Ayurvedic Clinical Support for people on GLP1 medication for Weight loss

Anneliese Hurlock
Clinical Ayurvedic Medicine Student
September 5, 2026

Obesity has become one of the fastest growing health issues in both the US and worldwide. With the numbers of obese people as defined by the body mass index of 30 or higher climbing up to 1 billion in 2022, it is safe to say that we are living in the midst of obesity pandemic.¹ Growing rates of obesity first were noted in the Western countries, however as the Western diet and lifestyle is spreading globally, so are the obesity rates.1 While one of the driving reasons for increased rates of obesity is energy surplus, the nature of obesity epidemic is multifactorial. Modern environment can often be described as obesogenic – one that promotes obesity.1 This is the environment where it is easy to overconsume calorie-dense foods. Calorie-dense and ultra processed foods and beverages are becoming ubiquitous and available. Food companies often manufacture foods that are easy to overeat. In addition to that, both rural and urban areas often lack areas for physical activities.1 More people rely on cars as the main source of transportation. Modern workforce shifting to the offices promoting sedentary lifestyles, while busy work schedules leave little opportunity to active leisure time or planned physical activity. Obesity also has a strong link with socioeconomic factors. The association with lower income and lower levels of education and higher rates of obesity is well-documented worldwide.¹

Additional important factors that play a role in obesity are genetics, endocrine and metabolic aspects.¹

From the point of view of Ayurveda Obesity is caused by many factors that accumulate and aggravate over time. It is important to note that when identifying a disease, Ayurveda traces symptoms. Primarily all diseases in the first stage are typically chronic low grade and untreated, which leads to an accumulation and aggravation that presents in a more recognizable symptom. We call this (PPM Possible Past Mild). Each dosha has a specific and clear pathway to break down each dosha’s disease pathway and how to treat it. For example, Kapha is the dosha primarily to responsible for obesity. Obesity does not happen all of a sudden as recognized similarly to stated above. However, in Ayurveda it starts as PPM, grows in significance to A/A Accumulation and Aggravation and final each acute presentation called Relocation Manifestation and Diversification or RMD. This is greatly important to recognize as Western Nutrition and Ayurvedic Medicine both have greater success by creating individualized long-term support with patient specific focus considering their needs, goals, lifestyle, habits, tendencies for sustainable and supported improvement. For prognosis Ayurvedic Practitioners consider the specific factors that make treating a person easier or more difficult by consideration of their Climate, Constitution, Age, Current Season, Duration of chief complaint, how many doshas are vitiated, and the pathway.

What makes rising rates of obesity a major issue is the associated health risks and co-morbidities. Excess body weight is associated with increased risk of several illnesses including cardiovascular complications, type two diabetes, liver disease, kidney disease, depression, metabolic syndrome, chronic inflammation, infertility, certain types of cancer and more.¹ Besides physiological factors, people living with obesity face psychological difficulties related to weight bias and stigma, societal pressure to fit certain physical standards, and as a result overall decreased quality of life.¹

To date, Western medicine utilizes several weight-loss interventions with varied success rates. Behavioral and lifestyle modification is one of the most common non-medical interventions typically leads to 5-7% weight loss, which is consistent with a significant improvement in metabolic health.^1,2

Diet and lifestyle interventions are typically individualized and include strategies to decrease caloric intake and increase energy expenditure. The focus is typically made to increase both planned physical activity as well as physical activity throughout the day. Diet interventions typically include strategies like portion control, mindful eating, addition of minimally processed foods and reduction of ultra processed foods. Diet interventions also focus on improving the quality of the diet such as limiting salt, saturated and trans fats, added sugars, avoiding alcohol, drinking more water and eating more fruits and vegetables.1 Mindfulness practices as well as cognitive-behavioral therapy have shown to be effective in developing healthier habits that support weight loss.¹

