SERENA WILLIAMS IS RO’s GLP-1 AMBASSADOR
GLP-1 drugs like Ozempic, Mounjaro, and Wegovy have completely transformed the weight loss industry since their introduction and are seemingly part of the news cycle every day. The latest is the launch of Wegovy in a pill form, with others slated to follow. These drugs have reshaped not just the landscape of obesity treatment, but metabolic health beyond the scale.
Almost all of us have friends and family whose dramatic weight loss has been hard to miss as a result of GLP-1s. Then there have been the powerhouse celebrities like Oprah Winfrey, and athletes like Serena Williams, inspiring an even wider population to take these drugs, now readily available on numerous telehealth platforms like AgelessRx, Noom, and RO, for which Serena Williams is the spokesperson. Recent polls indicate 1 in 10 adults in the US have used a GLP-1 drug for weight loss or diabetes.
GLP-1 drugs were initially designed to help manage blood sugar in type 2 diabetes, but along with that came the side effect of dramatic weight loss. That led to the development of these medications specifically for weight management. Although there are many brand names for GLP-1s, there are essentially only two drugs, semaglutide and tirzepatide. Both mimic the hormone GLP-1, or glucagon like peptide 1 (tirzepatide mimics both GLP-1 and GIP, or gastric inhibitory polypeptide hormone) which controls the release of insulin from the pancreas and regulates blood sugar levels. They also slow gastric emptying so you stay full longer, reducing appetite and increasing satiety.
Ozempic (semaglutide) was approved by the FDA in December 2017 for type 2 diabetes, and in 2021 the company introduced a higher-dose version of semaglutide, branded as Wegovy, that was approved specifically for weight management. Similarly Mounjaro (tirzepatide) for type 2 diabetes later introduced Zepbound for weight management.
What is relatively new is “microdosing” GLP-1s. This is for people who maybe have just 10-20 pounds to lose, or to mitigate the GLP-1 side effects like nausea, fatigue, or diarrhea by starting on a much lower dosage. Some are interested in the metabolic health benefits beyond weight loss, and GLP-1s are also being marketed as a longevity drug for their anti-inflammatory, cardiovascular, and cognitive benefits, among others.
“As estrogen levels decline, the body starts to store fat — visceral fat, i.e. belly fat — which is why menopausal women call me with ‘Oh my god, overnight I have a tire around my stomach and it won’t go away.”
Along with all these benefits, however, has come prominent concerns about much of that weight loss being muscle, critical to maintaining bone density, and the importance of eating protein and doing strength training to offset that. When our friend of SOS and contributing nutrition editor, Sarah Wragge, recently posted on Instagram about the responsibility that comes with taking these drugs, we decided it was time to dig in and have a conversation about GLP-1s…
SARAH WRAGGE: I’m excited to do this with you because I want to be very public about how often on a daily basis I am talking about GLPs. I must say the word over 100 times a day. I call it the “superhero cape” because it’s something to add to your regimen that will help you be more successful and help you fly. It is not the foundation of our wellness program, but has been a regular part of it for 3-4 years.
STYLE OF SPORT: How heavy are your clients that are taking GLP-1s?
SW: It’s all over the map, but the very first person was a young woman who was morbidly obese. I’ve seen her transform her life, getting her diet under control, and then in tandem with our endocrinologist, adding in Rybelsus, which was the hot med at that moment. She then switched over to Ozempic and eventually to Mounjaro, finding tirzepatide more effective than semaglutide. She’s lost about 150 pounds in tandem with our SW Method which includes diet and exercise. She’s somebody who was never going to have a win. She has Polycystic Ovary Syndrome (PCOS), which means your testosterone levels are elevated, and you have insulin resistance. Over 3 years she lost about 150 pounds. She is still on the highest dose of Mounjaro and will most likely remain on that medication.
SOS: And by the way, insulin resistance often increases during perimenopause and menopause, which is one of the new ways these drugs are being marketed.
SW: Yes. As estrogen levels decline, the body starts to store fat — visceral fat, i.e. belly fat — which is why menopausal women call me with ‘Oh my god, overnight I have a tire around my stomach and it’s this belly fat that won’t go away.’
SOS: I can totally relate. I take hormones but mine has come with the havoc back surgery wreaked on my system and not being able to train like I used to. That brings me to a new topic in the GLP1 conversation which is microdosing, targeting people like me that don’t have that much weight to lose but are finding it difficult because of physiological changes.
