Unexpected (But Common) Side Effects Of Taking GLP-1 Semaglutide

Co-authored with Jim Caras, owner of Health Direct and thought-leader in the nutritional supplement industry.

Estimated Read Time: 10 minutes

Article Summary

Whether you're using semaglutide/GLP-1 to control your blood sugar and Type 2 Diabetes or you're trying to lose weight, beware, there are common side effects with unexpected consequences that can leave you feeling horrible. We'll look at what semaglutide (you may know it as an Ozempic supplement or medication) does, how it works, how fast you can anticipate changes, and those unexpected side effects like "Ozempic face," "Ozempic butt," "Ozempic boobs," semaglutide headaches and more. We'll also review the supplements that can help you avoid those effects and the dietary guardrails you absolutely must pay attention to so you stay healthy. Our proactive recommendations are simple and easy to use!

Oh, Oh, Oh, Ozempic...Made My Stomach Hurt

Semaglutide (the key ingredient in Ozempic and other GLP-1 drugs) has taken the health and wellness world by storm, emerging as a groundbreaking treatment for obesity and type 2 diabetes. But, with any medication, there are side effects.

So, while semaglutide products are seemingly everywhere - TV commercials, social media ads, magazine ads - you need to know the downside of using them for most people that you might not expect and that can make life miserable.

As more people use semaglutide, reports of unexpected side effects are growing: unpleasant changes to your skin and body shape, digestive problems, and unexpected fatigue (sometimes called GLP-1 fatigue.)

I want to make you aware of these potential problems so you aren't caught off-guard and left holding your stomach and your head...and wondering why you suddenly look old and feel so tired if you opt for a GLP-1 drug.

I also want you to know that you can avoid or greatly reduce these side effects with some simple preplanning and lifestyle changes. There are easy ways to avoid the common problems associated with semaglutide use, especially since it amplifies collagen loss, can cause changes in your eating habits that rob you of nutrients, and there are even some medical concerns related to thyroid dysfunction.

We can also blunt or even avoid the nasty side effects by improving the ability of your digestive tract to work efficiently. It's crucial that you be able to absorb the nutrients and water your cells need. An effective detox and cleanse can be a vital first step to maintaining your health as a semaglutide support.

You're Eating Less, Yay!…But There IS A Downside

Often, because you aren't hungry and you are eating less, you don't get enough nutrients to keep your body healthy. When that happens, your body "robs Peter to pay Paul - it takes nutrients from non-essential body functions and organs to keep the crucial ones going. Your body is in survival mode, triaging what it needs to keep you alive. But there's an easy fix for that we'll talk about in a minute.

You probably aren't getting enough fiber, either. Most Americans don't get enough fiber in their diets in general, but if you're eating less than you used to, I'd be willing to bet you're getting even less fiber. That's not good, and you could actually feel and look bloated. That's the opposite effect of what we want! Again, there's a quick, easy adjustment to your daily habits that can be a game-changer for fiber that we'll look at.

Be An Informed Patient, Your Doctor Will Thank You

Knowledge is power, and I want you to be well-prepared for the journey. GLP-1 medication examples include Ozempic, Rybelsus, Wegovy, Mounjaro, and Zepbound. While not technically all the same, they tend to get the generic name of Ozempic, sort of like Kleenex is a catchall for facial tissue.

Whether you want to use semaglutide for either blood sugar stabilization or weight loss, it's important to make a plan for all contingencies so you have the best outcomes possible.

We are all biochemically unique. Determining which GLP-1 is best for weight loss and balanced blood sugar for your body should be based on a conversation with a skilled physician and good lab work. Please do not just go to a semaglutide or GLP-1 "party!"

What exactly is semaglutide and how is it used?

Semaglutide is an injection-dosed medication made from amino acids that mimic a hormone called glucagon-like peptide-1 (GLP-1). Our bodies naturally produce GLP-1 in our intestines.

Semaglutide is technically called a GLP-1 receptor agonist; meaning it activates your GLP-1 receptors. GLP-1 receptors are found in the pancreas, brain, heart, and gastrointestinal tract; they are part of the body's communication system for regulating insulin/glucagon secretion, glucose metabolism, appetite, and cardiovascular function.

