June 5, 2025 • 39 mins
Why These Drugs Aren’t Magic Bullets—And How to Maximise Their Clinical Impact
The sharp rise in GLP-1 agonist prescriptions – up over 42% in Australia since 2019 – is reshaping how we approach weight loss and metabolic health. But are we ready to support patients beyond the script?
In this evidence-informed episode, dietitian and exercise scientist Robbie Clark joins us to unpack the clinical realities of GLP-1 medications like Ozempic® and Wegovy®. Far from being quick fixes, these medications work best when combined with targeted nutrition, resistance training, and gut support.
Robbie explores how GLP-1 agonists enhance insulin secretion, suppress appetite, and deliver cardiovascular benefits, while sharing practical strategies to enhance patient outcomes and minimise side effects. From optimising protein intake (1.2–1.6 g/kg) to prevent muscle loss, to managing nausea and reflux, you’ll gain the tools to confidently guide your patients through every stage of their GLP-1 journey.
We also dive into the surprising science of bitter foods – like dandelion, grapefruit, and dark chocolate – that naturally stimulate GLP-1 receptors, offering a food-first support strategy that complements medication.
Perhaps most crucial is the discussion on weight regain post-discontinuation, with studies showing 60–100% of lost weight can return within a year without lifestyle foundations. Robbie provides realistic, sustainable strategies to help patients move from medication reliance to long-term metabolic resilience.
Whether you’re currently supporting patients on GLP-1 medications or preparing for their growing use in practice, this episode delivers the clinical insights you need to turn short-term interventions into lasting lifestyle change
Connect with Robbie: healthbank.io
Shownotes and references are available on the Designs for Health website
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:13):
Welcome back to Wellness by Designs.
I'm your host, andrewWhitfield-Cook.
Joining us again today isRobbie Clark, an accredited
practicing dietitian, and todaywe're going to be discussing how
integrated practitioners canhelp manage patients on GLP-1
agonist medications.
Welcome back to Wellness byDesigns, robbie.
(00:33):
How are you?
Speaker 2 (00:34):
I'm really well.
Thanks, Andrew, and thanks forhaving me back.
I love having a chat with youon all things health.
Speaker 1 (00:41):
Thank you, mate.
Thank you so much.
Now we're going to be talkingabout a very important topic,
one that has really takenaustralia society by storm,
because there are so many peoplewho are suffering from
overweight, um, and indeed type2 diabetes.
But we're talking about thisnewer class of drugs called the
glp1 agonists.
(01:02):
Um, firstly, can you take usthrough?
What are they, what are themechanisms of these drugs, and
are there certain populationsthat they're best suited to?
Speaker 2 (01:14):
Yeah, by all means.
Well, I think this is a reallyimportant topic because if there
are practitioners out therelike me, they're probably going
to have people coming throughthe door who are taking these
type of meds.
And what's interesting for meis about the prescribing in
Australia has just surged andreally accelerated.
So we had an annual increasebetween 2019 and 2023 of 42.3%
(01:41):
increase of prescription, andthat was to be compared to a
24.5% increase between the yearsof 2013 and 2019.
So, as you can see, theprescription is on the rise, so
we're going to be seeing more ofthese type of clients coming
through our door.
And for those who may not be asfamiliar with these meds,
(02:04):
basically it is a glucagon-likepeptide, one antagonist
medication, and, as we know,glucagon is a peptide hormone
which is secreted by our alphacells in the pancreas and its
primary function is to raiseblood glucose levels when they
are dropping too low, acting asthe counter-regulatory hormone
(02:28):
to insulin.
So an agonist is really allabout the production or the
synthesis to activate thatparticular hormone.
So the mechanisms there's somany as you can imagine, but I
think the main mechanisms beingan antagonist, an agonist sorry
(02:52):
is that you've got enhancedinsulin secretion first and
foremost because they stimulatethe pancreatic beta cells,
they're going to be releasinginsulin in a glucose dependent
manner and that really helpsreduce the risk of hypoglycemia.
Then you've got the inhibitionof glucagon secretion, which, in
(03:17):
terms of suppressing glucagonrelease from the
gastrointestinal tract and thepancreatic cells, that leads to
reduced hepatic glucoseproduction.
And then you've got delayedgastric emptying.
That's the big one, becausethat's going to tie back to the
symptoms that we'll probablytalk about later.
(03:39):
But there's usually a delayedgastric emptying and this is
slowing the effect, which helpsregulate that postprandial
glucose spikes that we usuallysee, and it also helps promote
satiety.
So it can be very beneficial inthat regard.
Appetite suppression that'sprobably another major one that
(04:00):
people will recognize fromtaking these medications,
because they basically act onthe hypothalamus to decrease our
appetite and also our foodintake, which then also helps
contribute to that weight lossprogress.
I suggest, and the finalbenefit of these medications or
mechanism is that there arecardiovascular benefits as well.
(04:22):
So there are some GLP-1agonists that have been shown to
reduce cardiovascular eventsand that's likely due to its
anti-inflammatory effects, bloodpressure lowering effects and
also that lipid modulating aswell that comes with these
medications.
Speaker 1 (04:41):
Yeah, yeah.
What about comparing the GLP-1agonists to other previous
attempts at controlling weightloss, things like bariatric
surgery, other pharmacologicalapproaches, for instance the um
uh, you know, the metabolicstimulants, if you like um,
which came with their own sortof set of issues?
(05:01):
Um, and course we have toinclude their lifestyle changes,
which have been both wellstudied but also poorly complied
to.
Speaker 2 (05:12):
All right.
So there's always going to bepros and cons of all things
prescription when we do it,whether it be lifestyle, whether
it be medication, whether it besurgery.
So let's probably break thatdown by each one.
Firstly, lifestyleinterventions, which obviously
include things like diet,exercise and also behavioural
modification.
So some pros.
(05:34):
With that you're obviouslygoing to be achieving
sustainable, long-term healthbenefits.
There is no medication sideeffects and also you're just
going to improve your overallmetabolic health.
That goes well beyond theweight loss component, because
that's why people arepredominantly taking these
(05:56):
medications.
The cons to the lifestyleinterventions is probably it
does require long-term adherence, which can be really
challenging for a lot of people.
As we talk about people arelooking for the magic bullet,
that real piece of informationor substance that can just
provide really fast results.
(06:19):
Then you've got weight losstends to be modest, so you're
looking at about five to 10% ofbody weight that is being lost
when you are doing it through alifestyle intervention.
And then you've got a highvariability in success rates
based on individual metabolism,genetics and also adherence.
(06:42):
So there are so many factors atplay when you're just focusing
on that, whereas the glp-1agonist comparison if you're
going to take that medication.
They enhance weight loss beyondlifestyle alone.
So you're getting a probably ahigher weight loss success of
around 10 to 15 percent of totalbody weight loss, and then the
(07:07):
best results obviously occurwhen it is combined with
lifestyle changes rather thanjust using it in isolation alone
.
Bariatric surgery so these arethings obviously like gastric
bypass, sleeve gastrectomy andall of these type of procedures
that people get done whenthey're finding that weight loss
(07:29):
extremely challenging or theyare extremely obese and it is
impacting on other aspects oftheir health.
So obviously the pros to thatit is the most effective weight
loss intervention where they canlose 20 to 35 percent of their
total body weight.
Metabolic benefits go wellbeyond just weight loss alone.
