Joey Wahler (Host): They help to address diabetes and weight loss management, so we're discussing GLP-1 medications. Our guest is Kiersten Haugerud. She's a Registered Dietitian Nutritionist with Cumberland Healthcare. This is Healthier You, a Cumberland Healthcare podcast. Thanks for listening. I'm Joey Wahler. Hi there, Kiersten. Thanks for joining us.

Kiersten Haugerud, RDN MS-RDN: Hello.

Host: Yeah, thanks for being with us. Great to have you aboard. So first, what exactly is GLP-1? What does it stand for and what does it do?

Kiersten Haugerud, RDN MS-RDN: Sure. So GLP-1 is actually a hormone that occurs naturally in the body and it stands for glucagon like peptide. So when we eat, blood sugar rises, and GLP-1 is a hormone that works with an organ in your body, your pancreas, to help release insulin and keep your blood sugar in balance. GLP-1s were originally discovered in the 1970s and then approved by the FDA for weight loss in 2005.

So they haven't been around that long. The more popular brands that we might hear about today are Ozempic, which was approved for Type 2 diabetes in 2017. And then we have Wegovy that's only marketed for weight loss and that was approved in 2021. So if you have Type 2 diabetes, or insulin resistance associated with obesity, your body might not be responding to your natural GLP-1 hormone properly.

So when we give you this hormone as an injection, it can help your body react to it better. When insulin isn't released at the right time or in the right amount, your blood sugar can get too high, and GLP-1 hormone helps balance the blood sugar, which can cause hyperglycemia. And what we know is prolonged hyperglycemia can actually lead to weight gain over time.

Host: And so how do you go about diagnosing a patient to see if they need GLP-1?

Kiersten Haugerud, RDN MS-RDN: That's a great question. Actually, the way to get prescribed a GLP-1, the best way is to go to your primary. I don't personally do the diagnosing. But we do know that patients that have pre diabetes, Type 2 diabetes, or are at a point in their weight loss journey where they feel that they're doing everything that they should, getting 150 minutes of physical activity a week, they're eating very well, non processed diet, they're doing everything that they can and they still aren't seeing the scale budge; then that might be perfect candidate for a GLP-1 medication. But again, always go to your primary because this is a medication, so we do need to make sure that there's not going to be any sort of medication interactions or anything like that.

Host: And speaking of which, as you well know, about as well as anyone, I'm sure, there's so much talk right now about Ozempic and the other GLP-1 meds, so how is it determined which one is best for a particular patient?

Kiersten Haugerud, RDN MS-RDN: Sure, well, there's a couple different types of GLP-1s. There's dulaglutide, which is Trulicity, and there's semaglutide, which is going to be your Ozempic, Wegovy and I don't like to say one brand is better than the other. There, there has been some shortages in the past couple of years just due to the influx of people wanting these medications.

They all are going to act in the body very similarly. So it's really based on what can a person get with their insurance.

Host: And so, speaking of which, can you give people an idea, Kiersten, of what GLP-1 typically costs and is it covered by insurance?

Kiersten Haugerud, RDN MS-RDN: Yes, that is a big question that we get. So, it really is insurance dependent. Medicare did expand their coverage and will cover GLP-1s with a diabetes diagnosis, keeping in mind that certain GLP-1s are targeted towards Type 2 diabetes, so you need that diagnosis if you're going to get any sort of insurance coverage.

And then there's Wegovy, who, which is a medication that is only targeted for weight loss and obesity. With Ozempic or Trulicity, if you have that diabetes diagnosis, generally Medicare will cover that. Co-pays vary based on your plan. For weight loss only for Wegovy, most insurances aren't going to cover it.

There's usually a large out of pocket expense associated with that. It can range anywhere from 900 to 1300 dollars a month. Those are just loose numbers. I always check with your pharmacy, but if you're seeing advertisements out there for certain weight loss clinics and they're saying, oh, you only need to pay 200 a month out of pocket for semaglutide, which is the generic, term for, for Wegovy or Ozempic, then you might want to just ask where are they getting that medication? Because compounding pharmacies may be able to charge a lower price versus a retail pharmacy, but the purity of that medication might not be as good as if you're getting it from a retail pharmacy.

So just always asking where are they getting that medication. But again, always check with your insurance, go to your primary. We'll, they'll let you know if you need a preauthorization.

Host: Gotcha. How about how important is having GLP-1 use in whatever form managed by a medical professional?

Kiersten Haugerud, RDN MS-RDN: It's very important to actually. GLP-1 was originally discovered or created for cardiovascular health. And I think a lot of people don't realize that. And what was found, is a side effect, a positive side effect, I guess, was blood sugar management and weight loss. So because it's a, it was originally created for the cardiovascular benefit, it's very important, again, to go to your primary to make sure that there's not going to be any sort of medication interactions.

So when seeing your primary, another very important management aspect is that they are going to want to decide on what the best dose is for you. They usually start at a very low dose and then progress your way up.

The higher the dose, the more you may see the side effects that might be associated with that medication. So that's why it's very important to work with your primary in the management of what specific dose is going to work best for you.

