Top 4 Foods To Avoid With Trulicity

Today, diabetes is a rapidly growing metabolic disease affecting people of all ages and ethnicities. It is estimated that 11.3% of the United States population is living with diabetes of which 28.7 million are diagnosed and 9.5 million are undiagnosed. Over the last few years, there have been great advances in the drugs for diabetes with newer classes and drugs being introduced. One such drug is dulaglutide sold under the brand name Trulicity. Let us understand what it is and what foods to avoid with Trulicity.

What is Trulicity 

Trulicity is a weekly injectable drug for patients with type 2 diabetes mellitus, approved by the FDA because it helps lower blood sugar levels. It must be prescribed by a doctor and is available as an adjunct to diet and exercise. The drug is dulaglutide which belongs to a class of drugs known as Glucagon-like Peptide- 1 (GLP-1) Agonists. It is not a first-line treatment for diabetes but it is beneficial and the once-a-week treatment provides an attractive option for people living with diabetes.

Also Read: Top nutrient dense foods on earth

How Does Trulicity Work?

As mentioned above, Trulicity is a GLP-1 agonist which means that it promotes the action of GLP-1 which is one of the incretins. Incretins are hormones that are released from the gut in response to ingestion of food, especially glucose, and cause the release of insulin from the pancreas. In patients with diabetes, there is either insulin resistance or insufficient insulin release which causes high blood glucose levels. Thus, these drugs are helpful because they work by activating these GLP-1 receptors and as a result cause glucose-dependent insulin release.

A study showed that type 2 diabetes patients when treated with dulaglutide showed a reduction in fasting and 2-hour postprandial glucose levels and an increase in both first and second-phase insulin secretion as compared to placebo.

Trulicity also works by decreasing glucagon. Glucagon is another hormone that is released from the pancreas. It works exactly opposite to insulin, which causes blood glucose to enter cells, glucagon causes glucose to be released in the blood. Thus, reducing glucagon secretion is beneficial in people with diabetes. The aforementioned study also showed a significant decrease in fasting glucagon levels with dulaglutide.

Trulicity is also beneficial in type 2 diabetes because it delays gastric emptying, this helps because slower gastric emptying causes sustained release of glucose in the blood rather than a glucose spike and increases satiety which is the feeling of fullness.

It may also cause a reduction in weight which is important in diabetes management as it may help improve insulin sensitivity. A study showed that dulaglutide resulted in 1.4-3 kg weight loss when used alone or in combination with metformin.

A study showed that dulaglutide reduces HbA1c (a long-term measure of blood glucose levels) by 0.9-2.2% depending on dosage and baseline HbA1c. 

Foods to Avoid with Trulicity

There are no specific food interactions seen with Trulicity, which means that no particular food or beverage taken with Trulicity will cause negative reactions. But as aforementioned Trulicity works best to manage diabetes when combined with a good diet and lifestyle changes, so certain foods that can increase your blood sugar levels, are calorically dense but not nutritionally dense should be avoided, let’s see a few:

1. Refined Grains and Flours: Refined flours are highly processed grains that are stripped of their fiber and nutrients, leaving behind the starch-rich portion. Such flours move rapidly through your digestive tract because they are already so processed the body doesn’t have to do much and thus causes a spike in blood glucose levels. It also lacks beneficial nutrients. Sometimes they are additionally polished or bleached to make them look white which further causes harm. Refined wheat flour and products made of it like white bread, bagels, pasta, doughnuts, cakes, cookies, etc., rice flour, corn flour, polished rice, etc. are some examples of refined products.
   
   Instead, prefer whole grains since they are nutrient-dense and rich in fiber. They are more filling and you would eat smaller portions of them as well. Whole wheat flour, brown rice, barley, oats, quinoa, barley, whole wheat bread, etc are some examples of whole grain products that you can opt for.
   
   
2. Sugar and Sugary Products: Sugar is a simple carbohydrate which means that it breaks down rapidly in the body and as a result causes a spike in blood glucose levels. Sugar is also calorically dense and has no beneficial nutrients. So, tabletop sugar should be avoided as well sugary products like sugar-added foods and sugary beverages.
   
