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By Dr. Mélanie DesChâtelets, ND · Naturopathic Doctor and Menopause Society Certified Practitioner · Burnaby and virtual care across BC

Most scary headlines about GLP-1 side effects use the same trick as a “50% off” sale sign: a number that sounds huge until you know what it’s 50% off of. If you’re weighing semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound), the real question isn’t “is this dangerous?” It’s which risks are genuine dealbreakers, which ones you watch for once you’re on it, and which ones are small and adjustable.

That’s what an informed consent conversation is for. And informed consent isn’t just the data. It includes your values, your preferences, and how you feel about a risk, because risk is a very personal choice.

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Why do GLP-1 risk headlines sound so scary?

Because most of them report relative risk, and a relative number on its own tells you nothing. Here’s the analogy I want you to carry into this decision, and honestly into a lot of other ones. I give you two 50% off coupons. One is for a single item at the dollar store. The other is 50% off the house of your dreams. Both are accurately 50% off. One barely touches your monthly budget, and the other shapes your financial future. That’s the difference between a relative number and an absolute one.

So when a headline says a GLP-1 “doubles” your risk of something, what you actually want to know is how many people on the drug get it, and how many people off the drug get it. What’s the real difference, and how do you feel about it? That last part is a personal call, not a right or wrong one. Health headlines love relative risk because it sounds dramatic and gets the clicks. That’s the whole trick.

What are GLP-1s actually good for?

They genuinely work. I prescribe them myself, and the evidence is solid for blood sugar, real weight loss, and other metabolic markers for most people while they’re on the medication. Where it’s thinner is research in PMOS (formerly PCOS) specifically. These drugs have changed fast, so a lot of the PMOS studies are on older GLP-1s that are rarely prescribed now. I’m looking forward to newer data on cycle length, ovulation, insulin resistance, and testosterone.

Why does this matter if you have PMOS? Metabolic conditions are more common with it, and that lowers the threshold for when doing something about them makes sense.

One thing comes up pretty consistently when I’m talking with people face to face: these medications make food noise a lot quieter. That quiet can be a bridge to building the skills and foundations underneath. I don’t prescribe them without actively working on that foundation too, because I want to set someone up for the long term.

Most people ask me about nausea first. I think that’s the wrong first question. So let’s sort the risks into three buckets instead: is this a fit for you, the red flags once you’re on it, and the small adjustable stuff.

What are the real dealbreakers for GLP-1s?

Bucket one is fit. Two things are automatic no’s: a personal or family history of medullary thyroid cancer or MEN2 (a rare inherited condition with a very high thyroid cancer risk), and pregnancy or breastfeeding, which is a no for now. A third is a real flag: a prior episode of NAION, a specific type of vision loss, in one eye, because the risk goes up in the other eye.

The thyroid warning comes from rat studies. Rat thyroid cells react to these drugs in a way ours don’t, because ours don’t have the same density of the receptors involved. And we do have human data now. A Scandinavian study followed over 145,000 people on GLP-1s for years and compared them with people on a different diabetes medication. The rate of medullary thyroid cancer was the same in both groups, about 7 in a million people per year either way. So why is it still a hard stop with a personal or family history? Not because we’ve seen it happen on the drug. The animal signal was strong enough that we’re not wanting to test high-risk groups.

The vision loss is NAION, a rare type of vision loss from reduced blood flow to the optic nerve. The first study on it was a smaller one out of Boston, which found people on semaglutide developed it 4 to 7 times more often. That’s the number that made the headlines, and it’s a relative number. A much bigger study of over 400,000 people in Denmark found the real increase is closer to double. In absolute numbers, that’s about 1 in 10,000 people a year without the medication and about 2 in 10,000 with it.

Sit with those numbers. It’s a legitimate increase. The final figure could still move as more studies come in, but the 2026 consensus statement from the North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology reads the evidence as closer to that doubling than the first study suggested, and says cause and effect hasn’t been established yet.

Why take it seriously anyway? NAION isn’t necessarily reversible, and that’s life-changing for the person it happens to. So if you’ve had vision loss in one eye, this needs a real conversation. For everyone else, a simple self check-in: are you up to date on your regular eye exams? Getting a good baseline before you start a GLP-1 is a reasonable step. Separately, bringing blood sugar down very quickly carries its own known eye risk, mostly for people who already have diabetic eye changes, so with metabolic control on these medications, faster isn’t better.

All three of these are rare in absolute terms. That doesn’t shrink the impact on the person who becomes that rare number, which is exactly why they belong in your risk-benefit thinking.

Which GLP-1 side effects need quick action?

