GLP-1 Receptor Agonists (Ie: Ozempic, Wegovy, etc.) & type 2 Diabetes and Weight Loss.

In an ideal world I would much rather have patients lose weight and support their health and wellness with therapeutic lifestyle changes (TLCs) such as transitioning to a healthy diet, optimal caloric intake along with regular exercise. Yet, I know many people over decades who have diligently tried TLCs and for various reasons they have not been able to loose weight and/or be consistent with those TLCs. Are there downsides to the new generation of “weight loss drugs” called GLP-1 Receptor Agonists? You bet there are. Are there deleterious effects of long term weight issues, obesity and insulin resistance? Sure. Life is sometimes a trade off of picking the less worse options, especially if they result in possibly less chronic health and less debilitation, as we age. Simply put, many people are loosing weight and feeling better with these medications. It is a better option than doing nothing and your quality of life can certainly be greatly improved. If you are going to choose taking a GLP-1 med then it is vitally important that you do it in the most healthy way possible.

These drugs act by stimulating GLP-1 receptors in the brain and gastrointestinal tract. This activation enhances insulin secretion, suppresses appetite, encourages stomach emptying, and slows down intestinal emptying. All together, these effects promote satiety and a prolonged sense of fullness. The end result is weight loss and increased insulin sensitivity (IS). IS refers to how responsive your body’s cells are to the hormone insulin. When people develop insulin resistance this can lead to type 2 diabetes.

GLP-1 medications potentially can provide very positive support for overall health and wellness due to their lowering of blood sugar levels and promotion of weight loss. Many people with type 2 diabetes who are slightly overweight, or even at a normal weight and BMI, have challenges maintaining healthy insulin sensitivity, even while on medication for type 2 diabetes such as Metformin.

​One of my concerns monitoring some of my patients while on GLP-1 medications, is loss of muscle mass. Muscle is our engine in our bodies that allows us to maintain a robust metabolism. Weight loss that includes loss of muscle is going to slow our metabolic rate and leave us more prone to easier weight gain in the future. Loss of muscle mass as we age predisposes us to falling more easily and overall de-conditioning and weakness. Maintaining optimal muscle mass contributes to longevity and healthier aging. Resistance training and safe weight lifting is paramount for muscle development while on GLP-1 therapy.

Unfortunately, the very mechanisms that support the clinical efficacy of GLP-1 drugs may inadvertently compromise nutritional status. Delayed gastric emptying disrupts the normal digestive process and can impair the absorption of essential nutrients. Reduced gastrointestinal motility (movement) may also change the gut microbiota and cause bacterial overgrowth, which can negatively impact nutrient absorption.

Another concern with GLP-1 medications is that research has shown a significant association between GLP-1 use and an increased risk of developing osteoporosis, particularly in long-term users. Overall, the effects of GLP-1s on bone health are complex and may vary by specific agent, necessitating further research to fully understand their impact on osteoporosis risk. Since increasing the mechanical load on bones will stimulate bone growth, resistance exercises/weight lifting is very important to mitigate the risk of osteoporosis. Maintaining and building muscle mass is helpful for bone health as well since optimal muscle mass will support a more optimal mechanical load on the bones, stimulating more bone growth.

GLP-1 signaling inhibits gallbladder contraction and optimal digestion of fat which can effect absorption of fat soluble vitamins such as vitamins A, D, E and K, omega fatty acids and CoQ10. Thus, nutritional and lifestyle interventions can be used along with GLP-1 medications to proactively support nutrient status and safeguard long-term health. For example:

1) Encourage proper hydration with water, herbal tea and other healthy beverages throughout the day. As a rule 1/2 your weight in ounces of water is a good rule, ie: if you weight 180 pounds try drinking 90 ounces of water and healthy beverages per day. GLP-1 agonists directly suppress our thirst reflex.

2) Exercise and physical activity promote stomach emptying and intestinal peristalsis (movement). 30 minutes of walking 5 out of 7 days per week significantly improves gut motility and GI transit time. If possible even walking for 10 to 15 minutes after each meal is very helpful.

3) Given less consumption of calories while on GLP-1medications and the drugs effects on stomach emptying, gastric acidity and thus nutrient absorption, it is vital that consumption of healthy, whole foods is intentionally monitored:

 
     A. Encouraging regular consumption of whole foods rich in calcium, such as green leafy  vegetables, yogurt, cheese,             sardines, and anchovies.
     B. Rich food sources of vitamin B12 such as liver, clams, beef, eggs and dairy products (if not sensitive to lactose              and/or casein) since GLP-1 drugs are known to slow gastric emptying and alter gastric acidity, which can impair             the release of B12 from the foods we eat and this will decrease its absorption in the small intestine.
     C.Encourage adequate intake of foods rich in vitamin D, such as fatty fish and eggs. Vitamin D is the most                         common nutritional deficiency reported with the initiation of GLP-1 therapy due to decreased fat absorption              while on these medications. Most people will need a vitamin D3 supplement with vitamin K1 and K2. If you are            on a baby aspirin or other blood thinner medication speak with your doctors about how much vitamin K1 and              K2 you should take. This is to avoid and monitor blood clotting function on regular lab tests, while changing                your diet and taking any form of vitamin K.
     D. While on a GLP-1 medication it is extremely important to make sure you get enough protein per day to support            healthy muscle mass and overall health and wellness. Proper protein intake is essential for overall health. Protein            intake plays a crucial role in various bodily functions, including:    

    Muscle Maintenance and Repair  Protein is vital for building and repairing tissues, especially muscles. Adequate        intake helps maintain muscle mass, particularly as one ages. 1.2—1.6 grams of protein (depending on level of physical activity) per kilogram of bodyweight, ie: 180 pound person who is very active with regular exercise, 5 out of 7 days per week, should try and have 125 grams of protein per day and if they don’t do a lot of exercise and are sedentary, 80 grams of protein per day. For those eating smaller portions while on a GLP-1  medication this can be a challenge and should be measured throughout the day, and they probably will benefit from daily protein drinks.

    Weight Management Consuming sufficient protein can enhance feelings of fullness, aiding in appetite control and potentially supporting weight loss efforts.

     Immune Function
Proteins are integral to the immune system, helping to produce antibodies and other immune molecules that protect against illness.

     Metabolism and Energy
Proteins are involved in metabolic processes and energy production, contributing to overall vitality.


Meeting daily protein needs supports muscle health, weight management, immune function, and metabolism, making it a cornerstone of a balanced diet.

In summary, GLP-1 drug therapy can be a huge game changer in people’s overall health and wellness with improved blood sugar levels, insulin sensitivity and weight loss, especially for those who have struggled with chronic obesity and weight gain. The important caveat related to the GLP-1 medications is to eat well, consume enough protein, exercise and do regular resistance training to support optimal muscle mass and adequate caloric intake.




****Some of the information above are excerpts from a Nutritional Support Protocol Standard Process article: Nutritional Support for GLP-1 Receptor Agonist Therapy.

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