Ozempic Nutrition & Weight Loss Separating Hype from Health

You know, today we've got a really exciting subject. It's all about those GPL-1 weight loss drugs, and they're huge at the moment. And I know that you're going to be breaking down the pros and cons about taking them. Welcome, Joanne, to Beyond Diagnosis Podcast.

Thank you, it's great to be back with you, Rita.

So let's dive in. With, yeah, what are weight loss medicines and how do they work?

Right, okay, so there are a couple of different classes of these meds. So the original medications were the GLP-1 agonists, and those we will recognize them under the names of things like Ozempic, Wegovy. Those were the original class of these drugs, um, and they replicated the action of GLP, the hormone GLP-1, in our systems. The latest tranche of drugs have a dual action, and those— the most high-profile name of those is Mounjaro, and they work on 2 different hormones, the GLP-1 again and GIP. Both hormones that one, they increase our levels of satiety, so they help us feel full. They reduce our levels of hunger, so they take down those hunger signals. They slow our rate of gastric emptying, i.e., slow the rate at which your stomach empties after you've eaten. So obviously keeping you feeling full. And they also— and it's specifically more the role of the GIP that enhances this effect— they increase insulin sensitivity. Going back, these drugs were originally developed to help patients with type 2 diabetes.

Yes.

And to help them achieve optimal blood sugar regulation and, you know, in certain cases helped them get off their, um, diabetes drugs.

Yes.

Um, helped put them into remission, etc. And it was found that these individuals were also losing weight. And so we kind of started to understand the dual action that they were having. But that increased insulin sensitivity improves that balance Um, and reduces the levels of insulin in our system. And of course, insulin is a fat storage hormone, so we want low levels of that. The short message, um, and I'm not very good at short messages, but the short message: we're fuller, we don't have the same hunger signals, we don't have that foodie chatter in our head, we're not constantly thinking about food. And our stomach stays full for longer. They naturally mean that we eat less. And so we are, you know, they support weight loss in that way.

Interesting. And interesting you said it works on a hormone. I never really— I didn't know that. So the GPL-1 is actually a hormone?

Yeah. And typically that is released in the body when we eat. So it'll be in response to food intake. Um, those hormones in the natural run of things get released as and when we eat. If the messages that those hormones are sending us are loud enough, are clear enough, and we're able to hear them, then they naturally help us put our knife and fork down and step away from the table. Um, these drugs effectively Um, are synthetic forms of those hormones, so they replicate the actions of those hormones.

So what happens— so my mind is going to, if those hormones are loud enough, as you said, so like they're kind of screaming at us, you've had enough, stop. So people who struggle to stop in the beginning, does that mean that they've dampened that hormone or they They don't have as much of that hormone. What is it that then we have to replicate this hormone? What's happening for those people?

Any patient is going to come in with a different backstory, um, and there could be a number of different reasons why they have been struggling with their intake or any weight loss efforts they've been making. You know, there can be lots and lots of reasons why they may have got to a certain weight and have the need or the desire to reduce the weight. It does seem as if these drugs allow them to receive those messages, hear those messages, in the same way that an individual who doesn't think about food from one meal to the next. Naturally does. You know, we have the individual that is constantly thinking about food, can't stop that chatter in their head, and that just seems to be the natural state. And then there's the individual who forgets to eat, that can go hours and not eat, and that's just their natural state. We see that these drugs seem to allow this first individual To almost then become like this second individual in terms of their relationship with food, how much food is occupying them through the day, both mentally and physically.

So it seems like it's more also personality-driven, or your type, whether you have, you know, you're a person who, you know, you get people who just love food.

Yeah.

And then you get other people who are just so disinterested in food, they couldn't care less if they ate or not. But other people have a passion for food. It's not that there's anything wrong with that. It's just sometimes, you know, you want to try everything, and it's not necessarily that healthy. So in your opinion, like, how effective do you think they are, these, these drugs?

