The Popular Drug Millions Are Taking—What You Need to Know About GLP-1

Experts say a comprehensive understanding of popular weight loss drugs can help patients decide whether and how to consider them.

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Joey Udovich was following the universal “eat right and exercise” template for better health and weight loss, getting up at 4:30 a.m., six days per week, to exercise and eating a mostly healthy diet. Nevertheless, her weight kept creeping upward.

Udovich, who had always been thin, rapidly gained 30 pounds as she approached her 40s.

“I was never even close to being overweight until perimenopause hit,“ she told The Epoch Times. ”My body was thrown into a state I wasn’t prepared for. I was looking down the pipeline of obesity, which is rampant in my family.”

Desperate and weary, Udovich visited a local weight loss clinic, where she opted to pay out of pocket for a glucagon-like peptide-1 receptor agonist (GLP-1 RA).

Like Udovich, many are turning to the increasingly popular weight loss drugs in their hopelessness about weight gain and frustration in facing disease. About 32.5 million Americans aged 18 or older have used GLP-1 RAs such as semaglutide—with the drugs’ popularity rising after treating obesity was added as an approved usage—and half of U.S. adults are now eligible for them.

Udovich was a few pounds shy of being eligible for the drug. She took a titrated dose, struggled with negligible side effects, and shed 35 pounds in less than five months.

While these drugs can provide powerful results, they are not a magic bullet for everyone. Without the right support and patient commitment, weight regain and side effects are common. Many problems can be avoided when you know ahead of time whether you are a good candidate for GLP-1 RAs, what the effective dose is, what to expect, and how to support your body while you are taking the drug. Experts say a personalized approach that blends integrative care with the popular medication is the smartest path forward.

Dr. Tyna Moore, a naturopathic physician and expert in GLP-1 RAs, told The Epoch Times that she has had patients who eat like birds but still gain weight.

She said there are data showing that people with fatty liver and Type 2 diabetes have less GLP-1 production.

“That tells me some folks might be set up—whether it’s genetic or from a life of eating poorly—to not release GLP-1 adequately,” Moore said. “Something’s gone wrong there, and that’s where I see potential utility in considering these [GLP-1 RAs] sooner than later.”

Expectations With GLP-1 RAs

GLP-1 is a hormone produced in the small intestine after eating. It helps control hunger and blood sugar by slowing digestion, reducing the release of sugar into the blood, and relaying signals of fullness to the brain.

GLP-1 receptor agonists are drugs that mimic this natural hormone. The term “agonist” means that the drug activates a specific receptor in the body. In this case, the receptor activated is the same one GLP-1 normally binds to, therefore producing similar effects.

The first GLP-1 RA was approved in 2005 for Type 2 diabetes. Most are injected weekly using a needle and syringe in fatty parts of the body, although a tablet is also now available. A newer medication, tirzepatide, has GLP-1 and glucose-dependent insulinotropic polypeptide, another hormone involved with insulin release.

Patients can expect to lose 5 percent to 20 percent of their body weight on GLP-1 RAs. For those who lose 5 percent to 10 percent of their body weight, this translates into improvements in obesity-related health concerns such as high blood pressure, polycystic ovary syndrome, depression, and even health care costs. At 10 percent weight loss, there can be improvements in obstructive sleep apnea, nonalcoholic fatty liver disease, and possibly even death rates.

Tirzepatide led to greater weight loss than semaglutide in a randomized trial of 751 obese participants reported in the New England Journal of Medicine. After 72 weeks, those taking tirzepatide lost 20.2 percent of body weight, compared with 13.7 percent of body weight lost by those taking semaglutide.

Tirzepatide was also found to be the most effective in managing diabetes in a meta-analysis of 15 GLP-1 RA clinical trials that was published in the BMJ. All the drugs were effective for lowering blood glucose.

Boosting GLP-1 RA Success

Drugs should be reserved for patients willing to commit to healthy habits, as medication alone is not sufficient for improving long-term health, Dr. William W. Li, an internationally recognized physician and two-time New York Times bestselling author, told The Epoch Times in an email interview.

