The effects of GLP-1 drugs on your heart

Some doctors call it a miracle drug. Others, the answer to America’s obesity epidemic. 

I call it an unknown quantity — because GLP-1 medications like Ozempic have many more long term consequences than are currently being discussed.

In the same way statins haven’t cured heart disease and SSRIs don’t solve depression, GLP-1 agonists aren’t necessarily a cure-all for obesity. 

And the more we learn about their long-term side effects, the less I’m sure they’re entirely safe for metabolic health.

So why do people love GLP-1 agonists?

For context, GLP-agonists are medications like Ozempic, Wegovy, and Rybelsus, which mimic the GLP-1 hormone in your body. They act like appetite suppressants by lowering blood sugar levels, modulating hunger cues, and slowing digestion. 

As you might imagine, this should eventually lead to weight loss. Some studies say this can be between 15% and 20% of your body weight within a year.

There are a few other benefits seen in early clinical studies:

• Protective effects on the kidneys. Patients with type 2 diabetes may reduce their risks for chronic kidney disease.
• Slows brain shrinkage. This could have ramifications on the development of mental health disorders such as Alzheimer’s and dementia.
• Possibly improved heart health. Some studies suggest fewer cardiac events and better heart health metrics, regardless of the amount of weight loss

But that doesn’t mean GLP-1 agonists are a silver bullet for obesity and heart disease. 

There are other studies worth mentioning here that make me concerned about your metabolic health. 

The dark side of GLP-1 and heart health

We know the initial effects of GLP-1 agonists are relatively unpleasant for the average patient.

For example, you may have to live with short-term:

• Nausea and vomiting 
• Allergic reactions
• Mood swings
• Headaches
• Fatigue

But we must also consider its (serious) long-term side effects:

• Nutritional deficiencies: There appears to be a direct connection between GLP-1 agonists like Ozempic and severe nutrient deficiencies.
• Gut damage: You might face serious complications due to disruptions in the microbiota, including pancreatitis, gastroparesis, and bowel obstruction.
• Muscle loss: Up to 40% of weight lost on GLP-1 medication can be muscle, not fat. Considering muscle is the most metabolically active tissue we have, this could be extraordinarily problematic to the heart. Which leads to my next point:
• Heart shrinkage: A December 2024 study found that Semaglutide shrinks heart cells in mice and cultured human cells. If the same happens in humans from taking these medications, this can ultimately affect cardiac structure and function, which may eventually put you on an operating table.

Finally, and perhaps most concerningly, you might gain the weight back if you stop taking Ozempic. That’s because GLP-1 doesn’t change lifestyle habits — just temporarily limits hunger and increases insulin production so long as you take regular doses.

A study from Dr. Tro shows that the biggest benefits of GLP-1 drugs, including hunger and cravings control, may return to baseline between years one and two. In other words, they’re temporary effects (although the loss of lean muscle mass certainly isn’t).

You should also know some people never lose weight on GLP-1 drugs. According to some studies, it might be as high as one in five people.

And remember: you can still be thin and suffer from a heart attack. Losing weight isn’t necessarily a panacea against heart disease. 

So what’s the verdict?

It’s not that GLP-1 isn’t effective at helping patients lose weight — it is, and demonstrably so. 

But what it doesn’t do is address the underlying factors that affect metabolic health, which I would argue is far more important than addressing obesity alone.

And remember: GLP-1 doesn’t build muscle tissue (quite the opposite, in fact). It also doesn’t prevent you from eating seed oils, processed foods, and added sugar, which can still harm your metabolic health. Considering it’s only been approved in the US since 2017, we don’t have much data on its long-term heart health effects. 

If you want to lose weight, GLP-1 can help you get there. But it cannot and will not restore your metabolic health. 

The good news is, it’s possible to mimic its effects.

It starts with lifestyle changes, which no amount of medication can change.

Designing a GLP-mimicking diet

A one-year study examining the effects of low-carb diets and chronic disease has shown it’s possible to achieve similar effects to Semaglutide drugs. It also proves it’s possible to experience sustainable weight loss even at the 12-month mark.

Compared to GLP-1 agonists like Ozempic, where you’re likely to lose around 15% of your body weight, this lifestyle approach (implemented across multiple employment environments) saw participants lose an average of 15.5% of their body weight.

That’s because there are many similarities between GLP-1 drugs and low carb diets — although the full explanation is a bit too complex for this piece.

That said, you can learn more about implementing a low-carb diet such as keto or carnivore on my website.

Eliminate cravings for processed foods

Like Semaglutides, low-carb diets significantly suppress sugar cravings, which ultimately reduces the amount of ‘near-food objects’ you eat every day.

That’s because low-carb diets:

• Encourage long-lasting satiety from foods like eggs, red meat, and certain dairy products, which can help reduce hunger spikes and cravings.
• Lead to stable blood sugar levels, as there are few if any carbohydrates rapidly breaking down into sugar. 
• Require less insulin, as there’s less sugar in your blood. Your body may start to naturally use fat instead of glucose for energy, which can lead to long-term health gains.

For the 16 million Americans currently taking GLP-1 drugs, low-carb is an easy way to deprescribe unnecessary medications. You’ll get many of the same weight benefits with none of the serious drawbacks, and without the $1,000+ monthly cost for a name-brand prescription.

Boost your natural GLP-1

Studies show exercise can boost GLP-1 sensitivity in the body, possibly by increasing the amount of blood flowing to the gut and intestines (the places where GLP-1 is produced).

One place to focus is on resistance or strength training, which can help build lean metabolic mass. It also encourages rapid fat loss, as a pound of muscle is far more metabolically active than a pound of fat.

That said, you don’t need a gym membership to reap the benefits of exercise. Even short bouts of walking after eating (read: six minutes per hour) can boost postprandial GLP-1 and possibly shrink stomach fat.

To medicate, or not to medicate?

I make it a point not to instruct patients what to do for their health — only to advise and provide guidance according to their goals. 

That said, I strongly believe you should explore lifestyle changes before considering Ozempic.  I’d rather see you use it as a way to get over the hump than take the drug indefinitely.

Taking drugs for your health isn’t necessarily bad, but their chronic use certainly might be.

Now, should you decide that GLP-1 agonists are something you want, be sure to have a candid conversation with your doctor about their long-term effects. 

And if you don’t have a doctor who gets it (or you want a second opinion), you’re welcome to explore my free physician vetting guide.