Tag Archive for: GLP-1

Adaptation: Maintenance

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While you’re losing weight, I’ve always taught people to adopt a diet you can maintain for the rest of your life, because that’s how you’re going to have to eat for the rest of your life to maintain your weight loss. During the process, you have an opportunity: it’s going to take time to lose the weight, so you can experiment with any type of diet or eating plan along the way. The same holds true for your fitness plan, because using those calories does help.

If you use GLP-1 RA, the same approach still holds true. Your body is being induced to release a hormone that slows down stomach emptying, thereby eventually letting you know you’re full. Ignore it, and that leads to vomiting, bloating, and diarrhea. The actual GLP-1 hormone our bodies produce works more subtly, and our task is to get to the point that we listen to the inner signals again. Based on the very limited research so far, here is the best way to do that, followed by my best estimate of the time it takes to get to actual maintenance.

The Best Way to Eat

The first step is learning the Mediterranean diet or a version based on your ethnic background and shifting your diet to that while controlling the amounts you eat. Because the focus is on higher fiber foods such as beans, grains, and vegetables, it’s easy to eat less because you’ll feel fuller sooner.

Second, research shows that fiber can be critical in promoting satiety. As you transition to a new diet, you can use fiber supplements to try to get to 30 grams or more of fiber every day. Because you may be battling the loss of muscle at the same time, maintain or increase your protein intake; there are plenty of great plant-based sources of protein.

Finally, try to reduce ultra-processed foods to a minimum. They are deconstructed and reconstituted to provide simple carbohydrates, excess fats from oils, and preservatives and shelf-life extenders that are not necessary for any body functions.

That’s it for now as this is the least researched part of the adaptation phase of weight loss.  In reality, maybe it’s all we really need but when there is more info, I’ll let you know.

The Timeline

To be blunt, there’s no research to suggest how long you have to pay attention before your body completes adaptation to your new weight. Think about it—every system has to adapt, from the digestive system processing food, the microbiome adjusting to new foods, the endocrine system producing the correct hormones, and on and on and on. That’s going to take time.

I haven’t found research that gives a precise timeline, but I can give you my observation from interviews with people who have lost significant amounts of weight and maintained it: 18 to 24 months is typical. At that point, their bodies seem to have adapted to natural cues again.

Understand that no matter how you lost the weight—medications or simply counting calories or however you do it—the adaptation phase begins then.

The Bottom Line

I’m hesitant to rely on medications for doing something we can do ourselves. The food industry has created a hostile environment of food, and we have to consciously overcome temptation. But if you think about it, everything we need foodwise is also available. We have to train our brains to seek the best and leave the rest. It doesn’t mean we have to eat twigs and berries; it just means we have to pay attention.

On the other hand, weight loss is so important to your health, I’d rather see you lose the weight by any means necessary—but still put the emphasis on healthy eating and exercise.

Medications or foods? Your body. Your choice.

What are you prepared to do today? Eat better. Eat less. Move more. For life.

        Dr. Chet

References:
1. Adv Nutri. May 2026. https://doi.org/10.1016/j.advnut.2026.100647
2. Nutr. 2026 Apr;156(4):101436.  doi: 10.1016/j.tjnut.2026.101436.

Weight Loss Myth Busted

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There’s been so much written about weight loss, no wonder it’s so hard to know what really works. But there’s one weight loss myth that has been busted. You may have heard experts and gurus say, “It’s not about the calories!” They have blamed junk food and renamed it ultra-processed food; they condemned sugar intake, seed oils, and a whole host of other things, but it’s not about the specific foods.

One fact that the increased use of GLP-1 receptor agonists has clearly demonstrated is that when people use the medication, they eat less. The biochemistry allows the body to do what the body is supposed to do when we’ve eaten enough calories: it makes us feel full, slows the stomach from emptying food, and decreases our appetite. That’s supposed to happen naturally, but we’ve allowed our body to ignore it and thus, we’ve eaten way more calories than we’ve needed; that’s why 70% of us are overweight. But at the end of the day, taking the medication forces us to eat fewer calories or suffer the consequences (which are rumored to be quite unpleasant).

Weight loss always was, still is, and always will be about the calories.

That myth is busted.

While we know that GLP-1 agonists work, are there any ways to help lose weight without medications? You’ll learn all about them when I update the Weight Loss Supplements webinar; it’s been 14 years since I originally did that webinar, and a lot has changed in the supplement world. Some are gone; remember hoodia? Some have stuck around, but new ones are on the scene. What has enough science to be a contender? Find out on January 24—more information to come.

