What diet is recommended for patients on Glucagon-like peptide-1 (GLP-1) receptor agonists?

Dietary Recommendations for Patients on GLP-1 Receptor Agonists

Patients on GLP-1 receptor agonists should follow a hypocaloric diet with a 500-1000 kcal daily deficit below total energy requirements, emphasizing high protein intake (to preserve lean muscle mass), combined with 150 minutes per week of physical activity including resistance training. 1

Caloric Deficit and Weight Management

• Implement a structured caloric deficit of 500-1000 kcal below daily requirements to optimize weight loss outcomes when combined with GLP-1 therapy 1
• This hypocaloric approach must be sustained long-term, as cessation of both medication and dietary changes leads to significant weight regain 1
• The caloric restriction should be maintained throughout the entire duration of GLP-1 treatment 1

Protein Prioritization to Prevent Muscle Loss

Prioritize protein intake at every meal to preserve lean body mass, as GLP-1 receptor agonists cause muscle loss alongside fat loss. 1

• Ensure adequate protein intake throughout treatment to minimize loss of lean body mass that occurs with GLP-1-induced weight reduction 1
• Select leaner protein sources and meat alternatives to simultaneously reduce saturated fat intake 1
• Combine high protein intake with resistance training (discussed below) for optimal muscle preservation 1

Fat Quality Over Quantity

• Substitute foods higher in unsaturated fats (omega-3 PUFAs and MUFAs) for those higher in trans or saturated fats 1
• Consume fish 2-3 times per week, especially oily fish such as salmon, sardines, trout, tuna, or mackerel 2
• Use extra virgin olive oil as the main added fat, particularly for dressing salads and vegetables 2
• Consume nuts and seeds as daily snacks 2
• Limit saturated fat intake to less than 7% of total calories 2

Carbohydrate Management

Moderate carbohydrate intake at each meal if taking GLP-1 receptor agonists alongside insulin secretagogues or insulin to reduce hypoglycemia risk. 1

• Eat a source of carbohydrates at each meal to reduce hypoglycemia risk when GLP-1s are combined with insulin or insulin secretagogues 1
• Do not skip meals, as this significantly increases hypoglycemia risk 1
• Choose whole grain varieties of breads and cereals over refined options 2
• Have legumes 2-3 times per week in place of meat 2

Fiber-Rich Foods

• Eat vegetables with all main meals, ensuring they compose the majority of the dish, and choose a variety of colors 2
• Consume a diet mainly composed of plant-based foods including legumes, vegetables, and fruits 2
• Have fresh fruit daily 2
• Increase consumption of high-fiber foods to meet the recommended 14g per 1000 calories 2

Foods to Avoid or Limit

• Avoid highly processed foods and beverages with added fructose, including ingredients labeled "high fructose corn syrup" and "glucose fructose syrup" 2
• Avoid sweetened beverages 2
• Limit consumption of fast food, commercial bakery goods, and sweets (discretionary foods) 2
• Consume small amounts of meat, especially red meat 2
• Avoid foods containing large amounts of added sugar 2

Sodium and Alcohol Guidelines

• Limit sodium intake to 2,300 mg per day 1
• If consuming alcohol, limit intake to one drink per day or less for women and two drinks per day or less for men 1
• Consume alcohol with food if taking insulin or insulin secretagogues to prevent hypoglycemia 1

Managing Gastrointestinal Side Effects Through Diet

Gradual dose titration is essential to minimize nausea, vomiting, and diarrhea, which are the most common side effects of GLP-1 therapy. 2, 1

• Take medication with food or 15 minutes after a meal if gastrointestinal symptoms persist during titration 1
• If side effects do not resolve over time (a few weeks), follow up with your healthcare provider 2
• These gastrointestinal effects typically diminish over time with continued use 2

Meal Timing Considerations

• Daily or twice-daily GLP-1 injections should be administered premeal 2
• Once-weekly GLP-1 formulations can be taken at any time during the day regardless of meal times 2
• Meals can be consumed at different times if on a multiple-daily injection insulin plan 2
• Meals need to be consumed at similar times every day if on a premixed insulin plan 2

Physical Activity Integration

Combine GLP-1 therapy with 150 minutes per week of physical activity, emphasizing resistance training to preserve lean body mass. 1

• Resistance training is critical to prevent muscle loss that occurs with GLP-1-induced weight reduction 1
• If physical activity is performed within 1-2 hours of mealtime insulin injection, the insulin dose may need to be lowered to reduce hypoglycemia risk 2
• Always carry a source of quick-acting carbohydrates during physical activity to reduce hypoglycemia risk 2

Supplement Guidance

• Do not use vitamin and mineral supplements, herbal products, or cinnamon specifically to manage diabetes, as there is lack of evidence for their efficacy 1
• Routine supplementation with antioxidants such as vitamins E and C and carotene is not advised due to lack of evidence of efficacy and concern related to long-term safety 2

Common Pitfalls to Avoid

• Failing to maintain adequate protein intake: This is the most critical dietary error, as it accelerates muscle loss during weight reduction 1
• Discontinuing dietary changes after starting medication: GLP-1 medications must be used long-term in conjunction with sustained lifestyle changes 1
• Skipping meals to accelerate weight loss: This increases hypoglycemia risk, particularly when GLP-1s are combined with insulin or insulin secretagogues 1
• Ignoring gastrointestinal symptoms: If nausea, vomiting, or diarrhea persist beyond a few weeks, medical follow-up is necessary rather than dietary self-management alone 2, 1