How Does GLP-1 Actually Work? Benefits, Risks, and the Weight Loss Buzz

I feel bad because when I'm on with patients and the Wi-Fi is not working, it's like what do I do? [laughter] Hello everybody. Welcome. Welcome. We are gonna give it a few seconds for people to funnel in. Um but if you are one of our punctual viewers, thank you. We always appreciate that. Um welcome to the Med Matrix Method podcast. Um we are here one to two times a week. We are talking about um everything functional medicine. Um we're focusing on our preventive personalized medical approaches to all aspects of health. Um while we just kind of let people stream in a little bit. Um Colin, you had a full full day of patience today, didn't you? Sure did. Full week of patience. Yes. Full week. Yeah. What day? What? Yeah, today's Thursday. That's a full week already. Today's Thursday. Yeah. Yeah. By Thursday afternoon, you know, the uh the the brain starts to, you know, get a little tired. [laughter] You're feeling it. Yeah. Yeah. You're starting to feel it. I mean, you you know, it's like you have to be when you're in healthcare, I don't think people realize when you're in health care, you take care of patients, you have to be extremely sharp all day with every patient. You got to come up with you gota wheels got to turn all day. That's true. There's not a lot of Yeah. So, we gota be not a lot of room for error. Yeah. Not a lot of room for error. No. So, we take good care of ourselves. We take care of our brains to make sure we're sharp all the time. Absolutely. Absolutely. Well, I'm excited to be here. Um, today we are talking about GLP1 medications. We're going to dive deep into kind of the benefits, the risks, um what's all the buzz about, and um why don't we I know you are I consider you to be an expert in this topic. Um so why don't we start with just kind of you introducing yourself a little bit and then I'll take care of some housekeeping items before we dive in. Sure. Thanks. Um I'm Colin Bernard. I'm one of the lead clinicians at MedMatrix. I have a pretty unique background. Um, I have a background in chiropractic medicine. Um, I'm also have a background in natural medicine. I practice as a PA at Med Matrix and I am mult I hold multiple board certifications and I am also fellowship trained in functional medicine and anti-aging medicine. So, I've been using GLP1s I think since they sort of came out. I think they kind of boomed after COVID essentially and there's a lot of new really exciting uses for the GLP ones that go beyond weight loss and metabolic issues. So definitely something I have been using for a while for different reasons other than metabolics and weight loss. So maybe we can dive into that too. But tell us a little bit about yourself, Dr. Rose. Yeah, my name is Dr. Sasha Rose. I am a naturopathic doctor, licensed acupuncturist. I sit on the Forbes Health Advisory Board. Um, I've been practicing functional medicine for going on 21 years now and I'm one of the lead providers here at MedMatrix. Um, and am using um, the GLP-1 medications on a daily basis and um, honestly it's like probably one of the most amazing they are one of the most amazing tools that I've come across in my 21 years. So um super excited and um yeah just want to also make sure that our listeners realize that um everything that is discussed today is for educational purposes only. Uh we are not um providing medical advice. Um, if you are interested in um, becoming one of our patients, um, you are more than welcome to, um, go to our website um, and book a discovery call if you're interested um, to see if you are a good fit. Um, the other thing to mention is that if you have questions, I know I know my current patients, I know a lot of people just in my life in general have a lot of questions about GLP-1 medications. um you can use the comment section and we are going to do um some Q&A at the end. Again, no direct medical advice, still educational, but um we do love questions. We do love to know that you're here. So um definitely definitely chime in um at the end. Uh you can put your questions in anytime. We will get to them at the end. So Colin, um, yeah. Should we get growing? Should we get Let's get going. Let's get going. Yeah. So I'll just give a little bit. I mean, I think a lot, again, a lot of our listeners know a lot about this because GLP1s are, you know, kind of talked about so much. Um, but I'll just do kind of a brief overview and then you can kind of help us dive into what they are exactly. So we know that GLP-1 medications um you know have become one of the most talked about topics in healthc care. People often know of them with in terms of their ability to support weight loss and improve improve blood sugar. Um we are also seeing you know benefits in terms of appetite and you already mentioned metabolism so some metabolic concerns. Um, but I think because there's so much out there right now on social media, in the news, um, a lot, you know, a lot of commercial brands out there, there's a lot of confusion. I know I have patients coming in often confused about what they actually are, how they work, what's the safety when it comes to them. Um, so today we're really looking at GLP-1 therapy from a functional medicine perspective and we're going to kind of talk about semiglutide, tzepide. People have sometimes heard those terms but they're kind of strange. So we'll get into that. Um, and then even some of the, you know, emerging ones like retatide. So hoping that we can talk today about differences between conventional prescribing and