Ozempic and Keto Work—Until They Don’t. What Every Body Deserves to Know About Sustainable Health

By Guardian Dietitian

As a dietitian, I’m often asked about popular trends like Ozempic and keto. Understandably, people want clarity: Do they work? Are they safe? Will the effects last? These are complex and valid questions. Yet the responses circulating in mainstream spaces are often reductive—like “just take this drug” or “ditch the carbs”—missing the individual context, lived experience, and long-term sustainability that real health conversations deserve.

That’s exactly why I’ve written this article — not just to share what the research says, but to reflect the real stories and insights I’ve gathered from walking alongside clients over time. Because nutrition is so much more than what’s on your plate. It’s about finding something that supports you for the long haul, feels safe in your body, and honors your whole self — physically, emotionally, and mentally.

What Ozempic and Keto Actually Do

You've likely heard a lot about Ozempic and the ketogenic diet—and with all the buzz, it's easy to feel curious or confused. So let's break them down:

Ozempic is a medication originally developed to help manage type 2 diabetes. It mimics a natural hormone, called GLP-1, which slows digestion, reduces appetite, and helps regulate blood sugar. Clinical trials show it can lead to significant weight loss when used alongside gentle changes to food and movement (Koman et al., 2024).

The ketogenic diet, or "keto", works quite differently. It reduces carbohydrate intake significantly and increases fat intake, shifting the body's energy source from using glucose as its main fuel to ketones. This state—called “ketosis”—may help with short-term fat loss and blood sugar control (Naude et al., 2023).

Both approaches create changes. But neither is a guaranteed solution—and neither replaces the importance of listening to your body or building habits that actually feel sustainable for you.

What Happens Over Time?

The short-term results from Ozempic or keto can feel very real—and for some, even life-changing. But most people regain weight after stopping Ozempic—even if they’re still making thoughtful choices around movement and nourishment (Wilding et al., 2021).

Keto comes with its own challenges. For most, maintaining that level of restriction over the long haul is hard—and it often means missing out on fibre-rich foods and key nutrients that support gut health, hormone balance and emotional wellbeing (Naude et al., 2023).

How These Choices Affect Your Gut

Our gut plays a big role in how we feel—physically, emotionally, and even hormonally. So it's worth knowing how different approaches might impact it over time.

Ozempic slows down digestion, which can sound helpful in theory—especially for managing blood sugar or appetite. But for some people, that slower emptying can lead to uncomfortable symptoms like nausea, bloating, or even gastroparesis, a condition where food moves through the stomach more slowly than it should (Al-Aly et al., 2025; Sodhi et al., 2023). There's also emerging research linking it to inflammation in the pancreas and kidneys, which is something to keep an eye on.

Keto takes a very different route—but it also affects the gut. By cutting down on carbohydrates, it often means missing out on fibre-rich foods that nourish beneficial gut bacteria. Without enough fibre, these bacteria can shrink in number, and that can lower your levels of short-chain fatty acids—special compounds that keep your gut lining strong, help regulate the immune system, and even impact mood and inflammation (Santangelo et al., 2023; Patikorn et al., 2023).

Mind Matters Too

Food isn’t just physical—it’s deeply emotional. Both Ozempic and keto can shape how people relate to food, their bodies, and themselves. Some people report feeling more anxious around eating, trapped in cycles of all-or-nothing thinking, or pressured to keep chasing thinness (Meule and Kübler, 2024).

Restrictive diets—especially without any support—can also lead to obsessive thoughts about what food is “good” or “bad”, which often pulls people away from trust, pleasure, and connection in eating. Leading experts from the Butterfly Foundation and the National Eating Disorders Collaboration remind us that how we eat matters just as much as what we eat—and that kindness towards ourselves is a form of nourishment too (Cox and Trobe, 2025).

What’s More Sustainable?

When researchers at Stanford University compared the keto diet with the Mediterranean diet—a more balanced approach that emphasizes whole grains, vegetables, lean proteins and healthy fats—both were shown to improve blood sugar control, but there were important differences in sustainability.

The Mediterranean diet typically includes around 50% of daily calories from carbohydrates, mostly from fibre-rich sources like legumes, fruit, and whole grains. In contrast, the keto diet limits carbs to just 5-10%, cutting out many nourishing foods that support gut and hormone health.

