GLP‑1 users often eat less—raising the risk of muscle loss and nutrient shortfalls.
In this premiere episode, NatMed editors Jeff Langford and Andrea Stafford share point‑of‑care counseling:
- How much protein should patients aim for—and how can they actually hit these goals across the day?
- How should patients fill their plates to protect protein and produce intake (MyPlate)?
- What hydration and fiber targets help keep bowel movements comfortable and regular for GLP-1 users?
- How can patients manage nausea during initiation and titration?
We also cover whole‑food priorities vs shakes/bars, what “eat the rainbow” really looks like for micronutrients, an activity anchor (including strength training to preserve lean mass), and age‑aware notes on vitamin D & calcium—plus quick talking points you can use with patients on semaglutide or tirzepatide.
Our listeners can get 10% off a new or upgraded subscription with code natmed1026b at checkout.
NatMed / TRC Healthcare Editor Hosts:
- Jeff Langford PharmD, BCPS, BCCP (Managing Clinical Editor)
- Andrea Stafford, PharmD (Assistant Editor)
CE Information:
This podcast is sourced from the NatMed January 2026 Newsletter. To claim CE credit, subscribers should read the newsletter and click “Take the CE Quiz” link to take the quiz.
The clinical resources mentioned during the podcast are part of a subscription to NatMed:
- 🌱 NatMed Pro
- 💊 TRC Healthcare
- GLP‑1 Toolkit
- Interactive CE Course: GLP-1 Agonists: Supporting Success with Nutrition and Lifestyle Considerations
- Newsletter
- Chart: Protein Content of Common Foods
- Chart: Calcium-Rich Foods
- Chart: Vitamin D-Rich Foods
- Chart: Fiber-Rich Foods
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The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Natural Medicines: Evidence in Practice is a production of TRC Healthcare.
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Transcript:
This transcript is automatically generated.
Introduction
[0:03] Jeff Langford
Welcome to Natural Medicines Evidence in Practice. I’m Jeff Langford, a pharmacist and managing editor at NatMed.
[0:10] Andrea Stafford
And I’m Andrea Stafford, a pharmacist and assistant editor with NatMed.
[0:15] Andrea Stafford
If you work with natural medicines or you’re just simply curious, you are in the right place.
[0:20] Jeff Langford
On this show, we’ll cut through the noise and trends to bring you practical, evidence‑based guidance.
[0:25] Andrea Stafford
And in today’s episode specifically, we are going to focus on nutrition and lifestyle counseling for patients using GLP‑1 receptor agonists for weight loss… to help meet key goals of reducing body fat while preserving lean mass and avoiding key nutrient deficiencies.
[0:41] Jeff Langford
And a quick note — CE credit is available for our podcast through our monthly NatMed newsletter. Check the show notes for how to claim it.
Background on GLP-1s
[0:49] Andrea Stafford
Now, you might be surprised that our first podcast isn’t focused on a popular supplement or vitamin. That’s certainly a key part of NatMed, and we will cover topics like turmeric in the future.
[1:02] Andrea Stafford
But NatMed is also about the big picture, including lifestyle strategies that make a difference. And right now, many patients are using GLP‑1 receptor agonists for weight loss. So equipping clinicians and patients with guidance on lifestyle considerations to support their journey is essential.
[1:20] Jeff Langford
Okay, Andrea. Well, let’s dive in with a little background.
[1:23] Jeff Langford
GLPs definitely are in the headlines every day. So this drug class includes semaglutide, Ozempic, or Wegovy are brand names there, tirzepatide, Mounjaro or Zepbound.
[1:34] Jeff Langford
And these medications have a key role in managing a lot of conditions — diabetes, kidney disease, and cardiovascular disease, to name a few.
[1:42] Jeff Langford
But where they’ve really exploded is for weight loss. And we can expect continued attention on this class of drugs. For example, in December, we saw the FDA approval of a new oral daily version of Wegovy. So attention has been there and is expected to stay there for quite a while.
[2:00] Andrea Stafford
That’s right, Jeff. Well, we continue to see this rise in popularity. GLP‑1s also have a range of uses, but it’s because of their effectiveness compared to other weight‑loss options that they are getting a lot of extra attention. In some cases, people may lose around 40 pounds on this therapy, which is approaching the magnitude of weight loss seen with bariatric surgery.