personalized dosing. who may benefit from a GLP-1 um therapy program, what the risks are, and why we believe that kind of long-term success is more than just being handed a medication. So, that's kind of what what we are hoping to to kind of cover today. So, why don't you start us out with what exactly are GLP-1 medications? Sure. um GLP1 what exactly they are is u an interesting question because a lot of people just know that name that like GLP-1 it's like it's actually um something that naturally occurs in the body a GLP-1 stands for glucagon like peptide one and it is a naturally occurring hormone that's produced actually in the gut and essentially the peptide and that's the other thing a lot of people don't know what's a peptide We talk about peptides all the time and we we we've done tons of podcasts on peptides and we use peptides all the time in the at Med Matrix, but GLP-1 is actually also a peptide. And um at its core, GLP1s help regulate your blood sugar and they help with appetite, they help with insulin release, and they help with digestion. So basically what the medication is designed to do is mimic the body's natural GLP-1 response. So the medication was originally developed for type 2 diabetes management. It's been widely utilized for weight loss and weight management, but there are some new really exciting emerging fields of GLP-1s being studied in like complex chronic illness. And you mentioned some of the different types of GLP1s, Dr. rose like tepatide um there's some new studies about how anti-inflammatory it is. So there's a lot of emerging exciting things that are going on with GLP1s and their utilization and they've become such a major topic as you mentioned and the um I think the biggest reason why they've become such a rising topic is because of the rate of obesity metabolic disease has significantly increased and I you made a great point when you were introducing this to say you know is this really appropriate you as part of a program, right? I think that's a huge point that we need to make about GLP1s is that when you come to Med Matrix, I will speak for all of us as clinicians, is if your chief concern is weight loss, you're not just going to be put on a GLP1 and like, "Okay, bye. See you in a year." That's not the way we do things. GLP-1 is a tool that we utilize as part of a big broadspectctrum treatment plan of lots of other things that need to be optimized. So um but we are seeing it much more common place because of the rise of obesity and metabolic disease and that's really what it was developed for. So people are using it. Um and you can get some pretty significant weight loss results. That's what the clinical studies have shown. Um, and there's just such a huge increase in media awareness, public um, public awareness. I mean, you can't I can't watch any of my streaming services without a commercial [laughter] for the new DLP1 pill or whatever. Um, yeah. So, there's such a growing demand. Um, are you seeing anything different, Dr. Rose? What are your thoughts? Have I missed anything about Yeah. No, I mean I think um I do think it's important because we kind of throw these this terminology around just to talk a little bit about the the evolution and maybe some of the differences with the GLP1s. Um yeah, so I mentioned semiglutide and semaglutide mimics um one hormone. So, it's an agonist to the GLP1 uh hormone or another way to put it is that it's basically kind of fits in the same receptor as that GLP1 hormone that we produce naturally. Right. So, that was kind of the first generation um tepide for people that Right. Exactly. So, the So, so people will sometimes say to me, what do you mean the GLP1s? Like, do you mean like the Ompic? So yes, commercial the commercial brand is ompic um oriaglutide or goi or wgoi. Um yep and so tepatide is uh works on two it's an agonist for two different hormones GLP1 and GIP. So that one has works kind of in two on two hormonal pathways and the commercial version of tzepatide is mjaro or zeppbound. Um there's also now an oral semiglutide. The commercial of that is rebelsis. Am I pronouncing that correctly? Rebelsis. That's how I sayis. Yep. So that's the oral semiglutide. Again, this is just kind of terminology. Um and then the one that um is still being studied um and I know but I know is out there on social media is retatride. And that's kind of like a third generation or next generation being studied for GLP1, GIP and glucagon pathways. So not one, not two, but three mimicking three three of those hormonal pathways. So um again each with each generation of these medications the the scientists the researchers are trying to affect additional metabolic pathways. anything you want to add to that? Um, I'm I'm so glad you said that because I think it's really important to define all these things. Um, because a lot of my patients will come and, you know, my doctor put me on ompic but I see tepatide or like my best friend's on tzepide. Should be on that instead like what's the difference? So, um, there's definitely an evolution of these. you know, Ompic was really the beginning of where we started and we're evolving. The drugs are evolving. Um, the understanding of what they're doing is evolving and as you very eloquently said, they are able to use the drugs in different ways now because they're affecting different receptors. So in the way I sort of explain it is when we use say tepatide which is that second generation the GLP1 and the gip it might work better for certain people because of two receptor um targets versus say one which