Provide Essential Nutrition Tips for Patients on GLP-1 Agonists

Manage nutrition in patients on GLP-1 agonists to prevent deficiencies, muscle loss, and GI side effects.
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition, BCNSP

Questions are coming up about proper nutrition for patients on a GLP-1 agonist (semaglutide, etc) or GIP/GLP-1 agonist (tirzepatide). These medications decrease appetite and promote fullness which can lead to weight loss. Plus they slow gastric emptying and often cause GI side effects (nausea, constipation, etc) which further limit food intake.

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But this can increase the risk of nutrient deficiencies, muscle mass and strength loss, and bone mass loss. There’s not much evidence to guide nutrition recommendations for patients using GLP-1 agonists yet. Be ready to discuss some general nutrition tips.

  • When starting a GLP-1 agonist, caution patients about appetite changes and emphasize “starting low and going slow” with the dose. Tell patients to slow the dose titration to improve tolerability if needed so they can eat. Also encourage patients to eat smaller meals, consume food slowly and stop eating before they feel full.
  • Reinforce that every bite counts when they’re not able to eat much and a balanced diet is key to limiting malnutrition. Recommend eating nutrient-dense foods (fruits and veggies, whole grains, beans, unsalted nuts, etc) to get adequate vitamins and minerals.
    • Emphasize the importance of eating protein (lean meats, fish, lentils, etc) first with every meal to ensure they get enough. Explain that it’s needed to help maintain muscle mass and strength.
    • In general, suggest 1 g to 1.5 g/kg of protein per day. Think of this as similar to protein recommendations after bariatric surgery.
  • Encourage adequate fluids usually water or calorie-free liquids in small amounts throughout the day so patients don’t fill up on fluids.
  • Warn patients about constipation due to slow gastric emptying and eating less. Advise hydration, eating fiber-rich foods (apples, beans, etc), and suggest a laxative, such as PEG 3350 (Miralax, etc), if needed.
  • Also caution patients about possible heartburn and to avoid trigger foods, such as spicy or fried foods, tomatoes, and citrus.
  • It’s too soon to recommend widespread vitamin level checks for patients on GLP-1 agonists like we do after bariatric surgery. But screen for and treat nutrient deficiencies (B12, iron, etc) as usual.
  • Continue to recommend at least 150 min/week of moderate activity, such as brisk walking. And encourage strength training at least twice weekly to help preserve or increase muscle mass and strength.

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References

  1. Almandoz JP, Wadden TA, Tewksbury C, et al. Nutritional considerations with antiobesity medications. Obesity (Silver Spring). 2024;32(9):1613-1631.
  2. Volek JS, Kackley ML, Buga A. Nutritional Considerations During Major Weight Loss Therapy: Focus on Optimal Protein and a Low-Carbohydrate Dietary Pattern. Curr Nutr Rep. 2024;13(3):422-443.
  3. Wadden TA, Chao AM, Moore M, et al. The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities. Curr Obes Rep. 2023;12(4):453-473.
  4. Elmaleh-Sachs A, Schwartz JL, Bramante CT, Nicklas JM, Gudzune KA, Jay M. Obesity Management in Adults: A Review. JAMA. 2023;330(20):2000-2015.
  5. Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019;42(5):731-754.
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition, BCNSP