GLP-1 Agonists: Are they right for you?

Everyone is talking about those weight loss shots. Much of my career has focused on health and wellness including healthy weight. I’ve watched many individuals struggle with weight loss. As a healthcare provider, it’s exciting for me to be able to prescribe a medication that seems to be a game changer for weight loss.

GLP-1 agonists are a class of medications initially developed to help manage type 2 diabetes. These drugs work by mimicking the action of a natural hormone in the body that regulates blood sugar levels, appetite, and digestion. GLP-1 agonists have also shown remarkable effectiveness in supporting weight loss, leading to their use in weight management programs. However, their rise in popularity hasn’t been without controversy. Critics have raised concerns about potential side effects, as well as the off-label use of these medications by individuals without diabetes. Additionally, some worry about the accessibility of these treatments, as high demand has sometimes caused shortages for patients who rely on them for diabetes care. At Amethyst Wellness in Palm Coast, Florida, we’re committed to providing informed guidance to help you navigate these options responsibly and safely.

What is a GLP-1 Agonist?

GLP-1 agonists work in the body by mimicking the action of the glucagon-like peptide-1 (GLP-1) hormone, which plays a crucial role in glucose metabolism. Here’s how they function:

1. Stimulating Insulin Secretion: GLP-1 agonists enhance the secretion of insulin from the pancreas in response to meals. This helps lower blood sugar levels, in individuals with diabetes particularly after eating. For people without diabetes, who typically have normal glucose regulation, GLP-1 agonists help prevent blood sugar spikes after eating without causing significant drops into hypoglycemia (low blood sugar).
2. Inhibiting Glucagon Release: Glucagon is a hormone produced by the pancreas that raises blood sugar levels by signaling the liver to break down glycogen into glucose and release it into the bloodstream. GLP-1 agonists reduce the release of glucagon. This plays a significant role in promoting fat burning by altering the body’s energy balance. When glucagon levels are reduced, the body’s access to glucose from the liver is diminished, leading to a decrease in available energy from sugars. As a result, the body is encouraged to shift toward using stored fat as an alternative energy source, a process known as lipolysis. By promoting fat breakdown while simultaneously curbing appetite and reducing food intake, the overall caloric deficit can enhance fat burning and support weight loss.
3. Slowing Gastric Emptying: By slowing the rate at which food leaves the stomach, GLP-1 agonists help promote a feeling of fullness and appetite reduction.
4. Promoting Satiety: They act on the brain’s appetite centers to decrease feelings of hunger, which can lead to reduced food intake and weight loss. The GLP-1 agonists also significantly reduce food cravings.

GLP-1 agonists were initially developed to treat type 2 diabetes and have now been studied for weight loss in non-diabetic patients. Medications like semaglutide (marketed as Wegovy for weight management) have shown substantial weight loss results in clinical trials with many patients achieving a loss of 15% or more of their initial body weight.

What are the Health Benefits of GLP-1 Agonists?

GLP-1 agonists have gained significant attention for their health benefits, particularly in the management of type 2 diabetes and obesity. Recent studies have suggested other health benefits associated with GLP-1 agonists:

1. Reduced Risk of Cardiovascular Disease: Studies suggest that GLP-1 agonists may lower the risk of heart disease and stroke by improving cardiovascular risk factors.

• Lowered Blood Pressure: These medications may reduce blood pressure by promoting vasodilation (relaxing blood vessels), which helps improve overall circulation.
• Improved Lipid Profile: GLP-1 agonists can help lower LDL (“bad” cholesterol) and triglycerides, further reducing cardiovascular risk.

2. Reduction in Inflammation: GLP-1 agonists have been shown to decrease systemic inflammation. Inflammation is the body’s natural response to injury or infection, designed to protect and heal. However, when inflammation becomes chronic—persisting for weeks, months, or even years—it can lead to tissue damage and contribute to the development of various diseases like cancer, heart disease and chronic pain conditions.

3. Potential Neuroprotective Effects: Emerging research indicates that GLP-1 may have neuroprotective properties, potentially benefiting brain health and reducing the risk of neurodegenerative diseases.