is what ompic does maybe potential for less side effects or a different outcome or um as I said a few minutes ago tzepatide is being studied at micro doses for or very small doses for different um other types of like inflammatory diseases, immune mediated diseases. So there's a lot of different nuances with this and we don't certainly want to confuse people but it's really important to make these definitions um aware for you know make people aware of the definitions. I think it's really important. So absolutely. Yep. Yeah. And I think it's important that we kind of Oh, go ahead. No, you go ahead. Finish your thought. No, I was going to say I think it's important, you know, for us to kind of talk about why this matters. Yep. You know, like why do we care, right? You know, why do we care about all this kind of thing? So, how do you how do you answer that? How do you answer why why they've become such a major conversation? Why people kind of, you know, why they're not kind of not going away? The GLP-1 medication. Well, it's not going away because like I said, there's such an influx of obesity and metabolic disease in mainstream uh or in in the mainstream media. That's how it's being advertised. But there is a huge shift in American culture anyway that a lot of people have obesity or metabolic disease. And um the other thing too I'll be kind of honest and say is that GLP1s, they're a bit lucrative. um you know there's a there's a cost factor there. So there's a lot of new things popping up on online and um like all tele medicine companies where you can kind of you know sign up with somebody but I don't love those because you're not getting a lot of personalized care. So um there's a lot of stuff in the media but um they they are really important because they are used as a tool for people to and what I try to explain to people is to kind of get started you know to kind of get the ball rolling. Um, you know, we we talk about diet, we talk about hormones, we talk about nutritional deficiencies, we do all this work in our patients, but sometimes the way I explain it to people is we just need something to kind of get you feeling a little bit better, get the weight loss started, and then that's how people start to evolve in say a weight loss journey or a metabolic journey. Um, and a lot of people struggle with um, you know, food noise, which we should talk about, right? cravings of food and relationships with food. And when you use the medications appropriately, I've seen people have completely changed um relationships with food during the process where they don't crave certain things. You know, they're their craving for sweets or bad food goes away, which is huge, right? If you can change the relationship that you have with food, I mean, that's that's really amazing. Um so yeah, I think that's one of the main reasons why this is really important. And what what are your thoughts, Dr. Rose? Why why do we care? I think that's I think it's a really good point to bring up about food noise and what we you know I think as we mentioned the GLP1s were originally designed for diabetes and then we saw that people were losing weight and they're now seeing these benefits that were not part of the original intention. It was not part of the original design and you know we're going to get into this in a little bit more but about how you know especially tursepide and maybe reatride lower inflammation and how and then separate from that we know that they you know in terms of that food noise there's an impact on brain chemistry not just kind of stomach chemistry and it's really about satiety and appetite and how that's both the brain and the gut And somehow these GLP-1 agonists kind of work in both the brain and the gut. And so it's, you know, hormonal and neurological. And it's not just about willpower. And so they're because of that brain chemistry, they're like investigating using the GLP1s for all sorts of addictive behavior, for different substance abuse. And that's where that's that brain chemistry. Not we're not just talking about food anymore, right? we're just talking about um addiction essentially. So um I just find that to be fascinating. Um and before we move on, I just want to say because I know there's some people that have just joined. So just to kind of get everybody on board, just uh we are talking about GLP1s if you haven't picked up on that already. Um the benefits, the risks, um [snorts] and kind of why all the why all the buzz around around weight loss and GLP-1 agonists. Um, just to say it again, we are here for educational purposes only, not medical advice. Um, if you have questions, please put those in the comments section. We are going to, um, get to that at the end. And thank you for being here. So, um, we were talking about food noise. Um, so do you feel like GLP1 medications really are only about weight loss? No, definitely not. and and um that you put you brought up the point a minute ago about inflammation and a lot of patients that I see I know you see too and just all of us providers at Med Matrix we see a lot of we see not a lot but we'll we'll get patients there's where there's a lot of complexity um you know there's autoimmune conditions or different inflammatory conditions or uh multi-system conditions that are inflammatory whether it's like a mass activation syndrome syndrome or a rheumatological issue or people that have had chronic fatigue syndrome or Lyme disease or something like that. And we start to ask the question, you know, all of these complex chronic illnesses have a stem of