Bucket two is the red flags once you’re on it, and the big one is pancreatitis. Persistent, severe abdominal pain, sometimes radiating to your back, with or without vomiting, means call your team and get checked out. Most cases resolve once you stop the medication, but in the moment it can be urgent. It’s not a wait-and-see.

This bucket also holds a warning that’s being walked back, even though it may still be on your label. The Canadian Wegovy label still excludes people with a history of suicide attempts or active suicidal thoughts, and calls for monitoring any new or worsening depression. Honestly, watching for new or worsening depression is good advice during any big change in your life. But the FDA in January 2024 and the EMA in April 2024 each independently reviewed the trial data, the cohort data, and the adverse event reports, and both found no proven cause and effect. The FDA has since asked for the warning to be removed from the label entirely. Health Canada’s label hasn’t caught up yet.

There is a signal in raw safety reporting databases. Those reports are self-reported, though, which is much weaker evidence than the formal reviews.

Which GLP-1 side effects are usually adjustable?

Bucket three is the stuff you hear about most: nausea and other GI symptoms, and low blood sugar, mainly if you’re also on insulin. These are often quite modifiable with the dose. And because these medications slow how fast your stomach empties, tell your surgical team before any procedure.

If something like nausea still isn’t tolerable after dose adjustments, there’s no rule that says you have to continue. There are other options on the table. What to watch for and when to reach out is a conversation with your own provider. If you’ve already made the decision and want the practical version, I’ve laid out what to watch for and what to do when starting a GLP-1 over on PCOS Health Collective.

What about muscle loss on GLP-1s?

It’s the one that doesn’t fit a bucket cleanly, and it gets missed. It isn’t urgent and it isn’t something we adjust the dose for. But with any significant weight loss, some muscle can go too, and if the weight comes back, the muscle doesn’t reliably come back with it. That’s part of the harm of weight cycling up and down: lean tissue gradually goes down with it. Early research on GLP-1s found people who focused on resistance training and enough protein had a lot better body composition than people who didn’t. So it can be mitigated, and I look forward to more research here.

So how do you decide if the risk is worth it?

Start with the numbers, not someone else’s story online. Their experience isn’t going to be yours. Ask yourself what your comfort level is with the more significant risks above, and whether the benefit is worth it for you. Sometimes action is what gives you information you can’t get any other way, and the first step into that is a genuine informed consent conversation about GLP-1 side effects with your prescriber.

I don’t see this as medication or lifestyle. The lifestyle piece is the foundation either way. If you’re still sorting out whether weight is even the right target for you right now, start with ethical PCOS weight loss and the honest middle road.

Watch the full video: Ozempic Side Effects: What’s Actually Reversible (And What’s Not), and subscribe to my YouTube channel so the next one finds you. I also made a GLP-1 Informed Consent Worksheet to go with it: the real numbers, questions to bring to your prescriber, and what to actually watch for. It’s exclusive to Shift Society members and lives in the GLP-1 lesson in the classroom.

This article is educational, not medical advice or a diagnosis. If something here resonates, bring it to your healthcare team, who can look at it through the lens of your individual health.

Main references

1. Pasternak B, et al. Glucagon-like peptide 1 receptor agonist use and risk of thyroid cancer: Scandinavian cohort study. BMJ. 2024. PubMed
2. Hathaway JT, et al. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmol. 2024. PubMed
3. Grauslund J, et al. Once-weekly semaglutide doubles the five-year risk of nonarteritic anterior ischemic optic neuropathy in a Danish cohort of 424,152 persons with type 2 diabetes. Int J Retina Vitreous. 2024. PubMed
4. DeParis SW, et al. Glucagon-Like Peptide-1 Receptor Agonists and the Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Consensus Statement by the North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology. Ophthalmology. 2026. PubMed
5. US Food and Drug Administration. FDA Requests Removal of Suicidal Behavior and Ideation Warning from Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) Medications. Drug Safety Communication. FDA

By Dr. Mélanie DesChâtelets, ND · Naturopathic Doctor and Menopause Society Certified Practitioner · Burnaby and virtual care across BC

If you’ve ever searched “how to lose weight with PCOS,” you’ve met two camps. One sells “join my group and lose 10 kilos in 2 months.” The other says we should never talk about weight loss because it’s always diet culture. I’ve sat with this question deeply, because two things are true at once. People with PMOS (formerly PCOS) carry, on average, more mental-health struggles and harder relationships with food and body. And for someone in a larger body where weight loss is genuinely indicated, a modest loss can improve ovulation, lower testosterone, and improve metabolic health. So how do we bridge that? With what I call ethical PCOS weight loss.

