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Story at-a-glance

• Ozempic users are reporting unexpected and concerning changes to their bodies. The latest reported side effect to join the growing list is saggy breast, aka “Ozempic breast”
• Semaglutide, the active ingredient in Ozempic and Wegovy, is a glucagon-like peptide-1 receptor agonist (GLP-1RAs), which works by mimicking GLP-1, a hormone responsible for managing blood sugar levels and appetite
• Aside from adverse bodily changes, relying on weight loss drugs puts you at risk of debilitating health issues like gastroparesis, and the weight you lost is likely to return once you discontinue their use
• Instead of relying on GLP-1RAs, a far safer way to increase your GLP-1 levels is by colonizing your gut with Akkermansia muciniphila. You can also take berberine, aka “nature’s Ozempic,” to help with weight loss

Rapid weight loss drugs continue to surge in popularity, making them the major contributor to the 13.5% increase in spending on prescription medications in the U.S. in 2023, according to a report1 from the American Journal of Health-System Pharmacy.

Leading this trend is semaglutide, better known by its brand names Ozempic, a diabetes medication, and Wegovy, a higher-dose variant specifically for weight loss. Both drugs come from the Dutch pharmaceutical company Novo Nordisk, whose market capitalization has soared to $609 billion, surpassing Tesla’s valuation by $40 billion.2

However, with the increasing demand for these drugs comes more reports of users experiencing a range of unexpected and concerning changes to their bodies, from loose skin to sunken cheeks colloquially termed "Ozempic face." The latest reported side effect to join the growing list is saggy breast, aka "Ozempic breast."

Ozempic Use Now Linked to ‘Deflated’ Breasts

Taking semaglutide doesn't just target the areas where you aim to shed pounds — it can also lead to fat loss in places where you'd want to maintain it. While earlier reports underscore the drug’s effects on facial fat, an article3 in the International Open Access Journal of the American Society of Plastic Surgeons highlights that similar changes in breast and body morphology can also occur.

Jennifer Brown, a 47-year-old hairstylist from Kentucky, is among the Ozempic users who have experienced these side effects. In an interview with the Los Angeles Times,4 Brown shared that she lost 40 pounds within a year of taking semaglutide, even without changing her diet and exercise routine.

However, the speedy results also created problems for her. "My breasts definitely got saggier," she told the LA Times, recounting how her breast implants started to shift after losing breast fat.

Since breast tissue is typically around 70% fat,5 significant weight loss can indeed result in decreased breast volume.6 Dr. Ronald F. Rosso, medical director at Peninsula Plastic Surgery in Torrance, California,7 further explains how Ozempic makes breasts saggy. As reported by the New York Post:8

"In the breast area, rapid fat loss can leave the skin envelope empty, causing the breasts to look deflated and the nipples facing downward. This appearance is very similar to what happens after patients have had more traditional weight loss procedures such as gastric bypass."

Additionally, the drug has been associated with sagging buttocks, often referred to on social media as "Ozempic butt." Some women have also reported tenderness around their breast tissue, which experts suggest could be linked to the hormonal fluctuations caused by semaglutide.9

How Does Ozempic and Wegovy Work?

Semaglutide, the active ingredient in Ozempic and Wegovy, is a glucagon-like peptide-1 receptor agonist (GLP-1RAs). It works by mimicking GLP-1, a hormone in your body that’s responsible for managing blood sugar levels and appetite.10

When you eat, GLP-1 is released in your intestines, prompting the pancreas to release insulin while suppressing the secretion of glucagon, another hormone crucial for blood sugar regulation.11 These processes help in regulating blood sugar levels, which is why Ozempic was originally developed for Type 2 diabetes.

Semaglutide also slows down the emptying of the stomach by inhibiting gastric motility,12 which means that food remains in the stomach for a longer period of time, causing feelings of fullness and satiety. The longer food sat in the stomach, the greater the weight loss effects became.13

Weight Loss Drugs Lead to More Expenses on Plastic Surgeries

In addition to the physical side effects, semaglutide can have a significant impact on your pocketbook. Its prescription alone costs $1,300 to $1,500, depending on where you purchase it.14 Fixing its unwanted effects on your body through cosmetic procedures costs even more. According to an article by the American Society of Plastic Surgeons:15

"A new trend is taking shape in the offices of many plastic surgeons. Amidst the familiar requests for nips and tucks, there's been an uptick in something quite substantial – patients seeking skin-tightening procedures after experiencing massive weight loss.