inflammation. And if we can use something like a GLP-1, specifically the trespide, that second generation, because it's been shown to be highly anti-inflammatory, if we can use this type of tool to reduce systemic inflammation that may affect someone's whole body, that could be a huge stepping stone in their health journey. um GLP1s at micro doses so very small doses have been studied for as you said addiction mass activation syndrome um autoimmune disease uh chronic fatigue syndrome so it there's that sort of begs the question like is is are GLP1s the answer to complex chronic illness or potentially like is that part of it and and it might be um I've I've used the GLP1s like I said for years now to treat very complex, you know, immune deficiency and MCAST and POTS and postline. Can you I'm going to stop you for a second. Can you can you can you uh define those for our listeners, please? Most people might not know what MCAST or POTS stand for. Massel activation syndrome, um postural orthostatic tacocardia syndrome, um chronic lime, chronic fatigue syndrome. So people that are struggling with a lot of these like I said chronic inflammatory states uh the GLP-1 might not necessarily be like the okay here and just goodbye you know there's a lot of work that we have to do but if we could use say something like a GLP1 as a tool to reduce inflammation and potentially get people feeling a lot better when they felt really bad for a while with whatever they're dealing with. That's a huge win. And I'm seeing such amazing progress with some patients in these complex illness um populations where we're using it as a tool. So I I do use it for weight loss. I know you do too in metabolic syndrome and pre-diabetes, diabetes, helping with blood sugar management. But you mentioned the addiction piece, you know, and complex illness. It's starting to ever so much evolve. Um, there's studies that are being done currently on GLP-1's effect on long COVID or sort of like long hauler COVID, whatever you want to call it, where people are getting sick uh from getting COVID. Um, like after it gets better, they're just chronically sick after COVID. Uh, there's a lot of big studies being done on it. So, I think we're going to start to see this a lot more in other realms, just uh not just diabetes or weight management. So yeah, it's a huge huge thing. Are there other things you're seeing, Dr. Rose? Did I miss anything? Just to kind of go over a little bit of some of the metabolic pieces. I think um two days ago I did a podcast um on, you know, um insulin resistance. And so insulin resistance is a great example of, you know, what can sometimes be part of the root cause of weight gain and metabolic dysfunction. And so often times a GLP-1 medication can be a really helpful part of working with that. Um, you know, as we've kind of mentioned and as we both of you and I both love to talk about is kind of hormonal changes, hormonal imbalance, thyroid dysfunction, kind of all of these things that can kind of go into metabolic dysfunction. Um, like those are some of the things that we see our patients coming to us with complaining about. Um, again, those really intense cravings, weight that they can't get rid of. Um, we've mentioned the blood sugar thing, you know, a couple times. Uh, definitely that like abdominal fat, belly fat, feeling really fatigued after you eat. Like those are all kind of signs and symptoms when there's a metabol when there is metabolic dysfunction. Um, and then what we see, you know, we we'll get into this again, you know, going forward, but on some of the labs, we'll see things like non-alcoholic fatty liver. Uh again those are all aspects of metabolic dysfunction and those are some other uh symptom pictures symptom pictures that we might see where um potentially a GLP1 can be part of a comprehensive plan. um talk to me about um well why don't we talk a little bit more about the weight piece and like why okay sometimes weight gain isn't just weight gain and maybe when you're like when you're with a new patient and they are talking about weighing more than they would like and you're looking at you know the metrics that we use which is we use like the inbody scan and you're looking at it and you know that this person is carrying more weight than they should. Um, what are you what are you doing? What are you looking at in terms of root cause for that weight gain? Cuz I know that you I've worked with you long enough. I know that you're not just handing out medications. Like you mentioned the tellaalth places where that's basically what it is. And I know that's not what you're doing and I know that's not what any of the providers here are doing. So, how are you looking at weight gain um you know before suggesting a treatment plan that may include um a GLP-1 agonist medication? Yeah. So, really what is the root cause of weight gain really and how are we assessing it um from a functional medicine perspective is very broad and I'll speak for all of us providers at MedM Matrix because we all have we've worked together very closely. We all have very similar sort of philosophies on this, but weight gain is very multiffactorial, right? You don't have weight gain because you have a trozepatide deficiency, right? That's not how that works. [laughter] Um, so that's why, as you said, and you're 100% right. If patients come to me and say, "Oh, I have weight, you know, as my primary concern. I'm overweight. Oh, well, here's a GLP1. I'll see you in a year." Nope. That's not what we do. Um weight gain is highly multiffactorial from