In this episode of the Eye – Q Podcast, Dr. Rudrani Banik welcomes Ashley Koff, a renowned registered dietitian and founder of the Better Nutrition Program, to discuss the pivotal role of GLP-1 medications in managing diabetes, weight loss, and metabolic health. With her extensive experience in personalized nutrition, Ashley delves into how GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) are transforming diabetes management, and why eye care professionals should consider these medications’ effects on overall health, including eye health. The conversation explores how these treatments work, their potential impact on ocular health, and how nutrition and lifestyle choices can optimize their benefits.

GLP-1 (glucagon-like peptide-1) is an incretin hormone that plays a critical role in regulating insulin and glucose metabolism. In healthy individuals, GLP-1 is released after food consumption, particularly in response to proteins and fats, signaling satiety and stimulating insulin secretion. However, in many patients, especially those with diabetes, GLP-1 signaling can be dysfunctional or delayed.

Dr. Rudrani Banik, an integrative neuro-ophthalmologist, explains, “The GLP-1 hormone acts like a switch, activating a cascade of metabolic processes that regulate hunger, insulin production, and blood sugar control. Unfortunately, for many people, that switch is either delayed or suppressed due to diet, genetics, or environmental factors.”

GLP-1 receptor agonists are synthetic versions of the naturally occurring GLP-1 hormone. These medications work by mimicking the effects of GLP-1 in the body, leading to enhanced insulin secretion, reduced glucagon production, and increased satiety, thereby improving blood sugar control and promoting weight loss. This is particularly beneficial for individuals with Type 2 diabetes, who often struggle with insulin resistance.

Ashley Koff, a registered dietitian and founder of the Better Nutrition Program, shares, “GLP-1 medications are essentially a 24/7 supply of the GLP-1 hormone. While the body’s natural release of GLP-1 occurs briefly and only when food is present, these medications flood the system, leading to sustained metabolic effects. This is why people experience weight loss and improved blood sugar control.”

However, as Dr. Banik points out, “The flood of GLP-1 signaling can sometimes overwhelm the body, leading to side effects such as gastrointestinal distress or even delayed gastric emptying. For some patients, this can also affect nutrient absorption, which is crucial for eye health.” This brings us to the importance of considering the full range of effects GLP-1 medications can have on patient health, particularly in managing chronic conditions such as diabetic retinopathy.

One of the primary concerns with poorly managed diabetes is its impact on the eyes, particularly in the development of diabetic retinopathy. High blood sugar levels lead to blood vessel damage in the retina, which can result in vision loss. GLP-1 receptor agonists help lower blood glucose levels, which can directly benefit patients with diabetic retinopathy by reducing the likelihood of further damage to the retinal blood vessels.

However, there is emerging research suggesting potential risks associated with GLP-1 medications. For example, a recent study indicated a possible link between GLP-1 use and an increased risk of an eye stroke, or optic neuropathy, especially in individuals with pre-existing anatomical risk factors such as a crowded optic nerve. This study, published in a large Massachusetts database, highlights the need for eye care professionals to be vigilant when treating patients on GLP-1 medications.

Dr. Banik notes, “While GLP-1 medications can improve glycemic control and reduce the progression of diabetic retinopathy, there is emerging evidence that they may be associated with a type of eye stroke. It’s crucial for eye care professionals to monitor patients on these medications closely and consider their individual risk factors.”

While GLP-1 medications offer significant benefits, they are not a cure-all. Patients taking these medications should also focus on optimizing their overall health through dietary changes, physical activity, and gut health. Ashley Koff highlights the importance of this comprehensive approach: “GLP-1 medications can act as a powerful tool, but they are not a substitute for the foundational work that needs to happen with nutrition, digestion, and lifestyle changes.”

Koff emphasizes the role of better nutrition in supporting the body’s natural GLP-1 production: “By improving digestion and ensuring the body has the nutrients it needs, patients can enhance their metabolic switch and optimize the effectiveness of GLP-1 medications.” Furthermore, she stresses that practitioners should not overlook gut health when managing patients with diabetes, as the gut plays a pivotal role in GLP-1 production.

For eye care professionals managing patients on GLP-1 receptor agonists, a holistic, patient-centered approach is essential. Here are some practical steps to consider: