Ask the Pharmacist

Q: What changes should we make to our diet and/or lifestyle when we start GLP-1 agonists, such as Ozempic/Wegovy?

A: In the last column, we discussed the possible nutritional deficiencies we may experience when we are losing weight which can happen when we take these GLP-1 agonists.

We ended the column discussing the importance of protein and ensuring you have enough in your diet, so that is a great place to start.

You may be wondering what might happen to your body if you do not get enough protein. First off, it puts you at risk of losing muscle and strength. You might think that is okay with you, especially if you are in your senior years of life and may believe that it is okay to let your muscles and strength diminish. But maintaining your strength is important for people of all ages.

You may feel less energetic, weak, unable to pick up or carry items like you used to. You may even find that you have difficulty getting up from a chair. You may also notice the droopy facial appearance due to the loss of muscle tone on the face of people who lose weight, regardless of the method used for weight loss.

The muscle loss is due to the weight loss and not related to the use of GLP-1 agonists. It is normal to have some amount of muscle loss along with the intended fat loss when you lose weight, but the key word is "some." This is even more common with people who are more overweight to begin with as some of the unwanted fat stores may have spilled over into the muscles.

You really want to preserve your muscle mass to keep your strength, so it is important to consume enough protein-rich foods to avoid the unintended muscle loss. In the last column, we gave a few suggestions of protein-rich foods that can be eaten. If you are finding you still cannot get your protein levels to the suggested amount, you may consider adding a protein powder to your food to achieve this.

Now, on to another important topic … water. The amount of water each person needs does vary but a minimum of two litres (L) of fluid each day is suggested. However, many see benefit from drinking three litres of fluid daily. To fine tune the amount of fluid you consume, try following the suggested guideline of 35 millilitres (mL) of fluid per kilogram of body weight.

Using the examples of body weight used in the last column, our 150-pound (68-kilogram) person should aim for 2,380 mL (about 2.4 L) of fluid and our 300-pound (136-kg) person should aim for 4,773 mL (about 4.7 L). This amount should account for all fluids in your diet, including water, juice, coffee, smoothies, milk in your cereal, liquid in soup, etc. Check your daily routine and see if you get enough fluids in a day. Many of us do not. However, do not follow these guidelines if you have been advised from your primary health-care provider or specialist to restrict fluids from your diet.

Fibre is another important nutritional topic to discuss. Though the amount of suggested fibre in your diet is not dependent on whether you take GLP-1 agonists or not, many of us truly do not eat enough fibre. Your reduced fibre intake puts you at risk of constipation which can then lead to hemorrhoids, fissures, rectal bleeding, or a rectal prolapse.

We discussed fibre and constipation in previous columns so feel free to go back and read them for an in-depth discussion. In terms of how much fibre you should be getting in your diet, women should aim for 25 grams of fibre daily and men should aim for 35 grams of fibre daily. If you are going to use an application (app) to track the protein in your diet (myfitnesspal for example), that same app will likely tell you the amount of fibre in your diet. Keep in mind that fibre needs water to be effective, so be sure you have increased your fluids too.

Many of us grew up eating three square meals every day. That may still work for you and your lifestyle. If, however, you are finding eating those three meals is challenging for you, consider eating smaller, and more frequent, meals over the course of the day to ensure you get all your nutritional needs. This tactic may be most beneficial when you are just starting a GLP-1 agonist medication and each time you increase your dose, as the medication can adversely affect your eating until your body adjusts to it.

If you do find it challenging to get your nutrition in, you may opt to drink or eat a meal replacement (Boost, Ensure, etc) or make a protein shake to give your body the protein and other important nutrition that it needs to avoid the muscle loss and other nutritional deficiencies. These also work to bring up the fluid content your body needs.

Now that we know about the importance of protein, fibre and fluids in our diet, among other nutritional requirements, you may want to consider requesting the help from a Registered Dietitian to achieve this.

In regard to your muscles, not only is your diet important but it is very beneficial to incorporate resistance training to your weekly fitness schedule. This would be important for everyone to adopt and not just people who take GLP-1 agonists. Resistance training is known to increase muscle mass which, ideally, prevents you from losing that muscle, and it also increases your strength which is important. For starters, try to incorporate 20-60 minutes of resistance training at least two to three times per week.

Some examples of resistance training using your own body weight are:
 

• Push-ups
• Squats
• Planks

You may choose to use equipment for your resistance training, such as:
 

• Resistance bands which are large rubber bands that stretch and provide resistance.
• Free weights, such as dumbbells, kettle bells or medicine balls
• Weight machines

Before starting any resistance training program, ensure you have cleared this with your health-care provider. Once you have done so, choose a weight or band that gives you enough resistance. You will know you have achieved this if your muscles tire out after about 12-15 repetitions. If you find you can do many more, you can look to increase your resistance. If you are struggling to do that many, you should reduce your resistance to avoid injury. You may need to see a fitness/athletic trainer to teach you the correct form.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/.