hormonal dysfunction to very poor diet. That's probably number one is poor diet. Um poor lifestyle, sleep being dis being off, chronic stress, nutritional deficiencies, gut issues. Um so those are the things that we assess at every new patient visit is okay, I I'm overweight. Help me. Okay. Well, number one, what are your weight loss goals? So, I can sort of understand what that looks like. You know, is it 100 pounds? Is it five pounds? Everybody's definition of obesity for themsel is different. And then let's talk about you, right? What are you eating every day? What are you drinking? How much alcohol do you drink? How much do you sleep? How much stress do you have? You know, let's take a look at your hormone at your hormone health. Are you permenopausal? Are you menopausal? Do you have low testosterone as a male um or a female? Um, there are so many metrics to this and like I said, I think what we do really well or what I try to do and I know you do too, like you said, we've worked very closely together for long enough now, we know each other to say that if some of these basic things are not being met and we've talked about this ad nauseium on this podcast, if we are not meeting some of the basics of diet, lifestyle, alcohol, sleeping, you know, all this stuff, you've got to do that. So the GLP1 is not just, okay, here you go, have a happy life. It is, okay, you want to lose a 100 pounds, great. We could use a GLP-1 as a tool. I'm happy to do that with you, but you have to meet me halfway. You have to do the work. We have to change your diet. We have to change the way you're doing things. I will meet you halfway with the medication, and I will also guide you on how to make changes in your life, but we have to optimize your protein levels. We have to make sure you're not snacking. We have to make sure that you're not drinking 30 alcoholic drinks a week. We have to make sure you're sleeping. All of these things are so so important. And that's really where people succeed. And I think that's where Med Matrix succeeds as a clinic and as us as providers is we do so much handholding with patients. And I don't mean that in a negative way. I mean it in a way to guide versus some of these online companies that offer GLP1s where they just give you the drug and there's no support. They're not talking about diet. They're not talking about your nutritional deficiencies. They're not addressing menopause. They're not addressing your eating habits. They're not addressing your sleep. And maybe the GLP1 will work a little bit for a little while, but you'll you'll run into a roadblock. And so many of my patients are those people. They'll come to me and say, "Yeah, I was on it like I don't know. I I wasn't getting a lot of help and I know I need to change my lifestyle and my diet but no one's telling me how. So that's what we do really well here at Med Matrix and that's really how I start the conversation of GLP1s. It is a very multiaceted approach with a lot of different variables. It's a total life change. You want to lose weight. It's it's you have to be ready for a life change. So it's not just being put on medication. Yeah. Yeah. Yeah. How do you approach this, Dr. Rose? Yeah. I mean, I just think I think it's a good point to make that it's not just it's not just a medication and it's it's it's it's how and in what context it's being recommended, at what dosing, etc. And I know that and again at Nauseium on this podcast we've talked about kind of conventional medicine versus functional medicine but what I'm seeing is that when um a provider within conventional medicine is prescribing a GLP-1 medication you know as we've talked about they are very their hands are tied mostly because of um insurance coverage and some limitations in terms of you know relationships or ties to the to to big pharma. So, usually if somebody is, you know, is prescribed a GLP-1, they have to basically have a certain BMI. They have to have a certain blood sugar uh status. Um, and their insurance may or may not cover it. And there's also commercial medication guidelines. So, they're very limited in kind of the amount that they're being given, at what, you know, at what titration um they're being given. And so there's very standard dosing and escalation schedules. And that's, you know, even if the conventional provider does have more awareness or more information um about the nuances of GLP-1 medications, they are limited. And so um one strength I think to the conventional approach is that there is you know there is real strong clinical research for obesity and for type 2 diabetes. there's very clear prescribing guidelines and people are often, you know, losing weight and improving blood sugar and so I don't want to make it sound like there's not great things happening um kind of within with GLP1s and conventional medicine. Would you agree with that? Totally. Yeah. I mean, there are really great things happening in both worlds. Um I just think we do it better. [laughter] Is that okay to say that? Well, let's be brutally honest. Yes, I'm not trying to be mean, but no shade. But I like I said, I I think we just we have so much more ability and time to utilize the medication as a tool. I think that's how it was intended. It's not just a set it and forget it, right? It's not a crockpot. You put it on and just like, okay, leave it there for a while. You have to do the work with the patient because metabolic disease is a lifestyle problem. It's a you know type two diabetes is a lifestyle problem and if you are in the conventional medical setting