What's REALLY Happening With Ozempic Side Effects After COVID?

Added: 2026-05-18

[00:00:01]I'm taking a deep dive to try and understand some of the more unusual side effects around ompic and what's going on post pandemic. For anyone who's been following me, I'm Dr. Philip McMillan and I've been analyzing patterns throughout the pandemic. My view is that because there's a change in physiological behavior at population level, many of the clinical assumptions that we have had prior to the pandemic no longer stand. And this is what we're starting to see now. So, this information is coming from the FDA because they are starting to be concerned about some of the use unapproved use of GLP-1 drugs for weight loss. And it's it's raising a lot of concerns with regards to what's happening because these are exceptionally powerful and valuable drugs. This is part of the issue. I'm not a critic per se of GLP-1 agonist.

[00:01:07]I'm a critic of it being used inappropriately because this is very important. This drug has been around for a while and has done great benefit in terms of the diabetic space and weight loss space. We shouldn't mess around with it. So, here are some science before I come back to what is going on. So just a few things is that when we talk about GLP1 we're talking about glucagon like peptide 1 it's a specific incretin hormone and it's part of a group of similar hormones that primarily work related to the gut and occur after eating. Now you have to remember that human physiology is set up in such a way that it's designed to do specific actions. When you eat, your stomach will stretch. It will release this hormone or this peptide to tell your body that you've eaten enough. And so part of the trick is that by injecting it, you can then tell the body that it is full even though the stomach isn't being stretched. That's kind of like the principle. Now you have to understand that whenever you interfere with human physiology, you are likely to have unintended consequences if you are not careful. And this is the bit that I'm talking about because these drugs as I said are very valuable. There are a lot of them that are around. This is the original GLP1. Then you have different groups exanide, luragide, semiglutide, d um dullutide, you know. So all of these with slight variations to the pro or the original um length. And all of this is about improving the um the availability of the drug so that it's not easily destroyed and has sometimes a longer duration of action all within good use of the pharmaceutical uh system. But where we have to be careful is that it has multiple effects on the body. When we look at the different organs, fat, kidney, brain, this is where it reduces um appetite, um heart, muscle, gastrointestinal tract. It slows down the the emptying of the stomach as well as the ins um insulin secretion. So it has a broad range of effects and these are very valuable if used appropriately.

[00:03:51]So what is happening is that there seems to be a greater use of these drugs merely for weight loss. People who are struggling with their exercise and they think you know what I I can do a trick and get rid of this weight so that I can go on holiday and look better and fitter in the summer. Let me just take these drugs.

[00:04:14]This is where I think we have to be careful because where we saw the great benefit was in people who had genuine issues with regards to obesity and people who are diabetic especially the combination of obesity with diabetes.

[00:04:29]This was a critical use of the drug and when we look at the timeline as to how long it has been around since the 1980s that's when it was discovered. Then by the '9s we started to understand a little bit more about how it could work.

[00:04:46]And then in 2005, eenide was the very first drug that was used for type 2 diabetes. And then later on 2010 to 2014 uh liagletide um was used and so you can see that was the first time it was approved for obesity not just weight loss. So where is this going? What exactly is happening? Well, what you have to realize is that there's a little bit of a problem occurring with regards to side effects. And the side effects that we're looking at specifically now is to do with gastrointestinal adverse effects. Now this was a paper that was done in October of 2023 in JAMA and it was looking at the fact that these glucagon like peptides which were approved for diabetes are now also being used for off label weight loss. That's fine now well not fine. This is the problem being used for off label weight loss. And they are finding that studies have found an increased risk of gastrointestinal adverse events, bowel obstruction, and gastroparesis.

[00:06:03]This is the one that I'm going to be zoning on. And so they are realizing that a lot more people are having some of these problems. And one of the big ones that I'm talking about here is this gastroparesis.

[00:06:18]So, I've got here um an NHS site which will show you uh let me just get this ready is what we're talking about when we say gastroparesis.

[00:06:29]So, this is where food passes through the stomach slower than it should. It's a long-term condition that can be managed with diet changes, medicines, and other treatments. Now once this happens it is not easy to reverse and this is why it is so serious because you have to then just manage it. Now with that changes so I guess the weight loss will be less of an issue. Um the main symptoms that you have feeling full sooner than usual feeling sick tummy pain heartburn bloating all of these things can happen with gastroparesis.

[00:07:11]Now, it's important to note that a lot of people have similar things.

[00:07:14]Gastroparesis is far more significant in that it's long-term.

[00:07:19]It starts to really affect your ability to eat and is sometimes associated with significant weight loss. So, that is different from just having a few problems with your tummy, some reflux disease and so on. But where we're going is the fact that I am looking at the analysis of the data. So I have an advantage because I'm looking at 186 million data points in terms of the NHS data. And so as soon as I saw this issue coming up with the FDA and gastroparesis, I went to my data and started to take a good look. And here is what I found. And this is where it's really relevant. When we look at what is happening with regards to gastroparesis here, this is K31.8 which is other specified and it's the proxy for gastroparesis and it's compared to other diseases of the stomach and the odinum. This is the control. And when you look from 2016 to 17, there's a very slight decrease significant decrease in 202021.

[00:08:31]And this trend continues into 24-25.

