In the last few years Hollywood stars, wellness influencers, and the media have brought increased awareness to a class of medications traditionally used in the treatment of diabetes, and now being used for weight loss: glucagon-like peptide 1 (GLP-1) agonists. The incidence of chronic metabolic disease has continued to surge in the US and these drugs have offered a solution to help halt and/or reverse this. The medications have been controversial for a variety of reasons, and our understanding of them continues to evolve. In this article, let’s dive into what GLP-1 is exactly, how our bodies naturally produce this, and how we can support our body’s own production.
What are these medications?
GLP-1 agonists, such as Ozempic, Trulicity, and Rybelsus, are a class of medications that mimic the GLP-1 compound we naturally create in our bodies. GLP-1 is naturally produced by cells in the intestines and released into the bloodstream in response to a variety of factors. These medications activate the GLP-1 receptors to increase the downstream effects of glucagon-like-peptides, including the increase of insulin, decrease of glucagon, and delayed emptying of food from the stomach.
Who can benefit from them?
These medications were originally approved for use in patients with type 2 diabetes or cardiovascular disease (Ozempic, Rybelsus, Victoza, Trulicity, Byetta, Mounjaro), and later on approved to treat obesity (Wegovy, Saxenda, Zepbound). Only individuals with these conditions can have this medication covered by their insurance, and typically a prior authorization is required showing the failure of other medications before insurance will cover it. Anyone wanting to take this medication otherwise would need to pay out of pocket which can be a significant cost. Those taking these medications should be willing to make other lifestyle modifications such as following a healthier diet and incorporating more exercise into their routines, as studies have shown significantly improved outcomes. (1)
How do they work?
GLP-1’s primary effects include increasing satiety, decreasing hunger, decreasing stomach emptying, increasing insulin secretion, and improving insulin sensitivity. Insulin is the hormone responsible for lowering blood sugar levels in the bloodstream. These medications can also have the added effect of reducing the “noise” associated with the craving cycle. One of the many contributing factors to the development of diabetes and weight gain is an impaired level of GLP-1 secretion. When our natural GLP-1 production is insufficient, the result can be insulin resistance, metabolic disease, weight gain, and diabetes. Long story short, GLP-1 can reduce our hunger, help us feel full more quickly, and improve how our body manages blood sugar levels.
GLP-1 medications are mostly administered via injections, though oral forms exist. There are various dosing strategies including standard dosing and a newer approach with microdosing. While there are many positive effects of taking these medications, they may come with negative side effects as well. Microdosing has become a popular alternative for those hoping for the benefits of GLP-1s but with fewer side effects.
Our understanding as to why these medications are so effective continues to evolve. It could be as simple as early satiety, thus reducing caloric intake, and therefore weight loss. This is why individuals taking GLP1s should be informed about the risk of nutrient deficiencies if the diet is not addressed when the medication is started. Some would say that the benefits of improving the metabolic state and reducing excess fat tissue and inflammation outweighs the potential side effects and nutrient deficiencies.
So what can I expect?
The primary ways in which GLP-1s can help individuals lose weight is by suppressing hunger and increasing satiety. Essentially, you don’t get hungry much and when you do eat, you get full quickly. Weight loss is only going to occur when there is a reduction in your caloric intake. GLP-1s also improve how your body manages energy stores, but it’s not simply a compound that will cause you to lose a significant amount of weight unless you are also changing the way you eat.
But wait, we already make GLP-1?
That’s right. So why has our natural production not been enough to help us maintain a healthy metabolic state any longer? There are many reasons, though the primary factors are likely: the addictive nature of many ultra processed foods that override our hunger signaling pathways, the higher calorie/lower nutrient qualities of these foods, the reduced intake of dietary fiber, our sedentary lifestyles, and the influence of antibiotics and other microbiome-disrupting chemicals in our food supply.
The gut microbiome (learn more in my other blog posts here) plays a key role in the process of our naturally produced GLP-1. Our gut bacteria produce metabolites that trigger the release of GLP-1. These metabolites include short chain fatty acids (SCFAs, a byproduct of bacteria breaking down fiber), indoles (byproducts of bacteria breaking down tryptophan), 2-OG and bile acids (byproducts of bacteria breaking down fats), and lipopolysaccharides (LPS, a product of bacteria dying). (2)
How to increase GLP-1 naturally
How can we start to turn this ship around and support our own production? Mainly by addressing the aforementioned factors:
- Increase prebiotic fiber intake – fiber feeds our bacteria which in turn leads to increased GLP-1production
- Follow a more balanced whole-foods focused diet with a diversity of plant foods
- Include a healthy portion of foods high in oleic acid (which leads to 2-OG formation): extra virgin olive oil, avocado, nuts and seeds, and fatty fish
- Eat foods high in tryptophan (leading to indole formation): turkey and chicken, eggs, cheese, fish, and legumes
- Consider herbs and other nutrients that support GLP-1 production: berberine, resveratrol, cinnamon, quercetin, ginger, and much more (3)
Whether you are taking a GLP-1 agonist medication or hoping to implement strategies to improve your own natural production, it’s important to have a medical practitioner on board who can support you in achieving your health goals while ensuring the risks do not overcome the benefits.
Meet Dr. Andrew Conway
Andrew Conway, ND has a gastroenterology-focused practice at Heart Spring Health and one of his areas of focus includes helping patients achieve weight loss without pharmaceutical intervention. To schedule an appointment with Dr. Conway, call 503-956-9396 to schedule an appointment today.
References
1. Sandsdal RM, Juhl CR, Jensen SBK, et al. Combination of exercise and GLP-1 receptor agonist treatment reduces severity of metabolic syndrome, abdominal obesity, and inflammation: a randomized controlled trial. Cardiovasc Diabetol. 2023;22(1):41. Published 2023 Feb 25. doi:10.1186/s12933-023-01765-z
2.Y. Zeng, Y. Wu, Q. Zhang, and X. Xiao, “Crosstalk between glucagon-like peptide 1 and gut microbiota in metabolic diseases,” MBio, vol. 15, no. 1, p. e0203223, Jan. 2024.
3. Yaribeygi H, Jamialahmadi T, Moallem SA, Sahebkar A. Boosting GLP-1 by Natural Products. Adv Exp Med Biol. 2021;1328:513-522. doi:10.1007/978-3-030-73234-9_36