David Jones

You do everything right. You hit the gym five or six days a week, you eat clean, and you never skip leg day. 

So why do you still feel bloated, exhausted and like you’re catching every cold going around?

According to fitness and health experts, the answer might be surprising – every time you push yourself through another punishing workout without giving your body the recovery it needs, you are messing with the delicate balance of your gut.

‘Productive training stress follows a simple pattern: you challenge the body, you recover, and you come back stronger,’ said Dr Desi Bartlett, creator of The Body Mind Work Out and a certified personal trainer.

‘The line gets crossed when the stress keeps coming and the recovery never catches up.’

That imbalance, Bartlett told Daily Mail, doesn’t just leave you tired. It can throw your gut and with it, your immune system, your mood and even your long-term health into chaos.

Not all workouts are created equal 

Long, high-intensity endurance sessions – particularly running – tend to be the biggest gut stressors, largely because of reduced blood flow to the digestive system combined with repetitive impact, Bartlett says. 

Working out and pushing yourself too hard without allowing time for proper rest and recovery could be silently damaging your gut

Daily HIIT sessions without rest days are a close second, as they can keep the body in a state of repeated physiological stress, contributing to elevated cortisol levels. 

Cortisol is a hormone produced by the adrenal glands and is essential for metabolism, and the sleep-wake cycle. 

Cortisol, commonly known as the ‘stress hormone’ itself isn’t bad – the concern is prolonged or poorly regulated elevated levels, which can occur with the combination of intense training without sufficient recovery, Bartlett explained.

Heavy lifting is generally easier on the gut, Bartlett said, but training at high intensity six or seven days a week without a planned period of reduced training intensity or volume can create the same recovery deficit.

‘The pattern matters more than the modality,’ Bartlett said. ‘Intensity plus duration plus no rest is the problem formula.’

What is actually happening inside your body?

During an intense workout, blood is diverted away from the digestive system and sent to the muscles, heart and lungs that need it most, a short-term survival response, she added.

The trouble, however, starts when workouts are too long, frequent and paired with poor fueling beforehand to prepare the body.

Daily HIIT sessions without rest days can keep the body in a state of repeated physiological stress, contributing to elevated cortisol levels

Over time, the gut lining is placed under stress from repeated blood diversion – not allowing it the chance to repair itself.

Dr Kim Barrett, a professor of medicine at the University of California, San Diego, told Live Science that the physical stress of endurance or extreme exercise can trigger an inflammatory response in the gut that leads to diarrhea, bloating and abdominal pain, and that hard training also diverts blood flow away from the digestive system in a way that disrupts healthy gut function.

‘The workout itself isn’t the villain,’ Bartlett said. ‘The dose and the lack of recovery are.’

When chronically elevated levels of the stress hormone cortisol are added into the mix, digestion suffers and the gut’s protective barrier can break down. 

A 2024 study in Physiological Reports found that a single 60-minute high-intensity treadmill run increased markers of intestinal barrier disruption in trained athletes.

And a 2025 review in the World Journal of Gastroenterology similarly linked intense or prolonged exercise to increased intestinal permeability, often called ‘leaky gut,’ via reduced blood flow to the gut and physical stress on the intestinal lining.

Though not a formal diagnosis recognized in mainstream medicine, leaky gut occurs when the lining of the intestine becomes more permeable than it should be. That means that food particles germs, and waste can pass into your blood and cause inflammation or food sensitivities. 

The consequences of a struggling gut 

The gut and brain are in constant communication, Bartlett said, and a stressed gut is linked to changes in mood, sleep and inflammation throughout the body – which she says is why chronically overtrained people so often show irritability alongside their digestive issues.

Regular exercise is generally linked to a lower risk of colorectal cancer, Blumenfeld said, but that protective effect depends on recovery keeping pace with training. 

Inadequate recovery can work against it by raising inflammation and putting stress on the gut’s protective barrier – the same mechanism that drives many of the other symptoms on this list. 

Fiber remains key, she said, since gut bacteria ferment it into a compound that fuels the cells lining the colon.

A 2022 review in Sports Medicine found that when training intensity and duration outpace recovery time, it can quantitatively and qualitatively alter gut bacteria.

This can promote dysbiosis, an imbalance of the gut bacteria, which then favors inflammation and disrupts metabolic balance.

