GLP-1 receptor agonists, also known as GLP-1 analogs medications have quickly moved to the front of the room – helping those with obesity, type 2 diabetes, appetite regulation, managing food cravings, and slowing digestion. Is it my ‘go to’? No. Could it be appropriate to consider for some people? Absolutely. Are nutrition and lifestyle modifications still key? You better believe it. If GLP-1 medications are to be considered, think of them more as a tool, not a ‘magic fix’.
What is GLP-1?
GLP-1 is an incretin hormone that is mainly synthesized in the intestinal mucosal L-cells, pancreatic islet α-cells, and neurons in the nucleus of the solitary tract. GLP-1 delays gastric emptying; this effect, however, is transient. GLP-1 plays a crucial role in regulating blood sugar; stimulates insulin release, blocks glucagon secretion, slows digestion, and regulates appetite. GLP-1 is released after a meal and alleviates hyperglycemia, increases B-cell survival, reduces body weight, and reduces inflammation. GLP-1 receptor agonists are synthetic protein preparations that have partial or complete amino acid sequence homology with GLP-1 found in the body. Unlike the natural peptide hormone, synthetic GLP-1 is resistant to degradation by the dipeptidyl peptidase 4 (DPP-4) enzyme, and thus has a longer half-life.
Why are we opting for GLP-1 Agonists?
They help to lower blood glucose levels, improve insulin sensitivity, and promote weight loss. Potential benefits may include a lower blood pressure, improved lipid disorders, improved fatty liver disease, reduced risk of heart disease and kidney disease, and delaying the progression of diabetic neuropathy. What about our mental health? For some, the use of GLP-1 agonists help quiet the ‘food noise’. Diets rich in fiber and supportive to the gut microbiome are key for enhancing the results of GLP-1 agonists or increasing endogenous levels.
Is it simply that easy?
Incorporating nutrition and lifestyle components to maximize results is strongly encouraged. These medications don’t work in isolation. Nutrition and lifestyle are key to prevent loss of muscle mass. And, if there is ever a desire or need to discontinue a GLP-1 medication, without adequate nutrition and lifestyle modifications, you will be back to where you started in no time at all. Research indicates that patients regain ~2/3 of the weight they lost once these medications are not being used. Again, this emphasizes the importance of nutrition, physical activity, and lifestyle modifications.
GLP-1 Agonist Side Effects
Common Side Effects:
Loss of appetite
Nausea – affects 50% of users
Vomiting – affects 5-10% of users
Diarrhea – affects 10-15% of users
Constipation
Abdominal pain/dyspepsia
Patients taking GLP-1 analogs, especially at a high dose, often experience delayed gastric emptying and cholestasis, so promoting appropriate gastric emptying is crucial.
Rare Side Effects:
Pancreatitis
Gastroparesis
Bowel obstruction
Gallstone attacks
Are GLP-1 Medications covered by insurance?
Possibly. If you have type 2 diabetes, insurance coverage is generally available. If you’re using one of these medications for weight loss, the likelihood of your insurance covering the cost is much less. Many people are opting to pay out of pocket though note that these costs can be significant. Average costs are frequently $1000 or more monthly. At one point, people were turning to compounded versions of these medications through specialty pharmacies to save on cost. Recent FDA regulations, however, have shut that option down. So, yes, for most, cost is a concern.
Foods to stimulate GLP-1
Foods high in protein, such as eggs, dairy, lean meats, fish, and legumes, are strong stimulators of GLP-1 secretion. High-fiber foods, especially those containing prebiotics like resistant starches, significantly increase GLP-1 production. These fibers promote the formation of short-chain fatty acids in the gut, which further stimulate GLP-1 release. Monounsaturated and polyunsaturated fats, present in foods like nuts, avocados, and olive oil, can also promote GLP-1 secretion. Certain phytochemicals, such as quercetin (found in apples, onions, and berries), have been shown to directly stimulate GLP-1 secretion. Drinking eight to 10 glasses of water throughout the day is important for appetite control.
Sunchokes, also known as Jerusalem artichokes, are high in fiber and inulin, both of which can stimulate the production of GLP-1 in the gut. Additionally, the inulin in sunchokes acts as a prebiotic, promoting the growth of beneficial gut bacteria, which can further enhance GLP-1 production.
Leafy greens like spinach, kale, and Swiss chard can help naturally boost GLP-1 levels, which are beneficial for weight management and blood sugar control. They are high in fiber, which can slow digestion and increase the release of GLP-1.
Fermented foods, packed with probiotics. These beneficial bacteria are champions for your gut health, which could have a knock-on effect of boosting the secretion of GLP-1 in your body.
