Dr. Bob Gabbay Answers your GLP-1 Questions

Dr. Robert “Bob” Gabbay, MD, PhD, is an associate professor of medicine at Harvard Medical School, an endocrinologist at the Joslin Diabetes Center in Boston, Massachusetts, and a member of the Beyond Type 1 Scientific Advisory Council. 

He recently presented on the use of GLP-1 for individuals living with type 2 diabetes (T2D) at Beyond Type 1’s Type 2 Diabetes Virtual Summit. 

Questions were submitted via social channels ahead of the summit. Let’s dig into Dr. Bob’s answers to your questions: 

Are there any negative effects to long-term use of GLP-1 medications?

A: Dr. Gabbay: The first GLP-1 medications were approved 20 years ago. They have been out there and FDA-approved for a long time, and in terms of long-term effects, there are few concerns. What people struggle with are the side effects, which can vary from person to person. 

Common side effects of GLP-1 medications may include:

• Nausea
• Diarrhea
• Vomiting 
• Low blood sugar levels
• Weight loss 

If you use a GLP-1 and are struggling with adverse side effects, talk with your healthcare provider to see if you need to change your dose or switch medications. 

Most side effects will ease after your body becomes acclimated to the medication. 

Do you have any tips for preventing or treating hair loss associated with GLP-1 usage?

A: Dr. Gabbay: In terms of hair loss, any sudden or rapid weight loss can cause hair loss. This can sometimes happen with GLP-1 usage as well. It is a side effect that people using a GLP-1 may experience, but not everyone does. 

A few tips: Try not to lose weight too quickly. Start with a small dose of your GLP-1 medication and let your body get used to it over time. And secondly, make sure you’re getting enough protein each day. Eating protein can help prevent hair loss.

You want to aim for 0.8 grams of protein per 1 kg of body weight. 

How can I get enough nutrients, including protein, in my diet when I have a limited appetite? 

A: Dr. Gabbay: Protein is really important. One thing that we noticed early on with our patients is that when people realize they could lose weight no matter what they ate, they gravitated towards junk food, which didn’t make them feel good, and they suffered.

Healthy eating recommendations are still important. Make sure you have a balanced diet. And try to pair protein with each meal and snack.

Healthy protein options include:

• Nuts and seeds
• Tofu or tempeh
• Lean proteins like chicken, turkey, or white fish
• Legumes
• Beans
• Nut butters like almond or peanut butter 

It is also important to get enough fluids- people really struggle with drinking enough water. Water and protein are really key! 

Drink water throughout the day instead of chugging a bunch of water all at once. 

Working with a registered dietitian is really important. They can personalize a healthy eating plan based on your needs and likes. Also, focus on eating smaller portions more frequently throughout the day. 

Can you explain the anti-inflammatory effects of GLP-1s? Are they beneficial for other conditions besides diabetes and weight management, like arthritis? 

A: Dr. Gabbay: GLP-1s are proven to be beneficial for kidney disease, liver disease, heart disease, osteoarthritis, sleep apnea, and heart failure. GLP-1s are in clinical trials for treating Alzheimer’s, substance abuse disorders, Parkinson’s, and even depression. 

Heart disease protection is experienced even in patients who do not lose weight. This is because GLP-1s help alleviate inflammation in patients living with heart disease and heart failure, as well as other conditions. The health benefits come from weight loss, yes, but also from a reduction in overall inflammation. 

Do all GLP-1s provide the same level of appetite suppression?

A: Dr. Gabbay: What we see in the studies is that the newer drugs like Wegovy, Zepbound, and Moujaro provide a lot more appetite suppression than older medications, like Byetta and Trulicity. 

Appetite suppression, weight loss and overall health benefits will vary from patient to patient. If you are on one GLP-1 medication and you’re not seeing your desired results, talk with your healthcare provider about changing your medication until you find something that works better for you. 

The same applies if you’re experiencing negative side effects and wish to switch medications.

Is it okay to take a GLP-1 medication with gastroparesis? Irritable bowel syndrome (IBS)?

A: Dr. Gabbay: Generally, we do not recommend people who have gastroparesis to take these medications. Gastroparesis results in slower-than-normal emptying of the stomach, and these medications slow digestion even more. Although I recommend that you talk to your healthcare provider about this.

With irritable bowel syndrome, the data is a little murkier, but talk with your healthcare provider to see what they recommend for you. You may have to try out the medication and see how your body responds. 

If you have additional questions about GLP-1s, talk with your healthcare provider and join our T2D community online!