Users of Ozempic-like drugs report stomach paralysis as a side effect

As the use of these drugs become more widespread so too are the reported side effects. And yet, how many doctors and patients are aware of these side effects?

Image from Well Water Expert

Apologies for readers who may find these reports on Ozempic and other GLP-1 receptor agonists a bit tiring. I personally find that there’s a lot to glean from this Ozempic era, as it provides insights into why we should have a greater understanding of drugs and their mechanisms of action.

One of the biggest failures of modern medicine is the idea that one takes a drug to treat a certain ailment or symptom without considering the ramifications of such treatments. Millions of prescriptions are provided for various medications nationwide, and yet how many people actually understand how these drugs work, or what side effects to look out for if they appear?

These failures became even more pronounced with the COVID vaccines and pronouncements of “safe and effective”, with Leqembi and Alzheimer’s immunotherapies following suit with unclear efficacy data and concerning side effects. Here, we are now seeing many of these medical failures coming to fruition when it comes to these Ozempic-like drugs.

As more people get their hands on these medications for weight loss, reports of side effects have begun to pop up with even greater frequency, from people reporting nausea, vomiting, and other issues related to these drugs.

And just this week a new, rather concerning side effect was reported. Yesterday CNN released a rather alarming article which reported on two cases of women who experienced gastroparesis, or stomach paralysis, following the use of Ozempic and Wegovy (both formulations contain Semaglutide as the GLP-1 RA). Gastroparesis occurs when the stomach does not contract to the same degree that it normally should, and so food is digested and removed far more slowly than normal. This leads to symptoms such as nausea and vomiting, which have been widely reported with the use of Ozempic-like drugs. Gastroparesis is also associated with many different diseases including Type II diabetes mellitus.

The two people featured in this article, Joanie Knight and Emily Wright, appear to have taken Ozempic for weight loss, only to later have complications including persistent vomiting.

Wright details a bit of her complications in the article:

Emily Wright, 38, a teacher in Toronto, started taking Ozempic in 2018. Over a year, she said, she lost 80 pounds, which she’s been able to keep off. But Wright said she now vomits so frequently that she had to take a leave of absence from her job.

After these complications, Knight and Wright would be diagnosed with severe gastroparesis:

Knight and Wright have been diagnosed with severe gastroparesis, or stomach paralysis, which their doctors think may have resulted from or been exacerbated by the medication they were taking, Ozempic.

Wright said she has also been diagnosed with cyclic vomiting syndrome, which causes her to throw up multiple times a day.

Not quite a glamorous side effect, and it appears that doctors have reported similar cases such as these as more people begin to take these GLP-1 RAs.

Now, it should be made clear that the two cases above may not be directly caused by these GLP-1 RAs, but that these two individuals may have been more at risk of developing gastroparesis, or they may have had underlying signs of gastroparesis that became exacerbated with these drugs. Note that Wright was diagnosed with diabetes 5 years prior, and given the association there is a possibility that the gastroparesis may have been exacerbated by the use of Ozempic.

The rest of the article is rather interesting. Doctors didn’t appear to associate Knight’s symptoms to her use of Ozempic. In fact, many doctors don’t really know much about the possible side effects aside from what is included in the package insert for these drugs, and so many doctors are likely to prescribe without assessing for risk factors.

All of this provides for a rather perplexing conundrum. Why is it that people are experiencing reduced digestion and stomach paralysis on these drugs?

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More than just an incretin

To spoil the lead-up, I wouldn’t be writing this article if not for an examination of possible mechanisms of action, and ones that seem to be grossly overlooked with these drugs.

In the CNN article a little remark was made that didn’t quite make sense to me (emphasis mine):

The diabetes drug Ozempic, and its sister drug for weight loss, Wegovy, utilize the same medication, semaglutide. These and other drugs in this family, which includes medications like tirzepatide and liraglutide, work by mimicking a hormone that’s naturally made by the body, GLP-1. One of the roles of GLP-1 is to slow the passage of food through the stomach, which helps people feel fuller longer.

