Thinking About Taking a GLP-1 Agonist? Here’s How to Take a Balanced Approach.

Most people coping with metabolic obesity are familiar with its health risks: high blood pressure, dysregulated blood sugar, metabolically active abdominal fat, and elevated cholesterol and triglyceride levels. Yet, despite efforts to eat healthier and exercise more, many find themselves stuck in a cycle. Old habits are hard to break, new ones aren’t moving the dial, and change feels out of reach.

Enter GLP-1 agonists, the class of diabetes and weight-loss drugs dominating headlines and scientific journals. For those who have long struggled with weight-loss resistance or metabolic health issues, these drugs may appear to be a quick fix to what feels like an insurmountable challenge.

And they can be. Taking GLP-1 drugs like Ozempic, Wegovy, and Zepbound often leads to significant weight loss in short periods of time while improving other health markers.

Yet these medications are not without drawbacks. They include daunting side effects, substantial expense, and open questions about the drugs’ long-term risks.

There’s also the thorny matter of lifelong dependence: Most patients who stop taking the drugs ­regain the weight they’d lost. That’s why some integrative providers are advocating for a more balanced approach — often with a focus on short-term use rather than ongoing dependence.

“My goal for my patients is that [these drugs are] not a long-term solution,” says Traci Eliszewski, NP, a functional-medicine practitioner in Madison, Wis. “It is just to get things started.”

This approach situates GLP-1 drugs as part of a broad, holistic strategy to support diet and lifestyle changes that address underlying causes of metabolic dysfunction at their roots.

It might offer the best of both worlds.

 

What Is GLP-1?

Glucagon-like peptide 1 is a hormone our bodies produce to help regulate metabolism, digestion, and satiety. It stimulates insulin release, slows gastric emptying, and signals feelings of fullness, which together help regulate blood-sugar levels and control appetite after meals.

Whenever you eat a meal, cells in the intestine, pancreas, and brain start to release GLP-1 within 15 to 30 minutes, explains Arianne Missimer, DPT, RD, LDN, a ­Pennsylvania-based functional-medicine practitioner. Once ­released, this hormone stimulates the pancreas to secrete insulin, which enables cells to absorb glucose from the blood. It suppresses the release of glucagon, a hormone that raises blood-sugar levels by prompting the liver to release stored glucose.

GLP-1 also helps moderate other hormones related to blood sugar and appetite, including leptin, which signals fullness, and ghrelin, the “hunger hormone.”

Additionally, GLP-1 slows gastric emptying, which sustains a feeling of fullness and decreases the speed at which glucose enters the bloodstream. This helps prevent postmeal blood-sugar spikes and supports insulin to manage a slower, steadier stream of glucose in the blood.

Finally, the brain receptors controlling hunger and satiety are responsive to GLP-1. Research has found that stimulating these receptors can reduce appetite, even when the stomach is empty.

All this metabolic regulation is why researchers were so eager to mimic the effects of this hormone in a medication. These drugs, GLP-1 receptor agonists, were originally designed to harness the same pathways that naturally produce GLP-1. The goal was to help manage metabolic conditions like type 2 diabetes.

Since 2022, the drugs have ­exploded in popularity, largely because their metabolic effects often include substantial weight loss. U.S. healthcare providers wrote more than 9 million prescriptions for Wegovy, Ozempic, and other GLP-1 agonists in the last three months of 2022 alone.

According to a 2024 KFF Health tracking poll, 12 percent of U.S. adults say they have taken a GLP-1 agonist, and 6 percent are currently taking one. Financial forecasts indicate the GLP-1 market will exceed $100 billion by 2030, when U.S. users — driven equally by blood-sugar management and weight loss — will number 30 ­million or more.

 

Turning Down the Food Noise

GLP-1s can lead to a drastic reduction in what’s known as “food noise” — the constant background thoughts about food that many people experience throughout the day.

This preoccupation has multiple drivers. Ultraprocessed foods are one of them; they’re typically high in sugar, which drives insulin resistance. This can interfere with other hormones, like leptin and ghrelin, which can impair gut–brain signaling and contribute to increased hunger signals. (For more on these foods, see “The Truth About Ultraprocessed Foods.”)

