Metabolic GLP-1 therapy
In brief
Section titled “In brief”- Metabolic recovery can often be achieved with TCR alone — GLP-1 is not required but a possible addition
- Goal: metabolic health and function recovery, not maximum appetite suppression
- Maintaining muscle mass is a hard requirement
- Start low, build slowly, stay on minimum effective dose
- Steer on metabolic markers (HbA1c, waist circumference, ApoB), not primarily on weight
Key message
Section titled “Key message”Metabolic recovery can often be achieved with TCR as standalone treatment. GLP-1 medication is not required, but can be an addition when:
- Cardiometabolic risk remains high
- TCR alone gives insufficient effect
- Eating drive and relapse structurally undermine TCR
Goal: metabolic health and function recovery with muscle mass maintenance — not maximum appetite suppression.
Goals of metabolic GLP-1 therapy
Section titled “Goals of metabolic GLP-1 therapy”Steer on multiple outcomes simultaneously. Weight is supportive, but not the primary goal.
| Goal | What to measure |
|---|---|
| Glucose regulation | HbA1c, glucose, fasting insulin |
| Visceral fat | Waist circumference, visceral fat score |
| Eating regulation | Fewer hunger spikes and eating drive |
| Muscle maintenance | Muscle mass and strength (safety goal) |
| Risk reduction | Blood pressure, ApoB, ALAT/GGT, CRP |
When TCR is often sufficient
Section titled “When TCR is often sufficient”TCR alone is often appropriate when:
- You can practically maintain it
- You see improvement in energy, eating drive, biometrics and lab values in 8 to 12 weeks
In that case, medication is usually not needed, unless there is a clear medical reason to combine directly.
When to consider GLP-1
Section titled “When to consider GLP-1”Consider GLP-1 especially risk-driven and functional:
| Indication | Explanation |
|---|---|
| Insufficient metabolic improvement | Despite serious TCR effort, HbA1c, blood pressure, triglycerides/ApoB or liver load remain too high |
| Persistent eating drive | Emotional eating or relapse pattern that prevents structural TCR |
| High cardiometabolic risk | Additional support desired (discuss with healthcare provider) |
| Comorbidity | Extra weight reduction and eating regulation supports functioning, provided active steering on muscle maintenance |
6 practical tips for responsible use
Section titled “6 practical tips for responsible use”1. Metabolic goal above weight
Section titled “1. Metabolic goal above weight”Steer on waist circumference, visceral fat score, blood pressure, energy, strength and (where measured) HbA1c and ApoB.
2. Start low and build slowly
Section titled “2. Start low and build slowly”Stay preferably on the minimum effective dose. No rush to increase.
3. Prevent undereating
Section titled “3. Prevent undereating”Plan meals. Make protein and whole foods leading, even if you have less appetite.
4. Muscle mass is a hard requirement
Section titled “4. Muscle mass is a hard requirement”Strength training and sufficient protein. With decline in muscle mass or strength: review pace, dose and nutrition.
5. Treat side effects early
Section titled “5. Treat side effects early”Small portions, eat slowly, drink systematically. With TCR: pay extra attention to salt/electrolytes.
6. Make a maintenance and tapering plan
Section titled “6. Make a maintenance and tapering plan”Record when the goal is achieved and which criteria lead to adjustment or tapering.
TCR in practice
Section titled “TCR in practice”Muscle maintenance
Section titled “Muscle maintenance”| Aspect | Guideline |
|---|---|
| Protein | About 1.6 g per kg body weight per day (unless otherwise advised) |
| Strength training | At least 2 times per week, with gradual progression |
| Signal to review | Protein not achievable due to nausea/aversion, or strength/muscle mass declines |
Limiting side effects
Section titled “Limiting side effects”- Eat smaller and slower; avoid large meals late in the evening
- Drink systematically; consider electrolytes with TCR and dizziness
- Constipation: sufficient fluid and vegetables; possibly psyllium or magnesium (in consultation)
- With persistent complaints: no increase and discuss adjustment with your healthcare provider
Measuring = steering
Section titled “Measuring = steering”Use mainly trends. Measure as consistently as possible (same time, comparable hydration).