Well, certainly, I mean, the evidence is, the evidence is very, very good. They do what, you know, they do what they're designed to do, um, versus Things like, you know, bariatric surgery, they're a lot more effective versus, it seems in these cases, versus just like traditional dieting, if we want to call it that. They're more effective. The dual-action medications, so the meds that work on both the GLP-1 and the GIP receptors seem to be a bit more effective. But on average, we are looking at between 15 and 25% of body weight being lost over a time frame of between, say, like 12 months to 18 months. So they're, you know, they are, they are very effective.

That percentage of weight loss, is that in combination Of a diet, or is— are people still eating the way they ate and this is that effective on top?

All of the research, um, all of the research papers that we've seen, um, it's medication plus lifestyle intervention. So, and then I think that's the part that's really important for anyone taking these meds to consider. I mean, there's lots of different reasons and hopefully we'll have time to go onto that, but the diet element, the wider lifestyle element is, is really, really important in the overall picture. What seems to be the case in any event is that the calorie deficit seems to be quite easy to achieve because people aren't hungry. They're not thinking about food. So in certain circumstances, it's very easy for patients to overdo it in terms of the extent of their calorie deficit. And the recommendation isn't that you eat as little as possible. Certainly, and obviously, you know, I'm in the British Isles, Rita. Here, the NHS recommendation is that you aim for a deficit of 600 calories.

Okay.

Um, now that's based on an average person. So for a woman, you'd be talking about an average of 1,400 to 1,500 calories a day. For a bloke, you'd be like 1,800, 1,900.

Right.

Um, that's the recommendation. The recommendation is such so that the metabolism doesn't take an enormous hit with, you know, basically people on the super low calorie regimes, which are, you know, can have quite an impact on the body going forward. and then contribute to weight rebound. So it's considered to be more effective to take it a bit more slow and steady and just go for regular, consistent loss.

Mm.

You know, just nice incremental losses over the weeks, over the months that you're on these meds. But as I say, lots of people find it easy to, to forget to eat or to feel like, you know, I really, you know, I don't want to have lunch. The flip side to that is that then it's really important that what you do eat is nutrient dense. So, because if you really don't feel like eating or you're thinking, right, I've only got these 1,400 calories, you've got to get the most bang for your buck in terms of, am I getting enough protein? Am I getting all of my—

Vitamins.

My vitamins and minerals, etc., because we need to maintain good health while we're doing this.

What about the fact that there's been in many papers write-ups around people having digestive issues and diarrhea and headaches, and, you know, some have heart palpitations, or, you know, some feel very, very tired, like they want to sleep all the time? What's happening there for people?

Yeah, those are amongst— you're absolutely right, Rita. Those are amongst some of the most common symptoms that people can experience. And I think this is another reason why it's wise to be quite diligent with your diet. Oh, you mentioned things like, you know, like headaches and fatigue and what have you. Sometimes one of the, you know, the contributor to that can be that these drugs, they don't just interfere with our hunger signals, they also interfere with thirst signals.

Oh, I see.

So we can get— we can forget to drink. So dehydration can be an issue. And then of course that has the knock-on effect. So we have to be very mindful about that. And maybe at the start we need to set a reminder in our, you know, in our phones to have a drink, get a glass of water, um, and to eat well so that we can Mitigate against some of those digestive system symptoms. So we've got reflux, bloating, diarrhea, constipation. These are all fairly kind of common side effects with the meds.

Yes. Yeah, I do know some people who are on these medications and they do have a lot of that, including vomiting and things. So it is something to be aware of. So Who can be prescribed these drugs? This is kind of like a 2-part question. So who can be prescribed these drugs? And then the second part, who shouldn't take them?

If we go to our, we go to our medical practitioner, so we go to our GP, certainly in the UK, there is a number of criteria that are applied. Our GP will prescribe it on the NHS. If we are a type 2 diabetic, Hmm. and assuming that there aren't any other contraindicating conditions or whatever, obviously we'll assume everything's fine. You're a type 2 diabetic, everything else is clear. You know, this could be something that your doctor will be happy to prescribe for you. So that's one criteria. Another one is that you have a BMI of 30 or above, so that puts you in the obese category. A 3rd category is that you have a BMI of 27 or above, and you also have a, what we call a comorbidity. So another condition that would be, that would, that would benefit from weight loss, benefit from better blood sugar regulation that these, that these drugs can, can offer. So there are kind of those, those categories within the NHS. Of course, there are a lot of other routes to get these, get these drugs. As you know, I'm working alongside a private GP practice, and, and the doctors there will, will apply their criteria for that. One thing I would always recommend, as you know, I mean, I'm not a doctor, but as far as these meds are concerned, for me, They're like any meds. Please, in the first instance, regardless of what happens in 2, 3, 4 months' time, please in the first instance talk to a doctor about them. Make sure they're appropriate for you.

