GLP-1 for Blood Sugar and Weight Control: Medication and Natural Alternatives for Chronic Disease

There has been an explosion of interest in glucagon-like peptide1 receptor agonists (GLP-1 RAs or GLP-1s) not only for blood sugar control in diabetes, but for other metabolic conditions such as obesity and arthritis. Like other medications, care needs to be taken to rely on medication, alone, for managing these conditions. GLP-1 receptors are not without potential side effects and risks. Let’s explore the current evidence for them as they relate particularly to blood sugar and weight control.

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

GLP-1 receptors are G-protein coupled receptors found in the central and peripheral nervous system. They play an important role in regulating appetite, glucose levels, and energy expenditure. GLP-1 receptor agonists work by stimulating the release of insulin from the pancreas, reducing blood sugar, and decreasing appetite. They also slow gastric emptying, decrease food intake, and promote feeling full (satiety). In addition, GLP-1 receptor agonists may increase energy expenditure, helping to burn more calories.

What are GLP-1s currently FDA-approved for?

Recently, some GLP-1s have been approved by the US Food and Drug Administration (FDA) for use in weight management. These drugs are believed to be more effective and safer than traditional weight-loss medications. Many are injected subcutaneously (just beneath the skin), although in addition to the injectable form, oral semaglutide (Wegovy®) is available in the United States, but not all countries. Semaglutide is also available as an injection (Ozempic®), although this version is FDA-approved for diabetes management, while Wegovy® is approved for weight loss management.

Some GLP-1 medications prescribed for diabetes have shown promise in supporting weight management, while others are neutral.¹  Liraglutide (Saxenda®) and semaglutide (Wegovy®) were combined with lifestyle interventions as a novel strategy against obesity in patients with and without diabetes. Semaglutide compared to liraglutide resulted in greater weight loss and it was noted that the effect on weight loss was more significant in patients without diabetes than those with diabetes, demonstrating its ability to help patients with obesity.^2,3 Semaglutide appears to be superior compared to other once-weekly GLP-1 RAs in patients with type 2 diabetes mellitus.³

When should you consider asking your provider to prescribe a GLP-1 receptor?

GLP-1s may be an effective treatment option for weight management for individuals who may not be able to lose weight through diet and exercise alone. These medications then, by promoting weight management, can reduce the risk of heart disease, cancer, and diabetes. However, it is important to speak with a healthcare provider to discuss the potential risks and benefits before beginning any weight-loss regimen.

What are the current risks of using GLP-1 medications?

Although GLP-1s are generally considered safe, there can be side effects associated with their use. The side effects are mainly gastrointestinal, with the most common being abdominal pain, nausea, vomiting, and diarrhea. Constipation, bloating, headache, or dizziness may also occur. Side effects may be severe and may indicate a need to slowly start the medication, or even discontinue it when severe symptoms occur. While these medications do not increase the risk of hypoglycemia (low blood sugar), it is important to consider other concurrent medications being used to manage diabetes.

Concerns about an increased risk of pancreatitis or pancreatic cancer have also been expressed with the use of GLP-1s. A 2020 study did not support this concern. ⁴ However, long-term studies are needed to support the risks and benefits of long-term use of GLP-1s.

It is important to speak with a provider before beginning any weight-loss regimen to ensure that it is safe and appropriate for an individual’s needs. With proper use and guidance, GLP-1s can be an important tool for achieving weight loss goals. Providers have access to clinical guidelines for prescribing GLP-1s.⁵ It is also important to discuss the potential risks and benefits of using GLP-1s with a provider before starting medication.

