Episode 147: Help! This GLP-1 is Causing a Side Effect!

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss, where I help you get on

[00:00:05] track and stay on track with your weight loss journey.

[00:00:09] I'm your host, Dr. Alicia Shelly.

[00:00:11] So let's get started.

[00:00:13] Hi, and welcome to the Back on Track Achieving Healthy Weight Loss podcast.

[00:00:33] I'm your host, Dr. Alicia Shelly.

[00:00:36] So this week I was in clinic and I realized that there was like a recurring fate.

[00:00:42] I've had several patients who were on GOP1, Injectables for Weight Loss.

[00:00:47] And they were complaining about having this constipation.

[00:00:51] Like they're just feeling so constipated, nausea.

[00:00:55] And I realize that this, I mean, I know it's one of the most common side effects of GOP1s, but I wanted to just share kind of some tips and strategies on how to overcome these different side effects from GOP1s.

[00:01:09] And so just, you know, this is for educational purposes, not deemed any medical advice because I don't know your history.

[00:01:16] It's important that you see your own medical doctor who knows you and who can make sure that this advice applies to you.

[00:01:24] But for everyone else, there's just some strategies and things that you may want to incorporate, especially if you're taking a GOP1.

[00:01:31] So these hormones are called Inquitent Hormones.

[00:01:35] They are natural hormones that are found in the body that regulate appetite, blood glucose level and digestion.

[00:01:41] And the first Inquitent Hormone was actually discovered in the 1970s by John Brown.

[00:01:47] And that was GIP, which stands for Glucose Dependent Insulinotropic Polypeptide, or GIP for short.

[00:01:54] And then in 1987, you know, 17 years later, GOP1 was found.

[00:02:01] And that GOP1 stands for Glucocon-like peptide.

[00:02:05] And so 18 years later, the first FDA approved GOP1 receptor agonist was released in 2005.

[00:02:14] So we've known about these hormones for some time, but it's taken over 20, 30 years for us to actually come up with a medication that can be helpful.

[00:02:24] And so the first medication was Exanitide or Bayetta.

[00:02:28] And that was a twice a day injection.

[00:02:31] And that was used for the treatment of type 2 diabetes.

[00:02:33] So it held with kind of controlling those blood sugars.

[00:02:36] Since then, there's been a whole host of GOP1 receptor agonists.

[00:02:41] And currently we have the two that are the most common for weight loss, or at least our FDA approved for weight loss is Wagovii or Simiglutide or Zep-bound Terepotide.

[00:02:53] So those two have been FDA approved for weight loss, whereas everyone else has been approved for diabetes.

[00:02:59] Now, how do these hormones work and these medications work?

[00:03:04] Well, the GOP1 receptors are found throughout the intestine, stomach, brain, pancreas, lung, kidneys, heart, so all throughout the body.

[00:03:11] And they help by increasing insulin secretion.

[00:03:15] So they allow the pancreas to increase its insulin.

[00:03:17] And also it allows the body to utilize glucose in a better way, in a more efficient way.

[00:03:23] So a lot of times when somebody has a history of diabetes, their blood sugar is higher.

[00:03:29] And the reason why it's higher is because the body is not responding to the blood sugar that's in the blood and it's not utilizing it for energy.

[00:03:37] So it's just kind of staying there with these particular hormones.

[00:03:41] They help with utilizing that glucose better so that it's being utilized for energy.

[00:03:47] So it's been taking up by the muscles, by the heart, by the organs so that it can be used for energy and to make the body run.

[00:03:53] Also, it helps with delaying gastric emptying.

[00:03:57] So it just kind of slows down the gut, which can lead to more nausea, can also lead to constipation.

[00:04:04] But most importantly, it leads to you're feeling more satisfied.

[00:04:07] You're not as hungry.

[00:04:08] You don't feel like eating.

[00:04:10] Also, these hormones help with protection of the heart.

[00:04:13] It actually increases the heart function so it pumps better.

[00:04:17] It protects the heart.

[00:04:18] It actually protects the blood vessels too, reduces inflammation within the heart vessels.

[00:04:25] Also, it has been shown in rats to improve memory.

[00:04:28] So increasing neuro protection and then also reducing addictive behaviors.

[00:04:33] So some studies have noted that when people are taking these medications that they're not thinking about taking alcohol or they're not thinking about other addictions that we may have, which makes it a little bit easier.

[00:04:46] Opiate addiction, things of that nature can reduce that.

[00:04:49] And then most importantly, it decreases your food intake because you're not eating as much.

[00:04:53] So these hormones do a lot and these medications help with increasing the hormones in our body.

[00:04:59] Now let's talk a little bit about why these hormones are important.

[00:05:03] Like what are the benefits?

[00:05:04] Well, it improves your diabetes control, reduces your appetite, decreases your food intake.

[00:05:10] Certain lyriglute and the simiglute or wagovie has been shown to help with cardiovascular outcomes, actually reduce the risk of mortality and people who have a history of heart attack, stroke, or other cardiovascular disease.

