The realm of weight loss is a big business that includes everything from shakes and powders to supplements and bars. Within this mentality of a “quick-fix” for weight loss, weight-loss medications are ever popular. As the holidays are approaching many individuals become concerned with “staying on track” as sweets and treats become more abundant. Now the demand has turned to popular diabetes medications to help individuals quickly lose weight or keep it off through the holidays. Even Elon Musk credited Wegovy (as well as fasting) for his dramatic slim down, and celebrities are using Ozempic for quick weight loss before big events. So, what are these medications and are they an answer for weight loss? Let’s dig in.

What is Ozempic?

Ozempic (semaglutide) is a medication used to reduce A1C levels, in individuals with type 2 diabetes. It also works to reduce the risk of heart attack and stroke in these individuals. Semaglutide works by targeting GLP-1 receptors in the pancreas and brain. These receptors control the release of insulin and glucacon in the body. Semaglutide binds to these receptors to increase the amount of insulin released and decrease glucagon levels. This reduces the amount of sugar in the bloodstream. The medication also slows gastric emptying, which leads to a decreased food intake due to a feeling of fullness.

When Ozempic first came on the market, patient weight loss results were so significant the manufacturer started running trials on the drug with the outcome of treating obesity.

Wegovy, which uses the same medication (semaglutide) as Ozempic, was released by Novo Nordisk to treat obesity along with a reduced calorie diet and physical activity.

What is the difference between Wegovy and Ozempic?

The difference between Wegovy and Ozempic is the dosing. Lower doses are appropriate for the treatment of type 2 diabetes, while higher doses are typically used for weight loss. However, there have been some instances where Ozempic has been prescribed off label and used for weight loss. Several articles detail celebrities losing weight for events using Ozempic.

Both medications are once weekly injections. The pens must be kept in the fridge until first use. After first use, Ozempic pens can remain at room temperature for 56 days. Wegovy pens are single-use only and should be discarded after use.

Side effects to be aware of with this medication:

• Diarrhea
• Nausea
• Constipation
• Vomiting
• Acute abdominal pain

New Trials for Weight Loss in Adolescents

New trials are now being conducted to test the appropriateness of this medication to combat obesity in teenagers. Approximately 17% of adolescents in the 10 to 17 age range are considered obese. This comes with serious health complications such as early onset hypertension, type 2 diabetes, high cholesterol, and joint problems. So far in trials, Wegovy has shown to be more effective for weight loss in obese teenagers than lifestyle interventions alone. More information is needed to understand the underlying cause of teenage obesity so targeted lifestyle interventions can be improved.

The Problem With Weight Loss Medications Alone

Many times weight loss medications are viewed as “quick-fix” options for extreme weight loss. The problem with this mentality is that this weight loss is not sustainable. Both Ozempic and Wegovy mention the drugs should be used in combination with “a reduced calorie meal plan and increased physical activity.”

A new study found that long-term 10% weight loss was achieved when the weight loss medication was used in conjunction with lifestyle interventions.

Also, depending on your individual health, wellness and goals, weight loss medications may not be right for you. Another study notes that, “In a head to head trial, lifestyle intervention was superior to pharmacotherapy in preventing type 2 diabetes in patients at high risk for the condition.”

It is also important to mention that one trial showed that weight loss slowed after stopping Wegovy , even with lifestyle intervention.  Further research is needed to determine an appropriate long-term plan for patients requiring Wegovy for weight loss.

Pharmacist Sam’s Tips:

• Semaglutide should be used appropriately – Ozempic for diabetes, Wegovy for weight loss. This prevents strain on the manufacturer to keep up with high demand and improves accessibility to medication for diabetics.
• Use these medications while working with a dietitian and pharmacist on lifestyle changes to improve long-term results.
• Ask your pharmacist about how to properly store, inject, and discard your medication.
• Know what to do if you miss a dose.
• Common side effects should reduce over time, typically within the first month.