What are you prepared to do today?

        Dr. Chet

By Any Means Necessary

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The second discussion was between a tech expert and a finance expert—neither one in the healthcare field. The tech expert shared a story of how a nurse who weighed over 300 pounds was using a GLP-1 agonist to get to a more reasonable weight so she could participate in more activities with her family. That really touched the tech expert.

But that story lit up the finance expert. The GLP-1 agonists are offered at a fraction of the price around the world compared to the U.S. price; Americans pay $936 to $1,396 per month compared to the next highest price of $169 to $319 per month in Japan.  He went on to say that if we were really serious about addressing obesity and health, the price of the GLP-1 agonists should drop to an affordable level of about $50 per month. The pharmaceutical companies would end up increasing sales overall and reduce the number of overweight and obese citizens from 70% by half or more.

That would have an effect of saving about half a trillion dollars in healthcare costs or more per year. That would help around 100 million people and probably save even more than his estimate. More than that, the population would be healthier as long as they were also trained on how to make better food choices, cook better, and exercise on a regular basis to maintain the weight loss.

Why This Approach?

Would I prefer to not even mention a medication when the solution is really simple at its core? Of course. But in the 35 years I’ve been doing what I do, I can’t say that anything else has really worked to help people eat less, eat better, and move more for life. I’ve had challenges myself; I’m still not at my ideal weight for height. That shouldn’t prevent me from giving you every approach to help yourself get there. If you have insurance that can cover the cost of the GLP-1 agonist, have a discussion with your physician about whether it’s right for you.

The Bottom Line

“By any means necessary!” I don’t usually quote Malcolm X but in this case, it fits. Getting to and maintaining a normal weight for height is important to live better and maybe live longer. Using the medications available, together with planning what to do when you stop the medication to maintain the weight loss, may be the solution for you as long as you can tolerate any side effects. For me, I’m modifying the Optimal Performance program slightly to achieve my goals including eating more protein, a challenge that seems to burden everyone over the age of 50. Whatever you decide to do, I’ll finish with a phrase that everyone seems to scream all the time: Let’s go!

What are you prepared to do today?

        Dr. Chet

Same Problem, Different Solution

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Close to 70% of all adult Americans, as well as an increasing number of children, are overweight or obese. The solution for society has been as elusive as it is simple: eat less. Eat better. Move more. But there’s one more part that’s the problem: for life. We could review the reasons why, but let’s look at alternative solutions.

I recently listened to a couple of podcasts that were completely unrelated but talked about the same subject: GLP-1 agonists. To review, GLP-1 receptor agonists are medications that allow the manufacture of the hormone GLP-1. Without getting technical, GLP-1 helps the body release insulin which can lower hemoglobin A1c (HbA1c) levels in diabetics. It also functions to increase satiety so users don’t eat as much and thus lose weight. GLP-1 agonists aren’t a panacea. The come with side effects, but most are manageable. With that in mind, here is a recap of the conversations.

In the first discussion, a physician stated that he puts his overweight patients on a low dose of a GLP-1 agonist to help get their appetite under control. The objective is to help the individual reduce hunger while transitioning to a higher protein diet. It’s using the pharmaceutical the way it was designed. The result helps the patient lose weight with an exit strategy of adopting a new lifestyle of eating less and moving more. Of course, that depends on whether they can afford the medication.

I’ll talk about the second podcast on Saturday. It’s all about the money.

What are you prepared to do today?

        Dr. Chet

Why You Need a Plan

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I recently watched a documentary about a weight loss game show that was very popular about 25 years ago and lasted for 17 seasons. The show was one Paula and I watched for a number of seasons, but eventually we lost interest as the show became more bizarre and unrealistic. The documentary was challenging to watch for a variety of reasons; from the brutality of the trainers, the absurd challenges that demeaned the contestants as human beings, and the constant conflicts between contestants, it was not enjoyable.

According to the documentary, after the winner was announced, the people who had lost hundreds of pounds were left to fend for themselves. They essentially had left reality behind to live on less than 1,000 calories per day and to be able to exercise up to six hours or more a day for close to a year—then, nothing. No plan for how to transition to a normal life again. No explanation from dieticians or trainers how to adapt to maintain their weight loss.

In reality, it’s happening again right now with people who are using GLP-1 RA injections to control blood sugar and lose weight. If you’re going to try it, you should plan an exit strategy well before you’re done losing the weight, the same planning as what the weight loss contestants should have been provided.