Host: Absolutely. And while we're talking here about meds, in order for someone, Kiersten, to boost their GLP-1 naturally, what dietary adjustments can you make? What foods promote that?

Kiersten Haugerud, RDN MS-RDN: Sure, another question I get is, do I have to see a dietician to get a GLP-1? And like you just said, there's ways to boost your natural GLP-1. It is not required, generally, by insurance to see a dietician before getting the GLP-1 prescribed, but it's definitely a benefit because we can help you promote those good lifestyle habits before you start your medication.

And it's all physician specific. Some physicians will say, yes, you need to see a dietician three months before I will prescribe this to you. Some physicians will say, I will prescribe it to you, but you do need to go see a dietician to make sure that you're being educated on the medication properly and following ways that you can boost your natural GLP-1.

So a couple ways you can do that is getting sufficient amounts of high quality protein to support yourself during this weight loss period. Because what happens is that we see this initial weight loss with these medications, but people don't realize that some of that weight loss or sometimes most of that weight loss is going to be loss of muscle mass or lean body mass.

And when we lose lean body mass, then we aren't helping our basal metabolic rate or how many calories that we're burning at rest in any way. We're actually decreasing that amount. So we want to make sure we're getting enough protein so that we can support our basal metabolic rate and make that faster.

 Then fiber is also very important, coming from vegetables and root vegetables, fruits, beans, ancient grains like farro, millet, quinoa, because those contain insoluble and soluble fiber. And insoluble fiber is going to act like that broom through the intestinal tract, and it's going to help keep things moving.

Where soluble fiber absorbs water, and it swells up in the intestinal tract, and it feeds that good bacteria that's in the intestinal tract. And the reason we want to feed that good bacteria is because there's over 30 hormones that are secreted in the gut when we have a healthy microbiome or gut bacteria.

And GLP-1 is one of those hormones. So we want to make sure that our gut is very healthy. We want to be mindful of hydration. So drinking at least 64 ounces of water per day, and also taking a probiotic is very beneficial because it kind of acts like a fertilizer to help that natural gut bacteria. So if we have the fiber, we have the hydration, the water, we're watering that good bacteria in there, it's kind of like a plant, and then we have the probiotic as our fertilizer, then we're going to create that perfect environment to help our GLP-1 medication do its best work.

We also want to steer clear of preservatives in foods because it can actually damage the gut bacteria. And then there's also some other natural supplements which I'm not going to address on this podcast. They're currently being researched on whether or not they're going to support our natural GLP-1, but there's no significant data yet on those supplements.

Host: And when we discuss diet, as you just did, that often goes hand in hand, of course, with exercise, which also promotes GLP-1. So what's a good minimum amount of activity for people that need this? And what should that include? Let's say, even for people that say they don't have a lot of time and they need something that's simple.

Kiersten Haugerud, RDN MS-RDN: Sure. So a good starting goal is to get 30 minutes of exercise a day. If you're not able to do that, I say at least three times a week is a good starting point. With your exercise, cardiovascular exercise is very good, but it can, in certain people, increase our cortisol levels, which can go against what we're trying, the goal that we're trying to get to, and that's to help balance the hormones out.

The best payoff if you will, when it comes to physical activity, especially when you're on a GLP-1, is going to be strength training; building resistance in the gym, building muscle mass, and that is because, again, like I talked about earlier, a lot of people that start a GLP-1 will lose some muscle mass, and we want to preserve and build that muscle mass.

So if you have 20 minutes in your day or even 30 minutes in your day, your best payoff, if you will, when it comes to calorie burn is going to be that strength training.

Host: And then finally, Kiersten, in summary here, for you and yours at Cumberland, what would you tell people listening is the main thing you all have to offer for people that need GLP-1 management and everything that goes along with it? Because it's really a multi pronged approach where it's not just as simple as you've pointed out as taking the medication. So what are you really offering people that helps to walk them through that process?

Kiersten Haugerud, RDN MS-RDN: Sure, absolutely. Something that's really special about Cumberland is that we're a rural health clinic and so we have great communication among the providers because we are smaller. So we all work in the same area. So the communication between the patient, provider and the diet or physician, patient, and dietitian is very intimate.

So, when a patient goes and sees their primary, they say, hey, I'm gonna prescribe you a GLP-1, but I want you to see our dietitian. We can usually schedule that appointment within the next couple of days so that you can get education on that medication. You can get your diet education. And then I will also assess and diagnose any other sort of nutrient deficiencies by ordering labs through the physician.

And so it's an all inclusive approach. It's not just getting the medication prescribed and sending you out the door. We're going to follow you and support you in any way that you, any way that we can.

Host: Excellent. Well, folks, we trust you're now more familiar with GLP-1 medications. Kiersten Haugerud, thanks so much again.

Kiersten Haugerud, RDN MS-RDN: Thank you.

Host: And for more information, please visit cumberlandhealthcare.com/patients-visitors/podcasts-healthier-you. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. Thanks again for listening to Healthier You, a Cumberland Healthcare Podcast.