The five warning signs your gut is struggling

If you are pushing your body beyond its limits, Bartlett says there are signs to watch for. Rather than just a single symptom, concentrate on these as a cluster:

1. Getting sick constantly. Frequent colds and infections in someone who is otherwise very fit is one of the clearest signs the immune system – which is closely tied to gut health – is overwhelmed by training load. 

2. Afternoon energy crashes. Smashing a hard morning workout only to hit a wall by 2pm every day isn’t normal

3. Bloating that won’t quit. Occasional bloating tied to a bad pre-workout meal is normal. Bloating that shows up most days is not. 

4. Poor sleep. A body stuck in a stressed ‘fight or flight’ state struggles to switch into deep, restorative sleep. 

5. Performance decline. Training harder but getting slower or weaker is not a motivation problem – it’s a sign the body hasn’t recovered properly. 

How to prepare your body for a workout

Training on an empty stomach and then going hours afterward without eating is one of the most common mistakes among overtrained gym-goers, according to Bartlett, and it makes gut stress worse.

Her advice: something easily digestible with carbohydrates before a hard session, and a proper meal with protein and carbs within an hour or two afterward, when the body shifts into repair mode.

On rest days, don’t cut calories. That’s the biggest mistake Bartlett sees. 

Instead, use the lower training stress as a chance to eat the fiber-rich foods that can be tough to digest around hard workouts – vegetables, legumes, whole grains and fermented foods like yogurt or kimchi.

How to actually rest and recover after a workout

A real rest day, according to Bartlett, is not a lighter version of a workout. Instead, she recommends activities that calm the nervous system and promote circulation: walking, easy swimming, restorative yoga or mobility work.

Bartlett is a strong advocate of practices like Yoga Nidra on rest days because they switch on the parasympathetic nervous system – the body’s ‘rest and digest’ state.

‘Your gut does its best repair work when your body is out of fight-or-flight,’ she said.

A proper rest day, Bartlett said, should also include unhurried meals, real hydration and a full night’s sleep.

Can probiotics help heal your gut? 

The best way to help heal your gut is through diet and rest, as evidence on using shakes and supplements is mixed

Bartlett’s advice: food first, recovery second, supplements a distant third.

Blumenfeld agreed, noting that while there’s decent evidence probiotics can offer athletes modest immune support, the evidence for easing gut symptoms specifically is weaker and depends heavily on the exact strain used – meaning a generic supplement off the shelf may not do much at all.

A 2021 meta-analysis of randomized controlled trials, published in the Journal of Athletic Training, backs that up.

The study found probiotic supplementation reduced the severity of upper respiratory infection symptoms in elite athletes, but had no clear effect on how many days athletes were sick or how often infections occurred – underscoring that probiotics are, at best, a modest supporting player rather than a fix on their own.

‘No probiotic can out-supplement chronic overtraining and under-eating,’ Bartlett said.

The bottom line on over exercising and gut health

If your gut symptoms started or got worse around the same time your training ramped up, Bartlett says that’s exactly where to look first – before cutting out entire food groups or reaching for supplements.

The fix, according to Bartlett, is rarely complicated: cut training volume by 30 to 50 percent for a week or two, prioritize sleep and proper fueling, then reintroduce intensity gradually.

‘Most people don’t need permission to work hard,’ Bartlett said. ‘They need a plan for recovering well.’

Once the bland poster child of 1980s diet culture, cottage cheese is suddenly having a very loud second act. 

It’s popping up on social feeds, back in fridges, and no longer just the boring scoop for canned peaches. 

Thanks to its protein-packed punch, wallet-friendly price tag, and mix-it-into-anything versatility, this humble tub of curds has officially gone from retro diet food to grocery-cart MVP. 

To find out why cottage cheese is suddenly everywhere again, Daily Mail asked two registered dietitians why this protein star deserves a spot in your fridge.

The Nutritional Anchor

Modern interest in protein has propelled cottage cheese back into the spotlight.

A 100-gram, or 3.5-ounce, serving contains just 100 calories but 12.5 grams of protein.  

And unlike many processed snacks, it offers a complete protein source, meaning it contains all essential amino acids the body requires. Beyond protein, it serves as a great source of essential micronutrients. 

‘Cottage cheese is a sustainable health food, it offers an excellent source of protein, calcium and B12, a good source of B6, riboflavin, phosphorus and selenium,’ said Julia Zumpano, a registered dietician at Cleveland Clinic in Ohio. 

This nutrient density is critical for consumers who are looking to maximize the nutritional value of every calorie consumed.