Medical weight loss includes pharmacological and surgical interventions. Surgical interventions are typically reserved for people with severe obesity and comorbidities with unsuccessful history of weight loss through lifestyle modifications and pharmacological weight loss.1 Weight loss medications include a wide variety of drugs with different levels of efficacy and safety. Pharmacological drugs typically work by decreasing appetite altering metabolic rates and/or nutrient absorption.¹ Medication such as naltrexone/bupropion acts as an appetite suppressant resulting in decreased food intake, including emotional eating. The medication has demonstrated significant however modest effects on weight loss.¹ Another type of weight loss medication that has been used for several years is Orlistat – a lipase inhibitor that decreases the absorption of dietary fats. Weight loss results are relatively modest while side effects include severe gastrointestinal symptoms including diarrhea as well as increased risk of fat-soluble nutrients.¹ The newer kind of weight loss medication that is growing in popularity is GLP-1 receptor agonists such as Liraglutide and Semaglutide, and a combined formulary of GLP-1/GIP receptor agonist such as Tirzepatide. This new class of medications works by decreasing appetite, slowing digestion and gastric emptying by binding to a specific G-protein coupled receptors.3 GLP-1 medication has been used for decades to treat type two diabetes due to its ability to lower blood sugars by stimulating insulin production and having protective properties towards pancreatic beta-cells.³

This class of medication has gained quick polarity due to its effectiveness on weight loss compared to the older weight loss medications. Clinical trials indicated weight loss between eight and fifteen percent,⁴ with most weight reduction taking place in the first six months. With the growing popularity of the GLP-1 medications there is a question regarding long-term usage. Clinical trials as well as lived experience of those who tried GLP-1 medication indicate significant weight re-gain if and when the medication is stopped.4 Efforts are made to create supportive practices to help patients on GLP-1 medication maintain weight loss after the medication is stopped. These include behavioral interventions as creating new healthy habits, change in diet and physical activity, as well as Complementary and Alternative Medicine or CAM.

Ayurvedic practices could provide a great support for people on GLP-1 medication and post medication in a variety of ways.⁵

Sluggish digestion is the first stage of weight gain due to a vitation of Kledaka Kapha in the Rasa dhatu of the Annavaha Srota, with no herbal treatment. This evolves to the following two Mild and Transient Overflow of symptions Systemic Swelling, which is the increase of Kapha in the Rasa Dhatu of the Rasavaha Srotas which is treated with Diaphoretics such as Ginger and Basil. Pale complexion and lethargy are next in with Kapha vitiation on the Rakta Dhatu of the Raktavaha Srotas, treated by circulatory stimulants such as Ginger and Cardamom. Next is the presentation of weight gain, due to Avalambaka Kapha in the Medas Dhatu of the Medovaha Strotas. This is treated with Lekhanas such as Guggul and Kutki. Ayurveda proceeds to detail factors that lead to this such as the state of Ojas, Ama, digestion. Ama presents as a coating on the tongue indicating state of digestion and state of absorption of nutrients. Prana, tejas, and Ojas, and Rasas are considered when designing the treatment plan for the patient as well intending to create a realistic path forward based on what is realistic. The consideration of Chakras and the correlation the elements are recognized. A patient is evaluated by their level of consciousness through the gunas. The Gunas, Sattvic, Rajasic, and Tamasic lead us to see the presentation of their state of mind and which of Nadis can be supported in breathwork to potentially cleanse, clear, purify and increase support based on what we know about the elements. Ultimately low agni, eating when full or food is not previously digested, being stressed, distracted, and day time sleeping lead to obesity. See Carka Samhita, Sutra Sthana 21.1-5 “Eight inherent sequelae of obesity: Amongst these, the too obese and too lean physical appearances are considered the most undesirable ones.

The excessively obese have eight inherent defects in them: reduced lifespan, constricted or limited movement (hampered due to loose, tender and heavy fats), reduced sexual activities or impotence (due to small quantity of semen produced and obstruction of the channel of semen by meda dhatu), debility (due to dhatu imbalance), emit bad smell (due to the inherent nature of fatty tissues as well as excessive sweating), profuse sweating (since meda dhatu and kapha are vitiated), and excessive hunger and thirst (due to excessive digestive agni and vayu in the body). Excessive obesity is caused due to over-nourishment as a consequence of the intake of a heavy, sweet, cold and fatty diet, lack of physical exercise, abstinence from sexual intercourse, sleeping during the day, uninterrupted cheerfulness, lack of mental activities, and hereditary/genetic defects. These consequences may lead to an excess of fat (with further accumulation of only fat) and consequent depletion of dhatu.”⁶ In-person residential centers around the world are available to support patients for short to long term stays. Panchakarma practices are in place here and overseen by medical professionals who monitor treatments such as purgation, abhyhanga, shirodhara, lepas, and bastis. These treatments vary in intensity depending on the state of the patient and can last for weeks at a time. Support from a practitioner before and after.

