Microdosing GLP-1s

The Big Picture

GLP-1 medications have gained attention for their effectiveness in supporting weight loss. Unfortunately, the side effects can be a roadblock for some.  Others are concerned by long term impact of taking the medication, while others are no longer enjoying the benefits of the medication and are slowly gaining the weight back.  Regardless of the reason, some people are trying microdosing of the medication.  Simply put, this is just taking smaller, flexible doses, often through compounded versions of these medications—to minimize side effects while still reaping benefits.  If you’re on weight loss medication, it’s essential to talk with your clinician before making any changes to your dose.

What is Microdosing?

Microdosing is just as the name suggests, it means taking a very small amount of a medication compared to the standard dose.

Anytime you microdose you run the risk of not putting enough of a drug in your system to get its benefits, but experimenting with lower doses may provide additional benefits, including fewer side effects. In addition, flexible dosing lets your doctor cater your treatment plan to your individualized needs instead of sticking strictly with the standard dose options.

When we talk about GLP-1s, a microdose is an amount that’s less than what the manufacturer recommends for weight loss. For example, semaglutide goes up to 2.4mg doses, but you could also take .25mg, .5mg, 1mg, or 2mg. Basically what macrodosing is revealing is that many people really don’t need to go to the maximum dose when they’re using GLP-1s for weight loss.

How Microdosing GLP-1s Works: Mechanism, Safety, and Evidence

What we noticed with microdosing GLP-1s:

• Reduce side effects: It’s common to experience side effects when taking GLP-1s, especially gastrointestinal issues including nausea, vomiting, and diarrhea. The smaller the dose, the lower the odds of side effects, so microdosing can help someone feel good enough to stay on the medication.
• Support a more tailored approach: No two bodies are the same, also the dose of a medication vary between individuals. By including the option of microdosing, your provider will be able to personalize your treatment plan to your unique needs. For instance, if you’ve reached your goal weight on a GLP-1, a microdose may be appropriate for maintaining your current weight over a long period of time.

The FDA does not currently have guidelines on microdosing GLP-1 medications and it’s clear that more study is needed to understand the risks, benefits, and efficacy of doses that are lower than those recommended by current prescription guidelines. For example, it’s not known yet if microdosing can actually result in the same level of weight loss as standard doses.

If looking to use a GLP-1 for help with weight loss, you will start with what is essentially a micro-dose:  you start on the lowest .25mg dose of semaglutide and then gradually increase the dosing as tolerated, and as needed, as long as it dovetails with your weight loss goals. Once you reach a healthy weight-loss pace, which is one to two pounds a week, you’ll stay at that dose until you achieve your healthy weight goal.

There are many benefits from this approach.  It puts the person in the driver seat as we tailor diet and lifestyle changes to current long term, sustainable results.

We work together to develop a plan where you see lifelong changes.

Who Might Consider Microdosing GLP-1s (and Who Shouldn’t)

GLP-1s in general are typically recommended and usually only covered by insurance for people with obesity (defined as a BMI greater than 30) as well as those with a BMI greater than 27 and one or more weight-related conditions like high cholesterol, high blood pressure, or type 2 diabetes.

This can be frustrating because many experts realize that BMI is an imperfect measurement and these cut-offs unfortunately leave out many people whose health would benefit from weight loss. The compounded versions of the drug often are a great solution as they are more affordable and also offer more flexibility in dosing. The dosing can be customized— allowing better control with micro-dosing.

Restoration Healthcare offers a compounded version through reputable, strictly-regulated pharmacies. Our pharmacy conducts third-party testing, which means that their products are inspected for quality by an organization not involved with the pharmacy. Our pharmacy is also certified to provide sterile compounding, so you don’t need to worry about contaminated medication. We want all patients to have access to reliable and effective treatment, at a lower cost, with a reliable, available supply.

Who shouldn’t take them, regardless of their weight or related health problems? People who have severe gastrointestinal conditions like inflammatory bowel disease (IBD) or gastroparesis should not go on GLP-1s, and neither should people with a personal or family history of multiple endocrine neoplasia 2A, multiple endocrine neoplasia 2B, medullary thyroid cancer, or pancreatitis. If you have issues like inflammatory bowel disease, pancreatitis, and gastroparesis you should discuss with our clinician what is right for you. People who are pregnant or trying to conceive should not take GLP-1 medications.