[00:08:35]That's red. But if you follow this green line, you can see that there was an increase pre- pandemic, flattened a bit of gastroparesis, dropped during the pandemic, and then shot off again.

[00:08:51]This is the bit that I think is causing the problem.

[00:08:56]There are some people who are falling into this category who don't know they are in this category and then are using these drugs and it's causing them side effects. Okay. So now you have to again follow what I'm talking about. So I'm going to take you um through some important science here for you to understand what is going on.

[00:09:20]So remember these drugs are designed to interfere one of the aspects of it is to interfere with the way how the stomach works. Slow it down. Let it give the sensation that it's full and therefore people won't feel hungry. And that's the principle. So here is where we run into a problem because a lot of people postcoid symptoms had veagal inflammation.

[00:09:50]Now this is where the vagus nerve comes in. And so this is the scientific bit.

[00:09:55]When we look at how the body works, this is the brain up here with the brain stem and the vagus nerves comes from the brain stem going down and it makes a root stop here in the nose ganglia and then it will continue down and part of its supply is to the stomach. Okay. And what it's doing because it's parasympathetic, it has the impact of having an an impact on how the stomach contracts. Okay. Now, because at the same time, the GLP1 effect on the stomach also will slow down the stomach emptying. What can happen is if people already have some degree of veagal nerve inflammation, this can kick them off to the point where they have gastroparesis. And this is the bit that I'm trying to explain is that a lot of people don't even realize that they have ongoing veagal nerve inflammation and this inflammation can cause symptoms. And this is what I'm trying to explain about. So when we look at some of the common symptoms with this veagal nerve inflammation, heartburn, nausea, bloating, early fullness, delayed emptying, all of these things are already there. Upper abdominal discomfort, throat irritation, palpitations, poor response to reflux medication. All of this may suggest someone already has veagal nerve inflammation. This cohort of person needs to be very careful when they're using a drug that can then also have an additive effect on top of that.

[00:11:52]And this is where I then created if you are interested in this I have put together a simple assessment that you can do and you'll be sharing is your vagus nerve inflamed or is it just your gut? And this is why I did this because so many people are struggling with gut-related symptoms and they don't realize that this is a post-pandemic pattern and without addressing this, especially if you've got veagal nerve involvement, you then run into trouble.

[00:12:27]Now listen, I I can't emphasize this enough. This is why both of our recent papers has been focused on gut and microbiome related topics.

[00:12:39]Because everything about even severe COVID, postcoavid, postcoavid inflammatory patterns remarkably seem to be coming from the intestine. Now that's an insight that we're building out on at the moment because very few people realize this.

[00:12:58]They think that it is just a respiratory disease. But the more we look at what exactly happens and who is affected, inflammation in the gut is one of the central drivers. And this is why I keep on emphasizing to people, please, if you have ongoing gut symptoms, do not underestimate the implications this can have in terms of your health. And so when you put the two together, if there is already an inflammatory process taking place with regards to the intestine, inflammation of the entic nervous system, stomach and otherwise, and then those people go on top of that and use a drug that has further impact on the intestine. It is no surprise that they will run into that very critical pattern of having something like gastroparesis.

[00:13:59]And this is the bit that I think people don't seem to understand. There is a huge appeal with regards to these weight loss drugs. Quick fix, you know, but it's the people in the gray zone.

[00:14:13]They're not obese, but they just want to speed it up. They want to lose 5 to 10% of their weight and they want to do it in a way that seems easy. Now I understand that and um the truth is is that it's not easy these days to lose weight especially as you go over the midpoint of the 30s and so on. that that actually is an important discussion about to what is causing weight to be so difficult even when people are dieting and exercising. I I'll do a presentation on that in in the near future. But that's one of the things that is driving the need for people to use these drugs to get over that hump. As I pointed out, it's not that these drugs are problem in the sense that these are really valuable drugs and I don't want to see them damaged because they are lifech changing when used appropriately. People who really are struggling with obesity, needing surgery, these drugs are huge.

[00:15:21]However, cosmetic misuse not only damages the public perception of this drug, but can put people at risk and it will undermine trust in the use of this drug. So, when there are people who actually need it, they will be hesitant saying, "Oh my goodness, I've heard about all of these side effects that people can get." Kind of like what is happening with regards to statins.

[00:15:47]that would be because it was overused in an appro inappropriate way and then it's causing damage to public trust. That's my biggest concern at the moment. And as I said, this is also the concern with the FDA. They as well are worried about unapproved use. Now, at the moment, it is very easy to get them prescribed.

[00:16:13]However, you do have to be careful and this is why I said that if you are going to do it at least I think do that check.

[00:16:22]I've put it in the description where you can take a look and see whether or not you have veagal inflammation.

[00:16:29]Look at addressing your gut and your microbiome. Address as many things as possible that could be a contributing factor to your health before you decide to go either even short, medium, or long-term on medication that could lead to other problems down the line. As I said, there are many challenges that we're having at the moment. And one of the biggest ones is that people are not aware that these patterns are changing.

[00:17:01]And here is the slide again. When we look at the pattern with gastroparesis like ICD codes, these are on the rise in a way that is post-pandemic driven and pointing to the fact that this cohort of people we need to be careful about in terms of their risks longer term. So still a lot of work to be done, but yes, the answers hopefully will be coming soon. Look in the description if you're interested and the links will be there.

[00:17:33]Have a great evening.