This isn't the result of traditional diets or even bariatric surgery but a wave brought on by the successes of glucagon-like peptide-1 (GLP-1) medications like Ozempic, which are increasingly seen in the media and touted by celebrities and everyday individuals alike."

Indeed, in both the LA Times and New York Post articles, cosmetic surgeons recommend plastic surgery to "tighten up" saggy skin. Other techniques surgeons may use include dermal fillers, fat autografting, collagen stimulators, radiofrequency, microneedling and laser skin tightening.16

"It is a dream weight until you spend $25,000 on plastic surgery, and you go every three months to your injector because you’ve got to just continuously pump Sculptra and fillers trying to keep that skin on your skull," Brown said.17 She underwent a series of treatments, including dermal fillers, an arm lift and a breast lift, to counteract the morphological effects of Ozempic.

The LA Times article featured another case involving a woman who lost 115 pounds after using Mounjaro, another GLP-1RA drug made by the American pharmaceutical company Eli Lilly. The woman reportedly spent $30,000 on a lower-face lift and neck lift, noting that her friends have done similar procedures after losing weight on these medications.18

Although she asserts the outcome was "worth it," this trend raises important questions about the necessity of losing weight sustainably to prevent adverse effects in the first place, which can sometimes extend beyond mere bodily changes.

Other Debilitating Side Effects of Ozempic

The use of GLP-1RAs has been linked to serious health problems. A 2021 study19 published in the Journal of Investigative Medicine found that it increases the risk of gastroparesis (stomach paralysis), a disorder that slows or stops the movement of food from the stomach to the small intestine.20

The researchers examined two cases of women who developed medicine-induced gastroparesis after taking GLP-1RA, manifesting hallmark symptoms like abdominal pain, bloating and nausea, which gradually resolved when they stopped taking the drug.

Another study21 published in JAMA noted that aside from gastroparesis, GLP-1RA also increases the risk of biliary disease, pancreatitis and bowel obstruction. Metabolic, nutritional, urinary, cardiac and eye disorders have also been linked to the use of semaglutide, according to data from EudraVigilance, Europe's system for monitoring and analyzing adverse reactions to medications.22

GLP-1RAs have been implicated in the development of pancreatic carcinoma23 and acute kidney injuries24 as well. While the long-term risks of semaglutide are still unknown, Wegovy carries a black box warning, as rodent studies have shown it causes thyroid C-cell tumors at doses similar to those used in humans.25 Its prescribing information also lists warnings and precautions for the following conditions:26

Acute pancreatitis

Acute gallbladder disease

Hypoglycemia

Acute kidney injury

Hypersensitivity reactions, including anaphylactic reactions and angioedema

Diabetic retinopathy complications

Heart rate increase

Suicidal behavior and ideation

Boost Your GLP-1 Naturally With Akkermansia

Instead of relying on GLP-1RAs, a far safer way to increase your GLP-1 levels is by colonizing your gut with Akkermansia muciniphila, a type of bacteria that naturally secretes a GLP-1-inducing protein. Researchers noted in a study published in the journal Nature Microbiology:27

"A. muciniphila increases thermogenesis and glucagon-like peptide-1 (GLP-1) secretion in high-fat-diet (HFD)-induced C57BL/6J mice by induction of uncoupling protein 1 in brown adipose tissue and systemic GLP-1 secretion."

Ideally comprising about 10% of your gut microbiome, Akkermansia is beneficial in your large intestine and plays an important role in supporting gut health. However, many people lack this vital microbe, possibly due to having impaired mitochondrial function and subsequent oxygen leakage in the gut.

One of the most important functions of Akkermansia is its ability to produce mucin, a thick, gel-like substance that forms a protective barrier on the gut lining. Mucin shields the epithelial cells of the intestinal wall from mechanical damage, harmful pathogens and chemical irritation caused by stomach acids and enzymes.

It also nourishes beneficial gut bacteria, which in turn helps support healthy digestion, promotes the production of essential nutrients and maintains an overall balance of gut flora.

Mucin can support the immune system as well, as it contains antibodies and antimicrobial peptides that can help combat infections. It also traps potential pathogens and other foreign particles to be expelled from the body through the digestive process.

How to Increase Your Akkermansia Levels

I recommend eating foods that help support Akkermansia, such as polyphenol-rich fruits like berries. Dietary fiber is also important to nourish your gut, but it needs to be the right kind. The ideal food for your microbiome is soluble fiber, particularly inulin, which is found in most vegetables.