This last sentence confused me a bit. Sure, slowing down food digestion would make one feel fuller mechanically (a literal full stomach). However, the wording here makes it out as if the intent of GLP-1 is to make people feel full longer. As in, the stomach slows digestion down in order to make us feel fuller.

This seemed a bit more of a mix-up between cause and effect. In this case, I was suspicious of whether feeling fuller was more of a consequence of GLP-1 rather than a direct intended action.

Consider that GLP-1 allegedly signals for the pancreas to release more insulin, with insulin signaling to other parts of the body that a high level of nutrients such as carbohydrates are present and should be dealt with.

The cascade of events here appear to be dictated by the degree of nutrients being consumed. By that logic, there may be a possibility that GLP-1 may act as a regulatory mechanism to prevent the body from becoming overwhelmed.

In looking into this assumption I came across this article from the BMJ¹ which seems to provide some insights into this alternative explanation. It appears that GLP-1 does not slow down digestion to make you feel fuller, but rather processes related to digestion may slow down in order to prevent the body from being inundated by acting as an enterogastrone- a hormone that regulates gastric motility and secretion (emphasis mine):

Endogenous GLP-1 stimulates pancreatic insulin secretion in a glucose-dependent manner. As such, it is involved in the so called ‘incretin effect’, meaning higher insulin release after oral glucose intake, than after intravenous glucose administration. Its potency is demonstrated by blockage of the GLP-1R, which results in a 50–70% decrease in insulin secretion after oral glucose intake.^18–20 In addition, GLP-1 may also serve as an enterogastrone, a hormonal mediator of the ileal brake phenomenon.²¹ This mechanism guards the distal intestine from caloric overload, by reducing GI transit, gastric acid secretion, pancreatic exocrine excretion and gallbladder emptying.²² Several studies using the GLP-1 receptor antagonist exendin (9–39) revealed an inhibitory role of GLP-1 on proximal GI motility.²⁰ ,^23–25 Some even suggest that the role of GLP-1 as enterogastrone outweighs its role as incretin in glucose homoeostasis.²⁶ ,²⁷

It should be noted that this process of attenuating gastric and intestinal function is not all too clear, and far more complex systems may be at work. Although the above excerpt mentions GLP-1 in particular, several of these GLP-1 RAs seem to produce similar functions as well.

And, as noted above, the complicated role of GLP-1 in health has even raised questions of whether GLP-1 should be considered an incretin hormone or an enterogastrone hormone.²

An excerpt from Müller, et al.³ also had a comment that caught my eye:

Because gastric emptying is a prerequisite for glycemic rises after meals, which in turn trigger insulin secretion, deceleration of gastric emptying in response to exogenous GLP-1 leads to lesser post-meal glucose excursions and reduced insulin secretory responses [809]. This has led to doubts about the importance of an incretin role for pharmacological GLP-1 administration, because incretin hormones should lead to a net increase in post-nutrient insulin secretory responses [810].

I probably should have read more into this review since I have cited it before, but I hope readers will forgive me for not wading through a 30-page review.

I also won’t confuse readers as I haven’t delved into the literature to provide a further assessment, but make note that there’s plenty of unknowns when it comes to these sorts of hormones. It’s possible its effect on diabetes may not be through regulating insulin release, but rather through other upstream processes.

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Fool me twice…

In lieu of these pathways the side effects of nausea and vomiting are more clear. I previously assumed that the influence of these drugs on the brain may be related to the nausea and vomiting, however it appears that these side effects may be related to reduced gastric emptying.