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Should you try to lose weight with PCOS?

My honest answer: most PMOS care should run from a weight-neutral lens, and when proper screening shows weight loss is genuinely indicated, it happens with consent and your full autonomy to know every option. I’ll be transparent: I have PCOS myself, and I’ve worked with thousands of women since 2010. What makes me a useful guide isn’t one roadmap, it’s that I’ve seen how differently this shows up person to person. You can’t just follow one guru saying “do what I did.” So I borrow what’s wise from both camps and land on a middle road that’s actually ethical.

Does losing weight actually help PCOS?

Research shows that even a 5 to 10% reduction in body weight can improve insulin resistance, ovulation, and cycle regularity in PCOS. But the science is just as clear that how you lose it matters. Constant dieting, weight cycling, and the stress of being weight-stigmatized can raise cortisol, raise inflammation, and increase the risk of disordered eating. So weight loss isn’t a zero-sum game, and it isn’t all-or-nothing. We can get real metabolic improvements from weight change, but not if the cost is your mental health. I don’t think we explain that side honestly enough.

How do you know if weight loss is right for you?

Before starting any PCOS weight loss plan, I run a four-question consent check:

1. Is weight loss medically indicated right now? We look at labs, metabolic pathways, and quality-of-life markers, not societal norms or body size.
2. Are you emotionally resourced for this? Have you self-screened for a more complicated relationship with food that deserves a provider’s support first? Skipping this and jumping straight to weight loss is like building a home on a shaky foundation.
3. Do you have a consent-based team? You deserve a practitioner who understands metabolic health and is deeply sensitive to the mental-health side.
4. Can we define success beyond the scale? Focus on the inputs and how your body feels: cycles, cravings, energy, lab improvement, not just pounds.

These four questions help you decide if, when, and how to focus on weight safely. There can be a time and place for it, which is exactly why the conversation should start from a weight-neutral place, and someone chooses to step into a consent-based weight-loss conversation.

Are GLP-1s like Ozempic a good option for PCOS?

GLP-1 medications like Ozempic and Mounjaro are a big topic right now, so here’s the honest version. There is research in people with PCOS, and they can help with insulin resistance, fat in the liver, and body size. But they also blunt appetite, and a healthy long-term relationship with food rests on staying connected to your hunger cues. So if you’re on a GLP-1, it really helps to work with someone who supports that connection, so your foundation is more than the medication. We also know weight can regain after stopping, and that weight cycling can be harmful, which is why this needs a thoughtful process: build the foundation first (mental health, mindset, a regulated nervous system), do it at the right time for you, and pair behaviour change, with or without medication, from a place of love.

Where does intuitive eating fit?

This is also exactly why you’ll never see me promise “X pounds in Y weeks,” and you’ll never see a before-and-after photo on any page of mine. You are so much more than that, and those numbers never tell the full picture. I love intuitive eating as a way to rebuild self-trust and reduce food guilt. Where I expand on it for PCOS is this: your metabolic health matters too. Intuitive eating says we chase healing, not weight loss, and I completely agree. In ethical weight loss, we chase healing, and if weight changes as a side effect of metabolic repair, that’s okay. Tools, medication-based or not, are also okay, as long as there’s informed consent, we’re honouring your body autonomy, it’s what you want, we’ve explored the foundation, and it’s the right time.

What does ethical PCOS weight loss look like in practice?

It focuses on metabolic health and quality of life, because when metabolic health is struggling, there are usually day-to-day symptoms of it. We build a nutrition plan that feels nourishing and is tailored to the person. We prioritize what helps regulate hunger cues, like protein and fiber, and self-love actions like movement and quality sleep. We support stress regulation so the whole thing is done from a grounded place. And if we use tools like medication or supplements, we pair them with that same foundation. That’s how you lose weight without losing yourself.

▶ Want the full conversation, including why both camps get something right? Watch the complete video here. I also made you the 4-Question Consent Check Worksheet so you can walk through this for yourself. Grab it at shiftpmos.com/consent-check.

This article is educational, not medical advice or a diagnosis. If something here resonates, bring it to your healthcare team, who can look at it through the lens of your individual health.

Main references

1. Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023. PubMed

By Dr. Mélanie DesChâtelets, ND · Naturopathic Doctor and Menopause Society Certified Practitioner · Burnaby and virtual care across BC

You can have the best nutrition IQ in the world, but if you’re disconnected from your body, I don’t believe it works long term. That’s why I think mindful eating is level one, the foundation of the house. Most people build from the roof down: rules, macros, protein targets, all stacked on top of a body they’ve stopped listening to. And that disconnection makes everything else feel harder, no matter how “healthy” the food is. So let me show you why mindful eating comes first, and how to start reconnecting in a way that finally makes the rest work.