“When people eat [high-glycemic] foods that spike their insulin levels, their blood sugar rapidly rises and falls,” explains Monique Class, MS, APRN–BC, a clinical nurse specialist in holistic health in Stamford, Conn. “This creates a vicious loop where they consume more food to raise their blood sugar again, only for it to spike and drop even lower, and it just keeps going and going. The higher the insulin goes, the more weight gets locked [around] the middle.” (Explore this list of common foods and their ranking on the Glycemic Index.)

Stress-related eating is a factor too, particularly in our chronically anxious society. GLP-1s can reduce the brain’s reward response to food, including the highly palatable ultraprocessed fare we often crave when stressed. The drugs blunt the hit we get from these foods, and they start to lose their grip on us.

The reduction in food noise can be a revelation for people who have long struggled with food addiction and metabolic issues. “That’s probably the biggest thing I hear from people [taking GLP-1s]: ‘I don’t think about food all day long,’” ­Eliszewski says.

This allows people the freedom to make different choices, Class explains. “Because they’re not being driven by their psychology or physiology anymore, there’s a golden opportunity to use it as a bridge to behavior change.”

 

GLP-1 and Your Brain

The effects of GLP-1 on the brain’s reward response may help explain why these drugs seem to help counteract addictions of all kinds, from gambling and shopping to alcohol and sex. The research on this remains mostly anecdotal, but some clinical evidence is emerging.

A 2022 clinical trial funded by Novo Nordisk (which makes Ozempic and Wegovy) found that a weekly dose of one GLP-1 drug reduced heavy-drinking days and total intake for people struggling with alcohol use disorder — but only in a subgroup of patients with a BMI over 30. Other studies are under way for addiction to alcohol, nicotine, and opioids.

Another unforeseen effect of GLP-1 drugs is their potential to reduce the risk of dementia and Alzheimer’s disease. Numerous studies have shown they can improve cognitive function, most likely by reducing neuroinflammation.

Alzheimer’s is now unofficially known as type 3 diabetes. “It’s [related to] the poor use of glucose in the brain. If you can improve the way you’re using glucose in your body and brain, you won’t trigger neuroinflammation, which accelerates damage to the neurons.”

Alzheimer’s is now unofficially known as type 3 diabetes, explains clinical pharmacist James LaValle, RPh, CCN, MT, Life Time’s chief science officer. “It’s [related to] the poor use of glucose in the brain. If you can improve the way you’re using glucose in your body and brain, you won’t trigger neuroinflammation, which accelerates damage to the neurons.”

Functional-medicine pioneer Frank Lipman, MD, uses and prescribes GLP-1s for this purpose alone. “I use low-dose GLP-1 for antiaging. I take it not to lose weight but because I was prediabetic, I’m 70 years old, and I’m predisposed to Alzheimer’s.”

Lipman takes his modest dose weekly, mainly for its neuroprotec­tive and metabolic effects. For him, weight loss, particularly the loss of muscle mass, is a side effect he needs to guard against. “Even at lower doses, people can lose muscle mass,” he notes. “It really needs to be used responsibly.”

 

Risks and Side Effects

Despite the salutary effects of GLP-1 drugs, most people don’t take them for long. An examination of ­pharmacy- and medical-claims data from 2021 for 4,066 nondiabetic GLP-1 users with obesity found 53.7 percent discontinued use within 180 days, and 67.7 percent stopped within a year.

One explanation is that the side effects are often harrowing. Among the most common are gastrointestinal symptoms, such as nausea, vomiting, constipation, and diarrhea. Some users have reported experiencing suicidal thoughts or behaviors; this has led to cautionary warnings.

Cost and availability are also at play. Insurance coverage is hit-or-miss, supply shortages have been an issue, and out-of-pocket costs can be prohibitive.

Other health risks include pancreatitis, thyroid cancer, kidney failure, gallbladder disease, changes in vision, hypoglycemia (low blood sugar), and allergic reactions. Anyone with a history of gastroparesis (slow gastric motility) or pancreatitis is not a good candidate for these medications, Eliszewski adds.