Ultimately, most participants found the Mediterranean approach easier to maintain, more enjoyable, and better aligned with long-term wellbeing (Gardner et al., 2023).

If You're Exploring Ozempic or Keto—You're Not Doing It Wrong

It's important to say: if you're considering Ozempic or the keto diet, or already trying them—that's okay! There's no shame in exploring what might work for you. Every body is different, and so is every healing journey.

From a non-diet, HAES®-aligned approach, our role isn't to judge your choices—it's to walk with you through them. If you're thinking about trying Ozempic or keto, a dietitian can help:

• Understand the potential benefits and risks, in the context of your symptoms, values and lifestyle.

• Talk through your motivations, goals, and any internal conflicts around food or body image.

• Co-create a plan that prioritises nutrient adequacy, gut health and emotional wellbeing, so you're supported every step.

• Reassure you that it's okay to adapt or change direction as your needs evolve.

You deserve care that's respectful, informed, and flexible—no matter which path you're exploring.

Working with a Dietitian: Collaboration Over Control

Nutrition isn't about having all the answers—it's about having a trusted partner who helps you find the answers that fit. Dietitians trained in non-diet, intuitive eating, or HAES®-aligned care won't hand you a rigid plan and send you off. They'll sit beside you, ask meaningful questions, and co-create strategies that respect your body's needs, history, and lived experience.

Here's what that might look like:

• Listening first—not prescribing. Your story, your relationship with food, and your goals set the direction.

• Unpacking beliefs about food, body image, and health that might be getting in the way.

• Rebuilding trust in your hunger and fullness cues, especially after years of dieting or restriction.

• Exploring small steps that support your symptoms (like fatigue, bloating, brain fog) without overwhelm.

You don't need to have "perfect eating." You just need someone who gets it—and can walk with you toward a way of nourishing that feels good and lasts.

Final Thoughts: Lasting Change Should Feel Like Home, Not a Battle

Health isn't about sticking to a plan—it's about finding an approach that honours your body, your energy and your life. It's about choosing strategies that support you for the long haul, not just for a few weeks.

Creating lasting changes means letting go of perfection and embracing what's realistic, flexible and—what do you know—feels GOOD.

Whether your journey to better health starts with exploring Ozempic, trying a new recipe, seeking emotional support, or working with a dietitian—the goal is never rigid rules—it's connection, care, and a path that actually feels like yours.

References

Al-Aly, Z., et al., 2025. GLP-1 receptor agonists and multi-organ risk: A retrospective cohort study. Nature Medicine, 31(1), pp.1–12.

Cox, S. and Trobe, S., 2025. GLP-1 medications and eating disorder risk: Clinical guidance for prescribers. National Eating Disorders Collaboration.

Gardner, C.D., Hartle, J.C., Garrett, R.D., Offringa, L.C. and Wasserman, A.S., 2023. Effect of a ketogenic vs Mediterranean diet on glycemic control and cardiometabolic risk factors in people with prediabetes and type 2 diabetes. BMC Medicine, 21(1), pp.1–15.

Koman, A.M., Przygodzka, S., Gadżała, K. and Chomać, L., 2024. Ozempic (semaglutide) – review of pharmacological properties, mechanism of action and clinical applications. Quality in Sport, 16, Article 52659. https://doi.org/10.12775/QS.2024.52659

Meule, A. and Kübler, A., 2024. GLP-1 receptor agonists and disordered eating: A systematic review of risks and therapeutic potential. Journal of Eating Disorders, 12(1), p.45.

Naude, C.E., et al., 2023. Ketogenic diets: A comprehensive umbrella review of efficacy, safety, and sustainability. BMC Medicine, 21(1), pp.1–20.

Patikorn, C., et al., 2023. Dietary fiber and gut microbiota: Implications for metabolic and mental health. Gut Microbes, 15(1), p.2204567.

Santangelo, G., et al., 2023. Short-chain fatty acids and gut integrity: A review of mechanisms and clinical relevance. Frontiers in Nutrition, 10, p.1251914.

Sodhi, G.S., et al., 2023. Risk of gastrointestinal adverse events with GLP-1 agonists for weight loss. JAMA, 330(13), pp.1234–1242.

Wilding, J.P.H., Batterham, R.L., Calanna, S., et al., 2021. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), pp.989–1002.