You’re eating right. You’re exercising, sleeping, and drinking enough water. You’re doing all of the things and still not losing weight. You don’t want to lose it and then find it again. You want to release it for good.

As a registered nurse and holistic health educator, I spent about a month studying these medications before releasing episode 79. Then I learned even more and gave an update in 114. My initial thought was that maybe the benefits outweighed the risks. As I learned more, my position changed. 

This blog has been updated to reflect all the information so you can weigh the pros and cons, look at all the options, and make the best decision for your own health. If you choose to use a medication, that, of course, includes a conversation with your provider.

What GLP-1 does in your body

GLP-1 is a hormone your body makes. It helps regulate blood sugar, regulates digestion, and reduces appetite. Medication GLP-1 also slows down your stomach emptying.

When you eat, your body needs to get fuel from that food into your cells. Insulin helps glucose, or blood sugar, enter the cells where it can be used for energy. Extra fuel can be stored for later.

I often call insulin the fat-storage hormone; storing fuel is not a bad thing. Insulin is doing a job your body needs it to do.

GLP-1 signals your pancreas to release insulin. It also signals your liver to slow its release of glucose. Think of it as saying, “Hey, I got this.” Food is coming in, so the liver can slow down for a little bit.

GLP-1 also acts on appetite through receptors in your brain. That connects to something called food noise. It is how much space food and thoughts about food take up in your brain. The cravings. Thinking about what you want to eat next. That running conversation in the background. GLP-1 can reduce that noise.

GLP-1 as produced by your own body and GLP-1 agonists (the medications) differ in a few things. One of the big ones is stomach emptying. The medications delay how quickly that happens. Movement through the rest of your gut is a separate question. I am less certain about how natural GLP-1 and these medications differ in their effects on that movement.

How semaglutide and other GLP-1 medications work

When you hear GLP-1 agonist, think of a medication that mimics natural GLP-1. These medications increase insulin release, reduce glucose production, slow stomach emptying, and decrease appetite.

You may recognize the brand names more easily than the medication names.

Efpeglenatide is another name you may come across.

Tirzepatide acts on GIP as well as GLP-1.

Benefits that go beyond the number on the scale

Better blood sugar regulation and weight loss are two reasons people consider these medications. Food noise can become quieter, too. When you have been trying so hard to lose weight, those potential benefits matter.

A friend taking these medications told me she had noticed increased energy and better sleep. She was trying to eat more protein, and the weight had come off slowly. At that point, she described the medication as a great tool for her.

When I followed up with her a year later, her insurance had stopped paying for the shots. She had to stop taking them, and even though she thought she had good plans and diet/lifestyle in place, she regained all the weight. She was so frustrated.

Side effects to consider alongside the benefits

Any time, in fact, every time, you consider a new medication, supplement, or even lifestyle, you get to weigh the benefits and risks before making your final decision.

While the benefits of GLP-1 agonist medications are tempting, the side effects must also be considered. When I initially recorded episode 79, I looked at the benefits vs risks and decided the benefits probably outweighed the risks. I said that on the episode. But then over the next year, more side effects came to light.

Side effects range from minor to major and from rare to common.

Rare but serious

Death is obviously a serious side effect.

Ozempic and other diabetes-weight loss drugs have been linked to at least 162 deaths and 10,000 cases involving ‘serious’ injuries since 2018… the FDA received at least 62,000 reports of side effects linked to Ozempic, Wegovy, Mounjaro, or Zepbound… the number of deaths… has increased by 40% over the last six months. – JDSUPRA

Digesive system side effects

In a medication designed to alter the digestive function of the body, you would expect to see side effects related to digestion and that is exactly what we see.

Digestive side effects of the medication can include nausea, vomiting, diarrhea, constipation, abdominal pain, bloating, and gas. Tiredness, headaches, and dizziness are other concerns.

Feeling full can become a problem if it causes someone to not want to eat enough, including enough protein.

The medical journal “Obesity Medicine” published an article Adverse effects of GLP-1 receptor agonists: Clinical Implications, regulatory perspectives, and future directions. Here’s what it said:

Gastrointestinal events, including nausea, vomiting, diarrhea, and constipation, remain the most prevalent, typically transient and dose-dependent. Biliary and gallbladder disorders have been increasingly reported with long-acting agents and rapid weight loss. Post-marketing surveillance identified rare but serious events such as acute pancreatitis, intestinal obstruction, thyroid C-cell hyperplasia, acute kidney injury, and transient worsening of diabetic retinopathy. 

Severe problems with stomach emptying are another concern. Feeling full and being unable to eat comfortably can affect much more than the number on the scale. While one meta analysis looked at 15 studies and found that gastric emptying is delayed by 36 minutes, a quick search online reveals that gastric paralysis also happens to some people.

