GLP-1 Agonists and Bone Health in Postmenopausal Women

GLP-1 receptor agonists, including Wegovy and Mounjaro, have become important allies for many in managing weight and type 2 diabetes. These medications emulate a hormone called glucagon-like peptide-1 (GLP-1), which plays a vital role in regulating blood sugar, controlling appetite, and fostering feelings of fullness. For women on a journey toward long-term weight loss and improved metabolic health, GLP-1 medications can provide essential support. However, the journey can be even more effective when combined with mindful eating practices. 

Mindful eating encourages us to engage fully with our meals, promoting a healthier relationship with food and enhancing body awareness. In this blog, we will explore how the combination of GLP-1 medications and mindful eating can create a more holistic and compassionate approach to weight management. We’ll discuss the many benefits of mindful eating, share techniques to help you get started, and offer guidance for overcoming common challenges. 

‍Understanding GLP-1 Medications and Their Role in Weight Management

GLP-1 receptor agonists have revolutionised the way individuals manage their weight and metabolic health. These medications mimic the natural GLP-1 hormone, which plays a role in:

1. Regulating Appetite: GLP-1 medications reduce hunger by sending signals to the brain that promote a sense of fullness, helping to control cravings and overeating.
2. Slowing Gastric Emptying: This causes food to remain in the stomach longer, reducing the urge to eat more frequently.
3. Modulating Blood Sugar Levels: By slowing the absorption of sugar into the bloodstream and increasing insulin production, GLP-1 medications help to stabilise blood sugar levels, which can reduce weight gain driven by blood sugar spikes and crashes.

Despite these physiological benefits, GLP-1 medications are not a magic bullet. Sustainable weight loss and improved metabolic health require lifestyle changes, including a balanced diet and a mindful approach to eating.

The Importance of a Balanced Diet and Mindful Eating Practices

While GLP-1 medications assist in appetite regulation, they do not dictate what or how to eat. Developing a balanced, nutrient-rich diet is essential for overall well-being and optimal weight loss outcomes. But even beyond the physical aspects of nutrition, how we approach eating can make a significant difference. This is where mindful eating comes into play. Mindful eating is about paying close attention to the experience of eating, focusing on the present moment and being fully engaged with the sensory experience of food. It helps cultivate a deeper connection between the mind, body, and food, allowing you to make intentional food choices that align with your body’s needs rather than emotional triggers or habits. Let us explore the key benefits of adopting mindful eating alongside GLP-1 medications.

Benefits of Mindful Eating

Mindful eating can profoundly enhance your relationship with food and support your weight loss journey. When combined with GLP-1 medications, the following benefits become even more pronounced:

1. Improved Appetite Control: By paying attention to hunger and fullness cues, you’re more likely to stop eating when you’ve had enough. This aligns with the appetite-regulating effects of GLP-1 medications, further preventing overeating or snacking out of habit or boredom.
2. Enhanced Taste Appreciation: When you slow down and savour each bite, the flavours, textures, and aromas of food become more enjoyable. You may find that you become more satisfied with smaller portions, which can naturally reduce calorie intake while enhancing your overall eating experience.
3. Reduced Emotional Eating: Mindful eating encourages you to assess whether you’re eating because of hunger or due to emotional factors such as stress, anxiety, or boredom. By being more aware of these patterns, you can address emotional triggers in healthier ways, preventing emotional overeating, which can interfere with the benefits of GLP-1 medications.
4. Increased Body Awareness: Mindful eating helps you connect with your body’s needs, promoting a sense of trust in your own hunger and fullness signals. Over time, this practice can help repair any disconnection caused by years of dieting or mindless eating patterns.
5. Improved Digestion: Eating mindfully involves chewing food thoroughly and slowing down, which gives your digestive system more time to process and absorb nutrients efficiently. This reduces bloating, indigestion, and other digestive discomforts often associated with fast or distracted eating.

Mindful Eating Techniques

Mindful eating techniques can help you approach meals with more intention and awareness, making your weight management journey more effective and fulfilling.

