Semaglutide and Food Issues

According to the WHO, in 2022, 2.5 billion adults aged 18 and older were overweight, including over 890 million adults living with obesity. This means that 43% of adults were overweight, a significant increase from 1990 when the figure was 25%. Given these statistics, it’s no surprise that a new class of weight loss drugs has become highly popular.

One such drug, semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has gained significant attention for its effectiveness in managing type 2 diabetes and obesity. However, like any medication, it has potential issues that need careful consideration. Two such concerns are decreased food tolerance and suppressed intake, impacting patient compliance and overall health.

Understanding Semaglutide and Its Potential Issues

Since its approval for diabetes treatment in 2017, semaglutide has rapidly become one of the most popular prescription drugs in the U.S. By 2021, it ranked 90th among the most commonly prescribed medications. Semaglutide mimics the incretin hormone, essential for regulating blood sugar levels. It boosts insulin secretion and reduces glucagon release, helping lower blood sugar and promote weight loss. However, despite these benefits, semaglutide can also impact the gastrointestinal system, leading to decreased food tolerance and reduced intake.

Gastrointestinal Side Effects

Patients on semaglutide have reported various gastrointestinal side effects, including nausea, vomiting, and diarrhea. These symptoms can significantly reduce food tolerance, making it difficult for patients to maintain a balanced diet. The mechanisms behind these side effects are thought to be linked to the delayed gastric emptying that semaglutide induces. This delay can cause a feeling of fullness and discomfort even after consuming small amounts of food.

Appetite Suppression with Semaglutide

Semaglutide has also been shown to suppress appetite, which is beneficial for weight management. However, this can become problematic if it leads to inadequate caloric intake. Patients may experience a significant reduction in their desire to eat, which, if not appropriately managed, can result in undernutrition.

In summary, while semaglutide offers significant benefits in managing type 2 diabetes and promoting weight loss, its influence on the gastrointestinal system and appetite needs careful monitoring to ensure patients maintain adequate nutrition and overall health.

The Lack of Emphasis on Examining Consequences

One of the most concerning aspects of semaglutide usage is the lack of emphasis on examining these potential consequences when instructing individuals about appetite-suppressing medications. Often, the primary focus is on the benefits of weight loss and glycemic control, with insufficient attention given to the adverse effects on food tolerance and intake. This oversight can lead to a patient education and awareness gap, ultimately affecting adherence and outcomes.

Case Study: Wernicke Encephalopathy Linked to Semaglutide Use and its Impact on Vitamin Intake

To illustrate this issue, we present a recent case found through the DrugCard platform. The case involves a 37-year-old man who came to the emergency room with symptoms including difficulty swallowing, slurred speech, trouble finding words, and limited eye movement. These symptoms were linked to non-alcoholic Wernicke encephalopathy (WE), which he developed while using semaglutide.

He reported starting semaglutide a few months earlier. The patient’s significant weight loss of 70 lbs over three months of semaglutide use severely impacted his appetite. A neurology consultation revealed that the ophthalmoplegia (eye movement problems) and other symptoms were due to WE, a condition caused by thiamine deficiency.

This case highlights the importance of educating patients about maintaining adequate vitamin intake, even when appetite is reduced, especially when using GLP-1 receptor agonists like semaglutide.

Improving Patient Safety with Effective Pharmacovigilance

Semaglutide offers significant benefits for managing type 2 diabetes and obesity, but its potential side effects, such as decreased food tolerance and reduced intake, require careful attention. Without full awareness of these issues, healthcare providers may struggle to manage adverse effects effectively. Additionally, patients may not recognize or report symptoms early without proper education, leading to delayed intervention. This underscores the need for better patient education and ongoing monitoring.

To address these challenges, effective pharmacovigilance is essential. This involves:

• Informing patients about potential side effects and the importance of reporting any symptoms.

• Adjusting treatment plans based on individual responses to the medication.

• Regularly monitor for side effects and make necessary adjustments to ensure patient safety.

By staying vigilant and responsive, the pharmacovigilance community can improve the safety and effectiveness of medications like semaglutide, leading to better patient outcomes.