Our bodies use two hormones, insulin and glucagon, to balance our blood sugar levels. The pancreas makes both of them. Activating our GLP-1 receptors sends a signal to increase insulin secretion and decrease glucagon secretion, which helps lower blood sugar levels. While some sugar in our blood is good - it helps give our muscles energy and feeds our brain - too much sugar wreaks havoc.

GLP-1 receptors also act as an appetite suppressant by slowing the pace at which your stomach empties, which makes you feel fuller (called satiety) longer after you've eaten.

In 2017, the FDA approved Ozempic and Wegovy to treat Type 2 Diabetes, offering a ray of hope to people who had struggled with the disease. Semaglutide is also a game-changer for people who struggle with obesity; consequently, it's caught on with the body-conscious diet industry.

Why Your Blood Sugar Is So Important

If you haven't used semaglutide (or if you are but don't understand what it actually does), here's a quick explanation of how it works: by mimicking the GLP-1 our bodies make, semaglutide enhances the release of insulin to lower blood sugar levels. Regulating the release of insulin is how our bodies keep our blood sugar levels steady. This is why semaglutide is so effective for individuals with diabetes or insulin resistance, as well as an appetite suppressant.

You may have heard of insulin resistance or metabolic syndrome if you can't lose weight. This happens when the body stops responding to insulin, so too much sugar builds up in the blood. Excess sugar in your blood is called hyperglycemia, and it can cause long-term damage throughout your body. It can affect:

• Large and Small Blood Vessel Damage - this can lead to heart attack, stroke, and problems with the kidneys. Fat can also build up in the blood vessels, which can increase the risk of heart attack or stroke.
• Nerve Damage - too much blood sugar means not enough oxygen in the blood, which can cause neuropathy. Damaged nerves stop sending pain signals, leading to problems in the feet, skin infections, ulcerations, and amputation.
• Eyesight Problems and Damage - the blood vessels of the retina can be damaged, leading to diabetic retinopathy and diminished vision.
• Skin Damage - high blood sugar can cause brittleness in your skin's elastin and cause inflammation; these make your skin age faster and create wrinkles and saggy skin.
• Liver Damage - especially from high fructose corn syrup can overload and impair the liver.

Whether you're using semaglutide/GLP-1 for weight loss or blood sugar control for type 2 diabetes, there are some changes you can expect and some that might catch you off guard.

We'll talk about the most common (but often unexpected) side effects here. But as with any medication, if you experience semaglutide side effects that seem odd, please see your healthcare provider immediately.

What Are The Typical Results of Using Semaglutide/GLP-1

Studies show adults using semaglutide lost an average of about 35 pounds, or 15% of their body weight. This is significantly more than the average 6 pounds (2.5% of body weight) lost by those taking a placebo. The typical benchmarks for results from semaglutide injections are:

• Reduced appetite within the first 1-4 weeks.
• More substantial weight loss after the first 4-5 months of treatment.
• Maintenance levels at about 17 weeks.

Your doctor will prescribe gradually increasing doses over 16-20 weeks. 2.4 mg is typically prescribed as a weekly injection for weight loss. A lower dose of 0.25 - 1.0 mg is used for diabetes management.

But remember, as with any medication, there will be side effects.

Unexpected (But Common) Side Effects of Semaglutide

The majority of side effects when using semaglutide fall into three major categories: unwanted physical changes, painful internal changes, and excessive fatigue. Even though your doctor is giving you a slowly increasing dosage of semaglutide, some of the side effects that are strong at the beginning of treatment but seem to taper off can come roaring back. It's best to be prepared!

The Saggy Butt, Face, and Boobs Effect

You may have heard about "Ozempic butt" and "Ozempic face" or maybe the latest "Ozempic boobs." These are terms that have been semi-playfully coined to describe the sagging and hollow look from the loss of underlying fat and reduced muscle mass in the body. These unintended changes to our body and facial shape can happen with any diet program if you're not attentive to your whole body's weight loss journey. But, because weight loss occurs more rapidly with semaglutide, we notice these distorting body changes more quickly.

The factors that cause us to sag, lose our tone, endurance, and healthy physique are related to lower protein intake and the loss of our lean body mass. Our bodies build lean body mass and maintain the integrity of our connective tissues inside and out from high-quality protein peptides and amino acids.