“Due to the obstruction of body channels by meda dhatu, the movement of vata is specially confined to koshtha (abdominal viscera) resulting in the stimulation of digestive power and absorption of food. Hence,the person digests food quickly and becomes a voracious eater. By not following rules of taking meals at specific times during the day, he is afflicted by dreadful diseases. Agni (pitta component responsible for digestion) and vata are the two most troublesome factors from the standpoint of obesity. These factors blight an obese person as wildfire destroys a forest. As the body gains excessive fat, vitiated dosha suddenly cause severe diseases resulting in rapid deterioration of life. The person is considered too obese when there is an excessive increase in fat and muscle tissue in the regions of buttocks, abdomen, and breasts, which become pendulous and suffer from deficient metabolism and energy. These are the causes, signs, and symptoms of an obese person”.⁷

Another area of concern regarding GLP-1 medication are the side effects. Those typically include gastrointestinal symptoms. Most common gastrointestinal symptoms are nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain and abdominal distention.⁴ In addition, early satiety and decreased appetite may lead to nutrient deficiencies and malnutrition. Rapid weight loss may result in loss of lean body mass including muscle and bone tissue. Inadequate nutrient intake may lead to vitamin and mineral deficiencies that may manifest in changes in appearance such as hair loss.⁴

Western evidence-based nutrition approach proposes several interventions to address those risks. GLP-1 medication is recommended to always be combined with nutrition and lifestyle interventions.

Administration of lower dose of the medication and gradual increase of the dose help reduce risk of rapid weight loss.4 The requirements of several nutrients are increased for patients taking GLP-1 medication. Specifically, people on GLP-1 therapy should aim to have adequate protein intake to support muscle mass and prevent sarcopenia.^4,8 One of the practical ways to approach this would be to aim for 80-120 g of protein a day or 16-24% of total calorie intake.4,8 Additionally, people on GLP-1 therapy are advised to include regular weight-bearing exercises to support muscle mass.4 Yet another area of focus is nutrient deficiencies on GLP-1 medication. Some of the most common nutrient deficiencies include several important minerals such as calcium, iron, magnesium and zinc.⁴ Common vitamin deficiencies on GLP-1 medication include all fat-soluble vitamins A,D,E,K and some water-soluble vitamins B1, B12, and C. These deficiencies often manifest as a variety of signs and symptoms, including fatigue, skin issues such as skin flakiness and itching; hair loss and muscle weakness, easy bruising and long wound healing are also common.⁴

From the Western nutrition and medicine perspective, addressing nutrient deficiencies through including a variety of nutrient-dense foods that are sources of these vitamins and minerals and addition of dietary supplements to address deficiencies as necessary.⁴

Ayurvedic approach includes the acknowledgment of the state of agni in its relation to absorption. When the doshas are vitiated in the digestive channel or Annavaha srota we consider the subdoshas. Samana Vata for absorption and distribution, Pachaka Pitta the ability to break down and transform the food, and the digestive fluids and container Kledaka Kapha. If and when these are out of balance food is not properly digested, nutrients are not assimilated and proper absorption of nutrients lead to further doshic imbalances and RMD issues. Dipana herbs can help improve digestion, following proper meal times and eating till you are 2/3 full, plus following Healthy Eating Guidelines also contribute. The goal would be in ayurveda to maintain a healthy state of agni. When the agni is in balance the nourishment of all tissues are taken care of by the proper digestion of food and assimilation of nutrients to build them.

