Considering Starting on a GLP-1?  What You Need to Know

Have you been thinking about starting a GLP-1 medication? If so, you will want to understand what your goals are first.  Why do you want to go on it? Is a GLP-1 is right for you? Thinking about the reasons why you want to consider going on a GLP-1 are important.  Ideally, there should be a detailed a discussion about the goals with your physician before getting started. Once you know what the goals are, you can come up with a solid detailed plan on how to get the most benefit with the least side effects. 

What are the main reasons to consider a GLP-1?  GLP-1s are most well studied for weight loss (obesity) and blood sugar control (type 2 diabetes). Of note it is also FDA approved for treatment of obstructive sleep apnea.  In my clinical experience, I also see improvements in lipid panels and inflammation markers also.  The GLP-1’s have multi-organ protective therapies with benefits spanning cardiovascular, kidney, liver, metabolic, and emerging neurologic domains as well.

Really, anything inflammatory it can be potentially helpful for. There’s some early data on it helping with cognitive impairment. There’s also some data on it for helping women with endometriosis and uterine fibroids as well. There’s a lot of research in many areas for the GLP-1s. But the devil is in the details. You want the right medication at the right dose for you. In addition, it is of utmost importance to make sure all the lifestyle factors are dialed in first. These include nutrition, sleep, exercise and movement, stress management, and toxin reduction. Nutrition and exercise are of course particularly important.  When starting on a GLP-1, your appetite is going to decrease because it slows gastric emptying, and also works on the brain to control hunger. Thus, you really do need to pay extra attention to what are you are eating.  The focus should be on getting adequate protein, fiber, and water intake.  Those are the top three nutritional advice pieces for someone starting on a GLP-1. 

Once you understand what the goals are and what the possible benefits might be, then you will also want to talk about the risks. We know it slows down gastric emptying, thus sometimes patients can experience nausea, abdominal pain, and acid reflux. These are the most common side effects. And then there are some more serious reported side effects as well. This is where, in my opinion, really good communication comes into play with a GLP-1 program. In my practice I like to have my patients check in once a week to report their weight and how they are feeling. This is so I can help guide the journey and reduce or mitigate unwanted side effects.

GLP-1’s come in both injectable and oral forms. Generally speaking, the injectable forms provide better weight loss, however, newer higher dose oral GLP-1s are making significant headway.  Most of the GLP-1 medications work only on the GLP-1 receptor.  However, tirzepatide works on 2 receptors, GLP-1 and GIP.  And next year, Retatrutide is expected to enter the market, and this will work on 3 receptor sites, GLP-1, GIP and glucagon. It is also important to make sure your GLP-1 is prescribed by a medical provider and comes from a legitimate pharmacy.  Currently, there are a lot of gray and black market options out there that have not been tested and thus lack quality and safety control. 

Current Available Once Weekly Injectable GLP-1 Medications:

• Tirzepatide (GLP-1 and GIP agonist)
• Semaglutide
• Liraglutide
• Dulaglutide

Current Available Daily Oral GLP-1 Medications: 

• Semaglutide
• Orforglipron

Of note, there are other GLP-1 medication combinations in the research pipeline, including a once a month injection, and oral medications that combine the GLP-1s with other beneficial compounds. Stay tuned! 

The injectable GLP-1s do have a fairly long half-life, of about four or so weeks. So, you really won’t fully know what it feels like to be on any certain dose until you get to about that four-week mark. With weight loss goals, we are looking for moderate weight loss of one to two pounds a week for males and for females, even half a pound to a pound a week on average.  I also have patients checking their body composition via the InBody about once a month so we can assess what’s going on with muscle mass and fat loss.  Of course, we want most of the weight that’s lost to be fat and not muscle. There are several strategies we can employ when trying to preserve muscle.  Obviously eating enough dietary protein and lifting weights are key.  But we sometimes also add in things like creatine, amino acids, and other targeted supplements to help promote muscle health. There are also some peptides that we can rotate in that help with muscle mass as well if needed. 

We know how hard it can be to lose weight and get blood sugars under good control. We know that while weight loss medications can be great options, they aren’t right for everyone. This is why our functional medicine providers offer a comprehensive, personalized approach to sustainable weight loss.  We work one-on-one with you to create a wellness plan that supports healthy weight loss.   Learn more about how we can help you here.

Resources:

1. GLP-1 Agonists
2. Dual GIP and GLP-1 Receptor Agonist Tirzepatide Improves Beta-cell Function and Insulin Sensitivity in Type 2 Diabetes
3. Safety of Semaglutide
4. Once-Weekly Semaglutide in Adults with Overweight or Obesity
5. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes
6. Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity
7. Medication-Induced Gastroparesis: A Case Report
8. Comparison of tirzepatide and dulaglutide on major adverse cardiovascular events in participants with type 2 diabetes and atherosclerotic cardiovascular disease: SURPASS‐CVOT design and baseline characteristics
9. Tirzepatide for the treatment of obstructive sleep apnea: Rationale, design, and sample baseline characteristics of the SURMOUNT -OSA phase 3 trial
10. Tirzepatide prevents neurodegeneration through multiple molecular pathways
11. Triple–Hormone-Receptor Agonist Retatrutide for Obesity — A Phase 2 Trial
12. Biology of Incretins: GLP-1 and GIP
13. GIP and GLP‐1, the two incretin hormones: Similarities and differences
14. GLP-1, GIP and glucagon receptor poly-agonists: A new era in obesity pharmacotherapy