You may have heard whispers in the running and triathlon community about athletes taking Ozempic to control their weight. As the whispers grow louder and the use of such prescriptions more widespread, it’s important to ask questions about potential health and performance risks.
We reached out to sports dietician Meghann Featherstun and integrative nutritionist Kristen Blake to get their expert takes on why endurance athletes take Ozempic, what the unintended consequences could be, and how someone who has a legitimate medical need can approach their training and racing.
Decoding Body Composition Changes
While it’s increasingly being used by endurance athletes to keep their body weight low and their power-to-weight ratio high, Ozempic was not initially intended for this purpose. It was originally cleared by the FDA to do two other things: treat type 2 diabetes and manage obesity. If an endurance athlete is looking to change their body composition by taking Ozempic, what they hope to achieve might not jive with what the drug has to offer.
“One of the biggest misconceptions, when someone takes a drug like Ozempic, is that they’ll just lose body fat,” Blake said. “They don’t know that they’ll also be losing muscle mass. Many endurance athletes already struggle to keep enough lean mass on because of their high training volume, and further reducing it with Ozempic is likely to compromise performance and overall health.”
Featherstun has written extensively about the challenges athletes face when trying to lose weight while simultaneously maintaining their well-being and performance.
“Research has shown that women who cut more than 300 calories per day can experience menstrual disturbances, amenorrhea, lower metabolism, higher cortisol, and lower hormone levels,” she wrote in a recent blog post on her website. “Men who cut out more than 400 calories per day are more likely to have lower testosterone, lower metabolism, and greater muscle breakdown.”
The other source that Featherstun cited in her article came from the Scandinavian Journal of Medicine and Science in Sports. The study, whose lead author was IL Fahrenholtz from the University of Copenhagen’s Department of Nutrition, concluded that when they didn’t eat enough to match their energy expenditure needs, “athletes spent more time in a catabolic state compared to eumenorrheic athletes. Within-day energy deficiency was associated with clinical markers of metabolic disturbances.”
According to integrative nutritionist Kristen Blake, this directly leads to one of the main pitfalls of athletes taking Ozempic, Metformin or similar drugs: underfueling. Appetite suppressing is a key mechanism for pharmaceuticals designed to treat diabetes and treatment-resistant weight loss. The idea is that if you’re not as hungry, you will eat less overall and consume lower amounts of sugar, which helps to regulate both body weight and blood glucose levels.
“If you take Ozempic, your impulse to eat meals and snacks will probably be greatly diminished,” Blake said. “Even after you exercise, which is a time when your body is going to tell you that you need to refuel and replenish through food, you might not feel a drive to eat. As a result, you may end up struggling with slower and incomplete recovery, more severe and longer-lasting muscle soreness, and other performance issues that make it less likely that you’ll achieve your goals.”
Fueling Insufficiently
During our interview, Featherstun noted that such issues aren’t merely confined to after you’re done exercising. “If someone is taking Ozempic, they’re less likely to fuel adequately before and during their runs, swims, or rides,” she said. “This will have a detrimental effect on their power, make it more likely that they will struggle to finish training sessions and possibly prevent them from reaching or maintaining race paces in faster workouts. They will also lack the fuel needed to strength train effectively.”
Another unintended consequence of taking Ozempic is one of the most dreaded issues for endurance athletes: stomach troubles. “If you use Ozempic, you might experience gas, bloating, diarrhea, and other forms of GI distress,” Blake said. Featherstun added that because Ozempic delays gastric emptying, your usual routine for timing bathroom breaks can be thrown off, which can be disastrous if you’re trying to qualify for an event like the Boston Marathon or hit a time-related goal.
The study on male athletes that Featherstun referenced was published in the International Journal of Sport Nutrition and Exercise Metabolism. The authors concluded that “endurance athletes are at increased risk of relative energy deficiency associated with metabolic perturbation and impaired health.” This suggests that you probably shouldn’t take Ozempic unless a doctor, dietician, nutritionist, or all of the above gives you the go-ahead to take it to manage diabetes or obesity.
You can’t always have volume, intensity, and collision/contact (in the case of running, the number of times your feet hit the street or the trail) dialed up to 10 out of 10 simultaneously. Likewise, it’s hard to reach your training and performance goals while also rapidly losing weight. So before you get a prescription for Ozempic or an equivalent, sit down with your coach and carefully consider whether you need to be taking it, and if so, how it might compromise your training and racing goals.
Racing While Taking Ozempic and Considering Alternatives
Not every athlete who is interested in using Ozempic or similar pharmaceuticals is doing so to try and keep their weight down, change their body composition or get an advantage over their competitors. Some athletes might legitimately benefit from taking it. But pursuing a course of treatment may need to come before they chase lofty performance goals, with overall health taking top priority.
“If an athlete is medically cleared to take Ozempic for diabetes or weight management, they’d do well to cut back on their training volume and not race for a while,” Featherstun said. “Then, once they’ve dealt with their condition, they can talk with their coach, dietician, and doctor about next steps.”
Blake believes there are some alternatives to Ozempic and other drugs in its class for any athlete whose doctor doesn’t insist on taking it. Some of them start with nutrients obtained from food and responsible supplementation.
“Berberine has long been studied and used for blood sugar regulation and has even been proven equally effective to the popular blood sugar and weight management drug Metformin,” she wrote in an article on her website. “In a 2008 clinical trial published in the journal Metabolism, type 2 diabetics were divided randomly into two groups and given either Metformin or Berberine (500 mg 3x/day) for three months. Results revealed Berberine was able to control blood sugar and cholesterol levels as effectively as Metformin, showing decreases in HbA1c, fasting blood glucose, postprandial blood glucose, plasma triglycerides, LDL, and total cholesterol.”
She went on to explain how fiber can help you modulate your appetite and how your body regulates glucose. If your goal is weight loss, eating more satiety-promoting protein and fat within a balanced diet that gives you enough ready energy from carbs is also a solid strategy.
“Omega-3s have been long studied for their effect on lowering fasting blood glucose and lowering inflammation as well, and they appear to be incredibly effective at both,” Blake added. “A large-scale meta-analysis (this is when researchers look at a large body of studies on a topic to help come to a consensus on that topic) found that omega-3 has protective effects on diabetes parameters such as insulin, HbA1c, and glucose. Remember, these are all biomarkers Ozempic also aims to improve.”
If you or your coach are unsure about anything you’ve read here or elsewhere, consider reaching out to a qualified professional like Blake or Featherstun and consulting with your physician.
References:
Blake, K. (2023, July 2). Ozempic Alternatives. Retrieved from https://www.kristenblakewellness.com/blog/ozempic-alternatives
Connoly, F. (2017, September 5). Game Changer: The Art of Sports Science. Retrieved from https://www.amazon.com/Game-Changer-Fergus-Connolly/dp/1628601183
Fahrenholtz, I., et al. (2018, March). Within-day energy deficiency and reproductive function in female endurance athletes. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29205517/
Featherstunn, Meghann. (2023, May 10). Weight Loss & Running. Retrieved from https://www.featherstonenutrition.com/weight-loss-running/
Klungland Torstveit, M., et al. (2018, July 1). Within-Day Energy Deficiency and Metabolic Perturbation in Male Endurance Athletes. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29405793/
