by Breanne Nalder Harward, MS, RDN
Weight loss drugs such as Semaglutide,Tirzepatide, etc. work by mimicking a hormone called glucagon-like peptide-1 (GLP1-RA) that targets areas of the brain that regulate appetite and food intake while also improving healthy blood sugar levels and insulin function. This combination results in reduced hunger and increased energy levels, which lead to weight loss. Some common side effects of GLP1- RA medications are nausea, constipation, diarrhea, and acid reflux. Management some of these side effects can be tricky and require nutrition intervention as well as supplement and medication consideration.
Managing Potential Symptoms: Nausea/Malnutrition/Dehydration
Treatment goals for nausea management are directed to prevent serious complications of persistent vomiting that could lead to dehydration, hypovolemia and vitamin deficiencies. Loss of appetite increases risk of malnutrition as well as dehydration. Dehydration can be detected if you are urinating less often than usual, have dark yellow urine, dry skin/lips/mouth, increased heart rate and dizziness. Signs of malnutrition include fatigue, mood changes, poor concentration, feeling cold, slow healing and skin changes.
Nutrition Intervention
- Choose nutritionally dense foods, full of color!
- Eat small amounts of food every one to two hours.
- Snack on foods high in protein (1g/lb/day) or carbohydrates, and low in fat.
- crackers, nuts, raw fruits and veggies, yogurt, granola, smoothies, etc.
- Avoid spicy, odorous, high-fat, acidic, and very sweet foods.
- Drink at least 30 minutes before/after solid food to minimize a full stomach.
- Fluids are better tolerated if cold, clear, or carbonated. Sports drinks and ginger ale are great for getting electrolytes and the anti-nausea effects. Popsicles or ginger chews too!
- Carbonation can delay gastric emptying, so try both still and sparkling water.
- Take vitamins with food in morning or night depending on timing needs for absorption.
Nutraceuticals
- Essential Amino Acids – Mitocore (also beneficial for energy/atp + immune support)
- Vitamin/Mineral Support – Alpha Base with Iron
- Essential Nutrition Support – Indigo Greens
Medications
- Your provider may prescribe an anti-emetic medication to help with nausea/vomiting.
Managing Potential Symptoms: Constipation
Nutrition Intervention
- Fiber: depending on your age and gender, adults should get between 22-34g per day.
- Whole grains like oatmeal, whole wheat bread or bran flakes
- Legumes: black beans, lentils and soybeans are a few examples
- Fruits: berries, apples with the skin on, oranges and pears
- Nuts: almonds, peanuts and pecans.
- Hydrate! Fiber (soluble vs. insoluble) need liquid to be absorbed and limit bowel obstruction and motility issues. Drink at least 10 cups per day, more when you exercise.
Nutraceuticals
- Fiber Plus
- Motility Pro
- Ortho-Biotic/probiotic
- Reacted Magnesium
Medications
- Bulk forming laxatives: Metamucil (Psyllium): is a bulk forming laxative: may take up to 1 tablespoon 3 times a day, this may take 12-72 hours for onset of action to occur.
- Osmotic agents: Miralax: is an osmotic agent, meaning this medication helps pull water back into your colon, softening your stool. May take 1 capful dissolved in 8 ounces of liquid once to twice daily. This may take 1-2 days to produce a bowel movement.
- Stool softener: Docusate sodium: is a stool softener. May take 100mg 1 to 2 times per day. This may take 24-48 hours to produce results.
- Stimulant laxatives: Senna: is a stimulant laxative; it affects electrolyte transport across the intestinal mucosa and enhances colonic transport and motility. Stimulants have the potential to cause some abdominal discomfort/cramping.
- Amino Acids: L-Glutamine: is an amino acid. Amino acids are molecules that play many roles in the body. Their main purpose is to serve as building blocks for proteins. Proteins are crucial to the organs. They also serve other functions, such as transporting substances in the blood and fighting off harmful viruses and bacteria. Glutamine’s immune system benefits are related to its role in intestinal health. Your intestines are a major part of your immune system. Glutamine is an energy source for intestinal and immune cells. It also helps maintain the barrier between the intestines and the rest of your body and aids with proper growth of intestinal cells. You can take L-Glutamine orally or we also offer it as an intramuscular injection.
Managing Potential Symptoms: Diarrhea
Nutrition Intervention
- Eat small, frequent meals
- BRAT diet: When reintroducing food, start with bananas, rice, applesauce, and toast.
- Avoid excessive sugar or products with sugar substitutes, fast food, caffeine, some raw vegetables like broccoli and cauliflower, and dairy products.
- Stay hydrated! Sport drinks are a good option too but be mindful that too much sugar can worsen diarrhea by causing an osmotic effect.
Nutraceuticals
- Fiber Plus
- Ortho-Biotic/probiotic
- Saccharomyces Boulardii
- Zinc
Medications
- Imodium is an OTC medication that can be used SHORT TERM for acute diarrhea.
Managing Potential Symptoms: Acid Reflux
Nutrition Intervention
- Eat small amounts of food at more frequent intervals rather than 3 meals a day.
- Wait at least two to three hours after eating before lying down or going to bed.
- Avoid foods and drinks that trigger reflux: alcohol, chocolate, caffeine, fatty foods.
Nutraceuticals
- Betaine + Pepsin
- Methyl B12 or CPC complex
- Motility Pro
Medications
- Antacids containing calcium carbonate: Mylanta, Rolaids, Tums neutralize stomach acid.
- Medications to reduce acid production: Tagamet HB, Pepcid AC, and Axid AR provide longer relief and may decrease acid production from the stomach for up to 12 hours.
- Medications that block acid production and heal esophagus: Prevacid, Prilosec, Nexium.
Weight Maintenance after GLP-1
Nutrition Intervention
- Maintain nutrient dense diet, full of color, lean protein, moderate healthy fats, and whole grains.
- Continue to focus on hydration, which includes water and electrolytes
- Exercise!
- Minimum goal of 30 mins of cardiovascular effort daily
- Strength workout 3x/week
- Core stability and stretching
Nutraceuticals
- Maintain Mitocore, Indigo Greens, and Ortho-Biotic
- Vitamin D
- Omega 3: Ortho Omega 820
- Methyl B12
- HiPhelonic
- Polyphenol blend (hibiscus and lemon verbena extracts) to maintain energy, blood pressure levels, manage weight, and increase satiety and appetite control.
- Magnesium Citrate is a cofactor in more than 300 enzyme system that regulate biochemical reactions in the body to maintain healthy BP and blood sugar.
- CM Core
- Berberine supports cardiovascular health by maintaining healthy cholesterol levels and supporting blood sugar balance
- Alpha lipoic acid (ALA) is a nutrient required for cellular metabolism, specifically the breakdown of carbohydrates and fatty acids. ALA is also a potent antioxidant. It scavenges free radicals while aiding in the regeneration of the body’s antioxidants including vitamin C, vitamin E and glutathione.
- PhytoPre
- Citrus-based prebiotic formula that provides flavonoid-rich polyphenols to promote a healthy gut microbiota composition while protecting the gut mucosal barrier and enhancing gut immunity.
For further information, questions, or to book an appointment with our Dietitian, contact Nervana Medical and ask for a consultation with Breanne Nalder Harward MS, RDN.