(07:54):
So obviously things like ifthey have diabetes, they could
go into diabetes remission andalso reducing their
cardiovascular risk as well.
The cons really invasiveprocedures, so obviously
anything that comes withsurgical risk.
You've got infection,nutritional deficiencies and
also dumping syndrome as well onthe gastrointestinal tract,
which is quite a challengingthing to treat as well.
(08:17):
Then you've got permanentanatomical changes in your body
and that can lead to additionalcomplications on top.
So it's not suitable for allpatients.
It's mainly those who aremorbidly obese and with
significant comorbidities aswell.
(08:37):
So medications in that regardnot as effective as bariatric
surgery, but it's a non-invasiveapproach and it can also be
used which it has done in a lotof cases as a pre-surgical
intervention.
So, as we know, wheneversomeone is going into surgery,
(09:00):
they need to achieve a certainweight to reduce their risk of
death and therefore thismedication can be used as a
pre-surgical intervention forthat post-surgical weight
maintenance as well.
Speaker 1 (09:16):
Yeah, there was.
You know, the standardprocedure before bariatric
surgery was to put people on acontrolled VLCD diet, and I
attended a bariatric conferenceand with the assumption that the
VLCD diet prior to surgery wasfor out of weight loss, to
(09:38):
reduce anesthetic risk andthat's only part of the story
what I learned was that thebiggest thing was actually the
surgeon wanting to decreaseliver engorgement, because the
instruments had to go in fromthe right side of the body,
behind the liver and then aroundand attack the stomach and if
(09:58):
you had an engorged liver and itfell apart, you had a second
surgical emergency on your hands.
So they were actually sort ofprotecting themselves against
that attendant risk for that,which quite surprised me.
It was also a big eye-opener asto just how engorged people's
livers can be on high-carb diets.
Speaker 2 (10:18):
Oh, completely, particularly with the excessive
visceral fat that is thencoating the organs, which is
then what is contributing tothese chronic health conditions.
Speaker 1 (10:32):
Yeah, yeah, yeah, yeah.
So are there any ways in whichwe can enhance the effects of
GPL1?
Sorry, GLP, glucagon-likepeptide, GLP1.
Is there any ways in which wecan enhance the effects of GLP1
(10:52):
medications?
Speaker 2 (10:55):
Yeah, there are, and there's some really interesting
ones which hopefully some ofyour listeners will not have
heard before.
But when I talk about theenhancement of these medications
, I look predominantly at thenutritional strategies as well
as lifestyle strategies.
So if we firstly look, we knowthat GLP-1 agonist medications
(11:18):
work best in combination withnutrition, exercise and
behavioral changes as well, andthat is obviously to optimize
the weight loss and to make surethat there is muscle retention
and also making sure ourmetabolic health remains intact
as well.
So if we look at thenutritional strategies, firstly,
(11:39):
you need to prioritize proteinintake.
That is number one, becauseGLP-1 meds they suppress
appetite and that increases therisk of inadequate protein
intake or protein malnutrition,and then that obviously then has
a flow-on effect to muscle loss, and that is something that we
(12:01):
absolutely do not want.
Therefore, as a general rulefor the general population, we
should be trying to target atleast 1.2 to 1.6 grams of
protein per kilogram of bodyweight per day.
Obviously, if someone isengaging in resistance training
or they're playing some form ofcontact sport, that needs to be
(12:23):
higher.
Then I would just say verysimple and it always comes back
to this is that we need to focuson a whole foods,
nutrient-dense diet.
And I really express the termnutrient-dense because, like we
mentioned, appetite suppressionleads to lower intake of food,
(12:44):
which then can lead to a lowerdiversity of food and nutrient
intake.
So therefore, that can lead tonutrient deficiencies as well as
malnutrition.
So we really need to look atthose things, particularly in
the gut, where those nutrientsare absorbed, and we could be
looking at things like iron, b12, magnesium deficiencies.
(13:08):
So we really need to monitorthat as well, and so therefore,
we need to emphasize vegetables,fruits, whole grains, legumes
basically a Mediterranean diet,right?
There's been a lot of studiesshowing the importance of a
Mediterranean diet on theproduction of GLP-1, which helps
(13:30):
with that natural appetitesuppression, purely because
which leads me to my next pointit contains high fibre and, more
importantly, it has a lot ofbitters.
Now, this could be the kickerfor a lot of people.
I think it's important foreveryone to be including bitters
(13:51):
or bitter compounds, becausethese bitter compounds are found
in food herbs and you can evenget them through supplements.
They stimulate GLP-1 secretionthrough their effects on gut
taste receptors and theenteroendocrine cells, so that
is really important.
(14:11):
So we all have taste receptors,right.
You've obviously got all thefive tastes, and the bitters
have been the ones that haveshown to be produced primarily
in the distal areas of ourgastrointestinal tract, so the
ileum and also the colon, andthat is what is going to um help
(14:36):
trigger these L cells in thesmall intestines to then release
GLP-1.
So, for education purposes,bitter herbs and botanicals can
be introduced into the diet, andthese are things like berberine
, you know, a fantasticcardiometabolic intervention for
(15:01):
support um, with all things,metabolism, andrographis,
wormwood, dill, ginger, oregano,celery seed, and then, of
course, you've got bitter foodsand phytonutrients as well, and
and so these are things likegrapefruits, lemons all those
citrus peels are very, very goodArtichokes, bitter lemon,
(15:26):
radicchio, all of those bittergreens that we love, like rocket
, dandelion, kale, even radishesand olives.
And finally, from more of apleasurable side of things,
probably, is the dark chocolateor those cacao polyphenols that
(15:47):
we get.
They're quite potent when itcomes to that stimulation of
GLP-1 in the gut.
Speaker 1 (15:53):
Yeah, with regards to chocolate and being practical,
how high a cacao do you advocate, like, I tried a 90% and I
couldn't eat it.
Yeah, it was a task.
Speaker 2 (16:09):
It is, I love, like really bitter chocolate.
So 90% for me is no problem.
Then you know, you typicallyhave your 85, then maybe 75.
I honestly am just tailoring itto maybe what people can
tolerate and you're still goingto get the benefits, because we
know that raw cacao on theantioxidant level and rating
(16:36):
dark chocolate is the highest,like it is through the roof.
So yeah, even if it's aroundthat 75, it's still going to
have some great benefits.
Oh, the other one too.
Interestingly enough, the um,the highest or the largest
consumption of bitters inprobably the Western diet
actually comes from coffee.
(16:57):
So coffee is going to alsoproduce that chlorogenic acids
and the catechins that we see inboth green tea and also coffee,
and that's probably where amajority of the Western diet
consumers get their bitters fromtheir diet.
Speaker 1 (17:20):
But we need to change that to make it more from those
whole foods that we discussedyeah, so there's a just a little
tidbit then would you thereforesuggest to people having coffee
after food, um to help with thestimulation of digestive juices
?
Speaker 2 (17:40):
That's a great question.
I mean, I don't usuallyadvocate fluids whilst eating
because it can also dilute thosedigestive enzymes.
So we really want to try togive our gut the best chance of
breaking down food but alsodigesting food.
However, stimulation of thesereceptors are what's important
(18:05):
to then produce GLP-1.
So you've probably heard ofprescription of bitters before
food.
So you know that age-old taleof consuming lemon water before
you consume foods may actuallyhave some benefit because of
(18:25):
those bitters.
