Over the past several years as people have started using semaglutide (Ozempic) and tirzepatide (Mounajro) more and more for weight management and diabetes, one question that’s started coming is whether these drugs might be able to also treat addiction. This is an interesting question and one that I don’t think anyone in the weight loss arena really thought possible. However, anecdotally more and more people on these drugs have started observing that they have reduced cravings for things like nicotine, alcohol and even things like methamphetamines and cocaine. What could be the science behind this? The answer likely lies in the reward system in the body for doing pleasurable things. Dopamine is a reward neurotransmitter that compels us to continue doing pleasurable things. Normally when you do something like drink alcohol, eat chocolate, take cocaine, engage in gambling etcetera you get a burst of dopamine from the brain. This makes us feel good and inclined to keep doing that thing. However, if we get reduced dopamine release from doing those things then we’re less inclined to do them. Well, it turns out that semaglutide (Ozempic) and tirzepatide (Mounjaro) may potentially lower the amount of dopamine that’s released in the brain when we do pleasurable things. That means there would be less pleasurable reward feeling from doing things like drinking alcohol, eating chocolate, gambling, doing cocaine, etc. While there aren’t large scale studies that have been published yet confirming this there’s been so much anecdotal evidence that probably there is some effect for reducing cravings. There have been some rat studies showing 50% less craving for alcohol when they’re given this class of drugs. Commonly I have seen in my own practice that when people are on semaglutide or tripeptide that they have reduced desire for alcohol. Either the desire isn’t there or the quantity that they desire has gone way down. I think over the next several years we’ll really see the science catch up with what’s actually going on but more than likely it is this reduced dopamine burst that’s released from the brain during a pleasurable activity that’s ultimately giving this benefit. Now I should remind people that this is anecdotal evidence which means that you can’t guarantee that someone’s going to have this effect when taking these drugs. I have personally had many patients notice that they have reduced cravings while taking Tirzepatide or semaglutide. However there are other people who have not experienced this benefit. So it isn’t something that can be guaranteed but more and more clinicians have started using semaglutide and Tirzepatide off label to help with recovery from addiction. In the next couple years when the studies on GLP1-agonists and addition are published we will likely get confirmation with what seems to already be a strong trend.
Do Ozempic, Wegovy and Mounjaro reduce muscle mass?
The newest and hottest weight loss drugs that have been sweeping the nation all fall into one class of drugs called GLP one agonists. They include drugs like Ozempic, Wegovy, Mounjaro, Zepbound etcetera. They’ve been touted as miracle drugs and by many accounts they have helped thousands of people lose weight who were previously stuck in their weight loss journey. I personally have observed incredible transformations in my patients when using these drugs. However, any drug is not without its risk. So, can this class of drugs lead to reduced muscle mass? Yes, they can. However, this is also the case with any rapid weight loss strategy. This includes things like bariatric surgery, banding, extreme dieting. Any extreme weight loss potentially has the risk of losing muscle mass. Loss of muscle mass is called sarcopenia and when someone undergoes rapid weight loss and anywhere from 1/4 to 1/3 of that weight loss can be from muscle. So, does that mean this class of drugs is inherently flawed and they shouldn’t be used? No. It means that if you’re going to go through rapid weight loss with any method you should do things to mitigate the muscle loss. Luckily there’s good research on things like adequate protein intake and strength training to mitigate the muscle loss that can happen with drugs like Ozempic and Mounjaro. Getting at least 25 to 30 grams of protein per meal can dramatically reduce muscle loss. Protein intake includes things like animal meats, eggs, dairy, beans and legumes, soy, etc. Weight training several times a week where the muscles are constantly being challenged and strengthened can dramatically reduce any kind of muscle wasting. Beyond that there are other treatments and therapies like peptides that can potentially be used, and they all have varying degrees of success. But one thing I’d like to remind everyone is that the potential for muscle loss isn’t isolated to this class of drugs. Any rapid weight loss potentially has the risk of muscle loss. Anyone undergoing a weight loss program whether it be with Mounjaro or Ozempic or some other intensive strategy will need to maintain their muscle mass or risk losing it. I counsel each of my patients on the proper intake of protein and the right kinds of exercise as to preserve and enhance muscle growth. These new drugs can be miraculous for assisting weight loss but as a conscientious physician, I always need to make sure that any potential harms are mitigated.
What Happens when you stop taking Ozempic or Mounjaro?
Both Ozempic (semaglutide) and Mounjaro (Tirzepatide) belong to the class of drugs called GLP-1 agonists. These are drugs that are both used to treat type 2 diabetes and obesity. I have personally witnessed the power of these drugs to accelerate weight loss and lead to incredible transformations in patients. However, what happens when someone stops taking these medications? Is it safe to simply stop? Do people regain all the weight they lost? These are very important questions that I get all the time and I’m happy to share the answers. Firstly, it is perfectly safe to stop these drugs. There isn’t a taper down that is needed, primarily because these drugs have a long biological half-life. The half-life of a drug is the amount of time for half of the drug to be cleared from your body. Ozempic, for instance, has a half-life is 1 week. So that means 1 week after your last injection, there is 50% less of the drug active in your body. It takes 5 half-lives for a drug to be completely out of your system, so again in the case of Ozempic, it would take 5 weeks for it to be fully out of the body. This is good news in many regards. Due to this long half-life the drug only needs to be given once a week to remain relatively high concentration in the body. Once someone comes off the drug, it solely tapers off so that even several weeks later there is still some biological activity and effect. So there is no rapid drop off when you stop. Now after several weeks, however, the effects will be gone and the body will return to its normal functioning without the drug. This means appetite will return. Does this then mean you will regain all of the weight you lost? Sometimes yes, sometimes no. If healthy eating habits and exercise are not maintained, some patients can regain half to 2/3 of the weight they lost while on the medications. Conversely, I have had some patients swear that the course of medication had reset their metabolism and they were able to maintain the weight loss even without exercise and healthy eating. However, from my experience most people will experience some degree of weight regain eventually after stopping the medications if they haven’t locked in healthy eating and regular exercise. For this reason, it is very important not only to lose the weight but also educate oneself about what activities and foods can assist their weight maintenance. Some patients elect to go on a maintenance dose of Ozempic or Mounjaro at a reduced dose or reduced frequency to help avoid rebound weight gain. I always discuss the various possibilities with patients interested in tapering down or stopping their GLP-1 drugs and help them make an informed decision that feels right for them. Losing the weight is a big part of the journey, but keeping the weight off is an equally important component that is often overlooked by many weight loss clinics. I love working with my patients to not only get the weight off but work with them to come up with a strategy that works best for them to keep the weight managed.