How can you do that on your own if the healthcare professional doesn’t? Remember when I wrote about the physician who lost weight by eating the same portions as his wife was eating? I saw him again a week or so ago, and he’s maintained his weight loss well. The plan was to eat like his wife ate, and it has worked.

The Bottom Line

No matter what program or strategy you have to lose weight and get fit, you’ll be more successful at maintaining your weight loss if you work on the exit strategy before you’re even done losing the weight.

  • Are you willing to eat the same foods you ate during the process, or have you been depriving yourself of things you know you want to eat again? How can you fit your favorite foods into your new eating plan? The worst thing you can do is go back to your old way of eating.
  • Have you been doing extra exercise to get there? What are you willing to continue after you’re done? If you go back to your old way of life, you’ll probably go back to your old weight.

Whatever your strategy will be, it has to be something you’re willing to do for the rest of your life. You have the chance to plan ahead. That plan may change as you progress, but it’s easier to adjust a plan you’ve already worked out than to come up with one out of thin air. As the saying goes, “Failing to plan is planning to fail.”

What are you prepared to do today?

        Dr. Chet

It’s Going to Be a While

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In the last Memo, When Will We Get Something Better?, we looked at research on a new drug to counter obesity. But don’t hold your breath.

The researchers developed a sophisticated algorithm and used AI to find the process and the potential obesity-protein hormone to help combat obesity. What’s next? Several years or longer of clinical trials to test its effectiveness and safety in human beings. If it works, it will be another pharmaceutical solution to obesity and a step better than the GLP-1 agonists currently available. Two of the researchers hold the patent for the process and the protein itself, but there are no shortcuts on the science.

In my opinion, the problem is this: that’s not really the solution. They’re looking for a pharmaceutical solution. This protein, called BRG for short, will still have to be regulated like a pharmaceutical, made like a pharmaceutical, and prescribed as such even though it’s a natural hormone made in the body.

Where the research should focus is on a natural way to stimulate the body to upregulate (turn on) the gene or genes with diet, exercise, or some other natural means. Turning specific genes on and off is where we want to be, not creating companies and chemicals that will create a single molecule. It’s just the wrong approach to me. It may very well work, but it’s not natural in any way. I’m not suggesting that people with massive obesity won’t benefit from it, but it’s treating the symptoms of the problem, not the problem itself.

The problem is that because we overeat the wrong foods while not moving enough, genes have become upregulated and stay that way. We need solutions that help us get to downregulating those genes so that weight loss can become permanent.  Eat less. Eat better. Move more. For life.

What are you prepared to do today?

        Dr. Chet

References:
1. https://med.stanford.edu/news/all-news/2025/03/ozempic-rival.html
2. Nature (2025). https://doi.org/10.1038/s41586-025-08683-y

When Will We Get Something Better?

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The quest for a pharmacological solution to obesity continues—the magic pill to make us thin. While Ozempic and Wegovy, discovered and developed to treat type 2 diabetes, have been successful in helping reduce HbA1c, it has also helped people lose weight; the problem is the side effects. As you might guess, there are receptors for GLP-1 agonists in numerous locations in addition to the brain, and other organs are impacted.

That’s why a press release from Stanford seemed promising: “Naturally occurring molecule rivals Ozempic in weight loss, sidesteps side effects.” This research used a unique approach: they designed a specific algorithm that used artificial intelligence to identify the hormone segments made by an enzyme prohormone convertase 1/3 (PC1/3); basically, it cuts prohormones into smaller segments. Some may have metabolic activity, most would not.

Based on the analysis of 2,600 protein segments, the researchers identified 373 potentials and tested the top 100 most likely to succeed. They identified a hormone segment with 12 amino acids that appears to impact hunger 10 times better than the GLP-1 agonists, which are cleaved from the same prohormone. When they tested it in mice and minipigs by injecting it into the muscles of the animals before eating, it reduced food intake by 50%.

The volume of work done by the specific algorithm using AI probably saved years compared to testing each prohormone by trial and error, but what’s next? When will it be available? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. https://med.stanford.edu/news/all-news/2025/03/ozempic-rival.html
2. Nature (2025). https://doi.org/10.1038/s41586-025-08683-y

Why Scientific Research Must Never Stop

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The current U.S. administration has tried to stop or delay basic and clinical research related to human conditions and diseases, and in the next few Memos, I’m going to illustrate why that’s a serious mistake. When I’ve laid it out, you can decide for yourself whether clinical research is a waste of money or critical for human health and well-being.