Obviously that is then going tohelp stimulate the taste
receptors, which then willstimulate the production of
GLP-1, which is obviously whatwe want to help postprandial
blood glucose spikes be as lowas possible.
So it could be used incombination pre-consumption of
(18:46):
meals and then alsopost-consumption as well.
Speaker 1 (18:51):
Gotcha, just flowing on from something you said about
diversity previously, withdiversity of foods and reducing
that diversity if you don't havean adequate hunger response.
I get that.
They've had an overabundanthunger response previously.
Speaker 2 (19:15):
I get that they've had an overabundant hunger
response previously, but can youtalk to us about the effect
that this might have on the gutmicrobiota and its diversity?
Oh yeah, well, we definitelyknow, like in terms of obviously
GLP-1 to begin with is where itis produced and that is in the
gastrointestinal tract.
So these medications, just likea lot of medications in general
(19:37):
, can have an impact on themicrobiota, but specifically the
GLP-1 receptor agonistsinfluence both gut the function,
motility and the microbiome.
Now, I will preface this withsaying that the research on this
is still emerging.
However, there are also seen tobe benefits, surprisingly, with
(20:03):
these medications as well,because the benefits could
potentially be increasedmicrobiome diversity and that is
then linked to improvedmetabolic health.
As a result, there might alsobe enhanced short-chain fatty
acid production, whichdefinitely aids in appetite
(20:24):
regulation, and also insulinsensitivity, and there could
also be reduced inflammatorybacteria and that opportunistic
bacterial overgrowth as well.
So that's obviously just goingto generally lower gut
inflammation and improve theintestinal barrier function as
(20:44):
well.
So the mucosal lining.
But the potential negativeeffects is obviously things like
slowed gastric emptying andthat is also going to alter the
gut motility and that is goingto people who already have some
gastrointestinal disorders,particularly SIBO.
(21:06):
That's going to impact quitesignificantly.
So this comes back to obviouslytreating the client
holistically, looking at whattheir medical history is and
seeing if they are a goodcandidate to begin with or what
they might potentiallyexperience as side effects on
the back of that.
There also could potentially bechanges in bile acid metabolism
(21:27):
as well, and that's going toimpact just the microbiome
ballasts really and then lead todysbiosis.
So that's something that weneed to affect.
We talked before we came ontothis podcast today is that the
main ones listeners will befamiliar with with these
medications are things likenausea, vomiting, reflux and
(21:53):
even diarrhea as well.
They're probably the major onesthat I see that come through my
door who are on thesemedications, so we need to be
able to control that and managethat whilst they're on these
medications and all of thosethings I just mentioned is going
to be an additional impact onhow they consume food.
(22:15):
So they will already have a lowappetite, but add all those
things in, they're not going towant to eat or they could go for
long periods of time withouteating to eat, or they could go
for long periods of time withouteating.
The more severe things that wemight see are things like
gastroparesis, and this is quitea chronic condition and a very
(22:36):
serious one too if it's nottreated or looked after whilst
these people are on thesemedications and pancreatitis as
well.
That's just a side one thatthere's been a few cases of that
that have been seen with theuse of these medications as well
, but that's more chronic andmore serious, obviously.
(22:57):
Yeah, yeah, yeah.
Speaker 1 (23:01):
That was a really good point you made about
potential improvements in themicrobiota with regards to the
GLP-1 agonist and I thought, youknow, while you were talking I
thought about it.
I thought, yeah, maybe ifsomebody was on a really high
carb diet they're going to havean increased abundance.
One would suggest they're goingto have an increased abundance
(23:24):
of the what we used to call themformicutes.
They've now changed their name,now called basalotta.
This taxa um.
So let's say formicities,because people are going to know
it, but it's called basalotta.
Now there's a whole argumentwith the microbiologists about
this um.
But yeah, if you decrease thecarb intake, you're going to
decrease the basal-, thefemicides, and therefore
(23:49):
potentially the inflammatoryprocesses that are attended to
that, the EPS yeah, yeah, that'sreally interesting, yeah,
thanks.
Speaker 2 (24:02):
And also it's all about supporting gut health
whilst they're on thesemedications, right?
So that should be the goal forthe practitioner, and the way
that we can do that is byincreasing our fiber intake,
both soluble and insoluble fiber, because, as we know, fiber is
so important to our gutmicrobiota and also our
(24:23):
digestion, and it can alsoalleviate things like
constipation if people areexperiencing that as a flow on
effect of the medication.
We should also be consideringto include fermented and
prebiotic foods as well, becausethat's just going to maintain
the microbial diversity in ourgut and you know we can get that
(24:47):
naturally through things likekefir, sauerkraut, kimchi,
garlic, onions, asparagus.
So all of these type ofprebiotic foods can be really
helpful as well.
The one thing we haven'tactually brought up, but is
equally as important, ishydration.
I think we know aspractitioners that a lot of our
(25:07):
clients have really bad fluidintake or, if they do, it might
come from other sources thatmight have added sugars in there
, so like fruit juices, softdrinks.
But we really want to focus onfluid intake because that can
also assist with things likeconstipation and delayed
digestion that can be an issuefor these clients on these
(25:33):
medications.
So, yeah, I typically recommend30 to 40 mils per kilogram of
body mass, and that is yourlower end of the range to the
upper end of the range.
Rather than that aim for eightglasses of water a day.
That's more tailored, morespecific, and that way you're
(25:56):
really going to make sure peopleare hydrated.
Speaker 1 (25:59):
Cool, other supplements, other things that
we can use to potentially helppatients, and I'm just wondering
about, if we think about theoriginal guidelines for the use
of GLP-1 agonists, and that wastype 2 diabetes, and if we think
about a lot of people who havediabetes are magnesium deficient
.
And then if you think about,okay, how are we going to
(26:20):
support liver detox and blah,blah, blah, taurine, and taurine
has some there's not a lot ofresearch on it, but some
potential aspects of benefitwith regards to fat loss.
What about using magnesium tohelp the diabetic issue and then
taurine to help the sort ofliver weight loss sort of arena?
(26:40):
Does that make sense to you?
Is that it?
Speaker 2 (26:44):
certainly does, because, if you think about it,
the types of clients who are onthese medications are not just
the obese.
They are the ones that have allthe risks associated with it.
So, yes, of course, it's beendesigned for specifically type 2
(27:04):
diabetes.
That's a given.
We know that that is ametabolic issue in itself.
But what about all the othermetabolic concerns and issues?
So people who havehypothyroidism, people who have
insulin resistance, people whohave polycystic ovarian syndrome
, so all of these conditionshave metabolic dysfunction.
(27:29):
So think of practitioners, orfunctional medicine
practitioners, who are alreadysupporting or supplementing
their clients with theseconditions with nutrients that
are going to support metabolicfunction.
It would be the same in any ofthese clients who are taking
these GLP-1 agonist medications.
(27:49):
So, yes, I'm in full support.
However, of course, it needs tobe personalised and tailored.
So you are looking at all thecomorbidities that this client
has and then, hopefully, there'salready been the hard work done
in terms of the investigationsaround any blood work pathology
(28:12):
done, in terms of theinvestigations around any blood
work pathology, maybe somemicrobiome stool testing and
then even urinary hormoneanalysis as well.
So you can do so many types ofinvestigations to really get to
the nitty-gritty and of courseAndrew you'll love this is if
they've gone the extra mile todo some DNA analysis and testing
.
Then you can really see wherethere might be some mutations on
(28:36):
their SNPs, that you can thenbe very personalized with their
supplement treatment.
