top of page

Weight Loss with GLP-1 medications

Lindsey Harding, ND

Jul 30, 2024

GLP-1 receptor agonist medications work really well. How exactly are they working and what are the risks?

The BUZZ around GLP-1 Weight Loss Medications


GLP-1 receptor agonists work really well to help individuals lose weight, reduce blood sugar, reduce high cholesterol, and reduce the risk of serious diseases related to high blood sugar and inflammation. However, there is a catch. They work while in use, once stopped, much of the benefit disappears and many individuals report reverting back to their previous state of health unless significant changes in other areas of health were made.  In general, these medications are only recommended for obese individuals (BMI >30) or overweight individuals (BMI >25 < 30) with other health conditions.

 

Glucagon-like peptide-1 receptor (GLP-1R) is the target for GLP-1 receptor agonist medications. GLP-1R is a type of protein made by the intestines and is expressed on the surface of many cells throughout the body. It is waiting for a peptide hormone called GLP-1 to bind to it, which will activate it. This binding hormone is called GLP-1. When GLP-1 peptide hormone binds to GLP-1R, it stimulates glucose-mediated insulin production from the pancreas. This all happens in response to consuming sugar. As blood sugar level increases, the pancreas will secrete more insulin. Insulin is a hormone made by beta cells in the pancreas, and it helps the body to use sugar by removing it from the blood and delivering it to the cells that need this sugar for fuel. By activating GLP-1R, the pancreas increases insulin secretion and decreases glucagon secretion. Glucagon is made by the alpha cells in the pancreas, and its job is to prevents blood sugar from dropping too low.

In a nut shell, GLP-1R agonists stop blood sugar levels from getting too high, and help to maintain a lower steady blood sugar level, through the action of reducing glucagon. High blood sugar not only causes metabolic issues such as diabetes, but it also causes significant inflammation increasing the risk of many diseases including kidney, liver, and heart diseases. Thus, keeping blood sugar levels, and subsequently, keeping inflammation low, can be extremely helpful in the management of many health conditions.


Let’s take a deeper dive to explore these medications and the differences between them.

 

Tirzepatide (Zepbound and Mounjaro)

Prescribed for type 2 DM and weight loss.

These medications are GIP and GLP-1R agonists.

GIP is gastric inhibitory polypeptide, which is the other, aside from GLP-1, hormone secreted by the intestines upon ingestion of glucose and other nutrients. GIP stimulates insulin secretion from the pancreas, similarly to GLP-1.

These medications help to reduce weight by reducing hunger and slowing the passage of food from the stomach to the small intestine (acid reflux & nausea are common side effects as a result of this slowing).

Tirzepatide lowers blood sugar by decreasing the amount of sugar the liver makes and increases insulin production to help the cells soak up the sugar from the blood stream.

Tirzepatide may have a more significant reduction in body weight than semaglutide because it acts on 2 different receptors.

Brands of Tirzepatide:

Zepbound – approved from obese / overweight individuals who have weight-related medical conditions like hypertension or cardiovascular disease.

Mounjaro – approved for T2DM to lower blood sugar.


Semaglutide (Ozempic, Wygovy, Rybelsus)

Semaglutide is a GLP-1 agonist that decreases glucagon release, increases insulin release, delays stomach emptying and suppresses appetite. Side effects of nausea and acid reflux are common.

Brands of Semaglutide:

Wygovy - approved for ages 12 and up for obese individuals with other medical conditions.

Ozempic – is approved for Type 2 Diabetes Mellitus with cardiovascular disease and risk factors.

Rybelsus - is a tablet taken orally once daily for Type 2 Diabetes Mellitus. This medication has been linked to many serious adverse effects, some of which are irreversible, including alopecia.

 

ALL should be used in combination with diet and exercise modifications for best results.

 

It is worth noting that there is a potential side effect of pancreatitis with these medications. This is because of the stimulation to the beta and alpha cells in the pancreas. GLP-1 and GIP stimulate these cells, and in doing so, they can increase the mass of the cells. This can lead to swelling of the pancreas, also known as pancreatitis. While this side effect is uncommon, slowly increasing the dosage (vs. quickly increasing), routine check ins with the prescribing physician, and monitoring blood markers all reduce the risk of this occurring.  


Resources:

1.     “GIP and LPG-1, the two incretin hormones: Similarities and differences.” Seino, Y., Fukushima, M., Yabe, D. Journal of Diabetes Investiagtion. 2010 Apr 22; 1(1-2): 8-23.

2.     “Molecular mechanisms and therapeutic targets for diabetic kidney disease.” Tuttle, K., Agarwal, R., Alpers, C., Bakris, G., Brosius, F., Kolkhof, P., Uribarri, J. Kidney International; Aug 2022; Vol 102, Issue 2; pg 248-260.



bottom of page