What dietary recommendations should be given to adults receiving a glucagon‑like peptide‑1 receptor agonist (GLP‑1 RA) for type 2 diabetes or obesity?

Dietary Recommendations for Patients on GLP-1 Receptor Agonists

Patients taking GLP-1 receptor agonists should follow a structured hypocaloric diet with 500-1000 kcal daily deficit below total energy requirements, prioritize protein at every meal to prevent muscle loss, and combine this with 150 minutes weekly of physical activity including resistance training. 1

Caloric Deficit and Energy Balance

• Maintain a 500-1000 kcal reduction below your daily energy requirements throughout the entire duration of GLP-1 treatment 1
• This structured caloric deficit optimizes weight loss outcomes when combined with GLP-1 therapy 1
• The caloric restriction should be sustained continuously, not intermittently 1

Protein Prioritization to Preserve Lean Body Mass

The most critical dietary modification is prioritizing protein intake at every single meal, as GLP-1 receptor agonists cause muscle loss alongside fat loss 1, 2

• Ensure adequate protein throughout treatment to minimize the loss of lean body mass that inevitably occurs with GLP-1-induced weight reduction 1
• This becomes especially important given that weight loss of 20% or higher with newer agents raises concerns about sarcopenia 3
• Protein-rich foods also naturally stimulate endogenous GLP-1 secretion from intestinal L-cells, creating a synergistic effect 2

Carbohydrate Management

• If taking GLP-1 receptor agonists alongside insulin secretagogues or insulin, moderate carbohydrate intake at each meal to reduce hypoglycemia risk 1
• Choose whole grain varieties of breads and cereals over refined options 1
• Avoid highly processed foods and beverages with added fructose, including ingredients labeled "high fructose corn syrup" and "glucose fructose syrup" 1, 2

Fat Quality Guidelines

• Substitute foods higher in unsaturated fats for those higher in trans or saturated fats 1, 2
• Limit saturated fat intake to less than 7% of total calories 1
• Consume fish 2-3 times per week, especially oily fish such as salmon, sardines, trout, tuna, or mackerel 1, 2

Fiber-Rich Foods

• Eat vegetables with all main meals, ensuring they compose the majority of the dish, and choose a variety of colors 1
• Increase consumption of high-fiber foods to meet the recommended 14g per 1000 calories 1, 2
• Dietary fiber promotes GLP-1 release by delivering nutrients to the distal small intestine where L-cells are concentrated 2

Foods to Limit or Avoid

• Limit consumption of fast food, commercial bakery goods, and sweets 1, 2
• 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

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 1

• Take medication with food or 15 minutes after a meal if gastrointestinal symptoms persist during titration 1
• Nausea, vomiting, and diarrhea are dose-dependent and more frequent with short-acting than long-acting formulations 4
• Slow titration is helpful in increasing gastrointestinal tolerability 4

Meal Timing Considerations

• Daily or twice-daily GLP-1 injections should be administered premeal 1
• Once-weekly GLP-1 formulations can be taken at any time during the day regardless of meal times 1

Physical Activity Integration

Combine GLP-1 therapy with 150 minutes per week of physical activity, emphasizing resistance training to preserve lean body mass 1, 2

• Resistance training is critical to prevent muscle loss that occurs with GLP-1-induced weight reduction 1, 2
• Exercise may enhance the incretin effect and improve insulin sensitivity 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 1

Common Pitfalls to Avoid

• Do not skip meals if taking GLP-1 receptor agonists with insulin or insulin secretagogues, as this dramatically increases hypoglycemia risk 1
• Do not rely on dietary modifications alone without the structured caloric deficit—the 500-1000 kcal reduction is mandatory for optimal outcomes 1
• Do not neglect resistance training, as this is the only proven strategy to mitigate the muscle loss that accompanies GLP-1-induced weight reduction 1, 2
• With weight loss of 20% or higher with newer GLP-1RAs, nutritional deficiency becomes a potential concern requiring monitoring 3