Collagen, the glue that helps us hold it all together, is the primary "ingredient" in our muscles and skin. When we are on a diet, reducing our caloric intake, or when we just don't have our regular appetite...or if semaglutide is making us nauseous...our protein intake suffers. You might also notice that your hair becomes dull, your nails become brittle, and your skin doesn't bounce back with its usual boing. You might also notice your joints hurt a bit more too; those knees, shoulders, and fingers remind you that they are there -- loudly!

The loss of collagen is the foundation of all of these complications, even if we aren't on a diet. Starting at about 30 years old, we begin losing collagen at the rate of 1% a year. At 60 years old, we lose our collagen even faster. Our ability to make our own collagen starts slowing down too. Our bodies need the protein peptides in collagen for our physical strength, resiliency, and body repair. Some of our body's natural collagen production is a "side effect" of exercise, especially resistance exercise. But, you need the energy from protein to fuel that muscle-maintaining exercise.

But, our body's greatest repair and rejuvenation occurs overnight. Taking added collagen at night is the secret to counteracting the natural aging effects we all experience and the accelerated effects of caloric restriction, especially if you're using semaglutide.

There are so many collagen products in the marketplace and some pretty audacious claims about them. Most collagen supplements are made from low-grade powdered sources broken down with acids so your body can absorb them. Your better choice is a true liquid collagen (meaning not just powdered collagen you mixed with water - that's not liquid collagen.)

A medical-grade liquid collagen that includes all nine essential amino acids is best. My go-to was developed and patented over 40 years ago for hospitals to use with bariatric patients who could not keep food down or were on a fasting, highly restrictive diet.

When you are on a program that reduces your caloric intake, you also don't want to dilute your protein intake with too much water. Mixing up a powder with eight ounces of water can make you feel too full and like you'll barf. Your body needs a clean, concentrated, highly predigested form of protein that can be rapidly absorbed into the bloodstream with as little digestion as possible. You don't want to trigger those hunger brain signals. You can focus on hydration at other times of the day. As I said, while you are sleeping is the best time to feed your muscles, skin, and lean body mass.

Nausea, Constipation, Diarrhea, and Bloat - Oh My!

By far, the most commonly reported side effects of using semaglutide are gastrointestinal upsets - nausea, vomiting, diarrhea, constipation, heartburn, and stomach pain. If you notice these side effects, physicians often recommend that you wait a few days. But if they don't clear, you need to be adamant about seeing your doctor; acute pancreatitis and gallbladder issues can be added risks.

Why Does It Happen?

Semaglutide can affect your central nervous system because it can cross the blood-brain barrier to affect areas of the brain involved in appetite regulation and nausea perception, potentially contributing to nausea and even vomiting.

Semaglutide also slows gastric emptying, which is called gastric motility (how things move along and at what pace.) Slowed gastric emptying can lead to feelings of fullness, nausea, and sometimes vomiting too. Also, as food sits in your stomach and colon, it can begin to ferment, producing gas, bloating, and heartburn along with constipation and diarrhea - often like a very unpleasant rollercoaster in cycles.

There's an easy way to combat this! But - you're probably not going to like the solution...until I tell you my all-time favorite hot tip.

All of the gastrointestinal issues you encounter while using semaglutide are a flare (so to speak) from your gut. It's like a bat alert in the sky - Need MORE Fiber! You need to be consuming about 30 grams of fiber a day.

If you're like most Americans, you're probably consuming about 7-10 grams of fiber a day. Now when you complicate things further by not eating as much...you've got a gastrodisaster in the making!

How To Find Relief

Because semaglutide slows your digestive transit time, having enough prebiotic fiber and resistant starches in your digestive tract is crucial. These are difficult for your body to digest as they transit your intestinal tract, but their slowness allows them to nourish beneficial bacteria that support healthy digestive function. They help build and maintain a healthy microbiome.

When most people think of a fiber supplement, they automatically envision a powder you add water to, stir quickly, drink really quickly, try not to gag, and then rinse your glass and spoon right away so they aren't permanently adhered to each other. If you are already not eating much and semaglutide is slowing your gut motility, powdered fiber supplements with the requisite 8 ounces of water can feel like a rock sitting in your stomach - it can cause burping, reflux feelings, and heartburn — just the opposite of what we want to accomplish.