• Improved Insulin Sensitivity in the Brain: Insulin resistance in the brain is linked to cognitive decline and Alzheimer’s. GLP-1 agonists improve insulin signaling in the brain, which may enhance cognitive function.
• Support for Synaptic Plasticity: GLP-1 agonists have been shown to improve synaptic plasticity, which is essential for learning, memory, and overall cognitive health.
• Reduction in Neuroinflammation: Chronic inflammation in the brain is a hallmark of neurodegenerative diseases. GLP-1 agonists can suppress pro-inflammatory pathways and reduce the release of harmful cytokines, helping protect neurons.

Side Effects of GLP-1 Agonists

GLP-1 agonists are generally well-tolerated, but they can have side effects. Most are self-limiting but some can be quite serious. To ensure client safety, we require monthly provider visits. Some of the common side effects include:

1. Gastrointestinal Issues: Nausea, vomiting, diarrhea, and constipation are frequently reported, especially when starting the medication. These symptoms often improve over time as the body adjusts.
2. Gastroparesis: These medications naturally slow stomach emptying, but in some cases, this mechanism may lead to persistent or worsening symptoms of gastroparesis, particularly after prolonged use. Patients might experience nausea, bloating, vomiting, or a feeling of fullness even after small meals.
3. Gallstones: Significant and rapid weight loss can cause an imbalance in bile composition, leading to the formation of cholesterol-based gallstones. GLP-1 agonists may slow the emptying of the gallbladder, causing bile to stagnate and increasing the likelihood of gallstone formation.
4. Pancreatitis: There is a slight risk of pancreatitis, or inflammation of the pancreas. Symptoms include fever and severe abdominal pain. If you experience this, it’s essential to seek medical attention immediately.
5. Injection Site Reactions: Since GLP-1 agonists are administered via injection, reactions such as redness, swelling, or itching at the injection site may occur.
6. Possible Thyroid Tumors: In animal studies, some GLP-1 agonists have been linked to an increased risk of medullary thyroid carcinoma. This is a rare type of thyroid cancer. While human studies have not shown a link between thyroid cancer and GLP-1 use, caution may be advised for individuals at high risk.

Medication Shortages

At Amethyst Wellness, we currently prescribe two types of GLP-1 agonists: Semaglutide (brand names Ozempic and Wegovy) and Tirzepetide (brand names Mounjaro and Zepbound).

Semaglutide works in the manner mentioned above. Tirzepatide is a dual GLP-1 and GIP receptor agonist, meaning it activates both the glucagon-like peptide-1 (GLP-1) receptor and the glucose-dependent insulinotropic polypeptide (GIP) receptor. This unique mechanism allows Tirzepatide to enhance insulin secretion, reduce glucagon levels, and promote weight loss. Tirzepatide may be prescribed initially or when clients do not tolerate the Semaglutide. Many times, if a person experiences a plateau in weight loss or suboptimal results, switching to Tirzepatide can stimulate further weight loss.

Due to the popularity of these medications, they may be difficult to obtain at traditional pharmacies. Commercially available medications are also very expensive.

Compounding pharmacies play a valuable role in making GLP-1 agonists more accessible and customizable for patients seeking weight loss solutions. These specialized pharmacies create personalized medications by combining or altering ingredients to meet individual needs. For GLP-1 agonists, compounding can offer options that may be more cost-effective or tailored in dosage and formulation compared to branded versions.

However, it’s essential to ensure that the compounding pharmacy is reputable and adheres to strict quality standards. Compounded medications are not FDA-approved, meaning they are not subject to the same rigorous testing as commercially available drugs. However, 503A pharmacies follow strict guidelines set by the FDA and state boards of pharmacy. At Amethyst Wellness, we collaborate with trusted compounding pharmacies to provide high-quality, customized solutions while maintaining a strong focus on patient safety and results. We encourage those who are not participating in our program to work closely with their healthcare provider to verify the safety, efficacy, and legitimacy of compounded GLP-1 agonists.

GLP-1 agonists offer a promising option for individuals seeking effective weight loss and metabolic health improvements. At Amethyst Wellness, we’re here to help you weigh the pros and cons of GLP-1 agonists, ensuring an informed, personalized approach to your weight loss journey. With our expertise and commitment to your well-being, we’ll guide you toward the most appropriate and effective solutions for your unique needs.