempic® and Wegovy®. It can be extracted from goldenseal, barberry, and various poppies.

Goldenseal has a long history of disinformation. There was a time when many people thought that taking a high dose of goldenseal would enable one to pass a urinalysis for illegal drugs. It did not work but was used so widely that the United States Environmental Toxicology Program and others tested its toxicity and pharmacology in test animals. Berberine has anti-inflammatory and anti-cancer effects. However, it has not been tested sufficiently in clinical trials for it to be approved by the FDA or any other country’s regulatory agency for treating any disease. They have sent warning letters to companies who have made false or unsubstantiated claims about berberine – especially when it is advertised as an alternative or in addition to metformin.

Still, berberine is available as a dietary supplement and can be taken without a prescription or the supervision of a pharmacist. Also, the dose inside a bottle containing berberine is often quite different than what is indicated on the label. Still, many people take it to lose weight and to treat their type-2 diabetes. Unfortunately, berberine can cause hypoglycemia (dangerously low glucose levels) when given to people who take metformin. Also, berberine should not be taken while pregnant or breastfeeding. Berberine can cross the placenta and harm the fetus. Kernicterus, a type of brain damage, has developed in newborn infants exposed to berberine.

Notes

1 Ozempic possible side effects.
2 Mahapatra, M.P. et al. Semaglutide, a glucagon like peptide-1 receptor agonist with cardiovascular benefits for management of type 2 diabetes. Reviews in Endocrine and Metabolic Disorders. Volume 23, p. 521-539, 2022.
3 Chamberlin, S. Dabbs, W. Semaglutide (Ozempic) for Type 2 Diabetes Mellitus. American Family Physician. Volume 100, p. 116-117, 2019.
4 Aroda, V.R. et al. Efficacy and safety of once-daily oral semaglutide 25 mg and 50 mg compared with 14 mg in adults with type 2 diabetes (PIONEER PLUS): a multicentre, randomised, phase 3b trial. The Lancet. 2023.
5 Wojtara, M. et al. Examining off-label prescribing of Ozempic for weight loss. Qelos. 6 June, 2023.
6 Blank, C. High demand keeps some diabetes medications in short supply: pharmaceutical companies are experiencing supply chain disruptions and shortages because of the popularity of diabetes drugs used for weight loss. Drug Topics. Volume 167, p. 16-17, 2023.
7 Gasmi, A. et al. Berberine: Pharmacological Features in Health, Disease and Aging. Current Medicinal Chemistry. 2023.