Hi Friends,
Dr. Storage here.
Pretty massive news if you haven’t heard:
The FDA just approved the first oral GLP-1 specifically for weight loss.
Which is exciting from an access standpoint... no needles means more people might get help sooner.
But looking at this through a GI physician lens, I’m cautiously optimistic.
Just because it’s a pill, doesn’t mean it has the same efficacy as the shots, or fewer side effects.
So if YOU are considering taking a GLP-1 pill for weight loss, you should read this now (and share this email with your family/friends 😁).
Today’s Opponent:
There’s Finally a ‘Magic Weight Loss Pill’.
But is it too good to be true?
The opponent today isn't the medication itself. It's the assumption that "pill = easy/gentle."
Because we’re used to taking vitamins or a baby aspirin, we subconsciously assume a daily pill is less intense than an injection.
With oral GLP-1s though, that is a dangerous misconception.
The chemistry required to get a peptide through your stomach acid is not insignificant, and the side effect profile proves it’s not a "light" version of the shot.
If your resolution involves metabolic health, you should read the fine print before you call your doctor.
And here are 3 things Dr. Tabibian and I want you to know about the new GLP-1 pill:
👉 It’s not a “gentle” alternative.
There’s a BIG misconception that the pill will be easier on your stomach than the shot. The data suggests otherwise.
In clinical trials, nearly 74% of patients on the oral version experienced GI side effects (nausea, vomiting, diarrhea, reflux). That’s almost double the rate of the placebo group.
So many of you who start taking an oral GLP-1 are going to see the same side effects: nausea, early satiety (feeling full too fast), constipation, and reflux.
Please, do not underestimate the potency just because there’s no needle.
👉 Taking it requires more discipline than you think.
We’re worried about dosing consistency. With the shot, you set a reminder once per week.
With the pill, it’s a daily commitment.
Because semaglutide is a peptide, your stomach acid tries to destroy it. So to get it absorbed, you have to follow a strict protocol:
You have to take it on an empty stomach, first thing in the morning.
With 4 oz. of water max, that’s not a lot.
And you cannot eat, drink (yes, coffee included), or take other meds for at least 30 minutes.
If you skip any of these steps, the drug doesn't absorb.
So, if you rely on morning coffee to function… adherence may become a real challenge. Is the plan to take a daily GLP-1 pill for life?
👉 Long term safety is a question mark.
As board-certified gastroenterologists, we have to ask the hard questions…
Is the plan to take this a daily GLP-1 for life?
Dr. Tabibian and I openly discuss our fear regarding the long-term impact of these medications on the endocrine system.
Because there is such a desperate desire for shedding weight in our culture (unlike the desire for, say, lower blood pressure), coupled with an obesity epidemic, we worry the FDA may be more lenient with approvals here than in other fields.
We know these drugs work for weight loss now.
But we don’t yet know the full picture of their impact on your health 20 years from now. We just don’t.
"The GLP-1 pill is exciting from an access standpoint. Injections scare a lot of people, so this solves for that. But I urge you not to underestimate the side effects of the pill. Absorption and dosing consistency will matter a lot."
“Something that seems too good to be true often times is. My fear is what we might see years down the road as a result of endocrine disruption from these medications. Are we open to the possibility that there could be thalidomide-like or other complications with long-term use?”
If you are interested in taking an oral GLP-1 for weight loss, ask your doctor this:
"I know the oral version has a high rate of GI side effects (74%). Given my history with reflux/nausea, is the oral route actually better for me than the injection? And am I a good candidate for the strict morning fasting requirements?"
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As gastroenterologists, we definitely have a lot to talk about when it comes to your gut health and well-being. But we can’t always get to everything (you know… like coffee enemas)! So reply directly to this email or DM us on TikTok below and maybe YOUR topic will be featured soon!
