unwanted side effects of glp-1 drugs explained by nutrition science
7 minute read
dr. john berardi, who lives in st. catharines, ont., has worked in body transformation for decades, co-founding a nutrition coaching company for health and fitness professionals around the world.
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with the rising availability of glp-1 medications, there’s a lot of “noise” surrounding the side effects of the drugs. these prescription receptor agonists, like ozempic and mounjaro, were designed to treat type 2 diabetes but are widely used to help people lose weight.
they work, but for some, fewer cravings and satisfaction with smaller portions come at a trade-off. glp-1s can cause nausea and fatigue, along with mood swings, irritation, fatigue and loss of interest in favourite foods and activities. these side effects have been labelled “ozempic personality” on social media, and now we’re seeing people stopping the medication, despite the weight loss success.
‘ozempic personality’ reflects low-energy diet
dr. john berardi, a fitness expert and mentor to elite athletes, says there’s a reason for these symptoms that can be explained by nutrition science. he has a doctorate in exercise physiology and nutritional biochemistry, and deep experience in the fitness industry as a coach and competitor. at 52, he competes in master’s class events in the 100-metre and 200-metre track.
“glps change people’s bodies in remarkable ways. they are miraculous compounds, and if you think about what’s happening, someone who starts on a glp gets 1/4 of a milligram of this compound a week. you can’t even see that much with the naked eye. it’s so small an amount of a compound. and it’s changing 100 years of the willpower narrative for people living with obesity. it’s powerful,” he says. “but whether it’s a supplement for sleep or muscle building or weight loss, if something has powerful positive effects, you can’t pretend that there isn’t a risk for negative effects.”
changing the narrative on obesity
dr. berardi, who lives in st. catharines, ont., has worked in body transformation for decades, co-founding a nutrition coaching company for health and fitness professionals around the world. he says the low food intake that happens for people taking glp-1s mimics what people in bodybuilding do intentionally to refine their physique. competitors go on a hypocaloric diet, which is a nutritional plan where you consume fewer calories than your body expends, pushing your body to use fat stores for energy.
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another health movement along these lines is intermittent fasting, where people fast for periods of time to reset their metabolism. researchers at the university of pittsburgh school of medicine recently published their investigation into fasting for metabolic health and longevity in the journal biogerontology, noting the need for more research on its potential.
“in the bodybuilding world, people intentionally go for three or four months on a very low-energy diet, doing high amounts of exercise. they get in a negative energy balance and their personality changes. they’re irritated and anxious a lot of the time because they’re in a low-energy state. their body produces more epinephrine stress hormones,” he explains, adding this helps them lose fat, but it also makes them have less patience and tolerance.
“they are also hungry, right? so, anyone who’s gone too long without a meal knows that feeling. well, imagine that feeling being your baseline of life.”
so, it’s no wonder that people are struggling with committing to glp-1 medication long-term. dr. berardi says whether you’re on a hypocaloric diet for a bodybuilding competition or taking this “miraculous” drug, your body is conserving energy. you’re apathetic and can’t imagine getting off the couch some days, which translates into the behaviours of ozempic personality of disinterest.
“i liked to go dancing before, or i would meet up with my friends and do x, y or z hobby. i’m not going to do that anymore because my body’s in conservation mode.”
glp-1 users need support and guidance to fully benefit
while he says there’s so much “noise” around glp-1s, these conversations that explain the side effects aren’t happening. dr. berardi, a keynote speaker at a recent health summit by obesity matters, wants to get the word out. he announced his launch of a new coaching platform for health professionals and glp-1 users to educate and support people on their health journey. the aim is to see people do well on the medication and experience more energy and lasting results.
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“there are about 30 million glp users in the world, and over the next five years, they predict it’ll be 70 million,” he says, noting that people need more than the prescription to do well on glp-1s.