Thanks to its protein-packed punch, wallet-friendly price tag , and mix-it-into-anything versatility, cottage cheese is rising in popularity

The Protein Equation

The science behind cottage cheese’s popularity often points to its unique protein composition. 

A 2025 study published in Clinical Reviews of Food Science and Nutrition touted how cottage cheese is primarily a source of casein, a protein that reacts with stomach acid to form a gel-like structure, which facilitates a slower release of amino acids into the bloodstream compared to faster-digesting alternatives like whey.

This has long been the belief for satiety and the clinical data continues to support this claim. 

‘Cottage cheese aids in satiety due to its protein-rich nature and being slowly digested rather than the slow casein structure,’ Zumpano told Daily Mail. 

While research results on satiety can vary, one study said the protein structure contributes to a stable feeling of fullness, which is particularly beneficial for those looking to manage energy levels throughout the day.

Blood Sugar and Metabolic Stability

If your energy crashes every afternoon, cottage cheese can help with that slump. It’s not just the protein, but it’s how that protein teams up with carbs. 

Pair it with fruit, crackers or toast, and the protein and fat can help slow how quickly sugar hits your bloodstream, making the ride steadier and less spike-and-crash, experts say. 

‘Adding protein to carbohydrate generally slows the overall digestive response and can reduce the size of the post-meal rise in blood sugar, rather than giving you the rapid rise and fall that can occur with carbohydrates alone,’ explains Dr Colleen Tewksbury, a registered dietician and assistant professor of Nutrition Science at Penn Medicine.

Cottage cheese can be paired with fruit, crackers or toast

Affordability in a High-Cost Era

In a grocery landscape where ‘healthy’ often equates to ‘expensive,’ cottage cheese remains a remarkably cost-effective grab. 

It bridges the gap between budget-friendly staples and high-protein health foods. It is often compared to more known protein sources like Greek yogurt, chicken, or eggs regarding both protein quality and price. 

Tewksbury reinforces this practical value: ‘Cottage cheese is affordable, accessible and nutrient-dense, and sometimes the boring grocery-store staple is actually the better value both financially and nutritionally.’

Culinary Versatility and Use

Perhaps the most significant factor in the cottage cheese renaissance is its adaptability. 

It is no longer restricted to a bowl with fruit. Because of its mild profile and creamy texture, you can use it in various recipes, from pasta sauces and smoothies to dips and dressings. 

To maximize health benefits, experts suggest focusing on ‘protein-plus-produce’ combinations. 

‘Think protein plus produce: let cottage cheese bring the protein and fruits or vegetables bring the fiber, color and variety,’ Tewksbury told Daily Mail. 

By integrating it into meals rather than consuming it only as a snack, you can easily elevate the protein source’s nutritional profile without a fuss.

The Bottom Line

Cottage cheese is no longer just a retro diet food hiding in the back of the fridge. It’s cheap, easy, protein-packed and surprisingly useful, basically the comeback kid of the dairy aisle. 

‘The modern-day hype is protein these days and cottage cheese is a great source of protein,’ said Zumpano.

‘It’s a versatile, convenient and inexpensive complete protein.’

Until recently, Sally White spent her life trying her hardest not to smile. Every time she grinned or laughed, she became painfully aware of the facial feature she felt marked her out from other people: her upper lip rising far too high and making her gums seem glaringly obvious.

Parties, social gatherings and family get-togethers were a nightmare for her – as someone was bound to produce a camera and start taking photos.

The 53-year-old office manager, from Hertfordshire, says: ‘I absolutely hated having my picture taken or seeing photos of myself – I felt uncomfortable and self-conscious because of my horrible, gummy smile. If I started smiling or laughing in public, I would either cover my mouth – or else force myself to stop.’

Two years ago, however, after a chance conversation, Sally made a life-changing discovery that finally allowed her to beam happily from ear to ear – namely that the gummy smile which had plagued her was caused by a recognised medical condition.

And better still, there was a simple treatment which involved – to her surprise – a course of anti-wrinkle injections.

She says: ‘It was a game-changer. It wasn’t something I’d ever heard of. I only wish I’d found out about it earlier.’

Sally White used to feel incredibly self-conscious due to her gummy smile, but since treating it with a course of anti-wrinkle injections, she has gained confidence 

A gummy smile is known formally as ‘excessive gingival display’. Although no precise clinical criteria have been defined, a smile exposing more than three or four millimetres of gum above the top teeth is considered disproportionate.

