Episode 22
THE TRUTH ABOUT GLP-1
Today's discussion centers on GLP-1 medications, elucidating their mechanism of action, their implications for appetite regulation, and the nuanced considerations surrounding their use. We aim to dispel the cacophony of conflicting information that often accompanies these treatments and provide a clearer understanding of who may benefit from them. Joining me is Kerry, a registered dietitian specializing in medical nutrition therapy, who offers valuable insights into integrating these medications into a holistic approach to health. Throughout our dialogue, we explore the potential side effects, the importance of dietary considerations, and the long-term commitments associated with GLP-1 usage. Our goal is to equip listeners with knowledge that fosters informed decision-making regarding their health and relationship with food.
Takeaways:
- GLP1 medications are designed to manage appetite by mimicking natural gut hormones, enhancing satiety.
- The dosage and frequency of GLP1 treatments should be adjusted collaboratively with a healthcare provider.
- Individuals taking GLP1 medications are advised to prioritize protein and fiber intake to mitigate side effects.
- Women, particularly those over 40, must consider the impact of GLP1 on muscle mass and overall health.
- Long-term adherence to GLP1 medications is essential to maintain weight loss and prevent weight regain.
- Monitoring for potential side effects such as nausea and constipation is critical when initiating GLP1 therapy.
Transcript
Hello, everyone, and welcome back to busy Free Mind Podcast where we talk about mental wellness, nourishment, and creating a healthier relationship with food and life.
Speaker A:Today's episode is all about GLP1 medications.
Speaker A:What they are, how they work, and what no one really explains once you start them.
Speaker A:There's a lot of noise, mixed messages, and strong opinions out there.
Speaker A:And our goal today is to slow things down and bring you clarity.
Speaker A:Joining me today is Kerry, a registered dietitian who is deeply passionate about helping individuals and families build a healthy, realistic relationship with food.
Speaker A:She specializes in medical nutrition therapy, which simply is about nourishing your body in a way that works with your current health challenges while also helping prevent future ones.
Speaker A:Let's dive into the show.
Speaker A:Hello, Kerry, how are you?
Speaker B:Hello.
Speaker B:Thanks for having me.
Speaker A:Thank you so much for joining us.
Speaker A:Give us some introduction about you and.
Speaker A:And then we jump into the topic.
Speaker B:Yeah, absolutely.
Speaker B:So my name is Carrie.
Speaker B:I'm a registered dietitian.
Speaker B:I love translating the science of nutrition to everyday choices.
Speaker B:It can be very complex when, you know, a new study comes out or we're told all these conflicting messages from different people, different sources, and sorting through that and translating that into like your everyday choice is very important.
Speaker B:And it seems simple, but it's actually pretty complex, you know, especially when you add different medical diagnoses, you know, on top of that, like diabetes or kidney problems or some mental health issues.
Speaker B:Like we start getting into eating disorders or arfid, or we have autism spectrum disorders that can really lead to some severe feeding difficulties that really up in the world of kids and their families.
Speaker B:And so navigating through that is really important.
Speaker B:And then as a 40 something woman myself, I see a lot of women who are struggling with that weight and they are asking lots of questions about GLP1s and, and that is a great thing to navigate someone through too.
Speaker A:What are GLP1 medications?
Speaker B:So GLP1s stand for glucagon, like peptide hormone.
Speaker B:So it is a hormone that our gut makes and it makes naturally all by itself.
Speaker B:Like when we eat something, your gut makes it, it, you know, releases it, it goes to your brain and says, that feels really good.
Speaker B:You know, that was a great meal.
Speaker B:And it also kind of slows down your GI tract.
Speaker B:It's supports digestion.
Speaker B:So we have mimicked this hormone and so this injection that people can take, it mimics that hormone.
Speaker B:So you feel very satisfied.
Speaker B:It reduces your appetite, it slows your digestion.
Speaker B:And you feel that, that feeling, you know, like when you eat some broccoli you don't really feel satisfied, right?
Speaker A:Yeah, yeah.
Speaker B:You know, you can eat a whole plate of broccoli but you don't feel like, ooh, that was great.