Amy RD’s Tips:

• Always discuss medications with your doctor as well as your pharmacist for questions
• Weight loss medications should be used in conjunction with lifestyle interventions, dietitians are experts in nutrition and lifestyle interventions
• Find a dietitian that will work with you and your specific needs and goals
• Remember that small changes can add up to big results, weight loss medications are not always the answer for long-term, sustainable weight-loss

References:

https://www.dailymail.co.uk/health/article-11236583/Celebrities-spending-1-500-month-diabetes-drug-incredible-weight-loss.html#:~:text=Celebrities%20are%20spending%20%241%2C500%20a%20month%20on%20diabetes,need%20it%20to%20manage%20their%20condition%20More%20items

Weight loss drug Wegovy helped teens with obesity lose weight (nbcnews.com)

https://pubmed.ncbi.nlm.nih.gov/33755728/

Improved Patient Outcomes with Dietitian and Pharmacist Collaboration

We are thrilled to be collaborating and working with Pharmacist extraordinaire Samantha!

It’s National Pharmacy Week!

Let’s celebrate our pharmacy friends and discuss how collaboration with them has the potential to improve patient outcomes.

Today our focus is diabetes education. There are numerous diabetes medications available to help manage insulin resistance. Some of these medications come with some not so wanted adverse effects – nausea, headache, urinary tract infections, etc. Other medications do have “desirable” side effects such as weight loss and appetite suppression, and several more medications have a mix of unwanted and wanted adverse effects. This makes medication choice and adherence quite difficult. While we agree that medication selection is between you and your physician, we can help make the most of your prescribed medication(s).

What if you could improve your outcomes with some help from a dietitian AND pharmacist?

A recent pilot study in Japan observed the link between pharmacist-dietitian collaborative support and patients’ Type 2 diabetes management outcomes. (A few things to note – this was a very small (pilot) study with only 8 participants, results were collected after 6 months, and two of the measured scores were subjective.) In this study, the dietitian provided nutrition and lifestyle modification counseling while the pharmacist counseled on the prescribed medications. The results showed a significant reduction in A1C and a significant increase in HDL. While more research on pharmacist-dietitian collaboration is needed, we believe more improved patient outcomes will be seen with this teamwork.

Until this collaboration is researched more and implemented in our healthcare sites there are some steps you can take to reach your health goals. 

1. Be your own health advocate!
2. Ask questions! Curious about your medications?  Pharmacists are there to help you understand everything about your prescribed medications. 
3. Ready to take steps to further improve your health? Dietitians love to discuss nutrition and provide personalized nutrition counseling.
4. Embrace the process! Change isn’t easy but small lifestyle changes produce big results!

Thrive Nutrition RDN’s Tips:

1. Diabetes can be complicated and overwhelming, find a dietitian to help you!
2. Keep a food diary and journal your meals and fluids.
3. Know your numbers, start tracking your blood sugar and look for patterns.
4. Small lifestyle changes can equal big results! Ask your dietitian for recommendations. 

Pharmacist Sam’s Tips:

1. Be consistent with your medications. Forget a dose? Call your pharmacist to know what to do!
2. Fill all your prescriptions at the same pharmacy so your pharmacist can monitor for drug interactions.
3. Some medication adverse effects resolve over time. 
4. Do not stop taking your medication without consulting your doctor or pharmacist.

Reference:

A pilot study of Pharmacist-Dietician Collaborative support and Advice (PDCA) for patients with type 2 diabetes in community pharmacy: A single-arm, pre-post study

PMID: 35919801

I received such great feedback from my collaboration with Vegnews on a the benefits of a plant-based diet for psoriasis I thought I would expand on this topic.

What is Psoriasis?

First off, what exactly is Psoriasis? Psoriasis is an immune mediated disease, meaning that the exact cause of this disease is unclear. What we do know is that it causes inflammation in the body which is generally characterized by raised plaques and/or scaly skin. The National Psoriasis Foundation estimates that psoriasis affects 3% of the adult U.S. population.

Current Treatments

Treatments for psoriasis can vary and include everything from pharmacology steroids, to light therapy to alternative treatments such as aloe Vera and fish oil supplements. The chronic inflammation of this disease is characterized by psoriatic lesions, resulting in oxidative stress. For those suffering with psoriasis the unpredictability of the disease can induce even more stress, triggering more psoriasis flare-ups.

While the internet is full of lots of helpful health information, regarding psoriasis, a 2019 research report estimated that nearly two-thirds of YouTube videos on psoriasis disseminate misleading or even dangerous content. Always consult your doctor or medical professional before making health changes. Registered dietitians are credentialed and licensed by state to provide you with expert nutrition recommendations.