Overall, an estimated 14 per cent of women and 7 per cent of men in the UK are affected.

The most common cause is over-activity in a muscle with the longest name of any in the human body – the ‘levator labii superioris alaeque nasi’, also known as the LLSAN.

Running downwards from the upper part of the jaw-bone beside the nose, it lifts the upper lip, flares the nostrils and helps form facial expressions such as a smile or snarl.

In many people with a this sort of smile, the muscle is too strong and pulls too hard, meaning it lifts the top lip higher than normal and reveals too much of the gum.

Dr Kate Carr is a former GP who runs Dr Kate Aesthetics in north London, one of many private clinics around the country offering treatment.

She said: ‘A significant number of people have excess gum tissue on show and feel very self-conscious about it.

‘Often it has been a problem from a young age. Kids can be cruel – and if someone has been bullied or called names because of their smile, it can have a really profound and lasting impact. Some patients could never relax when smiling and even altered the way they smiled in public or when having a photo taken.’

Treatment involves injecting a small dose of botulinum toxin, which is best known by the brand name Botox.

The chemical is a powerful natural poison widely used in medicine and the beauty industry. By blocking signals between nerves and muscles, it causes temporary muscle relaxation or weakness.

Sally’s smile before treatment… the most common cause is a muscle called the LLSAN pulling too hard, meaning it lifts the top lip higher than normal

A small dose of Botox injected into Sally’s lip caused the LLSAN muscle to relax, so that less gum is exposed when she smiles

As a cosmetic treatment, it can be injected into the face to smooth out wrinkles, frown lines and crow’s feet.

Doctors also use it for conditions including chronic migraines, overactive bladder and severe underarm sweating.

For a gummy smile, the botulinum toxin is injected into the LLSAN, to relax the muscle so it exposes less gum when smiling.

Dr Carr says: ‘It doesn’t paralyse the muscle, just weakens it slightly, so when someone smiles the lip isn’t pulled as strongly and doesn’t lift as much.’

It’s important, she explains, to start with a tiny dose.

Dr Kate Carr says getting the right dosage is a fine balance: ‘A larger dose might last longer. But if you overdo it, the lip drops too far’

‘It’s a fine balance,’ she says. ‘A larger dose might last longer. But if you overdo it, the lip drops too far. Instead of showing too much gum when they smiled, they would end up not showing enough of their teeth. It’s better erring on the side of caution.’ 

The effects of the botulinum are not immediate but increase gradually over three weeks, before starting to wear off again after six to eight weeks.

As a result, the treatment – which costs around £180 each time – typically needs to be repeated every three to four months.

Dr Carr says: ‘For many people with a gummy smile, this treatment works really well and gives them a smile they feel happy and confident with.

‘It’s quick and relatively straightforward but can be life-changing. The ability to just smile in a natural way can really improve a patient’s confidence. Yet many people with a gummy smile aren’t aware it can be treated.’

Sally only found out about the botulinum injections while chatting with her dentist. ‘When Botox first came out, you’d see celebrities with stiff-looking faces,’ says Sally. ‘I swore I’d never touch it – that I’d just grow old gracefully.

‘But then I discovered that just a tiny bit could completely change the way I feel.’

Although it doesn’t interfere with eating, drinking or talking, the muscle-weakening effect of the botulinum means that she cannot tighten her lips like she used to when applying lip balm or lip-stick.

However, every morning, while putting on her makeup, she’s delighted to check her smile in front of the mirror.

Sally adds: ‘I can tell when it’s time to book the next appointment. I’m just gutted it took me so long to find out about the treatment. I wouldn’t ever want to be without it. It’s fantastic to finally be able to smile again.’

By WILL STUART

Published: 00:29, 23 August 2026 | Updated: 00:55, 23 August 2026

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Eating pomegranates and walnuts may reverse some of the life-threatening damage caused by catastrophic heart failure, a new study has found.

Research shows that consuming these foods causes the body to produce a natural compound called urolithin A, which has been linked to anti-ageing.

Now, UK scientists have found that animals given urolithin A saw their heart function boosted by as much as 80 per cent. The researchers, at King’s College London, argue that urolithin A helps relaxes the heart muscles and also prevents scarring.

Experts say that the compound could eventually be turned into a treatment for an increasingly common form of heart failure.

They add that the findings may also suggest that heart failure patients could benefit from a urolithin A-rich diet.

