Obesity is a significant health concern associated with various comorbidities, including type 2 diabetes, dyslipidemia, hypertension, and sleep apnea syndrome. While lifestyle modifications are often recommended, they may not always lead to satisfactory weight reduction. Bariatric surgery, such as laparoscopic sleeve gastrectomy (LSG), has emerged as an effective weight loss therapy. However, some individuals may experience weight recurrence or suboptimal results after surgery. In such cases, medications like semaglutide, a glucagon-like peptide-1 (GLP-1) analogue, may be considered. Semaglutide, sometimes combined with cyanocobalamin (vitamin B12), has garnered attention for its potential role in weight management and improving metabolic health.
Understanding Semaglutide
Semaglutide is a synthetic GLP-1 receptor agonist that mimics the action of the natural incretin hormone, GLP-1. It was initially developed for managing type 2 diabetes. GLP-1 plays a crucial role in regulating blood sugar levels by:
- Stimulating insulin secretion from pancreatic β-cells in a glucose-dependent manner.
- Decreasing glucagon production.
- Slowing down gastric emptying.
The striking weight loss observed with GLP-1 receptor agonists like semaglutide has led to their use for weight management in obese and overweight individuals. Semaglutide has been approved for doses up to 2.4 mg. Semaglutide is the active ingredient in medications like Ozempic and Rybelsus, prescribed for type 2 diabetes and obesity.
Cyanocobalamin (Vitamin B12): An Essential Nutrient
Cyanocobalamin is a synthetic form of vitamin B12, a water-soluble vitamin essential for numerous bodily functions. It plays a vital role in:
- Red blood cell production.
- DNA synthesis.
- Nerve function.
Vitamin B12 deficiency can lead to symptoms such as fatigue, weakness, numbness, and mood disturbances.
Read also: Transformations with Ozempic
Potential Benefits of Combining Semaglutide and Cyanocobalamin
While there's limited scientific evidence directly linking semaglutide use to vitamin B12 deficiency or recommending routine B12 supplementation for people taking semaglutide, some healthcare professionals may consider the combination due to theoretical benefits. Compounded semaglutide with vitamin B12 is available but hasn't been approved by the FDA.
When combined, semaglutide and cyanocobalamin may complement each other in specific therapeutic settings, particularly for individuals managing type 2 diabetes, obesity, or general metabolic health.
Enhanced Weight Loss and Appetite Control
Semaglutide's appetite-suppressing effects can help reduce caloric intake. Vitamin B12 may combat fatigue or low energy, which often accompanies weight loss or caloric restriction. This synergy may support more sustainable weight loss efforts. A retrospective study included individuals who participated in a weight management programme at a commercial wellness studio receiving once-weekly compounded semaglutide/cyanocobalamin injections from June 2023 to January 2024. Injections started at 0.25 mg/0.125 mg and titrated to a maximum dose of 2.4 mg/0.24 mg. A total of 94 individuals were analysed (81F/13M), age in years mean (SD) = 46.57 (10.60). After 3 months, average weight loss was 4.11 (2.77) kg or 4.57% (2.96%). Individuals lost fat mass (2.67 (2.37) kg) and trunk fat mass (1.10 (1.36) kg), while also losing small amounts of lean mass (1.43 (1.41) kg) and skeletal muscle mass (0.88 (0.81) kg). This study demonstrates that meaningful weight loss is achievable on semaglutide/cyanocobalamin outside of a closely controlled environment.
Prevention of B12 Deficiency
Semaglutide slows down gastric emptying, potentially affecting the absorption of nutrients, including B12. Supplementing with cyanocobalamin may ensure adequate B12 levels, especially if experiencing reduced appetite or poor dietary intake. All GLP-1 receptor agonist drugs, like semaglutide, slow down gastric emptying and reduce stomach acid production. This means they could affect the absorption of vitamin B12, which can potentially lead to vitamin B12 deficiency or worsen it in someone who already has it. Vitamin B12 is absorbed in the stomach with the help of stomach acid and intrinsic factor, a protein produced by the stomach.
Improved Energy Levels
Vitamin B12 plays a key role in energy production. As semaglutide can sometimes cause nausea or fatigue during initial treatment, supplementing with cyanocobalamin may help mitigate these symptoms by boosting energy and preventing fatigue.
Read also: Comprehensive guide: Tirzepatide and Semaglutide for weight management
Support for Metabolic Health
Both semaglutide and vitamin B12 support metabolic function. B12 isn’t typically used as a primary weight loss treatment, but it’s important for overall health and may support the body’s metabolism and energy production, which could potentially complement the weight loss effects of semaglutide.