[00:05:27] Also, there are trials that are looking at treatment of heart failure with these medications as well as peripheral artery disease or in diabetic kidney disease.

[00:05:37] And then also looking at metabolic liver disease like your non-acoholic, Cetohepatitis or naffold or NASH for short.

[00:05:45] Also there are studies looking at neurodegenerative disorders like Parkinson's and Alzheimer's to see if these medications can play a role.

[00:05:53] And although anecdotally they noted that certain addictive behaviors like opioid cravings are improved, still more studies need to be done.

[00:06:00] The problem is that sometimes with the side effects, the nausea and things are too much.

[00:06:04] They end up stopping but more studies need to be done.

[00:06:08] Now I say all that to say let's go back to the side effects, right?

[00:06:13] Because if the side effects are too much then definitely you should not be on this medication.

[00:06:17] And so the common side effects that we see or that I see definitely in my practice are going to be nausea, vomiting, diarrhea, and constipation.

[00:06:26] Now let's talk about the constipation and what are some strategies to managing this.

[00:06:31] Now mind you this is not an exhaustive list but it gives you some strategies and things to consider.

[00:06:36] So when we look at more natural ways to improve constipation, increasing your water is important specifically at least 64 ounces.

[00:06:45] I mean getting more would be better but if you can hit those six to eight glasses of water a day you may find a difference.

[00:06:53] And why is that important?

[00:06:54] So the water that we drink is being absorbed by the body for different functions.

[00:06:59] And so what our body doesn't use, the water stays within the stomach or in the gut.

[00:07:05] And so that kind of helps to keep the stool moving a little bit better and then also it's softer.

[00:07:09] So definitely drinking water is important.

[00:07:12] Also increasing your fiber intake to at least 20 milligrams.

[00:07:17] Now sometimes I'll sit there and be like man I'm eating salad, I'm eating fruit.

[00:07:22] I don't understand why this is not enough.

[00:07:24] And it may be that you need to eat more.

[00:07:26] I had to do like a calculation of my fiber just to see am I actually getting 20 milligrams and I was surprised I wasn't.

[00:07:33] Even though I was eating salads every day.

[00:07:36] So you may want to check how much you're eating.

[00:07:38] Like let's say if you do need a salad you may want to add flax seeds or other different high in fiber foods to your salad to help.

[00:07:47] So some other foods that are high in fiber are going to be your prunes.

[00:07:51] They have like dried prunes that I really like.

[00:07:53] And I would eat one or two a day and it kind of helps me stay regular.

[00:07:57] Also okra, different foods like that green leafy vegetables help with kind of keeping that fiber as well.

[00:08:04] Interestingly enough even coffee is a natural stimulant.

[00:08:08] So it can kind of help you to have that bowel movement and magnesium.

[00:08:12] So magnesium rich foods kind of help with increased movement through the digestive tract.

[00:08:18] And it also helps with relaxing the muscles and drawing that water back into the gut so that the stool moves a little bit more easily.

[00:08:26] So what are some magnesium rich foods? Talk about green leafy vegetables,

[00:08:31] beans, lentils, avocados, bananas, seeds, nuts and oily fish like mackerel can help too.

[00:08:38] Also olive oil taken on an empty stomach.

[00:08:41] You just mix a few teaspoons in your water can also help with constipation.

[00:08:47] Plexi oil, olive oil gel and to orange juice can also encourage that process as well.

[00:08:53] And then of course avoid refined and artificial foods.

[00:08:57] They're just harder to process than the natural ones.

[00:09:01] And that can lead to less fiber that you have and it can lead to more constipation.

[00:09:07] So replacing those artificial or refined foods

[00:09:11] you know with beans, whole grains, fruits.

[00:09:14] This can also help improve your digestion.

[00:09:17] Now some people can have like an allergy to cow's milk and it can actually be something that you can have even as an adult.

[00:09:24] So it may be to avoid those cows milk is going to be helpful because cow's milk can also lead to some chronic constipation.

[00:09:32] So avoiding the cheese and milk as well.

[00:09:35] And then you can try drinking ginger tea two to three times a day to kind of help improve that flow in your bowels.

[00:09:42] And then as far as medications they have a lot over on where the counter.

[00:09:46] But see which one works for you as far as stool softeners, laxatives.

[00:09:49] There are two prescribed medications we use for chronic constipation like lenzase or amethysia.

[00:09:55] So these are just some strategies for constipation.

[00:09:58] As far as diarrhea if you're having diarrhea make sure you rehydrate.

[00:10:03] Make sure you're drinking lots of fluids even if it's diluted fluids like pedialyte or it has a little bit of flavor to it.

[00:10:10] Gatorade, you want to make sure that you're staying hydrated because you're losing fluid so much

[00:10:15] that it's so easy to get dehydrate with diarrhea.

[00:10:18] Also focusing on food or drinks that are high in sodium and potassium to replete what you're losing such as

[00:10:24] broths, bananas, boiled potatoes, low fiber foods like yogurt or lean meats, noodles that can be helpful.

[00:10:32] The brat diet is helpful too and the brat diet is bananas, rice, applesauce and toast.