Asthi Dhatu is the bone tissue, this is one of the dhatus of the 7 we recognize. If food intake is reduced, or not properly digested bone health will be depleted.

वातघ्नान्यन्नपानानि श्लेष्ममेदोहराणि च। रूक्षोष्णा बस्तयस्तीक्ष्णा रूक्षाण्युद्वर्तनानि च॥२१॥

गुडूचीभद्रमुस्तानां प्रयोगस्त्रैफलस्तथा। तक्रारिष्टप्रयोगश्च प्रयोगो माक्षिकस्य च॥२२॥

विडङ्गं नागरं क्षारः काललोहरजो मधु। यवामलकचूर्णं च प्रयोगः श्रेष्ठ उच्यते॥२३॥

बिल्वादिपञ्चमूलस्य प्रयोगः क्षौद्रसंयुतः। शिलाजतुप्रयोगश्च साग्निमन्थरसः परः॥२४॥

प्रशातिका प्रियङ्गुश्च श्यामाका यवका यवाः। जूर्णाह्वाः कोद्रवा मुद्गाः कुलत्थाश्चक्रमुद्गकाः॥२५॥

आढकीनां च बीजानि पटोलामलकैः सह। भोजनार्थं प्रयोज्यानि पानं चानु मधूदकम्॥२६॥

अरिष्टांश्चानुपानार्थे मेदोमांसकफापहान्। अतिस्थौल्यविनाशाय संविभज्य प्रयोजयेत्॥२७॥

प्रजागरं व्यवायं च व्यायामं चिन्तनानि च। स्थौल्यमिच्छन् परित्यक्तुं क्रमेणाभिप्रवर्धयेत्॥२८॥

“Ayurvedic practices may help support gradual weight loss and preservation of muscles and bones through food and drinks that alleviate vata and reduce kapha and meda dhatu (fat), enema with sharp, ununctuous and hot drugs, therapeutic powder massage, use of guduchi(Tinospora cordifolia Miers), musta (Cyperus rotundus Linn), triphala (haritaki-Terminalia chebula Linn, bibhitaka(Terminalia belerica Roxb) and amalaka (Emblica officinalis Gaertn), takrarishta (a fermented medicinal preparation of buttermilk) and honey are recommended for the management of obesity. A formulation prepared from vidanga (Embelia ribes Burm f.), nagara (Zingiber officinale Rose), yavakshara (alkali preparation of barley), ash powder of black iron along with honey, powder of yava(Hordeum vulgarae Linn) and amalaka (Emblica officinalis Gaertn) is also an excellent weight-loss drug. Similarly, Bilvadi panchamula (five major roots) mixed with honey and shilajatu along with the juice of agnimantha (Clerodendrum phlomidis Linn.f.) are also very effective preparations for weight loss.

A diet consisting of prashatika (Setaria italic Beauv.), priyangu (Aglaia roxburghiana Mig.), shyamaka (Echinochloa frumentaea Linn.), yavaka (small variety of Hordeum vulgarae Linn), yava (Hordeum vulgarae Linn), jurnahva (Sorghum vulgare Linn), kodrava (papalum scrobiculatum Linn.), mudga (Phaseolus mungo Linn.), kulattha(Dolichos biflorus Linn.), chakramudgaka, adhaki (Cajanus cajan Millsp.) along with patola (Trichosanthes cucumerina Linn) and amalaka (Emblica officinalis Gaertn) is very effective in tackling obesity and maintaining good health. Honey water and alcoholic preparations may be taken as postprandial drinks that help in reducing excessive fat and muscle tissues, while also alleviating kapha dosha. One desirous of reducing obesity should indulge more and more in vigil, sexual activities, as well as physical and mental exercises.”⁹

Gastrointestinal symptoms such as constipation may result from inadequate intake of fiber and fluid. To address constipation, Western nutrition science recommends adequate intake of fiber-rich foods and supplements, avoiding dehydration and regular physical activity.⁹

Ayurvedic approach to alleviating constipation is to treat the Vata dosha. Eating well cooked vegetables, properly spiced meals, taking ghee, and specific herbs such as Triphala can improve discomfort and reduce constipation. Cold water, smoothies, snacking between meals eating while distracted, and not sitting down to eat in a mindful way should be eliminated. Other foods that increase Vata Dosha such as popcorn, crackers, salads, should also be reduced. Yoga postures, walking and mindfulness can also alleviate constipation as evidenced by studies with California College of Ayurveda in Principals of Ayurvedic Medicine and Healthy Eating Guidelines.

