Ozempic and the Threat of Diabetic Gastroparesis

In late July 2023, CNN printed a shocker of a narrative, alleging that semaglutide (Ozempic, Wegovy) was inflicting extreme instances of gastroparesis, or delayed abdomen emptying, leaving some sufferers with abdomen paralysis that simply received’t go away. Whereas Ozempic has turn out to be the world’s buzziest drug as a result of it’s so efficient for weight reduction, the story appeared particularly regarding for folks with diabetes, as a result of gastroparesis is a standard complication of the situation.

The story raises crimson flags. Do Ozempic (and associated medicine) trigger gastroparesis? If you have already got gastroparesis, might Ozempic make it even worse?

What Is Gastroparesis?

Gastroparesis is a medical situation outlined by delayed abdomen emptying. Nausea, vomiting, early satiety, postprandial fullness, bloating, and higher stomach ache are amongst its signs. It’s a standard complication of diabetes, each sorts 1 and a couple of, and often develops years or many years after the onset of diabetes. It impacts about thrice extra ladies than males. 

Diabetic gastroparesis is attributable to excessive blood sugars, possible as a result of hyperglycemia results in vagus nerve dysfunction. That’s the nerve that largely controls the digestive tract. Injury to the vagus nerve means it might’t instruct the abdomen and intestinal muscular tissues to work correctly, resulting in delayed emptying. In case your abdomen isn’t emptying you’ll really feel full — even in case you eat little or no — and prolonged delayed emptying causes nausea and vomiting. Because it continues, you’ll be able to’t acquire sufficient vitamin and may’t handle your blood glucose. 

In response to the American Gastroenterological Affiliation (AGA), problems of diabetic gastroparesis can embrace extreme dehydration or lack of water and electrolytes from ceaseless vomiting, esophagitis, bezoar (a small mass of meals, fiber, or different substances within the abdomen that forestalls the physique from utilizing drugs), malnutrition, and decreased high quality of life.

Diagnosing Gastroparesis

Pritesh Mutha, MD, is a gastroenterologist and affiliate professor at McGovern Medical Faculty at UTHealth Houston. He stated it might tackle common as much as 5 years to diagnose.

“There are a number of causes,” he defined. “One is a ignorance. Sufferers current just one symptom and don’t discuss different signs as a result of they don’t suppose they’re essentially one thing they need to carry as much as their physician. Nausea and vomiting are so widespread it might be attributable to hundreds of thousands of various causes. That’s why once I give grand rounds I make an attraction to all of the upcoming residents and fellows and school that every time anyone presents with nausea and vomiting, be certain to take a look at the medicine they’re on and ask sufferers these questions, ‘Can you get by your whole meal?’ ‘Do you have got ache in your stomach?’ ‘Do you’re feeling bloated after your meal?’ ‘Do you throw up?’ ‘Does the meals you swallow depart a foul-smelling breath?’

“Not all sufferers have all of the signs and received’t even give it some thought till you probe them,” he added. “They’ve modified their dietary habits and life in such a method that this turns into their new regular they usually can’t perform their each day actions. It’s solely after they attain out to somebody who asks them questions that they lastly get identified.”

Dr. Mutha pointed to the gastric emptying scintigraphy, thought of by the AGA because the gold normal for diagnosing gastroparesis. However, he famous, this take a look at might be booked out for months, once more including to the size of time earlier than prognosis. 

There’s a less complicated methodology obtainable for screening sufferers for gastroparesis: “There are solely 9 questions you might want to ask they usually’re the symptom index referred to as the Gastroparesis Cardinal Symptom Index (GCSI). It takes 5 minutes to fill out.”

The questions ask about nausea, retching, vomiting, abdomen fullness, potential to complete a normal-size meal, feeling excessively full after meals, lack of urge for food, and bloating. Scores vary from none as much as extreme — 0 to five. 

Mutha emphasised the fantastic thing about this course of is that the sufferers themselves have seen these questions and the signs which are requested about: “It’s such a easy factor I really feel might be executed to create consciousness, make sufferers their very own advocate, and have docs within the loop on this course of.”

Ozempic, GLP-1 Receptor Agonists, and Gastroparesis

It looks as if Ozempic has been renting house in our heads totally free since its 2017 U.S. Meals and Drug Administration (FDA) approval. There are the various TV commercials which have given us the Ozempic earworm (Oh oh oh …). Then we began listening to about celebrities like Elon Musk and Chelsea Handler taking this diabetes drug for weight reduction, resulting in host Jimmy Kimmel beginning off the 2023 Academy Awards with a joke about it proliferating in Hollywood. 

