Actions From Insight: GLP-1 Receptor Antagonists and Building Healthy Habits

Actions From Insight: GLP-1 Receptor Antagonists and Building Healthy Habits

[00:00:00] Welcome to Healthier World with Quest Diagnostics. Our goal is to prompt action from insight as we keep you up to date on current clinical and diagnostic topics in cardiovascular, metabolic, endocrine, and wellness medicine.

Millie Kee: In the United States today, nearly one in three adults are overweight, and more than two in five adults are obese. Being overweight or obese increases the risk for many health problems, such as type two diabetes, high blood pressure, heart disease, stroke. Liver disease, gallstones, sleep apnea, joint problems, and other conditions.

Glucagon-like peptide, one receptor agonist, also known as GLP-1s, are a class of medications that were initially developed to treat Type 2 diabetes, but were also found to be very effective for weight loss and are now increasingly being used for treating overweight and obese adults. Today we're gonna be talking more about GLP ones, their [00:01:00] impact on weight loss, and specifically how do we support nutrition when an individual is prescribed a GLP-1, and what we may be able to expect in terms of improvement in their health.

I am Millicent Key, a nurse practitioner and a clinical and education specialist at Quest Diagnostics Center of Excellence at Cleveland Heart Lab and today. I am joined by my fellow clinical educator, Patty Bianchi, who is also a registered dietician to discuss these medications and their impact on our health a bit more in detail. Patty, thank you for talking with me today.

Patty: thanks for having me, Millie. Looking forward to this.

Millie Kee: So let's start at the very beginning, which is really basic knowledge.

What are GLP-1s specifically? I.

Patty: Sure. as you mentioned earlier, GLP ones, it's an acronym and that stands for Glucagon-like peptide-1 Receptor Agonists. And we actually all have GLP-1 in our body.

It's a hormone that's naturally produced in the body, and it's released in the gut after we eat. So it [00:02:00] does a few things. It stimulates the pancreas to release insulin, which thereby lowers our blood sugar. And it also slows down gastric emptying or how quickly food leaves the stomach, so your body releases less glucose or sugar from the food you eat into your bloodstream.

And additionally, it also helps to increase satiety by affecting that area of the brain that processes hunger. As you said, these drugs are used to treat Type 2 diabetes, but are now indicated for weight loss. Because what was seen in studies was that they did not just have an impact on blood sugar, but they're also helping people lose excess weight.

So they do work in both the brain and in the stomach, it decreases our appetite, it increases that feeling of fullness and it decreases gut motility, or it slows down gastric emptying, which is basically keeping food in the stomach longer.

And [00:03:00] interestingly, we also know that it also decreases what we're calling food noise.

Millie Kee: Okay. Now I hear a lot about that from my patients as someone who has prescribed these medications, I've had my patients come back into the clinic and say, you know, I just, I don't have that constant food noise.

Can you give us a little bit better explanation? What is food noise?

Patty: Yeah, we do hear a lot about it. Think about that constant thought of what you want to eat next, or you are thinking about food a lot, or you feel like you're snacking often.

And we know that, food noise can be a little bit different from appetite or just being hungry. So I think it is important to delineate the difference there too. Physical hunger, as we know, is prompted by physiological cues. Things like your stomach growling, or maybe you are feeling lightheaded or shaky. These cues tend to subside by eating a balanced meal that gives us energy, and [00:04:00] essential nutrients.

So, regular physical hunger generally develops over time. And with genuine hunger, you're more likely to eat more of a variety of foods versus craving a specific type of food. On the other hand, when we talk about food noise, it's, kind of like that voice in your head that makes you think about what you want to eat for lunch, but you're still eating breakfast.

It's more psychological and it can even come on shortly after you're eating something, a meal or a snack. And it really involves these intense cravings for specific foods. And unfortunately, eating may not even quiet the food noise, you may continue to think about food.

So these GLP-1s , we've noticed that it tends to quiet that noise, which is such a huge benefit for these patients who are taking them and for their weight loss efforts. I. So they don't feel so bombarded with these thoughts day in, day out, hour by hour.

Millie Kee: So traditionally and [00:05:00] for quite some time now, the advice for weight loss has always been eat less, eat less food, eat smaller meals, restrict your calories. Or, there's been over the years, so many different recommended ways of eating and also of course exercising more.

But what we're still seeing is in spite of all this, people are still struggling with weight. Why add a GLP-1 to the equation? Why not just say, okay, just restrict your calories, increase your exercise, and you should be able to lose weight with just doing that alone.

