What to eat when you’re taking weight-loss jabs

“People are losing too much weight,” he says. “Being released from your food demons means that you can eat a lot less and skip meals. It’s possible to go from overweight to malnourished in a very short space of time.”

One of his clients, he says, told him that when the medication kicked in she could get away with eating just an apple and a slice of cheese for dinner. She was delighted but he asked her: “If your daughter ate that, would you let her?” Another client told him all she’d eaten that day was a packet of fizzy Haribos.

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“When taking a GLP-1 medication, it’s quite possible to undereat simply because of lack of appetite, or indeed to ignore hunger signals because the medication makes it possible to power through on minimal amounts of food,” Marber says. “Losing weight can help improve overall health by reducing the risk of cardiovascular disease, type 2 diabetes and improving joint health and energy levels, but being undernourished carries its own health risks.”

GLP-1 medications affect the way that the body processes the glucose that is derived from what we eat and drink. They also suppress the appetite hormones that tell us to eat, and reduce the speed at which the stomach empties so that we can feel fuller for longer. The result is that we experience less hunger and ultimately eat less — we lose weight and the so-called food noise in our heads is turned off, but we may miss out on key vitamins and nutrients.

In his new book, The GLP-1 Handbook: Eating Well When Taking Weight Loss Medication, Marber explains why we need to make sure that the small amounts of food we do eat while on weight-loss jabs are packed with nourishment. Getting enough protein, for example, is vital to protect our muscles. “It’s estimated that of the typical weight loss that is achieved when using GLP-1 medication, some 25 to 39 per cent is actually muscle, not fat,” Marber says. “And once you’ve lost muscle it’s very difficult to get it back.”

Reduced muscle mass may lead to fatigue, an increased risk of fractures and falls, reduced immune function and can even reduce the sensitivity of cells to the action of insulin, so-called insulin resistance. “When intake of GLP-1 is reduced or stopped, there is every chance that the impaired glucose control will contribute to the amount and speed at which weight is regained,” Marber says.

Similarly, rapid weight loss can affect the quality and look of skin. “With traditional dieting, the speed at which fat cells are emptied is relatively modest, which allows the skin to adapt to the changing shape of the tissue it covers,” Marber says. “But rapid weight loss doesn’t allow the skin to readjust in the same way, which can result in loose and crêpey skin, giving rise to the disparaging term ‘Ozempic face’.”

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Marber is not anti-GLP-1s — he just wants those taking them to get their nutrition right. He knows from personal experience how challenging weight loss can be. After putting on weight in lockdown, he says he didn’t turn to GLP-1s because his BMI wouldn’t have allowed it. Instead, he says, “I ate less and exercised. I am grateful that it worked for me, because that’s not always the case. If things had turned out differently, I would have had no hesitation in seeing my GP to request the medication.”

Here he outlines his essential rules for ensuring you get the nutrients you need for maintaining optimum health while taking GLP-1s. “The clients I have worked with who follow these simple principles have lost weight, but they have done so while still maintaining nutritional health,” he says. Here’s how to eat well and make every mouthful count.

What to eat: Ian Marber’s rules

Eat protein at every meal — it stops muscles being broken down

Salmon and quinoa are good sources of protein

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Protein is essential to counteract the potential for muscles to be broken down to meet energy demands. For a woman, aiming for 1.5g of protein a day for every kilo of body weight will be ideal. A man should aim for more, a shade under 2g per kilo of body weight a day. For context, a salmon fillet (113g) has approximately 19g of protein; a chicken breast (113g) has 30g of protein and two tablespoons of cottage cheese (50g) has 5.5g of protein.

Ideally, every time you eat there will be some protein in the mix. Ask yourself “Where’s my protein?” when you are prepping or cooking your food.

Losing weight too quickly is harmful — make sure you know how many calories you need

Eating enough calories is essential to avoid overly rapid weight loss. If energy intake is cut to a level at which stored fat cannot be realistically broken down to create enough energy to meet the shortfall, then muscle can be broken down instead.

Sensible and safe weight loss means a drop to 1,300 to 1,500 calories for women and 1,800 to 2,000 for men. I urge you to get to at least the lower figure. You will still lose weight, be able to eat and nourish yourself while enjoying food, without overeating.

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A great way to gauge how many calories you are eating is to download an app, such as a fitness app, that will allow you to input what you are eating to calculate your rough calorie intake. You may find that the pre-installed health-related app on your phone offers this feature already.

Rather than enter everything, every single day, do this for a few days until you get used to the process. You’ll soon get the hang of it and will be able to judge if you are eating enough.

You may need to repeat the process as your GLP-1 doses increase, as it’s easy to eat a little less here and there without noticing.

