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Your patients are aware that GLP-1s reduce appetite, curb cravings, and control food noise, but primary care providers may want to consider proactively discussing wider nutritional implications of these medications, rather than only emphasizing hunger control.

Emphasizing the Significance and Impact of Nutrition

Patients prescribed GLP-1 should adjust their dietary objectives to boost protein and fiber intake while cutting back on sugar and salt. Highlighting the significance of protein intake can help patients plan effective meals and make better dietary choices. Here’s why:

Advise patients on the power of protein. This nutritional power of protein promotes fullness and provides energy.

“From day 1, suggest both animal and plant-based protein options,” said Gayle Brazzi Smith, registered dietitian for the Orlando Health Weight Loss and Bariatric Surgery Institute in Orlando, Florida. “This will help with weight loss and for establishing healthy eating habits for the long term.” In addition, she noted that protein, along with muscle strengthening exercises and/or aerobic exercise such as simple walking, will help to prevent muscle loss.

Encourage more fiber. GLP-1s may cause gastrointestinal side effects, but fiber can help. Advise patients that low fiber can lead to constipation, while a sudden increase may cause bloating, especially for those new to these medications.

Emphasize a broad diet. Eating a variety of healthy foods in frequently small meals is “key” to obtaining the variety of essential nutrients to help with hair, skin, and nails, said Brazzi Smith.

Highlight hydration. Reminding patients to increase the intake of water or low-sugar fluids is important. Aim for 2 liters or 64 ounces per day to prevent constipation and help with satiety, she noted. “Fluids are needed to help prevent constipation and dehydration and aim for 2-3 liters per day,” she said. “Limit or avoid caffeine during weight loss due to diuretic effect with high intake of caffeine.”

Recommend small meals throughout the day. “These medications slow down absorption so the patient rarely gets hungry, and less food and fluids can lead to early days of constipation and some nausea,” said Brazzi Smith. “This is very common and will pass once patients are on a regular schedule of small more frequent meals/snacks.” Patients report doing so much better with the smaller meals with protein, healthy vegetables and fruits, and whole grain bread or cereals, she said.

The Implications of Nutritional Absorption

Reduced food intake can result in nutrient deficiencies, while delayed gastric emptying may mask hunger signals. These results could cause a decline in nutrient levels and metabolic function.

Immunity and Nutrition Implications in GLP-1 Patients

One key directive is that protein is paramount to preserving muscle tone. 

“Muscle loss is a known side effect of rapid weight loss. Without professional guidance to prioritize protein quality and resistance activity, patients may lose muscle mass which can halt weight loss over time and reduce functional strength,” said Theresa Gentile, MS, RDN, CDN, media spokesperson for the Academy of Nutrition and Dietetics and the coordinator of home enteral nutrition at Maimonides Medical Center in Brooklyn, New York. Protein is also necessary for muscle formation and maintenance and the formation of enzymes, hormones, and antibodies, she added.

And if poor nutrition habits form, nutrient losses can lead to bone loss, hair thinning, or micronutrient deficiencies, she said.

Also, immunity improvement can easily be improved with heathier food choices and adding specific nutrients from noted deficiencies such as vitamin D, folate, vitamin B12, thiamine, and iron, said Brazzi Smith. “Getting nutrients from real foods and protein from lower-fat dairy products, yogurts, and cheeses, fortified plant-based foods along with supplementation is ideal,” she said.

Recommended fiber intake is 20-25 g for adult women and 30-35 g for adult men depending on age.

“Good sources found in fruits, vegetables, and whole grains. Use of a fiber supplement can be considered in patients that cannot meet their fiber needs with food,” she said. Be sure to call out calcium, which is beneficial for bones and teeth and especially for postmenopausal women and women of child-bearing age, said Brazzi Smith.

Gentile shared other nutrients to recommend to patients:

• Iron, which helps to prevent anemia
• Magnesium, which is needed for muscle function, nerve health, and blood sugar regulation
• Zinc, which is critical for immune function, wound healing, and taste perception

No disclosures reported.