GLP-1 Access: What Clinicians Need to Know and What RDNs Want to Understand, Pt. 3
In this episode of Nutrition411, Lisa Jones, MA, RDN, LDN, FAND, and Bonnie Chambers, MSN, FNP-C, explore what registered dietitians need to understand about the clinical and logistical aspects of GLP-1 therapy, emphasizing interdisciplinary communication between RDNs and prescribers.
The discussion reviews practical strategies for handling common adverse effects—such as nausea, constipation, and heartburn—including electrolyte loading around injection days, use of antiemetics, fiber and hydration support, stool softeners, and low-dose omeprazole. The episode also details flexible dosing and titration approaches to keep patients in a “golden zone” of steady weight loss or maintenance while avoiding over-suppressed appetite, including extending dosing intervals and stepping down doses when appropriate.
Additional Resources:
- Novo Nordisk. Wegovy (semaglutide) injection, for subcutaneous use: prescribing information. Revised August 2025. Accessed April 2, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/215256s024lbl.pdf.
- Eli Lilly and Company. Zepbound (tirzepatide) injection, for subcutaneous use: prescribing information. Accessed April 2, 2026. https://pi.lilly.com/us/zepbound-uspi.pdf
- Bjerre Knudsen L, Madsen LW, Andersen S, et al. Glucagon-like Peptide-1 receptor agonists activate rodent thyroid C-cells causing calcitonin release and C-cell proliferation. Endocrinology. 2010;151(4):1473-1486. doi:10.1210/en.2009-1272
- Rosol TJ. On-target effects of GLP-1 receptor agonists on thyroid C-cells in rats and mice. Toxicol Pathol. 2013;41(2):303-309. doi:10.1177/0192623312472402
Transcript:
Lisa Jones, MA, RDN, LDN, FAND: And we're back with another Nutrition 411 podcast episode. And we're back here with Bonnie Chambers. And last episode, we talked about that kind of teamwork that is so powerful, and it really highlights how essential interdisciplinary communication is. So now we're going to dig into what RDNs should know about the clinical and logistical side of GLP-1 therapy. Basically, Bonnie, we're going to talk about what dietitians need to understand because there's a lot that we need to understand to be doing this. So my question to you is, from a clinical perspective, what’s the most important things that RDNs need to understand about how these medications work?
Bonnie Chambers, MSN, FNP-C: Well, I think everyone knows what these medications do. They'll decrease appetite. They decrease gastric emptying, so you will feel fuller faster, stay fuller longer. It calms down food noise, calms down cravings, so it does a lot of great things. A good thing to always screen for, well, I screen for, and I'm sure you guys do too, is just to make sure that, again, like I said before, patients are meeting their nutritional goals and also making sure they're not having any significant side effects that are interrupting their ability to do so. That can be quite an issue, the side effects. A lot of times they're manageable. For instance, say if a patient came to you and said they were having nausea, what I counsel them to do would be to load up on electrolytes like the day of their injection and the day after that can be helpful. So that's something you could also communicate. So I guess things of that nature.
As far as dosing, doses can be adjusted. So there was a school of thought where it's one month is the starting dose, next month you go to the second dose, next month you have to go to the third dose and so on and so forth. It doesn't have to be that way. Again, if they're losing slow, steady, healthy, one to two pounds a week, tolerating it well, we can continue that dose for the next month or so.
You can also look at if you think a patient's appetite may be overly suppressed. It doesn't have to be every seven days that they take the medication. It can be 10 to 14 days, 14 days tops. We don't want them going more than two weeks without a dose. Definitely creative ways you can work with the dosing to make sure that they're in that golden zone of experiencing healthy weight loss with no bad side effects. I'm not sure if that answered the question.
Jones: Yeah, no, that was helpful. I think the one thing was you were given a new something that I haven't heard before, so I think that that was helpful to dieticians that are listening. And then the other thing is you did touch on the titration process.
Chambers: Yeah.