Plant-Based Diet Effect on Psoriasis

Now, back to psoriasis inflammation and how plants can help! As with all nutrition recommendations I go to the research. At the foundational level, a diet for inflammation should be anti-inflammatory focused. This is where a plant-based diet comes in.

Plant foods are rich in antioxidants and phytochemicals. Antioxidants are substances that protect against harmful effects of free radicals. Phytochemicals, also referred to as phytonutrients are chemicals found in plants, fruits, vegetables, whole grains, legumes, beans, nuts, herbs and spices that have the potential to stimulate the immune system, reduce inflammation and reduce oxidative damage to cells. Research shows that a diet rich in vitamin C, Beta-carotene and flavanoids helps to improve psoriatic skin lesions. Keep in mind many of these antioxidant nutrients are found in skincare products and oral supplements, however the best way to get the benefits of these nutrients is through food sources.

Key Nutrients for anti-inflammatory benefits:

Vitamin C: Vitamin C is an antioxidant and helps with collagen formation, a key structural component of our skin.

Sources: Broccoli, kiwi, strawberries, bell peppers, tomatoes

Vitamin E: This antioxidant is found in our skin oil and helps create a natural barrier to keep moisture in our skin and helps reduce skin’s inflammatory response.

Sources: Nuts, seeds, avocado, legumes

Omega-3: These polyunsaturated fatty acids have been suspected to have anti-psoriatic effects.

Sources: Walnuts, flaxseed, salmon, mackerel

Flavanoids: These plant compounds have been shown to have anti-inflammatory effects in the body.

Sources: Berries, onions, kale, cabbage, tea, parsley, citrus fruits

Dietary Fiber and short-chain fatty acids: Short-chain-fatty-acids are the by-products of fiber fermentation in the colon. They help to regulate inflammation in the intestines and have been shown to improve psoriasis.

Sources: Most SCFAS are made in the gut when following a plant-based diet. Sources include high fiber fruits and vegetables: garlic, onions, peas, lentils, bananas, apples, carrots. The list goes on!

Foods to Avoid:

Studies have shown that certain foods can promote the inflammatory response in the body and worsen skin disorders, such as psoriasis. Foods that promote inflammation include saturated fats such as those in red meat. Of course, if you are eating a plant-based diet red meat is not of concern. However, simple sugars have been shown to exacerbate psoriasis. So, avoiding excessive intake of simple sugars and simple carbohydrates is recommended.

Research shows that alcohol and smoking can exacerbate the symptoms of psoriasis and should be avoided when possible to reduce symptoms. Psychological stress is also a risk factor for psoriasis and dealing with psoriasis also causes stress, so this is a cycle that makes dealing with psoriasis very difficult.

Thrive RDN Final Thoughts:

Replacing processed foods, simple carbohydrates and simple sugars with vegetables, fruits, nuts, seeds, and legumes will help support healthy skin and help to ease the inflammation associated with psoriasis. A diet that is rich in antioxidants and plant-focused can help in providing relief to those dealing with psoriasis.

Interested in seeing how a plant-focused diet can help with your psoriasis? Contact Amy or schedule a free 15-minute consultation today.

References:

Garbicz, J., Całyniuk, B., Górski, M., Buczkowska, M., Piecuch, M., Kulik, A., & Rozentryt, P. (2021). Nutritional Therapy in Persons Suffering from Psoriasis. Nutrients, 14(1), 119. https://doi.org/10.3390/nu14010119

Kanda, N., Hoashi, T., & Saeki, H. (2020). Nutrition and Psoriasis. International Journal of Molecular Sciences, 21(15), 5405. https://doi.org/10.3390/ijms21155405

Musumeci, M. L., Nasca, M. R., Boscaglia, S., & Micali, G. (2022). The role of lifestyle and nutrition in psoriasis: Current status of knowledge and interventions. Dermatologic Therapy, 35(9), e15685. https://doi.org/10.1111/dth.15685

Phytochemicals’ Role in Good Health. (n.d.). Retrieved September 14, 2022, from https://www.todaysdietitian.com/newarchives/090313p70.shtml

Staff, E. (2020, September 21). Food for Healthy Skin. Tufts Health & Nutrition Letter. https://www.nutritionletter.tufts.edu/healthy-eating/food-for-healthy-skin/