Unveiling Semaglutide and Embracing a Dynamic Duo (Chapter 5)

Introduction:  

Over the years, the adoption of low carbohydrate eating plans has gained significant popularity due to their potential health benefits.  When combined with the use of medications such as semaglutide, a glucagon-like peptide-1 receptor agonist used to manage type 2 diabetes, a 5 net carb eating plan can provide remarkable results. This blog post aims to explore why a low-carbohydrate diet, specifically limiting net carb intake to 5 grams per meal works exceptionally well in conjunction with semaglutide, by elucidating the underlying physiological mechanisms involved.   

Understanding Net Carbs:  

Before delving into the physiological aspects, it is crucial to comprehend the concept of net carbs. Net carbs are the carbohydrates that significantly impact blood sugar levels, as they are the total carbohydrates minus dietary fiber and sugar alcohols. Dietary fiber and sugar alcohols are not fully digested and absorbed by the body. The reason for this is dietary fiber, a non-digestible carbohydrate, lacks the enzymes necessary for complete breakdown in the small intestine, leading to limited absorption into the bloodstream, thereby preventing significant blood sugar spikes. Sugar alcohols, like sorbitol and erythritol, are incompletely absorbed in the small intestine and are not efficiently metabolized, resulting in minimal impact on blood sugar levels compared to regular carbohydrates.  

Why 5 net carbs?  Stabilize blood sugar levels, decrease excess storage of glucose/glycogen, stop the conversion of glucose into fatty acids, improve insulin sensitivity and promote fat metabolism. The normal concentration of glucose in the bloodstream is tightly regulated within a narrow range. In general, a healthy adult typically holds approximately 0.7 to 1 gram of glucose per liter of blood. Given that the average adult has about 5 liters of blood, we can estimate that the blood stream only holds approximately 5 grams of glucose. When you consume carbohydrates, it quickly converts to glucose in your bloodstream.  If you convert glucose beyond the body's immediate energy needs, the excess is stored in the liver and muscles as glycogen.  Once the storage capacity is full of glycogen, excess glucose now becomes a fatty acid and is deposited inside your fat cells. It is important to note that this is an average approximation, and blood glucose levels can vary depending on factors such as age, health, and physical activity.  

The Mechanisms of Semaglutide:  

Semaglutide is a medication that falls under the class of glucagon-like peptide-1 receptor agonists (GLP-1 RAs). It works by mimicking the effects of the body's natural hormone GLP-1, which is involved in glucose metabolism and regulation of appetite.  Semaglutide stimulates the release of insulin from pancreatic beta cells, reduces glycogen secretion from the liver, slows down gastric emptying, and promotes satiety.  

Synergistic Effects of a 5 Net Carb Eating Plan and Semaglutide:  

1. Improved Glycemic Control: By limiting net carb intake to 5 grams, a low carbohydrate eating plan minimizes the postprandial rise in blood glucose levels. This reduction in carbohydrates, coupled with the blood glucose-lower effects of semaglutide, leads to improved glycemic control. The combination helps regulate insulin release, prevent insulin resistance, and helps to isolate fatty acids as the required form of energy to be utilized.  
2. Decrease Insulin Resistance: Insulin resistance is a condition in which the body’s cells become less responsive to the effects of insulin. One of the main reasons this occurs is over consumption of carbohydrates. Both a low carbohydrate eating plan and semaglutide use support the decrease of insulin resistance. A low carbohydrate diet decreases insulin resistance by reducing the body’s reliance on glucose as a primary fuel source, leading to lower blood sugar levels. Semaglutide lowers insulin resistance by enhancing insulin secretion, improving the glucose uptake by cells and by reducing glycogen release from the liver. These two aspects of eating and medication provide a synergistic response for optimal fat mobilization and weight loss.  
3. Enhanced Satiety: Appetite and Craving Control: Low-carbohydrate diets tend to increase satiety levels, leading to reduced food cravings and overall calorie intake. Semaglutide further augments this effect by slowing down gastric emptying and increasing the feeling of fullness.   
4. Increase Ketone Production: 5 net carbs and semaglutide can induce a state of ketosis, wherein the body primarily uses ketones as an alternative energy source.  Ketones are produced in the body through a process called ketogenesis, where fatty acids are broken down in the liver to generate ketone bodies as an alternative fuel source.  A 5 net carb eating plan achieves this by depleting glycogen levels in the body and prompts the liver to metabolize fats.  Semaglutide does not directly induce a ketogenic state but provides a supporting role to optimize a low carb eating plan.  This is achieved primarily by affecting appetite-regulating hormones which lead to decreased cravings for carbohydrate-rich foods.  Additionally, semaglutide decreases the release of glycogen from the liver into the blood which further pushes the reliance of the body onto the utilization of fatty acids for energy.   

In Summary:  

It is important to note that eating a high carbohydrate diet will limit the effectiveness of semaglutide and your weight loss efforts because it will lead to elevated blood sugar levels and insulin resistance counteracting the metabolic benefits provided by semaglutide.  

Combining a 5 net carb eating plan with the use of semaglutide can optimize fat loss through several key mechanisms. Firstly, a low-net carb diet restricts the intake of rapidly digestible carbohydrates, helping to stabilize blood sugar levels and reduce insulin spikes, which in turn promotes fat utilization as an energy source. Secondly, semaglutide, a GLP-1 receptor agonist, enhances satiety, reduces appetite, and slows down gastric emptying, leading to reduced calorie intake.  

Additionally, the synergistic effects of a low-carb diet and semaglutide will further improve insulin sensitivity and decrease overall calorie consumption, creating a favorable environment for sustained fat loss. This combination can help individuals effectively manage their weight, achieve better glycemic control, and optimize fat loss, leading to improved overall health and well-being.   

This combination of 5 net carbs and semaglutide can be particularly beneficial for individuals with diabetes, pre-diabetes, poly cystic ovarian disease (PCOS), carbohydrate addiction disorder, cardiovascular disease, fatty liver disease, and metabolic syndrome.   

As always consult with qualified healthcare professionals for personalized advice, care, and service. 

Author

David J. Bauder, PA-C David Bauder, PA-C, is a certified physician assistant and the assistant medical director at Weight Loss and Vitality in Manassas and Alexandria, Virginia, Washington, DC; and Gaithersburg, MD. He enjoys helping patients optimize their physical and mental health to improve their overall well-being. He earned his physician assistant degree from the University of Texas Health Science Center at San Antonio. Afterward, he gained admission into the reputable graduate program for physician assistant studies at the University of Nebraska Health Science Center in Omaha. David has over 26 years of experience working as a physician assistant. He’s practiced in podiatry, family medicine, emergency medicine, general surgery, urgent care, and functional medicine.