Semaglutide After Laparoscopic Sleeve Gastrectomy (LSG)
Semaglutide has also been investigated for its potential benefits after LSG, a bariatric surgery that involves removing a portion of the stomach. A study aimed to investigate the effect of treatment with once-weekly semaglutide after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes (T2D). This study was a single-center retrospective database analysis. They enrolled 29 Japanese patients with T2D who underwent LSG, and more than 12 months later received semaglutide. BMI and HbA1c decreased significantly by 10.7 kg/m2 and 1.1 %, respectively, 12 months after LSG, and decreased by an additional 1.6 kg/m2 and 0.6 % after 12-months of treatment with semaglutide. Decreases in serum albumin, vitamin B12 and zinc were observed only after semaglutide administration. A ratio of energy from protein, fat and carbohydrates changed from 13:31:56 before to 19:30:50 after LSG, and from 17:32:51 before to 15:29:56 after semaglutide. Skeletal muscle ratio, which is the ratio of skeletal muscle mass to body weight, increased after LSG, but did not change after semaglutide.
The study concluded that semaglutide after LSG in patients with obesity and T2D resulted in additional weight reduction and improved glycemic control, but worsened measured nutritional metrics. Administration of a low-energy, high protein formula diet may ameliorate adverse nutritional effects of semaglutide in patients with T2D after LSG.
Dosing and Administration
A semaglutide and B12 compounded injection is typically administered as semaglutide without B12 vitamin. It is a subcutaneous shot, meaning it’s injected under the skin. Here’s what you can generally expect from semaglutide treatment:
- Injection site: The injection is usually given in the abdomen, thigh, or upper arm. A healthcare professional will show you how to properly administer the injection or will do it for you.
- Frequency: Semaglutide with B12 is usually injected once a week. You typically start with a 0.25 mg dose of semaglutide and B12, and your doctor may adjust the dose to 0.5 mg based on your needs.
- Dosage: Administered once a week, the dosage of Semaglutide is carefully increased over time to minimize side effects and maximize effectiveness.
Potential Side Effects
Semaglutide may lead to gastrointestinal problems, such as nausea, diarrhea, or constipation. These side effects are usually mild and tend to improve over time. In addition, some people may experience increased hunger if they miss a dose of semaglutide.
Read also: Semaglutide Without Diet Changes
FDA Concerns Regarding Compounded Semaglutide
The FDA has expressed concerns regarding compounded versions of GLP-1 drugs, including semaglutide. Compounded drugs are not FDA-approved, meaning they are not reviewed for safety, effectiveness, or quality before being marketed.
Areas of Concern
- Improper storage during shipping: Injectable GLP-1 drugs require refrigeration. The FDA has received complaints that certain compounded GLP-1 drugs have arrived warm or with inadequate ice packs.
- Use of incorrect salt forms: Some compounders may use salt forms of semaglutide, such as semaglutide sodium and semaglutide acetate. These are different active ingredients than those used in FDA-approved drugs, and their safety and effectiveness are unknown.
- Counterfeit drugs: The FDA has identified counterfeit drugs claiming to be authentic but potentially containing the wrong ingredients, incorrect amounts of active ingredients, or harmful substances.
- Illegal online sales: The FDA monitors the internet for fraudulent or unapproved drugs and has issued warning letters to stop the distribution of illegally marketed semaglutide and tirzepatide.
Recommendations for Consumers
The FDA encourages patients to be vigilant and know the source of their medicine. Carefully check labels of compounded GLP-1 drugs for warning signs such as spelling errors or incorrect addresses and ensure your medicine is provided by a licensed pharmacy and prescribed by a licensed health care provider.
STEP UP Trial: Investigating Higher Doses of Semaglutide
The STEP UP trial was a phase 3b randomized controlled trial that investigated the safety and efficacy of a higher dose of semaglutide (7.2 mg) compared to a lower dose (2.4 mg) and placebo in individuals with obesity but without diabetes.
Key Findings
- The 7.2 mg semaglutide group had a greater mean weight loss than the 2.4 mg group (-18.7% vs -15.6%).
- The semaglutide 7.2 mg group was more likely to reduce 5% of their body weight or more compared to placebo.
- Digestive tract symptoms were more common at the higher dose.
The Role of Lifestyle Modifications
For optimal results, combining Semaglutide treatment with lifestyle modifications is recommended. Semaglutide, or any other weight loss medication, is a tool to assist in weight loss while the patient makes other lifestyle changes.
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