Speaker 1 (28:43):
Yeah, yeah.
What about?
You know these medicines arenot cheap.
There's a whole thrust at themoment about trying to get them
onto the PBS and that will haveits own political football sort
of stuff going on.
But you know these are notcheap medicines for patients.
You know, $300 odd a week, thatsort of thing.
(29:06):
What about if people stop them?
You know, I'm just wonderingabout the people getting hooked
into the quick fix and wantingthat.
They're extremely expensive andso, you know, do they have
attendant risks of I mean, I saythis word incorrectly
(29:26):
dependence?
I'm not talking physicaldependence, but wanting that
quick fix word incorrectlydependence?
I'm not talking physicaldependence, but wanting that
quick fix.
So the risk of dependence, ofthe effect of that and the
difficulty in maintaining weightloss after stopping them.
Is there anything that we cando to maybe manage their
expectations, to maybe help themto navigate stopping these
(29:50):
medications?
Speaker 2 (29:53):
You've raised a really good point and I loved
how you were cautious aroundthat term dependence, because if
you think about it, that's whenwe are talking about more
addiction.
So GLP-1 agonist meds are notaddictive in the traditional
sense, so there are nowithdrawals or cravings, or even
(30:17):
compulsive use of thesemedications.
So I think we should startthere and be very clear about
that.
However, there is a risk ofphysiological reliance that's
the term that I like to use whentalking about this Because
these medications alter yourappetite regulation and also
your metabolism.
(30:37):
So that's when there could bethat risk of physiological
reliance.
And the reason why somepatients may struggle after
stopping these medications is,firstly, they're going to
experience increased hunger, andwe know that these GLP-1 meds
(30:59):
suppress appetite, so stoppingthem can then also lead to
stronger hunger signals all of asudden and they don't know how
to deal with that.
They will maybe experiencereduced energy expenditure as
well.
So weight loss lowers restingmetabolic rate, as we know, and
(31:20):
that can predispose to weightgain, and there is no long-term
behavioural changes, if youthink about it.
So they've gone on thismedication, they've experienced
this, maybe potentially fastweight loss but patients who
have relied solely on thismedication may struggle to
(31:43):
maintain those results.
So they're the ones we need tobe the most cautious with.
And if we're looking at risksof weight regain after stopping
medication, the studies thathave been done to date show that
most patients regain around 60%to 100% of the lost weight
(32:05):
within a year of stopping themedication, unless there's a
caveat here, unless lifestylechanges have been also put in
place.
So I think that that's really agreat enforcer in itself.
It's that okay, there may besome weight regain, but not as
bad as if we implement somelifestyle interventions as well.
(32:28):
So, yeah, I think that that'sreally important.
But if you're talking to thepractitioner specifically about
what we can be doing to reallyfirstly navigate the
expectations that's number one.
I find that practitionersaren't having a serious
conversation, or serious enoughconversation, with their clients
(32:48):
around this.
So they need to navigate whatthe patient expectations are
around the medications inthemselves, because then you're
managing expectations around,firstly, weight loss speed so
how quickly they're going tolose it and also sustainability.
Educating your patients on fatversus muscle loss is also very
(33:12):
important, because they're goingto be seeing all this weight
fall off or reduce on the scalesas a number, but what they're
not realising is that a lot ofit can be fluid loss.
A lot of it can be muscle lossas well.
So that's really important.
And then I would be emphasisingthat GLP-1 agonist medications
(33:34):
are a tool, not a standalonesolution, for their weight loss
and improving their maybepotential chronic health
conditions that they're livingwith as well.
So there's some reallyimportant points there.
Speaker 1 (33:59):
Can I ask about talking about setting patients
up, if you like, from the get-go, for success long-term, what
sort of exercise would you tendto prefer?
We're talking weight, we'retalking resistance exercise
rather than cardiovascularexercise, at least in the
beginning, is that correct?
Speaker 2 (34:15):
Oh, absolutely Anyone who comes through my door who
is undergoing a fat loss journey.
It is a non-negotiableessentially is that we are
implementing some form ofstrength or resistance training
because we know that first andforemost, they're going to be
(34:36):
building lean muscle, which isimportant for long-term health,
but by doing so they're alsogoing to be improving their
basal metabolic rate, which isthen going to assist in further
fat loss.
But then, on top of that, thatresistance training is also
critical in preserving leanmuscle mass, and we know from
(34:58):
the studies to date that thesemedications can put people at
risk of protein malnutrition andalso muscle loss.
So we really want to make surethat we are providing some form
of strength training and for me,I would be starting at a
minimum of three days per week,and a lot of people are probably
(35:19):
listening.
I should preface this saying oh, you're just a dietitian, but
I'm also an exercise scientist,so I can prescribe some
recommendations around theexercise routine, and we are
definitely looking at both thatstrength training and also hip
(35:39):
training.
So high intensity intervaltraining can be really
beneficial to maximize thatmetabolic burn, if you will, and
to get real great results longterm from fat loss.
Speaker 1 (35:56):
Yeah, I'm glad you mentioned HIIT training because
if you think about this patientpopulation, so A, they're given
to wanting a quicker responsefrom therapy, right?
I'm just going to guess aboutthe patient characteristics here
and thinking about HIIT therapy, even though it's hard and fast
(36:19):
, but the results, even ontriglycerides, are immediate.
And so, talking about quoteunquote quick fixes if you
couldn't get a better quick fixfor your health that has
long-term benefits as well.
The other thing I was going tomention, talking about foods, we
were talking about quoteunquote quick fixes if you
couldn't get a better quick fixfor your health that has
long-term benefits as well.
The other thing I was going tomention talking about foods we
were talking about foods earlieris, I seem to recall a smaller
(36:39):
intervention regarding I thinkit was 30 mil, 30 mil of olive
oil per day with the polyphenolsbiophenols I think they call
them in Australia which they'renot in the olives but they're
actually made by the process ofextracting the oil.
Yeah, so it's reallyinteresting with this and they
(37:01):
were actually chugging down 30mils of olive oil and they were
having cardiovascular benefitsquite quickly.
Speaker 2 (37:07):
Yeah Well, do you know what's so funny that you've
mentioned that, andrews?
Because it's a trend now onTikTok, on Instagram.
There are all these peopleliterally shooting extra virgin
olive oil and we're looking ataround 30 to 40 mils, as you
mentioned.
So you're bang on.
And because of thosebioophenols or polyphenols, they
(37:32):
are a form of bitters, right.
So that is makes sense becauseit is stimulating those bitter
receptors, which then stimulatesthe synthesis and the
activation of glp-1 in the gut.
So, yeah, definitely, but thething is, do we need to be
(37:52):
shooting olive oil?
No, you can be using it in somany diverse ways in your diet,
but definitely making sure thatit's extra virgin olive oil most
importantly, because, as weknow, olive oils can come in
blends.
So we really want to make surethat it is extra virgin.
And, of course, that goes backto what I was saying earlier
around the Mediterranean diet.
(38:13):
That's another reason why itworks so well on the stimulation
of GLP-1.
Speaker 1 (38:21):
Yeah, cool.
Can I put an added call outthere?
And that is that it'sAustralian extra virgin olive
oil, because there's actuallybeen police stings overseas
where they've caught companiesadulterating olive oil with
other seed oils, and we'retalking about hundreds of
thousands of litres.