Speaker B:But that combination of food, fat and protein and fiber and carbohydrates, that leads to like that satisfaction factor.
Speaker B:That's what GLP1 mimics.
Speaker B:So people don't feel as hungry.
Speaker A:So how do GLP1 work in the body?
Speaker B:So in the body when you eat, it is released from the gut and it goes to your brain and it activates different parts of your brain, which is a whole another conversation there.
Speaker B:It has quite a few like brain like neuro neurological effects that positive at this point, at least as far as we know.
Speaker B:And so it tells your brain like, that was really good.
Speaker B:It affects your satiety and your fullness signals.
Speaker B:We know that like that gut brain access communicates in so many different ways and that fullness is really what that GLP1 is hacking into that fullness mechanism.
Speaker A:Who should consider taking GLP1 meditation?
Speaker B:Carrie?
Speaker B:So there's not a, say a particular substance.
Speaker B:I mean we know these medications are approved originally for diabetes management.
Speaker B:So you know, they're actually older than people thought.
Speaker B:GLP1, like the hormone itself was actually discovered in the 80s, so that's much older, you know, than we think.
Speaker B: st medication was approved in: Speaker B:And then as far as the weight loss, that's only about 4 years old that these have been approved for weight loss.
Speaker B:And so initially for diabetes, these are now for a lot of people who are interested in them.
Speaker B:And really the only people that really shouldn't take them or shouldn't even consider them are anyone that's had thyroid cancer.
Speaker B:It's kind of a no go.
Speaker B:Pancreatitis is another one where that this won't be an option for you.
Speaker B:And I have big red flags about teenagers being on them, which is becoming a thing.
Speaker B:And that has a lot of conservatives to go along with it, in my opinion.
Speaker B:But at the same time there are conditions where it would be appropriate.
Speaker B:Wow.
Speaker A:Can people take only for weight loss?
Speaker B:Yes.
Speaker B:You mean like only for weight loss?
Speaker A:Yeah.
Speaker B:Yes.
Speaker B:Like you can, that can be, you know, a convoluted, complicated thing.
Speaker B:I am what's called a haze aligned dietitian.
Speaker B:So HAY stands for health at every size.
Speaker B:And you know, it is the, the understanding that our health is not our weight.
Speaker B:And so we don't want to be so focused on weight that we're actually damaging Our health.
Speaker B:And we also want to recognize that you can be at a, at a larger weight and be metabolically healthy.
Speaker B:And so at the same time, though, we understand that weight complicates things.
Speaker B:It complicates how we feel about ourselves, how we are perceived in the world.
Speaker B:And that is heavy to carry.
Speaker B:And so even though I am a Hazel Line dietitian, I am not going to tell someone, oh, you're so self perception or your body image isn't a good enough reason to take a GLP one, because that's not my call to make.
Speaker B:I would, I would step in and express my concerns.
Speaker B:If there is, you know, malnourishment going on.
Speaker B:If they're a teenager, if there's a history of eating disorders, those are all red flags.
Speaker B:But, but there is really.
Speaker B:It's okay to take it just for weight loss, in my opinion.
Speaker B:Okay.
Speaker A:When you take that medication, why does appetite drops so much?
Speaker B:So it really is because of the mechanism.
Speaker B:So GLP1s are more effective than other weight loss drugs because they work in more than one ways.
Speaker B:So it works in your gut to slow down your digestion.
Speaker B:So your gut is that food is sitting there longer.
Speaker B:And when that happens, you feel full and you feel full longer.
Speaker B:And so you're not having what people call food noise, where it's constantly like, what am I going to eat next?
Speaker B:And you constantly have that food.
Speaker B:It really quiets that.
Speaker B:So the first mechanism is in your gut that it's working directly and the second mechanism is through your brain.
Speaker B:So it goes to your brain, it tells you you're full and it actually does more than that.
Speaker B:We have dopamine receptors like the reward system.
Speaker B:It actually impacts directly that reward system and it diminishes the dopamine that you get when you have food.