Weight loss and maintenance depend on more than just GLP-1 hormone regulation, and a more holistic approach can kickstart the body’s fat-burning and weight loss processes, Li said.

Those who begin exercising, and especially those who lift weights, can avoid some of the muscle wasting that’s common with GLP-1 RA use. Moore said GLP-1 RAs can protect bone and muscle as long as patients are eating and exercising properly. It’s also important to prioritize a protein-rich diet for the same reason. Moore suggested one gram of protein per pound of ideal body weight.

“Most women, in particular, are way undereating their protein,“ she said. ”I think that’s very concerning, because we don’t want to get into malnourishment. When we get into malnourishment ... we start to see the bad side and the dark side of GLP-1s, which is soft tissue wasting ... [and] potentially bone loss.”

Eating fiber-rich foods and drinking adequate water can help patients avoid constipation, although they may want to remove some fiber from their diets if they experience diarrhea.

Plant-based diets help trigger the body’s GLP-1, which is made in the gut. Plant fiber also feeds the microbiome. A healthy microbiome is associated with ideal metabolism, lower cholesterol, and insulin sensitivity.

Additionally, getting adequate sleep and managing stress can positively affect the gut microbiome, which can help mitigate gastrointestinal (GI) side effects that are common with GLP-1 RAs.

“Stress itself counters healthy metabolism, so lowering stress relieves this blockade,” Li said. “Poor sleep interferes with gut health and many other metabolic switches in the body. So good quality sleep keeps these systems functioning well.”

Reducing stress can also help lower or eliminate emotional eating, Danielle Desroche, naturopathic doctor and hormone coach, told The Epoch Times. Experts say curbing poor eating habits is especially beneficial if patients don’t intend to stay on GLP-1 RAs indefinitely.

However, for some people, the drug may be necessary to fix a physiological malfunction. Evidence suggests that binge eating is associated with GLP-1 signaling dysfunctions and that the drug could curb binge eating behavior.

A study published in the Journal of Endocrinology concluded: “Although psychological treatments for BED [binge eating disorder] and BN [bulimia nervosa] exist, there is a need to identify additional interventions to reduce binge eating. The GLP-1 system is a viable target for pharmacotherapies aimed at reducing the occurrence of binge eating.

“Evidence suggests that central GLP-1 signaling is altered in rodent models with binge-like eating, and GLP-1R activation can suppress overeating and binge-like eating in non-human animals.”

What Is Microdosing?

Titrating doses is an approach that’s gaining more acceptance, and there are good reasons to do this, according to a letter published in Diabetes Care:

• Better therapeutic responses
• Improved tolerability for patients with severe GI side effects that allows for continuum of care
• Affordability for patients paying out of pocket, extending the lifespan of medication
• Safer, controlled dose changes to more closely monitor patients

“Clinicians should consider microdosing as a patient-centered approach to care,” the authors wrote. “With careful patient selection, thorough counseling, and consistent monitoring, microdosing could play a valuable role in optimizing therapy amid challenges in availability, affordability, and tolerability.”

Those who may not be good candidates for this approach are those who are easily confused or cognitively impaired, since patients have to manually “click” their pens for dosing that is based on individual needs, according to the authors. They also noted that there are no clinical trials that have validated whether this method would be safe or effective.

Li said more research is needed before following a dosing approach that’s not indicated by the drug label.

“Microdosing is a popular fad that is not recommended,” he said.

However, Moore said a personalized dosing strategy that starts at lower doses is an ethical approach to any medication, even if it appears likely that someone will eventually need the full dose to lose a significant amount of weight.

Patient Monitoring Is Key

Patients considering taking a GLP-1 RA should be monitored regularly by their doctor, although the frequency and testing will vary from patient to patient.