The effects of GLP-1s on the gut microbiome still aren’t clear, but when digestion slows down too much, it can affect gut flora. “When we’re slowing digestion, that can potentially [lead] to more bacteria where it’s not supposed to be: in the small intestine,” Missimer explains. “It can contribute to fungal overgrowth as well.”

“You should not know you’re on a GLP-1. If you’re having side effects, your dose is too high.”

This delayed gastric emptying may lead to reduced efficacy of birth-control pills by reducing their absorption, though the research on this is still unclear. More positively, GLP-1s have been linked to improved menstrual regularity and enhanced fertility among people with obesity and polycystic ovarian syndrome. These could all be contributing factors to the phenomenon of so-called Ozempic babies.

One of the biggest concerns for people who shed significant weight on these drugs is the disproportionate amount of lean muscle mass they can lose. Muscle loss can contribute to frailty, particularly in older adults, and increases the risk of falls and fractures. It can also lead to a decrease in basal metabolic rate, mak­ing it harder to maintain weight loss over time.

“Muscle is metabolically active,” Missimer explains. “When we lose muscle, we’re going to reduce the amount of energy we burn when we move through our day.” (Muscle plays an important role in many areas of your health. Learn seven reasons why strength training to be a non-negotiable part of any fitness regimen.)

This loss of metabolic activity is one reason people are prone to regaining weight when they stop taking GLP-1 drugs. Worse, the lost muscle weight tends to return in the form of fat, leading to further challenges for metabolic health.

These are all reasons to work closely with a knowledgeable, integrative provider if you’re taking a GLP-1. Many of the side effects are dose dependent and can be reduced by taking smaller dosages. “I always tell my patients, ‘You should not know you’re on a GLP-1. If you’re having side effects, your dose is too high,’” Eliszewski says.

 

The Deprescribing Model

Unlike practitioners who prescribe GLP-1s for indefinite use, providers like Eliszewski and Class set out with deprescribing in mind.

They also recommend much smaller doses of the medication. “For many of my patients, I microdose them,” Eliszewski says. “We’re using the least amount needed because they’re also getting set up with dietary modifications, hormonal and thyroid management, and help with decreasing inflammation.”

These combined interventions support metabolic health while someone is taking the drug and after they stop using it, she adds. “In my experience, my patients don’t have to go back on it because we’re looking at all those underlying factors and addressing cellular health at the same time.” (Here nine often-overlooked factors can help you achieve — and sustain — a healthy weight.)

Integrative protocols call for a diet of fresh, whole foods with an emphasis on protein and fiber, along with hydration, microbiome balance, daily activity, and strength training to retain or add muscle mass, which ­Missimer calls our “organ of longevity.”

Working with a provider is key here. Missimer notes that many of her patients struggle to eat enough protein and fiber when they don’t have much appetite. “We need to make sure we’re getting in at least a gram of protein per pound of ideal body weight, spread out throughout the day. People may know that, but they don’t necessarily do it.”

“We need to make sure we’re getting in at least a gram of protein per pound of ideal body weight, spread out throughout the day. People may know that, but they don’t necessarily do it.”

Consuming at least 25 grams of fiber a day is also critical for maintaining healthy gut motility and detoxification. In the absence of hunger, people may need to incorporate protein shakes or fiber supplements to hit these goals. (Check out “Fiber: Why It Matters More Than You Think,” for more.)

Eliszewski monitors her patients’ lean muscle mass to ensure they’re not losing too much.

“Decreasing weight while increasing lean body mass is the goal, and that ­requires higher protein and good fats and lower processed grains and sugar,” she says. “We’re making sure you’re going to the bathroom every day, your microbiome is balanced, and your hormones are optimized. It’s a whole-system approach, which is why my patients come off [the drug] and do just fine.”

Adding in mindfulness rituals is also crucial, says Class. “We’re working on the physiology with the medication, and we’re working on the mind, body, and spirit with awareness practices. We’re looking to get them back in touch with their intuition around when they’re hungry, what they’re hungry for, and how they feel. It’s about empowering people who could never move the dial so they can take charge of their health.” (See “Intuitive Eating for Weight Loss” to discover how tuning in to your own instincts can help lead you to make healthier decisions.)

