Ozempic & GLP-1 Side Effects: Psychiatric Insights on Mood, Metabolism & Sustainable Weight Loss | ANEW Ep 129

In this powerful first half of a two-part conversation, Dr. Supatra Tovar sits down with quadruple board-certified psychiatrist and founder of Wellness Psychiatry, Dr. Vikas “Vic” Gupta, to explore one of today’s most urgent and misunderstood topics: how GLP-1 medications intersect with mental health, metabolism, nourishment, and whole-person wellness.

Dr. Gupta’s clinical work spans psychiatry, obesity medicine, lifestyle medicine, and metabolic health. Having served on the faculty at Harvard Medical School and Massachusetts General Hospital, and currently holding leadership roles within the American Psychiatric Association and AACAP, he is one of the nation’s leading voices on the future of integrative psychiatric care.

This episode begins with the foundation of his model: the inseparable connection between mind, metabolism, and meaning. Dr. Gupta explains that many individuals labeled “treatment-resistant” aren’t resistant at all — they’re experiencing disrupted sleep, erratic nourishment, ultra-processed diets, glucose instability, or chronic inflammation, all of which mimic or intensify psychiatric symptoms.

Dr. Tovar and Dr. Gupta take a deep dive into how GLP-1 medications reshape appetite, hormones, mood, and motivation — and why nutrient quality matters more than calorie quantity. They break down:

• What balanced nourishment looks like on GLP-1s
 • Why protein-only messaging is misleading and potentially harmful
 • How fiber, complex carbohydrates, and healthy fats stabilize mood and protect metabolic health
 • Why hunger cues disappear on GLP-1s — and why scheduled meals often become essential
 • How whole-food, plant-forward eating supports natural GLP-1 production

The conversation also turns to alcohol, delayed gastric emptying, nausea, and why even one drink can hit harder on these medications. Dr. Gupta outlines clear, practical risk-reduction strategies and explains why cravings for alcohol may drop due to GLP-1 receptor activity in the brain.

Side effects take center stage as Dr. Tovar asks about the real-world symptoms patients report online: hair loss, constipation, black stools, vision changes, and emotional flattening. Dr. Gupta offers evidence-based guidance on titration, dosing, nausea management, texture-modified diets, magnesium, fiber, hydration, and when to hit pause or decrease dosage to protect both physical and psychological wellbeing.

Together, they illuminate the psychiatric red flags often missed in purely medical weight-loss settings — including emotional blunting, rapid body-image shifts, resurfacing trauma, compulsive tracking, and substitution behaviors like increased alcohol use.

This episode is essential listening for anyone using GLP-1 medications, thinking about them, or supporting someone who is. It blends psychiatry, nutrition, lifestyle medicine, and compassionate mental-health care into one of the clearest, most practical conversations available anywhere.

About Dr. Vikas Gupta, want to know more about him here are his social medi

Thank you for joining us on this journey to wellness. Remember, the insights and advice shared on the ANEW Body Insight Podcast are for educational and informational purposes only and do not constitute medical advice. Always consult with a healthcare professional before making any changes to your health routine. To learn more about the podcast and stay updated on new episodes, visit ANEW Body Insight Podcast at anew-insight.com. To watch this episode on YouTube, visit @my.anew.insight. Follow us on social media at @my.anew.insight on Facebook, Instagram, TikTok, and Threads for more updates and insights. Thank you for tuning in! Stay connected with us for more empowering stories and expert guidance. Until next time, stay well and keep evolving with ANEW Body Insight!

Transcript

Supatra solo part ONE: 0:00

Hello and welcome. I am so thrilled and very honored to have quadruple board certified psychiatrist and the founder of Wellness Psychiatry, Dr. Vikas Gupta with us today. Oh my gosh, Dr. Vikas, it's such a pleasure to have you on my podcast. His practice specializes in integrative evidence-based psychiatric care across the lifespan with a focus on holistic wellness, weight management and lifestyle medicine. A nationally recognized leader in psychiatry, Dr. Gupta has served on the faculty of Harvard Medical School and Massachusetts General Hospital, the nation's top ranked psychiatric hospital. Dr. Gupta's clinical focus includes helping high performing professionals manage stress, burnout, and complex medication regimens, while also offering innovative treatments for obesity and mood disorders. Through his Wellness Psychiatry platform, he blends psychiatric expertise with whole person wellness to help patients achieve lasting transformation.

