As plan sponsors consider the costs and efficacy of GLP-1 drugs, they should not ignore alternatives
In the quest to manage diabetes and regulate blood sugar, GLP-1 drugs like Ozempic, Mounjaro, and Wegovy have garnered significant attention for their ability to improve insulin sensitivity, curb hunger, and promote weight loss. Secretins and similar diabetes medications represent the largest increase in drug spending in Canada in 2023.i Diabetes medications are now the top category for drug claims in Canada.
There are alternatives and complements to medications out there. From herbs to modern insights into the gut-brain connection, these natural alternatives are gaining momentum as viable, science-backed strategies for controlling blood sugar and potentially losing weight.
GLP-1 drugs work by enhancing insulin secretion, slowing gastric emptying, and reducing appetite. Potential natural alternatives therefore must work on one or more of these pathways, which combined can improve blood sugar regulation and potentially lead to weight loss in those with type 2 diabetes.
For plan sponsors seeking to cover obesity and diabetes, these alternatives can offer a worthy contrast or complement to pharmaceutical solutions.
Dietary fibre and resistant starch
Dietary fibre, particularly soluble fibre and resistant starch, can mimic some of the effects of secretins by slowing digestion, improving insulin sensitivity, and creating a sensation of fullness.
Soluble fibre is found in whole grains such as oats as well as legumes, and seeds like chia and flaxseed. It slows the absorption of sugar into the bloodstream. This can reduce post-meal blood sugar spikes, helping maintain stable glucose levels.
Resistant starches, found in foods such as cooked and cooled potatoes and legumes, resist digestion in the small intestine and ferment in the colon. This fermentation process promotes the production of short-chain fatty acids (SCFAs) like butyrate, which have been shown to improve insulin sensitivity and promote GLP-1 secretion.
Psyllium powder is a common supplement form of both resistant starches and soluble fibres, and research supports its role in both weight lossiii and glycemic control.iv
Clinical studies have demonstrated that a diet high in resistant starch improved insulin sensitivity and increased GLP-1 levels in individuals with insulin resistance.v Additionally, fibre-rich diets are strongly associated with improved glycemic control and reduced risk of type 2 diabetes. Soluble fibres and resistant starches are also safe to be used alongside diabetes medications.
Berberine
Berberine, a bioactive compound found in several plants, has been extensively studied for its glucose-lowering effects. Berberine activates a key regulator of glucose metabolism. It also appears to enhance insulin sensitivity and reduce glucose production in the liver, similar to the actions of metformin — another common diabetes medication.
A meta-analysis of clinical trials found that berberine significantly lowered fasting blood glucose, HbA1c, and insulin resistance in people with type 2 diabetes.vi Some studies suggest berberine may also promote GLP-1 secretion, enhancing insulin response following meals.vii Those who are on medications that make them at risk of hypoglycemia should use caution when considering berberine supplementation.
Probiotics and gut health
Gut health is increasingly recognized as a key factor in glucose metabolism. Certain probiotic strains have shown promise in regulating blood sugar by modulating gut microbiota and promoting the release of GLP-1.
Lactobacillus rhamnosus and Bifidobacterium animalis have been specifically studied for their role in enhancing GLP-1 secretion.viii Fermented foods like kimchi, kefir, and sauerkraut, which are rich in probiotics, can improve gut health and influence glucose regulation by enhancing the gut-brain axis and stimulating incretin hormones like GLP-1. Several of these foods also contain fibre, which can increase this effect. The role of probiotics in weight loss is being studied, with some promising results.
Probiotics are generally safe for those with diabetes.
Exercise and physical activity
Regular physical activity is one of the most effective natural ways to improve insulin sensitivity and regulate blood sugar. Both aerobic exercise and resistance training enhance glucose uptake by muscles and increase insulin sensitivity. Moreover, exercise has been shown to increase GLP-1 secretion in response to meals.
Research has found that both short-term and long-term exercise interventions increase GLP-1 levels, improve insulin sensitivity, and reduce post-meal glucose levels in people with type 2 diabetes.ix
Physical activity also aids weight loss and weight maintenance, and can help to offset muscle mass lost in those who are taking GLP-1 secretions.
While GLP-1 medications are effective for managing diabetes and promoting weight loss, several natural alternatives can offer similar benefits by improving insulin sensitivity; regulating supplements and lifestyle interventions such as exercise provide safe and effective ways to support glucose metabolism and potentially reduce reliance on pharmaceuticals. They may warrant further exploration as plan sponsors build out GLP-1 coverage.
Lisa Spriet is a registered dietitian, Master of Science, Food and Nutrition. Passionate about nutrition and building her own signature programs, Lisa co- founded NutriProCan in 2015, a company that strives to change lives through nutrition. NutriProCan offers registered dietitians’ services to individuals and groups throughout Canada.
