Generic GLP-1s Have Arrived: What to Know Before Starting

by

Practitioner’s Perspective

In May 2026, Canada became the first G7 nation to approve and roll out generic semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, the active ingredient in Ozempic and Wegovy, and these generics began arriving in Canadian pharmacies on May 15, 2026.

The price drop has been dramatic.

  • Brand-Name Cost: Before the generic rollout, brand-name Ozempic typically cost between $300 and $450 per month for those without private insurance coverage
  • Generic Cost: The generic GLP-1 slashed the baseline wholesale costs by more than half, so Canadians are now paying out-of-pocket approximately $100 to $150 per month.
BBDNutrition - What to Know Before Starting GLP-1s
What to Know Before Starting a GLP-1

Currently, seven other pharmaceutical companies have applications for these generic medications that are under review. Once a third manufacturer is approved, regulations will result in the baseline public plan price falling further to 35% compared to the brand-name cost (~$80 per month).

As prices drop, many more Canadians are thinking about beginning to use them; however, an important question remains: are people prepared for the effect on their bodies as the weight drops off? While there are ways to reduce body weight without hunger using dietary changes, not everyone wants to do that.

Those thinking of filling a prescription, or those already on these GLP-1 medications, need to understand the silent physiological shifts that occur on these medications, and why nutritional support is needed (a) while on them, and (b) for building a sustainable plan for once these medications are deprescribed.

Loss of Muscle Mass

GLP-1 medications cause a rapid and progressive weight loss, but in studies, loss of lean mass (muscle) ranges from 25% to more than 50% of total weight loss. A recent network meta-analysis found that ~25% of total weight loss across trials is attributable to lean mass reduction [1], and Semaglutide has been associated with loss of lean mass up to 40% of total weight loss and liraglutide with up to 60% [2]. Semaglutide is the active ingredient in the newly approved Canadian generic GLP-1s.

Decade of Muscle Loss

In healthy adults not on weight-loss medications, loss of muscle mass naturally decreases at a slow rate of 3% to 8% per decade after the age of 30, increasing to approximately 0.5% to 1% of total muscle mass per year after age 50, and then accelerates more after the age of 60 years [3]. The rapid muscle loss experienced by those using GLP-1s such as Semaglutide can equal a decade of muscle loss compressed into months.

A Decade of Muscle Loss in Less than a Year and a Half

Looking at the math,

  • A healthy adult over the age of 50 naturally loses approximately 0.5% to 1% of their total muscle mass per year. Over the course of a full decade (10 years), this results in a natural, cumulative loss of roughly 5% to 10% of their total skeletal muscle mass.
  • Clinical trial data from the SURMOUNT-1 sub-study showed an average total lean mass loss of 10.9% [4] over the course of the study, and data from the STEP-1 semaglutide study showed a 10% total reduction in skeletal muscle mass [5].

The acceleration in muscle mass using GLP-1s is clear.

  • Without the use of GLP-1s, it takes 10 to 20 years of natural biological aging to lose 10% of total muscle mass.

  • With the use of GLP-1s, loss of 10.9% of lean mass occurs in only 16 to 18 months (72 weeks).

Loss of Bone Mineral Density

An often-overlooked aspect of rapid weight loss on GLP-1s is the accelerated bone turnover and degradation, which is particularly relevant to older adults and post menopausal women who are already at increased risk of sarcopenia.

A clinical trial evaluating semaglutide found a significant increase in collagen type I cross-linked C-terminal telopeptide (P-CTX), which is a marker of bone resorption [6], which is where bone is broken down, releasing stored minerals like calcium into the bloodstream.

This accelerated bone turnover resulted in significantly lower Bone Mineral Density (BMD) at the lumbar spine, total hip, and tibia in people treated with semaglutide, escalating the long-term risk for osteoporosis and fractures [6].

Appetite Suppression and Nutrient Deficiency

Since these medications work by significantly delaying stomach emptying, they result in a reduction in daily calorie intake by 16% to 39% [7].

Along with a decrease in energy intake, there is also a reduction in macronutrient and micronutrient intake; however, currently there is a lack of comprehensive, evidence-based data in this area [7].

A retrospective study of the data that we do have found that after 12 months on a GLP-1 receptor agonist, those with type 2 diabetes had nutritional deficiencies worsened in 20% of cases [8], and nutrient intake has been reported in retinol, vitamin E, vitamin C, vitamin B6, vitamin B12, iron, zinc, folate, calcium, and magnesium [7,8,9].

For this reason, a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society recommends that use of GLP-1s include

  • nutritional counseling
  • a structured nutrition program that includes support for changing food choices
  • enables the development and maintenance of healthy eating habits
  • plans for an eventual discontinuation of the GLP-1 medication.

Recommended Protein Intake

A review paper published in January 2026 [10] outlines the recommended protein intake for individuals taking these medications for weight loss as follows

  • 1.25–1.5 times the Recommended Dietary Allowance (RDA) for daily protein intake with at least ∼25–30 g of protein per meal
  • Protein distribution of 25 to 30 grams of protein per meal to adequately stimulate muscle protein synthesis
  • Ensuring 2 to 5 grams of leucine to preserve lean mass

Interestingly, these are the same recommendations that I have outlined in the article about protein intake to prevent muscle loss in older adults.