If you rule out the above and are cleared to take GLP-1s, you still won’t know if the drug is working for you (at either standard doses or a microdose) until you start taking it. You essentially need to try the medication out so your provider can see how quickly you’re losing weight. We work with you to develop the right dosing and plan for you to lose the weight to reach your goal while working on underlying conditions.

You might also consider microdosing if you’ve reached your goal weight and want to reduce the amount of drugs in your system. For some, the time spent on GLP-1s has supported a change in habits and lifestyle that can help them maintain their weight loss on a low dose.

GLP-1 Microdosing vs. Traditional Weight-Loss Medications: How Do They Compare?

GLP-1s are more effective than other weight-loss drugs, resulting in more weight loss and keeping the weight off. For example, semaglutide can help you lose 15% of your weight in 68 weeks, while an older drug, Contrave, has been shown to result in closer to a 5% weight loss.

But those statistics are based on the maximum dose of semaglutide. Because there haven’t been studies done on smaller doses of GLP-1s, it’s hard to say for sure how they stack up. That said, if you’re microdosing a GLP-1 under guidance of a knowledgeable provider, they will ensure you are still hitting your one-to-two pound weekly weight loss even on a smaller dose.

While GLP-1s can be more effective than lifestyle changes alone, including changes to your diet and increasing physical activity, it’s worth noting that the best approach to using GLP-1s is to combine them with those healthy habits. The goal is to help maintain healthy muscle while on the GLP-1 medication. This is why we work closely with you to develop a plan to help you move forward leading to lifelong change.

Beyond Weight Loss: Other Emerging Uses of Microdosing in Healthcare

Microdosing is an area of research that is showing more and more promise. Taking smaller-than-standard amounts of a wide range of drugs may help with depression, anxiety, autoimmune disorders, and more.

With GLP-1s, microdosing has been identified as a potential way to help patients with addiction. The drugs have been shown to address other addictive behaviors in early studies.

There are also a growing number of people interested in microdosing GLP-1s for longevity. Because GLP-1s help flatten the glucose curve and decrease inflammation, which are both linked to longevity people are excited about the increased energy and mobility they experience while macrodosing.

While nobody can say for sure what the future of microdosing GLP-1s holds, RH is dedicated to staying updated on the best practices as evidence emerges.

Frequently Asked Questions 

How can I increase my GLP-1 naturally?

Eating certain foods, like foods high in fiber and unsaturated fat, may naturally stimulate the production of GLP-1s. This food list includes organic whole grains, eggs, avocados, and nuts. However, dietary changes alone cannot raise GLP-1 levels nearly as much as GLP-1 agonist medications.

Can you lose weight on GLP-1 medication?

Yes, research shows GLP-1 medications like semaglutide and tirzepatide can result in weight loss of 15% to 20% (or more).

Does microdosing GLP-1 medications work?

You may not need to take the maximum dose of GLP-1s in order to successfully lose weight and keep it off. Microdosing GLP-1s, which simply means taking anything below the recommended effective dose, can work for many people. Your provider will be able to monitor your weight loss and determine if you are a candidate for GLP-1s, and whether microdosing could be effective for you.

Are GLP-1s safe to take?

Yes, GLP-1s are considered safe to take by the FDA. While there are possible side effects, they tend to be mild-to-moderate, like nausea and diarrhea. There is a potential for more serious side effects, but they are rare.

Who should avoid GLP-1 drugs?

You should not take a GLP-1 drug if you have severe gastrointestinal conditions like inflammatory bowel disease (IBD) or gastroparesis or a personal or family history of multiple endocrine neoplasia 2A, multiple endocrine neoplasia 2B, medullary thyroid cancer, or pancreatitis.

Can you take GLP-1 medication without diabetes? 

Yes, GLP-1 medications are FDA-approved for weight loss in addition to helping manage type 2 diabetes. Providers are able to prescribe semaglutide, tirzepatide, and liraglutide specifically for weight loss in patients without diabetes.

The Takeaway

• Microdosing GLP-1s is when you take a dose below the recommended dose for weight loss. The hope is that by reducing the dose, you can still lose weight and keep it off without the side effects like nausea, vomiting, and diarrhea.
• However, research about these benefits has not been published and there are no national guidelines on the best way to approach microdosing.
• Before you change your dosage in any way, be sure to talk with a well-trained healthcare provider to go over your options and discuss the approach that may be best for your needs. We would love to help you take the next step toward your best life.