Vic SOLO part ONE: 0:03

So I'm a psychiatrist, uh, trained to think in diagnostic codes, but our patients, uh, live in bodies, families, workplaces, and kitchens. So the practice Wellness Psychiatry was born from realizing that mind metabolism and meaning are inseparable. Uh, during residency training, I had seen patients being labeled treatment resistant depression, yet, uh, you know, other factors were implicated. Um, what, what I foresaw was that we align all these three factors. People don't just lose weight, they regain agency and vitality. And our mission at Wellness Psychiatry is to make care, make sure that we provide, uh, humane evidence-based and doable care. Uh, less about heroic willpower, but more about building smart systems that can fit real lives Um, and I'm seeing a lot of difficulties with, um, you know, disordered eating, eating disorders. Uh, confusion about nutrition, and so that's why I really wanted to pick your brain today was to figure out how we can best help people that are struggling. Either before taking these medications, during, after, how can we be providing them with the best care and the most up to date nutritional education, as well as giving them some psychologic, uh, psychological and psychiatric support So. Such an important question. Um, so the GLP GLP ones do lower appetite, but they obviously don't teach nourishment. Um, my mantra is to eat less by default, not by depletion. And obviously when appetite drops, people often eat too little or the wrong things. Um, I recommend focusing on quality over quantity. Um, also important is the fact that healthy fats are needed to keep the brain and hormones balanced, um, especially for our vegan patients or plant-based patients. Uh, this may look like lentils, uh, ctan beans, tofu, or colorful produce, uh, which we get plenty in California and several other states. We schedule meals because hunger cues can vanish, uh, after the GLP ones.

Supatra solo part ONE: 0:08

Oh, absolutely. And I see out there an over emphasis on protein as the most important macronutrient that you can consume. Now, I understand that because. These medications, especially if you are consuming far fewer calories than normal, uh, you will experience first water and muscle loss, especially, most especially if you are on a high protein, low carbohydrate diet. You may lose some water and you may lose some muscle, uh, in the beginning of the diet, but long-term consumption actually damages, kidney and liver function. Contributes to cardiovascular disease and contributes, uh, to the, um, to insulin resistance. So how can we help people turn away from that thinking, especially when they are, you know, eliminating carbohydrates, especially f fibrous carbohydrates. Uh, you know, carbohydrates need to be there, fats need to be there, healthy fats need to be there. So, uh, I think, uh, a, a more optimum ba ballot, uh, messaging needs to happen. Unfortunately, in medicine, uh, a lot of nutrition edu education is not there and missing. So, um, I would, uh, definitely encourage working with, uh, experts in nutrition and folks who actually, uh, do this my day to day stuff and physicians collaborating with them and educating their patients in what is optimum, what is healthy, what is nutrition and. And, um, you know, I think looking into evidence-based nutrition, uh, studies and work, especially when it comes to overall disease prevention, but also just natural healthy, um, weight loss without dieting is really important, especially when you're on a GLP one. And if you look at his lifestyle heart intervention, you look at the work of Dr. And so that would be my suggestion as a dietician. And I think going to, um, dieticians and nutrition experts that understand the current, um, evidence-based, uh, nutrition is going to be really helpful for you when you are on a GLP one. I think it's also really important. Another person that you had at the conference was Dr. When we work in concert with a more of a whole food plant-based diet and we're really conscious of our circadian rhythm, that actually helps naturally produce GLP one and all of the other appetite suppressing hormones. So I encourage people to go and look into the. The, the work of these people, um, and, and really find out how we can naturally do this because I don't think it's hardly anybody's goal to be on these medications for life as they are, you know, touted to have to be.

Vic SOLO part ONE: 0:14

Absolutely. So with GLP ones and alcohol, your two systems are in collision. Uh. One, the GLP ones, uh, which are slowing the digestion and blunting the reward pathways while alcohol, which is both a gut irritant and a dopamine shortcut. So physiologically, um, there is slowed gastric ti emptying that is happening, which means alcohol will hit faster and stronger if someone is consuming alcohol on GLP ones. That substitution risk is real. So I usually advise a few week period, usually three to four weeks, um, alcohol free, uh, while titrating medication, and then reassessing, uh, if reintroducing, um, alcohol. I recommend pairing with food, hydrating and limiting portions, um, and if someone's drinking to take the edge off, um. Um. Folks can feel one more, one drink way more significantly than how they would otherwise feel without the GLP ones with under eating.

Supatra solo part ONE: 0:17

So you mentioned delayed gastric emptying, which is a big, um, effect of the medication. You also mentioned nausea. So I really wanna delve into some of these side effects. Uh, I'm seeing so many people online complaining of hair loss, significant hair loss, nausea. I have seen people have constipation for days.

