— Dawn M. Sweet, Ph.D.

GI side effects, along with GLP-1 medication’s impact on appetite, caloric intake, and food choices, can significantly affect nutrition. It’s crucial to take proactive steps to ensure you're consuming a nutrient-dense diet.

GLP-1 weight loss medications — Ozempic, Wegovy, and Rybelsus (semaglutide), Mounjaro and Zepbound (tirzepatide), Trulicity (dulaglutide), as well as Victoza and Saxenda (liraglutide) — are designed to mimic the naturally occurring GLP-1 hormone. The naturally occurring (and synthetic form) of the GLP-1 hormone is implicated in regulating blood sugar (glucose), slowing digestion and appetite reduction.

While GLP-1 medications have successfully helped patients with obesity and/or type 2 diabetes lose weight, they do have GI side effects; the most common are vomiting, diarrhea and nausea. Another GI side effect you may have heard about is GLP-1 delayed gastric emptying, which means your stomach is taking longer to empty its contents. This can result in bloating and/or gastric discomfort. These GI side effects, along with the medication’s effects on appetite, caloric intake, and food choices, can significantly affect nutrition.

 Because you are not hungry, you won’t eat as much; or, because you have GI side effects, you may not feel like eating. Compromised diet quality could have both short-term and long-term effects on your overall health as well as your metabolism, the chemical process that converts food into energy. It is important to take steps to ensure you are consuming a nutrient-dense diet.

Factors that can Negatively Impact Nutritional Health and Wellbeing while taking a GLP-1 Medication

Research on GLP-1 medications has highlighted several factors that negatively impact nutritional health and wellbeing while taking a GLP-1 medication. These factors include:

• Loss of lean body weight. Lean body weight refers to muscle mass. Muscle mass is important because it is metabolically active, which means that your body is burning calories even at rest. Lean body weight accounts for 40 percent or more of total weight loss — meaning that during active weight loss, patients are losing muscle mass as well as fat mass.
• Gastrointestinal side effects. GI side effects include nausea, vomiting, diarrhea and constipation, each of which compromises meeting daily caloric and nutritional needs.
• Altered food preferences. Altered food preferences reduce protein intake, which further amplifies the loss of lean mass. Altered food preferences also reduce fiber and essential vitamins and minerals (e.g. micronutrients).
• Daily caloric reduction. Because of GI side effects and altered food preferences, daily caloric intake has been shown to decreases by as much as 40 to 50 percent. A caloric deficit in this range is considered as extreme calorie restriction, which puts individuals at risk for malnutrition, fatigue, decreased energy, impaired immune functioning and nutrient deficiencies.
• Micronutrient deficiency. Micronutrients are important for healthy growth and development. They are vitamins and minerals that our bodies require in small amounts to ensure proper health and functioning. Deficiency in micronutrients can negatively impact our body’s health and could potentially lead to life-threatening conditions such as anemia. Examples of micronutrients are iron, folate and vitamin B12 — each of which is available through foods like broccoli, lean beef and eggs.
• Gut microbiome. Our gut microbiome is an ecosystem of microorganisms (microbes) that live our guts and is unique to each person. Gut bacteria helps to breakdown foods like complex carbohydrates and fiber like whole grains, beans, fruits, and vegetables. As your microbiome breaks down complex carbohydrates and fiber, it is converting food into energy and affects how our bodies store fat and regulate blood sugar. When our gut’s microbiome is imbalanced due to improper nutrition, we are at greater risk for bacterial infections such as H. pylori and C. difficile, small intestine bacterial overgrowth (SIBO), or inflammatory bowel disease (IBF).

While this may sound concerning, there are steps that could be taken to mitigate the side effects of GLP-1 medications while ensuring nutritional needs are being met.

How to Meet Your Nutritional Needs While Using a GLP-1 Medication

Adding a scientifically formulated nutritional supplement like Biocare can shore up your intake of essential dietary nutrients. Biocare is a nutrient-dense dietary beverage that is designed to counteract nutritional deficiencies associated with weight loss medications. It contains probiotics and prebiotic fiber to promote gut health and contains specialized ingredients to help manage GLP-1 side effects. Biocare also contains high-quality whey protein to help maintain lean muscle mass, and two servings provide 100 percent of the recommended daily intake of 26 vitamins and minerals.