Speaker B:So this can be a problem sometimes if it takes away the joy of eating because eating should be joyful.
Speaker B:And so I really counsel with people to find that right dosage where you still feel some joy of eating.
Speaker B:You want to be looking forward to your next meal while at the same time quieting that food noise.
Speaker B:It really is a balance.
Speaker B:And the dosage and even the frequency, you can adjust that with your provider.
Speaker B:So you got to get to that good balance.
Speaker B:But yeah, it really does affect the brain and the gut both.
Speaker A:So wouldn't you have a long term effect if you take.
Speaker A:Now it seems, seems strange to me.
Speaker B:Yeah.
Speaker B:You mean as far as like the weight loss long term or like the brain effects?
Speaker A:No, brain, brain effects.
Speaker B:So the, the.
Speaker B:Yeah, so the brain effects are being like researched right now.
Speaker B:It's really, really interesting.
Speaker B:There's quite a few studies going on.
Speaker B:It has really been promising as far as Alzheimer's disease and, and depression and mood stabilization.
Speaker B:So what they're seeing initially and again, these are studies that are all like actively being, but that it's been beneficial in basically diminishing the number of people who've been diagnosed with these early onset Alzheimer's.
Speaker B:And they see this mood stabilization, of stabilization effect.
Speaker B:So people with depression and things like that, which often go hand in hand with obesity, like often.
Speaker B:I see that all the time.
Speaker B:They see that it's stabilizing that a little bit.
Speaker B:And some people take less of their depression medication.
Speaker B:Some people can get off of it.
Speaker B:But again, this is done with a provider, not, you know, not their own call, but we also see there's a small subset where it can make depression worse.
Speaker B:And so that is something to be aware of, that we can't say that this is this great mental health benefit, you know, for everyone, because we see that it can actually make it worse for a subset of people.
Speaker B:And so it really becomes something you have to navigate one on one, like with your provider.
Speaker A:So what should I eat first on GLP1?
Speaker B:So a lot of people are like protein.
Speaker B:Yeah, I'm gonna say fiber.
Speaker B:So one of the biggest, the biggest side effects is constipation and we need to keep things going.
Speaker B:And so fiber is so, so important.
Speaker B:You know, the, the recommendation is 25 to 30 grams of fiber.
Speaker B:And it is hard to get that.
Speaker B:It is really difficult to get that.
Speaker B:It's even harder to get that when you don't feel hungry.
Speaker B:And so you're eating less and you have to make every bite count even more.
Speaker B:You know, if you're just kind of eating garbage and then you're eating less garbage, it's not going to make you healthier.
Speaker A:True.
Speaker B:Yeah.
Speaker B:And at the end of the day, we want these GLP ones to be an improvement for our health, not just making our bodies smaller.
Speaker B:And so fiber becomes really, really important.
Speaker B:And along with that is water.
Speaker B:So sometimes I will counsel people when you first start the drug to just take it, take a stool softener, like just every day for those first couple of weeks while your body is adjusting because it almost is like a slam on the brakes of the digestion and it's hard to make it work through that.
Speaker B:And so if you're not used to eating that much fiber, which most of us aren't, most of us don't get that much fiber, you really kind of have to step up to that, like piece by piece and work through that.
Speaker B:So fiber is definitely a big one.
Speaker B:And then protein, protein is, is a really, really important one.
Speaker B:And we'll, we'll talk about a little bit later.
Speaker B:I've seen one of your other questions, but fiber is, is a really, really, really important.
Speaker B:And then your vitamins and minerals, it is very hard again to get all these, this nutrient density in a smaller amount of food.
Speaker B:And so taking a multivitamin is really a good choice for a lot of people on these.
Speaker A:So do you think the recent trend on fiber, which is fiber maxing, would help when you take this medication?
Speaker B:Possibly.
Speaker B:It really depends on how much fiber a person is eating now.
Speaker B:You know, like if they are eating, you know, a ton of fiber and they're going into GLP1, great, keep going.
Speaker B:But there's not a reason to go beyond really that.
Speaker B:30.
Speaker B:I mean, if you're a male, it's 35 grams of protein a day.