Yes.

Because they are available online. You can go to an online pharmacy. To a certain extent, you can put whatever information you want In that application. There are meant to be safeguards. Certainly in the UK, there has been conversations around those safeguards needing to be tightened up. I think for your— there are risks and benefits with any medication. It's still a drug. Please talk to your doctor. Make sure that this drug is appropriate for you. Make sure you're taking it safely.

Yes, that's so important, that, yeah, self-prescribing or jumping on the bandwagon of what you think is the current trend is dangerous, you know.

Yeah, yeah, it really is. Yeah, it is. I mean, I'm— as I'm sure you are, you know, I'm, I'm a member of a number of different online, online groups, and I see comments coming through, people asking. Um, there was one the other day I saw, somebody had a BMI of 24, which is Happily within a normal weight. Obviously, we know BMI is a very blunt tool, but she had a BMI of 24, so she was perfectly healthy as far as, you know, that categorization was concerned. But she wanted her BMI to be lower. She didn't say why. Can I get prescribed Ozempic? The vast majority of responses, thankfully, were, why? Why would you want to do this? You know, you're perfectly healthy.

Yes.

You don't, you know, you know, this isn't for you. It's— this isn't, you know, that's not what these drugs are for. But clearly there are a lot of individuals, whether it's— whether they think it's, um, an easy answer, whether they think it's a fast-track route, whether they think it's getting on the bandwagon, or there's some kind of body dysmorphia or whatever it is. There are certainly a lot of people interested in taking the drugs if they're not already taking the drugs that perhaps shouldn't be.

Is there any precondition or any condition that someone has of why they shouldn't take these drugs if they're considering going to their doctor to talk about it?

I mean, clearly, if somebody is, you know, in most cases where somebody has an ongoing cancer treatment, of, you know, of certain types, that's going to be typical— that's more likely than not it's going to be ruled out. Um, if somebody has the gastrointestinal symptoms that people can have, if somebody has a severe gas, you know, gastrointestinal disease, this is not going to help them. If somebody has an eating disorder, clearly this is not a route that they want to, you know, that they, that they should be going down. So there are different categories of, of people.

Mm-hmm.

But again, it goes back to please talk to your doctor, make sure it's appropriate for you. And if you're told it's not appropriate, then please heed that advice. Please do. Yeah.

You're a nutritionist, so as a nutritionist, how are you— why are you interested in these drugs? And if someone is If they are on these drugs, would they need a nutritionist to help them?

I suppose the second half of that question is, I suppose it depends how food savvy they are, um, in the first place. As you know, as we've discussed, these, these meds are everywhere. You know, they're all over our media. We all know somebody, at least one person if not a group of people, who are taking these medications. So, given that, you know, given the area I work in, it, it's something I felt that, well, I should know about this. This should be something that I'm able to have a conversation about. But also, I think, as I've already alluded to, all of the trials, the results included lifestyle. It included lifestyle counseling. And as I've said, what these drugs are doing is replicating the actions of hormones that we do naturally produce. So if I can work alongside somebody who's maybe already taking these drugs or has stopped taking them and is now wanting to maintain that weight, if I can support them in stimulating a natural production of these hormones, then that is going to mean it's going to be an awful lot easier for them to, one, lose the weight healthily, um, and to maintain that weight going forward. And hopefully, in, you know, in a lot of cases, not need to go back on the meds.

Yes.

