How pharmacists can prevent nutrient deficiencies on GLP-1s

In this article:

• How GLP-1s affect nutrition
• Supplements
• Counseling tips
• When to follow up
• Bottom line

In this article

• How GLP-1s affect nutrition
• Supplements
• Counseling tips
• When to follow up
• Bottom line

Pharmacists are filling prescriptions for GLP-1 medications like Ozempic and Wegovy more than ever before. Nausea and vomiting are the most common side effects of these medications, and a drop in appetite is expected. After all, they’re often used to curb appetite and reduce caloric intake. However, these effects can sometimes lead to unexpected problems downstream, namely nutrient deficiencies. With so many patients visiting their local pharmacy to pick up their prescription, pharmacists may be the first ones who can spot these potential problems. 

How GLP-1s affect nutrition and metabolism

GLP-1 medications can change patients’ eating habits since they can directly cause a smaller appetite. Patients might eat 16% to 39% fewer calories each day without even trying. Because they’re reaching less and less for calorie-dense foods and snacks, they’re often seeing the significant weight loss they’re looking for. 

While reducing calories can help with weight loss, it could also create potential problems, especially when people eat fewer than 1,200 calories (for women) or 1,800 calories (for men). At these lower levels, patients might not get enough of the vitamins and minerals they need.

The GI side effects of GLP-1 drugs can also come into play. Nausea, vomiting, and diarrhea might cause a patient to eat even less than they normally would. These side effects can directly prevent the body from getting the nutrition it needs.

Common nutrient deficiencies to watch for

GLP-1s may affect various nutrients, including vitamins, macrominerals, and trace minerals. These micronutrients are required for overall health, and a lack of them could cause complications. 

Key nutrients that could be deficient in patients taking GLP-1s include: 

• Protein: Protein is important for keeping lean muscle mass, especially during weight loss. If patients on GLP-1s are eating less overall, they might consume less protein without realizing it. Many patients might skip protein-rich meals like meat, fish, or legumes.
• Fiber: Constipation is one of the most common side effects of GLP-1s, and too little fiber often worsens it. Since patients might eat fewer fruits, vegetables, and grains, their fiber intake can drop.
• Electrolytes: Vomiting or diarrhea can cause patients to lose fluids and electrolytes like sodium, potassium, and magnesium. As a result, they might experience bouts of dizziness, fatigue, or cramping.
• B vitamins: B vitamins help support metabolism, red blood cell production, and various body functions. People taking GLP-1s might eat less animal protein, dairy, or fortified grains, which could be good sources of B12, B6, and folate.
• Fat-soluble vitamins (A, D, E, and K): Patients trying to avoid fatty foods may also cut back on the fats that help absorb vitamins A, D, E, and K. Low levels can affect bone strength, vision, blood clotting, and the immune system.
• Iron: A lower appetite can lead to eating less red meat, chicken, or iron-rich vegetables, which could ultimately cause decreased iron levels. Pre-menopausal women and those with heavy menstrual cycles may be at a higher risk of lower iron levels. 
• Zinc: Zinc supports immune function and wound healing. Eating less meat or seafood may lower zinc levels, causing changes in taste or more frequent colds. 
• Calcium: When patients reduce their calories, they often eliminate dairy products. However, not getting enough calcium may increase the risk of bone loss. 

Nutrient deficiencies can cause different signs and symptoms. For example, muscle weakness, fatigue, slow wound healing, hair loss, and brittle nails are all potential signs of a nutrient deficiency. Memory problems, tiredness, or tingling in the hands or feet, in particular, could be indicative of low vitamin B12. That’s why pharmacists may need to be more aware of these signs to ensure patients get the help they need early on.

Supplements that pharmacists can recommend

Supplements could be beneficial for preventing deficiencies while on a GLP-1 drug. It’s also a good idea for patients to consult a healthcare provider to get lab work, pinpoint deficiencies if they’re showing signs or symptoms, and get the right treatment. 

