Three Tips on Incorporating GLP-1 Agonists into Your Integrative Practice

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While GLP-1 agonists seem to be at the center of media attention when it comes to healthcare, according to Darshan Shah, MD, many patients are still confused about what the medications are and what they actually do.

“I talk about this around 50 times a week to my patients,” said Dr. Shah. “People don't really understand what GLP-1 is; I spend a lot of my time explaining to patients that GLP-1s are actually hormones produced in your gut.”

Dr. Shah, a health and wellness specialist and founder of Next Health, is a board-certified surgeon who has performed countless bariatric surgeries. Now, instead of turning to surgery, he helps his patients achieve their weight loss goals with integrative protocols, often incorporating GLP-1 agonists.

According to Dr. Shah, GLP-1s are hormones that occur naturally in the body and control appetite. Like other hormones such as estrogen and testosterone, people sometimes lack GLP-1, leading to increased hunger. GLP-1 agonists mimic those hormones, reducing appetite. 

In a podcast interview, Dr. Shah spoke about a whole-person approach to GLP-1 agonists at the Integrative Healthcare Symposium in February. Before starting your patients on GLP-1 agonists, Dr. Shah said there are several tips to consider, including:

1. Address patients' lifestyle choices and relationship with food.

“If [a patient] is using a GLP-1 medication just eat as much junk and ultra-processed food as possible, and [they’re] not dedicated to making true lifestyle and health changes, GLP-1s are going to be deleterious and cause more problems than good,” said Dr. Shah. “Specifically in the range of metabolism, [a patient] may go from having a few extra pounds to becoming skinny fat, where [they] then have lost muscle mass and fat mass and have more metabolic dysfunction before.”

2. Assess patients' muscle mass and fat mass to determine their personalized goals.

“You have to assess [the patient’s] muscle mass, looking at their biomarkers, looking at their free fat mass and their fat mass with a DEXA [dual x-ray absorptiometry] scan, for example, to determine what their goal should be,” explained Dr. Shah. “It’s not just about weight. You should ask, ‘What number are we headed towards for fat mass?’ And ‘what number of skeletal muscle mass?’ If [you’re] not increasing muscle mass while decreasing the fat mass, [you’re] going in the wrong direction. So, it’s about tying goals to what the outcome is supposed to be.”

3. Continue to monitor patients’ progress and adjust their protocol based on real-time data.

“CGMS [continuous glucose monitors] are an incredibly powerful tool to understand a patient’s N-of-1, to figure out how food affects them specifically,” said Dr. Shah. “So, we use CGMs for a certain amount of time, and Ashley [Koff] helps us monitor that. We also have [patients] get a bioimpedance scale to track the trend of their skeletal muscle mass while putting these habits into place. Following [their] health journey with biomarkers from the very beginning really sets [patients] up for the long-term. Eventually, we will wean [them] off this medication based off their specific goals. One caveat is that we're humans, and we live a life, right? Life goes up and down. It's not guaranteed that they'll never have to take it again, but we do have an endpoint for the first journey.”

Editor’s Note: To listen to the full IHS podcast interview with Dr. Shah and Ashley Koff, RD, click here.