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Julie: Hey there, welcome to episode 379 of the Find Your Food Voice podcast. I am your host, Julie Duffy Dillon, and I’m also a registered dietitian. And I’m gonna be talking to today another registered dietitian. She’s actually someone that is local to me in my teeny tiny wonderful town. And we are two dietitians that have collaborated a lot over the years. And if you do any kind of non -diet work, you tend to gravitate towards other people doing the same because it can be really draining, right, to do this type of work that is countercultural. So I encourage you to find your supports, but I called Megan to go through some of the technical sides of GLP.

If wondering why I’m talking about GLP-1s, well, this all started when a local colleague of ours, their name is Jessie Spence, reached out to me to have a conversation about their personal experience using a GLP-1, specifically Ozempic, and just like how it’s been feeling and yeah, just the experience that they’re getting and sometimes not the support that they need within the non-diet, anti-diet community.

So if you are someone that is maybe thinking about trying one, just starting to kind of think about it, and you’re also rejecting diets or recovering from an eating disorder, we hope that these episodes help you to discern your next best steps. And this episode today in particular, I hope it is very practical for you, helps you to better understand just the physiology, the nuts and bolts about GLP -1s in general.

So we are going to hear from Megan after a very quick sponsor break. We’ll be right back.

Julie: Welcome back. Hey, Megan, how’s it going? It’s good to see you. And I love that we’re having this conversation and other people get to hear it. And one thing that the listener doesn’t know is that you and I know each other because we live in the same place and we’ve known each other for a long time. And I know that you used to work in pharmaceutical sales and had a role with GLP ones. Could you let us know like what you were doing?

Megan: Hey, Julie. Good to see you.

Megan: Yeah, so I was a pharmaceutical rep that promoted a drug for a large pharmaceutical company that was not a GLP-1 receptor agonist like you’ve been talking about, but worked in the same area. It increased levels of GLP-1 in diabetic patients, but just using a different mechanism of action, whereas like a GLP-1 receptor agonist is a mimicking GLP -1 in our bodies. It’s kind of giving us a dose of GLP-1. This blocked something else that breaks down GLP -1 in the body to help raise the levels. So the area is familiar to me. And at the time, there was a GLP -1 receptor agonist that had come onto the market prior, Xenotide, which I believe is the first to market. these conversations, like one of my jobs for a while was just to really be talking about GLP -1 because it felt like newer science.

Julie: Can I ask you a question really quick? What year was this?

Megan: you want me to do year?

Julie: Well, like even give us a range because it was years ago, right? I mean, it was like, yeah.

Megan: It was a long time ago. It was a long time ago. So I stopped working there in 2009 I believe 2010 it might have been 2009 Yeah, 2009 2010 somewhere in there and so the couple years or so leading up to that So we’re in the like maybe 2008 2007 something like that. Yeah

Julie: Got it. Okay, awesome. Thank you. But go ahead. 

Megan: Yeah, so that’s, that was, it’s kind of my unique background, you know, as a dietitian of, got to regularly have conversations with doctors about this and also what they were seeing in their patients and in particularly around the science. Cause like I said, it it felt like fairly new science to all of us because most doctors hadn’t learned about that in med school.

Julie: Mm -hmm. Yeah, it’d be surprising how little so many of us that work in healthcare like learn about certain things that we talk about all the time, right? Well, and I’m gonna write look at my notes because I when I texted you about this I was like I had like a very specific question that I knew you’d be so good at answering And here’s my question for you What do you wish people interested in trying a GLP one knew about how it functions in the body?

Megan: When I explain this to clients, I feel like one of the things that surprises them most and that I really feel like everybody should know is that there is nothing about GLP -1 receptor agonists that actually address like fat in the body that address fat cells. So these aren’t, when we think about weight loss drugs, we think about like, this is a drug that’s going to help me like, you know, quote unquote melt fat away or something like that, that it’s actually working and that its purpose is to work on fat in the body. And instead, like I mentioned, so the function of GLP -1 in the body, some of its functions that we’re aware of is, you know, to help with insulin secretion and to help delay, like, what is called gastric emptying, but essentially means, like, how quickly food moves through our stomach. And what we know is that people who have type 2 diabetes, their levels and function of GLP -1 are diminished.

Megan: And so we can give somebody with type two diabetes like a big sugar drink, like a glucose drink. And we can see compared to people without diabetes that the response of their GLP -1 is a lot lower. Like it’s a lot lower. So what I always like to help people understand is that a lot of the weight loss that we’re seeing that does come with these drugs in a variety of amounts per the individual has to do with reduced intake. The appetite decreases when you take these drugs. There’s sometimes nausea can be a side effect and a desire to eat in general becomes reduced when you use a GLP -1 receptor agonist. So what I always like to help people understand is that the drug’s not doing something to your body that’s making it lose weight. You’re eating less in response to taking the medication.