“when we think about the miracle that glps are, and then you go out into the world and talk to people using glps, you learn very quickly that the challenge isn’t weight loss anymore … so we’re no longer coaching weight loss. but there’s all these people who are going off glps because of the untenable side effects. so now it’s like, how do you coach people to get the benefits of their glp use without all these negative effects, which are making them want to stop?”
he also points out the psychological dilemma of successful weight loss on glp-1s. people will say, “i lost weight, i really wanted that. i’m lighter in my body, but i vomit three times a day, or i’ve lost 40 per cent of the weight as muscle mass, or i am so tired and fatigued and apathetic about movement and exercise. i thought that going on glps would help me get lighter and want to participate in activity. now i’m lighter and i feel like i have the body to participate in activity, but i can’t. i’m just exhausted now.”
what can people do to mitigate side effects and make the most of a lighter body?
dr. berardi recommends foundational exercises like resistance training to build muscle and strength. adequate nutritional intake of vitamins, minerals, hydration and protein is also critical.
“i’ve talked to 10 people in the last month who’ve told me that their hair is falling out, but they like being lighter. and why is the hair falling out? again, it’s not the glps, it’s the undernutrition that comes when you are eating so little,” he explains. “low appetite means that the most filling nutrient, which is protein, is the one you eat the least of.”
another key focus is sleep because hypocaloric intake causes sleep disruption and sleep is essential for overall health, both mental and physical. here, stress management also comes into play because of the increased production of stress hormones.
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“but the harder question is what should they do first? how should they do it?” he says, adding that the right coaching can provide a tailored plan of progression and a personal mentor for support along the way.
he emphasizes that how we look at obesity is changing dramatically because of emerging science and drug therapy.
“we had all this narrative around obesity is neurobiological. it’s often dysregulated appetite and metabolic differences and things like that. but glps came out in this tiny bit of compound, helping people normalize their body weight, quiet food noise and create the type of mental and physical environment that someone not living with obesity might be experiencing.”
while living with obesity and overweight stems from a wide array of factors, with genetics among them, glp-1s are making weight loss happen. they are the catalyst for people to fully participate in healthy, active lifestyles. dr. berardi says this opens the door to a better quality of life.
“glps are a once-in-history on-ramp for people who have their whole lives felt or been excluded from physical activity,” he says.
possibilities come with access and belonging
“they offer the promise that maybe my knees will hurt a little bit less if i don’t have those 40 extra pounds. a walk that was once punishing feels like a stroll. now you start to see this idea of physical access and then psychological access, so these possibilities start to open. you don’t necessarily have to have someone who can usher you into those spaces because you belong. for me, that is what is motivating here. this is the first time we’ve ever seen something like this where on mass, there’s the opportunity to help this whole group and multiple generations of people see themselves as capable of participating in physical activity.”
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the big ask is for health-care providers and fitness professionals to create an environment where people are showing up with knowledge to help glp-1 users overcome some of the side effects and challenges. these hurdles are threatening the huge benefit of access to physical activity and improved quality of life.
people without obesity who follow healthy lifestyle habits understand the power of movement, he adds.
“they understand that sometimes the best acute antidepressant is some exercise. even if it’s a hike in the sunshine in nature, so we’re talking about quality of life and mental health. living longer is nice, being able to do sports or whatever is wonderful, but just having access first to physical activity as a means for self-regulation and quality of life and happiness. that’s so critical. and it’s often missing from the dialogue of health and wellness providers.”
for dr. berardi, body transformation is a lifelong learning process. he was born premature to an overprotective italian mom who didn’t want her fragile little boy to get hurt. he had asthma and allergies, and spent a lot of time indoors reading books, so sports didn’t feel accessible to him growing up. but he met a gym owner when he was an older teen who mentored and inspired him to train and compete in track events. small and weak would hardly be how you’d describe him today.
“the animating questions of my life and career really are, to what extent do you have the power to change your body? and if you change your body, what else changes with it?”
he comes back to the potential of glp-1s as a normal part of weight loss: “it teaches us about ourselves and about how we see others. my point is that they are lifting some shame and blame from the community and now helping us talk about the more important things.”
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