Because they've got all the different tools at their disposal. And there are different foods that we know do naturally stimulate These, um, you know, these hormones. Um, it's unfortunate that those foods aren't the ones that by and large form the bigger part of our, our really crappy diets. You know, it's the— You know, a lot of the refined processed foods that make up such a big part of our standard Western diet. dampen down the effects of these drugs. Um, they don't keep us full. They're designed to keep us grazing through the day. If I can help somebody move all that stuff off their plates and then replace it with the stuff that's going to naturally stimulate these hormones, then hopefully that's me doing a good job.

Yes.

Um, and empowering that person to not need the drugs and ultimately not need me either.

Just because you're on one of these weight loss drugs doesn't mean you don't take a holistic approach. It's a bit of everything. And one of the common side effects that I've read about is that people, they really easily regain the weight after they stop these medications. So is that what you help educate someone about? Like the type of— what type of food specifically would really help them?

Encouraging them to fill up the bigger part of their plate with those foods that are going to keep them full, are going to stop that chatter in their heads. A lot of it is really kind of basic stuff, but we know that, um, having a high-fiber diet keeps us full for longer, um, and it promotes the production of GLP-1 in the gut. It promotes the production of the hormone that tells us we're full. You don't want to eat anymore.

Mm.

So if we're eating, um, getting lots of beans in our diet, lots of lovely vegetables in our diet, um, we're having our minimally processed oatmeal in the morning and, you know, and our lovely nuts and seeds and all these sources of fiber keep us full. And as I say, naturally provoke the, the secretion of these hormones that are gonna— the messages are gonna go to our brains and tell us that, all right, you're done for now, give it a few hours, um, and, and then we'll let you be hungry again.

What I'm hearing from what you're saying is that— and I don't know, please explain further on this— is if you have a very processed diet, does the fact that you've been on this processed diet dampen the gut, the GPL-1 hormone in your gut, whereas you're just saying the fiber, the beans, and everything sort of stimulates that hormone?

Yeah, yeah. Um, well, yeah, the evidence, the evidence that we've seen— so diets that are high in sugar, that are high in processed foods, that are devoid of, you know, they've had the fiber stripped out Um, et cetera, they do seem to impair the secretion of these satiety hormones, um, and they make us less sensitive to insulin. Um, and of course, that's one of the steps that takes us on the road to insulin resistance and ultimately potentially type 2 diabetes. I mentioned before that kind of made highlighted the difference between the individuals that are constantly thinking about food and those that it's fuel. They're not interested.

Hmm.

And, you know, and they can go all day and then realize that they've not eaten. That's kind of, that's kind of one part of the equation. But for me, that's a relatively small part. The bigger part of the picture is that, as I mentioned, we are living Within this awful food environment where the food is designed to, to make us overeat, the nature of the food means that all of these different hormone responses are dampened down; they're suppressed. So we don't—we just don't get the messages from our bodies anymore. So we don't—we don't get the—the signal that. You've taken in enough calories, you've taken in enough energy because we haven't got the nutrients in the food to trigger those messages being sent. So we just keep grazing. There's no fiber in the food. So our stomach's empty really quickly. Again, it's, there's nothing there that, that allows our bodies to work as they should. So I think the bigger food environment is such an enormous part of it. So if I can be part of that reeducation and encouraging people to look away from those aisles in the supermarket and focus more on— typically what you need to do is stay on the outer aisles. You know, that's where all your fresh produce is. Stay on your outer aisles and just avoid all the stuff that's boxed and, you know, and comes with, you know, all that bright packaging. Yes, it's just a no. That's a giveaway. Stay away.

So it sounds like, you know, definitely with that food, you know, it's that misconception we might be eating, we might be full, but we're not nourished. We are.

Yeah, we are taking in, um, that excess of energy, those— that excess of calories, but we're malnourished at the same time.

Yes, yes, I know. It's a struggle. No wonder why these drugs have come out, no wonder why so many people want to be on them, because it gives you that— it's give you— it's giving you what your body's not able to do anymore.

Yeah.

So, you know, we've talked about the, the pros. You know, it's fantastic for people with type— especially with type 2 diabetes, you know, for their insulin. It's also, uh, great for people with a high BMI, but What about some of the cons? Like, does it actually change those gut hormones so you're— you don't have a— you permanently have a reduced appetite? Like, you just can't get your appetite back once you stop these drugs?