There's a better way to incorporate fiber without having to eat lots of high-fiber foods or drink down those yucky-feeling powdered concoctions! It was developed for hospital use to help people experiencing constipation and diarrhea because they are bedridden or have IBS-C/IBS-D.

And now here's the really exciting part - it's a clear liquid fiber that pours like water, has no flavor, and no color. It makes anything you add it to naturally sweeter without adding sugar. And it delivers 12 GRAMS of prebiotic fiber in just 2 tablespoons. In fact, it helps build your gut biome, supports your intestinal tract's rebuilding efforts, and it will even settle your stomach.

Another thing you can do before you start using semaglutide and then every 12 weeks after is a good herbal colon cleanse to relieve excessive constipation gently and without the side effects (and connective tissue damage) caused by chemical laxatives. Health care professionals and hospital physicians love this form of liquid fiber!

Why Am I So DANG Tired?

A common question I get from my health coaching clients using semaglutide/GLP-1 is, "How come I'm so tired? What's with this headache?!" Semaglutide headaches and fatigue are common side effects for a variety of reasons. Because you are eating less, your body is getting less of the energy-generating nutrition you need. Let's take a look at three things that can zonk your energy level, what foods you can't skip, and how you can easily make up for the nutrition deficit your body is craving even if you're not interested in eating.

Could Be A Common Side Effect of Reduced Carbohydrate Intake

Carbs get a bad rap these days. While healthy, un-processed carbohydrates are an important part of a well-rounded diet, it's the ultra-processed ones that you want to steer clear of. Our bodies break down carbs into glucose. Any extra glucose is stored in the liver and muscle tissue until it's needed for more energy.

Our brain relies on glucose from those carbohydrates as its primary energy source—so less carb intake may result in temporary mood swings or mental fatigue. You may also experience "hypoglycemia headaches," or that dreaded 3 pm sugar slump. Suddenly, you can barely hold your head up, and you're looking for something - anything - with a crunch. The afternoon is usually when our blood sugar crashes.

Extreme carbohydrate restriction can also lead to increased urination, dangerous dehydration, and an imbalance of your electrolytes. So, don't be caught off-guard if your reduced appetite, loss of cravings for carbohydrates or sweets, and a more pronounced afternoon energy slump are the result of eating less carbs. Keep some unprocessed carbs in your daily meals.

Could Be A Common Side Effect of Reduced Fat Intake

Eating good fats is also important to your body's health; I often remind my coaching clients that you have to get some fat to get fit. For starters, your brain is about 60% fat, so you need to keep it supplied with good fats. Your skin also has a fat layer that keeps it supple and provides insulation. Many of the nutrients we need from our diet need to be combined with fats so we can digest and absorb them.

Without good fat, we can notice cognitive issues and mental fatigue. Another common effect is a loss of skin tone - that Ozempic face, butt, and breasts. Everything just gets saggy. Furthermore if you're trying to lose weight and you're over 50, the loss of your collagen (you typically lose over 60% of your collagen by age 50), compounds the problem of sagging and wrinkles. So if you're feeling tired, looking bedraggled, and have a fuzzy brain, you may need some healthy fats.

Could Be A Common Side Effect of Reduced Glucose

Using a GLP-1 medication or supplement can lead to hypoglycemia if your blood sugar falls too low. Symptoms include confusion, dizziness, and excessive sweating. If you are addressing Type 2 Diabetes, you already understand the importance of frequently monitoring excess blood sugar levels; but, if you're using semaglutide, you can have the opposite problem. When your blood sugar drops too low, you can even appear drunk with slurred speech or trouble speaking, you might have unexpectedly blurred vision, and your physical coordination could be off. If you're out of energy and feel totally off your game, it could be you need some glucose.

While using semaglutide you might consider asking your doctor for a CGM, a continuous glucose monitor. These are small discs that adhere to your skin for 14 days with a microfine needle in them. They transmit your blood sugar level to an app on your smartphone. I tried one to see what happened with my blood sugar throughout the day - I found out that my blood sugar crashes multiple times during the night while I'm sleeping. (My husband did not enjoy the alarm, signaling my levels were too low! Hot tip - you can turn off the alarm.) It was a great lesson about changing some of my eating habits to create more stable blood sugar levels.

