(Dr Explains) 8 Signs You're Taking Too Much Ozempic, Mounjaro, or Zepbound!

Added: 2026-06-01

[00:00:00]I've recently been having a lot of new patients coming to me asking about, you know, coming off of GP1s due to severe side effects. These range from nausea to insomnia, and honestly, sometimes they tell me they don't even feel like themselves. When I dig a little deeper, it usually always comes down to the same problem. The previous provider followed the typical dose escalation protocol and increase their dose every 4 weeks, even when there was no reason to do so.

[00:00:25]Unfortunately, as these medications become more and more popular, I think more and more people are going to go to their providers and have them prescribed. But that doesn't necessarily mean that the prescriber is educated on these medications. And trust me, I get it. Like, I have the same thing happen to me when I'm dealing with cardiac or renal medications, medications that have to do with the heart or kidney, respectively. I'm not as experienced with those. So, I always check with my cardiologist colleagues or neurology colleagues to make sure that I'm doing things correctly. However, because these medications have become so mainstream, a lot of providers just follow the typical titration schedule that Eli Liy and Novon Nordisk have recommended. However, that might not be what's best for you.

[00:01:03]So, in this video, I'm going to be talking about eight signs that may indicate that your GLP1 dose is way too high. And this doesn't necessarily mean that your dose needs to be immediately adjusted. But at least, you know, this will give you some insight into having an open discussion with your provider about either decreasing your dose or looking at your overall GOP1 plan as a whole because at the end of the day, knowledge truly is power and being able to advocate for yourself is the most important thing you can do. So, let's get started. For those of you who are new to the channel, I'm Dr. Kevin Joseph. I'm a board-certified internal medicine physician and medical director.

[00:01:36]But more importantly, I'm a recovering bingeater who lost over 150 pounds using GOP1s and peptides. Since then, I've kind of devoted a large chunk of my medical practice to focusing on people who are struggling with the same thing because trust me, if I can do it, I promise you that any single one of you can do it. And that's why I started this YouTube channel because I want you to know that you're not alone. So, let's keep going. All right. One of the first symptoms to watch out for is called anhidonia. Anhidonia is a lack of pleasure or enjoyment from activities that previously gave you happiness and joy. I most commonly see this with patients who had significant food noise.

[00:02:11]And honestly, I've unfortunately dealt with this myself to a certain degree.

[00:02:14]So, if you think about it scientifically, it makes sense, right?

[00:02:17]GLP-1 receptors are expressed in the vententral tegmental area and nucleus of encumbent. The brain is super complicated, so I don't want to go crazy here, but just know that this deals with the dopamine reward system. So, you may notice that when you're on in GLP-1, you don't want that dessert or cookie as much as you used to, or you don't have that constant food noise and food chatter because GLP1's blunt the dopamine response that you usually get from food. However, the blunting of that dopamine response can go a little too far and your body may, you know, these medications can overshoot it and it starts blunting reward signals from activities that you used to get joy from. I can say without a doubt that I've had similar feelings. And I think part of it is because I had such severe food addiction and food noise that I used to treat food as the ultimate reward. And when those dopamine signals were blunted and food was no longer a reward to my brain, it felt like the one thing that used to bring me the most joy, as sad as that sounds, honestly, really wasn't anymore. So, I had to slowly get used to that. Thankfully, it wasn't as severe as I've heard from some of my other patients. One thing I have noticed with anidonia and GLP1s though is that it is dose dependent. As your dose increases, I've had more and more reports of anidonia. So I always recommend my patients talking to whoever prescribed the GLP1 to decrease their dose or sometimes even switch to a different agent. I've had patients switch from semaglutide to trespatide or trespide to semlutide which usually seems to help with these symptoms. All right, the next one is more uncommon and I guess dare I say rare. It's a rare side effect at least with tzepide and semaglutide. It is a much more common side effect with reatide, especially if you look at the phase 3 clinical trial data, but you know, I'll save that for some other time and for some other videos on reiteride. But the symptom we're talking about or side effect is actually called alodenia. Allodenia is pain from something that usually doesn't cause pain. You know, the most common examples I can think of are a lot of my patients report that when they go to bed at night, the bed sheets touching their skin cause severe shooting pain or that when they're putting their clothes on, you know, when the clothes rub against their skin, that causes severe pain. The exact mechanism is still unclear, but the leading theory is that it has to do with the pain pathways in your body. In low doses, GOP1's actually have an analesic or pain reducing effect. But when that concentration of GOP1 increases, it almost kind of gets your nervous system hyperexited and overly active. And that hyperexitation can actually trigger these painful sensations. Once again, most of my patients experience this when their dose is escalated way too quickly. Actually, it's not even the rate of escalation. It has to more to do with their final dose.