1. Focus on the Present Moment: Engage fully with the experience of eating by noticing the colours, textures, and smells of your food. Put away distractions like phones or TVs, and take a moment to appreciate the meal before you. This helps you stay connected with the act of eating, rather than mindlessly consuming food.
2. Slow Down: One of the simplest but most impactful techniques is to slow down while eating. Take smaller bites and chew thoroughly. Not only does this aid digestion, but it also gives your brain more time to recognize feelings of fullness, which prevents overeating.
3. Listen to Your Body: Pause during meals to check in with your body. Are you still hungry, or do you feel satisfied? Recognizing and respecting these cues can help you stop eating when your body no longer needs food, reducing the risk of overeating.
4. Eliminate Distractions: Eating while watching TV, working, or using your phone can lead to unconscious overeating. Make mealtimes a focused activity where you concentrate on your food and the eating experience.
5. Practice Gratitude: Take a moment before meals to reflect on the food’s journey from farm to table, and acknowledge its role in nourishing your body. Practising gratitude helps you cultivate a more positive relationship with food, fostering a sense of respect for the nourishment it provides.

Mindful Eating and GLP-1 Medications: A Symbiotic Relationship

Mindful eating and GLP-1 medications work in harmony to promote sustainable weight loss and overall well-being. The medications help to regulate appetite, while mindful eating reinforces these effects by teaching you to respond to hunger and fullness cues with greater awareness.

GLP-1 medications help your body feel full, but mindful eating allows you to fine-tune how you respond to those signals. For example, you may feel full after a smaller portion, and by slowing down and paying attention, you can recognize and honour that signal instead of continuing to eat out of habit or social expectation. This combination creates a cycle of positive reinforcement: as you become more mindful, you’re less likely to overeat, and the medication’s appetite-regulating effects are maximised. In essence, mindful eating enhances the effectiveness of GLP-1 medications by encouraging you to be more attuned to your body’s needs, making weight loss more intuitive and less reliant on restrictive dieting.

MBEAT (Mindful-based eating awareness training) program

A randomised control trial on the Mindfulness-Based Eating Awareness Training (MB-EAT) program demonstrated that participants who practised mindful eating were more aware of hunger and satiety cues.

Tips for Incorporating Mindful Eating into Your Routine

For women using GLP-1 medications, here are some practical tips to help you integrate mindful eating into your daily routine:

1. Create a Peaceful Eating Environment: Set up a quiet, comfortable space for meals, free from distractions. This allows you to focus solely on your food and the act of eating, promoting mindfulness.
2. Mindful Meal Planning: Prepare balanced, nutrient-dense meals ahead of time. By planning meals that are both satisfying and nutritious, you’ll be more likely to eat mindfully and avoid impulsive, less healthy choices.
3. Practice Gratitude Journaling: Keep a food gratitude journal where you note what you’re grateful for in each meal. This practice can deepen your connection to food and reinforce the habit of mindful eating.
4. Join a Mindful Eating Group: Connecting with others who share similar goals can provide support and accountability. You can exchange tips, share experiences, and stay motivated by participating in group discussions or online communities focused on mindful eating.
5. Overcome Emotional Eating Triggers: When emotional eating arises, pause and ask yourself if you’re truly hungry or if you’re using food to cope with an emotion. If it’s the latter, find healthier ways to manage your emotions, such as journaling, meditating, or talking with a friend.

Overcoming Challenges

Mindful eating, like any habit, takes time to develop. You may encounter challenges along the way, such as emotional eating triggers, stress, or social pressures. Here are some strategies to help you navigate these obstacles:

1. Address Emotional Eating: Emotional eating can be a significant barrier to mindful eating. If you notice yourself reaching for food when you’re stressed, anxious, or bored, try to identify the emotion driving the behaviour. Once you’re aware of the trigger, you can take proactive steps to address the emotion without using food as a coping mechanism.
2. Manage Stress and Anxiety: Stress and anxiety can often lead to mindless or emotional eating. Incorporate relaxation techniques into your daily routine, such as deep breathing, meditation, or yoga, to help manage these feelings without turning to food.
3. Find Support and Accountability: Surround yourself with people who support your mindful eating journey. Whether it is through a group, a close friend, or a nutritionist, having accountability can make a big difference in staying committed to mindful eating.