Berries are rich in antioxidants and fiber. These attributes could help in slowing down the absorption of glucose and might also help increase GLP-1 levels.
Green tea/Matcha contains some caffeine that may serve to suppress appetite while not so much caffeine to disrupt sleep.
Supplemental Considerations
CaloCurb, or Amarasate, is a science-backed bitter hops extract shown to stimulate GLP-1, CCK, and PYY naturally. Taken twice daily, research suggests it decreases caloric consumption by 18%. Taking GLP-1 med injections, research suggests caloric consumption decreases by 24%. This effect lasts for 4-6 hours. Note that Calocurb is contraindicated for those with IBD.
Pendulum GLP-1 probiotic contains three-strains to stimulate GLP-1:
Akkermansia mucinphila – generates the short-chain fatty acid propionate which induce GLP-1 production
Clostridium butyricum - produces the short-chain fatty acid butyrate which induce GLP-1 production
Bifidobacterium infantis - produces the short-chain fatty acid acetate and lactate which feed bacteria such as Akkermansia and Butyricum, promoting an ecosystem in the gut that supports a healthy gut lining and naturally boosts GLP-1
Berberine regulates glucose metabolism by supporting GLP-1 production
Fenugreek contains various compounds that support glucose and insulin metabolism
Galactomannan is a type of fiber that slows sugar metabolism
American ginseng may improve glucose and insulin metabolism by modulating leptin levels.
Gymnema is associated with insulin release after eating that may serve to increase the production of GLP-1.
Key Takeaways Regarding the Use of GLP-1 Medications
Ensure adequate protein intake to preserve lean muscle mass. Aim for 1.5 gm/kg desired body weight. Divide your weight in pounds by 2.2 to determine your weight in kg; then multiply by 1.5 to determine gm protein daily. So, if you weigh 150 lbs, you weigh 68.2 kg, multiplied by 1.5. Daily protein goal would be ~103 gm.
Symptom management – yes, these meds come with common symptoms like nausea, constipation, and fatigue.
Strategies to help manage nausea
Fluids – aim to drink half of your body weight in pounds as ounces of fluid. If you weigh 150 lbs, aim to consume 75 fluid ounces daily.
Electrolytes – these can be a game changer. Be sure to include one that contains Mg and Zn beyond the usual sodium and potassium. Two good options are Seeking Health Optimal Electrolyte and Ultima Replenisher.
Start your day with ginger – ginger in your water, food, ginger tea, whatever way you enjoy ginger
Sweet foods & beverages as well as fatty/greasy foods typically exacerbate symptoms of nausea.
If you’re sensitive to smells, opt for cool or room temp foods.
Don’t want to ingest anything, simply smelling lemon balm essential oil may be helpful.
Strategies to help manage constipation
Eat a high fiber diet.
Be sure to consume enough fluids.
Foods that may be particularly helpful: kiwi, ground flax seed, chia seeds, beets, beet juice, green vegetable juice, sunchokes, dragon fruit
Consider 1 tbsp coconut or MCT oil.
Engage in physical activity.
Consider magnesium citrate and/or triphala.
Metabolic Maintenance or Pure Encapsulations Magnesium Citrate
Organic India or Metabolic Maintenance 100% organic Triphala
Consider Smoothe Move Tea (if you tolerate senna).
Seeking a fiber powder? Opt for psyllium or partially hydrolyzed guar gum (PHGG)
Organic India OR 100% organic psyllium fiber
Thorne FiberMend or Sunfiber for PHGG options
Strategies to help manage fatigue
Lots of fluids
Electrolytes daily
Aim for 1.5 gm protein/kg desired body weight daily
Include mild physical activity
Strength training is essential to support metabolism and maintain muscle mass. Incorporate strength training 3-4 times weekly. Consider assessing biomarkers – fat free mass and fat mass. Ensure that you are maintaining or increasing your fat free mass.
Support your digestion – focus on hydration and fiber to aid digestion. Aim for half of your body weight in pounds as fluid ounces. Do your best to consume 30gm fiber daily. Vegetables and fruits are great for fiber. Needing a fiber booster: consider sacha inchi seeds, ground flax seed, and/or chia seeds.
Support detoxification – Rapid weight loss may mobilize toxicity at a rate that overcomes the physiological threshold of the innate detoxification pathways in the liver, kidneys, and GI tract. Fiber is crucial.
Think long-term strategies for behavior change – These strategies are always helpful, and become pivotal if ever to discontinue these medications. Address your relationship with food.
Unless we're living under a rock, no doubt, you've been hearing the buzz about GLP-1s. I hope you found this newsletter educational and helpful.
In Health,
Natalie