Dietary Recommendations for Patients on GLP-1 Receptor Agonists

Introduction to GLP-1 Therapy

• The American Diabetes Association recommends a hypocaloric diet with a 500-1000 kcal daily deficit below total energy requirements, emphasizing high protein intake and 150 minutes per week of physical activity, including resistance training, for patients on GLP-1 receptor agonists 1

Caloric Deficit and Weight Management

• A structured caloric deficit of 500-1000 kcal below daily requirements is recommended to optimize weight loss outcomes when combined with GLP-1 therapy, with a strength of evidence level of high 1
• The caloric restriction should be maintained throughout the entire duration of GLP-1 treatment, with a moderate level of evidence 1

Protein Prioritization to Prevent Muscle Loss

• Prioritize protein intake at every meal to preserve lean body mass, as GLP-1 receptor agonists cause muscle loss alongside fat loss, with a high level of evidence 1
• Ensure adequate protein intake throughout treatment to minimize loss of lean body mass that occurs with GLP-1-induced weight reduction, with a moderate level of evidence 1

Fat Quality Over Quantity

• Substitute foods higher in unsaturated fats for those higher in trans or saturated fats, with a high level of evidence 1
• Consume fish 2-3 times per week, especially oily fish such as salmon, sardines, trout, tuna, or mackerel, with a moderate level of evidence 2
• Limit saturated fat intake to less than 7% of total calories, with a high level of evidence 3

Carbohydrate Management

• Moderate carbohydrate intake at each meal if taking GLP-1 receptor agonists alongside insulin secretagogues or insulin to reduce hypoglycemia risk, with a moderate level of evidence 1
• Choose whole grain varieties of breads and cereals over refined options, with a high level of evidence 2

Fiber-Rich Foods

• Eat vegetables with all main meals, ensuring they compose the majority of the dish, and choose a variety of colors, with a high level of evidence 2
• Increase consumption of high-fiber foods to meet the recommended 14g per 1000 calories, with a moderate level of evidence 3

Foods to Avoid or Limit

• Avoid highly processed foods and beverages with added fructose, including ingredients labeled "high fructose corn syrup" and "glucose fructose syrup", with a high level of evidence 2
• Limit consumption of fast food, commercial bakery goods, and sweets, with a moderate level of evidence 2

Sodium and Alcohol Guidelines

• Limit sodium intake to 2,300 mg per day, with a high level of evidence 1
• If consuming alcohol, limit intake to one drink per day or less for women and two drinks per day or less for men, with a moderate level of evidence 1

Managing Gastrointestinal Side Effects Through Diet

• Gradual dose titration is essential to minimize nausea, vomiting, and diarrhea, which are the most common side effects of GLP-1 therapy, with a high level of evidence 4, 1
• Take medication with food or 15 minutes after a meal if gastrointestinal symptoms persist during titration, with a moderate level of evidence 1

Meal Timing Considerations

• Daily or twice-daily GLP-1 injections should be administered premeal, with a high level of evidence 4
• Once-weekly GLP-1 formulations can be taken at any time during the day regardless of meal times, with a moderate level of evidence 4

Physical Activity Integration

• Combine GLP-1 therapy with 150 minutes per week of physical activity, emphasizing resistance training to preserve lean body mass, with a high level of evidence 1
• Resistance training is critical to prevent muscle loss that occurs with GLP-1-induced weight reduction, with a moderate level of evidence 1

Supplement Guidance

• Do not use vitamin and mineral supplements, herbal products, or cinnamon specifically to manage diabetes, as there is lack of evidence for their efficacy, with a high level of evidence 1
• Routine supplementation with antioxidants such as vitamins E and C and carotene is not advised due to lack of evidence of efficacy and concern related to long-term safety, with a moderate level of evidence 3