Biocare is unique because it includes absorbable nutritional ingredients supported by evidence-based, empirical research. Biocare’s nutritional parameters could help you reach your daily recommended allowance (RDA) for macronutrients and micronutrients. Macronutrients are protein, fiber, fats and carbohydrates; micronutrients are vitamins and minerals. These ingredients include whey protein, leucine, ground flaxseed and micronutrients for optimized nutritional intake. The importance of each is discussed below. 

• Whey protein. Whey is a protein found in milk. It’s the liquid byproduct of milk during the cheese-making process. Whey is found in consumer products like yogurt and cottage cheese. GLP-1 medications slow the rate of digestion, so it is important to consume whey protein because it facilitates quicker digestion compared to animal proteins, while offering the benefits of lean mass preservation and sustained energy levels. Whey protein optimizes the availability of amino acids (building blocks of protein) to not only preserve lean mass and metabolic function but also support healthy weight loss and weight maintenance. Whey protein also supports gut microbiome for immune system support and nutrient absorption
  • • Biocare provides 20 grams of high-quality whey protein per serving. The RDA for protein for adults is 0.8 grams of protein for each kilogram of body weight, which is the minimum daily protein intake. However, dietary plans that include 1.2 – 1.6 g/kg body weight, or >20 percent the RDA, yield greater benefits for weight loss in the contexts of aging, type 2 diabetes or metabolic syndrome. Be sure to talk with your healthcare provider to determine your optimal daily protein intake. Additional resources include Biocare’s Protein Meal Plans, GLP-1 grocery list, and protein calculator.
• Leucine. Leucine is one of the three essential amino acids (building blocks of protein). It is not produced naturally by our bodies, so it must be derived from food. Examples of foods with leucine include eggs, salmon, lentils, beef, chicken and brown rice. Leucine is important because it is part of the chemical process that synthesizes proteins for muscle preservation; leucine benefits include supporting a healthy metabolic rate, which is key in sustaining a healthy weight. Leucine also mitigates activity- or exercise-related muscle soreness to support the pursuit of physical activity.
  • • Biocare offers 2.5 grams of leucine from dairy ingredients. Because we sometimes rely on supplements, you may be asking yourself, “What is the best L-leucine supplement?” You may also be curious about leucine powder. While supplements or powders might be helpful, it is generally best to derive nutrients from foods or scientifically vetted medical-grade products like Biocare. There are L- leucine benefits and side effects, so it is important to work with your healthcare provider to determine an appropriate daily dose for you.
• Ground flaxseed. Flaxseed is used to support digestive health and to relive constipation. Ground flaxseed is also a source of omega-3 fatty acids (the “good fats”), which support health, brain function and immune system health.
  • • Biocare includes healthy fats from ground flaxseed. Ground flaxseed provides a dietary source of Omega-3s that are required for proper heart, brain and immune function.
• Vitamins and minerals. Reduced gastric emptying and reduced caloric intake compromise the recommended daily allowance for vitamins and minerals. Biocare offers essential vitamins and minerals such as iron, vitamin B12 and Zinc.
  • • Iron. Reduced iron intake can result in fatigue, anemia and lower immunity. 
    • B12. Reduced B12 intake can result in fatigue, weakness, and constipation or digestive gas. 
    • Zinc can alleviate diarrhea and promote nutrient absorption in the gut.
    • Other key vitamins in Biocare include:
      • Vitamin D and Vitamin K. Vitamins D and K are important sources of calcium, which supports bone density.
      • Vitamin A, B12 and Magnesium. These vitamins support our gut’s lining and produce gastric enzymes that break down food and promote nutrient absorption.
    • Additional micronutrients found in Biocare for optimized nutrition intake include:
      • Vitamin C. Vitamin C is important for antioxidants, molecules that protect our bodies from oxidative stress, and immune support.
      • Vitamin K2. Vitamin K12 facilitates calcium in bone functioning and promotes cardiovascular health.