treating it just as any other pathology and just medicating it. A you're not teaching the patient anything about how they got there and B what we're trying to do is instill change in the patient long term. If you just set it and forget it and don't give guidance, how is that creating a new perspective for the patient on how they're supposed to treat their health, treat their body, understand what their body does, understand how their health is important and active health care is so important, right? This isn't just passive where we give you something and you don't have to do anything. Yes, healthcare is active on the part of the patient and our philosophy at MedMatrix and just as a functional medicine provider um the philosophies of functional medicine is looking at all the parameters and really instilling active health care in the patient so they can understand what it is they need to do to change um change to get their goals that they're looking for. So um it definitely plays a lot of roles and it you know it conventional medicine does well. It's just if there's not a lot of guidance, it probably isn't doing as well as it could. I think that's really the take-home for that from my perspective. Absolutely. Yep. And I think we've touched on this a little bit, but you know, one of the biggest differences is I think our ability to to really personalize the dosing, like which GLP1 medication and what is the you know, how we can really personalize um the pace of the titration, the personalized dosing. Um, why don't you talk a little bit more about what we mean when we say because I use the term micro doing with my patients all the time. Tell us kind of what what that means and how you're adjusting things. Um, and a little bit more maybe with, you know, how you might use a GLP-1 medication with somebody with mass cell activation syndrome versus the person who does need to lose 75 pounds. Right. So, as you said a few moments ago, Dr. Rose, about how conventional prescribing guidelines sort of dictate the care of these drugs, and that that's very true. um the the drugs are prescribed at very specific doses. So if people are familiar with the GLP1s that you would say get from a commercial pharmacy, a big box pharmacy, they come in an auto injector pen mostly where you just set the dose on the little dial on the skin and hit the button. Um, with the GLP1s as a drug though, there's a lot of potential benefit of the drug at various doses that are not those standard doses that have been laid out for type 2 diabetes and obesity. So, I won't give numbers because I don't want to I don't want anybody to take these numbers and run with it. But if let's say tzepatide right the the type 2 the second generation GLP1 is being used at certain incremental doses for obesity right it starts at this dose then it can go up to that one and that one and that one and that's how some people might progress in an obesity situation we could we could use tzepatide as a micro dose sometimes like a tenth of the starting dose of the tzepide for weight loss for someone say with mass activation syndrome or some sort of inflammatory multi-systemm inflammatory condition at the micro doses these very small doses often less than a milligram um they can they've been highly studied as being extremely anti-inflammatory. So you we may not we're we're not using it to right like you said shed 70 pounds. We're using it for full systemic anti-inflammatory benefits. The tzepide molecule the GLP-1 molecule has also been highly studied as for example a massel stabilizer. So it can stabilize this part of your immune system to be more functional and not as um dysfunctional, inflammatory, reactive. So as a very I guess as you called me I don't want to call myself an expert but I am very wellversed in the GLP1s [laughter] for a lot of different things from metabolic disease, diabetes, obesity to these complex chronic illnesses. Um the ability to utilize them in various ways is very grand. So when we are talking to patients, when I'm talking to patients as a clinician at MedMatrix and I'm saying, "Okay, what are our goals, that's so important because it will tailor what we're going to do." And if we were to rely on a trespide, say, at a standard dose, we wouldn't get those um the ability to do that treatment at a at a bit of an altered dosing schedule so that we can get some of those other benefits. So um and and the thing I want to make it very clear is that these things are being highly studied too. We're not sort of making this up. This is not information or um uh kind of winging it. You know, Dr. Rose and I are not winging it. These are um uh protocols and and dose schedules that have been highly studied. Micro dosing has been highly studied for various conditions that we're speaking of. So this isn't like a med matrix thing although we do it really well. Um so you can come to med matrix for us to do it. U but this isn't something we like made up out of thin air. These drugs are being highly researched in these different arenas and micro doing protocols and other complex disease besides diabetes. So definitely really interesting. Absolutely. The other piece when we're trying to kind of fill out for somebody that uh what it what it might look like when we in what context and what you know what might kind of prompt us to consider GLP-1 therapy. I think it's also important to talk about the amount of uh labs that we do uh when we are kind of evaluating determining if this is the right medication for somebody. And so that's going to include um markers that