GLP -1 agonists are a class of medication that was initially approved for the treatment of type 2 diabetes. e.

It works by mimicking the effects of a hormone called glucagon-like peptide-1 (GLP-1), which helps regulate appetite and food intake. It can also slow down the movement of food through the stomach, leading to a feeling of fullness and decreased hunger. 

However, it has recently gained attention for its potential to aid in weight loss.  Millions of obese and overweight people are using this medication as a sure-fire pharmaceutical approach to weight loss, but without proper mention of the essential lifestyle and dietary changes that need to be put into place for sustained and healthy weight loss.  Ideal weight loss (from a metabolically healthy point of view) is weight loss of adipose tissue (fat), and especially the fat around and in, the vital organs.  The issue is, with any weight loss program (especially with the GLP-1 agonists) with rapid weight loss, is that loss of muscle (sarcopenia) often/does develop.    There are a number of very good meta-analyses on the use of GLP-1 agonists now, that confirm that non-fat mass loss (AKA muscle) is anywhere from 25-39%.  This is in comparison to non-dharma approaches, where muscle loss is between 10-30%. 

If you want a little context, with normal again, we lose 8% of our muscle every year.

There are controversy and debate over why this happens, and in addition to the question of “loss” is also the question of the muscle composition.  Some studies describe an improvement in muscle quality, even though there is a net loss.  But even less known, and to my knowledge, not studied is the effect on the muscle function.  Why is that important? It’s because muscle tissue ha a central role in glucose utilization, and when you reduce skeletal muscle insulin resistance is worsened. And when you are insulin resistant, blood sugar becomes more dysregulated (higher), which can and will worsen Type 2 diabetes.  What’s more is that when you have less muscle, your metabolic rate slows, which mean that you gain weight more quickly, and now what you are left with is a body that is going to gain back it’s fat, and has less muscle.  This deterioration  of body composition is going to slow physical performance, and decrease quality of life.

I hope this has begun to explain the complexities of the fat/muscle/insulin dynamic.  If we embark on this weight loss program together, we are going to work on your protein and amino acid intake, maintain and BUILD your muscles, as you lose your weight. To summarize the above, the more muscle you have, the easier it will be for you to lose weight.  Weight loss may your only goal, but my goal, as your naturopathic physician is ALSO to make your body more metabolically healthy, so you can prevent bone loss, increase your cognitive function and optimize your cardiovascular health.

In addition there will be a body-mind discussion. GLP-agonists, when used with positive behavior and lifestyle changes, help to make healthy habit creation easier and more sustainable. By increasing satiation and reducing cravings, people start to make healthier food choices from a calmer, more intentional state.  But my goal is ultimately for you to have a more stable relationship with food.

If you chose to work with me for your weight loss, I will encourage you to build a comprehensive weight loss program, which includes whole foods nutritional coaching, (focusing on an intentional/mindful eating, and nutrient dense foods), regular movement, strength training, stress management, and adequate sleep.  I will be there to help you with a lot of it, but you may also enlist other support, such as a physical therapist, personal trainer and/or a therapist.

Before considering semaglutide or any other weight loss medication, we will run labs to check the health of your liver, kidneys, and pancreas, as well as test your cholesterol levels, blood sugar, cortisol and fasting insulin levels.

Once you have reached a weight that feels good to you, we will begin to decrease the dose and frequency of your injections and bring you into maintenance phase. We continue to check in, just to make sure that you are still committed to the healthy lifestyle changes as you wean off this medication.

Like any medication, GLP-1 agonists can have potential side effects, including nausea, vomiting, and diarrhea, constipation, and fatigue. But many of these side effects can be mitigated or even avoided with some simple naturopathic techniques and dietary adjustments.

Interesting article alert: This is one favorite articles, it speaks to me because it’s just real people telling their real-life stories. But, I can’t deny, I do love the idea of the junk food industry getting crushed. https://www.nytimes.com/2024/11/19/magazine/ozempic-junk-food.html