(38:41):
We're not talking little things, we're talking big business
here.
So I would buy Australian here,definitely, definitely only.
Speaker 2 (38:50):
Agreed.
Speaker 1 (38:52):
Robbie, there's so much that we could cover here.
I mean, this is a big topic.
This is a seminar, not apodcast topic.
But I thank you so much fortaking us through your true
expertise here and it's prettyevident that, with regards to
when you're saying personalizedmedicine and programs here, that
it's self-evident about yourcare for your patients.
(39:14):
So thank you so much for reallyeducating us on not just the
practical things to do, but howmuch you give a damn about these
patients, not just short-termbut long-term health.
Thank you so much for joiningus today on wellness by designs
thanks, andrew, it's been apleasure.
And thank you everyone.
Remember you can catch up onall the show notes and the other
podcasts on the Designs forHealth website.
(39:36):
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
Welcome back to Wellness by Designs.
I'm your host, andrewWhitfield-Cook.
Joining us again today isRobbie Clark, an accredited
practicing dietitian, and todaywe're going to be discussing how
integrated practitioners canhelp manage patients on GLP-1
agonist medications.
Welcome back to Wellness byDesigns, robbie.
(00:33):
How are you?
Speaker 2 (00:34):
I'm really well.
Thanks, Andrew, and thanks forhaving me back.
I love having a chat with youon all things health.
Speaker 1 (00:41):
Thank you, mate.
Thank you so much.
Now we're going to be talkingabout a very important topic,
one that has really takenaustralia society by storm,
because there are so many peoplewho are suffering from
overweight, um, and indeed type2 diabetes.
But we're talking about thisnewer class of drugs called the
glp1 agonists.
(01:02):
Um, firstly, can you take usthrough?
What are they, what are themechanisms of these drugs, and
are there certain populationsthat they're best suited to?
Speaker 2 (01:14):
Yeah, by all means.
Well, I think this is a reallyimportant topic because if there
are practitioners out therelike me, they're probably going
to have people coming throughthe door who are taking these
type of meds.
And what's interesting for meis about the prescribing in
Australia has just surged andreally accelerated.
So we had an annual increasebetween 2019 and 2023 of 42.3%
(01:41):
increase of prescription, andthat was to be compared to a
24.5% increase between the yearsof 2013 and 2019.
So, as you can see, theprescription is on the rise, so
we're going to be seeing more ofthese type of clients coming
through our door.
And for those who may not be asfamiliar with these meds,
(02:04):
basically it is a glucagon-likepeptide, one antagonist
medication, and, as we know,glucagon is a peptide hormone
which is secreted by our alphacells in the pancreas and its
primary function is to raiseblood glucose levels when they
are dropping too low, acting asthe counter-regulatory hormone
(02:28):
to insulin.
So an agonist is really allabout the production or the
synthesis to activate thatparticular hormone.
So the mechanisms there's somany as you can imagine, but I
think the main mechanisms beingan antagonist, an agonist sorry
(02:52):
is that you've got enhancedinsulin secretion first and
foremost because they stimulatethe pancreatic beta cells,
they're going to be releasinginsulin in a glucose dependent
manner and that really helpsreduce the risk of hypoglycemia.
Then you've got the inhibitionof glucagon secretion, which, in
(03:17):
terms of suppressing glucagonrelease from the
gastrointestinal tract and thepancreatic cells, that leads to
reduced hepatic glucoseproduction.
And then you've got delayedgastric emptying.
That's the big one, becausethat's going to tie back to the
symptoms that we'll probablytalk about later.
(03:39):
But there's usually a delayedgastric emptying and this is
slowing the effect, which helpsregulate that postprandial
glucose spikes that we usuallysee, and it also helps promote
satiety.
So it can be very beneficial inthat regard.
Appetite suppression that'sprobably another major one that
(04:00):
people will recognize fromtaking these medications,
because they basically act onthe hypothalamus to decrease our
appetite and also our foodintake, which then also helps
contribute to that weight lossprogress.
I suggest, and the finalbenefit of these medications or
mechanism is that there arecardiovascular benefits as well.
(04:22):
So there are some GLP-1agonists that have been shown to
reduce cardiovascular eventsand that's likely due to its
anti-inflammatory effects, bloodpressure lowering effects and
also that lipid modulating aswell that comes with these
medications.
Speaker 1 (04:41):
Yeah, yeah.
What about comparing the GLP-1agonists to other previous
attempts at controlling weightloss, things like bariatric
surgery, other pharmacologicalapproaches, for instance the um
uh, you know, the metabolicstimulants, if you like um,
which came with their own sortof set of issues?
(05:01):
Um, and course we have toinclude their lifestyle changes,
which have been both wellstudied but also poorly complied
to.
Speaker 2 (05:12):
All right.
So there's always going to bepros and cons of all things
prescription when we do it,whether it be lifestyle, whether
it be medication, whether it besurgery.
So let's probably break thatdown by each one.
Firstly, lifestyleinterventions, which obviously
include things like diet,exercise and also behavioural
modification.
So some pros.
(05:34):
With that you're obviouslygoing to be achieving
sustainable, long-term healthbenefits.
There is no medication sideeffects and also you're just
going to improve your overallmetabolic health.
That goes well beyond theweight loss component, because
that's why people arepredominantly taking these
(05:56):
medications.
The cons to the lifestyleinterventions is probably it
does require long-term adherence, which can be really
challenging for a lot of people.
As we talk about people arelooking for the magic bullet,
that real piece of informationor substance that can just
provide really fast results.
(06:19):
Then you've got weight losstends to be modest, so you're
looking at about five to 10% ofbody weight that is being lost
when you are doing it through alifestyle intervention.
And then you've got a highvariability in success rates
based on individual metabolism,genetics and also adherence.
(06:42):
So there are so many factors atplay when you're just focusing
on that, whereas the glp-1agonist comparison if you're
going to take that medication.
They enhance weight loss beyondlifestyle alone.
So you're getting a probably ahigher weight loss success of
around 10 to 15 percent of totalbody weight loss, and then the
(07:07):
best results obviously occurwhen it is combined with
lifestyle changes rather thanjust using it in isolation alone
.
Bariatric surgery so these arethings obviously like gastric
bypass, sleeve gastrectomy andall of these type of procedures
that people get done whenthey're finding that weight loss
(07:29):
extremely challenging or theyare extremely obese and it is
impacting on other aspects oftheir health.
So obviously the pros to thatit is the most effective weight
loss intervention where they canlose 20 to 35 percent of their
total body weight.
Metabolic benefits go wellbeyond just weight loss alone.
(07:54):
So obviously things like ifthey have diabetes, they could
go into diabetes remission andalso reducing their
cardiovascular risk as well.
The cons really invasiveprocedures, so obviously
anything that comes withsurgical risk.
You've got infection,nutritional deficiencies and
also dumping syndrome as well onthe gastrointestinal tract,
which is quite a challengingthing to treat as well.
(08:17):
Then you've got permanentanatomical changes in your body
and that can lead to additionalcomplications on top.
So it's not suitable for allpatients.
It's mainly those who aremorbidly obese and with
significant comorbidities aswell.
(08:37):
So medications in that regardnot as effective as bariatric
surgery, but it's a non-invasiveapproach and it can also be
used which it has done in a lotof cases as a pre-surgical
intervention.
So, as we know, wheneversomeone is going into surgery,
(09:00):
they need to achieve a certainweight to reduce their risk of
death and therefore thismedication can be used as a
pre-surgical intervention forthat post-surgical weight
maintenance as well.