Jones: And what else could you say about what does it mean for, let's say, appetite energy and then side effects? Really, I'm talking about in the early weeks of the therapy or the medication that you're taking.
Chambers: What? Go over the side effects? Is that what you’re asking?
Jones: Yeah. How do you manage somebody that's new to the medications? They start to have some side effects in their early weeks in terms of your process of titrating it.
Chambers: Yeah. So some patients experience no side effects whatsoever. Other patients do have side effects. Usually it's when you start the medication and when you increase the dose and then they kind of taper off. So I'll just communicate with my patients, ask them to message me if they're having bad nausea or heartburn or constipation's a big one. And then usually we look at, well, how can you correct that? So nausea, a lot is going to be at the day of injection and the day after, and then it kind of gets better. So if that's the case and it's manageable, we can do some Zofran or we can load the electrolytes, that type of thing. But of course, if they're having terrible nausea all the time or vomiting, then this just may not be the medication for that individual.
So constipation, making sure you're adding the fiber. Benefiber is great, making sure they are indeed getting all their fluids in, staying nice and hydrated, stool softeners, things of that nature.
Some people get heartburn, you can do, and that's from that decreased gastric emptying, that's where that side effect comes from, but you can just do low dose omeprazole. Usually that will take care of that.
The most concerning side effect, and really the only reason I've ever had to take a patient off the medication is if they were developing issues with constant chronic diarrhea. And a lot of times that just, if they're having it every single week, it's not going to get better. And I wouldn't even probably decrease the dose in that situation. I usually just take them off that medication.
As far as decreasing the dose, that's usually if their appetite's overly suppressed, or we go from being in the active losing weight phase to the weight maintenance phase, because these medications can be used for maintenance also. And so say they're on Zepbound 10 milligrams every seven days to lose weight. Some patients can stay on that and maintain, but others may need to start taking that 10 milligrams every 10 to 14 days. That's usually what I will start with.
And then if they're still overly suppressed, we need to start decreasing the dose down. And so then we'll go down to the 7.5. So that's usually as far as titrating down, it's usually for an appetite issue more so than a side effect issue.
Jones: Got it. That's really helpful too. I think too, knowing ... But again, it goes back to what we're talking about in the previous episode with communication, that collaboration with your healthcare provider that you're seeing and letting them know this is what's happening, not you're okay and you're just dealing with the side effects and not telling anybody. So I think it's also important the patient shares that as well as the whole care team.
Chambers: Absolutely. Yeah. It's definitely number one.
Jones: Yeah. Let's talk a little bit about lab values or some type of metrics that will be monitored. Which ones are most closely monitored to assess safety and effectiveness of the medication?
Chambers: So when I first have a patient come in, it depends. If they have a history of bariatric surgery, then the lab panel I'm doing is going to be more extensive than if they're coming in as a medical weight management patient. I will always be grabbing a CBC, CMP for liver and kidney function, A1C, vitamin D level, lipids and thyroid function. That will always be an initial panel for medical weight management. And then there's certain deficiencies, all the anemia numbers, B12, vitamins, all that for the bariatric patients. And then as we go along, so after about six months, we like to recheck labs and just make sure everything's looking good. But of course, if someone's coming in and they're having abdominal pain or some other issue is happening, then you want to check your liver function, and of course, lipase level, because there is that risk of pancreatitis with these medications. It's amazing the effect you'll see on a person's A1C when you go to repeat it in 3 to 6 months, but it's also good to make sure that the protein numbers are in there, good protein and you're repeating the lipids and things like that.
I do a lot of lab work. I went in to get my labs drawn one day and the girl, the phlebotomist, looked at me and she said, "Are you Bonnie Chambers, the nurse practitioner?" And I was like, "Uh-huh." I was like, "Why?" And she was like, "Oh, we just draw your labs all the time!”
Jones: Well, that’s good news. You’re being safe.
Chambers: Yeah. Exactly.
