EVERYone these days seems to be taking a GIP- or a GLP-1-agonist! They’re so common, social media posts are blowing up about “Ozempic Face” (and “Ozempic Butt,” for that matter). The drug ads are working beautifully—almost as good as word of mouth—so patients are coming into their doctors’ offices asking if that drug is right for them. Or just asking for the drug!

So, what happens if you’re an ND in an unlicensed state? Or, you’re in a licensed state with no prescriptive scope? 

Better yet, what if you’re an ND in a licensed state WITH prescriptive scope, but unwilling to accept liability of GIP/GLP-1 agonists? (That’s a thing!) What happens when the patient is doing “all the right things” on the physical level with no shift in weight? Or, after the drug for weight loss is discontinued, the weight gain happens all over again? Or, what about the patient on the GLP-1-agonist, who’s experiencing the scary and/or ugly potential side effects of the agent, who comes to you desperate to go off the medication, but unsure how to do so safely?

THOSE situations are what I’d like to address in this article. (For non-prescribers, this is for YOU, no matter your scope!)

Scenario One: unwilling to accept liability of GIP/GLP-1 agonists. What could possibly go wrong, you wonder? (“Ozempic Face/Butt” didn’t get your attention?) As a Class of drugs, the GIP and GLP-1 agonists share these BOXED WARNINGS and the following Precautions:

(While I’m using the Boxed Warning for Ozempic, most of the GLP-1 agonists and GIP agonist have these SAME Boxed Warnings! The exceptions are exenatide and lixisenatide—the two synthetic analogs; the rest are biologics—grown on other critters’ pieces-parts. The Precautions vary slightly and are still quite significant, meaning potentially fatal!)

Precautions:

• Pancreatitis
• Diabetic retinopathy complications 
• Hypoglycemia with (or without!) concomitant use of insulin secretagogues or insulin (when the brand name version for weight loss is used, just “Hypoglycemia” is listed)
• Acute kidney injury 
• Hypersensitivity 
• Acute gallbladder disease 
• Severe gastrointestinal adverse reactions (not yet listed for liraglutide; current class action suit for this newly added precaution)
• Pulmonary aspiration during general anesthesia or deep sedation (not yet listed for dulaglutide)
• Heart rate increase
• Suicidal behavior and ideation¹

(These last two that are bolded are only listed in the weight loss version of the drugs. Interesting, huh? Same ingredients, same dosing schedule, same manufacturer. Different risks.?)

• Add “drug-induced thrombocytopenia” and “immunogenicity” to exenatide,² just “immunogenicity” to lixisenatide.³

If that’s not enough to make you think twice about accepting liability for these agents, how they’re made may be of interest to you. Semaglutide is a GLP-1 analogue with 94% sequence homology to human GLP-1. The peptide backbone is produced by yeast fermentation. The tablet version contains magnesium stearate, microcrystalline cellulose, povidone and salcaprozate sodium (SNAC)⁴. (SNAC is an intestinal permeation enhancer.)⁵ 

Here are the others:

Exenatide is a synthetic peptide, glucagon-like peptide-1 (GLP-1) receptor agonist, that was originally identified in the lizard Heloderma suspectum.⁶

The peptide precursor of liraglutide, produced by a process that includes expression of recombinant DNA in Saccharomyces cerevisiae, has been engineered to be 97% homologous to native human GLP-1. (This is likely the same as semaglutide’s “yeast fermentation”. Stick a pin in that; I’ll come back to Saccharomyces cerevisiae later.)⁷

Dulaglutide is produced using mammalian cell (Chinese hamster ovary) culture. The GLP-1 analog portion of dulaglutide is 90% homologous to native human GLP-1 (7-37).⁸

Lixisenatide is a synthetic analogue of human GLP-1. Lixisenatide is a protein containing 44 amino acids, which is amidated at the C-terminal amino acid (position 44) and has a molecular weight of 4.8585 kDa.⁹

Each manufacturer’s product monograph contains this consistent disclaimer: “GLP-1 agonists alone can’t treat Type 2 diabetes or obesity. Both conditions require other treatment strategies, like lifestyle and dietary changes.”

Say what?! That’s Step ONE on the Therapeutic Order! 

