Semaglutide, commonly known under the brand names Ozempic and Wegovy, has taken the weight loss world by storm. And, since it helps with weight loss, it is good for type 2 diabetes, as weight loss is the primary way to reverse the symptoms of type 2 diabetes. Semaglutide does reduce appetite because you feel fuller longer. However, it is not a miracle cure, and it comes with side effects. I have written previously about Ozempic face, weight loss plateaus, regaining weight after you stop Ozempic, ineffectiveness for some people, as well as natural alternatives and fiber-rich foods that naturally work like semaglutide, just to a lesser degree. But now a new side effect is emerging—SIBO (small intestinal bacterial overgrowth). So, let’s take a closer look at this.
Understanding SIBO and Its Connection to Semaglutide
SIBO occurs when excessive bacteria grow in the small intestine, leading to symptoms like bloating, diarrhea, abdominal pain, and food intolerances. A lack of gut motility may be part of the cause of SIBO, along with a low production of hydrochloric acid in the stomach. In the end, the natural defenses of the small intestine are compromised, and SIBO results.
The Published Case Report of SIBO and Semaglutide
A case report published in Canadian Journal of Physiology and Pharmacology describes a 35-year-old male who managed to lose 50 pounds ( 22.7 kg) over 120 days on oral semaglutide. Though he had previous lactose intolerance, it got worse while taking semaglutide. And he also developed a new gluten intolerance. Then about six months after discontinuing semaglutide, he was diagnosed with SIBO, suggesting the drug may have contributed to or made this condition worse. The fact that the food intolerances didn’t just go away when he stopped taking semaglutide is especially concerning. Apparently, there was a change both in the GI tract motility and the bacteria that liked those conditions that persisted after the drug was stopped.
How Semaglutide Might Contribute to SIBO
Semaglutide’s main effect is slowing down the emptying of the stomach and slowing down intestinal transit. That effect makes you feel full longer for sue, but it also creates the perfect environment for bacteria to proliferate in the small intestine. Bacteria die-off in the stomach isn’t perfect, and the bacteria load can be substantial. So, even if 1 in 10,000 bacteria get through, but they get to hang out in the small intestine and adapt resistance to bile salts, then they can colonize the small intestine and live off the sugars and short chain carbohydrates that come their way.
This case report is just from one guy, but anecdotal reports from other clinicians suggest this is far from the only case. If you already have type 2 diabetes, and have any kind of food intolerances, this new side effect should give you pause. Do you really want to deal with SIBO?
Semaglutide’s Side Effect List is Getting Longer
In our previous articles about weight loss and semaglutide, we’ve covered several side effects associated with semaglutide. “Ozempic Face: How to Lose Weight Without Looking Older” discussed the gaunt, aged appearance some users experience due to rapid fat and muscle loss when taking semaglutide. “How to Overcome a Weight Loss Plateau” explored why progress stalls for some. In the article “Struggling with Ozempic Not Working? Here’s How to Fix It” I talked about how Ozempic doesn’t work for everybody, and the common myths that people believe about weight loss drugs. I didn’t talk about the rare side effects like increased risk of pancreatitis.
SIBO adds a whole new kind of side effect to the list. Unlike cosmetic concerns about Ozempic face, or plateauing weight loss, SIBO really impacts your quality of life. It is probably worse than the diabetes itself. You must at least temporarily use a low FODMAP diet to manage the bloating and diarrhea. It is a very restrictive diet and doesn’t really help you get better either.
For some people, the trade-off of easy weight loss with Ozempic for a chronic case of SIBO. I know a few people who have struggled with SIBO for years and still have not overcome it. I think dealing with type 2 diabetes is much easier than overcoming SIBO. Trying to change entrenched bacteria in the intestinal tract is a difficult proposition.
We have several articles about ideas for sustainable weight loss. You can see an overview of them in the article, “The Complete Guide to Healthy Weight Loss: What Works and Why.” After all, even with weigh loss drugs, to be successful long-term you have to learn to eat healthy foods, and get exercise to maintain weight loss.
Conclusion: Is Semaglutide Worth the Risks?
Semaglutide is a powerful drug for helping people lose weight. But it has drawbacks. If you end up with SIBO, you might have wished that you had never taken the drug to start with. It isn’t known yet how prevalent the incidence of SIBO is with semaglutide use. But if you already have food intolerances, you probably have a higher chance of SIBO with the drug.
As mentioned above, you should check out our guide on sustainable weight loss tips. There are alternatives to going on a crash course with Ozempic.