Patty: This Medication, really it's another tool that we have, we know that lifestyle changes regular physical activity. Eating healthy, we know it's crucial for managing and potentially preventing things like type two diabetes, and even other chronic diseases like high blood pressure or managing high cholesterol levels.

But there are going to be people who will continue to struggle despite their best efforts at making lifestyle changes. So, this medication is another tool for the toolbox. [00:06:00] Yes, you are going to need to practice a healthy lifestyle still, but this medication, when added to a healthy nutrition plan, it's really allowing you to make those better choices.

Millie Kee: I think that's so well put. We're seeing, it's a lot easier for people to have more success with their weight management and their weight loss goals on these medications.

So, let's talk about guidelines for diet and exercise, because that's where I really wanna dive in deeply into your area of expertise, not just from a weight loss standpoint, because as we've talked about with the GLP ones, we know that a person taking this medication is very likely to lose weight.

But nutrition's still an important part of this, so how do they support their body's nutritional needs while they're taking the medication?

Patty: Excellent question these GLP-1 medications, especially from a weight loss perspective, they're newer on the market here. there is limited. Information out there on specific nutritional recommendations for people taking GLP-1s.

So additional [00:07:00] research is needed. However, nutritional recommendations for people taking these drugs can also be based on evidence from. The general population and those people following lower calorie diets or maybe those people who have had bariatric surgery. Since people taking these drugs, experience that reduced appetite and consume less food each day, there is a greater risk of developing nutritional deficiencies.

So, a healthy, balanced diet we know supports weight loss. But there are a few things that I would really stress. First and foremost, I would stress prioritizing protein, fiber rich foods, healthy fats, and adequate hydration.

Millie Kee: I wanna touch back a little bit because you talked about protein and maintaining adequate protein intake, and we are seeing that as more and more people do take GLP-1s for weight loss, that we're also seeing that they're experiencing muscle loss as well. What [00:08:00] strategies do you suggest to help prevent this?

Patty: Yeah, so one of the many challenges, first off of weight loss is that you don't just lose fat, you also lose muscle mass. So, this is a concern because it impacts your overall strength which can make it harder for you to do your day-to-day tasks, and it increases someone's risk. For falls and fractures, muscle also impacts your metabolism. Muscle tissue burns more calories than fat tissue, even when you're resting. So, more muscle mass means your body uses more energy.

Making it easier to lose weight and keep it off. So, when you lose muscle, your metabolism slows down and then you require fewer calories to even just maintain your weight the RDA, or what we call the recommended dietary allowance for protein for healthy adults is 0.8 grams per kilogram of body weight per day. But research is really showing us that higher intakes, can be more [00:09:00] beneficial, especially for those in a calorie deficit.

So, for those on GLP-1s, we're looking at closer to upwards of 1.5 grams per kilogram of protein per day. Even things like meal replacement products like protein shakes , they can be used to help meet protein needs. And I would also encourage eating high protein, foods first, especially at your meals, just to ensure that you're getting adequate protein.

Since we also know that these, GLP-1 drugs can affect our appetite and we may not be able to finish our portion. So, making sure that you're getting and eating that protein first on your plate is a great strategy to make sure you're getting that protein in.

So focusing on lean and easy, digestible protein sources is really key.Think things like eggs, chicken or Turkey, breast fish, tofu, Greek yogurt, cottage cheese, excellent sources [00:10:00] of protein.

Millie Kee: Okay, we talked about the importance of adequate protein intake as it relates to maintaining your muscle mass, and you also mentioned how it relates to maintaining our strength. The guidelines also suggest the use of exercise alongside these medications. Can you talk a little bit more about that?

Patty: So, resistance exercise or strength training anywhere from two to three times a week can optimize and help you build muscle over time and the more muscle you have. The more calories you can burn at rest this means that even when you're not working out, your body works harder, just burning more calories throughout the day.

Strength training can involve things like lifting weights or dumbbells, using resistance bands or even using your own body weight to create, strengthening. For example, think of like a squat or a pushup.

It's also important [00:11:00] to move, move more. As you know, we spend a lot of time sitting behind screens. We need to be more mindful of the importance of what we call non-exercise activity thermogenesis, or it's an acronym, neat, NEAT. So neat includes tasks that you might not even think of as exercise, whether it's cleaning your home, whether it's playing with your kids, maybe going for a brief walk with the dog or maybe even doing yard work.

So, moving more throughout the day will increase your mobility and stability. It strengthens that core. It increases the amount of calories you burn. So, I encourage you: take the stairs, park far. I know we've all heard of these tips, but they truly do make a difference. Stand up at your desk instead of sitting, pace around your office or around your, home.