But what’s rather worrying is the fact that doctors and patients may not be aware of these mechanisms of action and how they may relate to side effects. When CNN asked Ozempic maker Novo Nordisk for comment in regards to these cases of stomach paralyses, they responded with the following:

“Gastrointestinal (GI) events are well-known side effects of the GLP-1 class. For semaglutide, the majority of GI side effects are mild to moderate in severity and of short duration. GLP-1’s are known to cause a delay in gastric emptying, as noted in the label of each of our GLP-1 RA medications. Symptoms of delayed gastric emptying, nausea and vomiting are listed as side effects,” the statement said.

Again, this comment doesn’t say anything about why these side effects may occur, just that they may be a possibility.

So now as millions of people worldwide clamor to receive these miracle drugs we are witnessing an all-too familiar scenario in which a drug that is touted to be relatively “safe and effective” may actually be quite harmful in certain groups. Or put another way, not every drug is safe for everyone. What’s important is figuring out who may be harmed and why these people may be harmed.

Should patients with a longstanding history of diabetes be told that they may be at higher risk of gastroparesis? Should patients be screened for gastroparesis prior to an Ozempic prescription? What exactly should patients know in order for them to be more informed and aware of the significance of nausea and vomiting when on these drugs? What does it mean when those symptoms decline (i.e. is that a sign of reduced efficacy and possible tolerance to these drugs?).

This burden doesn’t fall on patients but also on doctors as well. How many doctors have been made knowledgeable about these types of drugs as the Ozempic craze rages on? How many doctors know what GLP-1, or even incretin hormones are before they prescribe these medications? Or are doctors prescribing these medications solely under the guise that they are relatively “safe and effective”? They treat obesity and diabetes, and that’s all that matters- side effects such as stomach paralysis be damned!

All of this is not intended to suggest that these Ozempic-like drugs may prove to be extremely harmful. Rather, it emphasis the point that we should know more about the things we are taking, and doctors should be more knowledgeable about the drugs they prescribe before we commit to these new treatments.

Instead, the current paradigm in medicine seems to be “prescribe and see” rather than informed consent. Remember the comments made that wouldn’t know the degree of side effects for the COVID vaccines until everyone received them? It appears that the same is taking place with Leqembi-like and Ozempic-like drugs- administer drugs to everyone and let them report their adverse reactions.

Note that one serious concern about these drugs is that they may complicate surgeries, as patients may still have food remaining within their guts by the time of their surgical procedure. Patients on these drugs may then vomit or experience complications with anesthesia, making surgical procedures even more precarious and possibly even deadly.

Unfortunately, we seem to be dealing with a cultural paradigm of widespread ignorance while simultaneously having the most information possible at our hands. The information is out there, but the ability to parse it and be critical thinkers is what seems to be lacking.

The precautionary principle also seems to be lacking, but that seems to be the case with all forms of medicine and health. We should take more care to be cautious of what we take, especially if they are intended to provide quick fixes.

As of now, it appears that Wright and Knight are managing their gastroparesis. Unlike other patients, their symptoms seem to have not cleared up after stopping Ozempic.

And so as more and more people rush to take these medications we may see more adverse reactions being reported in the near future. The question becomes how many people would have known beforehand, and if they had known would they have taken these drugs?

Prior post on Ozempic:

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1. Smits MM, van Raalte DH, Tonneijck L, et al

GLP-1 based therapies: clinical implications for gastroenterologists

Gut 2016;65:702-711.

2. Horowitz M, Nauck MA

To be or not to be—an incretin or enterogastrone?

Gut 2006;55:148-150.

3. Müller, T. D., Finan, B., Bloom, S. R., D'Alessio, D., Drucker, D. J., Flatt, P. R., Fritsche, A., Gribble, F., Grill, H. J., Habener, J. F., Holst, J. J., Langhans, W., Meier, J. J., Nauck, M. A., Perez-Tilve, D., Pocai, A., Reimann, F., Sandoval, D. A., Schwartz, T. W., Seeley, R. J., … Tschöp, M. H. (2019). Glucagon-like peptide 1 (GLP-1). Molecular metabolism, 30, 72–130. https://doi.org/10.1016/j.molmet.2019.09.010