Vic SOLO part ONE: 0:18

Great question. Uh, so these are all real side effects that we see, uh, with patients. Nausea is probably the most, uh, common side effect and uh, basically it's a signal, right? Uh, the goal is to kind of understand it, respect it, not push through nausea. Um, it does give us some framework also to work with in terms of dosing, timing, texture, and tempo. Um, I've seen a lot of folks, uh, a lot of patients who are eating fried foods, um, complain a lot more about nausea. So, um, those greasy foods, uh, definitely tend to trigger more of this. The other piece is, um, the tempo of eating, like eating slowly and sipping through it steadily and moving gently after meals. Um, I've also clinically seen that, uh, the nausea is way more significant after each specific dose for a day or so. Uh, so ensuring that, uh. The day that they are going to take the medication, uh, the day off and the subsequent one or two days. Uh, the meal consumption is, uh, somewhat, uh, limited because what can happen with the GLP ones is that when it comes time for the next weekly dose, your appetite can be triggered a little bit and you may actually end up eating a lot more than what you would, um, during, uh, uh, the early phase of the GLP, after the GLP ones have been. Um, injected. So, um, the day off and the subsequent couple of days are critical, uh, to not eat too heavily. Uh, the other piece is constipation, sometimes can also masquerades nausea. So fiber and magnesiums, uh, magnesium intake early on are helpful. Uh, sometimes short courses of ginger, um, or anti-acid medications or anti-emetics can help if the nausea persists.

Supatra solo part ONE: 0:21

Wow. You know, it's so interesting. I, I personally love your advice and I don't see that as often as I should see that, uh, you know, there with my clients who come in after listening to their doctor or psychiatrist or what I see online. And what is so interesting about your advice, uh, Vic, is that that really is wonderful advice for anyone, even if they're not on the medication. When we follow our circadian rhythm by, you know, trying to wake more when the sun is coming up. Trying to eat more earlier in the day, and focusing on fiber rich meals, most especially in the morning, and then tapering down our food towards the evening, but really focusing on these whole foods throughout the day. Trying to get adequate sleep, making sure we're walking and moving throughout the day. All of those things help increase our GLP one, GIP and PYY production. And I love, love, love, and we never hear this eating mindfully. When we actually slow down, there's a process in our digestion. Our digestion actually starts with looking at food and our salivation when we are looking at food, when we really slow down. And all of that also goes into hormonal balance. So. We need more psychiatrists like you, Dr. Gupta. We need people who are trained in lifestyle medicine. That's why I thought that that psychiatric conference, which the focus was on lifestyle medicine, was so good because doctors, you know, they just don't get this nutritional advice or, or education in their, um, programs most often.

Vic SOLO part ONE: 0:24

Great question. Uh, so I see that there are three domains, really, uh, mood, motivation, and self-image. And, uh, GLP can, GLP ones can impact these three in all nuanced ways. Uh, with mood. We've seen that some patients feel brighter as the inflammatory processes and their sleep improves. Uh, but also we've seen that under fueling or low hydration or caffeine or alcohol changes can trigger anxiety or irritability in terms of their mood. Um, as regards to body image stuff, um, rapid physical changes can outpace the psychological adaptation. Patients sometimes struggle to recognize themselves or feel pressure to maintain their results. Um, in terms of, um, red flags to watch out for when someone is on GLP one, um, I think there is one concern for emerging disordered eating, which includes like feeling guilty about food, compulsive trap tracking of food and diet and meal skipping. The other important, uh, red flag to watch out for is, um, flattening, uh, or affective flattening or irritability or overall depression after dose increases. Um, there could also be substitution behaviors where we, you know, folks use alcohol or stimulants instead of few food. And, uh, there is also, um, on occasion, uh, there is issues with, uh, folks, uh, reporting old trauma kind of resurfacing once food is no longer helping regulate emotions. Therefore, um, I would say with while on GLP ones, uh, a good psychiatric screening at baseline and during, um, those increases is critical. We are also, we are not just treating weight, we are also tending to identify, you know, issues with motivation, emotional safety, and mood. Um, also remember, um, and I tell my patients. Um, you know, weight is just a number, but the wellbeing is the most significant and critical fact. And, uh, my job really is to help my patients or author a healthier, uh, you know, narrative for themselves and their efforts. for them to eat very, very difficult for them to even think about consuming maybe even 800 calories, which is not going to be good for anyone. So if you are experiencing that, you probably should go to your doctor and maybe perhaps lower that dose so that your weight loss is more gradual. It is more healthy, it is more sustainable.