Conclusion

Mindful eating is a powerful tool that can complement the effects of GLP-1 medications, helping individuals develop a balanced and sustainable approach to nutrition and overall wellness. By slowing down during meals, tuning into hunger and fullness cues, and making intentional food choices, individuals can not only enhance the medication’s benefits but also cultivate a healthier relationship with food. These practices can lead to improved digestion, better portion control, and long-term success in weight management.

While GLP-1 medications support appetite regulation and metabolic health, incorporating mindful eating can reinforce positive habits that extend beyond the duration of the treatment. Establishing these mindful behaviors now can set the foundation for lasting health improvements and a more intuitive way of eating.

If you’re looking for expert guidance on integrating mindful eating practices with your GLP-1 regimen, contact us at SheMed. Our team is here to provide the support, education, and personalized strategies you need to achieve lasting success on your wellness journey.

‍

References

1. Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., Kushner, R. F., & STEP 1 Study Group. (2021).https://pubmed.ncbi.nlm.nih.gov/31801807/ 
2. Authors: Canadian Agency for Drugs and Technologies in Health (CADTH) Title: CADTH Reimbursement Recommendation for Wegovy (semaglutide) Year: 2020, Source: CADTH https://www.ncbi.nlm.nih.gov/books/NBK602627/
3. M. C., & Davies, M. (2023). Tirzepatide once weekly for the treatment of obesity in adults without diabetes. New England Journal of Medicine https://pubmed.ncbi.nlm.nih.gov/36751934/
4. Gallwitz, B. (2013). Glucagon-like peptide-1-based therapies for the treatment of type 2 diabetes: A focus on exenatide  https://pmc.ncbi.nlm.nih.gov/articles/PMC3778098/
5. Morgan, S., & Skovgaard, D. (2020). Two-year effects of semaglutide in adults with overweight or obesity: The STEP 5 trial. Nature Medicine, 26(12), 2074-2081 https://pubmed.ncbi.nlm.nih.gov/32825124/
6. T. A., Wharton, S., Yokote, K., Zeuthen, N., & Kushner, R. F. (2023). Once-weekly semaglutide in adolescents with obesity https://pubmed.ncbi.nlm.nih.gov/39096914/
7. Violante Ortiz, R., Jensen, C. B., & Wilding, J. P. H. (2015). A randomised, controlled trial of 3.0 mg of liraglutide in weight management. New England Journal of Medicine https://pubmed.ncbi.nlm.nih.gov/26331843/
8. Kang, Y., & Park, S. (2017). Gastric hormonal secretion and its regulation by ghrelin in rats. Biomolecules & Therapeutics https://pmc.ncbi.nlm.nih.gov/articles/PMC5439358/
9. Rosenstock, J., Gurney, K. J., & Davis, S. N. (2017). Efficacy and safety of once-weekly exenatide versus insulin glargine in type 2 diabetes:https://pubmed.ncbi.nlm.nih.gov/27990172/
10. ‍Le Roux, C. W., & Batterham, R. L. (2014). The role of the gut in obesity and metabolic disease. Nature Reviews Endocrinology https://pmc.ncbi.nlm.nih.gov/articles/PMC4159612/

Have you ever wondered why your weight loss efforts seem to plateau, no matter how hard you work? It’s not just about cutting calories or increasing exercise. For many women, the key to unlocking successful weight loss lies in essential nutrients like calcium and vitamin D. Unfortunately, most women are unaware that they may be deficient in these crucial vitamins. It can drastically impact their ability to lose weight. In fact, approximately 1 in 5 adults is vitamin D deficient, which can lead to poor muscle function and slower metabolism—two key elements in any weight loss plan.

Imagine putting in all the effort—meal planning, exercising regularly, and still not seeing results. It’s incredibly frustrating and can make you feel like you are missing something important. Addressing deficiencies in these nutrients can be the breakthrough you need to support stronger bones, better muscle function, and even regulate hormones that play a role in fat storage and metabolism.

