“Ozempic and GLP-1s: Hidden Dangers? Unpacking the Science”
Dr. Eric Westman (feat. Dr. Rhonda Patrick commentary)
This article is a summary of a video by Dr. Eric Westman, in which he reacts to commentary from Dr. Rhonda Patrick on the pros, cons, and hidden dangers of GLP-1 medications like Ozempic. You can watch the original video here.
[INTRO – Dr. Eric Westman]
Ozempic and the GLP-1s are being sold as a quick fix, but are there hidden dangers that we need to know about them? Let’s unpack the science and debunk some of the worries and claims.
Hi, I’m Dr. Eric Westman, and welcome to my channel where I debunk nutritional misinformation online. In this video, we’re going to hear from Dr. Rhonda Patrick. I’ve known about her but have never met her. She is going to be talking about the concerns about Ozempic, GLP-1s, and we’re going to get into the pros and cons of them (how to use them safely, if you should) and I think we’re going to see in this video the difference between book knowledge and practical clinical knowledge. Be sure to wait until the end when you hear my final thoughts.
[DR. RHONDA PATRICK – Commentary]
We’re living in the shortcut era. If you think about Serena Williams — she did a GLP-1 commercial for a Super Bowl. You see what she looked like when she played tennis, and you see what she looks like today. The average woman looks at that and says, “If she couldn’t do it naturally, why should I try to do it naturally with exercise?”
Oprah Winfrey — she appeared on The View and said, “It took me this many years to realize that being fat is not my fault. It’s my genetics or it’s my DNA.”
[OPRAH WINFREY CLIP – played within the video]
“All these years, I thought I was overeating. I was standing there with all the food noise; what I ate, what I should eat, how many calories was that, how long was it going to take? I thought that was because of me and my fault. Now I understand that if you carry the obesity gene, that is what makes you overeat. You don’t overeat and become obese. Obesity causes you to overeat. Obesity causes you to have all of that food noise. And what the GLP-1s have done for me, and I know a number of other people, is to quiet that noise.”
[DR. WESTMAN – Response to Oprah clip]
That was a pretty effective way to say things. We’re going to hear the other side of the story from Dr. Patrick, and I think the answer is going to be somewhere in between. Is it possible that they’re both right at the same time?
I like the style of saying “it’s not your fault,” because certainly people blame themselves for being obese or having any metabolic issue or addiction. But the answers aren’t always drugs; that’s where the interesting conversation begins.
[DR. PATRICK – On the “obesity gene” claim]
There’s no single obesity gene. There are genes associated with predisposing someone to gaining fat more easily and affecting satiation, but it’s not like there’s just one obesity gene that makes you obese. Just about every health condition has both a genetic predisposition and an environmental aspect to it.
What she’s talking about; we have studies now where you can take healthy men, not overweight or obese, and put them on a high-caloric, ultra-processed food diet for just 5 days. They’re consuming 1,200 to 1,500 more calories per day, predominantly from processed foods. Food high in added sugar and saturated fat. What happens is it causes their brain to become insulin resistant.
Insulin in the brain plays a very important role: it tells the body how to store fat, how to use energy, and whether or not you’re satiated after eating a meal. When you’re insulin resistant in the brain, it all gets disrupted. Your body starts storing fat not as subcutaneous fat (the kind you can pinch and see) but as visceral fat. This is the belly fat deeply surrounding your organs. It is the very dangerous type because it is metabolically active, generating inflammation, and constantly being metabolized into free fatty acids, which then cause further insulin resistance.
These healthy young men gained visceral fat even though they didn’t gain much weight on the scale.
[DR. WESTMAN – On diet and carbohydrates]
What Dr. Patrick is saying is that diet matters. What you consume can cause insulin resistance in as little as 5 days. And you can call it ultra-processed foods or junk food, but it’s really the grams of carbohydrates; sugars and starches, including cereals that get digested to sugar.
If you take carbohydrates out of the diet, just about everyone experiences a reduction or elimination of food noise. The hunger goes away in a day or two.
Now, once obesity is established, Oprah is also right, because once fat cells reach a certain size, the adipose tissue sends out signals to “feed me,” almost like a tumor wanting to grow. That food noise then comes from the fat cells themselves. So actually, both Dr. Patrick and Oprah are talking about the same process; just at different points along it.
A GLP-1, as Oprah says, can cut out the food noise. It works by mimicking the hormones that come out of the GI tract after you eat, tricking the brain into thinking you’ve already eaten.
[DR. PATRICK – On the insulin resistance cycle]
Every time you eat a refined, ultra-processed meal, your body makes insulin but you’re insulin resistant, so you can’t respond to it effectively. Your pancreas overcompensates by releasing even more insulin. Then your blood sugar crashes, telling the brain it’s in a crisis and needs energy right now; and you crave high-calorie, calorically dense foods. It becomes a vicious cycle of overeating.