Natural GLP-1 Agonists

Medications always have risks. While they may be indicated for those with advanced disease or who are unable to control their diet and lifestyle factors to manage their disease, natural alternatives can be safer and more available to most individuals who are trying to manage their blood sugar and weight. Here are some natural alternatives that can promote GLP-1 function.⁶ :

• Berberine-Berberine has effects on inflammation and blood glucose control. It has been shown to actively work in the intestine as a GLP-1 agonist.⁷
• Curcumin-Curcumin is a well-known anti-inflammatory and also significantly supports glucose control through stimulation of GLP-1^8–10
• Cinnamon-Cinnamon stimulates GLP-1, promotes satiety, and decreases gastric emptying, creating a sense of fullness.¹¹
• Wheat fiber-A high wheat fiber diet, especially in less processed kernels promotes GLP-1 response. ^12,13
• Soybean-Dietary or supplemental soy can support weight management, increased blood insulin levels, and decreased blood glucose levels through GLP-1 activation.^14,15
• Allulose– Interestingly, the sugar substitute, allulose, has been shown not to impact insulin levels, but also, stimulate GLP-1 in the body. 16 This sugar substitute is a viable alternative to others being low in calories and its palatability. It is about 70% as sweet as sugar, is easily dissolvable, and does not have an aftertaste. It can be purchased here.

The Importance of Diet and Lifestyle

Don’t discount the importance of diet and lifestyle to support healthy weight management and blood glucose levels. Many individuals believe that “a pill will cure every ill”, when in fact, pills do not cure disease. Diet and lifestyle changes are important to balance the body’s metabolic functions and to repair disease. In fact, it is essential to continue following healthy lifestyle habits while taking GLP-1s to maximize their effectiveness and minimize side effects.

GLP-1s for Other Chronic Conditions

GLP-1s may be helpful for a number of chronic inflammatory conditions, such as chronic lung conditions, asthma, sepsis, kidney disease, allergies, stroke recovery, cardiovascular disease, and others although further research is needed. ^17–21 Inflammation is associated with obesity and chronic disease. Several studies have shown that targeting GLP-1s may be beneficial in reducing inflammation associated with arthritis. This could help reduce pain and improve mobility for those affected by the condition.

Summary

Overall, GLP-1s appear to have a wide range of potential applications in treating both metabolic and inflammatory diseases. While more research is still needed to determine their efficacy and safety for use in various conditions, the current evidence suggests that they may be an effective treatment option for individuals seeking to manage their weight and improve their overall health.

However, there is much individuals can do to take control of their own health and weight management through working with a functional practitioner, nutrition practitioner, and/or health coach to address natural alternatives as well as diet and lifestyle changes to support blood sugar control, weight management, and inflammation causing chronic conditions.

To learn more, get your Free Discovery Call

References:

1.          Haddad F, Dokmak G, Bader M, Karaman R. A Comprehensive Review on Weight Loss Associated with Anti-Diabetic Medications. Life. 2023;13(4). doi:10.3390/life13041012

2.          Jensterle M, Rizzo M, Haluzík M, Janež A. Efficacy of GLP-1 RA Approved for Weight Management in Patients With or Without Diabetes: A Narrative Review. Adv Ther. 2022;39(6). doi:10.1007/s12325-022-02153-x

3.          Christou GA, Katsiki N, Blundell J, Fruhbeck G, Kiortsis DN. Semaglutide as a promising antiobesity drug. Obesity Reviews. 2019;20(6). doi:10.1111/obr.12839

4.          Cao C, Yang S, Zhou Z. GLP-1 receptor agonists and pancreatic safety concerns in type 2 diabetic patients: data from cardiovascular outcome trials. Endocrine. 2020;68(3). doi:10.1007/s12020-020-02223-6

5.          Li S, Vandvik PO, Lytvyn L, et al. SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: A clinical practice guideline. The BMJ. 2021;373. doi:10.1136/bmj.n1091

6.          Yaribeygi H, Jamialahmadi T, Moallem SA, Sahebkar A. Boosting GLP-1 by Natural Products. In: Advances in Experimental Medicine and Biology. Vol 1328. ; 2021. doi:10.1007/978-3-030-73234-9_36

7.          Zhang Q, Xiao X, Li M, et al. Berberine moderates glucose metabolism through the GnRH-GLP-1 and MAPK pathways in the intestine. BMC Complement Altern Med. 2014;14. doi:10.1186/1472-6882-14-188