Li said the prescribing doctor should schedule follow-up visits at least every three months to check on blood sugar effects using A1C testing, a blood test for managing diabetes that can monitor two to three months of blood sugar levels. Additionally, patients who are being treated for diabetes or obesity should undergo regular testing for kidney and liver function, which should be continued even while taking medication.

“These follow-ups should also carefully assess if there are any potential side effects, such as nausea, vomiting, abdominal pain, and potential drug interactions, which require guidance by the doctor for patient safety and well-being,” Li said. “Because side effects can also be caused by many other factors, it’s important for patients to stay in touch with their doctor to communicate about any unusual signs or symptoms they are experiencing while taking GLP-1 drugs.”

Those who have previously struggled with GI issues are more likely to be prone to those types of side effects, Desroche said.

She works alongside prescribing doctors to follow up with patients on GLP-1 RAs. A red flag for patients, she said, is online prescribers and doctors who prescribe uniform dosing without a plan unique to a patient’s needs.

“If they’re just telling them to ‘Take this dose for two weeks, after that increase to this dose because this is what we do with everyone,’ this blanket treatment protocol—regardless of how their body is responding to the GLP-1—is really concerning,” Desroche said.

Udovich said beginning with a lower dose allowed her to find the dose that kept her side effects at bay. She had mild nausea, which she noticed corresponded with heavy, greasy, or sugar-laden meals. She planned ahead by having anti-nausea medication on hand as she learned what would trigger the symptom.

She was also more tired on the days when she increased her dose. She found that prioritizing protein every day maintains her energy and even allows her to enjoy small servings of treats such as cake during celebrations without overeating or feeling ashamed.

Once Udovich hit her goal weight, she began to extend the time between doses. Rather than taking her GLP-1 RA weekly, she began taking it every two to three weeks. She described feeling less inflamed, more focused and calm, and more in charge of eating decisions.

“My only regret is not taking it sooner,” Udovich said.

Concerning Side Effects

Studies showing various dangers of GLP-1 RAs have garnered many headlines in the past few years. Experts say some side effects could be overblown, dose- and situation-dependent, or worthy of consideration.

Muscle, Bone, and Hair Loss

There are reports of muscle, bone, and hair loss among those taking GLP-1 RAs. Rapid weight loss and improper nutrition can also cause these issues. A way to counter all three problems, experts said, is to eat a high-protein diet and exercise regularly, particularly with strength training.

Muscle wasting, in particular, can result from malnourishment, Moore said, and can happen when someone is severely restricting calories. High doses of GLP-1 RAs, she said, can lower appetite so severely that patients starve themselves into muscle loss.

“People who are very active while being on these—who are doing strength training and eating enough protein—report back that they’re gaining muscle,” Moore said. In other cases, she said, the decrease in muscle size could be the loss of fat marbling inside the muscle. That could make the size of the muscle shrink as the strength of the muscle improves.

Gallstones and Pancreatitis

Slowing down digestion could create a sluggish gallbladder, which concerns Moore. Gallstones can become lodged in the pancreas, causing pancreatitis, swelling, and pain in the abdominal region and sometimes the back. People with obesity and Type 2 diabetes are already prone to these conditions, she said.

Even if you have a history of gallbladder or pancreas problems, you’re not excluded from using GLP-1 RAs. However, you should be very closely monitored by your doctor, Moore said.

“There should be a lot of hand-holding for these patients to make sure you are dosing responsibly, and if you’re the patient, you shouldn’t be crushing high-fat foods because you could really risk aggravating your gallbladder and your pancreas,” she said.

Blindness

Moore is also concerned about what appears to be a real but small increased risk for blindness among adults with Type 2 diabetes taking semaglutide: non-arteritic anterior ischemic optic neuropathy. It is the leading cause of acute optic neuropathy in older adults. Acute optic neuropathy is swelling or damage to the optic nerve that can cause rapid vision loss.

A retrospective study in JAMA Ophthalmology noted that the risk is smaller than previously reported. The mechanism is unknown, and the dose at which it occurs has not been determined in data. More research is warranted.