Speaker B:If you're a female, it's 30 grams of protein a day.
Speaker B:We don't want to overdo that.
Speaker B:You know, it can cause problems.
Speaker B:More of a thing.
Speaker B:It's not better.
Speaker B:Morph's not always better.
Speaker B:True.
Speaker B:Yeah.
Speaker B:And so we really want to keep that in balance.
Speaker B:But I don't see going beyond 30, 35 grams of fiber as being beneficial.
Speaker A:Right.
Speaker A:How much protein do we have to take while we on GLB1?
Speaker B:So I really recommend that people are doing 30 grams of protein three meals a day.
Speaker B:It sounds easy.
Speaker B:It's actually very hard to get that much expecting if you just don't feel like eating.
Speaker B:And the reason why is because of that muscle loss.
Speaker B:So almost a third of the weight that you lose on a GLP one can be just muscle, lean muscle mass.
Speaker B:And that is not what we want to lose.
Speaker B:And that also diminishes our metabolism because muscle is what burns calories and where our metabolism habits.
Speaker B:And so if a third of the of the weight that we've lost is muscle mass, that's like, that's not what I wanted, you know, so having that protein can diminish the muscle mass loss, but you have to couple it with weight resistance training.
Speaker B:So you have to be lifting weights or doing Pilates or swimming, which is a great weight resistance exercise.
Speaker B:Something that is supporting those muscles so they don't get lost in that weight loss.
Speaker A:If the muscle is getting lost during that period, what happens to the fat?
Speaker B:So fat will be lost as well.
Speaker B:Like it will be lost as well, but the muscle comes off as well.
Speaker B:And so we are, you know, that muscle, the muscle mass is that about a third of it?
Speaker B:It can be up to a third.
Speaker B:And so you still have like 2/3.
Speaker B:Is that fat?
Speaker B:You know, and like things like glycogen stores and water weight, frankly.
Speaker B:So that is making up a two, two thirds of it.
Speaker B:And we're like, yay, that's awesome.
Speaker B:But that third, that's, that's, you know, muscle mass, that's not so awesome.
Speaker B:So if we can get that down, there will be some muscle mass loss no matter what.
Speaker B:But if we could get that down to 10% or 15%, we would feel like that's a great success.
Speaker A:Right.
Speaker A:Why do those medications cause bloating or nausea?
Speaker B:So because of the, the impact on the gut.
Speaker B:So remember, they make you feel full.
Speaker B:You know, that's the job of this hormone.
Speaker B:They make you feel like, oh, that feels so good.
Speaker B:And so if you couple that along with your food, you can feel kind of like distended a little bit and like, oh, I feel really full.
Speaker B:People will experience what's called early satiety, where you take a few bites of your meal and you're just like, wow, I'm done.
Speaker B:Like, I can't eat anymore.
Speaker B:And it's kind of surprising to people how little they can eat.
Speaker B:And so it really becomes planning meals is very important and being aware of what you're eating is really, really important.
Speaker A:Maybe we have to load up on our supplements at the time.
Speaker A:Right.
Speaker A:Because if our.
Speaker A:The portion food portion itself is very small, then how are we going to get all the remaining minerals and vitamins?
Speaker A:Right?
Speaker B:Yeah.
Speaker B:So taking a multivitamin is great.
Speaker B:Also it can help to have some of these protein supplements, like protein drinks or like, like some go to things when you're.
Speaker B:You still have your life to live, you still have your work, you still have kids, you know.
Speaker A:Yeah, yeah.
Speaker B:It's not realistic to expect people suddenly you're spending all this time spanning a meal if they weren't doing that before.
Speaker A:Right.
Speaker B:And so Greek yogurt is one that I recommend.
Speaker B:You know, look at the brands.
Speaker B:Make sure it has like at least like 13, 14 grams of protein and so something you can take like on the go that's like.
Speaker B:And we, you know, minimal volume for maximum nutrition is what you're looking for.
Speaker B:And that really does include, you know, the fruits and the veggies and all of those things.
Speaker A:Yeah.
