Latest / The Gastro Truth with Dr. Mel Ona / Gastroenterologist Ranks Ozempic Side Effects From Annoying to Dangerous

Transcript

Gastroenterologist Ranks Ozempic Side Effects From Annoying to Dangerous · The Gastro Truth with Dr. Mel Ona

• 0:00
  SPEAKER_00: Burps that taste like rotten eggs.
• 0:02
  SPEAKER_00: That's one of the Ozempic side effects nobody warns you about.
• 0:06
  SPEAKER_00: And it's the one people don't bring up at their appointment.
• 0:09
  SPEAKER_00: They'll mention the nausea or that they're not hungry, but not the sulfur burps.
• 0:14
  SPEAKER_00: So if you're on Ozempic or Weigovi or Zeppound or Monjaro or any of the ones like them, or you're about to start one, I'm going to take you through these in order.
• 0:24
  SPEAKER_00: From the ones that are just annoying to the one that can land you in an emergency room.
• 0:28
  SPEAKER_00: The last one is the one I see fall through the cracks constantly, and it's the one nobody tells you about before a procedure.
• 0:34
  SPEAKER_00: So I'm Dr.
• 0:35
  SPEAKER_00: Mel Ona.
• 0:36
  SPEAKER_00: I'm a gastroenterologist in Hawaii and have treated over 10,000 patients.
• 0:40
  SPEAKER_00: What I sometimes do is see the people taking these meds.
• 0:43
  SPEAKER_00: Usually months in, once the gut symptoms have gotten loud enough that somebody sent them to a specialist.
• 0:49
  SPEAKER_00: So I'm not here to talk you into one of these or out of one.
• 0:52
  SPEAKER_00: That's between you and whoever prescribed it.
• 0:55
  SPEAKER_00: What I can tell you is what these drugs do to your gut.
• 0:58
  SPEAKER_00: Okay, let's start with why all of this is happening.
• 1:02
  SPEAKER_00: So these medications slow down how fast your stomach empties.
• 1:05
  SPEAKER_00: That's not a side effect.
• 1:07
  SPEAKER_00: That's a large part of how they work.
• 1:09
  SPEAKER_00: Food stays in your stomach longer.
• 1:11
  SPEAKER_00: You feel full longer, you eat less.
• 1:14
  SPEAKER_00: That's the whole idea.
• 1:15
  SPEAKER_00: But your digestive tract is a conveyor belt, and this drug slows the front of the belt down.
• 1:20
  SPEAKER_00: Everything downstream is now running on a different schedule than it used to, which is why the symptoms are almost all digestive.
• 1:27
  SPEAKER_00: Worse in the first few weeks and worse again after every dose increase.
• 1:32
  SPEAKER_00: Now hold on to that.
• 1:33
  SPEAKER_00: The belt slowed down.
• 1:35
  SPEAKER_00: That's what's behind every symptom I'm about to name.
• 1:37
  SPEAKER_00: So the sulfur burps.
• 1:39
  SPEAKER_00: So the rotten egg burps.
• 1:41
  SPEAKER_00: When your food sits in your stomach much longer than it used to, some of it starts to break down before it moves on.
• 1:48
  SPEAKER_00: That process produces sulfur gas.
• 1:50
  SPEAKER_00: The gas comes back up, and it tastes exactly as bad as you'd imagine.
• 1:55
  SPEAKER_00: Now this one is unpleasant, but it's usually not dangerous.
• 1:58
  SPEAKER_00: It's just the belt running slow.
• 2:00
  SPEAKER_00: So here's what helps.
• 2:02
  SPEAKER_00: Though I'll be honest with you, this is managing it, not fixing it.
• 2:06
  SPEAKER_00: So smaller meals, less fat, and less protein in any single sitting, because those are the slowest things to leave your stomach.
• 2:14
  SPEAKER_00: Now don't lie down after you eat.
• 2:16
  SPEAKER_00: If the burping is constant and it becomes with a lot of bloating and you're bringing up food from hours earlier, that's not a burping problem anymore.
• 2:24
  SPEAKER_00: Tell your prescriber, that's a reason to talk about your dose.
• 2:28
  SPEAKER_00: Now, real quick, I want to ask you something.
• 2:30
  SPEAKER_00: If you're on one of these, drop in the comments what your first gut symptom was and how long after starting it showed up.
• 2:36
  SPEAKER_00: I read those.
• 2:37
  SPEAKER_00: Honestly, they're more useful to me than a lot of what gets published.
• 2:40
  SPEAKER_00: Okay, back to the video.
• 2:42
  SPEAKER_00: So this next one I want you to take seriously.
• 2:44
  SPEAKER_00: A pain in your upper mid-abdomen or epigastrium, or up under your right rib cage, especially after a fattier meal.
• 2:52
  SPEAKER_00: Maybe it travels around to your right shoulder blade, maybe it comes in waves that build and then ease off.
• 2:58
  SPEAKER_00: Now that's your gallbladder, not your stomach.
• 3:00
  SPEAKER_00: Now two things are happening at once.
• 3:02
  SPEAKER_00: Now losing weight quickly changes the chemistry of your bile, and that makes stones more likely to form.
• 3:08
  SPEAKER_00: And these medications also make the gallbladder squeeze less often, so bile sits there longer instead of moving through.