Supplements should typically come second to eating a balanced diet. If possible, try emphasizing getting these nutrients from their diet, but supplementation can be helpful when diet isn’t the only solution. 

Daily multivitamin

A daily multivitamin could act as a safety net for many patients on GLP-1s, especially during the first few months when eating habits can change the most. Recommend quality brands with third-party verification. For example, USP-verified or NSF-certified products typically meet higher standards for purity and potency.

Protein powders

Many patients might not get enough protein while using a GLP-1 drug. Protein supplements can help patients meet their daily intake recommendations of around 1.2 to 2 g/kg per day. Recommend whey or plant protein supplements, depending on the patient’s dietary preferences. In addition, taking 5 g per day of creatine may help with maintaining muscle mass and strength. 

Specific vitamins or minerals

Vitamin D and calcium are key nutrients that many patients may be lacking, even if they’re not on a GLP-1. For example, people with obesity are about 35% more likely to have low vitamin D levels than others. Pharmacists might also want to recommend a vitamin B12 supplement, especially for certain patients who are eating less meat, such as vegetarians and vegans.

Digestive health supplements

Many patients on GLP-1s might not be getting enough fiber, which could worsen constipation, a common side effect of GLP-1s. Soluble fiber supplements like psyllium husk may help alleviate constipation. Probiotics might also help since they can support regular bowel movements.

Counseling tips for pharmacists

Pharmacists are often the go-to for medical advice for many patients who come to pick up their GLP-1 prescriptions. If it’s their first time, they may be both excited and nervous about taking their medication correctly.

Here are some potential counseling points to remember:

• Reinforce the dosage instructions: Remind patients to follow their prescribed dosing schedule and not to increase or skip doses on their own.
• Set their expectations: Tell patients that nausea and a reduced appetite are common at the start of treatment but usually improve over time. Small, frequent meals and avoiding greasy or fried foods may help with the nausea.
• Stress hydration: Many patients underestimate how much water they need, especially with nausea or vomiting. Encourage getting enough water daily or even having electrolyte drinks on hand if GI side effects occur.
• ​​Recommend nutritious snacks: Suggest easy, nutrient-dense options like nuts, yogurt, cheese sticks, or protein shakes for when patients don’t feel like eating full meals.
• Promote mindful eating: Advise patients to eat slowly and stop when they feel full. They can also try splitting their large meals into smaller ones to help manage early satiety and reduce nausea.
• Watch for dehydration or fatigue: If patients report dizziness, dark urine, or tiredness, advise them to drink more fluids and check in with their provider.

Always take note of interactions with patients, especially if they discuss ongoing side effects or start taking supplements. The key is to make every counseling interaction count, even if it’s just a minute at the counter.

When to refer or follow up

Even if pharmacists do everything right on the counseling side, some patients may need extra support beyond the pharmacy counter. Knowing when to refer or follow up can be important for patients’ safety. 

Consider referring patients if any of the following occur:

• GI symptoms persist or worsen, especially beyond the first few weeks
• Weight loss is rapid or excessive
• Patients show signs of nutrient deficiencies, such as weakness, fatigue, or hair loss
• Hypoglycemia occurs, especially in those taking other medications like insulin
• Other medications are affected due to poor absorption, such as warfarin, levothyroxine, or contraceptives
• Mental health concerns come up, which could indicate depression or an eating disorder
• Patients ask about stopping treatment

Pharmacists don’t have to solve every problem on the spot, but they can often recognize early warning signs before they become serious. Communicating clearly and making a referral when it’s needed can help ensure patients get the right care at the right time.

Bottom line

Over 20% of patients on GLP-1s have nutritional deficiencies, and pharmacists might be the first to notice when a patient needs extra help. These medications can be powerful in managing weight and glucose levels, but they can also cause changes in appetite and nutrition that shouldn’t be overlooked. 

A quick conversation at the counter about hydration, balanced meals, and potential supplementation may prevent bigger problems later on. It’s also important to know when to refer patients to their providers, so they can get the most benefit from treatment while keeping their overall health in focus.