Welcome back to the series of blood sugar and insulin focus!
In Part 1 of this series, we dove into why the ketogenic diet could be the ultimate game-changer for your health in 2026.
At its core, keto isn't just about ditching carbs—it's about keeping your insulin levels low to unlock better metabolic health, reduce inflammation, and promote sustainable fat loss.
But in our quest for low-insulin living, many are turning to pharmaceutical shortcuts like Ozempic, the injectable drug that's exploded in popularity for weight loss. Is it a miracle jab or a risky detour?
To unpack this, we'll lean on the insights of Dr. Benjamin Bikman, a renowned metabolic scientist and professor at Brigham Young University. Dr. Bikman, author of Why We Get Sick, appeared on The Diary of a CEO podcast with Steven Bartlett in early 2026 (watch the full episode here). His research focuses on insulin resistance and metabolic disorders, and he's no stranger to calling out overhyped trends. Let's break down what Ozempic is, why Dr. Bikman cautions against it, and what natural alternatives he recommends to boost your body's own GLP-1—the hormone at the heart of this discussion.
Understanding Ozempic: The GLP-1 Mimic That's Taking Over Weight Loss
Ozempic (semaglutide) is a prescription medication originally developed for type 2 diabetes but now widely used off-label for weight loss. It's a GLP-1 receptor agonist, meaning it mimics glucagon-like peptide-1 (GLP-1), a hormone naturally produced in your small intestine. GLP-1 plays a starring role in regulating blood sugar, slowing digestion, and signaling to your brain that you're full, which curbs appetite and promotes satiety.
In the podcast (starting around 01:25:52 ), Dr. Bikman explains that GLP-1 is constantly produced in varying amounts, influenced by what you eat. GLP-1 promotes satiety (feeling full), slows gastric emptying, enhances insulin secretion, and helps regulate appetite and blood sugar. Medications like Ozempic are synthetic GLP-1 receptor agonists that mimic and amplify these effects, often leading to reduced cravings (including for sweets) and substantial weight loss in people with obesity. Sounds promising, right? But as Dr. Bikman digs deeper, the downsides emerge.
Why Dr. Bikman Doesn't Recommend Ozempic: The Hidden Costs of the "Quick Fix"
While Ozempic can deliver impressive results, Dr. Bikman is blunt about its risks, emphasizing that it's not a sustainable path for most people. Drawing from clinical trials like the STEP 5 study (published in the New England Journal of Medicine), he highlights how the drug's weight loss comes at a steep price. At around 01:29:10 in the interview, he notes: "For every 6 pounds of fat lost, 4 pounds of lean mass were lost." That means up to 40% of the weight shed is from muscle and bone—not just fat. This "fat-free mass" loss is permanent for many, especially those over 60, as muscle and bone don't rebound easily after discontinuation.
Here are some more risks that may be a concern.
Rapid weight loss reducing mechanical stress and nutrients on bones: This is well-supported. Rapid, significant weight loss (common with GLP-1 agonists like Ozempic) can lead to bone mineral density (BMD) loss, increased bone resorption markers (e.g., CTX), and potential long-term risks like osteoporosis or fractures. This occurs partly because less body weight means reduced mechanical loading on bones (less "stress" to stimulate maintenance), combined with lower calorie/nutrient intake and possible muscle loss. Studies confirm this pattern in calorie restriction, bariatric surgery, and GLP-1 use—it's not unique to Ozempic but amplified by rapid loss.
Discontinuation rates tell a grim story: By two years, 69% of users in the UK stop taking it, often regaining fat quickly while the lost muscle stays gone. Dr. Bikman argues that relying on Ozempic outsources self-discipline to a drug, rather than building habits like carb control. In his view, it might have a short-term role for severe cases to "reset" behaviors, but for long-term weight loss in otherwise healthy people?
It's a no-go. As he puts it, the drug can make users "skinny but sickly," prioritizing aesthetics over true metabolic health.
Watch the interview