Doesn't seem to be, um, what the evidence— what we're seeing as far as the evidence is concerned. That, in fact, it still seems to be that over time, even when we're taking the drugs, we will start to We will start to have a sense of a greater appetite over time, not necessarily as it was previously, but from starting out with very, very low appetite base, it will start to come back over time, even whilst we're on the meds. But no, it doesn't seem to be the case that once a patient comes off the medication that they are almost—

Normal.

left in no man's land, for want of a better expression, in terms of I'm not getting any signals at all from my body.

Because there's no behavior modification around taking these kind of drugs, and someone may have had, like we were saying, a very depleted sort of diet, you know, a very processed sort of diet, and they want to continue a processed sort of diet, can there be a dependency on these drugs? Is there that concern around dependency?

Well, well, I'm not aware that there is any physical dependency that develops with the drugs. I'm not aware of, and as you know, Rita, I'm not a doctor, but I'm not aware of any. But I think certainly from anecdotal evidence that I've heard, that I think there can certainly become a psychological dependency on it where people are almost afraid to come off the drugs because they're, they're worried about basically they're just going to go back to how they were. Or it's not even an element of fear, it's just a, no, I'm staying on these for life because I, you know, I finally got the body that I want. I'm finally the size I want to be. I'm finally the weight I want to be, or whatever it is. And I'm refusing to come off. No, it's not going to. And obviously then people are using the black market and all the rest of it. As I say, anecdotally, We have seen some of that. In the normal run of things, if somebody hasn't initiated the lifestyle changes and they come off the meds and they go back to their old diet, then you're inevitably going to see the rebound. I mean, on average, we do see some rebound anyway. Again, it tends to be less of a rebound if you're on the dual action drugs, so the likes of Mounjaro, making the lifestyle changes, including those foods that naturally prompt the release of these hormones. So the fiber I've talked about.

Yeah.

Protein, another one, particularly in the morning, getting a really high protein breakfast. Top tip, getting a really good high protein breakfast, um, seems to trigger a greater release of these hormones than at any other time of the day.

That's interesting.

Protein has a higher effect at that time of day. Why? I don't know. A microbiologist would, or an endocrinologist would probably be able to tell you. But that's to say, that's just what we're seeing in the evidence. Adopting, you know, that, that healthier lifestyle, um, including movement evidence, um, exercise of some nature. In your, you know, in your day-to-day existence is going to help, not just in terms of calorie expenditure, but in how exercise can help stabilize blood sugar levels. It helps with the secretion of, again, these hormones. Avoiding stress, because that plays havoc with our, you know, with our hormones across the board. But that plays havoc particularly with our blood sugar regulation, um, and can impair the secretion of these particular gut hormones, the GLP-1, etc., that we've been talking about. So holistic care, think about it holistically. You know, it, it maybe starts with the medication, but that's just one part of the overall picture.

Yes, and it really sort of um, talks to people really taking responsibility around their own health and educating themselves and understand, like, you know, nutrition is everything, you know, like—

Oh, yeah.

Or to seek out someone like you, a nutritionist, and say, how can I support myself whilst on this medication with good nutrition? I think that's like just so important. You can't go past it. There's no— I don't think there's any get-around Healthy food outside, like in addition to weight loss, in your research, have you found that there's any further benefits for people's health in taking these medications?

It's interesting, and the research is continuing. Um, they've even— we're even seeing emerging evidence, um, around potential, potential protective effects against things like Wow. Yeah, it's— I'm obviously— this is, you know, it's early doors, but, um, they're seeing some kind of protective effect against those neurodegenerative disorders. Um, but it appears to also be helpful, um, with things like, um, fatty liver disease, with PCOS, so polycystic ovarian syndrome. Um, seems to be helpful for that. Diabetes we've touched upon. Also seems to be helpful where somebody has, um, hyperlipidemia— so, um, lipidemia, I should say. So basically high levels of your cholesterol, etc. So it seems to be helpful in those cases. Yeah, I think, I think the, you know, the scientists are quite excited. I bet.