Speaker 1 (09:16):
Yeah, there was.
You know, the standardprocedure before bariatric
surgery was to put people on acontrolled VLCD diet, and I
attended a bariatric conferenceand with the assumption that the
VLCD diet prior to surgery wasfor out of weight loss, to
(09:38):
reduce anesthetic risk andthat's only part of the story
what I learned was that thebiggest thing was actually the
surgeon wanting to decreaseliver engorgement, because the
instruments had to go in fromthe right side of the body,
behind the liver and then aroundand attack the stomach and if
(09:58):
you had an engorged liver and itfell apart, you had a second
surgical emergency on your hands.
So they were actually sort ofprotecting themselves against
that attendant risk for that,which quite surprised me.
It was also a big eye-opener asto just how engorged people's
livers can be on high-carb diets.
Speaker 2 (10:18):
Oh, completely, particularly with the excessive
visceral fat that is thencoating the organs, which is
then what is contributing tothese chronic health conditions.
Speaker 1 (10:32):
Yeah, yeah, yeah, yeah.
So are there any ways in whichwe can enhance the effects of
GPL1?
Sorry, GLP, glucagon-likepeptide, GLP1.
Is there any ways in which wecan enhance the effects of GLP1
(10:52):
medications?
Speaker 2 (10:55):
Yeah, there are, and there's some really interesting
ones which hopefully some ofyour listeners will not have
heard before.
But when I talk about theenhancement of these medications
, I look predominantly at thenutritional strategies as well
as lifestyle strategies.
So if we firstly look, we knowthat GLP-1 agonist medications
(11:18):
work best in combination withnutrition, exercise and
behavioral changes as well, andthat is obviously to optimize
the weight loss and to make surethat there is muscle retention
and also making sure ourmetabolic health remains intact
as well.
So if we look at thenutritional strategies, firstly,
(11:39):
you need to prioritize proteinintake.
That is number one, becauseGLP-1 meds they suppress
appetite and that increases therisk of inadequate protein
intake or protein malnutrition,and then that obviously then has
a flow-on effect to muscle loss, and that is something that we
(12:01):
absolutely do not want.
Therefore, as a general rulefor the general population, we
should be trying to target atleast 1.2 to 1.6 grams of
protein per kilogram of bodyweight per day.
Obviously, if someone isengaging in resistance training
or they're playing some form ofcontact sport, that needs to be
(12:23):
higher.
Then I would just say verysimple and it always comes back
to this is that we need to focuson a whole foods,
nutrient-dense diet.
And I really express the termnutrient-dense because, like we
mentioned, appetite suppressionleads to lower intake of food,
(12:44):
which then can lead to a lowerdiversity of food and nutrient
intake.
So therefore, that can lead tonutrient deficiencies as well as
malnutrition.
So we really need to look atthose things, particularly in
the gut, where those nutrientsare absorbed, and we could be
looking at things like iron, b12, magnesium deficiencies.
(13:08):
So we really need to monitorthat as well, and so therefore,
we need to emphasize vegetables,fruits, whole grains, legumes
basically a Mediterranean diet,right?
There's been a lot of studiesshowing the importance of a
Mediterranean diet on theproduction of GLP-1, which helps
(13:30):
with that natural appetitesuppression, purely because
which leads me to my next pointit contains high fibre and, more
importantly, it has a lot ofbitters.
Now, this could be the kickerfor a lot of people.
I think it's important foreveryone to be including bitters
(13:51):
or bitter compounds, becausethese bitter compounds are found
in food herbs and you can evenget them through supplements.
They stimulate GLP-1 secretionthrough their effects on gut
taste receptors and theenteroendocrine cells, so that
is really important.
(14:11):
So we all have taste receptors,right.
You've obviously got all thefive tastes, and the bitters
have been the ones that haveshown to be produced primarily
in the distal areas of ourgastrointestinal tract, so the
ileum and also the colon, andthat is what is going to um help
(14:36):
trigger these L cells in thesmall intestines to then release
GLP-1.
So, for education purposes,bitter herbs and botanicals can
be introduced into the diet, andthese are things like berberine
, you know, a fantasticcardiometabolic intervention for
(15:01):
support um, with all things,metabolism, andrographis,
wormwood, dill, ginger, oregano,celery seed, and then, of
course, you've got bitter foodsand phytonutrients as well, and
and so these are things likegrapefruits, lemons all those
citrus peels are very, very goodArtichokes, bitter lemon,
(15:26):
radicchio, all of those bittergreens that we love, like rocket
, dandelion, kale, even radishesand olives.
And finally, from more of apleasurable side of things,
probably, is the dark chocolateor those cacao polyphenols that
(15:47):
we get.
They're quite potent when itcomes to that stimulation of
GLP-1 in the gut.
Speaker 1 (15:53):
Yeah, with regards to chocolate and being practical,
how high a cacao do you advocate, like, I tried a 90% and I
couldn't eat it.
Yeah, it was a task.
Speaker 2 (16:09):
It is, I love, like really bitter chocolate.
So 90% for me is no problem.
Then you know, you typicallyhave your 85, then maybe 75.
I honestly am just tailoring itto maybe what people can
tolerate and you're still goingto get the benefits, because we
know that raw cacao on theantioxidant level and rating
(16:36):
dark chocolate is the highest,like it is through the roof.
So yeah, even if it's aroundthat 75, it's still going to
have some great benefits.
Oh, the other one too.
Interestingly enough, the um,the highest or the largest
consumption of bitters inprobably the Western diet
actually comes from coffee.
(16:57):
So coffee is going to alsoproduce that chlorogenic acids
and the catechins that we see inboth green tea and also coffee,
and that's probably where amajority of the Western diet
consumers get their bitters fromtheir diet.
Speaker 1 (17:20):
But we need to change that to make it more from those
whole foods that we discussedyeah, so there's a just a little
tidbit then would you thereforesuggest to people having coffee
after food, um to help with thestimulation of digestive juices
?
Speaker 2 (17:40):
That's a great question.
I mean, I don't usuallyadvocate fluids whilst eating
because it can also dilute thosedigestive enzymes.
So we really want to try togive our gut the best chance of
breaking down food but alsodigesting food.
However, stimulation of thesereceptors are what's important
(18:05):
to then produce GLP-1.
So you've probably heard ofprescription of bitters before
food.
So you know that age-old taleof consuming lemon water before
you consume foods may actuallyhave some benefit because of
(18:25):
those bitters.
Obviously that is then going tohelp stimulate the taste
receptors, which then willstimulate the production of
GLP-1, which is obviously whatwe want to help postprandial
blood glucose spikes be as lowas possible.
So it could be used incombination pre-consumption of
(18:46):
meals and then alsopost-consumption as well.
Speaker 1 (18:51):
Gotcha, just flowing on from something you said about
diversity previously, withdiversity of foods and reducing
that diversity if you don't havean adequate hunger response.
I get that.
They've had an overabundanthunger response previously.
Speaker 2 (19:15):
I get that they've had an overabundant hunger
response previously, but can youtalk to us about the effect
that this might have on the gutmicrobiota and its diversity?
Oh yeah, well, we definitelyknow, like in terms of obviously
GLP-1 to begin with is where itis produced and that is in the
gastrointestinal tract.