[2:26] Jeff Langford
And how they work, of course, is reducing appetite and food intake. Now, the risk and the downside that we need to have front and center is that without a plan, patients can lose muscle and miss key nutrients. Some data suggests that about 20% of the weight lost with the GLP‑1 is actually muscle loss. So one of the goals of our conversation today is simple: How can we help patients lose fat, protect that lean mass, and cover their micronutrient bases?
The Three P’s: Protein, Plate, Plenty
[2:54] Andrea Stafford
And to do that, Jeff, we want to make it easy using a three‑part framework we call the three Ps. Protein, looking at protein intake and tailoring it to the patient’s needs, portion control or plate, meaning we keep protein and produce front and center, and then plenty. Plenty of water and fiber to keep everything comfortable.
[3:17] Jeff Langford
Well, I love that 3P approach, Andrea — protein, plate or portion, and plenty of water and fiber. The points you lined out there, Andrea, are really key for success while working to lose weight. And we can keep in mind this framework also applies to patients as they’re seeking to maintain that weight loss further down the road, or for an overall health approach for patients who have diabetes or cardiovascular conditions.
Protein Targets
[3:41] Andrea Stafford
So let’s start with the first P, protein, because having a target is helpful. Ideally, increasing protein is important, but there’s not necessarily a one size that fits all. And different professional organizations and guidelines do have slightly different recommendations. But a simple rule of thumb for people using weight‑loss medications — this aligns with the guidance from ASPEN, the American Society of Parenteral and Enteral Nutrition — is to aim for one to 1.2 grams per kilogram of body weight per day for adults who are sedentary and 1.5 grams per kilogram of body weight per day for physically active adults to preserve muscle.
[4:21] Jeff Langford
Well, Andrea, one thing that comes to my mind as we start talking about these targets is how do they compare to the new dietary guidelines that we’ve been hearing so much about?
[4:29] Andrea Stafford
Yes, perfect question. Not a lot of variation, but slightly. The new 2025 to 2030 dietary guidelines recommend 1.2 to 1.6 grams per kilogram of body weight per day, and adjusting that as needed based on individual caloric requirements.
[4:49] Jeff Langford
Okay, so these different guidelines are giving pretty similar numbers. Yes. What’s the background behind those targets?
[4:56] Andrea Stafford
Another great question because we don’t just have these numbers out of thin air. There is some evidence behind it. In clinical research, intakes around one gram per kilogram of body weight per day have been associated with a greater risk of muscle loss, while higher intakes, often 1.3 grams per kilogram of body weight per day, are more consistently linked with better muscle preservation.
[5:19] Jeff Langford
Okay, Andrea, that’s really helpful. That gives us some idea of how much protein we need to get to preserve muscle, but let’s break it down to an example. If we had a patient who weighs about 90 kilograms or roughly 200 pounds and is sedentary, based on those ASPEN guidelines, we could target 90 to 108 grams of protein per day. Now, the thing that comes to my mind is this might be a little tricky to actually do. How do we get that much, how do we help patients get that much protein in their diet?
[5:47] Andrea Stafford
Exactly. I think that’s a great question because we hear those numbers and then we think, what do we do with them? So first, we want to spread protein across three meals. It’s usually easier on the stomach, too, than trying to get it in all at once anyway. Second, we can have patients eat protein first before we start to feel full. And then third, when possible, we want to lean on whole food proteins — so think chicken, fish, eggs, and dairy.
[6:14] Jeff Langford
And to help patients meet these specific intake recommendations, we do have a resource on our site, the NatMed Protein Chart, that shows how many grams of protein are in typical portions of different foods. And that can really help make these recommendations very concrete and specific for patients to determine how much and what foods they can target to meet those protein intake goals.
Plate and Portions
[6:36] Jeff Langford
Now that we’ve got protein set, let’s think about that second P in our framework — protecting space on the plate. So we’re going to talk about portion size and the plate, because those things go really hand in hand.
[6:48] Jeff Langford
And I think in my practice, one of the things that I’ve particularly liked is the MyPlate method because it’s so visual. So we can just picture one of those compartmentalized plates that may be divided into four sections, and we can illustrate for patients how to fill that ideally. And that would be using one section, or one‑fourth of the plate, for protein; half of the plate, or two of those sections, for vegetables and fruit or all vegetables; and then the last section for grains.
[7:17] Jeff Langford
And if we can illustrate that, that gives patients a very concrete visual for how they can fill their plate ideally. And then the second thing that we can talk about is really how much is a serving size when we talk about filling one of those compartments. We can put some examples to that as well. So if we’re thinking about vegetables and using chopped vegetables as an example, a baseball is a good illustration of a serving size there. A fruit serving of a whole fruit, like a whole apple or orange, is about the size of a tennis ball. If we’re thinking about carbs or grains, a serving size is roughly equivalent to the size of your fist. And we can think of a deck of cards being a good equivalent for a protein serving. So we can help patients see the plate and how it should be divided up, and then some nice clear examples of the amounts of food that comprise those different servings.