[00:04:43]when most of them get to the highest dose possible, the side effect flares up more frequently. So, I always recommend speaking with your medical provider about reducing your dose or switching agents. Once again, more specifically, I I remember having a patient who was on Ozic for diabetes and blood sugar control. She was escalated to 2.4 millig pretty quickly and once she hit the 2.4 milligs, the pain started occurring almost daily. Switching her to Tzepide significantly got rid of the pain and almost reduced it completely. So, please speak to your medical providers about that if you're experiencing this. Nausea is another side effect that is often seen when escalating doses too fast. The mechanism of why GOP1's cause nausea is pretty complicated and multiffactorial and it involves certain receptors in the brain as well as receptors in the stomach which hold on to food longer and food sits in the stomach. When that happens, this signals certain nerves in the stomach to cause nausea. I mean, think about it. It's reaction to gastric issues. And you know, for a lot of people or evolutionarily at least, nausea and vomiting are actually a beneficial defense mechanism. If you eat something bad or have like GI issues, when food sits in your stomach and it causes the nerves to fire abnormally, it can be very, very uncomfortable and it's an issue that's been seen with escalating doses very quickly. This is why I always preach about micro doing and I'm a huge fan of micro doing if you haven't seen my previous videos.

[00:05:58]Ironically, micro doing is becoming much more mainstream and popular. It's funny because when it came to GLP-1s, the medical community was so adverse to micro doing even though we micro do other medications all the time. What do I mean by micro dose? Micro doing means taking a sub therapeutic dose of a medication. A dose that in clinical trials of a designated patient population has not been shown to have any significant clinical benefit at a statistical level. In real life data however and actually you know working with real life patients daybyday these doses do have an effect and a serious effect at that. People micro dose all types of medications from heart medications to anti-inflammatory medications to kidney medications. There are medications that get micro dosed all the time. However, when it came to GP1s, because of how popular and mainstream these medications had become so quickly and how easily it is to get your hands on them, for a lot of people in the medical community, they were against micro doing. This is exactly the reason I'm a huge proponent of micro doing though, because if it's done properly, it can really mitigate the risk of side effects. So, if you're having severe nausea and vomiting on GB1 medications, please, please, please speak to your provider about going down in dose.

[00:07:03]Nausea and vomiting are actually at least you know based on my clinical experience significantly more common in patients on ozic or wiggoi or you know cenoglutide when you start adding in that gip agonist you know with tzepide you know zeppan mangjaro the nausea and GI symptoms actually improve significantly so if you are on semaglutide or one of the brand name versions please speak to your medical provider about switching to tzepide or zeppound because honestly you will notice a huge difference I can absolutely guarantee it. Next is extreme fatigue and lethargy. This is a very very common side effect unfortunately um especially as your dose gets escalated and increased. This is actually one of the first warning signs that I have my patients watch out for which will tell you if your dose is too high because it's something that you can you know experience within 24 to 48 hours of dose increase. When it comes to extreme fatigue and lethargy there are two components to what's actually driving all of this. There's the metabolic part and that you know GOP ones reduce hunger and food intake. So if you're barely eating and if you ha if you're having side effects on top of that then that just puts your body in such a nutrient deficit that it doesn't have anything to work with your glycogen stores get depleted very quickly and you don't have any excess energy reserved. So that's one component of it. The other component has to deal with once again uh the central nervous system or the brain.

[00:08:16]GOP1 receptors are expressed in the hypothalamus and this region of the brain regulates arousal and energy expenditure and how much energy you are using. High doses of GLP-1s suppress certain feedback loops and pathways in the brain which overall decreases what we call the sympathetic outflow. The sympathetic nervous system when activated and honestly you might have heard of this before it's called the um fight orflight response. It increases your alertness. It increases your heart rate and it gives you that boost of energy. GOPs can actually blunt that response and you'll notice that you're a little bit more lethargic. You'll feel tired all the time and your heart rate slows down. You know, you don't really want to get out of bed. The problem here is that no matter how much sleep or rest you get, that fatigue will always be there because it's your nervous system and your brain telling your body that you're tired. It's not that you're actually tired. It's your body and brain playing tricks on your on your body, basically. So, the best way to combat extreme fatigue and lethargy isn't always rest or more sleep. It's actually decreasing your dose and speaking to your provider about maybe even changing the timing of your dose. I've noticed a lot of my patients who take their doses first thing in the morning may experience this throughout the day. for them. I usually recommend switching to an evening dose or injection. Now, ironically enough, although GLP1s may cause extreme fatigue, they can also cause insomnia. This is the worst combination because I will have patients who come in with extreme fatigue throughout the day. And you would think, okay, you're tired throughout the day.

[00:09:36]That means, you know, your body is going to shut down. So, when you get ready for sleep, your body will fall asleep in 3 seconds. However, the second their head hits the pillow, they don't fall asleep at all. Their minds are racing. You know, they're unable to fall asleep.

[00:09:47]This deals with a different area of the brain called the locus ceruius and the role of this area is to regulate your sleep wake cycle. High circulating GOP windows can disregulate the cycle and interfere with sleep architecture especially the transition into and the maintenance of deep slowwave sleep which is what you need to honestly feel fully rested. So for my patients who experience this and if it's not paired with extreme fatigue throughout the day, I will recommend that they take their GOP 1 dose in the morning. I also recommend them speaking to their provider about decreasing and staying at the lowest dose possible. As always, I mean, it's a common theme with this video and sometimes they may even need a sleeping aid such as melatonin or unism.