Eat more fibre to support your gut — GLP-1s slow digestion

Fibre is already an essential part of a healthy diet. But taking GLP-1 can slow gastric emptying, leading to potential constipation, which in turn can also raise the risk of haemorrhoids, fissures and diverticulitis (an inflammation of the intestine).

Half an avocado provides 4.5g of fibre, about a fifth of the minimum daily requirement

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Fibre is found in fruits, vegetables and grains, and so getting a minimum of 25g fibre a day, ideally more, will also provide a multitude of vitamins, minerals, antioxidants, carotenoids, organosulphides and glucosinolates. A large apple, for example, provides 5g of fibre, while half an avocado provides 4.5g. Fresh produce contributes to overall hydration too.

Drink at least a litre of water a day — it protects skin and muscles

Fluid intake is often almost an afterthought when weight loss is discussed, but it takes on added importance when using GLP-1 medication. The side-effects of the medication, such as nausea and constipation, can be offset to some extent by adequate hydration. Skin can also be drier and less supple when dehydrated. In addition, when appetite is reduced it is inevitable that we will consume less fluids, as we are eliminating the fluids found naturally in the food we eat.

Hydration also plays an integral role in a process called lipolysis in which the stored fats are broken down to release energy. This is especially relevant when taking GLP-1 as we want that process to be efficient as it may help in reducing muscle breakdown.

I’d aim for at least 1 litre of water a day, more in warm weather and when exercising. This is in addition to soup and juice, at least one of which I recommend daily. Many people may also drink a protein shake as well.

Slash your alcohol intake — it stays in your system longer when on GLP-1s

A small study published in The Journal of the American Medical Association in March suggests that the influence of GLP-1 medication on dopamine can have an effect on alcohol consumption, and in some cases lead to a reduced appetite for alcohol.

GLP-1 slows down the speed at which food and drink pass through the digestive system, which allows us to feel fuller for longer. This also means that the alcohol will be absorbed at a slower pace, resulting in a higher level of alcohol staying in your system for longer, so you may feel the worse for wear for longer after drinking.

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Alcohol may exacerbate side-effects such as nausea and dizziness that some people experience when taking GLP-1. There is also a risk that excessive alcohol consumption can exacerbate sarcopenia, or muscle loss.

You may want to avoid alcohol in the early stages of taking GLP-1, especially if you are experiencing other side-effects — and if you do choose to drink later on, try to be modest in your consumption.

GLP-1s reduce appetite — variety is key to helping you enjoy eating

A smaller appetite can mean that one enjoys food less, and I have certainly heard from clients that while they are enjoying not having to battle any cravings, the flip side is that they take less pleasure in eating.

To retain enjoyment and make it easier to keep up a good intake of food, I advise clients to mix things up with different flavours and textures. Eating a variety of food helps to supply various nutrients, each with a slightly different role, as the spread of nutrients differs between even similar foods. To boost nutrient intake, I also recommend soups and juices, as well as wholefoods, as they are easy to eat and are concentrated sources of nutrients.

Your daily menu

The primary effect of GLP-1 is to reduce appetite, so you may find yourself wanting to eat as little as possible. Although the temptation to minimise mealtimes may be strong, I would urge you to see this as a golden opportunity to focus on the nourishment that food provides — remember nutrients offer the building blocks to maintain a healthy body. Here are some meal and snack ideas that are light and flavourful, easy to eat and prepare, and that provide a wide range of essential nutrients to promote optimum nutrition.

Breakfast

• A generous two-thirds teacup-sized portion of porridge made with any milk topped with walnuts and a few berries (or stir in some crunchy almond butter).

• Smoked salmon on toast.

• A palmful of nuts and an apple, if you’re short of time.

• One Weetabix with flaked almonds and apple.

• Pâté/fish paste on toasted brown bread.

• Eggs, two, cooked any way plus a cracker or piece of granary bread and some grilled tomatoes.

• Leftovers also make a decent breakfast — any meat, fish, poultry along with a grain-based something (bread, cracker).

Lunch or dinner

Essentially, have any protein with any complex carb. If you want muesli on sliced beef, then go for it, or porridge with hummus, again, that works. My clients report that eating this way helps them to feel energised and satiated, as modest amounts of food in the day creates a slow but steady supply of glucose and energy.

• Grilled steak with green beans, broccoli, courgettes and a generous tablespoon of brown rice or quinoa.

• Vegetable or chicken soup with added shredded chicken, or added chickpeas/lentils/mixed beans.

• Hummus, with tomato, radish, celery, salad leaves; crumble an oatcake and a few sesame seeds over the salad.

• Two hard-boiled eggs, mashed up with a small teaspoon of Greek yoghurt, half a diced red pepper and a pinch of curry powder, turmeric, black pepper and sea salt. Serve with salad leaves or spread on oatcakes or toast.