You can totally reset that system by decreasing your calorie intake. There are a variety of ways to do that. Also, including high-intensity interval training or any type of aerobic exercise is good. It causes you to lose visceral fat.
[DR. WESTMAN – On caloric reduction approaches]
All of the programs we use in obesity medicine (I’m past president of the Obesity Medicine Association, a group of 5,000 practitioners worldwide) lead to lower calorie intake for weight loss. Whether it’s weight loss surgery, injections, pills, or carb restriction, they all lead to reduced caloric intake.
The tactic of lowering calories could be through carb restriction (a low-carb, keto, or carnivore diet) or through explicit calorie restriction. The difference is I never tell people to eat less directly. It happens automatically. But how you talk about it in the clinic depends on the person.
If you’re a carb eater, you’re going to be a carb burner. And if you’re a carb burner, you’re going to want more carbs. It doesn’t last very long; like putting paper on a fire. Once you make the change to fat burning, the food noise and cravings go away, just as they would on medication.
[DR. PATRICK – On intermittent fasting]
A lot of people like intermittent fasting; it’s something I do. I’m 47, and I’ve realized that as hormones change with age, you do tend to gain more visceral fat. That’s known to happen with women as they age.
When people first start intermittent fasting, it can be challenging because they’re not metabolically flexible — meaning their body isn’t efficiently using fatty acids as energy to make ketone bodies. Ketone bodies like beta-hydroxybutyrate are a very clean source of energy, great for the brain, and they’re satiating.
The body can store glucose in the liver as glycogen, and you have to be fasted anywhere from 12 to 36 hours for liver glycogen levels to deplete, depending on your diet. If you’re eating a lot of refined carbs, it’s closer to 36 hours. If you’re eating whole foods (protein, lean meats, poultry, fish, vegetables) glycogen depletes after about 12 hours.
I usually stop eating at 6:00 p.m. and don’t eat my first meal until around noon; about 18 hours of fasting. After a couple of weeks your body adapts, and you’re simply not hungry until noon.
[DR. WESTMAN – On GLP-1 medications]
Intermittent fasting really just means you’re not eating as much or as often. If that happens organically (whether on a pill, a shot, or a keto diet) as long as you’re eating sufficient protein, that’s fine.
GLP-1 medications like Ozempic, Wegovy, and Zepbound mimic the hormonal effect of what happens after you eat. The difference is that these molecules last much longer than natural GLP-1 hormones. A shot can last a week, whereas the natural GLP-1 hormone rises and falls quickly. That prolonged appetite suppression is powerful — but it also means you’re locked in. You might experience nausea the first day or two, and the slowing of the intestines can lead to constipation or abdominal pain. In rare cases, it can be serious enough to require an emergency room visit. The actual percentage of serious complications isn’t fully established, but these side effects do exist alongside the significant benefits.
So you can learn a dietary technique (taking just a few days to kick in) that gets you to eat less and essentially achieve the same effect as the medication. If you do it through diet alone, you avoid the cost and side effects.
[DR. WESTMAN – On Oprah and carb addiction]
If you are a carb eater and think you can’t live without carbs, you may be unknowingly addicted. From everything I know about Oprah over the decades, she has been a carb addict. There was never a real period where she properly followed a very low-carb approach like Atkins induction, and the rumor of the time was that eating fat was bad, which was the prevailing wisdom.
Jackie Eberstein, the nurse who worked with Dr. Atkins for 30 years, told me they were once asked to appear on Oprah’s show but were warned off; that they would just be ridiculed. And indeed, another doctor was brought in to dismiss the Atkins approach.
If you’re a carb addict and think you can’t give up carbs, you’ll gravitate toward a pill, a shot, or shakes and bars — and then relapse when you go back to carbs. Many
people have benefited from GLP-1 medications, but the hazard is thinking that’s the only way, leading to the belief that you need to stay on the medicine forever — which isn’t necessarily true.
[DR. WESTMAN – Final Thoughts]
Many patients come to me already on medication shots, having never tried a dietary change alone. They’re skeptical about diet, partly because other doctors never told them about keto or carnivore approaches.
A key concern with GLP-1 medications as currently formulated is the risk to muscle mass. If you lose weight too fast, muscle tissue is at risk. You want to support your muscle by eating sufficient protein and doing resistance training. Stressing the muscle so the body heals and keeps it strong.
If you’re on a GLP-1 medication and it’s working, that’s great. But everything you eat while on it should prioritize protein and fat — not carbs or sugar, which are essentially empty calories in that context.
Dr. Patrick is right, but she speaks to the subset of people who don’t want to use shots, pills, or surgery. She’s also laying the groundwork for how to off-ramp from a GLP-1 when the time comes. You want to have a plan for that transition and diet is the foundation of that plan.
This article is for informational purposes only and does not constitute medical advice. Consult a qualified healthcare provider before starting any new dietary regiment, particularly if you are pregnant, breastfeeding, on medication, or managing a health condition.