   Aside from the obvious ones like chocolates, cookies, cakes, etc. some products with added sugar may be difficult to spot because there are several hidden names of sugar, also because of false marketing of products. Products that may seem healthy may contain added sugars like granola bars, energy bars, flavored yogurts, cereals, dried fruits, sauces, etc. Always read the ingredients and look for hidden names like glucose, high fructose corn syrup, dextrose, honey, maple syrup, fructose, ethyl maltol, fruit juice concentrates, etc. and also look at the sugar content per serving size before consuming it.
   
   Sugary beverages contribute to a large content of sugar in your daily diet because in small volumes they contain a large amount of sugar. For example, one 7.5 oz can of coca cola contains 25 g of sugar (5 teaspoons). Some sugary beverages include sodas, sweet teas, sugary coffee drinks like frappes, sweetened and flavored lattes, etc., energy drinks, and fruit juices. In terms of juices, even homemade fresh juices should be avoided because they are processed and the fiber content decreases, so always prefer eating the whole fruit preferably with the skin.
   
   
3. Red Meat: Red meat like beef is rich in fats, furthermore it contains poor-quality fats like saturated fats, this is harmful and also increases inflammation in the body, diabetes is already an inflammatory condition, so further contribution to inflammation is not recommended. Furthermore, it may be heavy to digest so should be avoided if you face any side effects of Trulicity like nausea and vomiting. Instead prefer lean meats like lean chicken, fish which is also anti-inflammatory due to its omega-3 content.
   
   
4. Fried Foods: Fried foods are not recommended because they are calorie dense and may contribute to weight gain. Further, the quality of fats is also poor, when you consume fried food, especially from restaurants the oil is cooked at high temperatures and reused as well, this causes the structure of fat to change and there is an increase in the trans-fat content which is extremely harmful. Fried foods should also be avoided because of the side effects caused by Trulicity.

Trulicity and Alcohol:

Alcohol is not completely restricted while taking Trulicity but you must be careful and mindful of alcohol consumption with any drug for diabetes because the risk of hypoglycemia (low blood glucose) increases. The liver is responsible for this because it works to maintain blood glucose levels by breaking down stored glycogen and releasing it into the blood when the levels drop as well as metabolizing alcohol, so when excess alcohol is consumed it prioritizes metabolizing that. Certain drugs that cause insulin production like sulphonylureas, and dulaglutide already have a risk of hypoglycemia, so combined with alcohol consumption the risk increases. So, it is important to avoid excess alcohol consumption, and also eat a meal before drinking.

Trulicity and Caffeine:

There are no studies that suggest any negative effects or interactions of caffeine with Trulicity.

 Trulicity in Very Low Carbohydrate Diets:

Low carbohydrate diets like the Keto diet are popular in diabetes, keeping aside the discussion of whether they are effective or not, let’s talk about how effective Trulicity would be on such a diet. As mentioned earlier, Trulicity causes glucose-dependent insulin release so if your diet is very low in carbohydrates (which breaks down to glucose in the body), Trulicity might not be very effective in such a situation. That being said, it does not mean that you need to overload on carbohydrates either. In case you are on such a diet, it is recommended to inform your doctor and other healthcare providers so they can make an informed decision about the course of your treatment.

Trulicity in Type 1 Diabetes:

Trulicity is not effective or helpful in type 1 diabetes because here there is destruction of the beta cells that produce insulin, so there is a lack of insulin. Since the mechanism of Trulicity involves insulin secretion it will be pointless in people with type 1 diabetes. Such people require exogenous insulin as prescribed by their healthcare provider.

How to take Trulicity:

Trulicity should be given once a week at any time of the day, it is better to keep the same time every week. It is to be injected subcutaneously which means under the skin in the abdomen, thigh, or upper arm. There are two available dosages of Trulicity- 0.75 mg and 1.5 mg, take it as prescribed by your doctor. If a dose is missed, administer it within 3 days (72 hours) of the missed dose. It can be administered with or without food. 