So these medications, just likea lot of medications in general
(19:37):
, can have an impact on themicrobiota, but specifically the
GLP-1 receptor agonistsinfluence both gut the function,
motility and the microbiome.
Now, I will preface this withsaying that the research on this
is still emerging.
However, there are also seen tobe benefits, surprisingly, with
(20:03):
these medications as well,because the benefits could
potentially be increasedmicrobiome diversity and that is
then linked to improvedmetabolic health.
As a result, there might alsobe enhanced short-chain fatty
acid production, whichdefinitely aids in appetite
(20:24):
regulation, and also insulinsensitivity, and there could
also be reduced inflammatorybacteria and that opportunistic
bacterial overgrowth as well.
So that's obviously just goingto generally lower gut
inflammation and improve theintestinal barrier function as
(20:44):
well.
So the mucosal lining.
But the potential negativeeffects is obviously things like
slowed gastric emptying andthat is also going to alter the
gut motility and that is goingto people who already have some
gastrointestinal disorders,particularly SIBO.
(21:06):
That's going to impact quitesignificantly.
So this comes back to obviouslytreating the client
holistically, looking at whattheir medical history is and
seeing if they are a goodcandidate to begin with or what
they might potentiallyexperience as side effects on
the back of that.
There also could potentially bechanges in bile acid metabolism
(21:27):
as well, and that's going toimpact just the microbiome
ballasts really and then lead todysbiosis.
So that's something that weneed to affect.
We talked before we came ontothis podcast today is that the
main ones listeners will befamiliar with with these
medications are things likenausea, vomiting, reflux and
(21:53):
even diarrhea as well.
They're probably the major onesthat I see that come through my
door who are on thesemedications, so we need to be
able to control that and managethat whilst they're on these
medications and all of thosethings I just mentioned is going
to be an additional impact onhow they consume food.
(22:15):
So they will already have a lowappetite, but add all those
things in, they're not going towant to eat or they could go for
long periods of time withouteating to eat, or they could go
for long periods of time withouteating.
The more severe things that wemight see are things like
gastroparesis, and this is quitea chronic condition and a very
(22:36):
serious one too if it's nottreated or looked after whilst
these people are on thesemedications and pancreatitis as
well.
That's just a side one thatthere's been a few cases of that
that have been seen with theuse of these medications as well
, but that's more chronic andmore serious, obviously.
(22:57):
Yeah, yeah, yeah.
Speaker 1 (23:01):
That was a really good point you made about
potential improvements in themicrobiota with regards to the
GLP-1 agonist and I thought, youknow, while you were talking I
thought about it.
I thought, yeah, maybe ifsomebody was on a really high
carb diet they're going to havean increased abundance.
One would suggest they're goingto have an increased abundance
(23:24):
of the what we used to call themformicutes.
They've now changed their name,now called basalotta.
This taxa um.
So let's say formicities,because people are going to know
it, but it's called basalotta.
Now there's a whole argumentwith the microbiologists about
this um.
But yeah, if you decrease thecarb intake, you're going to
decrease the basal-, thefemicides, and therefore
(23:49):
potentially the inflammatoryprocesses that are attended to
that, the EPS yeah, yeah, that'sreally interesting, yeah,
thanks.
Speaker 2 (24:02):
And also it's all about supporting gut health
whilst they're on thesemedications, right?
So that should be the goal forthe practitioner, and the way
that we can do that is byincreasing our fiber intake,
both soluble and insoluble fiber, because, as we know, fiber is
so important to our gutmicrobiota and also our
(24:23):
digestion, and it can alsoalleviate things like
constipation if people areexperiencing that as a flow on
effect of the medication.
We should also be consideringto include fermented and
prebiotic foods as well, becausethat's just going to maintain
the microbial diversity in ourgut and you know we can get that
(24:47):
naturally through things likekefir, sauerkraut, kimchi,
garlic, onions, asparagus.
So all of these type ofprebiotic foods can be really
helpful as well.
The one thing we haven'tactually brought up, but is
equally as important, ishydration.
I think we know aspractitioners that a lot of our
(25:07):
clients have really bad fluidintake or, if they do, it might
come from other sources thatmight have added sugars in there
, so like fruit juices, softdrinks.
But we really want to focus onfluid intake because that can
also assist with things likeconstipation and delayed
digestion that can be an issuefor these clients on these
(25:33):
medications.
So, yeah, I typically recommend30 to 40 mils per kilogram of
body mass, and that is yourlower end of the range to the
upper end of the range.
Rather than that aim for eightglasses of water a day.
That's more tailored, morespecific, and that way you're
(25:56):
really going to make sure peopleare hydrated.
Speaker 1 (25:59):
Cool, other supplements, other things that
we can use to potentially helppatients, and I'm just wondering
about, if we think about theoriginal guidelines for the use
of GLP-1 agonists, and that wastype 2 diabetes, and if we think
about a lot of people who havediabetes are magnesium deficient
.
And then if you think about,okay, how are we going to
(26:20):
support liver detox and blah,blah, blah, taurine, and taurine
has some there's not a lot ofresearch on it, but some
potential aspects of benefitwith regards to fat loss.
What about using magnesium tohelp the diabetic issue and then
taurine to help the sort ofliver weight loss sort of arena?
(26:40):
Does that make sense to you?
Is that it?
Speaker 2 (26:44):
certainly does, because, if you think about it,
the types of clients who are onthese medications are not just
the obese.
They are the ones that have allthe risks associated with it.
So, yes, of course, it's beendesigned for specifically type 2
(27:04):
diabetes.
That's a given.
We know that that is ametabolic issue in itself.
But what about all the othermetabolic concerns and issues?
So people who havehypothyroidism, people who have
insulin resistance, people whohave polycystic ovarian syndrome
, so all of these conditionshave metabolic dysfunction.
(27:29):
So think of practitioners, orfunctional medicine
practitioners, who are alreadysupporting or supplementing
their clients with theseconditions with nutrients that
are going to support metabolicfunction.
It would be the same in any ofthese clients who are taking
these GLP-1 agonist medications.
(27:49):
So, yes, I'm in full support.
However, of course, it needs tobe personalised and tailored.
So you are looking at all thecomorbidities that this client
has and then, hopefully, there'salready been the hard work done
in terms of the investigationsaround any blood work pathology
(28:12):
done, in terms of theinvestigations around any blood
work pathology, maybe somemicrobiome stool testing and
then even urinary hormoneanalysis as well.
So you can do so many types ofinvestigations to really get to
the nitty-gritty and of courseAndrew you'll love this is if
they've gone the extra mile todo some DNA analysis and testing
.
Then you can really see wherethere might be some mutations on
(28:36):
their SNPs, that you can thenbe very personalized with their
supplement treatment.
Speaker 1 (28:43):
Yeah, yeah.
What about?
You know these medicines arenot cheap.
There's a whole thrust at themoment about trying to get them
onto the PBS and that will haveits own political football sort
of stuff going on.
But you know these are notcheap medicines for patients.
You know, $300 odd a week, thatsort of thing.
(29:06):
What about if people stop them?
You know, I'm just wonderingabout the people getting hooked
into the quick fix and wantingthat.
They're extremely expensive andso, you know, do they have
attendant risks of I mean, I saythis word incorrectly
(29:26):
dependence?
I'm not talking physicaldependence, but wanting that
quick fix word incorrectlydependence?
I'm not talking physicaldependence, but wanting that
quick fix.
So the risk of dependence, ofthe effect of that and the
difficulty in maintaining weightloss after stopping them.
