Friday Q&A: GLP-1s to lose a few pounds; tick bites and Lyme; magnesium supplements; & seed oils and butters

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The following questions have been lightly edited for length and clarity.

QUESTION #1: GLP-1S TO LOSE A FEW POUNDS

I’m wondering if you’re getting questions about what I’ll call GLP-1 Lite — meaning someone like me who wants to lose 10 to 15 pounds. I go back-and-forth between 1. hey, a little GLP-1 and I could lose this excess weight and 2. what the heck who cares I’m buying my jeans in a bigger size, concentrating on eating healthfully (including drinking less or even not at all!), and trying even harder to get more exercise, including weight lifting. What are your thoughts?? P.S. All that said, I do worry a lot about the GLP-1 side effects, including nausea, not to mention muscle loss.

—Debbie

Hello Debbie,

I really appreciate the framing here—and your honesty! As you might imagine, I get this question a LOT.

Here’s my honest take: for someone without metabolic issues—e.g., diabetes, pre-diabetes, high blood pressure, high cholesterol—GLP-1 medications offer less of a benefit than they do people who do have those problems. So what your weighing (no pun intended) is the psychological benefit of losing weight versus the potential for real side effects, real costs, and a real need for medical supervision while on the drug.

As for side effects, nausea is common, particularly in the early weeks. The muscle loss concern is legit and requires active countermeasures (adequate protein and resistance training) to mitigate. The other issue is that the weight sometimes returns when the medication is stopped, which raises the question of whether this becomes a long-term commitment for a goal that is, by your own description, somewhat negotiable.

What you’re already doing—eating better, drinking less, lifting weights—is also, not coincidentally, exactly what the research supports for long-term metabolic health.

That said, if the 10 to 15 pounds is genuinely affecting your quality of life, or if you’ve been fighting the same weight for years without traction despite real effort, a GLP-1 might be great for you. GLP-1s aren’t only for people with obesity; they work on the neurobiological drivers of eating behavior in ways that go beyond simple appetite suppression, and some people find that genuinely freeing regardless of how much weight they have to lose. (Ashley Koff and I covered some aspects of this topic in our conversation here.)

The upshot: Instead of asking your doctor, “Can I take a GLP-1,” reframe your question to get the answer you want—and ask, instead, “What are the risks and benefits of GLP-1s for my specific situation?” I hope this helps!

QUESTION #2: TICK BITES & LYME

Dr. McBride, the ticks are out of control this year! There are so many in my area, and just the other day I found one crawling on me (so gross), and it’s making me nervous. What should I be doing when I find a tick on me, and what symptoms should I be watching for afterward?

-Hannah

Hi Hannah,

It’s tick season, and these little buggers can transmit a variety of infections beyond Lyme, including anaplasmosis, babesiosis, and Rocky Mountain Spotted Fever, so let’s run through some key things to know.

My top advice is to keep your eyes open for ticks. Finding a tick early, that is, before it gets embedded into your skin, is key. Transmission of most tick-borne illnesses requires the tick to be embedded for a meaningful period of time, so regular checking and prompt removal dramatically reduce your risk. Do a thorough once-over after spending time outdoors. Check your scalp, behind the ears, underarms, behind the knees, and groin. Ticks are small and favor warm, hidden spots.

For prevention: DEET-based repellent on skin and clothing, light-colored clothing that makes ticks easier to spot, and that daily check are your best tools.

If you do find one attached, remove it promptly with fine-tipped tweezers. Grab it as close to the skin as possible and pull straight up without twisting. Save it in a sealed bag with the date noted. Having the tick gives your doctor something to work with if symptoms develop. If you think the tick has been embedded less than 48 hours, your doctor may want to prescribe a preventative dose of doxycycline (200 mg, once). But timing is everything.

Here are the symptoms to look for after a tick bite: fever, fatigue, body aches, headache, or any rash near the bite site in the weeks that follow. Most tick-borne illnesses respond well to treatment when caught early, which is exactly why checking yourself regularly is the most important thing you can do.

Here’s my deeper dive on preventing Lyme disease—let me know if that helps.