“I believe very strongly that if you are going to sign up to take one of these drugs it comes with a responsibility. That is to continue to eat, even if you’re not hungry.”
SW: In a perfect world, a microdose gives you the benefits of the medication without the side effects like nausea, fatigue, or constipation. Sometimes that includes appetite suppression. There are also people who don’t want to lose weight, but want the benefits like heart health, cardiovascular health, brain health. We work regularly with an OB, general practitioner, longevity doctor, and neurologist who all believe in microdosing GLP1 for longevity.
SOS: I kept hearing about all these benefits but didn’t have enough weight to lose to qualify, but now a lot of these telehealth companies are marketing it to people like me.
SW: I have high cholesterol because of hereditary issues. My doctor suggested I take a microdose of it. I would rather do that than go on a statin. My dad has been on Lipitor for 25 years. I’d prefer he goes on 2.5 mg of Zepbound and get all the other benefits. He’s always struggled with weight, and it would give him everything.
SOS: So let’s talk about the warnings on taking these drugs that have become a big part of the discussion, like the loss of muscle and bone density, and the importance of eating protein and doing strength training. Let’s run through that list you posted on Instagram that got us here talking. Is it as relevant with microdosing?
SW: I believe very strongly that if you are going to sign up to take one of these drugs it comes with a responsibility. That is to continue to eat, even if you’re not hungry. You want to be hitting your protein numbers of roughly .8 or 1 to 1 of your ideal body weight.
SOS: So I’m at 125 pounds and want to get down to 120 pounds.
SW: So the Claudia I know that’s biking, running, training hard, if you want to be 120 pounds then eat 120 grams of protein a day – or at least 96 grams. This is literally why I created our protein powder. Not to sound like a salesperson, but it has 45 grams of protein per serving. So you could have two shakes a day and basically be at your protein number.
SOS: I’m curious, what’s your protein source?
SW: Grass fed, grass finished, beef protein isolate, and pea protein, with 10 grams of inulin, a prebiotic fiber with no fat. So if you want to add in nut butter or avocado or some kind of fat you’d be safe to do that — especially on your menopause journey, because I’m trying to watch the amount of fat you’re consuming on a daily basis.
SOS: What should my fat be? My carbs are low but I think my fat is too high.
SW: I would say your carbs should be higher than your fat given your activity level. I would say you want to stay between 40-50 grams of fat per day. Carbs probably 150+ grams.
SOS: I’m not hitting either of those because I’ve been on the paleo diet for so long.
SW: What you’re thinking is ‘I’m hungry, I’ll have a scoop of nut butter instead of a piece of sourdough bread’.
SOS: Totally!
SW: Flip it!
SOS: Wow. But that was never your theory was it?
SW: My theory has changed a little bit with understanding more about menopause and activity. You are an active person. Even if you’re not exercising to the extent you were, I’m assuming you’re still walking around the city. Like how many steps a day are you doing?
SOS: At least 10,000.
SW: You’re not sedentary. In order to get energy your body needs carbs — good carbs like apples, blueberries, bananas, sourdough bread, sweet potato, lentils. No white carbs. You really do have to watch your fat if you want to lose weight.
SOS: Let’s keep going down the list: strength training. Does that have to be lifting a piece of metal, i.e. a weight?
SW: Yes
SOS: Why can’t it be an elastic? What is the difference between strength training and resistance training?
SW: The definition of strength training is to lift to the point of fatigue. I want to see you struggling for that last rep. That’s proper strength training. And this is where the GLP conversation comes in that’s really important: you must be eating and fueling correctly. These medications mute your hunger hormones and you don’t want to eat. You need to make sure you’re working with somebody to monitor your dosage. What I see too often is doctors write you a script and then that’s it. I’m working with you on a daily basis and you have no appetite. I’m calling the doctor saying, “You know your patient is withering away because she can’t eat.” Or, it’s the other way around. Someone might be at a standstill and still have 30 pounds to lose. I’m telling them to ask their doctor if they can go up. Doctors are not paying attention because they’re writing scripts for this all day long.
SOS: What about bone density and body composition?
SW: We do a DEXA Scan to track bone density and InBody scan to track body composition at the beginning of your GLP-1 journey. We monitor those numbers bimonthly. Only once have I seen a person lose muscle, one case in hundreds, because they are doing what they need to do. I am militant about strength training. The most successful type of client we see use a GLP is somebody who comes to us, gets their diet and training locked and loaded, and then we add in the GLP 6-8 weeks later. That’s when we see real long term success because they have not relied on the medication. They did their homework first.
