GLP-1 medications explained: How to use them safely (or avoid them)

You've seen the headlines. Your doctor may have mentioned them. Perhaps your friend lost 20kg on Ozempic. GLP-1 medications like Ozempic, Wegovy, Saxenda and Mounjaro are everywhere right now, and as a clinical nutritionist specialising in metabolic health, I'm having these conversations daily with patients in my Brisbane clinic and online.

Here's what I want you to know: I fully support informed medical decisions, and these medications can be valuable tools. I recognise that obesity is an illness and we need to treat it as such. But they're not magic pills, and they're definitely not without risks. Whether you're considering them, currently taking them, or looking for alternatives, this guide will help you make the best decision for your body and your long-term health.

What are GLP-1 medications and how do they work?

GLP-1 (glucagon-like peptide-1) receptor agonists are medications that mimic the natural gut hormone GLP-1. They are primarily prescribed for type 2 diabetes and obesity but increasingly for weight management in non-diabetics and even for some non-weight related concerns. They can help the body to:

• Regulate blood sugar

• Slow gastric emptying (so food stays in the stomach for longer)

• Reduce appetite

• Increase feelings of fullness

Are they for everyone?

The short answer is no, they're not for everyone, and here's why that matters. Whilst they can have the effects above and are medically necessary for some, they also come with risks. People with thyroid or pancreatic conditions, gallbladder disease or gastrointestinal issues should use them with caution, as should anyone with a history of disordered eating. They are not a quick fix solution and are often relied upon too much or prescribed too readily without ongoing support. I see this a lot in people with only a few kilos to lose.

Weight loss that happens too quickly and without getting necessary nutrients can also lead to issues like excessive muscle loss which increases fall risk and diminishes metabolic health. We need muscle to use up glucose and burn fat, so we get stuck into a cycle of less natural ability to manage our metabolism and more reliance on drugs to do it for us. Muscle is a key element in bone strength too. Energy also decreases, mood is affected, and skin tone can be lost (so called 'Ozempic face').

Further information is coming out weekly about the potential benefits and risks of these medications. It is important to have a broad conversation with your health practitioner about your particular situation. If you only have a few kilos to lose (5-10), consider a supported and personal nutrition plan first.

What I'm seeing in clinical practice

Many people on GLP-1s experience a noticeable reduction in hunger and opt for smaller meal portions. This might sound great as it makes it easier to control food intake, but it does increase the risk of under-eating and nutrient deficiencies. These nutrient deficiencies are particularly dangerous for any individuals who might have mental health conditions, are neurodivergent or are in a hormone shift like perimenopause. They impact energy, stress, detox and more.

Some people feel like they are finally in control of their food choices, but control is not always a good thing. For others it can cause unwanted changes in taste and fullness cues. But, when paired with balanced nutrition and activity they can be the start of a positive change.

The medications alone are not the answer though, and even the World Health Organisation, in its recent recommendations, has stated that these medications should be paired with structured movement and dietary intervention.

Three types of patients I see

The conversations I have in clinic generally fall into three categories:

1. People who have tried GLP-1s and chose to stop them because they felt awful (nausea, joy of food gone), they couldn't afford them anymore, weight rebounded after stopping, or they realised that there was another way.

2. People who have been offered them when they mentioned to their doctor that they wanted to lose weight, but decided to investigate a whole food, targeted nutrition approach first.

3. Those who are on them and intend to stay on them either because they have had great results or think that you have to stay on them once you start (spoiler alert, you don't).

   
   

The deprivation trap

Many of my patients come to me undernourished. Like me, they have come from the generation where we were told that weight loss could only be achieved though deprivation. I regularly see skipped breakfasts, all-day coffee, rabbit food lunches, and the 'hero' dinner that usually has decent protein and veg.