Is there anything that we cando to maybe manage their
expectations, to maybe help themto navigate stopping these
(29:50):
medications?
Speaker 2 (29:53):
You've raised a really good point and I loved
how you were cautious aroundthat term dependence, because if
you think about it, that's whenwe are talking about more
addiction.
So GLP-1 agonist meds are notaddictive in the traditional
sense, so there are nowithdrawals or cravings, or even
(30:17):
compulsive use of thesemedications.
So I think we should startthere and be very clear about
that.
However, there is a risk ofphysiological reliance that's
the term that I like to use whentalking about this Because
these medications alter yourappetite regulation and also
your metabolism.
(30:37):
So that's when there could bethat risk of physiological
reliance.
And the reason why somepatients may struggle after
stopping these medications is,firstly, they're going to
experience increased hunger, andwe know that these GLP-1 meds
(30:59):
suppress appetite, so stoppingthem can then also lead to
stronger hunger signals all of asudden and they don't know how
to deal with that.
They will maybe experiencereduced energy expenditure as
well.
So weight loss lowers restingmetabolic rate, as we know, and
(31:20):
that can predispose to weightgain, and there is no long-term
behavioural changes, if youthink about it.
So they've gone on thismedication, they've experienced
this, maybe potentially fastweight loss but patients who
have relied solely on thismedication may struggle to
(31:43):
maintain those results.
So they're the ones we need tobe the most cautious with.
And if we're looking at risksof weight regain after stopping
medication, the studies thathave been done to date show that
most patients regain around 60%to 100% of the lost weight
(32:05):
within a year of stopping themedication, unless there's a
caveat here, unless lifestylechanges have been also put in
place.
So I think that that's really agreat enforcer in itself.
It's that okay, there may besome weight regain, but not as
bad as if we implement somelifestyle interventions as well.
(32:28):
So, yeah, I think that that'sreally important.
But if you're talking to thepractitioner specifically about
what we can be doing to reallyfirstly navigate the
expectations that's number one.
I find that practitionersaren't having a serious
conversation, or serious enoughconversation, with their clients
(32:48):
around this.
So they need to navigate whatthe patient expectations are
around the medications inthemselves, because then you're
managing expectations around,firstly, weight loss speed so
how quickly they're going tolose it and also sustainability.
Educating your patients on fatversus muscle loss is also very
(33:12):
important, because they're goingto be seeing all this weight
fall off or reduce on the scalesas a number, but what they're
not realising is that a lot ofit can be fluid loss.
A lot of it can be muscle lossas well.
So that's really important.
And then I would be emphasisingthat GLP-1 agonist medications
(33:34):
are a tool, not a standalonesolution, for their weight loss
and improving their maybepotential chronic health
conditions that they're livingwith as well.
So there's some reallyimportant points there.
Speaker 1 (33:59):
Can I ask about talking about setting patients
up, if you like, from the get-go, for success long-term, what
sort of exercise would you tendto prefer?
We're talking weight, we'retalking resistance exercise
rather than cardiovascularexercise, at least in the
beginning, is that correct?
Speaker 2 (34:15):
Oh, absolutely Anyone who comes through my door who
is undergoing a fat loss journey.
It is a non-negotiableessentially is that we are
implementing some form ofstrength or resistance training
because we know that first andforemost, they're going to be
(34:36):
building lean muscle, which isimportant for long-term health,
but by doing so they're alsogoing to be improving their
basal metabolic rate, which isthen going to assist in further
fat loss.
But then, on top of that, thatresistance training is also
critical in preserving leanmuscle mass, and we know from
(34:58):
the studies to date that thesemedications can put people at
risk of protein malnutrition andalso muscle loss.
So we really want to make surethat we are providing some form
of strength training and for me,I would be starting at a
minimum of three days per week,and a lot of people are probably
(35:19):
listening.
I should preface this saying oh, you're just a dietitian, but
I'm also an exercise scientist,so I can prescribe some
recommendations around theexercise routine, and we are
definitely looking at both thatstrength training and also hip
(35:39):
training.
So high intensity intervaltraining can be really
beneficial to maximize thatmetabolic burn, if you will, and
to get real great results longterm from fat loss.
Speaker 1 (35:56):
Yeah, I'm glad you mentioned HIIT training because
if you think about this patientpopulation, so A, they're given
to wanting a quicker responsefrom therapy, right?
I'm just going to guess aboutthe patient characteristics here
and thinking about HIIT therapy, even though it's hard and fast
(36:19):
, but the results, even ontriglycerides, are immediate.
And so, talking about quoteunquote quick fixes if you
couldn't get a better quick fixfor your health that has
long-term benefits as well.
The other thing I was going tomention, talking about foods, we
were talking about quoteunquote quick fixes if you
couldn't get a better quick fixfor your health that has
long-term benefits as well.
The other thing I was going tomention talking about foods we
were talking about foods earlieris, I seem to recall a smaller
(36:39):
intervention regarding I thinkit was 30 mil, 30 mil of olive
oil per day with the polyphenolsbiophenols I think they call
them in Australia which they'renot in the olives but they're
actually made by the process ofextracting the oil.
Yeah, so it's reallyinteresting with this and they
(37:01):
were actually chugging down 30mils of olive oil and they were
having cardiovascular benefitsquite quickly.
Speaker 2 (37:07):
Yeah Well, do you know what's so funny that you've
mentioned that, andrews?
Because it's a trend now onTikTok, on Instagram.
There are all these peopleliterally shooting extra virgin
olive oil and we're looking ataround 30 to 40 mils, as you
mentioned.
So you're bang on.
And because of thosebioophenols or polyphenols, they
(37:32):
are a form of bitters, right.
So that is makes sense becauseit is stimulating those bitter
receptors, which then stimulatesthe synthesis and the
activation of glp-1 in the gut.
So, yeah, definitely, but thething is, do we need to be
(37:52):
shooting olive oil?
No, you can be using it in somany diverse ways in your diet,
but definitely making sure thatit's extra virgin olive oil most
importantly, because, as weknow, olive oils can come in
blends.
So we really want to make surethat it is extra virgin.
And, of course, that goes backto what I was saying earlier
around the Mediterranean diet.
(38:13):
That's another reason why itworks so well on the stimulation
of GLP-1.
Speaker 1 (38:21):
Yeah, cool.
Can I put an added call outthere?
And that is that it'sAustralian extra virgin olive
oil, because there's actuallybeen police stings overseas
where they've caught companiesadulterating olive oil with
other seed oils, and we'retalking about hundreds of
thousands of litres.
(38:41):
We're not talking little things, we're talking big business
here.
So I would buy Australian here,definitely, definitely only.
Speaker 2 (38:50):
Agreed.
Speaker 1 (38:52):
Robbie, there's so much that we could cover here.
I mean, this is a big topic.
This is a seminar, not apodcast topic.
But I thank you so much fortaking us through your true
expertise here and it's prettyevident that, with regards to
when you're saying personalizedmedicine and programs here, that
it's self-evident about yourcare for your patients.
(39:14):
So thank you so much for reallyeducating us on not just the
practical things to do, but howmuch you give a damn about these
patients, not just short-termbut long-term health.
Thank you so much for joiningus today on wellness by designs
thanks, andrew, it's been apleasure.
And thank you everyone.
Remember you can catch up onall the show notes and the other
podcasts on the Designs forHealth website.
(39:36):
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
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