Does Ozempic Lower Cholesterol?

Ozempic (and Wegovy and Mounjaro and Zepbound) are seemingly everywhere, a topic of conversation for everyone, and appear to be the miracle drugs for everything (diabetes, obesity, heart disease, chronic kidney disease, the list is likely to go on and on). 

Could they lower cholesterol too? 

As I’m seeing more and more patients who are taking these drugs and as more and more people ask about them – including whether they lower cholesterol - this week’s blog delves deep into many details around this group of medications, of which Ozempic is probably the best known brand.

 

What is Ozempic and How Does it Work?

Ozempic is a GLP-1 agonist medication that contains the active ingredient semaglutide. GLP-1 agonists work by mimicking the actions of the glucagon-like peptide-1 hormone that our bodies naturally produce in the intestinal tract in response to eating.

GLP-1 agonists modulate insulin secretion, which helps to stabilize blood sugar levels. They also help block the release of glucagon, which normally raises blood sugar levels. Both of those effects help improve blood sugar control, which is why this drug was approved for type 2 diabetes treatment. 

GLP-1 agonists also trigger satiety signals in the brain thus controlling appetite, and slow down gastric (stomach) emptying, thus slowing digestion and keeping people feeling fuller longer.  These latter two effects can be especially impactful in people trying to lose weight.

Finally, GLP-1 agonists have also been found to have some anti-dopaminergic effects, reducing the pleasure from eating food, thus cutting down on cravings. 

Ozempic is FDA-approved for treatment of blood sugar elevations in adults with type 2 diabetes when combined with physical activity and a reduced-calorie diet. Ozempic is also approved to reduce the risk of major cardiovascular events like heart attack and stroke in adults with type 2 diabetes and a known heart condition. It is not approved for weight loss, although it has been used off-label for this purpose.

 

Are There Other GLP-1 Agonists Besides Ozempic?

Yes. Wegovy is also a GLP-1 agonist delivering semaglutide, the exact same active component as in Ozempic. It is produced by the same company that makes Ozempic, but sold under a different name and provided at different dose levels.  Wegovy is specifically approved for weight loss, but because it is essentially the same drug as Ozempic, it shares the same diabetes/heart benefits.

Mounjaro is another GLP-1 agonist (tirzepatide) that has some additional properties that might make it more powerful in controlling blood sugar levels in type 2 diabetics as well as in achieving weight loss.  It is not approved for weight loss, but like Ozempic, has been used off-label for weight reduction as well. 

Zepbound is basically Mounjaro sold under a different name and is approved for weight loss. 

Like Ozempic, all of these drugs are self-administered by injection.  None of these drugs are approved for lowering cholesterol, although their effects may lead to lower cholesterol levels.

More on that below.

 

Do GLP-1 Drugs like Ozempic Have Cardiovascular Benefits?

Yes. Ozempic has been shown to lower the risk of major cardiovascular events such as heart attack and stroke in adults with type 2 diabetes and known heart disease. Blood sugar modulating effects likely play a big role here. However, shedding excess pounds is also one of the top recommended ways to lower your risk for heart disease. So, the potential weight loss benefits of Ozempic come into play here too.

One study observed the effects of semaglutide vs placebo in participants who were overweight or obese with a pre-existing heart condition. The study found that the group taking semaglutide experienced 20% fewer heart attacks, strokes and/or death.

 

What Are the Advantages of Taking Ozempic?

Ozempic offers several approved benefits, along with some potential off-label benefits. These benefits include:

• Controlling blood sugar levels - Ozempic is approved to help lower A1C levels in adults with type 2 diabetes. The American Diabetes Association recommends A1C levels under 7% for adults with type 2 diabetes. According to studies, most diabetic adults taking Ozempic reached A1C levels under 7% and maintained it over time. The average A1C reduction was between 1.9 to 2.2%.
• Lower cardiovascular risks - As mentioned above, semaglutide has been shown to make a statistically significant difference in reducing the risk of cardiovascular events in people who are overweight or obese with a known heart condition regardless of whether they have type 2 diabetes.
• Weight loss - Although weight loss is an off-label use for Ozempic, it has been shown to help people lose weight. Studies show that type 2 diabetics taking Ozempic lose an average of 12 to 15 pounds. Weight loss with Wegovy, Mounjaro and Zepbound can be greater.

