Part 1 – Managing Side Effects
As a dietitian and nutrition professional, I have worked with many clients taking weight loss medications. I am also frequently asked my opinion about these drugs with most people expecting me to be critical. My response is always the same, “New weight loss medications are a game-changer.” They have been shown to be very effective in helping individuals who have previously struggled with weight loss to experience life-changing improvements to their overall health and well-being.
You may have heard the names Ozempic and Wegovy but there are even more weight loss drugs in development. These weight loss drugs are here to stay because they work. They help people change how they eat and how they think about eating. Of course, with all the positive aspects of weight loss drugs, it is important to understand how they work, the possible side effects, and why it is still important to eat a healthy diet.
How do these drugs work?
I won’t get into the detailed mechanism of drug action but rather, I’ll focus on what happens in simple terms.
Today, these drugs are a once-a-week injection available by prescription…although pills are in the works. Based on the patient’s body weight, a physician will start with a low dose and gradually increase the dose over time to minimize side effects.
Known as GLP1 and/or GIP-RA drugs, they are class of incretin drugs or hormones that trigger the pancreas’ insulin response and receptors in the body that regulate appetite. In a nutshell, these drugs do three things to promote weight loss:
- Decrease appetite – quiet “food noise”. There is less of an urge to eat unless hungry.
- Slow gastric or stomach emptying. You get full quicker and stay full longer.
- Increase insulin production and action. Enhances the metabolism of glucose or sugar.
These drugs have been shown to be so effective that many people who have never been able to sustain weight loss through dietary changes and exercise are now losing weight and seeing improvements to weight-related health conditions, such as type 2 diabetes, cardiovascular disease, and hypertension. Some of my clients report still losing weight while eating foods like pizza, hoagies (aka submarine, hero, etc.), and desserts…just in smaller amounts.
This is all wonderful news that begs the question, “Why do I need to eat healthy and exercise if I’ll lose weight anyway?” That is a fair question, but the simple answer ‘yes’. Our bodies need a variety of nutrients and physical activity to stay strong and healthy, particularly during weight loss. A healthy balanced diet with physical activity will also increase weight loss and improve long-term health outcomes. As a dietitian, I always focus on the overall health of my clients and my goal for those taking these weight loss drugs is to:
- Manage side effects
- Stay hydrated
- Relearn hunger cues
- Emphasize adequate protein intake
- Favor nutrient-dense foods
- Promote exercise to maintain muscle mass
Managing Side Effects
Of course, there are some negative aspects of these seemingly “magical” drugs. Most people experience some side effects particularly when they first start taking them. The good news is that side effects are not typically severe and can be managed with a few simple modifications.
The gastrointestinal (GI) side effects of these drugs occur largely because of how they work. The most common GI issues are nausea, constipation and/or diarrhea, heartburn, and a feeling of being full.
Nausea usually occurs the day after or a few days after each injection. This can go away over time or may continue during the treatment. Nausea is so common that you will likely be prescribed anti-nausea medication in addition to the medication.
So, what can you do nutritionally to help like the nausea?
- Do not skip meals. When your stomach is empty your stomach acid may increase and lead to feelings of nausea.
- Eat small meals. Aim for small portions of a low-fat protein and a carbohydrate at each meal.
- Avoid too much fat. Undigested fat in the stomach can increase stomach acid.
- Snack on very small servings of simple carbohydrates (e.g., crackers, banana) when feeling nauseous.
Excess stomach acid and slow gastric emptying can also result in heartburn. To limit the effects of heartburn, eat small meals, limit caffeine and alcohol, and avoid lying down for a couple of hours after eating.
Constipation and diarrhea are also common side effects. It is important to understand that diarrhea and constipation may occur together. Thus, the term “irregularity.” The best dietary intervention for constipation and diarrhea is to have between 25 and 30 grams of fiber per day with about two liters or 70 ounces of water. Fiber and water together create the intestinal bulk required for regular bowel movements. Because of the weight loss drugs are slowing the emptying of your stomach it is important to create that intestinal bulk to move waste through the body.
Water and fiber. Increasing your water intake is vital for both fiber and the increase in protein that we’ll talk about later. You may want to add a natural fiber supplement like psyllium husks or oat bran. For example, I like to mix oat bran into my yogurt for an added fiber boost in the morning. You can also use Metamucil which is a flavored and processed version of psyllium husks that many find easier to take.
Finally, I always recommend trying to get your fiber from food if possible. Why? Because high-fiber foods also have the needed vitamins and minerals to promote general health and well-being. In fact, when you are reducing your food intake it is even more important that you try to eat foods that have more nutritional value so that you’re able to maintain your health during your weight loss.
Next week we’ll talk about Hunger v. Appetite.
For more information about healthy nutrition and lifestyle changes, contact Karen Kruza, Registered Dietitian Nutritionist at Kruza Nutrition.
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