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Why isn’t your healthy eating working?

Often it’s because the foundation got skipped. I’ve had patients laser-focused on hitting a protein goal who realize late in the day they’re behind, so they chug four shakes before bed. On paper, goal met, check the box. But when I ask the mindful questions (how did your digestion feel? how was your energy?), the answer is “off” and “I’m struggling.” That’s the tell. Mindful eating is the foundation because it helps you catch the red flags even when you think you’re checking all the boxes.

Why does digestion need a relaxed state?

Because we were designed to eat in one. Meet your autonomic nervous system: think “automatic,” because it shifts you toward parasympathetic (rest and digest) or sympathetic (stress) on its own. If a bear were chasing you, you’d want your heart rate up and blood flowing to your legs without having to think about it. The catch is that today’s stress is mostly mental and psychological, and many of us live in that go-go state far longer than it was meant to last. In that sympathetic state (think “S is for stress,” to help you remember), the body deprioritizes digestion, because digesting lunch isn’t the priority when you’re surviving. Picture food as a pearl necklace and your body’s job as making scissors to break it down. In the stress state, you make only a few scissors. In the parasympathetic state, you make more saliva, more stomach acid, more enzymes, so you’re breaking down that same necklace with far more scissors. This is just physiology.

How do you check in with your nervous system?

Start by noticing your own stress cues. In the sympathetic state, breaths tend to be short and shallow, shoulders and jaw get tight, heart rate climbs. Learn what your body does when it’s in that mode. And here’s an important nuance: stress can be good. Some of my highest achievers say “I’m not stressed, I love my work,” and they’re right. Stress helps you perform, deliver, and show up. I’m not here to vilify it. It’s just not the right mode for digestion. Being “stressed” here doesn’t mean freaking out, it can simply mean you’re in the get-it-done state, and you need a moment to downshift before you eat.

How do you shift into “rest and digest” before a meal?

Here’s the cool part: the nervous system runs automatically, but you also have a say. Because it’s so tied to your breathing, you can actively raise the tone of your parasympathetic, rest-and-digest response. So bring back the pre-meal ritual. A few minutes of slow, deep breathing before you eat can genuinely shift your state and set the stage. Breathing isn’t the only way to do this, but it’s one of the most accessible places to start.

What does it actually mean to eat mindfully?

It means being right here, in the now, with your food. I think it’s one of the biggest acts of self-love we have, and we get to do it several times a day. So notice the environment: the lights, the pace, the presence. Eating in front of the TV or scrolling your phone is a bit like ghosting your own body. I’m not here to vilify those things, they have a real place in joy and downtime, but studies show again and again that when we’re distracted, we eat significantly more, because we can’t hear our cues. So try eating without the big distractions sometimes. Music, a candle, slowing down, whatever turns eating into presence instead of just function. You’re dating yourself here. What does that look like?

How do you slow down and read fullness?

Fullness takes time to register, so if you eat fast, you blow right past it. If quick, rushed eating sounds like you, try timing a meal, then actively stretching it by five minutes. Chew slowly, pause between bites, put the fork down. Pick whatever works. Then get curious instead of controlling: what does 80% full actually feel like? What does over-full feel like? If you’re not sure yet, that’s fine, the curiosity itself is the first step. Mindful eating is about being present with your body in the moment, not policing it.

Does mindful eating replace nutrition knowledge?

No. It grounds it. Evidence-based nutrition still matters, it’s just layered in on top of connection, not forced on top of disconnection. I’ve worked with people who felt great on a very high-fat way of eating and had genuinely tuned into their bodies (a real win), but the structure still mattered: it turned out to be far more energy-dense than their body needed. And with insulin resistance, the signals can get noisy, more cravings, a bit disconnected from what you actually need. That’s exactly when we add gentle structure on the foundation: how are the fruits and vegetables, the fiber, the minimum protein? Those things sharpen cravings, satiety, and metabolic health, so the signals get clearer again. Nutrition IQ supports the connection. It doesn’t replace it.

▶ Want the full walk-through, including the breathing homework for your next meal? Watch the complete video here. As a member bonus I made 30 mindful-eating affirmations to reinforce this kind of thinking. Grab them by joining Shift Society and heading to the classroom.

This article is educational, not medical advice or a diagnosis. If something here resonates, bring it to your healthcare team, who can look at it through the lens of your individual health.

Main references

1. Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023. PubMed