So, how can you make sure you are not sabotaging your efforts with a nutrient deficiency? Let’s dive into how calcium and vitamin D work together to help you achieve your weight loss goals and what steps you can take to ensure you are getting enough of these vital nutrients.

Recommended Daily allowance of Calcium and vitamin D for women

According to guidelines from NHS the daily recommended intake of calcium and vitamin D for various age groups should be: 

‍

The Link Between Calcium and Vitamin D and Weight Loss

Calcium and vitamin D play crucial roles in various bodily functions, particularly for women seeking weight loss. Their impact on bone health, muscle function, and hormonal balance can significantly influence physical activity levels and metabolic processes.

Bone Health

Calcium is vital for maintaining bone density and preventing osteoporosis, especially in postmenopausal women. Adequate calcium intake helps mitigate the risk of fractures as bones become more brittle with age. Without sufficient vitamin D, the body cannot absorb calcium effectively, leading to potential deficiencies that can impact bone health.

How it links to weight loss: Strong bones support an active lifestyle, allowing for more intense physical activity without the risk of injury. This is crucial for maintaining regular exercise during weight loss programs.

Scientific evidence: A study found that calcium supplementation can enhance weight loss in women with low calcium intake. Among participants who consumed less than 600 mg of calcium daily, those taking calcium and vitamin D supplements lost an average of 13 pounds over 15 weeks, compared to just 3 pounds in the placebo group. This highlights the importance of adequate calcium intake for maintaining bone health and enabling physical activity.

Muscle Function

Calcium and vitamin D are crucial for muscle contractions. It enables muscles to contract and relax properly, which is essential for physical activity and exercise.

How it links to weight loss: Calcium is essential for muscle contractions, while vitamin D helps maintain muscle strength. A deficiency in these nutrients can lead to muscle weakness, making it harder to stay physically active, which is key for weight loss.

‍

Scientific evidence: A study involving 40 obese women, underscored the necessity of calcium and vitamin D for muscle function during weight management efforts.

Hormonal Balance

Adequate levels of calcium and vitamin D may influence weight-regulating hormones. Some studies suggest that these nutrients can help reduce fat storage, improve metabolism, and even suppress appetite by regulating hormones like leptin and insulin.

Scientific Evidence: A large-scale study examined the effects of calcium plus vitamin D supplementation on postmenopausal women. The results indicated that women with low baseline calcium intake (less than 1200 mg) had an 11% lower risk of gaining weight when supplemented compared to those who received a placebo. This suggests that calcium and vitamin D may play a role in regulating body weight by affecting hormonal pathways.

Calcium and Vitamin D Deficiency: A Common Problem

Calcium and vitamin D deficiencies are significant public health concerns in the UK, particularly among women. 

Research: Approximately 30% to 80% of the general population globally may experience low levels of these nutrients, with higher prevalence noted in specific groups such as older adults, ethnic minorities, and women of childbearing age. 

Risk Factors for Deficiencies

Several factors contribute to calcium and vitamin D deficiencies:

• Limited sun exposure: Vitamin D is synthesised in the skin through sunlight exposure. Individuals living in northern latitudes or who spend significant time indoors are at higher risk. For example, those with darker skin pigmentation have reduced synthesis capabilities due to lower UV absorption 5.
• Dietary factors: A diet low in dairy products or fortified foods can lead to inadequate calcium intake. Vegetarians and vegans may also struggle to meet their calcium needs if they do not consume fortified alternatives 23.
• Age and gender: Postmenopausal women face increased risk due to decreased oestrogen levels, which negatively affect calcium absorption and bone density. Studies show that around 30% of postmenopausal women in Europe have osteoporosis .

Health Consequences of Deficiencies

The health implications of calcium and vitamin D deficiencies are profound. These includes: 

• Bone health: Insufficient intake can lead to osteoporosis, increasing the risk of fractures. Osteoporosis affects millions globally, particularly postmenopausal women 12.
• Muscle weakness: Vitamin D deficiency has been linked to muscle weakness and falls in older adults, which can further complicate weight management efforts.
• Chronic diseases: Low levels of these nutrients are associated with various chronic diseases, including cardiovascular disease, diabetes, and certain cancers.

