What diet should you follow when taking GLP-1 drugs?

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A new study has put together optimal nutritional recommendations to help guide people taking GLP-1 drugs for weight loss. Alba Vitta/Stocksy
  • Experts have debated the best dietary patterns for people taking GLP-1 medications to maintain health as they lose weight.
  • A new review has gathered optimal nutritional recommendations available from existing research.
  • The new guidelines could prove valuable to anyone interested in losing weight in a healthy way, but they will be most helpful to healthcare professionals who prescribe these medications.

GLP-1 medications developed for treating diabetes are very effective in helping people lose weight. People taking these drugs can achieve a weight loss of up to 15% of their starting weight within a year.

GLP-1 agonists mimic the glucagon-like peptide-1 hormone produced in the gastrointestinal tract. As a result, the brain experiences fewer sensations of hunger, the stomach feels fuller with less food, and food leaves the stomach more slowly. These medications are based on the compounds semaglutide, tirzepatide, dulaglutide, or liraglutide.

Only two of these medications, Wegovy and Zepbound, have received approval from the Food and Drug Administration (FDA) as a weight-loss drug. Other GLP-1 drugs, such as Ozempic, Rybelsus, Saxenda, and Trulicity, are prescribed off-label for weight loss.

A new study presents nutritional guidelines for people taking such drugs to prevent nutritional deficiencies and work optimally for weight loss. The findings appear in Obesity.

The goal of the new research review is to present a centralized informational source based on the best current research available.

According to the study authors, nutritional recommendations could guide physicians and patients taking GLP-1 medications on what foods to eat and avoid.

Since people taking these drugs experience a reduced appetite — and consume less food each day — there is a heightened risk of developing nutritional deficiencies.

According to the study’s senior author, Lisa M. Neff, MD, executive director of Global Medical Affairs – Diabetes and Obesity at Eli Lilly and Company, evidence guiding nutritional recommendations for people treated with anti-obesity medications (AOMs) is currently limited.

“For this reason, the nutritional recommendations proposed in this review include evidence from general population health, , and VLCDs [very low calorie diets],” Neff told Medical News Today.

The GLP-1 medications in this study are collectively referred to in shorthand as AOMs.

“Our review provides targeted dietary recommendations for patients receiving AOMs, with a focus on healthy dietary patterns enabling adequate intake of energy, macronutrients (proteins, fats, and carbohydrates), micronutrients, fiber, and fluids,” Neff said.

Mir Ali, MD, a board certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, not involved in the research, told MNT the recommendations are more or less “the same kind of diet that you would recommend to anyone trying to lose weight.”

Guidelines for a healthy, balanced eating pattern to promote weight loss emphasize protein and vegetables while reducing simple carbs and sugar intake.

Neff said the study’s information will also help doctors successfully adjust a patient’s dosing if gastrointestinal adverse events, such as:

“Dietary modification may also be helpful. Patients can be advised to consume smaller and more frequent meals, stop eating prior to feeling full, and avoid foods and beverages that may worsen gastrointestinal symptoms — e.g., high-fat foods, spicy foods, alcohol, and carbonated beverages.”

— Lisa M. Neff, MD, senior study author

The review confirms the importance of following a healthy, balanced diet while taking weight loss drugs.

The information in the study is available to anyone, though it will likely be most useful to professionals working with people taking AOMs.

Weight loss drugs decrease hunger and food intake, which means that “dietary quality becomes even more important because nutritional needs must be met within the context of reduced food intake,” Neff noted.

Ali said the new dietary guidelines will help medical professionals steer their patients toward foods that are not only the most healthy but are also more likely to promote weight loss.

“What are [patients] supposed to be eating? What should they avoid? A lot of patients are unaware of these things. You have to tell them, ‘This is not going to improve weight loss if you eat these things because you’re getting too many simple carbs.’ Your body uses that as fuel rather than burning fat as fuel. Our goal is to switch your body into a mode where it’s burning fat, not just using the calories you’re consuming as energy.”

— Mir Ali, MD, a board certified bariatric surgeon

Michelle Routhenstein, RD, a preventive cardiology dietitian at EntirelyNourished, who was not involved in the research, told MNT clinicians treating people with GLP-1s should discuss the risk factors and symptoms associated with nutritional imbalances.

“Oftentimes, GLP-1 medications can over-suppress an appetite, and without proper nutrition guidance, it can lead to muscle loss, nutrient deficiencies, constipation, and dehydration,” Routhenstein said, noting the importance of consulting with a registered dietitian.

Ali agreed that dietary patterns for weight loss tend to be more safe and effective when followed under the guidance of a healthcare professional.

“When you have somebody who’s making good dietary recommendations for you and you’re following up with them on a regular basis, it makes a big difference,” Ali said. “It’s easy to slip back into old habits and start eating the wrong things.”

Neff noted that counseling people treated with AOMs can help healthcare professionals identify and manage any preexisting risk factors for malnutrition. “[It can also] provide patients with goals for the intake of key nutrients including protein, dietary fiber, micronutrients, and fluid,” Neff said.

“Ongoing monitoring during treatment can enable early recognition and management of any concerns that emerge, including inadequate nutrient intake, gastrointestinal symptoms, or mood disorders,” she added, adding that future studies could further inform best practices for people taking AOMs.

“The availability of AOMs with greater efficacy and a generally favorable safety profile may enable more clinicians to play an active role in the treatment of their patients with obesity. This review provides practical nutritional recommendations and tips for patient monitoring and management to empower clinicians and promote optimal health outcomes among patients treated with AOMs.”

— Lisa M. Neff, MD, senior study author

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