Speaker A:Gary, this GLP medications, does it really working on brain or our body?
Speaker A:I Mean like inside digestion process where it really works.
Speaker B:Yeah, it, it really is both.
Speaker B:And you know, I have talked to people before that actually gained weight on a GLP1 initially because they thought that it was doing something magical inside their body.
Speaker B:Like they thought that I can just eat whatever I want and it will magically, you know, do something to food.
Speaker B:You know, that's not the way it works.
Speaker B:It is just making you eat less and it's.
Speaker B:You get less of a pleasure from the food that you're eating and changing that dopamine reward system.
Speaker B:And so especially people that have like binge eating disorders, Prader like syndrome, some of those things that are, we don't, we don't understand fully complex, they can be very beneficial because they break that reward system cycle that's associated with food.
Speaker B:And so there is, there is that aspect of it.
Speaker A:Yeah.
Speaker A:How can we reduce those side effects of glp?
Speaker B:So the most common side effects are nausea, constipation.
Speaker B:And that can really be, you know, and then there's also hair loss is one which.
Speaker B:Muscle loss.
Speaker B:Those things, you know, the muscle loss and the hair loss are not caused directly by the GLP1 themselves.
Speaker B:They are a result of the weight loss.
Speaker B:So if you lose weight very quickly, a lot of weight very quickly, that's when the muscle mass really comes off.
Speaker B:And also hair loss, the hair loss has actually triggered our hair grows.
Speaker B:Okay.
Speaker B:This is a concerning one for a lot of women.
Speaker B:And so I'm a little bit for a minute.
Speaker A:Yeah.
Speaker B:But our hair actually grows and sheds and cycles naturally.
Speaker A:Yeah.
Speaker B:And so the theory right now is that this weight loss triggers a shedding cycle, intelligent phase.
Speaker B:Yeah.
Speaker B:And so it will just shed and shed and people start panicking like, oh, I'm going to be bald in a month, you know.
Speaker B:Yeah, not the case.
Speaker B:Like the shedding will stop, but if you're taking a multivitamin and you're getting your protein, that will help stop the shedding phase.
Speaker B:And it will grow back, but it will take, it'll take a year and a half or so.
Speaker B:So that's a year and a half of eating very well.
Speaker B:So that's just, that's just something, you know, to, to consider.
Speaker B:But as far as the nausea, a lot of, in the constipation, a lot of these side effects, people experience very strong when they first start the dose.
Speaker B:If you are going to a provider or a clinic, make sure they start you at the smallest dose possible.
Speaker B:We see a reduction in side effects when people do a stepwise approach.
Speaker B:You Know, you're not coming out the gate with 1 milligram of semiglutide.
Speaker B:You start at the 0.25 milligram semiglutide, you know, so we that can really help manage.
Speaker B:Also, a lot of providers will offer a Zofran prescription or an anti nausea medication.
Speaker A:Okay.
Speaker B:And I really recommend that people have that on hand because they still have to do about your real life.
Speaker B:And if you feel like you're going to vomit and you can't go to work, that's a problem.
Speaker B:And it's okay, have half a Zofran to get you to work that day because the nausea is often very temporary in the subside.
Speaker B:And so I really recommend that people ask their doctor for that, have that on hand, you know, for those times where it's just there.
Speaker B:But typically after like the first six to eight weeks, the side effects have really settled down, your body is adjusted and you can kind of, you know, they really are minimal.
Speaker A:Okay, so how long do we have to take these medications and what happens if we stop suddenly?
Speaker B:So you will see weight loss like as soon as you start taking it, because you feel the effects right away, you know, within days, you know.
Speaker B:And these drugs though, are designed to be taken for the rest of your life.
Speaker B:And that is the part that it's very, very difficult because that's a high cost, you know, that's a high commitment.
Speaker B:There's a lot going on there.
Speaker B:So we see that when people stop taking these drugs that they gain the weight in about a year and a half and that, that is, can be almost like worsted at so long because if you've lost £20 on these, on these drugs over a year and a half, that's only a weight gain of about a pound a month.