Nausea symptoms can be partially alleviated by small frequent meals, avoid skipping meals, slow eating. During the first days of treatment it is often recommended to avoid high fatty and high fiber foods⁴ and opt for bland foods such as white bread, bananas, applesauce, and rice.

Ginger or Ardraka is helpful in reducing nausea. Cooking with fresh or dry ginger, having ginger tea between meals can also help manage nausea. In Susruta Samhita Sutra 46p228 the pungent, heating and appetizing qualities are stated to help with bloating and abdominal discomfort. Cardamom, fennel, and coriander are also helpful as a tea, to cook with or even part of an herbal formal in pill form.¹⁰ Caraka Samhita talks¹¹ about Ardraka relevant in assiting low or variable digestion. Caraka Samhita. Sutra Sthana 27/166

Diarrhea is a common side effect, especially when the GLP-1 medication dose is increased. Clinical recommendations state to increase the medication slowly and remain on the dose that is most tolerated.4 With severe diarrhea, there is a concern for dehydration and loss of important minerals and electrolytes. Adequate hydration and replenishment of electrolyte minerals such as sodium, potassium, chloride, and magnesium are recommended by the Western medicine.⁴

Ayurveda views diarrhea as a Pitta dosha condition called Atisara . The pitta sate of agni creates this. Intake of too many hot, raw, spicy foods, excessive exercise, stress and dosha imbalance plays a role. Think of too much heat, oil, and sharp qualities. Avoid caffeine, alcohol, and sugary drinks. Cooling foods such as cilantro, mint, fennel, coconut, watermelon, and mung beans are beneficial. CCF tea a main staple is great too.

Dehydration may also result from excessive vomiting especially if paired with diarrhea. Therefore, maintaining adequate hydration and electrolyte balance is recommended if those two occur together. Ayurveda suggests staying in moderation with room temperature water through the day and between meals. Hydrating with watermelon, coconut water and mint tea between meals is helpful to stay hydrated and replenish when dehydrated.

While abdominal pain and abdominal distention are less common side effects on GLP-1 medication.⁴ Some Ayurvedic practices to reduce abdominal pain and distention is often similar to the treatment of constipation because the pathology is similar. Too much air and ether which is cold, dry, mobile and ungrounded._¹² Slowing ones mind and body down through restorative yoga, and yoga nidra, taking warm baths with oils and implementing a daily routine such as abhyanga with warmed sesame oil before a shower or bath may improve the symptoms and increase the element of earth, fire and water bringing in more balance. Some treatments are daily rituals done at home by oneself, and some treatments can be done at a local spa or clinic. The growing number of spas incorporating Ayurvedic treatments that go beyond the surface and include the ancient use of herbs, oils and treatments specifict to the patients doshas are growing and expanding.

Carminative, Dipanas and Vata appropriate herbs such fennel, hingvastak, CCF tea, and ajwin also are suggested. Determining the type of abdominal pain by dosha is key to success. Vata, Pitta and Kapha abdominal pain manifest in different ways and need to be treated properly by a AP who is considering the state of imbalance.” An excess of Váyu in the body is marked by such symptoms as roughness of the skin, emaciation of the body, darkness of complexion (lit : blackness of hue), a little tremor or trembling of the limbs, longing for heat, or for hot things, insomnia, thickness or increased consistency of the fecal matter and decrease of bodily strength.⁵