• 3:16
  SPEAKER_00: And both of those push in the same direction.
• 3:18
  SPEAKER_00: The rule here is simple.
• 3:19
  SPEAKER_00: Mid and or right upper belly pain that lasts longer than a few seconds or minutes, or keeps coming back, gets a phone call.
• 3:27
  SPEAKER_00: One episode bad enough that you can't get comfortable gets a phone call.
• 3:31
  SPEAKER_00: Not a wait and see.
• 3:32
  SPEAKER_00: Gallbladder problems have a way of going from annoying to an emergency room over a weekend.
• 3:37
  SPEAKER_00: Now two more symptoms where I don't want you to wait at all.
• 3:41
  SPEAKER_00: The first one, severe pain that sits high in the middle of your belly and bores straight through to the back, usually with vomiting and usually constant and not letting up.
• 3:51
  SPEAKER_00: That needs to be looked at the same day.
• 3:53
  SPEAKER_00: It's on the label of these medications for a reason.
• 3:56
  SPEAKER_00: Now the second one, vomiting that won't stop to the point where you can't keep fluids down.
• 4:00
  SPEAKER_00: Now dehydration on top of one of these drugs is its own problem.
• 4:05
  SPEAKER_00: It's how people end up admitted for something that started small.
• 4:08
  SPEAKER_00: You don't push through either one of those.
• 4:10
  SPEAKER_00: You don't wait until your next appointment to mention them either.
• 4:14
  SPEAKER_00: Okay, here's the one I really wanted to get to.
• 4:17
  SPEAKER_00: I watch this fall through the cracks constantly, and I'm the one on the other end of it because I'm the one doing the procedure or scope.
• 4:24
  SPEAKER_00: Now, if you're on one of these medications and you've got a procedure coming up with sedation, or any procedure, say a colonoscopy, an endoscopy, a surgery, a dental thing under anesthesia, you have to tell them you're on it in advance, not on the morning of.
• 4:40
  SPEAKER_00: Well, why does that matter so much?
• 4:42
  SPEAKER_00: Because sedation depends on your stomach being empty.
• 4:45
  SPEAKER_00: That's the entire reason they tell you not to eat after midnight.
• 4:49
  SPEAKER_00: And these drugs are specifically designed to keep your stomach from emptying on schedule.
• 4:53
  SPEAKER_00: So you can follow the fasting instructions perfectly and still have food sitting in there.
• 4:59
  SPEAKER_00: And if that food comes up while you're sedated and your reflexes are switched off, it can go into your lungs.
• 5:05
  SPEAKER_00: That's a serious complication and can be lethal.
• 5:08
  SPEAKER_00: It's also avoidable if the team knows ahead of time.
• 5:11
  SPEAKER_00: Now, the guidance on exactly how to handle this keeps changing as these medications get more common.
• 5:16
  SPEAKER_00: I'm not going to give you a number of days when to hold it.
• 5:19
  SPEAKER_00: That's for your doctors and surgeons to communicate with you.
• 5:22
  SPEAKER_00: What I am telling you is this put it on the form, say it out loud to the anesthesiologist and to whomever is doing the procedure.
• 5:30
  SPEAKER_00: Let them make the plan.
• 5:32
  SPEAKER_00: That one sentence from you is the whole fix.
• 5:34
  SPEAKER_00: So when to bring in a gut doctor?
• 5:36
  SPEAKER_00: So when does this stop being your prescriber's conversation and start being mine?
• 5:40
  SPEAKER_00: If your symptoms are settling as the weeks go on, that's the expected pattern.
• 5:44
  SPEAKER_00: Your prescriber handles that.
• 5:46
  SPEAKER_00: But if they're not settling, or they got worse instead of better, or you're bringing up food from hours before, or you're constipated in a way that isn't responding to anything, that's when I'd want to see you.
• 5:58
  SPEAKER_00: That visit isn't dramatic.
• 5:59
  SPEAKER_00: We talk through the timing.
• 6:01
  SPEAKER_00: We look at what else you're taking.
• 6:03
  SPEAKER_00: Sometimes we test how fast your stomach is actually emptying.
• 6:07
  SPEAKER_00: The point is to sort out one thing.
• 6:09
  SPEAKER_00: Is this the medication doing its job in a way we can manage, or is it something separate that was already there and is now getting blamed on the drug?
• 6:17
  SPEAKER_00: That second one happens more than you'd think.
• 6:19
  SPEAKER_00: So either way, that's a conversation with somebody who knows the gut, not a symptom to sit on for another six months.
• 6:26
  SPEAKER_00: So I made a separate video about why the bloating, the fatigue, and the brain fog usually turn out to be one problem instead of three.
• 6:33
  SPEAKER_00: If you're on any of these GLP meds and you're feeling wiped out on top of everything else, that one's worth your time next.
• 6:40
  SPEAKER_00: I'll link it here.
• 6:42
  SPEAKER_00: See you in the next one.