Heart failure affects about 920,000 Britons. Around 50 per cent of sufferers have a form called heart failure with preserved ejection fraction – where the organ becomes stiff, meaning it cannot fill with blood.

There are few effective treatments, and more than half of sufferers will die within five years of diagnosis.

However, the new study claims urolithin A could be the answer. It is produced when gut bacteria break down foods that contain polyphenols – a plant compound found in pomegranates, walnuts and berries.

Berries and nuts may reverse life-threatening damage caused by heart failure, a new study has found (stock image)

King’s College London researchers injected animals suffering from heart failure with urolithin A and found their heart function drastically improved.

The compound was then tested on human heart tissue in a laboratory, which the scientists say also had a positive effect.

Experts say the next step will be to develop a drug that contains urolithin A, but added that patients should consider boosting their polyphenol intake.

Dr Joseph Burgoyne, senior author of the study, said: ‘While there isn’t enough evidence to suggest that people should eat pomegranates to treat heart failure, these findings raise the possibility that diets that enhance urolithin A production may help alleviate this condition.’

When a box containing Sophie Ashton’s first pack of Wegovy pills arrived on her doorstep, the 39-year-old felt a flicker of hope.

Finally, she thought, here was a way to control her weight – without the eye-watering cost of the injections she could no longer afford. Like thousands of others, she had been forced to stop taking weight-loss jab Mounjaro last year after its manufacturer dramatically increased the price from around £100 a month to more than £200.

Over nine months on the drug, the mother of one had lost one-and-a-half stone. But once she stopped taking it, inevitably, her weight slowly began to creep back up.

So when a pill version of Wegovy became available – containing semaglutide, the same drug used in the injection – for just £60 for a month’s supply, Sophie jumped at the chance to try it.

‘I just wanted to feel better in my body,’ says the content creator from Greater Manchester. ‘I was in quite a bad place, having been through a difficult break-up. I knew something had to change.’

She had recently been prescribed sertraline, an antidepressant, which helped steady her racing thoughts and lift her low mood. Losing weight felt like the final piece of the puzzle – or so she thought.

On Mounjaro, Sophie had barely been troubled by common side effects such as nausea, constipation and bloating. She assumed switching to a daily pill would be similarly straightforward.

When a box containing Sophie Ashton’s first pack of Wegovy pills arrived on her doorstep, the 39-year-old felt a flicker of hope

But just ten days into treatment, her mental health began to spiral.

‘My mind was racing constantly,’ she says. ‘I was waking up in the middle of the night, I couldn’t focus and just had this overwhelming feeling of anxiety.

‘The worst part was that even my three-year-old daughter could tell something was wrong. I became irritable and short with her. I just felt out of control.

‘I hate to think what could have happened if I stayed on the pill.’

When she reported her symptoms to the online firm that prescribed the drug, Sophie alleges she was advised to switch back to injections – after being told some patients may experience mood disturbances on the drug.

‘In my mind it wasn’t that simple – I don’t want to take another weight-loss drug. I know it means I’m likely to carry on gaining weight, but I just don’t want to take that risk again.’

Her story is concerning, yet she is far from the only patient to report troubling symptoms after taking the new pill. The daily Wegovy tablet was billed as a cheaper, easier alternative to jabs. But experts speaking to The Mail on Sunday have warned there may be a significant downside.

To get enough semaglutide into the bloodstream when swallowed rather than injected, the pills contain a far higher dose. And experts say this could help explain a growing catalogue of reported side effects – including gastrointestinal problems, mood disturbances and, in some cases, potentially serious complications affecting the kidneys and pancreas.

It comes as UK health officials have linked 216 deaths to weight-loss drugs – although there is no way of knowing whether the medications caused the deaths, only that it was suspected.

‘The pill may be easier to take [than jabs], but it does come with its own set of issues,’ says Dr Madusha Peiris, a neurogastroenterologist at Queen Mary University of London.

For a start, taking it is more complicated than simply swallowing a tablet with breakfast. The pill must be taken on a completely empty stomach – meaning first thing in the morning, before breakfast – with only a small amount of water. Users must then wait at least 30 minutes before eating, drinking or taking any other oral medication.

But there is another striking difference between the pill and the jab – the dose. While the standard maintenance dose of injected Wegovy is 2.4mg once a week, the pill contains 25mg of semaglutide – taken every day.