| Frequency | What to measure | Why |
|---|---|---|
| Weekly | Weight (weekly average), waist circumference, blood pressure/pulse, complaints score 0-10, energy and sleep 0-10 | Trend in risk, tolerance and recovery |
| Every 2-4 weeks (BIA) | Muscle mass, fat percentage, visceral fat score | Follow muscle maintenance and visceral fat decline |
| Warning signs | Decline in muscle mass or strength, rapid decline in intake with fatigue, persistent vomiting or constipation | Reason to review pace/dose/nutrition |
Lab monitoring
Section titled “Lab monitoring”| Level | Tests |
|---|---|
| Level 1 (basic) | HbA1c, lipids (preferably with ApoB), liver enzymes (ALAT and GGT), kidney function (creatinine/eGFR), fasting glucose and/or insulin |
| Level 2 (expanded) | CRP, TSH and free T4, electrolytes (for dizziness/dehydration), vitamin B12 (with metformin) |
Stop and tapering criteria
Section titled “Stop and tapering criteria”Don’t increase (or temporarily step back) if:
Section titled “Don’t increase (or temporarily step back) if:”- Side effects remain more than mild after 1-2 weeks on the same dose
- You structurally eat too little or don’t achieve protein intake
- Muscle mass or strength declines (trend over 4-8 weeks)
- Dizziness or dehydration increases despite good hydration
Consider tapering or stopping if:
Section titled “Consider tapering or stopping if:”- Metabolic goals are stable and TCR is maintainable
- Side effects persist or quality of life clearly diminishes
- There is repeated malnutrition or unwanted muscle loss
- Alarm symptoms occur
Decision route
Section titled “Decision route”| Step | Action |
|---|---|
| 1. Basis (TCR) | Start with TCR. Build structure in meals, protein, exercise and sleep. Measure waist circumference and body composition as trend. |
| 2. Evaluation after 8-12 weeks | If energy, eating drive, waist/visceral fat and risk markers improve: continue with TCR alone. |
| 3. Consider adding GLP-1 | With insufficient metabolic improvement or eating drive/relapse: discuss GLP-1 with minimum effective dose and slow build-up. |
| 4. Monitor and adjust | Don’t increase with persistent side effects, decline in muscle mass/strength or structural undereating. |
| 5. Maintenance and tapering | With stable goals: maintenance on low dose or stepwise tapering, in consultation. |
When to contact immediately
Section titled “When to contact immediately”Summary
Section titled “Summary”Veelgestelde vragen
Is GLP-1 medication necessary for metabolic recovery?
No, metabolic recovery can often be achieved with TCR (Therapeutic Carbohydrate Restriction) as standalone treatment. GLP-1 medication is not required, but can be an addition when TCR alone gives insufficient effect or when eating drive structurally undermines TCR.
What are the main goals of metabolic GLP-1 therapy?
The goals are: improve glucose regulation (HbA1c), reduce visceral fat (waist circumference), restore eating regulation, maintain muscle mass, and improve risk factors (blood pressure, lipids, liver load). Weight is supportive, but not the primary goal.
How do I prevent muscle loss with GLP-1 use?
Muscle maintenance requires sufficient protein (about 1.6 grams per kg body weight per day) and strength training at least 2 times per week. With decline in muscle mass or strength: review pace, dose and nutrition. Plan meals and make protein leading, even if you have less appetite.
When should I stop increasing or consider tapering?
Don't increase with: side effects that remain more than mild, structurally eating too little, declining muscle mass or strength, or increasing dizziness. Consider tapering if: metabolic goals are stable, side effects persist, or there is repeated malnutrition or muscle loss.
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Medical Disclaimer: The information provided by Stichting Je Leefstijl Als Medicijn regarding lifestyle, diseases, and disorders should not be construed as medical advice. Under no circumstances do we advise people to alter their existing treatment. We recommend that people with chronic conditions seek advice regarding their treatment from qualified medical professionals.