Scenario Two: the patient is doing “all the right things” on the physical level with no shift in weight. I suggest you delve past the surface physicality of excess weight. While these pharmaceutical agents have indications for use in both Type II Diabetes and Obesity, and there are similarities between the two as far as obstacles to cure go, there are also significant differences.

The similarities include poor dietary choices, excess consumption of sugar, the use of chemical sugar substitutes¹⁰ and zero fat gram “foods” (seriously; we went “sugar free” in the 1970s and “fat free” in the 1980s. By this point, we should be a country of super skinny people. The truth is, we’ve never been more overweight than we are right now),¹¹ nutrient devoid foods, poor exercise habits, poor sleep, excess screen time,¹² eating late, self-medicating with food, poor stress management skills, and taking prescription medications (see my previous work/CE offerings on this topic.)

As many as 10% to 15% of weight issues are related to medications.” –Louis Aronne, MD, director of the Comprehensive Weight Control Center at Weill Cornell Medical College.

Here are some less obvious obstacles: environmental pollution¹³ and overworking¹⁴ for Type II diabetes; high ACES scores for obesity.^15-17 (Mic drop.) It’s true!

Start asking “hard” questions—you know, the kind that make both you and your patient uncomfortable. If she’s had complex childhood trauma, wouldn’t it make sense that she’d at least unconsciously want a bit more insulation from the world? Think metaphorically with your patient so you both really understand the true etiology of the suffering and delve deep to dig up those roots that no longer serve.

Getting to the root of the issue with each individual patient is a big part of step two, “Stimulate the Vis!” It’s highly likely that you’ll need to counsel around other consumables in your patient’s life, like music, movies, magazines, books, social media quantity and quality.

Scenario Three: after the drug for weight loss is discontinued, the weight gain happens all over again. I see this all the time. It goes back to focusing only on the physical, when the problem got its start in the emotional or mental realm. Don’t be afraid to get really “real” with your patients. I believe that’s why they seek out naturopathic doctors: tired of the sterility of conventional practices, they’re looking for something different, something more wholistic. 

Y’ALL! That’s our heritage, the legacy we’re to be stewarding! If you aren’t attracting patients that push your buttons to encourage your own personal growth, so that you can help more people with deeper problems, I think you’re missing out on some great opportunities!

Scenario Four: the patient on the GLP-1-agonist who’s experiencing the scary and/or ugly potential side effects of the agent, comes to you desperate to go off the medication, but is unsure how to do so safely. These agents tend to stay in the system for about five weeks. Make incremental dosage decreases no more often than every four weeks. Expect to focus on gut health while tapering them off. But don’t touch the meds until you’ve:

• Removed obstacles to cure
• Restore(d) (or established for the first time) the determinants of health
• Gotten the patient’s agreement to live differently for a different outcome
• Taught the patient to track both subjective symptoms with objective signs—these  prove the inevitable over-medication and logical dose reduction/removal

While the Standards of Care are written by medical doctors for medical doctors, the Therapeutic Order was written by naturopathic doctors for naturopathic doctors. MDs/DOs have historically “lived” on steps six and seven. Functional medicine, by definition, are steps three and four. Everybody these days is utilizing step five! 

Who is focusing on Foundational Steps One and Two? 

(Don’t remember the Therapeutic Order? I’ve drawn it as a staircase below. BONUS: the Naturopathic Principles and Disease Reversal Basics are also included in this schema!)

To REVERSE disease, one must pull out the “big guns,” says medical-fasting champion Alan Goldhamer: the return to real food, clean water, daily movement, restorative sleep, healthy relationships and living life on purpose! (steps one and two!) I concur! And whole-heartedly invite and encourage you to focus on the foundation of health with your patients/clients, helping them identify and remove their own obstacles to cure, resolving past trauma along the way!

Let’s give our patients what they require for whole person healing. If you’re a naturopathic doctor, you have the range of the entire Therapeutic Order to explore with your patients—the art of choosing multiple steps and therapies to paint a gorgeous treatment plan for each. You are not limited to the conventional medical Standards of Care. (They don’t even apply to NDs.)