Pancreas and kidney problems concern me, too. Pancreatitis is a known side effect. A friend who is an ICU nurse told me about caring for someone with necrotizing pancreatitis; she told me that it was from GLP-1 medications.

Why protecting your muscle matters during weight loss

You want to lose fat. You do not want to lose the strength you need to live your life.

It seems that losing weight by using GLP-1 agonist medications causes more muscle and bone loss than is expected with natural weight loss.

Muscle loss can range from 40-60%. This means if you lose 10 pounds, 4-6 pounds of that is muscle. That is concerning for several reasons, one of which is how muscle drives your metabolism. If you lose ten pounds and then, when you quit using the shots, you regain ten pounds, that is frustrating. But if you gain back all fat instead of the muscle you lost, that makes future metabolism and weight loss even harder.

I do not want you to go through injections and side effects, lose weight, and then regain the weight with less muscle than you had before. Your plan needs to consider what happens after the initial weight loss, too.

Bone density is another concern I would want to discuss with the prescribing doctor. This bone mineral density loss is different from osteoporosis, but can lead to the same outcomes like having an increased risk of fractures.

Hashimoto’s and semaglutide require a thyroid medication conversation

GLP-1 medications carry a black box warning about a risk of thyroid cancer. This was found in rodent studies. Although the medications still carry a black box warning from the FDA, research since that time indicate it is not as big of a risk as initially thought. (Although I’m sure that the 65 people in the quote below might feel differently.)

The journal “Diabetes, Obesity, and Metabolism” published an article, Assessment of thyroid cancer risk associated with glucagon-like peptide 1 receptor agonist use. It states:

This analysis, which included clinical trial, post‐marketing surveillance, and real‐world data, does not suggest an association between liraglutide or semaglutide exposure and an increased incidence of thyroid cancer in populations with type 2 diabetes or obesity/overweight. Among 101,732 participants included in the clinical trial data, 65 thyroid cancer cases were reported, indicating a low overall incidence.

Ask your prescribing doctor about thyroid cancer warnings and your own thyroid history. That discussion matters when you are weighing a medication’s potential benefits and risks.

Back in episode 67, I taught you how drinking coffee changes the speed that your thyroid medication goes through your gut and therefore can impact your absorption/dosing. It stands to reason, then, that slower stomach emptying may also affect how your thyroid medication is absorbed. Your symptoms and labs matter when you and your doctor are deciding whether your dose is right for you.

Weight loss may also change how much thyroid medication you need. You might need a dose adjustment, but that is something to evaluate with your doctor.

Do not adjust your thyroid medication yourself.

Sort through the benefits and risks of Semaglutide and other GLP-1 medications

My job as a nurse is to help people understand what they are considering. You get to ask about the potential benefits and the potential risks. You also get to ask how those apply to YOU. One of your jobs as the CEO of your own health is to weigh the pros and cons. Your doctor can, and should, be helping you make an informed decision.

Cost and a plan you can sustain

GLP-1 medications have a reputation for being expensive if insurance doesn’t cover them. Here’s a table of prices in 2026.

The cost is more than the price of the prescription. It is also the stress of wondering whether you can keep paying for something that has been helping.

People I have talked with have had coverage for a while and then lost it. They are left deciding whether they can pay out of pocket. The worry, stress, and mental energy that takes are costs, too.

Discuss how long treatment may continue, what it will cost, and what the plan would be if you need to stop. Decisions about dosing and stopping belong with your prescribing doctor.

How do you decide?

So what do you do with this information? Are Hashimoto’s and semaglutide or other GLP-1 agonists compatible and the right route for you?

GLP-1 medications offer so much hope because we want the benefits they give. At the same time, these GLP-1 agonists do have side effects. And those side effects are impacting a lot of people. We want to think that will never happen to us, but these do happen, and unfortunately, to a lot of people.

Like I said earlier, you always have to look at the scale, benefit versus risk.

So are the benefits of these GLP-1 agonists more than the risks? A year or two ago, I said maybe.

But now I’ve seen more data. And no longer can I say that.

In my opinion, the benefits do not outweigh the risks, especially since in the next couple episodes, I will be telling you how we can activate your own GLP.

Remember, GLP-1 agonists are mimic. They’re mimicking what God gave you and how your body is supposed to work.

So in the next couple episodes, we will talk about activating that so that you can lose weight naturally using the GLP-1 that God gave you. Start with episode 115 which is my interview with Jenny Crane. In a nutshell, she will share about an all natural product that increases your own GLP-1 production.