 

What are Possible Ozempic Side Effects?

As with any medication, taking a GLP-1 agonist comes with the risk of experiencing side effects. The most commonly reported side effects of Ozempic include:

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Stomach pain

These are primarily related to slowing of the digestive process that results from taking Ozempic and can range in severity from mild/tolerable to incapacitating. 

Even if you don’t experience any of these symptoms, food can stay in your stomach much longer than normal.  This can lead to serious problems when undergoing anesthesia.  Patients are therefore typically instructed to temporarily halt Ozempic injections for a period of time before any elective surgical procedures. 

There are also risks for more serious side effects. These include:

• Pancreatitis or inflammation of the pancreas
• Changes in vision
• Low blood sugar or hypoglycemia
• Kidney problems or kidney failure
• Gallbladder problems
• Serious allergic reactions
• Depression/suicide

Although not common, these are not to be whitewashed.  Pancreatitis can markedly affect quality of life and lead to recurrent bouts of this very painful condition even after you stop taking GLP-1 agonists.  Low blood sugar levels can cause you to pass out.  Pass out on a ladder and you might sustain life-threatening injuries.  The anti-dopaminergic effects may reduce food cravings (as well as cravings for cigarettes, alcohol and gambling), but they can also lower mood in general, triggering serious mental health issues.

 

Are There Other Downsides to Ozempic?

Yes. There are also two very important caveats when it comes to weight loss with Wegovy, Ozempic or any other GLP-1 agonist:

1. The weight loss seen with these medications is not limited to fat tissue. As with any weight loss program you can also lose muscle tissue.  So unless you participate in regular exercise and strength training while on these medications you will come out weaker.
2. If you don’t change what you eat - not just in quantity but quality - you will gain all your weight back when you go off these drugs. A dietary overhaul remains a critical component of any weight loss attempt, whether or not you are using these medications.

 

Ozempic and High Cholesterol Levels

Ozempic does not possess any direct cholesterol-lowering properties.  However, it can help you attain lower cholesterol levels as a secondary benefit. 

If you’re overweight or obese, your risk for developing high cholesterol increases. This is because being overweight or obese affects how your body produces and manages cholesterol, triglycerides and other lipoproteins in a multitude of ways. Being overweight or obese can increase inflammation, insulin resistance and affect metabolism in general, which can all play a role in elevating cholesterol levels.   

It goes to the reason, therefore, that losing weight can make a big difference. One study found that overweight or obese adults who lost 5-10% of their body weight showed significant reductions in triglycerides, total cholesterol and low-density lipoprotein (LDL) cholesterol.

So, if you have high cholesterol and are overweight or obese, it’s possible that semaglutide medications like Ozempic may help you lower your cholesterol levels as you lose weight. 

Controlling blood sugars better if you have diabetes or prediabetes also leads to better cholesterol control.  So diabetics using Ozempic can see better cholesterol readings before losing significant amounts of weight.  

However, since not everyone who has high cholesterol is overweight, obese or has type 2 diabetes, GLP-1 agonists aren’t ideal or even appropriate cholesterol-lowering solutions for many people.  When it comes to GLP-1 agonists you can view improved cholesterol control as a potential side benefit of the drugs, but not as an indication for them. 

 

Can I use Step One Foods if I’m on Ozempic?

Yes!  In fact, our foods may be the perfect complement to your efforts.  Whether you have been prescribed a GLP-1 agonist for diabetes management, weight loss, or as part of your heart disease treatment plan, Step One Foods can help ensure that the quality of your diet is improved, supporting your treatment goals. 

But I always go back to first principles – excess weight, obesity, type 2 diabetes – these are not caused by a deficiency of Ozempic.  These conditions are caused in part or in whole by a deficiency of the right foods.  Optimal nutrition is central to optimal health.  That may not be easy to achieve, but it is the truth.  And that's why Step One exists: to help you succeed!