Gastric Motility and Relief from GLP-1 Gastrointestinal Side Effects

Gastric motility refers to the coordinated movement of the stomach muscles and secretions that help propel food and liquids through the digestive system. In some cases, GLP-1 medications can disrupt this process, leading to motility issues. Because GLP-1 medications cause delays in gastric emptying, small intestine motility is reduced. This means that food is slower to be digested, nutrients are slower to be absorbed, and the absorption of key fat-soluble vitamins like Vitamins A, D, E and K will be hindered.

 Stomach paralysis (delayed gastric emptying) — identified as an Ozempic symptom (and other GLP-1 medications) — could be managed with Biocare. Biocare offers 24 key vitamins and minerals that could mitigate the deficits caused by reduced nutritional intake and slow gastric emptying, thereby improving gastric motility. Biocare’s scientifically formulated ingredients also offer relief from gastrointestinal side effects, including:

• Soluble prebiotic fiber. Prebiotics are foods or supplements that have live microorganisms that promote “good” bacteria, microflora, in the body. Prebiotics are typically high-fiber foods that are a food source themselves for microflora. Prebiotics promote digestive and gut health and reduce the occurrence of diarrhea and constipation, and address the micronutrient deficits related to GLP-1 medications
  • • Gastrointestinal side effects of Ozempic or “Zepbound bloating” could be managed with Biocare. Biocare could be used as part of GLP-1-related stomach paralysis treatment (delayed gastric emptying) because it offers prebiotic fibers that promote gut health and gastric motility, the contractions of your stomach muscles that help move food through your digestive tract.
• Digestively stable probiotics. Probiotics are also living microorganisms that can help control harmful microbes found in the gut. Probiotic products support GI tract health and strengthen your gut’s microbiome. Probiotics are implicated in reducing bloating and GI discomfort, both of which are side effects of GLP-1 medications. Probiotics also rebalance beneficial bacteria in the gut microbiome, which is important for digestive health. 
  • • Biocare’s probiotics could help mitigate “Zepbound bloating” or bloating caused by other GLP-1 medications.
• GutGard®. GutGard helps sooth an upset stomach and mitigates the GLP-1 side effects like nausea, fullness, gas and heartburn. GutGard works with probiotics to reduce GI symptoms associated with GLP-1 medications.
  • • Biocare is designed to help manage symptoms of nausea and promote gastric motility; it helps calms an upset stomach and manage digestive symptoms such as nausea, fullness, gas and bloating, while helping to maintain normal digestion and healthy bowel movements to relieve constipation. (Note: You may have heard that you could take licorice root for nausea and may be asking, “Does licorice help nausea?” While licorice root for nausea (i.e. glycyrrhiza glabra supplement) may help, there are also negative side effects, so be sure to consult with your healthcare provider to ensure you are consuming scientifically formulated, medical-grade products [such as Biocare].)
• DigeZyme®. DigeZyme is a group of digestive enzymes (e.g., a-Amylase, Protease, Lipase, Cellulase and Lactose) that promote digestion and facilitate nutrient absorption. These enzymes help with the absorption of carbohydrates, proteins, fats, plant fibers, and lactose to ensure nutritional needs are being met.
  • • Biocare’s blend of digestive enzymes helps promote proper digestion for enhanced nutrient absorption, and they help alleviate GI side effects from GLP-1 medications.
• PepZinGI™ (Zinc L-Carnosine). PepZinGI — a highly bioavailable source of zinc — reduces dyspepsia, e.g., upper abdomen discomfort, gastritis, bloating, nausea and vomiting — all common gastrointestinal side effects of Ozempic and other GLP-1 medications. Zinc offers anti-inflammatory properties to protect cells from oxidative damage. PepZinGI also supports healthy digestion and immune health.

Prior to starting any weight loss program, whether it includes anti-obesity medication or not, be sure to consult with your healthcare provider to make sure your desired weight loss strategy is right for you.

About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.