Semaglutide (Ozempic, Wegovy, Rybelsus), dulaglutide (Trulicity), and liraglutide (Victoza) are glucagon-like peptide-1 (GLP-1) receptor agonists used to deal with sort 2 diabetes. Medicine on this household stimulate the discharge of insulin and suppress glucagon secretion solely when blood glucose concentrations are excessive, stabilizing, and reducing blood glucose in folks with sort 2 diabetes. Tirzepatide (Mounjaro) works in an analogous method.

GLP-1 receptor agonists additionally stabilize blood sugar by slowing down digestion, retaining meals within the abdomen for an extended time. Much less meals equals much less sugar within the bloodstream — and lowers meals consumption by curbing your urge for food. It additionally sends a sign to the mind that you simply’re full. That’s why folks on Ozempic and different GLP-1 receptor agonist medicine drop some pounds.

However as a result of GLP-1 receptor agonists work by slowing down the digestive system, they’ll additionally trigger delayed gastric emptying — the signature characteristic of gastroparesis.

When requested if diabetes sufferers with gastroparesis signs ought to take medicine like Ozempic, Victoza, and Trulicity, Mutha declined to make a definitive assertion, explaining that it’s a really tough state of affairs. Sufferers with diabetic gastroparesis must have a dialog with their physician to weigh the advantages with the danger of uncomfortable side effects.

“We don’t have the information to point out how lots of the individuals who take this drug truly expertise gastroparesis.” 

The profound abdomen paralysis reported by CNN seems to be very uncommon. In much less extreme instances, it may be tough to determine the basis reason for gastroparesis. What Mutha advocates is easy — asking some very particular questions. He factors again to the GCSI questionnaire:

“That’s the place you’ll see the crimson flags and that may be step one in figuring out what the state of affairs is,” he defined. “For those who take a mean of the scores on all 9 solutions and it’s 2.6 or greater, they’ve one thing of concern, and you’ll take a look at to see if they’ve gastroparesis already. If not, they are often warned that taking the drug might put them in danger for gastroparesis, however perhaps not. However you’ve acquired baseline to start out with.”

Mutha warned that individuals who have been identified with gastroparesis who select to remain on the GLP-1 receptor agonist medicine will maintain shedding pounds however probably in an unhealthy method: 

“They turn out to be malnourished and weaker, and lose muscle mass,” he stated.

Mutha beneficial that sufferers with any concern make themselves conscious of the signs of gastroparesis, in order that they’ll readily acknowledge them if their new remedy seems to be making them worse. After all, if the questionnaire solutions present one thing of concern, Mutha beneficial ordering a gastric emptying research.

Treating Gastroparesis

One of many admittedly scary points that got here up within the CNN story was how elusive restoration has been for the folks interviewed. Fortunately, such experiences are uncommon: Most individuals who expertise uncomfortable delayed gastric emptying on a GLP-1 receptor agonist like Ozempic seem to recuperate after stopping the drug.

Mutha has handled many sufferers with gastroparesis and had some course for folks affected by it: 

  • Keep away from all processed meals and animal merchandise; as an alternative eat a weight-reduction plan strictly made from fruits, greens, nuts, beans, seeds, and complete grains.
  • Don’t eat uncooked greens until they’re blended. In any other case, prepare dinner them effectively. 
  • Chew meals completely earlier than you swallow. The smaller the particles, the much less workload for the abdomen and meals might be emptied simply.
  • Don’t eat or drink after 6 p.m. That offers your physique time to digest. In any other case, you danger affected by reflux, exacerbated bronchial asthma, and even choking in a single day.
  • Stroll no extra however at the least quarter-hour after each meal at a straightforward gait. Analysis has proven that in case you stroll after a meal, it improves abdomen emptying. Not exercising will shut the digestive system down, as will intense exercising.
  • Eat each 4 hours. That offers the abdomen time to empty out.

Extra invasive procedures may assist deal with gastroparesis, together with a brand new approach that Mutha favors named G-POEM (gastric per oral endoscopic myotomy). This endoscopy basically enlarges the opening of a small muscular valve referred to as the pylorus the place the abdomen meets the small bowel. The pylorus often is closed till properly digested meals hits the abdomen to launch into the small gut. When the pylorus doesn’t open, slicing the valve to make the opening wider permits meals to enter the small gut.

GLP-1 receptor agonists might be highly effective instruments for the administration of sort 2 diabetes, and by reducing each blood sugar and weight, they’ll make problems like gastroparesis much less prone to happen. Nonetheless, the gastrointestinal signs of medication like Ozempic might be very important, and it may be clever for sufferers with diabetic gastroparesis to be particularly vigilant when taking any new remedy.

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