[8:12] Andrea Stafford
Yes. And as a visual learner, this helps me immensely when I’m thinking about my plate and the best way to kind of organize that. And as we’re talking with patients through that MyPlate picture — what to eat and how much — I think there’s one big thing we can’t ignore.
[8:27] Andrea Stafford
And that’s that these medications can change how eating feels. A lot of people deal with these gastrointestinal side effects, things like nausea, diarrhea, or constipation. And you’ll hear numbers in the ballpark of 20 to 40% of patients experiencing these. And it’s usually most noticeable when they’re just starting the medication or when that dose was just increased. So I think it’s important that we give patients a few practical tips up front, because if they’re feeling crummy, it’s a lot harder to hit protein goals or our nutrient goals or our fluid goals. And with that being said, stay tuned because this will be discussed in more detail toward the end of our show, because this is a common concern for many patients.
Plenty of Water and Fiber
[9:11] Jeff Langford
Okay. Well, thanks for teeing that up, Andrea. I do think that’s a super common question. Let’s move to our last P, and that’s plenty of water and fiber. Both of these are important for comfort and health. And you just really described the frequency of constipation and other GI adverse effects for GLP‑1s. In addition to the medications causing that themselves, as patients move to a higher‑protein diet, that can also contribute to constipation. So we want to really focus on hydration and fiber to help keep everything in the GI tract moving through normally and reduce side effects and problems for patients.
[9:44] Jeff Langford
So we can encourage them to get two to three liters of fluid per day, especially during that GLP‑1 dose initiation or titration phase. And just to couple that with good dietary advice, we would like them to favor water — still, sparkling, or flavored water — as a way to meet that fluid‑intake goal. And one thing that I think works very nicely to help people along this way is just using a reusable water bottle, filling that, measuring off their target for the day, and then kind of checking in to see how they’re moving toward that goal.
[10:20] Andrea Stafford
Yes. And if you could see us, we have our refillable, reusable water bottles next to us, even. And so building off what you just said about hydration, Jeff, fiber really works best when it’s paired with plenty of fluids. But looking and thinking about targets, the Dietary Guidelines for Americans state women need 25 to 28 grams per day, and men need about 31 to 34 grams per day. And for people actively losing weight, the ASPEN Guide for Clinicians suggests aiming for at least 21 grams per day for females and 30 grams per day for males. So again, very close in numbers.
[10:58] Andrea Stafford
Either way, starting with a food‑first approach is ideal — fruits, vegetables, beans, and whole grains. And if someone just can’t get enough fiber through their diet alone, psyllium, a soluble fiber, can be helpful as an add‑on and is found in several over‑the‑counter products in various forms, such as powder and capsules.
Micronutrients and “Eat the Rainbow”
[11:21] Jeff Langford
Okay, so we’ve talked about the three P framework — emphasizing protein, portions and plate, and plenty of fiber and water — but that’s really not the whole story yet, is it?
[11:31] Andrea Stafford
No, it is not. And these three Ps are a great and simple foundation, but you’re right, it’s not the whole story. When someone’s food intake drops a lot, like it often does on GLP‑1s, nutrient deficiencies are a concern. It’s just more challenging to get enough vitamins and minerals when you’re eating less overall.
[11:52] Andrea Stafford
The ones I’m most mindful of are fat‑soluble vitamins like A, D, and E, and then a few of the B vitamins, particularly thiamine, folate, and B12. On the mineral side, iron, calcium, and magnesium are important too.
[12:07] Andrea Stafford
Our main message again is to try and cover that with a whole‑food strategy first. You may have heard the phrase “eat the rainbow,” and it kind of sounds like a cliché, but it really works. More colors mean a wider mix of nutrients. For example, leafy greens are a great source for vitamins A, C, E, and K. Red and orange produce really help with vitamins A and C as well. And then don’t forget legumes — beans, lentils, chickpeas. They’re not just for protein and fiber; they also bring in iron, magnesium, and B vitamins.
[12:43] Jeff Langford
Okay, so real takeaway is to keep it whole food first. Refined and processed options are going to strip out fiber and key nutrients. So we do want to steer patients toward those minimally processed choices.