Strategies for Increasing Calcium and Vitamin D Intake

Dietary Adjustments

Incorporating calcium and vitamin D-rich foods into the diet is essential. Some calcium and vitamin D rich food includes: 

• Calcium sources:
  
  • Dairy products (e.g., milk, yoghourt)
  • Leafy greens (e.g., kale, broccoli)
  • Fortified foods (e.g., almond milk, orange juice) .
• Vitamin D sources:
  
  • Fatty fish (e.g., salmon, mackerel)
  • Fortified foods (e.g., cereals)
  • Egg yolks.

Supplementation

When dietary sources are insufficient, supplements may be necessary:

• Calcium supplements: Recommended for individuals unable to meet their dietary needs. The RDA for women over 50 is approximately 1,200 mg/day.
• Vitamin D supplements: Particularly important during winter months or for individuals with limited sun exposure. The recommended daily allowance ranges from 400 to 800 IU, depending on age and health status.

Sun Exposure

Safe sun exposure is crucial for vitamin D synthesis:

• Aim for about 15-30 minutes of sunlight exposure several times a week while considering skin type and geographic location.
• Use sunscreen after this period to prevent skin damage while still allowing for some vitamin D production.

‍

Alt text:A rustic table showcasing a variety of calcium sources, including dairy, leafy greens, and legumes, arranged appealingly for a healthy meal, with SheMed logo at the corner.

Addressing Common Concerns: Calcium and Vitamin D

Dairy-Free Options

If you are avoiding dairy products, there are numerous alternatives that provide adequate calcium and vitamin D:

• Fortified Plant-Based Milks:
  
  • Soy Milk: One cup of fortified soy milk contains about 300-450 mg of calcium, comparable to cow's milk. It is also often fortified with vitamin D, providing around 2.7-3.0 mcg (108-120 IU) per cup 13.
  • Almond Milk: Enriched almond milk can provide up to 450 mg of calcium per cup and about 2.4 mcg (96 IU) of vitamin D 34.
• Calcium-Rich Foods:
  
  • Chia Seeds: One ounce (about 2 tablespoons) contains approximately 179 mg of calcium. These seeds can be easily added to smoothies or oatmeal.
  • Tofu: Depending on the brand and preparation, tofu can contain between 275-861 mg of calcium per half-cup if made with calcium sulphate.

Interactions with other medications

Calcium and vitamin D can interact with certain medications, which is important for individuals taking these drugs:

• Antibiotics: Calcium can interfere with the absorption of certain antibiotics, such as tetracycline and ciprofloxacin. It is advisable to take these medications at least two hours apart from calcium supplements or high-calcium foods.
• Thyroid medications: Calcium can also affect the absorption of thyroid medications like levothyroxine. Patients are often advised to separate the intake of these medications from calcium-rich foods or supplements by at least four hours.

Individual needs

Calcium and vitamin D requirements can vary based on several factors:

• Age and gender: Women over 50 require about 1,200 mg of calcium daily and between 800-1,000 IU of vitamin D. Younger women aged 19-50 need about 1,000 mg of calcium and 400-800 IU of vitamin D.
• Lifestyle factors: Individuals who are physically active may have higher needs due to increased bone turnover and muscle function requirements. For example, athletes might benefit from higher intakes to support their training regimens.
• Health conditions: Conditions such as osteoporosis or malabsorption syndromes (e.g., celiac disease) may necessitate higher intakes of these nutrients. Clinical studies have shown that postmenopausal women with osteoporosis benefit from calcium and vitamin D supplementation in reducing fracture risk.

Conclusion

Calcium and vitamin D are more than just nutrients for strong bones—they are essential allies in your weight loss journey. Addressing potential deficiencies can enhance muscle function, improve metabolism, and support hormonal balance, making your weight loss efforts more effective. If you’ve been struggling to see results despite your best efforts, consider whether your body is getting enough of these key nutrients.

Ready to take the next step toward healthier weight loss? Start by making small dietary adjustments or exploring supplementation. If you found this article helpful, share it with others who might benefit or get in touch with us for personalised advice. 