If you want to use a CGM, please do so under medical advice; I know there are companies on the internet offering you great deals on them, but this isn't something to go cheap on. Improper reporting can give you false confidence in your food choices and can ultimately lead to acute kidney injury, heart disease, acute gallbladder disease, and more.

How To Get The Nutrients You Need When You're Eating Less

It's very common for doctors to give people using semaglutide B-12 shots. But your body burns through its Bs quickly, so I don't think this is the best long-term solution to feeling fatigued from eating less.

You need all the B vitamins and vitamin C, which will help you maintain your skin's elasticity, especially if you're taking collagen. Vitamins A, D, and K help keep your bones and immune system healthy. Your body needs its minerals, too. Most people don't realize how many hundreds of metabolic functions in our bodies require minerals.

At this point, you're probably envisioning a lineup of bottles on your bathroom counter to get all the nutrients you need. Taking that many pills and capsules can also give you a stomach ache, and the cost might give you a headache, too.

There's an easy solution to getting the broad spectrum of nutrients your body needs: A premium liquid vitamin will give you all the vitamins, minerals, spices, superfoods, and herbs you need to fill in the gaps from eating less. Dealing with side effects can also trigger stress and anxiety, so a multivitamin with adaptogens like ashwagandha can help keep you calm and anxiety-free.

By choosing a liquid multivitamin, you're also ensuring that you can quickly and easily absorb the nutrients you need with almost no digestion.

Making Your Food Choices Count

Nutritionists typically recommend a 1,200-1,500 daily calorie intake for women and 1,500-1,800 for men for weight loss. Protein consumption should be between 60 and 75 g/day, but don’t go overboard on the protein; don’t exceed 1.5 g/kg of body weight daily. Because you won't feel hungry, you might have trouble meeting these caloric recommendations, especially if you're using a GLP-1 medication.

Because you're eating less when taking semaglutide, there's no wiggle room with what you do eat. You must be very mindful of your diet and eat smaller portions to avoid the semaglutide nausea and reflux. Hydration isn't something to ignore either; your body (especially your kidneys) needs plenty of water to function well. Without enough water, your system will become sludgy, and your blood can get thick, too.

We also have to be mindful about what foods we do well with and which we don't; allergic reactions/food sensitivities often cause blood sugar and inflammatory health problems. Certain foods might naturally make your symptoms worse if you have a food sensitivity. A good food sensitivity scan is always a good idea.

Even though we are each biochemically unique, you can reorient your food choices to high-quality proteins, healthy fats, and unprocessed carb choices.

These are some of my food suggestions:

• Healthy fats: Nuts (like almonds, walnuts, pecans), Seeds (such as pumpkin seeds, sunflower seeds, hemp seeds), Avocados, Olive oil, Fatty fish (like salmon, sardines, mackerel)
• Lean proteins: Skinless chicken breast, Lean beef, Fish, Eggs (don't skip the yolk), Low-fat dairy product
• Foods rich in prebiotic fibers and resistant starches: Cooked and cooled whole grains and potatoes, Legumes, Lentils, Kiwi fruit, Less-ripe bananas, Undercooked oats (such as overnight oats
• Low-glycemic foods: (These break down gradually and provide a steady, slow release of glucose.) Non-starchy vegetables (spinach, kale, cucumbers), Whole grains (brown rice, quinoa, barley), berries

Avoid these kinds of foods: Fried foods, Foods high in saturated/trans fat, Spicy foods, Fast foods, Foods with added sugars or high-fructose corn syrup, Fatty protein cuts, Baked goods, Candy, Ice cream, Soft drinks, Beverages with added sugar (juice and "energy drinks.")

