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  • Anne Mullens

A commonsense prescription for weight loss drugs

If you decide to lose weight or improve your blood sugar by trying one of the new high-profile weight loss drugs, do you no longer need to worry about diet or exercise?

No, the opposite is true! It's more important than ever.

That's the advice of two lifestyle physicians, Dr. Leanne Reimche and Dr. Brendan Byrne, who are closely associated with the IPTN.

Dr. Reimche is an internal medicine specialist at the University of Calgary, a founder and director of Calgary-based IMWellness, and the chief medical officer of the IPTN. Dr. Byrne is medical director of LifestyleRx, and a board director of the IPTN.

Both doctors specialize in lifestyle medicine for weight loss, improved metabolic health, and type 2 diabetes remission. They say that while these drugs with names like Ozempic, Wegovy, and Mounjaro do work to help patients lose weight and improve metabolic health, users must fully understand the pros and cons, embed lifestyle changes to address their eating habits, and have an exercise plan to maintain muscle. Plus patients should have a plan for how to come off the drugs, so they do not end up worse than they started.

Dr. Reimche and Dr. Byrne have created a short commonsense guide for the use of weight loss drugs, provided here:

"First, let’s briefly explain what these drugs do. Called GLP-1-receptor agonists, they were developed to lower blood sugar in type 2 diabetes by mimicking a hormone called glucagon-like peptide 1.

The drug sends a powerful signal to the brain that we are full. Stomach emptying slows while hunger and cravings diminish, and the usual result is significant weight loss, typically in the range of 15% of total body weight. 

Studies show some positive results: better blood sugar control, possible type 2 diabetes remission, reduced cardiovascular risks, and other health benefits that come with weight loss, such as reduced joint pain.  

However, the drugs are not only very expensive, but also have significant side effects, including nausea, vomiting, diarrhea, constipation, and abdominal pain. Rarer but very serious side effects include gastroparesis (stomach paralysis),  intestinal blockages, depression, or declining mental health. 

One very common and concerning side effect that is not getting enough attention is significant muscle loss.  

In at least two clinical studies, 40% of the weight lost on GLP1s was lean muscle mass. Losing muscle is never good, but it’s particularly detrimental for people over the age of 50 who may never be able to build that muscle back.  

Involuntary muscle loss is called sarcopenia and is associated with a wide range of adverse health outcomes, including higher rates of chronic disease and inflammation, increased falls and immobility, postoperative complications, slower metabolic rate, cognitive decline, and more. 

Due to the drugs’ side effects and cost, many people come off them after 12 to 18 months. 

However, if people have not learned how to change their lifestyle before they stop the drugs, they will rapidly regain the weight they’ve lost. And it won’t come back as muscle, it will come back as fat, worsening their underlying metabolic health.

In short, after a short trial of these drugs, they may end up in worse health than when they started.

So, what to do instead?

Here is our commonsense prescription: embed lifestyle changes first. We are not talking about the old dogma of eat-less-move-more that sets people up for failure by having them slow their metabolism while fighting fatigue, hunger, and cravings.

Rather, we advise the following therapeutic nutrition approach: 

  • Eat whole, minimally processed foods; 

  • Prioritize protein at every meal (whether from animal or vegetable sources); 

  • Eliminate ultra-processed foods – i.e anything in a package with a long list of ingredients;  

  • Eliminate all added sugars and avoid foods that rapidly digest to sugar (i.e. fast carbs, starches like potatoes and rice, and flour products like bread and pasta); 

  • Eliminate sweet beverages including pop, fruit juice, sports drinks, and sweet tea or coffee; 

  • Eat plenty of vegetables and leafy greens for adequate fibre and nutrients; 

  • Include healthy fat sources such as olive oil, avocado oil, and nut oils.

When you eat this way, you don't need to count calories or drastically restrict portion sizes while working out fiendishly in a gym. Instead, you can eat in the style of your choosing, be that the diet of your cultural heritage, a Mediterranean diet, a vegetarian or vegan diet, a low-carb or keto diet, or a simple fare of predominantly meat and vegetables.

Add in regular, enjoyable movement – such as walking each day – and do some easy resistance training, like squats and push-ups, to build and maintain muscle.

You won’t go hungry, and you’ll likely lose weight and restore your metabolic health. Many people adopting this way of eating, combined with light exercise, never need to take the drugs. 

If weight loss is slow and excessive hunger impedes your results, we can add in a trial of a GLP1-receptor agonist while you continue to work on solidifying these lifestyle changes.  

Then, if or when you choose to come off the drugs, you won’t risk the obesity rebound. You will already know how to eat differently, prioritize protein, increase muscle strength, and enjoy healthy movement. And you’ll increase the likelihood of weight loss maintenance and a healthier metabolism. 

Finally, anyone taking these drugs should have a close relationship with the prescriber.  This will ensure continued follow-up to discuss possible side effects, to support lifestyle changes, and to share the decision whether to stop these agents or continue them life-long. "

Thank you Dr. Reimche and Dr. Byrne for sharing your wisdom and clinical experience for how to safely use the new GLP-1 receptor agonists in combination with a therapeutic nutrition approach!




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