The reason for this huge difference is that semaglutide is poorly absorbed when swallowed. Much of the drug never makes it from the digestive system into the bloodstream, so more is needed to achieve the desired effect. But experts say the large amount of semaglutide passing through the digestive system every day could explain why some patients report particularly troublesome gastrointestinal side effects.

On paper, the side-effect profile of the pill looks remarkably similar to that of the jabs. The most commonly reported issues include nausea, vomiting, diarrhoea, constipation, bloating, heartburn, fatigue and dizziness – many of the complaints familiar to users of injectable weight-loss drugs.

In clinical trials, around 70 per cent of people on Wegovy injections experienced these gastrointestinal side effects.

The figure for the pill was roughly the same. In late-stage trials, 74 per cent of those taking oral semaglutide reported at least one gastrointestinal problem, with nausea among the most common. Yet anecdotal reports from patients taking the pill paint a rather different picture. Online forums and TikTok pages are awash with users complaining of relentless nausea, frequent vomiting and debilitating diarrhoea after starting the drug.

One Reddit user who switched from jabs to pills claimed ‘the side effects, specifically nausea, have been off the charts’.

‘First month on the starting dose completely fine, but after increasing the dose in the second month, I have had two instances of debilitating nausea and one of them I went to the ER because I thought I was dying,’ they added. ‘I never had side effects on the shot, so I am going back to the shot.’

Another user described the nausea as ‘unbearable’. ‘I was on the lowest-dose pill for a week and the nausea was debilitating. I could barely breathe and certainly couldn’t eat. It was awful,’ they said. ‘I stopped taking it today. I just can’t do it. And I’m still feeling terrible.’

And unlike many jab users, who often find the side effects improve over time, some Wegovy pill users say it only gets worse. After increasing the dose from 1.5 to 4mg, one user wrote: ‘Out of nowhere, I could no longer eat. I threw up non stop. Even an empty stomach made me sick.

‘I went to the doctor twice and despite improvements in my cholesterol levels, I was advised to come off the pill, and warned it could take a month to feel better.’

On TikTok, accounts are largely similar. In one video, which has racked up more than 107,000 views, a user named Meg talks of coming off the pill after experiencing nausea for three weeks. ‘I seriously don’t know how people do this,’ she says. ‘I thought after I stopped taking it I would feel better, not worse. I am still throwing up, to the point I can’t get through a short car journey.’

‘The worst part was that even my three-year-old daughter could tell something was wrong. I became irritable and short with her. I just felt out of control,’ writes Sophie

Others speak of headaches, migraines, severe bloating and fatigue. One Reddit user said the pill left them so exhausted they could hardly get through the day without a nap.

Another replied saying their ‘never ending fatigue’ couldn’t be relieved by coffee or sleep, and was interfering with their work and exercise routine.

And according to Dr Peiris, these heightened adverse effects – along with mood disturbances such as those suffered by Sophie – may not be entirely surprising.

Experts have long questioned whether delivering a large dose of semaglutide directly into the stomach every day could prove tougher on the body than a much smaller injection given just once a week.

Indeed, Dr Peiris says these concerns were being raised even while the oral version was undergoing clinical trials. ‘With jabs, you get a steady release of the drug over seven days. With the pill, however, the drug is released relatively quickly once it dissolves in the stomach,’ she says.

Dr Peiris believes this could help explain why some patients experience particularly severe nausea on the pill. GLP-1 drugs such as Wegovy mimic a hormone naturally released by the gut after eating. One of its effects is to slow the rate at which the stomach empties, keeping food there for longer and helping us feel full.

This is part of what makes the drugs so effective for losing weight. But if digestion slows too much, it can leave patients feeling bloated and nauseous – and, in severe cases, cause vomiting.

Dr Peiris believes exposing the stomach to a large dose of semaglutide every day could amplify these effects in some patients.

And there may also be another consequence – one that could help explain the mood problems of patients such as Sophie. This involves serotonin, a chemical messenger best known for its role in regulating mood and anxiety.

Perhaps surprisingly, the vast majority of the body’s serotonin is produced in the gut, which does not travel directly into the brain.

But the digestive system and brain are in constant communication via a complex network of nerves, hormones and chemical signals – known as the gut-brain axis. GLP-1 drugs are known to act on this, and early research suggests a large daily dose delivered by the pill may alter serotonin signalling in the gut.

Dr Peiris argues this could have downstream effects on the signals travelling between the digestive system and the brain, potentially affecting areas involved in mood and anxiety.