A Medical Side Effect You Must NEVER Ignore - Thyroid Dysfunction

One last but important caution if you're using semaglutide is your thyroid health. GLP-1 medications have been linked to an increased risk of thyroid C-cell tumors in animal studies. While it's not definitively known how this translates to human risk, take precautions if you have a family or personal history of medullary thyroid carcinoma (MTC), which is a type of thyroid cancer, or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). You might not want to use semaglutide due to these potential risks. If you and your doctor do opt to use semaglutide, please watch out for and report these immediately to your doctor:

• A lump or swelling in the neck
• Hoarseness or voice changes
• Difficulty swallowing
• Shortness of breath

These can all indicate nodules or thyroid tumors. Other control medications may be a better fit for your family history. Nothing is worth needlessly risking your health.

Also of Note: Side Effects May Be More Difficult With Age

Semaglutide injections can be challenging at any age, but it's worth noting that those who are 65 years and above report a higher incidence of gastrointestinal side effects, with 86% experiencing discomfort compared to younger patients.

It seems that experiencing any side effects is significantly greater after 50. Reports show a fourfold increase in side effects as we get older. The seriousness of these side effects tends to peak at a median age of 61 but then become more mild for those 64.5 years and older.

While I understand the desire to lose weight when it just seems to sneak up and firmly plant itself around your middle after 50, remember using semaglutide isn't a fad. You will need to stick with it, stay consistent, and you may need to use it for the rest of your life. If you stop using it, rebound weight gain is common and can leave you just as heavy or more so with an unbalanced gut microbiome.

How To Create Your Perfect, Simple Semaglutide Support Program

I'm confident that if you've read this article and you follow my simple suggestions, you'll be aware of the common semaglutide/GLP-1 agonist side effects and know how to avoid them. I hope your journey back to good health is as effortless as possible! Here's a quick recap for creating your own plan:

• Eat smaller portions
• Since you're eating less, choose your foods carefully
• Avoid spicy foods
• Make up for lost nutrients with a premium liquid multivitamin
• Maintain your lean muscle mass, body shape, and skin/hair/nails with medical-grade liquid collagen
• Relieve constipation and diarrhea along with stomach upset and heartburn with fast-absorbing liquid fiber instead of chemical laxatives
• Be sure to use a cleanse and detox supplement before you start and continue quarterly to keep your digestive tract healthy.
• Use regular resistance exercise sessions to keep your body and mind working well.

Want to Learn More?

• Semaglutide Food List
• What are low-glycemic foods?
• Avoiding muscle-loss on Semaglutide
• Ozempic face explained
• Easy resistance exercises for any fitness level

References

• Al-Atif H. Collagen Supplements for Aging and Wrinkles: A Paradigm Shift in the Fields of Dermatology and Cosmetics. Dermatol Pract Concept. 2022 Jan 1;12(1):e2022018.
• Feier CVI, Vonica RC, Faur AM, Streinu DR, Muntean C. Assessment of Thyroid Carcinogenic Risk and Safety Profile of GLP1-RA Semaglutide (Ozempic) Therapy for Diabetes Mellitus and Obesity: A Systematic Literature Review. Int J Mol Sci. 2024 Apr 15;25(8):4346.
• Filippatos TD, Panagiotopoulou TV, Elisaf MS. Adverse Effects of GLP-1 Receptor Agonists. Rev Diabet Stud. 2014 Fall-Winter;11(3-4):202-30.
• Gibbons C, Blundell J, Tetens Hoff S, Dahl K, Bauer R, Baekdal T. Effects of oral semaglutide on energy intake, food preference, appetite, control of eating and body weight in subjects with type 2 diabetes. Diabetes Obes Metab. 2021 Feb;23(2):581-588.
• Hathaway JT,Shah MP,Hathaway DB, et al. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmol. 2024;142(8):732–739.
• Smits MM, Van Raalte DH. Safety of Semaglutide. Front Endocrinol (Lausanne). 2021 Jul 7;12:645563.

About The Authors

Jim Caras is the owner of Health Direct, a thought-leader in the nutritional products industry, and the first to make collagen available for purchase. Over 30 years ago, Jim brought the patented, original liquid collagen formula used in hospitals, care centers, plastic surgery centers, and elder care facilities to consumers. He continues to offer science-backed, innovative formulas to help people create optimal health at any age.

Lisa Moretti is a certified health coach from the Institute of Integrative Nutrition (IIN), the largest nutrition school in the world. She was at the top of her cohort in 2015. She's been involved in the natural health and supplement world professionally since 1981.