That's a fair list, which actually, you know, As you were talking, it really sparked my curiosity, as in, if these drugs work on the GPL-1 gut hormone and lowering our insulin, making us more insulin sensitive, Mm-hmm. is it the drug that's helping these other conditions, or is it that if we raise our GPL-1 naturally through diet and lower our insulin That it would have the same effect on these conditions that you've just mentioned?

I suppose if we look at the example of a condition that's more in my kind of, you know, my wheelhouse, which would be the likes of PCOS, because, you know, I mean, obviously my, you know, to date I have been, you know, most of my work has been around hormone balance. But, um, so if we look at the likes of PCOS though, we already know that somebody Losing weight, that more than likely is is helpful with the symptoms of PCOS. Somebody improving their insulin resistance tends to be helpful in cases of somebody with PCOS. There tend to be there tends to be a bit of a symphony of different metabolic abnormalities going on with that particular condition. If we're seeing a resolution in some of those, then It's then we're starting to see, you know, as I say, this kind of ripple effect with all of these conditions that to a certain extent have these same issues at their root.

But it does, in my mind, it sort of makes sense that if you can— I mean, there's obviously other benefits to these drugs that, you know, that scientists and the medical profession will find out in the long term. But in my mind, it was like, you know, well, if food can do that, But again, some people, you know, like we said before, are a bit more addicted to the processed foods, or they just don't care about foods, or they're just, you know, they find it hard to have that, uh, wholesome sort of diet like you were saying, the nuts.

Or they could be living in a food desert, or— Yes. Um, or their socioeconomic circumstances are such that either they just haven't had the the time or the energy or understood how much of a priority it should be to make that time to, to, to prepare food, or, um, have had the lessons where they can learn how easy it can be.

Yes.

To actually just pull something together. It doesn't necessitate hours standing in the kitchen. You don't need to be a super duper chef. to, you know, open a can of that, open a packet of this, um, defrost that, you can have a, you know, a superb plate of food. Um, you know, there are different ways and means of achieving that, you know, that, you know, that end goal.

Yes.

One other thing I must say as well, just in terms of these different conditions, and again, it's, it's another bit of a curveball, but because Of how have we seen these, these meds quietening down that food chatter. What they're also seeing as well is them being helpful in, in certain addictions. So they're taking down— so people that have an alcohol dependency or some kind of drug dependency, it's quietening this. And actually facilitating people being able to reduce whatever that, whatever that dependency is. They appear to be brilliantly useful therapeutic meds. Talk to your doctor first, make sure it's right for you.

But absolutely, like you said, one of the things just then when you said to quieten the mind, I mean, that is just relief for so many people. There are obviously some side effects. There's obviously people who shouldn't take these medications, but the benefits seem to be very high up on the list. There seems to be so many, and I'm sure the evidence coming out around these drugs is going to be a lot more interesting. But like you said, you know, don't just order it, don't just jump on the bandwagon. Really evaluate why you're taking it. So Just to wrap up for today, what advice can you give to someone who's considering taking these drugs?

Talk to a medical professional. Have that very frank, honest conversation. And if you are going to go ahead, be mindful of all of the other factors that have contributed to the results that we've seen in the research. for these medications. Look at, look at how, you know, look at what you're doing diet-wise, um, in terms of giving yourself the time and the space to make those changes so that you can more happily transition off the meds at the end of the process and feel more confident that you're going to be able to maintain that weight going forward, because that's what everybody wants for you.

Consulting a nutritionist like yourself prior to going on to them, and definitely once you stop, is a no-brainer. You just have to do it. Like, having some education or some awareness around food and even your food choices while you're on it is, you know, so important.

Yeah.

So honestly, thank you so much, Joanne, for coming on to the show and explaining about these from a nutritionist's point of view and what people can do and how they can benefit from them. And if anyone would like to contact Joanne, all her details will be in the show notes. Do reach out because I think education is so important, and to speak to someone like you to even, you know, pros and cons about taking it, you know, from a holistic point of view.

Because, you know, there's no such thing as a miracle drug. You know, there's no such thing as just a one-way bet. Yeah, make sure that you are Getting all of the expert information before you, you know, before you start down that road.

Absolutely. Contact Joanne. Thank you so much for coming on the show and explaining this to us. It's been very interesting.