How GLP-1s Suppress Hunger And What That Does To The Body

Transcript generated by AI.

Dr. Mitchell Rothstein 0:00

The thing to understand about the GLPs is that they're part of our evolutionary heritage. We've been hungry for thousands and thousands of years, and our physiology is actually addressed toward satiating hunger, but that hunger sgnal is always there.

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What GLP-1s Do In The Body

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facts.

Dr. Mitchell Rothstein 0:24

Hi, I'm Mitchell Rothstein. I'm a principal investigator in Jacksonville, Florida, and I wanted to talk today about GLP-1s, a popular tool now out there in the community. A lot of feedback on that, and a lot of social media energy is directed toward it as well. But I think it's important for people to understand what actually the medication is doing, how it works, and what some of the side effects are so that they can be addressed proactively and reduce those kinds of problems. So the thing to understand about the GLPs is that they're part of our evolutionary heritage. We've been hungry for thousands and thousands of years, and our physiology is actually addressed toward satiating hunger, but that hunger single is always there. More humans have died from starvation than anything else. So the people that could adapt to starvation, usually by binge eating when it was available, were the survivors, and we've inherited that proclivity. So our body is designed to be hungry on all the time. And when we do get enough food, we shut that off. Those mechanisms to shut that hunger drive off include this class of hormones, essentially called incretins, that are secreted by our intestinal tract that feed back to our brain and tell us, yeah, we've had enough food and help us digest the food that we've eaten. GLPs are do this through enhancing insulin sensitivity as well as slowing GI motility. And that's where some of the issues become

GI Side Effects And Dose Pacing

Dr. Mitchell Rothstein 2:03

problems for patients. Adverse effects with GLPs are primarily centered around the slowing of GI motility. So that causes food to remain in your stomach longer, which is good because it sends your brain a message that I'm full, I don't need anymore, and reduces that hunger drive. But it can also lead to delayed gastric emptying, which can put you at risk for bloating as well as reflux. And then the other thing that slows down is the entire intestinal tract, and that's mostly done through the vagus nerve and inputs through that since our vagus nerve and our autonomic nervous system controls our motility throughout our GI system. When our GI system slows down, the result is often constipation. Paradoxically, some patients can experience diarrhea. The way we approach this is to have an open dialogue with our patients, making sure that we're not advancing the dose too quickly, and if they are experiencing those kinds of side effects, backing off on the dose until they adjust to it. Not every patient needs to be escalated to the highest dose available of these medications. Some people can lose weight effectively at much lower introductory

Muscle Loss, Protein, And Exercise

Dr. Mitchell Rothstein 3:20

doses. The other issues that people are struggling with in terms of using GLPs is this issue on lean body muscle loss. Now, if you look at any study that involves relatively significant weight loss, everybody loses muscle mass. That's just part of the process. The difference between starvation diets and diets involving GLP1s is that when you're on a starvation diet, you still have that hunger. You're still wanting to eat. And when you're using a GLP, that hunger drive, that hunger noise isn't there that much, and people don't eat that much. By not eating as much as they should while taking GLPs, they become protein deficient, which enhances the lean muscle mass loss we see when people are on. Like I said, any diet will do it. GLPs tend to do it a little bit more because people don't eat quite as much. So we are here to encourage patients to make sure their dietary intake of protein is adequate to reduce that lean body muscle loss to acceptable levels so that you can still lose weight and maintain that. The other part that adds to lean muscle loss is that people are tired when they lose weight. In fact, there are GLP receptors throughout your entire body, your brain, your hypothalamus, and some of them can affect your mood and your desire to do exercise and activity. So the other aspect of maintaining lean muscle maintenance is to exercise. And generally, doing about 150 minutes a week of aerobic activity. You don't have to do weight training specifically. You can use your own body weight to train with, doing squats, push-ups, those kinds of things will effectively maintain your lean body mass as well. So those two issues, we're here to help support you through your journey with GLPs. And the primary ways that you can help yourself are number one, not escalating your dose if you're having side effects, letting your doctors know that you're having side effects so that the dose can be effectively adjusted. Number two, you need to maintain that protein floor. You need about 1.5 grams of protein per kilogram, somewhere probably for most people, around 100 grams of protein a day will do it. And then the third thing is exercise. You don't have to be sweating in the gym all day long. You need about 150 minutes a week. Go for a walk three, four times a week for 20, 30 minutes. That should cover you. So those are our primary, and we're here to support you, and those are the primary ways that you can avoid the side effects that most people are complaining about with GLPs.

Three Practical Takeaways And Wrap

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