So it’s not unlike choosing to eat less in some ways. It’s just happening in a little bit more of a physiological way, like a physiological imposition, if that makes sense.

Julie: Yeah, it does. Yeah, that does. Yeah. And I think it’s a helpful thing, especially if people have experience with that behavior and how their body reacted to eating less. Like for I guess there’s some people they eat less and then nothing happens. And then for probably most of us, they experience something where like, eventually they’re going to hit some panic hunger, maybe when the medication stops or the body gets used to it. I know something that we talked about when I was talking to Jessie and their interview, like mentioning, like after being on for a while, they said, like, eventually their hunger came back and it was kind of like, Whoa, what the hell’s happening? You know, I’m not used to this. But like, yeah, that’s like a normal natural reaction. Of course, I’m not eating enough. But yeah, so for some people, they may experience like a binge eating or food thoughts, you know, right. And, I’m just thinking about what you said, like, we can kind of like put that in our pocket, then if someone goes on a medication that they’re not eating as much, they may experience the same thing that they have in the past when they don’t eat as much, you know?

Megan: Yeah, absolutely. It’s another, like I don’t think we have undone any of the challenges that we have seen thus far with any other methods of restriction that have been put in place. And what studies are showing is that rebound weight, meaning gaining the weight back that somebody’s lost before, is also prevalent with these drugs. And so, as we know, the back and forth, regardless of the methods that you’re using to decrease your weight,

Megan:the weight regain again can put us at risk for increased risk for type 2 diabetes. For some of the problems that we’re trying to solve, not to mention like 100 % frustration when you feel your weight increasing if it’s something that feels important to you. So I think it’s important to understand that these aren’t necessarily like a new magic bullet for sustainable weight loss.

Megan:I recently was part of a continuing education where a study was presented that showed that the dropout rate for these medications can be, half studies are showing half of individuals not being able to stay on the drug after 12 months due to the side effect profile. And a lot of times that comes from pushing the dose higher and higher and higher for the purposes of achieving the weight gain versus looking at it just from blood sugar management, which it can be beautiful for that because I had mentioned there’s that deficit. There’s nothing wrong with an individual’s GLP -1 levels who does not have diabetes like they already have. So now we’re kind of really doubling up on GLP -1. Whereas, know, with somebody with diabetes, we’re really helping address that deficit, which is, I think, really cool and really neat.

Julie: Yeah, yeah. Yeah, I remember when it first came out and I was still a diabetes educator and people were like so excited about this medication when it came out because of that, like, my gosh, this is like a brand new tool. And, you know, that’s some of my fears of it. I’d I’d love to have catastrophic thinking, but like, all the like rapid increased dosing and how that may have some negative effects and you know, only time’s gonna tell like what ends up happening. Like what about folks who are using it at a lower dose to manage their blood sugar and they feel so much better. I know Jessie talked about how like they felt so much better on this. And it’s a lower dose that they’re on. And how they just like have energy and feel so great. And they’re sleeping through the night. Things that we should all have. But yeah, like by it being also uses a kind of like weight loss, like tool, how that may get in the way of its like availability for safety and things like that. I don’t know. So, hey, I appreciate all this information. This is super helpful. And tell people where they can find you if they want to know more about like how you can help them. And yeah.

Megan: Yeah, simplenutritioncounseling.com. That’s such a mouthful. I know you might put it in show notes or something someplace. But that’s a place that you can find out about the practice that I’m in in Greensboro, North Carolina. And we see clients virtually and in person, me and my associate, Donetta. And there’s also a spot on there that you can sign up for our newsletter. We are offering different education opportunities. And if somebody wanted to stay in the loop about those types of things, as well as receive occasional resources, that that would be something that they can sign up for and continue to hear from us.

Julie:  Awesome. Well, thank you for giving us a peek behind the curtain of what goes on in pharmaceutical sales, you know, like all the different things and sharing some helpful information about how it works in the body. So I appreciate it. Thanks, Megan.

Megan: Thank you, Julie.

Julie: So there you have it. I hope you enjoyed my conversation with my friend, Megan Hadley. You can find out more about her and her practice at simplenutritioncounseling.com and look for the companion episode to this episode. And the next day or two, you’re going to be hearing from Donnetta Floyd, and we are going to dive deeper into the connection with diabetes and how GLP ones interact when you have diabetes. And if you haven’t listened to my conversation with Jessie Spence, who kind of started all of this wonderful kind of nuanced conversation on Ozempic and trying to navigate using this medication while also doing things like intuitive eating or other anti -diet work. So check out that as well. And we hope you enjoy this episode and until next time, take care.