The Growing Evidence on GLP-1s and Gut Health
In the past few years, the world of metabolic medicine has been transformed by GLP-1s. Once a niche treatment for type 2 diabetes, these medications are now used far more broadly, particularly for weight loss and metabolic health. But with this rapid rise in use comes a responsibility to understand how GLP-1s affect the body, especially the gut.
GLP-1 Use Has Increased by Over 700%
A recent analysis published in The BMJ found that the number of people without diabetes starting GLP-1 treatment increased from roughly 21,000 in 2019 to more than 174,000 in 2023. That represents an increase of over 700% in just four years (2).
This rapid growth highlights how effective GLP-1s can be for weight loss and metabolic health. It also raises important questions about their broader effects on the body. One of the most important areas to consider is the gut.
The Gut Is Central to How GLP-1s Work
GLP-1 is a hormone that is naturally produced in the gut in response to food. It plays a key role in regulating appetite, blood sugar, digestion speed, and feelings of fullness.
When someone takes a GLP-1 medication, these gut-based signals are amplified. This explains why many of the common experiences people report, such as reduced appetite, feeling full more quickly, constipation, nausea, or bloating, are closely tied to digestion.
Because GLP-1s work through the gut, it makes sense that they can also influence the gut microbiome.
How GLP-1s Affect the Gut Microbiome
Multiple studies have begun to untangle the links between GLP-1 therapies and gut microbial communities:
GLP-1 analogues can alter the composition, diversity, and abundance of gut microbiota, though results vary by drug and population studied (1).
Some GLP-1 treatments have been associated with increases in beneficial bacteria such as Akkermansia, Bacteroides, Ruminococcus, and others that are linked to improved metabolic outcomes and gut integrity (1).
However, effects are inconsistent: semaglutide in some human studies was shown to increase certain beneficial microbes but decrease overall diversity — a key marker of gut health (1).
GLP-1s also exert anti-inflammatory effects and can modulate immune signaling pathways that intersect with gut health (2).
This complex interplay underscores why gut health isn’t just a side note — it’s a central part of how these drugs work and how patients experience them.
Why Prioritizing Gut Health While Using a GLP-1 Matters
The gut does much more than digest food. It plays a major role in blood sugar control, inflammation, nutrient absorption, hormone signaling, and immune function.
When gut health is not supported, people using GLP-1s may experience ongoing digestive issues, low energy, nutrient deficiencies, or inconsistent results. Supporting the gut helps the body respond more smoothly to GLP-1s and may reduce unwanted side effects.
Ways to Support Gut Health While Using a GLP-1
Supporting gut health does not require extreme measures. Consistent, simple habits can make a meaningful difference.
1. Focus on Fiber
Fiber feeds beneficial gut bacteria and supports regular digestion.
Good sources include vegetables, beans, lentils, whole grains, berries, nuts, and seeds. Because appetite is often reduced on GLP-1s, it can be helpful to increase fiber gradually to avoid discomfort.
2. Include Probiotics
Probiotics introduce beneficial bacteria into the gut and can help support balance.
These can come from fermented foods such as yogurt with live cultures, kefir, sauerkraut, kimchi, or from high quality probiotic supplements. Consistency matters more than quantity.
3. Add Prebiotic Foods
Prebiotics are specific fibers that feed healthy gut bacteria.
Foods such as garlic, onions, leeks, asparagus, and slightly green bananas help support bacterial growth and balance, especially when overall food intake is lower.
4. Add Resistant Starches
Resistant starches pass through digestion and are fermented by gut bacteria in the large intestine.
Examples include cooked and cooled potatoes or rice, beans, lentils, and green bananas. These foods can support gut comfort and long-term metabolic health.
5. Support Digestion and Motility
GLP-1s slow digestion as part of how they work, but regular movement through the digestive system is still important.
Staying hydrated, walking regularly, eating smaller balanced meals, and avoiding long periods of skipping meals can all help support digestion.
6. Prioritize Nutrient-Dense Foods
With reduced appetite, nutrient quality becomes even more important.
Focusing on protein, colorful fruits and vegetables, healthy fats, and whole foods helps support energy levels, digestion, and overall well-being.
The Takeaway
GLP-1s can be a powerful tool for weight loss and metabolic health, but the research is showing that things should not end there. Gut health plays an active role in how the body responds to these medications.
When gut health is supported, many people experience fewer side effects, better digestion, and support their long-term health.
Want to Talk More About GLP-1s or Your Experience?
If you are using a GLP-1, considering starting one, or navigating side effects or plateaus, support can make a meaningful difference.
✨ You are invited to schedule a complimentary call to talk through your experience, ask questions, and explore supportive strategies that fit your needs. You can also check out our GLP-1 Guide here!
👉 Schedule your free call to connect and learn more.
Resources
Alharbi SH. Anti-inflammatory role of glucagon-like peptide 1 receptor agonists and its clinical implications. Therapeutic Advances in Endocrinology and Metabolism. 2024;15. doi:10.1177/20420188231222367
Mahase E. GLP-1 agonists: US sees 700% increase over four years in number of patients without diabetes starting treatment BMJ 2024; 386 :q1645 doi:10.1136/bmj.q1645