Health & Exercise Forum

Part 1 of 2

The popularity of glucagon-like peptide-1 (GLP-1) medications, such as semaglutide (Ozempic, Wegovy, Mounjaro) for weight loss, have increased exponentially over the past few years. Many medical experts predict that it is only the beginning. Medicare recently announced that it will begin a pilot program for those who qualify for GLP-1. If approved and covered by Medicare, GLP-1 use will become widespread. While the potential benefits of these weight-loss drugs exceed the risk for those suffering from obesity, it is not without some risk and side effects such as gastrointestinal problems and loss of muscle mass. Following a healthy diet and engaging in an exercise program to maximize the benefits and minimize the side effects from GLP-1 medications is necessary.

GLP-1

Glucagon-like peptide-1 (GLP-1) medications, when used for weight loss, reduce food cravings, increase fullness, slow digestion and control blood glucose. However, gastrointestinal (GI) side effects and maintaining muscle mass and energy levels are common concerns. These medications are designed to mimic the action of a natural hormone GLP-1, which is produced in the intestines after eating. This hormone regulates appetite, blood sugar levels and digestion. Ultimately, by slowing digestion, GLP-1 users feel fuller for longer periods of time. A recent study published in Journal of the American Medical Association (JAMA) strongly recommends that people using GLP-1 medications eat more protein, consume smaller meals and snacks, avoid certain foods to reduce constipation, nausea and heartburn, stay hydrated, and engage in regular exercise including aerobic exercise and strength training to minimize muscle and bone loss.

Diet and Nutrition Considerations for GLP-1 Users

FOOD TO AVOID

1. High-Fat Foods
   • High-fat foods can increase nausea and bloating.
   • Fried foods: French fries, fried chicken, and doughnuts.
   • Fatty Meats: Bacon, sausage and fatty meats
   • Creamy Sauces and Dressings
2. Sugary Foods and Beverages
   • Foods with high sugar content can spike blood sugar levels which counteracts the benefits of GLP-1 medications without significant nutritional value. Some include candy, sweets, pastries, desserts, sodas, sweet teas, fruit juices which can also contribute to GI issues.
3. Starchy Vegetables and Fruits
   • Some starchy vegetables and fruits have a high glycemic index which causes spikes in blood sugar. However, due to the nutritional value that this food group provides, moderation, not elimination, is the best approach when eating potatoes, corn, and peas. High sugar fruits such as very ripe bananas, mangos, and grapes must be consumed prudently.
4. Highly Processed Foods
   • Highly processed foods are never a healthy choice and more so for GLP-1’s. They often contain unhealthy fats, sugars and preservatives that can contribute to side effects. Some examples are; fast foods, prepackaged snacks (chips, cookies), and instant meals.
5. Alcohol
   • Overuse of alcohol can contribute to GLP-1 side effects…so drink in moderation and discuss it further with your physician.

Alternative Food Choices for GLP-1 Users

While it is important to eliminate unhealthy foods from your diet as previously discussed, it is equally important to include a diet rich in nutritious and wholesome foods to prevent the loss of muscle mass associated with GLP-1 use.

1. Lean Proteins
   • Chicken, fish, and plant-based proteins such as lentils, chickpeas, and tofu.         
2. Non-Starchy Vegetables (low in carbohydrates and calories)
   • Leafy Greens (spinach, kale, Swiss chard)
   • Cruciferous Vegetables (broccoli, cauliflower, Brussels sprouts)
   •  Colorful Vegetables (bell peppers, tomatoes, zucchini)
3. Whole Grains
   • Brown rice, quinoa, oats
4. Healthy Fats (good for your health and long-lasting satiety)
   • Avocados, nuts and seeds, olive oil
5. Hydration
   • Water is the first and best option for hydration in GLP-1 users. Other options include; herbal teas, infused water with fruits and herbs.

Tips for Maintaining a Balanced Diet for GLP-1 Users

1. Portion Control – GLP-1 medications reduce hunger. Eat smaller, balanced meals.
2. Be Mindful - Listen to your body - stay focused and listen to your body…don’t eat if you’re not hungry. GLP-1’s will make you feel full if you are paying attention.
3. Regular Meal Times – try to eat meals at consistent times to avoid blood sugar spikes.
4. Consult with a Dietitian – get professional advice from a registered dietitian to tailor a plan for your specific needs.

SOURCES: Journal of the American Medical Association, Trimrx.com, National Institutes of Health

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NEXT WEEK: Part II of II “Diet & Exercise Considerations for GLP-1 Users”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!