Physical Activity
[12:55] Andrea Stafford
Yes. So we’ve talked a lot about what to eat to support success. But how we move can be just as important, especially for long‑term weight maintenance and lowering health risks. The big‑picture guidance here comes from the U.S. Office of Disease Prevention and Health Promotion, and that’s basically: move more.
[13:17] Andrea Stafford
But they do provide some additional guidance regarding substantial health benefits. They recommend either at least 150 minutes a week of moderate‑intensity activity — such as brisk walking or recreational swimming — or 75 minutes a week of vigorous activity, like running, jogging, or lap swimming.
[13:39] Andrea Stafford
And then there’s that piece we can’t forget, which is strength training. We want to aim for muscle‑strengthening workouts at least twice a week. That’s also where our nutrition and our movement connect, because strength training paired with enough protein is what helps preserve muscle mass when we see that number on the scale decreasing.
[14:00] Jeff Langford
That’s right, Andrea. And really one of the things I want to emphasize here, because I think these numbers are things that people loosely have heard and are pretty familiar with, is this: I think one of the opportunities we have as clinicians is taking those goals and then helping our patients individualize for success.
[14:16] Jeff Langford
And that might be around individualizing to the patient’s preferences — so learning what movements they like or conversely hate, and which ones we can help them identify as part of reaching that activity goal.
[14:28] Jeff Langford
So it may be very traditional things like walking or biking. It might be some less‑traditional things like gardening or pickleball or tennis, but learning their preferences is going to be key to helping them consistently hit those activity numbers.
[14:43] Jeff Langford
And then secondly, what I think is super important is that for some patients, they may not be very active now — and that may be due to mobility limitations. So we need to figure out what their abilities are and how we can further tailor our recommendations.
[15:01] Jeff Langford
So if we’re talking about strength training, for some people that may be as clear‑cut as going to the gym to lift weights. Other people may prefer something that’s home‑based, using just simple body‑weight workouts or using exercise bands for resistance. And in some cases, we may want to recommend that our patients pull in a trainer or physical therapist to get started if they have very low mobility at baseline.
[15:26] Jeff Langford
So I think simple messages we can reinforce for our patients are: start low and go slow. Consistency is gonna beat intensity. And really, any activity is better than none.
[15:39] Andrea Stafford
And I think that’s a great point, Jeff — to meet patients where they are and also remind them that any movement is better than no movement, like you had stated. And I know I feel better, as we probably all do, when we get up and just have some type of purposeful movement throughout the day.
NatMed Pro
[15:55] Jeff Langford
Absolutely. Let’s take a detour for a quick spotlight. If you want to take this guidance further, NatMed Pro gives you point‑of‑care tools that can help you make counseling more efficient and more effective.
[16:09] Andrea Stafford
Yes — think practical charts and visuals. So we have charts with foods high in protein, calcium, vitamin D, fiber, so that you and patients can easily map the way to hit their intake targets. You can also get detailed reports or monographs for specific substances like vitamin D or B12, and don’t forget our GLP‑1 toolkit to help with quick, confident decisions at the point of care.
[16:36] Jeff Langford
Plus CE options and our monthly newsletter for ongoing updates and clinical pearls.
[16:42] Andrea Stafford
And the best part — listeners can save 10% with code NATMED1026 at checkout. Links are in the show notes. But now back to where we put this content into a real‑world perspective.
Q&A
[17:02] Jeff Langford
And at this point we’re usually going to pull a patient case, a story, or listener questions and answers into our conversation.
[17:09] Andrea Stafford
And this time, the questions bubbled up close to home. As coworkers have shared their personal stories and challenges about GLP‑1s for weight loss, one important question always came up. And that was: Is it okay to use protein shakes or bars to meet protein goals?
[17:26] Jeff Langford
Yeah, so important. And this really reflects what we talked about earlier. We do want the first target to be aiming for whole foods. Bars and shakes often come with a lot of added sugars and fats. So we want to start with whole foods, and then we can think about those things if needed to kind of fill in our protein intake to hit the target — but kind of saving those as a second‑ or third‑line option after we’ve done optimization of the whole foods.
[17:52] Jeff Langford
And a related question that I heard, Andrea, as we were talking about this — as we’re thinking about how to meet nutritional goals — was: Should I take a supplement or vitamin? Or what supplements and vitamins should I take while using a GLP‑1?