Example One: Glucagon-like Peptides

Sometime during the last century, chemicals were found in the intestines that seemed to increase the release of insulin in response to glucose. It wasn’t until the early 1980s that a gene was identified that resulted in the manufacture of proglucagon. Continued research found that when the protein was unfolded, it was responsible for the production of six different hormones. While all are important, one in particular has become popular 40 years later: GLP-1 (glucagon-like peptide-1). Depending on where it’s produced, its major function is to increase satiety by delaying digestion in the stomach. The net effect is to reduce food intake; that impacts glucose levels in people with pre-diabetes and type 2 diabetes, which can lead to weight loss and the possible prevention of every other condition downstream from diabetes such as cardiovascular disease or diabetic neuropathy.

You may recognize GLP-1 agonists, chemicals which will turn the production on, by their brand names such as Ozempic and Trulicity. They are helping millions of people control their type 2 diabetes with a side benefit of weight loss. From the time that the chemical was discovered, through identifying the gene that produces it, and the development of a chemical that could stimulate the gene to produce GLP-1, the process took over 50 years. The scientists began with basic research and ended with clinical trials to prove the efficacy of the medication. And the research is still not done—if research is able to continue to find something that stimulates only GLP-1 receptors in specific locations in the body instead of systemically, side effects could be controlled more effectively.

Another illustration on Saturday. Tomorrow is the March Insider Conference Call. The primary topic will be more detail on how drugs like Ozempic work as well as answering your questions. Maybe it’s time you become an Insider and join the call.

What are you prepared to do today?

        Dr. Chet

Reference: J Clin Invest. 2017 Dec 1;127(12):4217–4227. doi: 10.1172/JCI97233

Is It Worth It?

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At an obesity conference, the report on the clinical trials for a pre-diabetes and diabetes medication left the crowd on their feet and cheering. There are reports of well-known personalities who’ve used the drug with great results. But the ultimate question about a pharmaceutical approach to obesity has to be this: is it worth the money? Let’s start by looking at the pharmaceutical and then the return on investment.

How It Works

The body makes proteins called incretins which can stimulate the release of insulin. One incretin hormone, GLP-1 (glucagon-like peptide-1), is manufactured in the upper digestive system in response to carbohydrate intake. In subjects with type 2 diabetes, this hormone effect is diminished or no longer present.

The ability to stimulate the production of insulin and prevent the release of glucose by glucagon can be stimulated pharmacologically by semaglutide, a receptor agonist—that means it turns on the glucagon. In subjects with type 2 diabetes, semaglutide stimulates GLP-1 receptors significantly, thereby reducing blood glucose and improving glycemic control. In addition, it has multiple effects on various organ systems; most relevant are a reduction in appetite and food intake, leading to weight loss in the long term. Since GLP-1 secretion from the gut seems to be impaired in obese subjects, it was logical to test it in obese populations. Those were the study results I reported on Tuesday.

All in all, this sounds like it might be a potential solution to our obesity crisis, but there are some unanswered questions. What is the long-term safety of regular use of the drug? How does the microbiome impact the effectiveness of the drug? But more than that, everything comes with a price, which begs the question: is it worth it?

The Price

The price of using semaglutide for obesity is really two-fold. First is the actual cost of the weekly injections which is about $1,400 per month at retail. If your insurance will cover it, I’ve seen prices as low as $25 per month. We know that people lost an average of 18% of their starting weight at 68 weeks—the length of the longest study to date—but the rate of weight loss declined near the end of the study. How long will insurance cover it beyond that, and will a person continue to lose weight? We don’t know.

After using the drug for 20 weeks, the placebo group was switched to a placebo and immediately began to gain weight. By the end of 68 weeks, they had regained all but 5% and were still gaining. Would an investment of close to $17,000 to lose about 20% of your weight be worth it if you began to gain it back? There are many questions around whether people can take this drug for the rest of their lives; every pharmaceutical intervention must have an end strategy. The researchers did not address the issue.

The Bottom Line

The research into this pharmaceutical intervention was well done. However, unless the intervention includes an exit strategy, it could be a waste of money. Perhaps a lower carbohydrate diet may be a partial solution because this drug impacts carbohydrate metabolism. But we don’t know whether the weight loss would be enough to have the body take over and do the same thing on GP-1 by itself.

I think this shows a hopeful approach and it may turn out to be a boost to someone who is absolutely willing to change their lifestyle or someone who needs to lose weight for a specific purpose, such as joint replacement surgery or preparing for IVF. But for most of us, maybe it’s better to save the time and money and do what we know works: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619