‘When you have all this drug hitting the stomach at the same time, it can trigger a surge in serotonin activity,’ she says. ‘There will be a knock-on effect in the brain.’

Dr Peiris stresses this link is not yet proven, but she believes it could offer one explanation why some patients report anxiety, depression or other changes in mood while on the drugs.

With the injection, by contrast, semaglutide is absorbed gradually from beneath the skin into the bloodstream, rather than a large oral dose passing into the stomach every day.

In late-stage trials, 74 per cent of those taking oral semaglutide reported at least one gastrointestinal problem

Dr Peiris believes this difference in how the drug enters the body could explain why some patients find the pill particularly difficult to tolerate.

Part of the appeal of a daily tablet is that it could make GLP-1 drugs far more attractive to people put off by needles or the idea of a weekly injection. That, doctors say – and no doubt the drug’s maker hopes – could open this new wave of weight-loss treatments up to a much wider group of patients.

But Dr Peiris says it also makes proper medical oversight even more important. ‘These are still medicines, they need to be prescribed by someone who knows the patient and is keeping an eye on them,’ she says.

‘Making them easier to take is good, but we don’t want people to start thinking of them as just another weight-loss product.’

Currently, the daily tablet is available to patients with a BMI (body mass index) of 30 or above – the same threshold as the Wegovy injection.

Patients with a BMI of between 27 and 30 who also have a weight-related condition – such as heart disease, high blood pressure or sleep apnoea – may also be eligible. But it is not yet available on the NHS.

Dr Peiris says the concern is that many people taking GLP-1 drugs are also being treated for other health problems and may be taking several different drugs.

‘We still don’t know everything about how these drugs interact,’ she warns. ‘That’s why proper medical supervision matters.’

Like the injections, the pills also carry a risk of the rebound effect, whereby when treatment stops, the weight piles back on and its health benefits disappear.

‘As such, we may end up with a generation of people who have to take these drugs for life, unless we can come up with an exit strategy,’ says Dr Peiris.

‘The biggest danger is not the drug itself, but poor information, rushed decisions and the assumption that the pill is just another online purchase.’

She says that ‘in a perfect world we would have clear guidelines’, but cautions that ‘until then it’s up to providers to give the best care possible’.

In response to the claims made by Dr Peiris and users of the pills, Wegovy manufacturer Novo Nordisk told The Mail on Sunday: ‘We care deeply about patient safety.

‘Like all medicines, treatments used for chronic conditions can have side effects, and these can vary from person to person. That is why medicines are prescribed by healthcare professionals, who consider the potential benefits and risks for each individual.

‘Consistent with the available evidence, anxiety and mood disorders are not currently listed on the UK label of side effects for the Wegovy pill.’

The company added: ‘We are committed to ensuring healthcare professionals and patients have a detailed understanding of our medicine’s safety profile.

‘Anyone with concerns about side effects should speak to their doctor, nurse or pharmacist, who can provide personalised medical advice and support.’

Louise stuck with the pills despite her daily nausea 

Louise Atkinson, 62, is a writer who lives in Oxfordshire with her husband, Jonathan. She lost 2st on Mounjaro (dropping from 13st to 11st over the last year and switched to the Wegovy pill in July.

As soon as the Wegovy pill came out I leapt at the chance to switch. I had spent ten months on an expensive weight-loss plateau, paying £170 a month for my Mounjaro jab but with my weight hanging stubbornly half a stone short of the ‘healthy’ BMI category I had always been aiming for.

Louise Atkinson, 62, lost 2st on Mounjaro (dropping to 11st over the last year and switched to the Wegovy pill in July)

The new Wegovy pills were temptingly cheaper and I liked the relative normality of a taking a daily pill. I started on a 4mg pill a week after my last Mounjaro jab and in the first week I was hit by attacks of vicious heartburn if I went ‘off message’ and dared to drink wine or eat biscuits.

On day four, a wave of nausea struck as I got out of bed, and continued each morning for the next two weeks. I decided to take this as a good sign that the pills were working.

But the morning sickness continued and after two weeks I was tempted to quit. I felt sick much of the time, sluggish and tired.

I ploughed on, however, and by week three all side effects had vanished and my weight had finally started shifting on the scales once more.

I’m very glad I stuck with the pills. I love the way they take away hunger for most of the day, but start to wear off so I feel peckish for a healthy evening meal.

My hope is that this daily pill will take the place of the blood pressure tablet and statin I no longer need now I’ve lost weight.