GLP-1’S
By Sue Kangas, PA
The GLP-1’s (glucagon-like peptide-1) are the newest weight loss medications available, and they seem to be all the rage right now. Many people know these medications by the following names: Zepbound and Mounjaro, known by their generic name, Tirzepatide and Ozempic, Wegovy, Rybelsus, and their generic name, Semaglutide.
I wanted to share some information on these drugs, what they are and how they work, side affects and what can be done to try and mitigate them and the cost of these medications.
GLP-1’s are a hormone found in the intestinal tract mainly and in smaller quantities in the pancreas and in the brain. The mechanism of action is to signal satiety to the brain that in turn helps to reduce the appetite. They work by slowing down digestion which slows down the rate of food leaving the stomach which makes people feel fuller longer.
Like any other weight loss method, most people do lose weight on the GLP-1 drugs, but after a year of using the drug weight lose stalls. Why? As a person loses weight, the body becomes more efficient at using fewer calories. The same amount of effort to cut calories is met with resistance as weight loss increases our feedback control circuit stimulating the appetite which may or may not correspond to a person’s weight loss goals.
There are side effects to the GLP-1’s that can be problematic for some people. The most common side effects are GI (gastrointestinal) nausea, vomiting, diarrhea constipation and loss of muscle mass. There are ways to control these side effects. GI side effects seem to be dose dependent and normally dissipate over time. Starting with the lowest dose and tapering up the dose over many months as tolerated is helpful. Other options are to eat slowly, have smaller portions, eat a low-fat diet, take small sips of fluids, eat crackers, apples, mint or ginger for nausea. Stay hydrated by drinking 2-3 liters of water daily and avoid sports drinks, coffee, alcohol and soft drinks. To control muscle loss, engage in exercise like strength training and resistance exercises most days of the week. With the use of the internet, making a habit out of getting some exercise in our home has become much easier. There’s YouTube videos and apps that people can search for to pick an activity that they enjoy one they feel they can stick with.
There are more serious side effects, including thyroid cancer, pancreatitis and bowel obstruction. People who have a history of these conditions should be sure and tell their provider and make an informed decision as to whether trialing one of the GLP-1’s is safe.
These drugs are expensive, and many insurance companies do not cover them. There are compounding options that are less expensive for a self-pay option.
Like any other weight loss diet or medication, if eating a healthy diet and exercising habits aren’t accompanying the medication, once the drug is stopped the weight returns.
If you are interested in trying one of these weight loss medications, please see your primary care provider and have a discussion to see if they are right for you.