The GLP-1 Drawback Most Doctors Don't Tell You About

What you need to know if you're on Ozempic (GLP-1) or considering it.

By: Gabby Lester-Coll

In the last two years, GLP-1 agonists — such as Ozempic — have surged in popularity, with news headlines touting their unparalleled ability to support weight loss, blood sugar regulation, and overall metabolic health.

By all accounts, GLP-1s seem like miracle drugs— and they can be life-saving for those struggling with Type 2 Diabetes and other obesity-related conditions. But since miracle drugs don’t exist and these medications are increasingly being used as a rapid weight-loss tool by those who don't suffer from obesity, we wanted to look at the unintended effects of using them.

WHAT ARE GLP-1s AND HOW DO THEY WORK?

GLP-1, or glucagon-like peptide-1, is a naturally occurring hormone in your body that plays a powerful role in regulating blood sugar levels, appetite, and digestion. The meds on the market are a class of drugs that mimic the action of this hormone, helping to lower blood sugar by stimulating insulin release and reducing glucagon secretion when glucose levels are high. They also slow gastric emptying, promoting a feeling of fullness, which controls appetite.

However, according to nutritionist and cleanse expert Elisa Goodman, “because GLP-1s override the body’s natural hunger cues, this can also lead to under-eating, which could result in malnutrition or an unhealthy relationship with food.”

Plus, when the numbers on the scale go down quickly, it often leads to unintended muscle loss along with the loss of fat— and that’s problematic.

WAYS TO PRESERVE MUSCLE MASS

Prioritize Protein: To keep muscle density at a healthy level during any rapid weight loss regimen, Goodman recommends prioritizing protein to ensure you’re meeting daily requirements (20-30 grams per meal), incorporating strength training into weekly workouts, and supplementing for bone health when needed. Her go-tos for high-protein snacks, especially when you may not feel hungry, include:

High-protein smoothies
Edamame with half an avocado and a sprinkle of sea salt
Bone broth
Goat or sheep yogurt
Eggs
animal protein (chicken, steak, salmon, other fish)
Plant-based proteins, such as pumpkin seeds, tofu and chickpeas

Strength Train: “Studies have shown that GLP-1 treatment alone (without exercise) reduced bone mineral density,” says Elena Ivanina, M.D., quadruple board-certified integrative gastroenterologist and functional medicine physician. So exercising is imperative and strength-training increases both muscle mass and bone density.

Why is this so vital? Loss of muscle mass slows down metabolism, making it harder to maintain weight loss in the long term. Also, when muscle mass declines, the body has fewer resources to draw upon during illness or injury, which can weaken immune responses and slow recovery. “Muscle wasting or atrophy (decrease in size of muscle) can lead to poor balance and frailty,” says Dr. Ivanina.

For women in particular, preserving muscle mass during perimenopause and menopause is critical, as it helps counteract many of the physical and metabolic changes that occur as estrogen levels fluctuate and begin to decline.

SHORT-TERM VS LONG-TERM -TERM USE

Data shows that patients are starting to rely on GLP-1s over longer periods to maintain certain health markers, including weight loss and blood sugar regulation— with mixed results. “When you’re relying on the medication to control appetite and maintain weight, both psychological and physiological dependencies can develop,” warns Goodman.

Over time, the body may adapt, leading to a plateau in weight loss, so many people end up putting the weight they lost back on when they stop taking the medications, or end up staying on them longer than they initially intended… maybe longer than they should.

“Long-term use of GLP-1 medications carries several potential risks, particularly around metabolic adaptation, gut health, and organ function (gallbladder, pancreas, and thyroid),” says Goodman.

Making sustainable lifestyle changes can offer some protection. Focus on eating a balanced diet, exercising regularly, and cultivating a healthy relationship with food so you can gradually wean off the medication with the support of your doctor and the use of protein-forward programs that feature high-quality sources of protein in lower volumes that may be more appealing as you transition off the medication.

Dr. Ivanina’s advice for anyone considering a GLP-1 medication: “Start low and go slow— the higher the dose the greater the side effects. Patients should check in with their physician frequently, especially before dose escalation to optimize health outcomes.”

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