8.          Takikawa M, Kurimoto Y, Tsuda T. Curcumin stimulates glucagon-like peptide-1 secretion in GLUTag cells via Ca2+/calmodulin-dependent kinase II activation. Biochem Biophys Res Commun. 2013;435(2). doi:10.1016/j.bbrc.2013.04.092

9.          Alli-Oluwafuyi AM, Luis PB, Nakashima F, et al. Curcumin induces secretion of glucagon-like peptide-1 through an oxidation-dependent mechanism. Biochimie. 2019;165. doi:10.1016/j.biochi.2019.08.013

10.        Kato M, Nishikawa S, Ikehata A, et al. Curcumin improves glucose tolerance via stimulation of glucagon-like peptide-1 secretion. Mol Nutr Food Res. 2017;61(3). doi:10.1002/mnfr.201600471

11.        Hlebowicz J, Hlebowicz A, Lindstedt S, et al. Effects of 1 and 3 g cinnamon on gastric emptying, satiety, and postprandial blood glucose, insulin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and ghrelin concentrations in healthy subjects. American Journal of Clinical Nutrition. 2009;89(3). doi:10.3945/ajcn.2008.26807

12.        Eelderink C, Noort MWJ, Sozer N, et al. Difference in postprandial GLP-1 response despite similar glucose kinetics after consumption of wheat breads with different particle size in healthy men. Eur J Nutr. 2017;56(3). doi:10.1007/s00394-016-1156-6

13.        Freeland KR, Wilson C, Wolever TMS. Adaptation of colonic fermentation and glucagon-like peptide-1 secretion with increased wheat fibre intake for 1 year in hyperinsulinaemic human subjects. British Journal of Nutrition. 2010;103(1). doi:10.1017/S0007114509991462

14.        Watanabe K, Igarashi M, Li X, et al. Dietary soybean protein ameliorates high-fat diet-induced obesity by modifying the gut microbiota-dependent biotransformation of bile acids. PLoS One. 2018;13(8). doi:10.1371/journal.pone.0202083

15.        Purwoko AE, Astuti I, Asdie AH, Sugiyanto. Effect of Soybean-based Food Supplement on Insulin and Glucose Levels in Type 2 Diabetes Mellitus Patients. Indonesian Journal of Pharmacy. 2019;30(3). doi:10.14499/indonesianjpharm30iss3pp208

16.        Chen Z, Gao XD, Li Z. Recent Advances Regarding the Physiological Functions and Biosynthesis of D-Allulose. Front Microbiol. 2022;13. doi:10.3389/fmicb.2022.881037

17.        Kikkawa K, Hoshi H, Isoda A, et al. Long-Acting Glucagon-Like Peptide-1 Receptor Agonist-Induced Rheumatoid Arthritis in a Patient with Type 2 Diabetes Mellitus. Dubai Diabetes and Endocrinology Journal. 2021;27(3). doi:10.1159/000519008

18.        Deska K, Bąk B, Kosmalski M, Pietras T. GLP-1 analogues in the treatment of obesity and non-alcoholic fatty liver disease. Postepy Hig Med Dosw. 2023;77(1). doi:10.2478/ahem-2023-0001

19.        Rizzo M, Nikolic D, Patti AM, et al. GLP-1 receptor agonists and reduction of cardiometabolic risk: Potential underlying mechanisms. Biochim Biophys Acta Mol Basis Dis. 2018;1864(9). doi:10.1016/j.bbadis.2018.05.012

20.        Fandiño J, Toba L, González-Matías LC, Diz-Chaves Y, Mallo F. GLP-1 receptor agonist ameliorates experimental lung fibrosis. Sci Rep. 2020;10(1). doi:10.1038/s41598-020-74912-1

21.        Mehdi SF, Pusapati S, Anwar MS, et al. Glucagon-like peptide-1: a multi-faceted anti-inflammatory agent. Front Immunol. 2023;14. doi:10.3389/fimmu.2023.1148209