What Actually Determines Whether a GLP-1 Works Long Term?

About this Podcast

A GLP-1 prescription comes with a dose. It rarely comes with instructions for the rest of the plan. In part 2 of this conversation, Zach Dancel and Stephanie Misanik explain why the medication is only ever half the equation, and what actually determines whether the results last.

There is no guest this week. This is part 2 of a two-part Longevity Unfiltered conversation between Zach Dancel, COO of Nava Health, and Stephanie Misanik, Clinical Director at Nava Health, continuing their breakdown of what a GLP-1 can and cannot do on its own.

What this conversation covers: the three mistakes almost everyone makes on a GLP-1, the real protein target for someone on one, why appetite suppression needs food to work safely, and why the goal with any dose is the smallest one that still works.

Appetite Suppression Only Works If You're Eating Enough

As GLP-1 prescriptions have become more affordable and more available through telemedicine, the number of people on these medications has grown much faster than the number of people getting real nutrition and behavioral support alongside them. Stephanie's read on why that gap matters: the medication works by quieting appetite signals in the brain, which is a genuine relief for anyone who has spent years battling constant food noise. But when appetite suppression isn't paired with intentional eating, it can push someone toward eating far too little, sometimes going a full day or more without a real meal. That's not a side effect of the drug working correctly. It's a sign the support system around the prescription hasn't caught up with how many people are actually using it.

Two Very Different Reasons Weight Isn't Moving

Stephanie separates the women she sees into two very different groups, and the distinction matters because the fix is different for each. The far more common pattern, built up over years of dieting advice, is chronic under-eating: calorie totals that don't cover basic bodily function, workouts stacked on top of that deficit, and a body that responds by holding onto weight rather than releasing it. The second, smaller group genuinely cannot control their appetite, and Stephanie is direct about what that is: a real, researched pattern that behaves very much like addiction, not a personality flaw or a lack of willpower. Both groups need the same thing before anything else. An honest, personalized look at where they actually stand, rather than a generic calorie target borrowed from someone else's plan.

The Protein Number That Actually Moves the Needle

Stephanie's floor for protein intake is half a gram per pound of body weight, with most women realistically landing closer to 0.75 grams per pound once exercise and personal factors are accounted for. That number does more than protect muscle. It's also one of the most effective tools against GLP-1 nausea, since a lot of that nausea traces back to not having enough food, particularly protein, in the system. Her practical fix is simple: a few bites of protein first thing in the morning, eaten before anything else, to get ahead of the stress-hormone response that makes nausea worse the longer a stomach stays empty.

Not All Protein Is the Protein She's Talking About

Stephanie is blunt about her frustration with how the protein conversation has been co-opted by processed food marketing. Chips, shakes, and popsicles stamped with a protein claim are not the same as real, whole-food protein, and treating them as interchangeable works against the goal, not toward it. Her definition is specific: food that grows in the ground, swims in the sea, or walks on the ground, plant-based or animal-based depending on the person. Loading up on processed versions of protein instead of the real thing can drive inflammation and undercut the very results someone is trying to achieve.

The Real Goal Is the Smallest Dose That Still Works

Zach and Stephanie both push back on the instinct to chase the highest GLP-1 dose available. Stephanie's clinical experience points toward the opposite goal: the minimum dose that produces real, sustainable results with the fewest side effects, which for most people ends up being a microdose rather than the ceiling. That matters for cost, for side effects, and for avoiding weight loss beyond what's actually necessary. It also reframes who genuinely needs a GLP-1 in the first place. Stephanie's rough guideline is at least 15 to 20 pounds of weight to lose, not the five or ten pounds someone wants gone quickly. Getting the dose right, on either end, takes a provider with real experience titrating these medications, not a one-size-fits-all schedule pulled straight from the label.

How much protein should I eat while on a GLP-1?

Stephanie recommends a floor of half a gram of protein per pound of body weight, with most women realistically aiming closer to 0.75 grams per pound depending on activity level and individual needs.

Why do GLP-1 medications cause nausea, and how can I reduce it?

Nausea is a common GLP-1 side effect, and a large part of it comes from not eating enough, especially not enough protein. Getting a few bites of protein in early in the morning can significantly reduce it.

Is a higher GLP-1 dose more effective than a lower one?

Not necessarily. Stephanie's clinical view is that the goal should be the smallest dose that produces real results with the fewest side effects, not the highest dose available.

Who is actually a good candidate for a GLP-1?

Stephanie's general guideline is someone with at least 15 to 20 pounds to lose. For smaller amounts, she recommends targeted lifestyle changes over medication.

Listen to the full conversation on Longevity Unfiltered.

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