Frequently Asked Questions

1. Why are calcium and vitamin D important for weight loss?

Calcium and vitamin D play crucial roles in supporting metabolic processes that influence weight management. Calcium helps with fat breakdown and reduces fat storage, while vitamin D improves calcium absorption and may regulate hormones that affect weight, such as insulin.

2. Can a vitamin D deficiency slow down my weight loss progress?

Yes, vitamin D deficiency can impact your ability to lose weight. Studies have shown that lower vitamin D levels are linked to increased body fat and difficulty losing weight. In the UK, due to limited sunlight, many women may be at risk of deficiency, which can slow down metabolic function and make it harder to burn fat.

3. What are the best dietary sources of calcium and vitamin D?

For calcium, dairy products like milk, cheese, and yoghourt are excellent sources. For vitamin D, oily fish (such as salmon), fortified foods (like cereals and plant-based milks), and eggs can help. In the UK, given the limited sun exposure, many women may need to consider supplements to meet their vitamin D needs.

4. How much calcium and vitamin D should I be consuming for weight loss?

For women in the UK, the recommended daily intake is 700mg of calcium and 10 micrograms of vitamin D. If you are on a weight loss plan, it’s essential to ensure you’re getting enough of both to support your efforts. However, individual needs may vary, so it’s best to consult with a healthcare provider.

5. Should I consider taking supplements to increase my calcium and vitamin D levels?

If you're struggling to get enough calcium and vitamin D from your diet, supplements may be necessary—especially during the winter months when sunlight exposure is limited. A healthcare professional can guide you on the correct dosage to support your weight loss goals without over-supplementing.

6. Can too much calcium or vitamin D cause problems?

Yes, taking excessive amounts of calcium or vitamin D can lead to health issues. High calcium levels can cause kidney stones, while too much vitamin D can lead to hypercalcemia (elevated calcium levels), which may cause nausea, weakness, and kidney damage. It’s important to stay within the recommended guidelines and consult a doctor before starting supplements.

7. Are there any risks of not getting enough calcium and vitamin D while trying to lose weight?

Yes, deficiencies in calcium and vitamin D can affect not only your weight loss progress but also your overall health. Insufficient calcium can weaken your bones, while low vitamin D levels can impair your immune system, muscle function, and metabolism, making it harder to lose weight and stay healthy.

8. Can calcium and vitamin D support muscle function during weight loss?

Absolutely. Both nutrients are essential for muscle health. Calcium supports muscle contractions, while vitamin D improves muscle strength and function. Ensuring adequate intake of these nutrients can help maintain muscle mass during weight loss, which is key for a healthy metabolism.

9. What are some dairy-free sources of calcium and vitamin D for women avoiding dairy products?

For calcium, consider fortified plant-based milks (such as almond or soy milk), leafy greens (like kale and broccoli), tofu, and almonds. For vitamin D, look for fortified cereals, mushrooms, and supplements, especially if you're not getting enough sun exposure.

10. Should I focus more on calcium or vitamin D for weight loss?

Both nutrients are essential, but vitamin D may have a more direct impact on metabolism and fat storage. However, since calcium relies on vitamin D for absorption, it’s crucial to balance both in your diet to optimise weight loss and overall health.

References:

1. Institute of Medicine/Food and Nutrition Board. (2013). Dietary Reference Intakes for Calcium and Vitamin D. PubMed. https://pubmed.ncbi.nlm.nih.gov/30313003/ 1
2. Bianchi, M. L. (2022). Vitamin D and Calcium Supplementation in Osteoporosis: A Narrative Review. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9944083/ 2
3. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Osteoporosis. https://www.nice.org.uk/cks-uk-only 3
4. McGowan, J., et al. (2014). Vitamin D and calcium supplementation in the prevention of osteoporosis: a systematic review. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4010554/‍
5. Nutrition Society. (2021). Vitamin D and Immunity: Q&A. https://www.nutrition.org.uk/media/1tuj1zrs/vitamin-d-and-immunity_qa.pdf#:~:text=Almost%201%20in%205%20UK%20adults%20aged%2019,risk%20of%20osteomalacia%20%28adults%29%20and%20nutritional%20rickets%20%28children%29