By Bob Mehr, R.Ph, FIACP
With GLP-1 weight loss drugs (like Ozempic and others), we are still discovering many potential adverse effects, and it may take years before these risks are fully understood.
In patients with diabetes who take these drugs, it is important to note that recent studies have found increased risks of gastrointestinal adverse events (such as biliary disease, pancreatitis, bowel obstruction, and gastroparesis).
Since diabetic patients already have a higher baseline risk for gastrointestinal problems, the risk for others taking these drugs for off-label weight loss may differ.
Interestingly, recent reports indicate that while GLP-1 drugs can cause rapid weight loss, it’s often with more pronounced effects on the face. Facial fat serves a protective function and plays a role in facial aesthetics and elasticity.
Rapid weight loss can also cause dermatological changes, including sagging skin, as the fat that stretches and cushions the skin is no longer present.
Additionally, the skin loses its ability to retract after rapid weight loss due to reduced levels of elastin and collagen, which are vital for structural integrity.
As a result, people taking Ozempic or other GLP-1 medications may experience the following facial symptoms:
What is GLP-1?
Glucagon-like peptide-1 (GLP-1) is a gut-produced hormone essential for regulating blood sugar levels and appetite.
Did you know that GLP-1, the hormone that these drugs are designed to induce, is naturally produced by the body to help maintain healthy blood sugar levels, curb cravings, and support a healthy weight?
Or that certain bacteria in the gut microbiota can induce the natural production of GLP-1?
GLP-1 is part of a group of metabolic hormones called incretin hormones, which help decrease blood glucose levels. The majority of GLP-1 is produced by L-cells lining the small intestine and colon, with smaller amounts secreted by the pancreas and central nervous system.
In the pancreas, GLP-1 stimulates the release of insulin, increases the number of insulin-producing pancreatic cells (beta cells), and reduces the release of glucagon — a hormone that raises blood sugar levels. GLP-1 also signals appetite centers in the brain, promoting a sense of fullness during and between meals by slowing gastric emptying.
Primarily triggered by food consumption, GLP-1 release occurs 10–15 minutes after eating. Although it remains in the bloodstream for several hours, nerve activity and other hormones can influence GLP-1 production and levels.
For example, somatostatin, a hormone mainly produced in the nervous and digestive systems, reduces GLP-1 production. Dipeptidyl peptidase-4, an enzyme expressed on the surface of cells, terminates the blood glucose-lowering action of GLP-1.
Remarkably, GLP-1 is glucose-dependent — it reduces blood glucose levels only after a person eats; it does not reduce glucose levels on its own.
In clinical studies, intravenous GLP-1 administered to fasting patients did not lower blood sugar levels, unlike when patients consumed a meal.
This inability to induce hypoglycemia, or low blood sugar, in patients given IV GLP-1 led to the development of GLP-1 receptor agonists (commercially produced pharmaceutical drugs).
Diet and the role of gut microbiota in GLP-1 production
The human gut, commonly referred to as the gastrointestinal (GI) tract, is home to more than 1,000 microbial species that form a complex ecological community known as the gut microbiota.
This microbiota, composed of bacteria, viruses, yeast, fungi, and other microorganisms, plays a pivotal role in health and disease.
It performs several functions, including food fermentation, pathogen protection, immune response stimulation, and vitamin production. The composition, proportion, and diversity of an individual’s gut microbiota are influenced by genetics, lifestyle (including diet), medications (especially antibiotics), aging, and other factors.
Certain foods — such as eggs, nuts (almonds, pistachios, and peanuts), high-fibre grains (oats, barley, and whole wheat), avocados, olive oil, and vegetables (Brussels sprouts, broccoli, and carrots) — have been shown to support GLP-1 levels.
Multiple studies have linked gut dysbiosis (an imbalance in the diversity, composition, and functions of the microbiota) to reduced GLP-1 levels. Reduced GLP-1 levels are directly associated with the development of metabolic disorders, including type-2 diabetes and obesity.
How probiotics can support GLP-1 production
In addition to eating GLP-1-supportive foods, specific strains of probiotics can significantly alter the gut microbiome and increase GLP-1 production.
One specific strain, the probiotic Akkermansia muciniphila (A. muciniphila), secretes a protein that induces natural GLP-1 production.
Another unique strain of A. muciniphila, AH39, targets the mucosal layer of the gut, which is crucial for maintaining gut barrier integrity and promoting healthy inflammatory markers. It also supports healthy systemic metabolic outcomes within the gut lining.
The Bifidobacterium animalis HN019 strain promotes the production of short-chain fatty acids in the gut microbiota. It also supports intestinal barrier function and healthy inflammatory markers.
The Bifidobacterium animalis B420 strain aids in weight management and supports metabolic health by influencing gut microbiota composition and promoting short-chain fatty acid production, which contributes to GLP-1 secretion.
Lactobacillus rhamnosus GG is believed to support gastrointestinal health and immune balance. It may help promote the structural and functional integrity of the gut barrier, support beneficial bacteria, and increase short-chain fatty acid production.
These actions may help maintain a healthy intestinal environment, support healthy inflammatory markers, and enhance metabolic functions.
Clostridium butyricum nourishes the gut lining, promotes healthy inflammatory markers, and supports a healthy gut barrier function.
Clostridium butyricum 10 is known for its butyrate-producing capabilities, which is a primary energy source for colonocytes, supporting their health and promoting a strong intestinal barrier. It also supports the healthy expression of tight junction proteins, further enhancing barrier integrity.
The final word? Let Food Be Our Medicine unless medical intervention is prescribed.
With the right diet, we can induce natural production of GLP-1 with no off-label drugs required.
Bob Mehr, RPh, FIACP, is the founder and CEO of Pure Integrative Pharmacy. His vision is family, health and community for all.
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