Diet Tips
- Eat smaller, more frequent meals. Focus on high protein snacks and whole foods.
- Avoid greasy and spicy foods. One of the most sure fire ways to upset your stomach and trigger heartburn when taking GLP-1 is by over consuming fatty or spicy foods. If you do crave these, eat them in very small amounts and in the morning or early afternoon.
- Avoid sugary and starchy foods. Rice, bread, candy, cake, and cookies may not upset your stomach, but these foods all have a high glycemic index and can increase your insulin levels and make fat loss more challenging.
- Drink water and tea over carbonated beverages. Water and tea are important for staying well hydrated. Ginger tea can also help with nausea. Carbonated beverages can increase a sense of bloating and abdominal discomfort. Plus, many carbonated drinks, like soda and beer, are particularly counterproductive for shedding excess fat.
- Chew well. This will help with minimizing fullness and indigestion.
- Pay attention to the temperature of foods. Some patients taking GLP-1 agents have more stomach upset with hot or cold foods.
- Stop eating at night. Not only is eating in the evening significantly more likely to negatively affect weight loss, it also increases the likelihood of heartburn and poor sleep. Try to eat your last solid food at least 4-6 hours before bedtime.
Maintaining Muscle Mass on While Losing Weight
Adequate protein intake and resistance exercise is critical when using GLP-1 weight loss medications to prevent losing lean body/muscle mass instead of fat.
It is recommended to consume 0.5-1g of protein per pound of body weight daily. This is much higher than the recommended daily allowance (RDA) on nutrition labels as proposed by the USDA. For example, a 200lb person should eat 100-200g of protein daily to maintain healthy lean body mass. This can be achieved with a mix of animal and non-animal sources of protein (however, animal protein sources are more easily converted to muscle).
Healthy High Protein Foods:
- Chicken
- Fish
- Seafood
- Soy products such as tofu (a good option if you cannot tolerate dairy)
- Legumes (chickpeas, peanuts, beans)
- Tree Nuts (cashews, almonds, walnuts)
- Dairy (cheese, milk, yogurt) *if tolerated
Given the reduction in appetite that patients experience when taking GLP-1 agents, it is often necessary and helpful to add a protein powder supplement to water, milk, or a smoothie to boost daily protein. We recommend this organic formula which is high fiber and gluten and dairy free: (Chocolate | Vanilla )
Resistance Training
“Exercise more,” is a common recommendation from healthcare providers, but hard to follow since there are so many types of exercise with various and distinct benefits. While every variety of exercise can offer benefits, it’s important to prioritize resistance training while taking a GLP-1 agonist medication to prevent muscle loss.
Even among resistance training, there are numerous plans and programs with various types of equipment. Some examples include: Nautilus type resistance machines, resistance bands, free weights, and calisthenics. If you already do resistance training, great! Keep it up! If you have never done resistance training or it’s been awhile. A resistance band workout is a good place to start. These are affordable, portable, and can easily be adapted for your level of fitness. Here’s a great, free 10 minute beginner resistance band workout to try. We recommend doing this every other day or about 3-4 times per week.
Listen to your body! Everyone has different orthopedic issues and limitations. Don’t do any exercise that is painful. It’s ok if they’re challenging – that’s the goal – but you shouldn’t experience pain. Here’s an affordable resistance band set for under $20 to get started.
For more personalized resistance training guidance, we recommend finding a local, experienced personal trainer to advise you and monitor your progress. In the meantime, the resistance bands and 10 minute workout video are a great way to get started today! They can also be used if you’re binging your favorite Netflix show and easily packed in a carry-on to use while traveling!
Managing Side Effects
While some patients experience few or no side effects, most patients will experience at least one gastrointestinal side effect. With a few basic strategies, almost all patients can continue their GLP-1 treatment. Most side effects are gut-related and can be managed with dietary changes. Most side effects will decrease over time the longer you are on the medication.
Nausea
To manage occasional nausea (feeling queasy and an urge to vomit):
- Eat smaller meals.
- Do not take medications or supplements on an empty stomach.
- Avoid alcohol and caffeine.
- If these measures don’t work, try ginger tea.
- Flow Wellness can prescribe ondansetron (Zofran) for occasional use for severe nausea. This can cause constipation or make it worse. Do not take ondansetron every day without discussing it with your clinician.
**If these measures do not alleviate symptoms, please reach out to your provider for a check-in visit to discuss further and consider changing dosage or medications**
Heartburn
To manage occasional heartburn/acid reflux (burning/acid taste in the mouth or upper stomach after eating and/or when lying down):
- Eat more slowly and smaller portions. Stop eating when you feel 80% full.
- Reduce citrus, coffee, and spicy foods.
- Don’t eat in the 3-4 hours before bedtime.
- Use a liquid antacid according to package instructions.
- If these measures don’t work, you can try famotidine 20-40mg every 8 hours as needed. Stomach acid does have a role for healthy digestion and nutrient absorption, so it’s best to not use this medication daily without speaking to your clinician or other healthcare provider.
Constipation
To manage occasional constipation (hard stools, needing to strain for bowel movements, abdominal cramping, decreased frequency of bowel movements from normal):
- Increase water intake so that urine is the color of lemonade or lighter. Generally at least 64 ounces daily. Tea and sparkling water count. Sodas and coffee don’t
- Increase your intake of vegetables and other non-grain sources of fiber and roughage (ex: spinach, almonds, cashews, broccoli, carrots, apples, blueberries).
- Psyllium husk capsules can be used twice daily with 16 ounces of water.
- Take a magnesium supplement twice daily with food. Magnesium is important for nerve, brain, and muscle health and most people don’t get enough from their diet. We recommend two capsules of this Magnesium citrate formulation with food twice daily. Magnesium citrate is the most effective for constipation.
- Have a cup of caffeinated coffee or tea in the morning (if you can tolerate this) – caffeine is a mild bowel stimulant.
- Avoid using Zofran/Ondansetron (as able) as this can worsen constipation.
- If these measures don’t work, occasionally using a laxative such as Senna and/or Miralax (polyethyelen glycol powder) may be necessary. Use these according to package instructions and do not use either laxative more than two days per week without discussing with a healthcare provider.
Diarrhea
To manage occasional diarrhea (loose or liquid stools and having multiple loose bowel movements daily with abdominal cramping). Stools that are bloody or black should be evaluated immediately in urgent care or the ER.
- Decrease caffeine intake.
- Increase protein intake (lean meats or dairy are best if experiencing diarrhea).
- Choose vegetables over fruits (the fructose in fruits can worsen diarrhea).
- Take a multiple strain daily probiotic with food.
- If these measures don’t work, occasionally using loperamide (generic Imodium) according to the package instructions is safe. Do not use more than 2 days per week.
As always, please feel free to message your clinician to schedule a follow-up visit to discuss any questions or concerns.
Wishing you the best of health,
The Flow Wellness Team
Disclaimer: This blog post is for informational purposes only and should not be considered medical advice. Always consult with a healthcare provider for personalized medical advice.