[18:04] Jeff Langford
And I think the best way to consider this is really individually for the patient in front of us, based on what we know about their specific intake and needs. So upfront, during that initial transition period, as people’s diet becomes acclimated to GLP‑1, I think it’s reasonable for many patients to consider a daily multivitamin upfront. They may help us avoid some deficiencies due to low dietary intake. Now, they may not need a multivitamin long term, but it may be reasonable for a couple of months just to give us a little bridge to see where we land in terms of their overall diet as they adjust to therapy.
[18:41] Jeff Langford
And then thinking specifically again about our patient — in some cases, such as older or postmenopausal adults — there are certain supplements that might be beneficial in those cases, like vitamin D and calcium. And I would say we’d approach that the same way: It may be reasonable upfront to say, “Let’s add this supplement. Let’s get back together in three months as you’ve adjusted to therapy. And if you’re not meeting nutritional goals dietarily, we can consider whether to keep those supplements on board longer.”
[19:08] Jeff Langford
Now, I know a few minutes ago you set up a really nice teaser for us that we were going to talk about some dietary ways to help manage nausea. So what do you have for us there, Andrea?
[19:17] Andrea Stafford
Yes, as we had just discussed a little bit earlier about some of these side effects, nausea is a really common one with GLP‑1s. And there are some practical changes that can make a difference for patients. One, for example, is to eat smaller, more frequent meals slowly.
[19:35] Andrea Stafford
Other changes they could implement include stopping when you feel satisfied but not stuffed; avoiding fatty or high‑fiber foods during the first few days of treatment; as well as avoiding very sweet or spicy foods, dressings or sauces that contain high amounts of fats and additives; and avoiding strong smells — think sardines, anchovies, and sauerkraut. Now, you won’t find me eating those, but for individuals who do enjoy that, that strong smell can lead to that feeling of nausea.
[20:09] Andrea Stafford
I also tell patients to try and find patterns. Again: Are there certain foods or smells that trigger those symptoms? Is there a time of day that is worse? And kind of planning their meals around those?
[20:21] Andrea Stafford
Lastly, we don’t want you to skip meals to try and kind of avoid it. Nausea often shows up in the morning or after longer stretches without eating. So instead, we usually recommend small, frequent meals or snacks about every three to four hours while you’re awake.
[20:39] Jeff Langford
Well, those are practical solutions and recommendations, Andrea. And I think what came to us as we had this conversation with our team — and we’re learning the questions they had as real GLP‑1 users — was that there is an opportunity for us to really support both diet and lifestyle recommendations for patients who are getting started with the GLP‑1.
[20:59] Jeff Langford
And those kinds of questions and ideas are exactly what we want to hear from you. So please send us a text or email at contactus at trchealthcare.com — link is in the show notes — with questions, topic ideas, or any other feedback.
Summary
[21:14] Andrea Stafford
Perfect. So really, just to kind of wrap this up, I think the takeaway for patients could be very simple, such as: Have a plan. Thinking back to those three Ps that we discussed earlier — protein, meaning we prioritize protein; portion or plate, eating regularly, focusing on whole foods, referencing that “eat the rainbow”; and plenty of water and fiber.
[21:40] Jeff Langford
Absolutely. These medications get a lot of publicity, as we said upfront. And I do think they’re a powerful tool, but they’re not a panacea. So we do want to encourage that proactive and long‑term lifestyle modification — both in what we eat and how we move — hand in hand with these meds to set our patients up for long‑term success.
A few more things…
[22:00] Andrea Stafford
And on that note, let’s kind of wrap this up and how we can claim CE.
[22:06] Jeff Langford
Absolutely. So you can follow instructions linked in the show notes. We’ve also included the GLP‑1 toolkit and the newsletter article we discussed so you can bring these tips straight to practice.
[22:17] Andrea Stafford
And also just want to bring notes to our January newsletter, where we also cover some other interesting and timely topics, including supplements for Dry January, long COVID recovery, and we do a spotlight on chickpeas that we just mentioned a little bit earlier.
[22:34] Andrea Stafford
And in our most recently published February newsletter, we dive into vitamin D supplements, including what to consider for daily use. It’s a quick, practical read that pairs well with today’s conversation, specifically if someone may need vitamin D support.
[22:51] Jeff Langford
And I also want to mention one of our sister podcasts, Rumor versus Truth. It just covered more on GLP‑1s in their January episode. So go check that out. And now for our show — follow and subscribe in your podcast app so Episode 2 lands automatically.
[23:07] Andrea Stafford
And we want to thank you for listening to Natural Medicines Evidence in Practice — evidence, not hype.
[23:13] Jeff Langford
See you next month.
Natural Medicines: Evidence in Practice