[00:10:24]I really, really try to avoid these medications, especially with the new data coming out about melatonin associated with heart failure. So, I do try to avoid these medications if possible, but sometimes my patients have no other option. All right, the next one is pretty easy to spot, and that's no oral intake. I know, you know, most of us are in GOP wants to lose weight, but the extreme of that can also be just as bad for the body. We all know that GOP wants suppress appetite and slow down gastric emptying. However, you should still be maintaining and hitting a minimum calorie goal. I recommend looking up a calorie calculator online, finding out the minimum number of calories that your body needs and trying to hit that goal daily. I think all too quickly, you know, people focus so much on eating as little as possible that they actually do more damage than good.

[00:11:05]Eating too little can do a few things.

[00:11:07]Number one, it shuts down your metabolism. In the short term, it's not as much of a problem because you're in such a calorie deficit. And those of us, including myself, who are morbidly obese, you know, we have a little bit of wiggle room with that. That's not something I'm concerned about immediately, but it is something that can hurt you down the line because as you lose more weight, the medication by itself will not be sufficient enough to help you with calorie restriction.

[00:11:28]You'll need that metabolic boost from your natural metabolism. If you blunt that early, it can be kind of difficult to restart, but it's not as much of a problem for me with patients who are just starting on GLP ones, but it's something to keep an eye on. The bigger concern here is when you're in such a severe calorie deficit, your body goes into starvation mode, and it looks to anything to give it energy. And unfortunately, the only other readily available sources of energy other than fat is muscle and bone. And this is where the concern for muscle breakdown and sarcopenia, which is the breakdown of bone, really becomes an issue. I always recommend my patients hit their minimum calorie goals and if they aren't hungry then they need to be on a lower dose of medication. It's really that simple. You know, end of discussion, be on the lowest effective dose that will allow you to hit your minimum calorie goals. All right, this next issue typically goes handinhand with poor oral intake and that's severe dehydration. If you're feeling palpitations, brain fog, dizziness, really look into your water intake and you know actually not just your water intake but also your electrolyte intake. I think it gets overlooked how significant of an effect GOP ones have at the level of the kidney. They are a diuretic and that means that these medications cause your kidneys to secrete out more water. When you lose water from this medication, as you know, as well as you're not taking in enough water, this is the perfect combination for dehydration. If you're having symptoms like brain fog or dizziness or lightadedness, especially if you go from lying to standing up, that's something that we call orthostatic hypotension. That usually means that your blood pressure is very low. And one of the most common causes of that is dehydration. It's a very common sign of dehydration. Also, please focus on electrolytes. I think, you know, if you're not taking in too much food and if you're urinating a lot and you're hitting the gym as well, you are definitely going to be in an electrolyte deficiency. So, please keep track of your electrolytes, um, get an electrolyte supplement. I've kind of preached about this. And, you know, it doesn't have to be anything crazy. I get the cheapest one at Sam's Club or Costco. And, you know, whatever you're able to tolerate or you enjoy, that's the one I would get. Last but not least is hypoglycemia or severe low blood sugar. This isn't necessarily an inherent risk of GOP1s because they do work on the pancreas and they tell your pancreas to secrete or release insulin in a glucose dependent manner. Meaning that if your blood sugar is too low, the GOP1 won't let your pancreas secrete insulin. But if it's too high, the GOP1 will signal for your pancreas to secrete more insulin. But the real issue comes if you're already on a medication like a sophonal ura or if you're already on um exogenous insulin because you have type two diabetes or even type 1 diabetes.

[00:13:55]Although please remember these medications um GLP1s are not FDA approved for type 1 diabetes. But you know if you're on a combination of all of these the risk of your blood sugar dropping is pretty severe because the GLP1 will you know in and of itself optimize your blood sugar and it'll fix the foundation. So when you add all these other agents on your blood sugar will drop. So, when you're working with your medical provider, if you're having symptoms of low blood sugar, such as um shakiness, sweating, or confusion, or if you're wearing a uh continuous glucose monitor and you've been checking your blood sugars and they've been on the lower end, please speak with your medical provider about not really lowering your GP1 dose, but lowering your insulin and other anti-hypoglycemic medications because a lot of my patients are either able to come off insulin completely or use very, very little of it. So ultimately GOP1 medications are the most powerful medications at least metabolically that we have right now.

[00:14:45]And I think as more and more people have access to them. There's going to be need for higher levels of and more diligent education on it and not just patient education but actually provider education as well so that doses aren't escalated too quickly and without proper need. I think that people need to understand that these doses don't scale you know infinitely and that there are you know receptors throughout your entire body. So although at one dose you might not notice anything, at a higher dose these medications may affect receptors that they weren't activating before. If you notice any of these side effects I mentioned before, please please speak to your medical provider about lowering your GP1 dose because honestly the best dose is the one where you know you are having clinical benefit with minimal to no side effects. Please, please be able to have an open discussion with your medical provider and stand on a foundation of knowledge.

[00:15:29]And I'm hoping this video provides that.

[00:15:31]I'll see you next time.