If the level of pathology is high enough to warrant you skipping multiple stairs to reach the level of intervention that matches, do so! But touch down firmly on each step once the patient is stabilized, please, teaching along the way. Without a firm foundation, none of the upper-level therapeutics can be expected to “hold,” just like with the structure of a building.

Weight loss and type 2 diabetes cannot be reversed by pills and pokes. Health cannot be gained by pellets or potions. Teach (Docere) the foundations of health and enjoy the “medical miracles” your patients experience.

Remember the yeast Saccharomyces cerevisiae on which many ingredients used in pharmaceuticals and nutraceuticals are now grown? Remember the lab test run to distinguish Crohn’s disease from Ulcerative Colitis—pANCA and ASCA? ASCA stands for “anti-Saccharomyces cerevisiae antibodies”!¹⁸ Is it possible that our use of these products is potentiating IBD? Just some food for thought as I bring this Rx Rant to a close. 😉

As for “Ozempic Face…,” I’ll let you research that on your own. 

References

1. Drugs.com/pro, Ozempic. https://www.drugs.com/pro/ozempic.html Accessed March 3, 2025.
2. Drugs.com/pro, Exenatide. https://www.drugs.com/pro/exenatide-injection.html Accessed March 3, 2025.
3. Drugs.com/pro, Adlyxin. https://www.drugs.com/pro/adlyxin.html Accessed March 3, 2025.
4. Drugs.com/pro, Ozempic. https://www.drugs.com/pro/ozempic.html Accessed March 3, 2025.
5. Riley MG, Castelli MC,Paehler, EA. Subchronic oral toxicity of salcaprozate sodium (SNAC) in Sprague-Dawley and Wistar rats. International Journal of Toxicology. 2009;28(4):278-93. doi: 10.1177/1091581809337737. National Library of Medicine website. https://pubmed.ncbi.nlm.nih.gov/19636071/ Accessed March 3, 2025
6. Drugs.com/pro, Exenatide. https://www.drugs.com/pro/exenatide-injection.html Accessed March 3, 2025.
7. Drugs.com/pro, Liraglutide. https://www.drugs.com/pro/liraglutide-injection.html Accessed March 3, 2025.
8. Drugs.com/pro, Dulaglutide. https://www.drugs.com/pro/trulicity.html Accessed March 3, 2025.
9. Drugs.com/pro, Adlyxin. https://www.drugs.com/pro/adlyxin.html Accessed March 3, 2025.
10. Not sweet nothings. Forks Over Knives website. https://www.forksoverknives.com/wellness/artificial-sweeteners-can-make-you-gain-weight/ . Accessed March 3, 2025.
11. Adult obesity prevalence maps. CDC website. https://www.cdc.gov/obesity/data-and-statistics/adult-obesity-prevalence-maps.html. Accessed March 3, 2025.
12. Robinson TN, Banda JA, Hale L, et.al. Screen media exposure and obesity in children and adolescents. Pediatrics National Library of Medicine website. 2017;140(Suppl 2):S97–S101. doi: 10.1542/peds.2016-1758K. Accessed March 3, 2025.
13. Ratter-Rieck J, Roden M, Herder C. Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders. Diabetologia. 2023;66(6):1003–1015. doi: 10.1007/s00125-023-05901-y. Accessed March 3, 2025.
14. Kivimaki M, Virtanen M, Kawachi I, et.al. Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals. The Lancet, Diabetes & Endocrinology. 2015;p27-34. https://www.thelancet.com/journals/landia/article/PIIS2213-8587%2814%2970178-0/fulltext. Accessed March 3, 2025.
15. Wiss D, Brewerton T. Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies. Physiol Behav. 2020:223:112964. DOI: 10.1016/j.physbeh.2020.112964. Accessed March 3, 2025.
16. Szalavitz M. How Childhood Trauma Can Cause Adult Obesity. Time. https://time.com/archive/6934059/how-childhood-trauma-can-cause-adult-obesity/. Accessed March 3, 2025.
17. Burke N. How childhood trauma affects health across the lifetime. TedTalk, YouTube. https://www.youtube.com/watch?v=95ovIJ3dsNk. Accessed March 3, 2025.
18. Crohn’s disease prognostic profile. Labcorp website.  https://www.labcorp.com/tests/162020/crohn-s-disease-prognostic-profile. Accessed March 3, 2025.