These are all great ways to maximize calorie burn here. I think lastly, what I would recommend with [00:12:00] activity and exercise is just like anything, choose exercises that you find motivating and enjoyable, because at the end of the day, you are more apt to include them into your life.

Millie Kee: I really like how you're highlighting that,

Emphasis on making sure your protein intake is adequate, making sure you're getting that weight bearing exercise to maintain your muscle mass, and showing how the GLP-1s just part of a healthy lifestyle. It's more than just weight loss that we really support a person's health journey by making sure that they're also doing the other part.

To ensure that their body is really functioning as it should besides muscle loss. We hear a lot about some of the other side effects that these medications can cause.

Can you talk a little bit more about those?

Patty: Yeah, so the most common side effects are gastrointestinal related.

Things like bloating, nausea, vomiting, constipation, and even [00:13:00] diarrhea. and that's all a result of that delay in gastric emptying and the food staying in that GI tract longer. So these side effects generally are more likely to happen when you start the medication or if you're taking an increased dose.

But there are ways that we can minimize these effects. There's a few things that we can do. First, constipation can be managed by getting enough fiber in your diet and drinking plenty of water. So those are two things that I already highlighted when we were talking about things we can do within our nutrition.

So, plant-based foods are great sources of soluble and even insoluble fiber. So prioritizing fiber rich foods like beans and lentils, nuts and seeds, fruits and vegetables, they can actually help to improve digestion, and also they contribute to that feeling of fullness, which also aids in blood sugar control.

Also eating smaller, more frequent [00:14:00] meals throughout the day can help to avoid bloating and nausea, as well as eating more slowly, chewing your food thoroughly and stopping eating when you feel full, listen to the cues that your body's giving you, and you might also want to avoid like strong smells or even fatty foods and spicy foods and maybe stick to things that are a little bit more bland.

If you're experiencing bloating and nausea, things like crackers or toast or even rice sometimes even a temporary liquid diet of. Protein shakes or blended meals might help if nausea is really persisting.

We also know ginger is a well-known remedy for nausea. Ginger tea is probably the easiest way to incorporate it, and probably the most soothing on the GI system as well. Lastly, I think something else I would just be mindful of is try to steer clear of some of those sugar substitutes.

So, things like sucralose or Splenda, or aspartame are also known [00:15:00] as equal. A lot of these things are found in foods that are kind of marketed for weight loss or quote unquote sugar free, so I do think when someone's looking to lose weight, they might gravitate to those types of products but I would caution that just because those sugar substitutes can really cause some stomach discomfort as well.

Millie Kee: I definitely found that in my patients when they came back there were two top reports of GI side effects that would happen, and one was after a high fat heavy meal, particularly eating out.

Millie Kee: Anything that would cause a little bit of stomach upset anyway seemed to really be intensified on this medication. And then I would also find that too, with the sugar substitutes that you spoke of, particularly in morning coffees and things like that, they would have a good deal of nausea the rest of the day as a result.

Now, I know as a registered dietician you're a deep well of knowledge about nutrition, but I also know when you're speaking to patients that you are [00:16:00] pulling in all the parts of their lifestyle.

As far as how they can maintain their health, how they can improve their health. What other recommendations do you have for us when it comes to lifestyle?

Patty: So, some other areas to focus on, outside of nutrition and of course your physical activity.

I would look at your stress level and I would also look at getting adequate sleep. I'm sure those are two things that are not surprising to think about but chronic stress, as we know, has a pretty detrimental effect on our blood sugar levels. Insulin sensitivity as well, and just overall health.

So, it's really important to even prioritize stress management techniques. Think about what you can incorporate in your daily routine. Maybe it's a short meditation before even jumping out of bed in the morning, maybe it's a few deep breaths midday during your lunch break, or maybe it's even a short. five-minute break in nature. I'm not even saying go for a walk, just go outside. This can really, truly improve your overall quality of life.

I know I mentioned [00:17:00] sleep, lack of sleep can lead to higher levels of hunger. And can also lead to increased cravings, especially for high calorie foods. So, sleep is crucial for metabolic health. It also is essential for hormone regulation and to manage those cravings. So, aiming for anywhere from seven to nine hours of sleep per night.

It's that time for having your body to recharge.

I would also encourage you to surround yourself with supportive people, family, friends, those who are going to support you on your weight loss journey as well.