In an ideal scenario, this modified approach helps people tap into a different way of eating, moving, and living that might have been out of reach before. As old habits dissolve and new ones are formed, the pharmaceutical support is phased out.

Class describes her approach to helping patients attain metabolic health with GLP-1 drugs as “low and slow” — starting with a low dose, slowly ramping up until they’ve reached their goal dose, staying there until new lifestyle choices have become habits, and then slowly weaning off.

This approach isn’t designed for people with diabetes, who are more likely to need medication for the long term. “Most of my clients are looking to lose 40 or 50 pounds, and they just need a jump-start,” Class says. Her goal is to help her patients quiet the food noise in their heads long enough to develop new behaviors.

“I start really low, with 2.5 milligrams or even less,” says Class. She slowly increases the dose over the course of four to six months, all while focusing on behavior and habit change, as well as on awareness practices.

“We’re getting them moving, drinking more water, and putting in more phytochemicals,” she says. She helps them emphasize protein, produce, and healthy carbohydrates. “You make it really simple for people, give them little wins, and go slow.”

Once someone has achieved their goal, Class holds them at a steady dose for six months to a year. “I want them to feel like OK, I’ve got it. I’ve created new physical, emotional, and spiritual set points. These new ways of being in the world are deeply rooted.”

Then she helps her patients slowly wean off the drug over the next four to six months. “We deprescribe really slowly so they have confidence they’re not going to gain back what they’ve lost,” she says.

“Now you’re making different c­hoices. You’re moving your body, you’re going for the phytochemicals, you’re going for good proteins, you’re getting your circadian rhythm back. You did it! The medication was just a bridge.”

 

GLP-1 and Metabolic Dysfunction

Lifestyle measures for losing unwanted weight and improving metabolic health include engaging in physical activity; eating fresh, whole, unprocessed foods that are high in protein and fiber; calming inflammation; and supporting the gut microbiome.

Yet for some people, these tools aren’t enough. “Sometimes people are trying to do all the right things. They’re trying to exercise and eat differently, but they’re not able to [lose weight]. They have what we call fat-loss resistance,” says ­functional-medicine practitioner Arianne ­Missimer, DPT, RD, LDN.

This resistance occurs when the body’s metabolism becomes so adapted to calorie deprivation that traditional methods of weight loss — such as calorie reduction and increased physical activity — are no longer effective. It can be the result of chronic dieting, when the body responds by reducing its energy expenditure. (See “Why Dieting Doesn’t Work — and Never Has” to learn about the starvation study from World War II.)

“No supplement or drug replaces behavioral and lifestyle change. But it can be an avenue for people who are struggling to get to that next step.”

Other contributing factors include hormone imbalances. Dysregulated insulin, cortisol, thyroid hormones, and leptin can also make it difficult to lose visceral fat. Inflammation can interfere with the body’s ability to lose weight by disrupting normal metabolic processes, and imbalances in gut bacteria can also play a role. (See “6 Factors that Affect Weight Loss” to learn why conventional weight-loss strategies often fail and the variables that matter most.)

“In that case, their metabolism has to be influenced in some way,” Missimer says. This is where GLP-1 mimetics can be helpful, particularly when used as a bridge to more sustainable diet and lifestyle habits.

Though the effectiveness of this new class of drugs has led to an outsize focus on GLP-1, “weight-loss resistance is really much bigger than any one hormone,” she notes.

Some foods, supplements, and drinks (such as olive oil, berberine, and yerba mate tea) are now being marketed as natural stimulants of GLP-1 production. The probiotic bacteria Akkermansia muciniphila has also gained attention for its potential to enhance metabolic function, partly by stimulating the production of GLP-1.

Still, sustainable metabolic health ultimately ­requires thinking beyond a single hormone, ­Missimer says. “No supplement or drug replaces behavioral and lifestyle change. But it can be an avenue for people who are struggling to get to that next step.”

This article originally appeared as “A Balanced Approach to Weight-Loss Drugs” in the March/April 2025 issue of Experience Life.

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