Ask the Pharmacist

Q: Before I start on a GLP-1 Receptor Agonist medication, such as semaglutide (Ozempic, Wegovy), are there any lifestyle changes I should know about?

A: Let us first give a quick summary of what GLP-1 Receptor Agonists are. But before we get into that, you may want to know that Glucagon-Like Peptide-1 (GLP-1) is a naturally occurring hormone we have in our body. Its role is to:
 

• Promote your pancreas to release insulin (a hormone that lowers blood sugar)
• Block secretion of glucagon (a hormone that increases blood sugar)
• Slow your stomach digestion (reduces blood sugar)
• Promotes a feeling of fullness.

It is amazing that GLP-1 hormones can do all that. However, in order for this hormone to accomplish these functions, it needs to connect with receptors both in our gut and our brain. Unfortunately, for people who suffer from certain health conditions, such as obesity, diabetes, and/or heart disease, to name a few, the connection of our GLP-1 hormone to the receptor is not efficient.

Over the many years, scientists and researchers have developed medications to mimic these effects with the advent of GLP-1 Receptor Agonists. They were initially promoted to help manage diabetes by reducing blood sugar levels. As was soon discovered, many people were able to lose weight while on this medication. Though its weight loss is more of a side effect, it is a welcome one for many. We are in an obesity crisis and add to that the rising cost of health care that is associated with obesity due to the increased risk factors it causes in our body.

These GLP-1 Agonists may help to reset the gut-to-brain connection in the hopes that it will tell our brain that we are indeed full and, in turn, we will consume less food. The GLP-1 medications also help with food cravings and using food as a reward. It is easy to see why many physicians are now prescribing GLP-1 Agonists to their patients for weight loss which, ideally, will reduce the health risks associated with obesity.

That all seems like wonderful effects we wish to see with GLP-1 Agonists. However, sometimes, these medications can cause too much appetite suppression, and people may either forget to eat or choose not to eat because they are not hungry or they feel nauseous.

To help reduce these unwanted side effects, it is important to start at a low dose and increase slowly. If you are experiencing any ill effects, you may wish to consider increasing your dose even more slowly. This effect should last only a few weeks while your body is adjusting to the new medication. During this phase, you may need to set reminders for you to eat so you keep your nutrition up.

Another possible concern with GLP-1 Agonists is nutritional deficiencies they may cause. Though there might already be some nutritional deficiencies in your body before you began taking GLP-1 Agonists, this can be greatly enhanced with these medications. This can be due to the nausea and/or the lack of interest in food that may occur with GLP-1 Agonists.

Some deficiencies or sub-optimal levels that can occur are:
 

• Vitamin D
• Vitamin B12
• Iron
• Calcium
• Fibre
• Protein

It is easy enough for your health-care provider to assess for deficiencies for many vitamins and minerals in your body by requesting you to get some blood work. Many of the deficiencies can be corrected with the specific supplementation. However, there isn't a blood test to evaluate protein. Though it is rare to have a protein deficiency, it is common to see sub-optimal protein levels.

The best way to assess your protein level is to look at your diet and count the grams of protein you are consuming each day. There are a few applications (apps), such as "myfitnesspal," that you can use to track the protein in your diet. This app, and others like it, will not only give you the protein levels in your food choices but will also give you the number of calories, carbohydrates, sugars, fats (good and bad), Vitamins A, C and minerals calcium, iron, and levels of sodium and potassium. This could be very beneficial to know and learn if you are consuming too much of, or lacking in, a specific nutritional requirement.

Let’s talk more about protein. How much protein should we all be aiming for? There isn't one amount or protein that is right for everyone which makes it difficult to make a recommendation. For starters, the Recommended Daily Allowance (RDA) for protein in our diet is 0.8 grams(gm)/kilogram(kg)/day and this was established to provide the minimum daily protein needs. This equates to about 55 grams of protein for a 150-pound (68-kg) body weight or 109 grams of protein for a 300-pound (136-kg) body weight.

However, it has been discovered that our body actually requires more protein during weight loss, regardless of the method used to lose the weight, in order to maintain our lean body mass and muscle mass. Therefore, it is suggested to opt for 1.2 to 2 gm/kg/day of protein to preserve our lean body mass. For the examples above, that would mean our 150-pound (68-kg) individual should consume 82-136 grams of protein daily and our 300-pound (136-kg) individual should consume 163-272 grams of protein daily.

If you entered your food into a food diary app and discovered you were low on protein, be sure to get more protein rich foods in your diet. A few examples of foods that could help boost your protein in your diet are:
 

• Greek yogourt - 125 millilitres (mL or 1/2 cup) of plain, fat-free Greek yogourt contains 11 grams of protein and you also get the added benefit of live, active bacterial cultures which are great for your gut
• Eggs - Two large eggs contain 12 grams of protein but also with added calories and saturated fat; four egg whites contain 13 grams of protein and no saturated fat
• Cottage cheese - 125 mL (1/2 cup) contains 14 grams of protein
• Nuts - 30 gm (one ounce) of dry-roasted peanuts contain seven grams of protein; 30 gm (one ounce) of whole, raw almonds contain six grams of protein
• Canned tuna in water - 90 gm (three ounces) contain 90 grams of protein
• Boneless, skinless chicken breasts - 90 gm (three ounces) contain 27 grams of protein

These are just a few examples and there are many more protein-rich foods that can be added to your diet. If you are struggling with your nutritional needs, consider booking an appointment with a registered dietitian who can help get you started on a healthy journey whether you are taking GLP-1 Agonists or not.

We will continue this topic in our next column, so stay tuned.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/.