Deprivation is not the answer to sustainable health or weight loss, but these medications can feed into this narrative and beauty standards that are unfortunately shifting back to skinny chic. If we don't feel like we can 'control' our eating then there must be something wrong with us, right? If we feel like our bodies are betraying us when we are going through hormonal transitions like perimenopause then we need to force them into submission, right? I understand this thinking intimately, but there's a better way.

Essential nutrition strategies if you're taking GLP-1 medications

Your first few weeks: what to expect

In the first few weeks you might notice changes in appetite, digestion and energy levels. Some experience nausea, constipation, reflux, bloating and fatigue and these may pass.

This is the perfect time to retrain your body and mind to eat for health. This is exactly where I see patients struggle, which is why clinical nutrition support becomes critical.

During this transition stage (and beyond), your focus should be on:

• Prioritising protein at every meal (meat, eggs, dairy, nuts/seeds, legumes). Vegemite on toast won't provide the protein foundation your body needs.

• Building regular eating patterns with smaller nutrient-dense foods. Don't fill your plate or your stomach with empty carbs like bread or chips. Instead, focus on getting a variety of proteins, fruit, veg, nuts, seeds, fermented foods, healthy fats. Smaller portions of big nutrient hitters.

• Supporting gut health so that it can absorb nutrients properly. Diarrhoea, vomiting and delayed gastric emptying can all impact nutrient absorption.

• Soups, smoothies and broths can be a great way to increase nutrient intake comfortably.

• As your energy allows, start to move and lift things. Go gently to start and build up. Remember, if you want to build and maintain strength, you need the nutrient building blocks to do so. Hello protein.

Easing nausea and digestive symptoms

• Bland, simple meals like chicken, rice and soft vegetables might help

• Try ginger, peppermint or lemon tea to soothe the stomach

• Eat smaller, more frequent meals

• Drink fluids between meals rather than during

• Keep your bowels moving (at least once per day) with fibre, gentle exercise and good hydration. You should aim for 35ml water for each kg of your weight, and that's every day.

Transitioning off GLP-1 medications safely

This can be a tricky and scary time. When we have become reliant on something to resolve an issue, it is hard to imagine life without it. Without having taken the steps above, it is very common for weight to come back.

Appetite returns quickly and old habits can resurface. Working with your nutritionist can help you to rebuild natural and healthy hunger cues, intuitive eating, reduce cravings, keep muscle mass and energy and avoid the rebound weight gain.

Having the right nutrients can help you become more resilient to those things that led to weight gain in the first place, from cravings, to hormonal shifts, stress and so much more.

How I can help as your clinical nutritionist

Nutrition support bridges the gap between medication and sustainable health. I can help you monitor nutrient intake, prevent deficiencies and build a plan that supports energy, digestion and emotional wellbeing. This includes monitoring of your blood work from a functional viewpoint to make sure that you are thriving. Common nutrient deficiencies include protein, iron, vitamin B12, folate, magnesium, calcium and electrolytes. I can also work with your prescribing doctor to ensure better long-term outcomes.

This 7-day meal plan, including recipes, that I've developed will give you an idea of how to nourish yourself in a way that works with GLP-1s. Nutrients and taste are high but smaller portions won't make you feel like you've had a massive Christmas dinner every mealtime. Also, try it for some new recipes or if you just want to feel lighter and more nourished. Medications are not a prerequisite.

Evidence-based alternatives to GLP-1 medications

Of course, I can also work with you using highly personalised nutrition to avoid you having to take on any of the risk and cost of GLP-1s. Metabolic Balance® is the gold standard for quick, yet healthy results based on your distinctive biochemistry. You can be strong, nourished and feel confident using a whole foods approach that is as unique as you are. I can help you to start getting appropriate hunger and fullness signals again, something that people often feel like they have lost.

Managing insulin: the key to metabolic health

Whichever path we choose, managing insulin is key to health, not just weight but full system health. Insulin is a hormone that is released in response to eating and specifically to glucose (sugar) in the blood. This can come from natural foods, or processed foods and sweets. Even stress can cause increased glucose and therefore insulin. This is a normal process, and we want it to happen to help get glucose into our cells for energy. Insulin resistance occurs when there is excess glucose, and our pancreas is having to constantly produce more insulin to get the glucose into our cells. Eventually, our cells become less responsive, or sensitive, to insulin and insulin resistance occurs.