Clinical Recommendations

Having nutritional support to minimize the loss of lean body mass and bone mass, and to ensure adequate dietary intake of nutrients, is essential while taking a GLP-1 medication; however, it is important to keep in mind that a Meal Plan designed for your specific needs will enable you to lose weight and keep it off, without medication and without being hungry. When I design a Meal Plan for weight loss, I include teaching about the hormones that drive hunger, and how to eat in a manner that supports the release of the body’s own GLP-1.

More Info

For those who were prepared to spend $300 to $450 per month on brand-name GLP-1s, switching to a $100 generic option frees up the margin to invest in the GLP-1 Nutrition Support Package to ensure you protect your lean muscle mass and bone health while using the medication.  It also supports changes in food choices, enables the development and maintenance of healthy eating habits, and plans for eventually coming off the GLP-1 medication.

Learn about me and the GLP-1 Nutrition Support Package and if you would like me to design a Meal Plan for you to support weight loss without use of these medications, the Comprehensive Dietary Package is where to get started.

To your good health.

Joy

You can follow me on:
Twitter: https://twitter.com/jyerdile
Facebook: https://www.facebook.com/BetterByDesignNutrition/

 

Dietary Support Before or While Taking a GLP-1

I can help you minimize muscle and bone loss while ensuring you are taking in sufficient nutrients while taking a GLP-1 medication, and if you’d prefer to approach weight loss from a dietary perspective, I can help!

Book an Initial Consultation to discuss.

Book an Appointment

References

  1. Karakasis P, Patoulias D, Fragakis N, Mantzoros CS. Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis. Metabolism. 2025 Mar;164:156113. doi: 10.1016/j.metabol.2024.156113. Epub 2024 Dec 22. PMID: 39719170.
  2. Linge J, Birkenfeld AL, Neeland IJ. Muscle Mass and Glucagon-Like Peptide-1 Receptor Agonists: Adaptive or Maladaptive Response to Weight Loss? Circulation. 2024 Oct 15;150(16):1288-1298. doi: 10.1161/CIRCULATIONAHA.124.067676. Epub 2024 Oct 14. PMID: 39401279.
  3. Volpi E, Nazemi R, Fujita S. Muscle tissue changes with aging. Curr Opin Clin Nutr Metab Care. 2004 Jul;7(4):405-10. doi: 10.1097/01.mco.0000134362.76653.b2. PMID: 15192443; PMCID: PMC2804956.
  4. Look, M., Dunn, J.P., Kushner, R.F., Cao, D., Harris, C., Gibble, T.H., Stefanski, A., & Griffin, R. (2025). Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. Diabetes, Obesity and Metabolism, 27(10), 2720–2729. https://doi.org/10.1111/dom.16410
  5. Wilding, J. P. H., Batterham, R. L., Calanna, S., Van Gaal, L. F., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wharton, S., Yokote, K., Zeuthen, N., & Kushner, R. F. (2021). Impact of semaglutide on body composition in adults with overweight or obesity: Exploratory analysis of the STEP 1 study. Journal of the Endocrine Society, 5(Suppl 1), A16–A17. https://doi.org/10.1210/jendso/bvab048.031
  6. Hansen, M.S.; Wölfel, E.M.; Jeromdesella, S.; Møller, J.-J.K.; Ejersted, C.; Jørgensen, N.R.; Eastell, R.; Hansen, S.G.; Frost, M. Once-Weekly Semaglutide versus Placebo in Adults with Increased Fracture Risk: A Randomised, Double-Blinded, Two-Centre, Phase 2 Trial. EClinicalMedicine 2024, 72, 102624.
  7. Almandoz JP, Wadden TA, Tewksbury C, Apovian CM, Fitch A, Ard JD, Li Z, Richards J, Butsch WS, Jouravskaya I, Vanderman KS, Neff LM. Nutritional considerations with antiobesity medications. Obesity (Silver Spring). 2024 Sep;32(9):1613-1631. doi: 10.1002/oby.24067. Epub 2024 Jun 10. PMID: 38853526.
  8. Johnson B, Milstead M, Thomas O, McGlasson T, Green L, Kreider R and Jones R (2025) Investigating nutrient intake during use of glucagon-like peptide-1 receptor agonist: a cross-sectional study. Front. Nutr. 12:1566498. doi: 10.3389/fnut.2025.1566498
  9. Mozaffarian D, Agarwal M, Aggarwal M, et al. Nutritional priorities to support GLP-1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. Obesity (Silver Spring). 2025;33(8):1475-1503. doi:10.1002/oby.24336
  10. Barana, L., De Fano, M., Cavallo, M., Manco, M., Prete, D., Fanelli, C. G., Porcellati, F., & Pippi, R. (2026). Nutrition and Physical Activity in Optimizing Weight Loss and Lean Mass Preservation in the Incretin-Based Medications Era: A Narrative Review. Nutrients, 18(1), 131. https://doi.org/10.3390/nu18010131