Millie Kee: I wanna pivot just a little bit before we wrap up in your role as a clinical educator and as a registered dietician, you counsel people on how to improve their cardiometabolic health, how to maintain their cardiometabolic health. You look at their labs, you help them come up with a nutrition and exercise and a lifestyle plan based on their current health status, and also based on their health goals.

So, I [00:18:00] would like to talk with you about what this would look like in a patient. As a provider, say I have a 42-year-old female coming to me for a first visit and she has a BMI of 31. So, she's in the range of obesity and she doesn't have other health issues, but she does know that her weight is problematic and that it puts her at risk for future health problems.

But she also says. But she's struggled. She's had cycles of weight gain and loss. She's tried multiple diet plans. She exercises five times a week but she just doesn't seem to be able to lose the weight. So she's probably a great candidate for a GLP-1.

And as a provider, I'm gonna be looking at it from that perspective. I'm gonna be trying to reduce her cardiovascular risk on down the road, trying to reduce her risk of Type 2 diabetes and insulin resistance and all that comes with that. So I'm gonna be focusing on, for her looking at her labs, looking at her lipid markers, seeing if there's a [00:19:00] cholesterol problem, but I'm gonna advise her to lose weight. Right. And then I'm, I'm going to send her to you. I'm gonna send her to a registered dietician to kind of get into the details about that.

So, once I've sent her to you and you guys have worked out a nutrition and exercise plan, and she comes back to me, what I've seen so often in these individuals is that they have an improvement. If their hemoglobin A1C was in the pre-diabetes range, it's, normalized. Insulin resistance on labs that's improved. If they had evidence of lipid dysfunction, that has improved.

Have you seen that when you're counseling these patients? I.

Patty: Yes, 100%. First of all, that, that picture you just painted of this woman struggling, that's someone I probably talk to every single day. And to your point, what a wonderful candidate for a GLP-1 because in addition to taking that medication, when they come to me, I can highlight and reinforce you are [00:20:00] doing the right things, but let's work on it just a little bit more. So, of course if we're looking at reversing insulin resistance and improving those cholesterol numbers. I would definitely reinforce focusing on those whole foods. How do we put an emphasis on fiber because we know that's also gonna help their glucose levels, which can also help to reverse insulin resistance. Working with them on practicing that mindful eating, making them more aware of the fact of are you hungry? Do you feel that fullness cue, even though maybe you're only halfway through your plate? It doesn't mean you have to finish what's there. Start to listen to your body.

We live in a very fast paced world. As you know, most of us multitask maybe while eating lunch and checking emails or checking our social media, but really kind of working with them on those lifestyle changes to set that aside and let's start focusing on these internal cues. I might even talk a little bit about meal timing with them.

How do we start shifting your calorie intake to [00:21:00] earlier in the day? Because if they're working all day long, they have that free time in the evening, which is the time where they unwind and usually that involves food. So encouraging them how do we shift those calories?

Eating a majority of your calories earlier in the day reinforcing that regular physical activity as well, aerobic activity, getting in that walking, moving a little bit more during their day, it's been shown that this can help blood sugar control.

So even providing those little tips to work with them and the strength training piece, we wanna make sure to maintain and preserve that muscle mass, and also build that muscle mass, which we know can improve insulin sensitivity. So, all of these different lifestyle changes that I mentioned, in addition to that GLP-1 it just compliments everything and then we see that insulin resistance score. We see that improve and get into that normal range. We see cholesterol levels improve as well. So, all of these things working together [00:22:00] is really key.

Millie Kee: Absolutely, and I love how you put that.

It's, a team effort that you can come along as a clinical educator, as a registered dietician and help them really learn how to eat well, how to feed their bodies well, how to exercise properly, how to manage their lifestyle, which is also gonna be equally impactful for their long-term health.

It just gives us that useful tool where we can all really work together to improve her health journey.

Before we wrap up, any final words? What else should we know about GLP-1s?

Patty: We know that GLP-1 drugs they're effective, they're an effective tool for overweight and obesity. But it's not a cure. Poor nutrition, lack of regular exercise, poor sleep, stress, unfortunately, those are the foundations of disease.

I always like to say one healthy behavior feeds another. So to fully harness the benefits of these [00:23:00] medications, it's really essential to compliment them with healthy lifestyle habits.

Millie Kee: I think that's an excellent point to end on, and you have given us so many good tips and such good insight today. Patty, thank you so much for joining me and sharing your expertise with us.

Patty: Thanks so much for having me, Millie.

That's a wrap on this episode of Healthier World with Quest Diagnostics.

Please follow us on your favorite podcast app and be sure to check out Quest Diagnostics Clinical Education Center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world, one life at a time.