Speaker B:And you think how little we would even notice that, you know, like how, you know, a pound a month, you know, it.
Speaker B:Our weight fluctuates with how much water we drink, like our cycles, like all of those things.
Speaker B:So wouldn't alarm us, but after 18 months, that's £20 almost, you know, and so, so it is about a year and a half that people will regain the weight.
Speaker B:I recommend that people start tapering, you know, if they're not, they've reached their goal weight.
Speaker B:And then you can start tapering, you know, if you've been taking the shot like every week, you can go to every 10 days and sit there for a while, like let's do every 10 days and see how that goes.
Speaker B:If that's going well, then you go to Every other week, you know, and see how that goes.
Speaker B:And again, working with your provider to find a dosage and a frequency where you're maintaining is a good plan.
Speaker B:It is possible to wean off these drugs and maintain the leak.
Speaker B:You know, that is possible.
Speaker B:But when we see that, we study this from the perspective of, you know, many, many people, we see that most do not.
Speaker B:And so there needs to be not only this understanding that these drugs are designed to be used long term and that your appetite and all of that will come right back, you know, when you stop taking them, but while you're taking them, you also need to be developing habits that support this sustained weight loss.
Speaker B:So, you know, having three meals a day with 30 grams of protein at every meal, with vegetables, with whole grains, having these healthy habits in place will help not only support your weight loss, but your health.
Speaker B:And it is really at the bottom line, your health that we're more concerned about.
Speaker A:Right.
Speaker B:Wow.
Speaker A:That's expensive.
Speaker B:Yeah.
Speaker B:Yeah.
Speaker B:Right.
Speaker B:Yes.
Speaker B:Wow.
Speaker A:So what labs should be checked on glbs.
Speaker B:So it depends on, you know, the person's, like, personal health situation.
Speaker B:If they've gone on these drugs as partly, you know, as diabetes, definitely their blood Sugars and their A1C, that should be checked.
Speaker B:You know, hopefully they were doing that before they got on a GLP1.
Speaker B:If there's any renal issues or liver concerns, like, those labs should be checked.
Speaker B:You know, some people will suggest lipid panels that can get a little convoluted because especially for women, as we get older, our cholesterol will go up as a natural result of our hormones.
Speaker A:Right.
Speaker B:And so I'm not sure that that's the best measure, you know, these lipid panels.
Speaker B:But if there's other indications, that might be a good one to start with, too.
Speaker B:Some people will get their B12 checked or different vitamins and minerals.
Speaker B:I wouldn't say that that's something everyone needs to do.
Speaker B:But if there's a concern or if there's been a deficiency in the past, that's definitely something that should be continued to be monitored.
Speaker B:Right.
Speaker A:So we talk about women and muscle loss after menopause.
Speaker A:Definitely women are going to lose some protein.
Speaker A:I mean, muscle loss.
Speaker B:Right.
Speaker A:So when we take this GLP on medications, wouldn't it aggravate that muscle loss?
Speaker B:Yeah, absolutely.
Speaker B:And so that's why, especially, like, for a perimenopausal woman, you know, like in their 40s or maybe even like 30s, like, you really have to go into it with clear eyes about what this will do.
Speaker B:To your muscle mass and what's your plan to prevent that?
Speaker B:You need to have a plan in place and have wide eyes about that because that really determines that, you know, decades of your health as you're going.
Speaker B:You know, we want to be hiking when we're 90.
Speaker B:You know, we want to be active in doing things.
Speaker B:And so we want to make sure that we're setting ourselves up for that healthy lifestyle when we're 70.
Speaker B:When we're 80.
Speaker B:Yeah.
Speaker A:Wonderful.
Speaker A:That sums up my question.
Speaker A:Thank you so much.
Speaker A:Kerry, thank you so much for joining us today and for sharing your wisdom so generously about GLP1 medications and and viewers.
Speaker A:I hope today's episode helped clear confusion, reduced fear and gave you a more grounded understanding of what GLP1 can support and what it can look like when done thoughtfully.
Speaker A:I will see you in the next episode.
Speaker A:Bye.
Speaker A:Bye.
