Ozempic, one of the most popular brand names for semaglutide, is making headlines for its remarkable weight loss effects and a slew of unexpected side effects. You might have already heard of "Ozempic butt," "Ozempic breasts," and "Ozempic lips." Well, now we have "Ozempic tongue."

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Ozempic tongue’s changing tastes

Systematic reviews have shown obesity affects taste perception and the brain's reward response to specific tastes, increasing cravings for sweet and fatty foods and reducing taste sensitivity due to high leptin levels. [1]

“GLP-1 receptor agonists are known to reduce cravings for sugary foods and even alcohol,” Jennie Stanford, MD, a family physician and obesity medicine specialist, tells MDLinx. “Recent studies demonstrate that Ozempic may also make foods taste different to people who are taking it, a phenomenon called ‘Ozempic tongue.’ Some people taking Ozempic report that sweet foods taste metallic, sour, or bitter. As this is less palatable, it discourages eating those types of foods, providing an additional avenue for weight loss.” 

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Impacts on taste receptors

Ozempic tongue isn’t necessarily a “bad” side effect. A change in taste or dysgeusia can occur as early as 2 weeks after starting semaglutide therapy and affects up to 6% of patients. [2]

Dr. Stanford explains, “Changes in taste are considered an adverse effect of Ozempic treatment, just as decreased appetite is a side effect as well, and both of them are useful in achieving the desired goals of improved glycemic control and weight loss.”

The mechanism behind Ozempic-induced taste changes remains unclear. Yeily Hernandez Mato, MD, a board-certified physician at Community Health of South Florida, Inc., tells MDLinx, “We don’t know yet what is causing this. There are theories that Ozempic alters the gene on the taste receptors of the tongue, but no theory has yet been backed up by conclusive evidence. More research is required.”

Functional MRI measured brain responses to a sweet solution after a standard meal, and tongue biopsies evaluated mRNA expression. Researchers found that semaglutide enhanced taste sensitivity, altered taste perception gene expression in the tongue, and modified brain reactions to sweet tastes. [3]

The structure of semaglutide is 94% similar to endogenous GLP-1.[4] The 2021 trial protocol for the aforementioned study noted that taste bud cells produce GLP-1, which sends paracrine signals to GLP-1 receptors on gustatory nerve fibres involved in sweet taste perception. [3] This could explain heightened sensitivity to sweet tastes and reduced desire for sugary foods in patients on Ozempic.

These findings build on previously reported experimental studies showing GLP-1 receptor agonists cause aversion to sweetness.[4]

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Other oral side effects 

Board-certified physician and obesity specialist Michael O. McKinney, MD, explains to MDLinx, “Besides taste modifications, other oral effects that can be noticed in patients on Ozempic are xerostomia, altered salivary composition, and in a few cases, oral ulcers or mucosal irritation.”

Dr. Hernandez Mato adds, “Because of the delayed gastric emptying, some patients can develop acid reflux, which will result in an acidic taste in the mouth stemming from more stomach acidity.”

Xerostomia and halitosis

Semaglutide affects GLP-1 receptors in the brain that govern water intake, diuretic, and natriuretic properties, and reduces renal angiotensin II levels. This can lead to diuresis, chronic diarrhoea, and nasopharyngitis, promoting xerostomia.

A 2023 case series reported severe dryness in the mouth and minimal frothy saliva in patients using semaglutide, leading to halitosis or “Ozempic breath.”[5] Furthermore, eructation, another prevalent side effect, can also cause halitosis.[6]

Loss of tongue fat

Obesity causes sarcopenia of the genioglossal muscle with increased tongue fat, contributing to obesity-associated sleep apnea. A pilot study in Diabetes Research and Clinical Practice found that semaglutide can significantly reduce this tongue fat content.[7]

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Counselling your patients with Ozempic tongue

“Changes in taste perceptions should be monitored,” Dr. Stanford warns. “Hypoglycemia can occur if patients don’t eat many carbohydrates, not liking the taste. In addition, if certain foods or food groups are excluded from the diet based on lack of palatability, nutrient deficiencies may occur.” For severe taste disturbance, she recommends using flavoured mouthwashes and toothpaste, chewing sugar-free gum, or eating sugar-free mints.

Patients should be advised to consume foods with varied flavours and textures to "compensate for any changes related to tastes,"

-Dr McKinney

For oral health, as Dr McKinney explains, “improving oral hygiene such as regular brushing and drinking enough fluids [is] the best way to reduce problems related to mouth.” Staying hydrated throughout the day is especially beneficial for patients with xerostomia. Such patients should also be recommended to avoid caffeine and alcohol.

As Ozempic-induced delayed gastric emptying and frequent gastric reflux can cause halitosis and enamel erosion, advise patients to take their last meal of the day at least 3-4 hours before bed. Encourage them to avoid late-night snacking, eat smaller meals, and steer clear of spicy or acidic foods and smoking.

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Disclaimer: This story is contributed by Alpana Mohta and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.