“It is exceedingly rare, but it is happening,” Moore said. “That’s a signal to watch out for.”

Suicidal Ideation

The Food and Drug Administration (FDA) announced in 2024 that it is monitoring reports of suicidal thoughts or actions from patients taking GLP-1 RAs. So far, there is no clear relationship between the drugs and suicidal ideation, the agency reported.

However, the absence of clinical evidence doesn’t mean that a risk doesn’t exist—the FDA is continuing to monitor cases involving GLP-1 RAs and suicidal thoughts.

Moore said patients who are already at risk for depression and suicidal ideation should especially be cautious.

Thyroid Cancer

Many GLP-1 RA drugs have a “black box” warning about thyroid cancer. Black box warnings are the most serious labels that the FDA requires pharmaceutical companies to put on products to warn doctors and patients about life-threatening side effects.

The potential link was found in animal studies in which rodents were given high doses of GLP-1 RAs, but this link is not yet proven, according to a review in Thyroid. The review concluded that there is no definitive evidence that GLP-1 RAs elevate thyroid cancer incidence. Cases are infrequent and observational studies are inconsistent.

“A blanket statement to say GLP-1s are unsafe because of these side effects—I don’t think that’s quite correct,“ Desroche said. ”I think we have to look at it as, ‘Why are these side effects happening in certain people on certain doses and not in others?'”

GLP-1 RAs for Other Uses

Early research and anecdotal evidence show that GLP-1 RAs may be beneficial for a wide range of conditions, such as heart disease, obstructive sleep apnea, fertility struggles such as polycystic ovary syndrome, addiction, neurodegenerative disorders, depression, and autoimmune diseases.

Li said the GLP-1 system appears to be vital in regulating overall health, making the drug a potential widespread solution for many conditions.

“One area of particular interest is improvement in vascular health,“ Li said. ”There are receptors of GLP-1 protein on blood vessels, and the effect of these drugs appears to be beneficial for vascular health. This may explain the reduction in cardiovascular mortality seen in people taking GLP-1 drugs.

“So, there is a lot more potential to this GLP-1 system for improving health beyond blood sugar and body weight. But much more research is needed and is indeed underway.”

The reason it appears to have many benefits is that GLP-1 is a key player in metabolism, which affects every cell in the body. GLP-1 RAs also appear to have an anti-inflammatory effect on tissues throughout the body, including the brain, skin, joint tissue lining, and intestinal lining.

Among the beneficial side effects of GLP-1 RAs are a reduced risk of kidney failure and improved heart and lung health, as reported in a study published in The Lancet Diabetes & Endocrinology. The meta-analysis combined the results from 11 clinical trials on diabetes and obesity drugs.

The study examined seven different GLP-1 RAs in more than 85,000 patients. It found that the drugs lead to a 16 percent reduced risk of kidney failure, a 13 percent reduced risk of major cardiovascular events (such as stroke and heart attack), and a 12 percent lower risk of any cause of death.

However, Desroche noted that not only should GLP-1 RAs be considered only after exhausting all other options, but also patients should have a clear goal in mind. She noted that for some, weight loss can be addictive. A goal might be to take the medication until reaching one’s goal weight or for a certain timeframe.

Choosing Your Provider

Experts advise that patients carefully consider the source of their GLP-1 RA prescription. There can be risks, particularly associated with online clinics and compounding pharmacies.

Online programs marketing GLP-1 RA prescriptions are plentiful. Experts said consumers should research the level of support, testing, and follow-up exams they’ll receive from any doctor.

“I’d be concerned if somebody is willing to prescribe you a GLP, take your money, and send you on your way,” Desroche said. “It’s different if they’re also offering nutrition counseling, looking at your labs, and meeting with you one-on-one.”

Online programs for GLP-1 RAs sprang up in response to a shortage of semaglutide drugs that allowed compounding pharmacies to produce versions of the drug. The shortage designation was lifted, and compounding pharmacies have been told that they can no longer offer it, although many still do.