[00:10:38] So more bland foods to kind of help slow up the diarrhea.

[00:10:42] Also avoid foods that can put pressure on the gut like your high fat foods including fried foods, chips, pastries.

[00:10:50] Foods containing artificial sweeteners.

[00:10:52] I remember this case where this lady was chewing this gum but it had artificial sweetener in it and she was just chewing and she would chew it

[00:10:59] like multiple times throughout the day and she couldn't figure out why she was having diarrhea.

[00:11:04] And when she stopped using that gum, the diarrhea improved because artificial sweeteners can contribute to diarrhea too.

[00:11:11] Also avoid foods that are high levels of fructose

[00:11:15] and then avoid foods that are like fatty meats such as bacon, high fiber foods.

[00:11:19] So if you're having diarrhea, you want to avoid the high fiber foods like beans or vegetables

[00:11:25] or even cabbage because that can make you want to go more.

[00:11:28] Some medications you can take over the counter is low-paramide or modium AD and things of that.

[00:11:33] But make sure if you're having a lot of diarrhea,

[00:11:36] make sure you follow up with your doctor, your primary care, your gastroenterologist just to make sure that there's nothing else

[00:11:42] that's going on because sometimes diarrhea, if you're taking GOP ones and it's happening after you take it then definitely

[00:11:48] we know that's the case but if it's just happening all the time, you may want to get checked out.

[00:11:52] All right, so how do you manage nausea and vomiting? Which is common.

[00:11:56] I do find with the nausea that it happens a couple of times. It happens when you do start the medication

[00:12:02] and when you increase the dose you can feel more of that nausea. A lot of times it's just because

[00:12:07] the hormones are being increased in the body and it's just hitting your body quickly.

[00:12:11] So sometimes what my patients will do is they'll change the site of injection if we're giving it to themselves in the stomach

[00:12:16] they'll go to the thighs or behind their arm.

[00:12:18] It just kind of helps reduce that nausea. The other thing too, I find with nausea is sometimes if you don't eat

[00:12:25] you can feel nauseous and when you overeat you can feel nauseous.

[00:12:28] So it's important to make sure that you're getting in even a small meal. Sometimes you don't feel hungry on GOP ones

[00:12:34] but you still need to eat your body still needs calories.

[00:12:38] So it's important to kind of get that food in even as it's three to four small meals throughout the day.

[00:12:43] This allows your body to get the calories it needs and then it won't stall out and go into starvation mode

[00:12:48] and then does the exact opposite that you want done which is hold on to the weight and not lose it.

[00:12:53] So you definitely need to have that balance. Also too, sometimes I don't know about you if you're

[00:12:58] kicking something that you really enjoy sometimes it's easy to overeat but if you start to feel

[00:13:03] full then it's important to just kind of stop and hold it for your next meal.

[00:13:08] Alrighty so some other natural remedies that you can try or strategies is like I mentioned before

[00:13:13] eating ginger, ginger tea that can help with nausea. For women who have nausea during pregnancy

[00:13:19] they noted that some peppermint aromatherapy like tea or oil smelling peppermint oil may help with the

[00:13:25] nausea. Maybe you want to try acupuncture or acupressure that can reduce nausea and then

[00:13:30] that's been scientifically noted and for women who are pregnant also certain citrusy smells

[00:13:36] whether a fresh cut lemon or some essential oils may help reduce nausea especially during pregnancy.

[00:13:43] Also controlled breathing so some breathing exercises may be beneficial and it basically involves just

[00:13:50] inhaling through your nose counting to three holding your breath to a count of three and then

[00:13:54] exhaling for a count of three. So just kind of inhaling for three holding your breath for three

[00:14:01] and then exhaling for three. And sometimes taking that moment and just refocusing may help

[00:14:09] with the nausea. Also taking vitamin B6 can help with nausea and that's been noted even in pregnancy

[00:14:16] too and then being active staying active and drinking lots of water can help with that nausea.

[00:14:22] If the nausea is still so severe even after trying these natural strategies you may want to

[00:14:27] talk to your doctor about other medications that they can prescribe to help the nausea for you.

[00:14:32] So I hope this was helpful for you just different strategies and tips and tricks and how you can

[00:14:37] overcome some of these side effects because the GOP1 it is so helpful with losing weight

[00:14:43] and so sometimes these side effects can be just mild not anything that are too much but at

[00:14:49] least you have some strategies and I will say this if the nausea, vomiting, constipation,

[00:14:55] diarrhea is getting severe where it's happening all the time. It is stopping you from your life

[00:15:00] obligations and just you doing the things you enjoy doing then it's important that you check with

[00:15:06] your doctor because this may be a sign of something else that they need to evaluate you for and

[00:15:12] possibly stop the medication because the medication is not everyone can tolerate it and

[00:15:16] that's okay but you want to make sure that you're being followed so make sure you're

[00:15:20] being followed by your doctor especially when taking these medications. Alrighty thank you so

[00:15:26] much for your time thank you for listening to the back on track achieving healthy weight loss

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