My patient with a classic bullseye rash, two weeks after a tick bite (photo shared with permission)

QUESTION #3: MAGNESIUM SUPPLEMENTS

I see various forms of magnesium in the supermarket and pharmacy. I hear it is recommended for some of the issues I deal with - like muscle spasms, joint pain, sleep and digestion. My gynecologist recommended Magnesium L-threonate, but would another form be better? Like glycinate, oxide, citrate etc. Can you break down which versions do what?

-Lee

Hi Lee,

Yes! I don’t put too much stock in any one supplement, however, as part of a holistic health plan, magnesium can help with various issues like the ones you describe. Magnesium comes in several forms. Here’s a breakdown of some common types and their specific uses:

Magnesium Glycinate (or Bisglycinate): This is my personal fave. It is known for its high absorption and bioavailability and can help relieve muscle cramps and spasms, anxiety, and sleeplessness. It’s also less likely to cause diarrhea compared to other forms of mag.

Magnesium Citrate: This form of magnesium is highly bioavailable (which means it can provide a quick increase in magnesium levels). It is good for digestive health and can help relieve constipation. Fun fact: in high doses, magnesium citrate is used as part of a colonoscopy prep.

Magnesium Malate: This is often recommended for conditions like chronic pain and fibromyalgia. It’s believed to help with energy production in the cells, however, the mechanism of action isn’t fully known.

Magnesium Oxide: This form is commonly used as a supplement but has lower bioavailability. It’s often used for to help treat heartburn, indigestion and constipation.

Magnesium Sulfate: Also known as Epsom salts (another personal favorite), it’s used in baths for muscle relaxation and to reduce inflammation.

Magnesium Taurate: This form is often recommended for cardiovascular health due to its combination with taurine, an amino acid beneficial for heart function. It can support heart health, may help regulate blood pressure, and has a calming effect on the nervous system.

Magnesium L-Threonate: I sometimes recommend this form for cognitive health and overall brain function. It has been shown to cross the blood-brain barrier effectively, potentially aiding in memory and learning.

Talk to your doc before you start any magnesium supplement. Each form of magnesium has its unique advantages, so the best one for you depends on your specific health needs and how your body responds to each form.

QUESTION #4: SEED OILS AND BUTTERS

Hey Doc, I eat sunflower seed butter pretty much daily, because my body is a bit sensitive to peanuts (I tend to get headaches and just feel physically unwell after eating them). I also like the taste of seed butter better than, say, almond butter. I’ve been seeing a lot out there about avoiding seed oils, and I’m wondering if it might be a bad idea to eat seed butter every day for similar reasons. What do you think?

-Amy

Hello Amy,

The seed oil debate is one of the noisier corners of nutrition social media right now, and it’s worth separating what’s real from what’s being amplified well beyond the evidence.

Here’s the actual concern: seed oils like sunflower, soybean, and corn oil are high in omega-6 fatty acids, specifically linoleic acid. The hypothesis (and it is only a hypothesis right now) is that excessive omega-6 intake promotes inflammation, particularly when the ratio of omega-6 to omega-3 in the diet is heavily skewed toward omega-6, which it is for most people eating a Western diet. That part is biologically plausible and worth paying attention to at the level of overall dietary patterns.

What doesn’t follow from that is that sunflower seed butter eaten daily is harming you. Whole food sources of fat—seeds, nuts, nut butters—come packaged with fiber, protein, vitamins, and minerals that change how the body processes them compared to refined oils used in industrial food production. The seed oil concern is primarily about highly processed, heavily heated oils showing up throughout the food supply, not about someone eating a tablespoon of seed butter with their breakfast.

Sunflower seed butter is also a reasonable source of vitamin E, magnesium, and healthy fats. The fact that your body tolerates it better than peanuts, and that you actually enjoy it, are not small things nutritionally.

If you want to be thoughtful about the omega-6 to omega-3 ratio, the more meaningful lever is making sure you’re getting enough omega-3s through fatty fish, walnuts, flaxseed, or a quality supplement, not eliminating a whole food you’re already eating and enjoying. I hope this gives you some peace of mind!

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