We want to improve this sensitivity, and we can do that through food and lifestyle. How? We prioritise foods that promote fullness and meal satisfaction naturally. These are foods that are higher in protein, fibre and healthy fats. Foods such as eggs, almonds and high fibre grains like oats are great and can increase GLP-1 naturally. They also improve insulin sensitivity which means that your blood glucose is more regulated and without the knock-on effects to liver, cardiac and metabolic health. Insulin resistance is also a key player for many with PCOS. Foods will not be as strong as a pharmaceutical intervention, but are just as effective, much more sustainable and you can feel great while achieving your goals.

From a lifestyle perspective, we support restorative sleep which is so important for metabolic and brain health.

Some signs you might have insulin resistance

• Weight gain

• Belly fat

• Craving sweets

• High blood sugar

• Tired after meals and generally

• High or low blood sugar

• Fatty liver

• High triglycerides and/or high cholesterol

• PCOS

• Decreased, or increased testosterone

• Hair loss

• Skin tags

• Acne

• High blood pressure

Key takeaways

• Your body can heal itself, including losing weight, with the right nutritional support.

• GLP-1 medications alone will not retrain you how to eat and are not a standalone fix. You need to take advantage of the time you are taking them to learn what and how to eat. If you don't your weight will rebound when you come off them.

• They come with physical and psychological risks. As with all medications, the risk must be weighed against the benefit.

• It is harder to build muscle the older we get. Deprivation, whether pharmaceutically induced or not, will reduce your lean muscle mass. This muscle is critical for metabolic health and longevity and is easier to maintain than to have to rebuild it.

• Most importantly, there is no shame in seeking help, whether that is medication or otherwise. This is a safe and judgement-free space 💚

Ready to take the next step?

Download my free 7-day GLP-1-supportive meal plan, complete with recipes designed to maximise nutrition while you're eating less. Perfect whether you're on medications, transitioning off, or simply want to feel lighter and more nourished.

[Download Free Meal Plan]

Want personalised support? Whether you're navigating GLP-1 medications or seeking evidence-based alternatives, I'm here to help you achieve sustainable results without deprivation.

Let's chat -> Book your discovery call here.

FAQs

How long do I have to stay on GLP-1s?

There's no set timeframe. Some people use them for a few months as a circuit breaker, others stay on them longer term. The key is using the time you're on them to establish healthy eating patterns and address the root causes of weight gain. Many people successfully transition off with proper nutritional support.

Isn't it good to reduce calories?

For many people it is necessary, where calorie excess is the cause of stubborn weight. Often, however, I see people who are already depriving themselves and are then so frustrated that it isn't 'working' that they turn to medications. The stress that deprivation causes on the body makes us hold on to weight. There are so many factors involved in health and weight loss though. Much more so that calorie restriction.

Will my appetite return to normal after stopping GLP-1 medications?

Yes, your appetite will return, often within days to weeks of stopping. This is why preparation is crucial. Working with a clinical nutritionist before and during your transition helps you rebuild natural hunger cues and sustainable eating habits so you're not caught off guard.

Are GLP-1 medications safe during perimenopause?

GLP-1 medications can be prescribed during perimenopause, but this life stage already comes with hormonal fluctuations affecting mood, energy and metabolism. It's essential to work with both your doctor and a nutritionist who understands the perimenopause-metabolism connection to ensure you're addressing root causes, not just symptoms.

Can I take GLP-1 medications if I have PCOS?

GLP-1 medications are sometimes prescribed for PCOS, particularly when insulin resistance is present. However, addressing insulin resistance through targeted nutrition can be equally effective without the side effects or ongoing costs. PCOS responds incredibly well to personalised nutritional intervention.