Pharmaceutical companies have sued compounding pharmacies in several states, and the matter may continue to be one of legal dispute.

Li warned against using compounding pharmacies and online programs. The FDA has warned of counterfeit versions of GLP-1 RAs. Additionally, the agency has received 1,000 reports of adverse events associated with compounded versions of semaglutide and tirzepatide.

“Online medicine has become an important way for doctors and patients to interact,“ Li said. ”However, nothing replaces in-person visits with a doctor who becomes truly familiar with the whole patient. If you are interested in GLP-1, just ask your actual doctor for advice on whether it is right for you.”

What Happens When You Stop?

More than half of GLP-1 RA users stop after a year, seemingly because of cost—as a month’s supply is about $1,000. A JAMA Network study noted that for every percentage increase in cost, the odds of discontinuation rose.

Northwestern Medicine cardiologist Dr. Sadiya Khan called for more research to determine why people quit, saying she is concerned that rapidly stopping could harm overall health.

“The high cost of these therapies is likely a large barrier,” Khan said in a Northwestern news release. “Also, unlike therapies that are used to treat blood pressure or cholesterol, the perception that these are not chronic disease therapies may also be contributing. For instance, some individuals think they will stop taking them once they’ve lost weight, while others are only using them cosmetically and not for management of a chronic disease.”

A year after stopping semaglutide, 327 participants who had lost an average of 17.3 percent of their body weight on the drug regained an average of two-thirds of their weight loss, according to the results of an original trial published in Diabetes, Obesity and Metabolism.

“Findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health,” the authors wrote.

Moore noted that for people who need to lose 25 pounds, they’ll probably need a standard dose and may need to be on the GLP-1 RA for life. It depends on whether their body is capable of producing GLP-1 on its own, and there’s no test to gauge that—yet.

“The impacts on human health are vast and potentially phenomenal,” she said. “That said, I think high-dosing them forever without managing the patient well can be potentially very problematic down the line.”

Are GLP-1 RAs Worth It?

It may be worth considering that GLP-1 RAs are the “latest shiny object” in medical weight loss strategies, according to Dr. Craig Backs, internist and founder of the CureCenter for Chronic Disease. The drugs come with known and potentially unknown risks.

Attaining a healthy body mass index might be easier with surgery and weight loss drugs, but an article in JAMA Open Network noted that it’s feasible to lose weight with lifestyle changes that can lower the risk of cardiovascular diseases, other chronic diseases, and weight-related mortality.

“The relative weight reduction of 6.5 percent observed in our study was more modest,” the authors said. “Despite this, our findings highlight clinically meaningful long-term health benefits in the general population. Future studies should cover a wider range of outcomes, including health-related quality of life and the risk of frailty, which is associated with overweight at midlife.”

Some doctors are concerned that their peers and patients are overlooking cheaper yet effective weight loss strategies. For instance, one study published in Nutrition & Diabetes showed that people who followed a low-fat, plant-based diet for 16 weeks lost weight and improved cholesterol levels.

A recent Physicians Committee/Morning Consult survey found that while half of adults are aware that a plant-based diet can improve their health and lead to weight loss, just one in five primary care practitioners discuss diet with their patients.

Putting the emphasis on a drug rather than on avoiding ultra-processed foods, eating in moderation, and exercising does nothing to further safe, long-term weight loss strategies that have been proven effective, Backs told The Epoch Times.

Patients who have tried the drug have told him that it’s caused constipation severe enough to make them stop taking it.

Those aren’t the stories people tend to hear, Backs said, noting that social media and marketing fill our feeds primarily with success stories. That can mislead us about the overall tolerability and effectiveness of GLP-1 RAs.

“Human beings have a hard time with these three words: ‘I was wrong,‘“ he said. ”Most have an even harder time with the three words ‘I was fooled.’”

Correction: A previous version of this article mistakenly said GLP-1 feeds microbes in the gut. It does not. The Epoch Times regrets the error.