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Welcome to our first full-length episode in our 12-part series, “Anything Meds Can Do, You Can Do Better.” Today we talk about Decreased Incretin Effect. This is a core problem in type 2 diabetes. We break down what it means, why GLP-1 and GIP medicines are so popular, what they do in your body, side effects, cost, and simple ways you can boost your incretin effect without meds.

Hosts:

• Amber Wilhoit, RD/LD, CDCES
• Richie Wilhoit, TRS-C

Note: This episode focuses on type 2 diabetes. Type 1 diabetes is different. Type 1 is an insulin deficiency from an autoimmune process.

• The incretin effect is your gut telling your pancreas, “Food is coming—make insulin now.”
• In type 2 diabetes, the incretin effect is weaker. This is called Decreased Incretin Effect.
• GLP-1 and GIP medicines (like Ozempic, Mounjaro, and Wegovy) help by slowing stomach emptying, calming hunger, and helping the pancreas release insulin when food is present.
• These meds can help with blood sugar and weight. But there are side effects and costs.
• You can also boost your incretin effect with food and lifestyle.
• The goal: use meds wisely (if needed), then build habits so your body does it better over time.

• When you eat, your gut releases hormones called GLP-1 and GIP.
• These hormones tell your pancreas to release insulin quickly and more efficiently.
• Fun fact: The body makes more insulin when sugar is eaten by mouth than when sugar is given by IV. That’s because the gut hormones kick in when you eat.

• In type 2 diabetes, the incretin effect is not as strong.
• Your body may make less GLP-1 and GIP or not respond to them well.
• Result: slower insulin release after meals and bigger blood sugar spikes.

• Brand names mentioned: Ozempic, Wegovy, Mounjaro
• What they do:
  • Slow gastric emptying (food leaves the stomach more slowly)
  • Help your pancreas release insulin when glucose is present (glucose-dependent)
  • Act on brain hunger and fullness signals (ghrelin and leptin)
• Why this can be helpful:
  • Lower after-meal blood sugar spikes
  • Less hunger, more fullness
  • Possible weight loss
  • Possible protection of beta cells (insulin-producing cells)
  • Some heart and kidney benefits have been shown in people with type 2 diabetes

• Weight loss effects and appetite control make them appealing.
• Social media and celebrity buzz add to demand.
• There were shortages of FDA-approved products. That opened the door for a 503A exemption, where compounding pharmacies can make versions. These may vary in purity and potency and are not FDA-approved versions.

Note: We are sharing what we discussed on the show. Always talk with your own healthcare team about risks and benefits.

• Brain: Less hunger. You feel full sooner.
• Stomach: Food empties more slowly. This can reduce after-meal blood sugar spikes.
• Pancreas: Releases more insulin, but only when food/glucose is present. This is why these drugs have a lower risk of causing low blood sugar in people not using insulin.

• Nausea and vomiting (most common)
• Diarrhea
• Dehydration (can stress the kidneys)
• Slow stomach emptying can be a risk if you are going under anesthesia (talk to your care team before procedures)

Amber shared a serious case reported where slowed gut movement led to backup and aspiration during anesthesia. This is rare but important to know. Always tell your surgical team if you take these meds.

• Some people see “rebound” weight gain when they stop, especially if they did not build strong habits while on the meds.
• You can lose muscle mass if you eat too little protein/calories, which can slow metabolism and make weight regain more likely.
• There is a concern that your body may downregulate its own GLP-1 production while on the medicine. If you stop, you may need time and habits to rebuild your natural signals.
• Best path: Use meds (if needed) plus nutrition, movement, sleep, and stress tools. The goal is to transition to lifestyle as your main therapy when safe and possible.

• With type 2 diabetes and insurance: many pay about $25–$200/month.
• Without coverage: list price can be about $950–$1,350/month.
• Compounded versions (during shortages) may be offered at lower prices, like ~$270–$400/month or ~$4,500/year. These are not FDA-approved versions and can vary in purity and potency.
• Actual costs vary a lot. Your doctor may need prior authorization.

Remember our series theme: “Anything Meds Can Do, You Can Do Better.” These habits can support GLP-1 and GIP, lower after-meal spikes, and improve insulin sensitivity.

Food:

• Fermented foods: kimchi, kombucha, sauerkraut
• High fiber: whole grains, beans, lentils, veggies, fruit with skin
• Resistant starches: cooled potatoes, green bananas, cooled rice, oats
• Protein at each meal: eggs, fish, poultry, tofu, Greek yogurt, beans
• Healthy fats: omega-3s (salmon, chia, flax), nuts, seeds, olive oil
• Colorful, antioxidant-rich foods: berries, leafy greens, peppers

Lifestyle:

• Move daily: walking, strength training, and activity after meals help lower glucose spikes
• Build muscle: muscle is metabolically active and improves insulin sensitivity
• Sleep 7–9 hours: poor sleep raises hunger and insulin resistance
• Manage stress: breathing, prayer, mindfulness, or time in nature

Weight loss (if advised by your care team) can restore insulin sensitivity and improve Decreased Incretin Effect.

Pro tip: Combine protein + fiber + healthy fat at meals. Eat slowly. These steps can reduce big after-meal sugar spikes.

• This episode is about type 2 diabetes and Decreased Incretin Effect.
• People with type 1 diabetes usually have very low insulin production from an autoimmune process. In some rare cases, a person can have type 1 and also develop type 2 features. Work closely with your care team.

• Decreased Incretin Effect is a core defect in type 2 diabetes.
• GLP-1/GIP meds can help blood sugar, fullness, and weight, with some added heart and kidney benefits shown in type 2 diabetes.
• Side effects can include nausea, vomiting, diarrhea, dehydration, and risks with anesthesia. Always tell your provider.
• Costs can be high. Insurance coverage varies. Compounded versions are not the same as FDA-approved products.
• Habits are the foundation. Build food and lifestyle skills so you are not dependent on the medicine long term.

• Do I have Decreased Incretin Effect?
• Would a GLP-1/GIP medicine help me now?
• What dose and what side effects should I watch for?
• How should I change my eating, protein, and strength training to protect muscle?
• Do I need to stop this medicine before a procedure or anesthesia?
• What is my plan to step down off the medicine in the future?

Part 2 in the core defects series: renal glucose reabsorption. We’ll talk about SGLT-2 medicines like Farxiga, Jardiance, and Invokana—and how lifestyle can help here too.

• Drop your questions in the comments. We’ll do our best to answer.
• Like and subscribe so more people can learn at no cost.
• Our mission: to shift the national focus from type 2 diabetes management to remission

• Amber Wilhoit, RD/LD, CDCES: Registered dietitian and certified diabetes care and education specialist.
• Richie Wilhoit, TRS-C: Co-host and curious question-asker, learning right along with you.

Disclaimer:

The information in this podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.

Results vary from person to person. Examples, statistics, or studies are shared to educate, not to promise outcomes. Any discussion of medications, dosing, or side effects is general in nature and may not be appropriate for your specific situation. Do not ignore professional medical advice or delay seeking it because of something you read or heard here. If you think you are experiencing an emergency or severe side effects (such as persistent vomiting, severe diarrhea, signs of dehydration, allergic reaction, or symptoms of lactic acidosis), call your local emergency number or seek urgent care right away.

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