Jones: You're famous for sending them labs. They should be happy with the work as much as the lab bills out. Any lab.
Chambers: Putting the name and the face together, but also they can see kidney function in there, make sure they're not looking dehydrated, all that good stuff. So labs are definitely an important part of prescribing.
Jones: Yeah, thank you for that. So I know you talked a little bit about common side effects, but is there any other red flags that dieticians should be aware of and how should they then advise their patients to respond appropriately?
Chambers: Yeah, red flags with these medications. So any changes in vision, you want to ask them to let the prescriber know right away. Also, palpitations can happen with Wegovy, so obviously bad abdominal pain, well, any abdominal pain. There really should not be abdominal pain. Nausea, heartburn, constipation, those type of GI side effects are not expected, but not uncommon, but abdominal pain or vomiting, that should not be happening. So if someone were to report that, then please send them to us, the prescribers right away. Those are the big red flags.
Jones: Yeah. And then also too, there's at least a Wegovy or a Zepbound commercial I see anytime I'm watching the TV. I don't know how much... It just seems like they're always on. Anytime I turn the TV on, one's on. But one of the things they talk about is, and they'll say, "Don't stop taking it if you develop these..." What is it, the thyroid?
Chambers: Yes. Yes, you're right. I missed that one. Yes, a lump in their throat because they didn't see this in human studies, but they found in animal studies a risk for thyroid medullary cancer, which is a rare form of thyroid cancer, but that's what they're alluding to there. So yes, that would also be included on that list. I just never actually had anyone come to me with a complaint of a lump in their throat. I've never seen that. It's not very common at all. Whereas I have had people come to me complaining of abdominal pain, complaining of changes in vision, complaining of palpitations. Unfortunately, it's very rare, but I have seen pancreatitis develop in one or two people. But yes, that is one of the risks associated with the GLP-1s is that thyroid medullary cancer.
Jones: Well, thank you for mentioning it because it's always like if one person, if they do a study and they find that one person has had this symptom, they list it and then all of a sudden it's an adverse reaction, so they have to list it. But even some of the commercials, and I'm not talking about the weight loss medications right now, I'm talking about medications in general, some of them I'll be listening to the commercials and at the end it'll say, "And even death."
Chambers: Yeah, I think they all say that actually.
Jones: And you're like, "What? Do I want to go like…?" So it's kind of like one person might've died, I don't know, for them to say it. So it's interesting. So just be aware, but that's really helpful for dieticians listening and how they can respond to their patients.
Chambers: Yeah. And just for everyone's knowledge, that is an actual contraindication to starting the GLP-1s. So a history of medical, non-gallbladder, pancreatitis, a family or a personal history of thyroid medullary cancer or multiple endocrine neoplasia syndrome type two and also gastroparesis. Those are the things that I'm always going to ask a patient before starting these medications. So they did find a pretty significant link there, but again, it was only in animals. However, we don't prescribe to those patients in humans.
Jones: You just made me think of a thought because in the very beginning when I first came out, I'm talking maybe years ago by now, there was these people that would, not on a medical chat, but just in the news or something like that saying that the medications weren't good because it caused gastroparesis and then the person couldn't eat anymore or something like that. So they would scare people, I think in the very beginning. Do you remember that?
Chambers: Yeah, people are still scared. I think there are some horror stories out there. It's one of the reasons, and again, this is just my belief from what I've gathered from what I've seen. These medications, the pure medications from the manufacturer are very safe. Of course, complications can happen, but if it's managed correctly, a lot of the time, everything's good. But I think a lot of those horror stories, unfortunately, may have been in situations with the compounded medications. So again, there's a greater risk with those medications, which is another reason why I don't work with them.
Jones: Yeah. Yeah. I think that's a good plan. So thank you. Thank you for mentioning that. And again, thank you for sharing your insight and experiences with us and for helping bridge the gap between clinical management and nutrition care. And thank you to our listeners for joining another episode of Nutrition 411, the podcast.
Chambers: Thank you.