Yet another area of focus is nutrient deficiencies on GLP-1 medication. Some of the most common nutrient deficiencies include several important minerals such as calcium, iron, magnesium and zinc.⁴ Common vitamin deficiencies on GLP-1 medication include all fat-soluble vitamins A,D,E,K and some water-soluble vitamins B1, B12, and C. These deficiencies often manifest as a variety of signs and symptoms, including fatigue, skin issues such as skin flakiness and itching; hair loss and muscle weakness, easy bruising and long wound healing are also common.⁴ From the Western nutrition and medicine perspective, addressing nutrient deficiencies through including a variety of nutrient-dense foods that are sources of these vitamins and minerals and addition of dietary supplements to address deficiencies as nessesary.⁴

Ayurvedic approach includes the acknowledgment of the state of agni in its relation to absorption. When the doshas are vitiated in the digestive channel or Annavaha srota we consider the subdoshas Samana Vata for absorption and distribution, Pachaka Pitta the ability to break down and transform the food, and the digestive fluids and container Kledaka Kapha. If and when these are out of balance food is not properly digested, nutrients are not assimilated and proper absorption of nutrients lead to further doshic imbalances and RMD issues. Dipana herbs can help improve digestion, following proper meal times and eating till you are 2/3 full, plus following Healthy Eating Guidelines also contribute.

The goal would be in ayurveda to maintain a healthy state of agni. When the agni is in balance the nourishment of all tissues are taken care of by the proper digestion of food and assimilation of nutrients to build them. Rasa, rakta, mamasa, medas, asthi and majja are the main dhauts. This is a simplified look at the correlation between the tissues and how they are built and maintained. For example mamsa the muscles are important to maintain strength. Asthi Dhatu is the bone tissue, this is one of the dhatus of the 7 we recognize. There are herbs and doshic support such as bone tonics and tending to the health of the colon that contribute. It is also important tht the practitioner considers each dosha having an afffinity to weaker bones. Vata Dosha tends to have smaller, weaker bones where Kapha has denser and stronger builds. Pitta dosha is moderate in bone. Depletion is likely to happen in relation to the airy and ether Vata dosha and have a greater impact. The tissues of the body relate to the heath of digestion and in turn each tissue relates and supports one another. Ashit dhatu is part of the bones, and teeth If food intake is reduced, or not properly digested bone health will be depleted.¹²

This paper clarifies that weight loss and obesity management is not one size fits all. Success in treatment of weight loss and long-term support can be supported by Western and Ayurvedic Practitioners who recognize the mental, physical, societal and accessible limits and how to empower individuals based on their specific needs. An Ayurvedic Practitioner who can recognize the root cause of obesity through the doshas can effectively create a long-term treatment plan that helps stabilize the mental aspect, and the muscle, bones and tissues of the body using CAM practices such as yoga, improving and balancing appetite. Despite the different language, the overlap in Western Medicine and Ayurveda both maintain the goals of the patient and also see similar challenges in treatment. Movement, sustainable nutrition, and balanced routines are both valued. Encouraging Kapha Dosha support such as pranayama, walking, strong yoga asana, and a Kapha pacifying diet can support the long-term benefits of weight loss. For those who require more traditional personalized treatment the therapies supported by a guided Panchakarma might be appropriate but not in replace of other treatments and should always be supervised. Collaborations between practitioners, clear effective communication and slow and steady Ayurvedic lifestyle , doshic nutrition education, and guided care creates a safe and effective holistic approach to managing symptoms of GLP-1 usage and how to manage weight loss, digestion and keeping the body healthy long term. Empowering individuals to take pride, accountability and futher interest in a collaborative approach gives the chance to make positive and impactful choices moment to moment. Health is the accumulation of our choices and tendencies as both forms of pathology agree. Creating simple and clear goals with supportive practitioners hopefully increase effectiveness and longevitiy. Seeing as so much of the world is suffering from obesity uniting collaborations between Western and Ayurvedic approach may be a good start to assisting in changing the statistics in a healthful, uplifting manor.

Sources:

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6. Caraka Samhita Sutra 21.1-5 Medas Obesity
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9. Susruta Samhita Sutra 46p228
10. Caraka Samhita 19.4-5 abdominal symptoms, low agni, diarrhea
11. Caraka Samhita- Chikitsa Stahana 19 Atisra Chickitsa 19.4-5.
12. Caraka Samhita 19.14-195. Caraka Samhita bone tissue asthi dhatu