Examples of high-inulin veggies include Jerusalem artichokes, garlic, leeks, asparagus and bananas. However, if your microbiome is significantly dysregulated, introducing high amounts of fiber too quickly can worsen gastrointestinal (GI) symptoms, so gradually increasing fiber intake is key.

Berberine — A Natural Alternative to Ozempic

Berberine, a naturally occurring compound in plants like goldenseal, barberry, Oregon grape and tree turmeric, has been dubbed as "nature’s Ozempic"28 because of its weight loss potential. Traditionally used in Ayurvedic and Chinese medicine, berberine has antibacterial, anti-inflammatory, antidiabetic and immune-supporting properties.29

One systematic review showed that berberine may help regulate blood sugar levels and improve insulin sensitivity.30 This is crucial because insulin resistance is closely linked to weight gain and obesity.31

Another study32 published in Frontiers in Cellular and Infection Microbiology found that berberine may help "alleviate the pathological conditions of metabolic disorders, and the mechanism is related to the regulation of gut microbiota."

Berberine also helps activate the adenosine monophosphate-activated protein kinase (AMPK) pathway, which plays a role in controlling how energy is produced and used by the cells. By activating AMPK, berberine helps normalize lipid, glucose and energy imbalances.33

It’s Wiser to Get to the Root Cause of Weight Gain

I strongly believe that the elusive "miracle cure" for weight loss will not exist in our lifetime. Relying on drugs to lose weight puts you at risk of permanent and debilitating health issues, and the weight is likely to return once you discontinue their use.

In fact, participants in one study34 regained two-thirds of their prior weight loss one year after stopping semaglutide — a phenomenon dubbed as "Ozempic rebound." Most of the changes in their cardiometabolic variables also reverted to pretreatment levels.

For longer-lasting results, I urge you to address the primary factor driving the overweight and obesity epidemics, which is the excess consumption of linoleic acid (LA). LA is a type of omega-6 fat found in seed oils like soybean, cottonseed, sunflower, rapeseed (canola), corn and safflower.35

Consider reducing your LA consumption to below 5 grams per day, which is close to what our ancestors used to consume before chronic health conditions, including obesity, became widespread.

Avoid processed foods, fast foods and restaurant foods, as virtually all of them contain LA; preparing your food at home is your best option. To learn more about linoleic acid, read my article "Linoleic Acid — The Most Destructive Ingredient in Your Diet."

Sources and References

• 1 American Journal of Health-System Pharmacy, 2024;zxae105
• 2 CNN, March 8, 2024
• 3, 16 Plast Reconstr Surg Glob Open. 2024 Jan; 12(1): e5516
• 4, 17, 18 Los Angeles Times, February 22, 2024
• 5 Med Phys. 2008 Mar; 35(3): 1078–1086
• 6 Obes Surg. 2017; 27(4): 1013–1023
• 7 Peninsula Plastic Surgery
• 8 New York Post, May 12, 2024
• 9 DailyMail.com, May 2, 2024
• 10 StatPearls [Internet]. Glucagon-Like Peptide-1 Receptor Agonists (Archived)
• 11, 12 Mol Metab. 2019 Dec; 30: 72–130
• 13 Lancet Gastroenterol Hepatol. 2017 Dec;2(12):890-899
• 14 GoodRx, Wegovy
• 15 American Society of Plastic Surgeons, November 13, 2023
• 19 J Investig Med High Impact Case Rep. 2021 Jan-Dec:9:23247096211051919
• 20 NIDDK, Gastroparesis
• 21 JAMA. 2023;330(18):1795-1797
• 22 Expert Opinion on Drug Safety, 22(6), 455–461
• 23 Int J Clin Pharm. 2023 Mar 28
• 24 Kidney Medicine March-April 2021, Volume 3, Issue 2, Pages 282-285
• 25 NovoMedLink.com Wegovy, Important Safety Information
• 26 Wegovy Prescribing Information, Page 1
• 27 Nature Microbiology volume 6, pages 563–573 (2021)
• 28 The New York Times, June 7, 2023
• 29 Front Pharmacol. 2018; 9: 557
• 30 Frontiers in Nutrition, 2022; 9, Abstract
• 31 Nature Communications volume 11, Article number: 1841 (2020)
• 32 Frontiers in Cellular and Infection Microbiology, 2022;12(854885)
• 33 Oncotarget. 2018 Feb 9; 9(11): 10135–10146
• 34 Diabetes, Obesity and Metabolism, April 19, 2022
• 35 Int J Mol Sci. 2020 Feb; 21(3): 741