How Long Does Trulicity Stay in Your System:

 The elimination half-life of dulaglutide for both doses is approximately five days. This means that it will take five days for your body to get rid of half the dose of Trulicity. Usually, it takes 4-5 half-lives for a drug to be eliminated from the body, so it would take 20-25 days for Trulicity to leave the system. 

Side Effects of Trulicity:

The most common side effects reported in ≥5% of patients who received dulaglutide are nausea, diarrhea, vomiting, abdominal pain, and decreased appetite. Since it causes the secretion of insulin, the risk of hypoglycemia also increases but it is less than in drugs like sulphonylureas or insulin

Precautions and Warnings:

Boxed warning: It was seen that dulaglutide caused an increase in the incidence of thyroid C-cell tumors after lifetime exposure in rodent studies. It is not known whether dulaglutide causes thyroid C-cell tumors in humans.

Thyroid C-cell tumors in animals: Patients should be counseled about the risk for medullary thyroid carcinoma with the use of dulaglutide.

Pancreatitis: The use of dulaglutide reported pancreatitis-related adverse reactions so it should be promptly discontinued if pancreatitis is suspected and should not be restarted if it is confirmed.  

Hypoglycemia: When given in combination with insulin or insulin-secreting drugs lowering the dose is warranted to reduce the risk of hypoglycemia. 

Hypersensitivity reactions: Dulaglutide should be discontinued if a hypersensitivity reaction is suspected. Patients should be monitored and treated promptly until the signs and symptoms of hypersensitivity resolve.

Renal impairment: Renal impairment should be monitored in patients with renal impairment who report severe adverse gastrointestinal reactions.

Conclusion: Trulicity is a relatively new drug for diabetes, it is a GLP-1 Agonist and needs to be administered once a week using an injection. It helps lower blood glucose levels. There are no specific food interactions with Trulicity but it works best to manage diabetes when combined with a healthy diet and lifestyle.

References:

1. National Diabetes Statistics Report | Diabetes | CDC. (2022). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/data/statistics-report/index.html?ACSTrackingID=DM72996&ACSTrackingLabel=New%20Report%20Shares%20Latest%20Diabetes%20Stats%20&deliveryName=DM72996
2. Smith L, Mosley J et al. (2016) Dulaglutide (Trulicity): The Third Once- Weekly GLP-1 Agonists. Pharmacy and Therapeutics 41(6): 357–360.
3. Umpierrez, G., Tofé Povedano, S., Pérez Manghi, F., Shurzinske, L., & Pechtner, V. (2014). Efficacy and Safety of Dulaglutide Monotherapy Versus Metformin in Type 2 Diabetes in a Randomized Controlled Trial (AWARD-3). Diabetes Care, 37(8), 2168–2176. https://doi.org/10.2337/dc13-2759
4. Yu, M., Yuan, G. Y., Zhang, B., Wu, H. Y., & Lv, X. F. (2020). Efficacy and Safety of Dulaglutide by Baseline HbA1c in Chinese Patients with Type 2 Diabetes: A Post Hoc Analysis. Diabetes Therapy, 11(5), 1147–1159. https://doi.org/10.1007/s13300-020-00804-2
5. How much sugar is in Coca-Cola? (2019, December 5). The Coca-Cola Company. https://www.coca-colacompany.com/faqs/how-much-sugar-is-in-coca-cola#:%7E:text=in%2Dcoca%2Dcola-,There%20are%2039%20grams%20of%20sugar,12%20oz%20Coca%2DCola%20can
6. Engler, P. A., Ramsey, S. E., & Smith, R. J. (2010). Alcohol use of diabetes patients: the need for assessment and intervention. Acta Diabetologica, 50(2), 93–99. https://doi.org/10.1007/s00592-010-0200-x
7. Alcohol and Diabetes | ADA. American Diabetes Association. https://www.diabetes.org/healthy-living/medication-treatments/alcohol-diabetes
8. Fal L (2015). Trulicity (Dulaglutide): A New GLP-1 Receptor Agonist Once- Weekly Subcutaneous Injection Approved for the Treatment of Patients with Type 2 Diabetes. Am Health Drug Benefits, 8 131-134