Around the holidays, when many people are baking cookies for Santa, enjoying cocktail parties or having festive family feasts, some adults who use popular medications for diabetes or weight loss explore skipping doses for a week or two.
These medications can suppress appetite or sometimes cause uncomfortable side effects that some people might want to avoid during the holiday season. And according to some doctors, some of their patients have said they want to fully delight in their favorite foods or just save some money during a season of high spending.
“People are bound to wonder about doing this,” said Dr. Judith Korner, professor of medicine in the Division of Endocrinology at New York Presbyterian/ Columbia University Irving Medical Center in New York.
“Sometimes they think about it if they’re going on a cruise or a vacation,” she said. “I have patients who are in the other situation, where they have been going up on the medication and we have kept them at their current dose and we’re not escalating during the holidays.”
Dr. Alyssa Dominguez, an endocrinologist with Keck Medicine of USC in Los Angeles, says some of her patients also ask about pausing doses during the holidays.
“Patients have come to me asking about skipping doses of these medications around the holidays, around vacations. Another thing that often comes up is delay of either starting the medication or escalating the dose of a medication,” Dominguez said.
“It is not uncommon for somebody to want to hold the dose or hold off on a dose escalation,” she said. “These medicines have side effects such as nausea, stomach pain, constipation or diarrhea. So, certainly, if somebody was thinking about starting the medication as a new start or increasing the dose, it’s totally understandable why somebody would not want to be experiencing those symptoms if they’re going to be on a plane for a long time or in a foreign country.”
Additionally, if these medicines are not covered by insurance, they can be expensive – ranging from several hundred dollars to about $1,000 a month.
Different risks for different people
GLP-1 receptor agonists and dual agonists – such as Ozempic, Wegovy, Mounjaro and Zepbound – are typically used as weekly injections. The GLP-1 receptor agonists work by mimicking the GLP-1 hormone in the gut, and the dual agonists work by mimicking both the GLP-1 and GIP hormones, which regulate blood glucose and appetite.
In most cases, when people start on these medications, they are prescribed low doses and gradually increase to higher doses in the following weeks.
But the effects that a pause may have on your body depends on why you’re taking the medication in the first place, Korner said.
“If you’re taking the medication to control your blood sugar because you have type 2 diabetes, you have to realize if you’re skipping a dose, that your blood glucose is going to become higher,” she said. “But if you are very well-controlled with type 2 diabetes and your blood sugar goes a little bit higher, that may not be clinically that significant.”
Dominguez said the risk of elevated blood sugar levels would be a concern if someone with diabetes skips a dose. But for other people who are using these medications specifically for weight loss, the risks would be different.
“We would expect that a person would have less appetite suppression and more quick stomach emptying, so they would likely be able to eat more, which may interfere with some weight loss efforts” by raising the risk of overeating, Dominguez said.
However, “these medications stay in your body for a while. So even if you skip one dose, it’s not like the levels of the medication go down to a complete zero,” Korner said. “You will still have some of the medication in your system, so you may still have an effect helping to control your appetite. These are things to consider.”
The prescribing information for Ozempic notes that if someone misses a dose, they should take it within five days. If more than five days have passed, the person should skip the missed dose and administer the next on the regularly scheduled day.
It’s similar for Mounjaro and Zepbound. The prescribing information advises taking a skipped dose within four days, but if more than four days have passed, the missed dose should be skipped and the next given on the regularly scheduled day.
The prescribing information for Wegovy notes that if one dose is missed and the next is more than two days away, the patient should take the missed dose as soon as possible. But if the next dose is less than two days away, they should not take the skipped dose and resume their regular schedule.
For many of these medicines, “you can miss up to two weeks of your medication without having to go back down to a lower dose. So, from a safety standpoint, it’s manageable,” said Dr. Deborah Horn, director of obesity medicine at UTHealth Houston in Texas.
“However, I wouldn’t recommend someone skipping their dose just because they want to have a little more in the holiday season,” she said. “We do worry that beyond two weeks, you have a much higher risk of having side effects, even if you didn’t have them as you were dose-escalating the first time,” such as nausea, constipation, diarrhea or vomiting.
‘The holidays aren’t always just about food’
For many patients, maintaining their dose schedules is helpful during the holidays.
“People actually, at least in my patient population, they actually would rather stay on it, because the holidays are tough, right?” said Dr. Eduardo Grunvald, medical director of the Center for Advanced Weight Management at the UCSD Bariatric and Metabolic Institute.
Some providers said they guide their patients about how to stay on the medications and still enjoy their favorite treats, for example, by trying smaller portion sizes.
“Keep that meal size at a place where you can tolerate it. We know that if you eat too much on these GLP-1 medications, it can bring on nausea or uncomfortable abdominal pain,” Horn said. “Just be careful about the volume.”
For some people, it helps to eat every four hours, which can reduce the risk of side effects, she said. “Some people can struggle with nausea and some of these GI side effects if they go long periods of time without eating.”
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Though it can be challenging during the holidays, try to be careful with foods high in fat and carbohydrates.
“Some of these symptoms like nausea can be particularly worsened especially by greasy or heavy foods,” Dominguez said. “So you should not deviate too much from what you’re used to eating. Otherwise you could experience some unpleasant side effects.”
But “putting some beautiful fiber or protein next to them will help avoid some of the GI symptoms associated with it,” Horn said.
It also can be helpful to skip alcoholic drinks while attending holiday parties, Korner said.
“Sometimes, people really don’t tolerate having alcohol together with the medication. The other thing is that if you get a little tipsy with the alcohol, you may find that your judgment isn’t as sound as it usually is, and that might then lead to eating things that you might not tolerate,” she said.
If you do take a holiday break from your GLP-1 medication and notice side effects when you restart doses, Horn said, “consider reaching out to your health care provider, because we can offer anti-nausea medication in those scenarios.”
Lastly, there are many ways to still enjoy the holiday season through activities or gatherings that are not tied to food: gift-wrapping, caroling or ice-skating.
“The holidays aren’t always just about food,” Korner said. “While that’s certainly a very big part of it, we do have to remember that it’s about family and friends and being together.”