• Boil brown rice or quinoa in chicken or vegetable stock (simply add a stock cube to the water), allow to cool a little, place two tablespoons of the cooked rice on a plate, add a whole small can of sardines, tuna or salmon, then some radishes or celery for crunch.

• Half a medium-sized avocado, tomato, mozzarella and a handful of spinach leaves. Dress with two tablespoons of olive oil mixed with a drizzle of balsamic vinegar.

• Baked halloumi cheese served with sliced beetroot, lettuce and a dressing of horseradish sauce mixed with lemon juice and a little olive oil.

• Baked potato with a third of the centre removed and replaced with baked beans. Top with a small amount of grated cheddar cheese if desired.

• A slice of ham with a baked sweet potato, drizzled with walnut oil and topped with a large pinch of sunflower seeds.

• A mixed-bean salad with tahini on oatcakes.

• If you prefer a sandwich, use one slice of bread rather than two to account for a smaller appetite. Then choose any protein source you like (meat, fish, tofu, beans etc), but remember to add some vegetables, such as tomato, lettuce or peppers.

Mid-morning and afternoon snacks

Even with a modest appetite, having something small to eat between main meals helps to keep glucose levels stable, and also contributes to a healthy calorie intake to avoid muscle being broken down.

• Leftovers: if you have, say, salmon, mash up what’s left with a little yoghurt, add some lemon juice and eat with a small serving of pitta or spread on two oatcakes.

• Apple, pear or kiwi etc, with almonds, walnuts, seeds.

• Taramasalata or hummus on oatcakes or Ryvita, or with a carrot dipped in the spread.

• Almond, cashew or peanut butter on rice cake or half a piece of granary bread.

• Sliced chicken breast or hard-boiled egg with radishes.

• One third of a medium avocado mashed up with hot sauce, pumpkin seeds and cherry tomatoes.

• Half a teacup of cooked chickpeas with a teaspoon of Greek yoghurt, seasoned.

• Two slices of tempeh wrapped in lettuce leaves.

• Sauerkraut on a cracker.

• One tablespoon of cubed feta with diced radish.

• Red pepper hummus with raw cauliflower crudités.

• Mixed seeds and a small banana.

Supplements — what to take

If you’re not eating enough calories then a daily supplement is vital. So what do you take to supplement the nutrients that may be reduced when eating less, plus compensating for the effects of potential muscle loss and associated skin issues? Few clinical studies have explored potential deficiencies linked specifically to GLP-1, but there is some evidence to suggest insufficient levels of several macro-nutrients and nutrients, namely fibre, calcium, iron, magnesium, potassium, choline and vitamins A, C, D, E and K.

There are many variables of course, such as how good your diet is, any medication you might be taking, your age and general health. But here is what will work best for most of us.

You should already be taking a vitamin D supplement, at least 400iu a day.

A multi-nutrient

Multivitamins offer a moderate amount of a wide range of the nutrients found in food, and are a way of topping up your nutrient intake in the simplest and most convenient way. In my opinion a mid-range multivitamin is fine. The nutrients that support every function will be there, including those that help skin quality, such as vitamins A, C and E, as well as the minerals zinc and selenium.

Protein supplements

You really don’t want to lose muscle, and so adding some extra protein by way of a supplement is a smart move. In general, I advise clients taking GLP-1 to have one protein shake mid-morning or afternoon, in addition to a snack. Most packs of protein powder include a scoop to help measure out a standard dose, usually 20-25g. Some clients choose bone broth rather than a powdered protein supplement, which contains some 16g of protein per serving on average.

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For what it’s worth, I have 25g of additional protein several times a week. I’ve opted for a blend of soy, hemp, brown rice, pumpkin and pea proteins, to which I add water and ice, before giving it a good shake. Making a shake combining your multi-nutrient with protein provides a “safety net” and is easy to drink.

Extra fibre

Fibre is an essential part of any diet, and for the most part, we don’t get enough, even without the effects of GLP-1.

Adding extra fibre to the mix of a powdered multi-nutrient and protein is a convenient way to fulfil your nutritional needs. Try adding fruit and seeds to your shake and blend.

Omega-3s

Omega-3 fats play many roles, ranging from offsetting inflammation to reducing the risk of cardiovascular disease. They also help skin integrity and hydration. They are found in foods such as oily fish, walnuts and chia seeds, among others.

On average, 1,000mg of omega-3 a day will suffice. If you eat oily fish then you can take a supplement on days that you aren’t eating fish — there’s no need to double up.

Extracted from The GLP-1 Handbook: Eating Well When Taking Weight Loss Medication by Ian Marber (Little, Brown £16.99). To order a copy go to timesbookshop. co.uk or call 020 3176 2935. Free UK standard P&P on online orders over £25. Special discount available for Times+ members