are pretty much all included on our initial comprehensive uh lab panel. And that's a fasting glucose or fast fasting blood sugar, fasting insulin, a hemoglobin A1C, which is a threemon average of your blood sugar, um a lipid or cholesterol panel, liver enzymes, a full thyroid panel, multiple inflammatory markers, nutrient levels, hormones, kidney function, and then as I mentioned earlier, the inbody scan, which gives us a really great uh picture a full metrics about about body composition. So all of these are basically in addition to what we've learned from the patient and in the health history markers that help us determine if you know is this is one of the goals to lose fat to change body composition to preserve muscle to improve metabolic health or as Colin um articulately put it more about these other kind of longterm inflammatory conditions. And so just to give our listeners, our viewers a little bit of a perspective that we're always including these test results in our assessment. Talk to me a little bit about muscle preservation and I know that is a concern um with kind of um in general when we are considering GLP-1 therapy. So so give give our listeners a little bit of a context in terms of muscle preservation. Yeah, muscle preservation and GLP1s are such an important discussion point to be made together and I talk about muscle preservation with GLP-1s with every single patient because it is very well known that um there is a potential for muscle loss with GLP1s all of them um not just ompic not just tepatide but all of them can have some amount ount of muscle wasting. So, okay, when we talk about muscle wasting, we're talking about it in the sense of preservation. We know that um there is a certain amount of risk of that. So, the thing that we have to do is we have to talk about the diet, right? Again, something your conventional doctor, your primary care doctor may know nothing about or may not even address. and I have asked the question and my patients, yeah, no, they don't tell me anything about that. Or again, some of these sort of online companies that are prescribing the GLP1s and there's no guidance. They're not talking about it. So, one of the most important things is protein awareness. Um, being adequate with protein amounts is really important in the diet. So, again, as I mentioned earlier, if we're not if we're not talking about that, you're you're not getting the drug. I'm not prescribing it to you. If you're not gonna meet me halfway and say, "Yes, I'm gonna work on my diet with you." Great. You have to do it. It's like a It's like a must. Um because we have to make sure we're doing this the healthy way. You know, we're not trying to cause chemical anorexia, right? We're not trying to lose 50 pounds in a month. It's not none of that's healthy. We're trying to do this in a very sensible, healthy, logistical way so that you're getting the results you want and we're keeping you healthy along the way. So muscle preservation is one of the most important things we discuss but protein in relation to that is the biggest thing. So we calculate you mentioned BMI um your the BMI before um you know how much body mass you have but we also measure something called basil metabolic rate which or BMR which is like how many calories you burn just from laying around on the couch all day. You know we need to know that we need to make sure you're eating enough. We need to make sure you're eating enough protein to match how much weight you are. um you know how many pounds you weigh should equate in some way to how many grams of protein you should eat and that's all very personalized care right we can't just spit out a number because everybody's different so that's all part of the discussion from the very beginning that I have with my patients um about what this drug really means in terms of other parameters that we have to deal with um so the muscle wasting is a big one for sure yeah are you saying one thing I do I am asking that so this is how I'm talking about it. And this is based on some research that I a couple different studies that I came across because I had that concern, my patients had that concern about muscle preservation when being on a GLP-1. And what I learned from these studies is that um and I do feel like I'm seeing this clinically as well is that when somebody is on a GLP-1 medication for weight loss, like this is an individual who needs to lose say 30 to 100 pounds, we're going to see uh muscle loss initi we're going to see it initially. And what the studies showed have shown is that the muscle that's lost initially when it's kind of that much that has to be lost is lost is actually not healthy muscle. It's striated with fat. And so what the studies show is that kind of until you get closer to the ideal weight for that individual, it's kind of okay to lose that muscle. Now, that doesn't mean that they're not focusing on protein and that they're not kind of aware of it, but when you get closer to that goal weight, it should plateau. Like the muscle loss should plateauate. And I also have a just a caveat that when we are say micro doing um that's kind of a different picture. like I'm not seeing the same degree of muscle loss because I don't think it needs to happen and it's kind of um so that same principle applies protein etc like make sure that you're doing strength training and doing the things to kind of maintain muscle but we're just not also seeing that degree of muscle loss so yeah um just a kind of a clinical note and the research that I came across uh when I was concerned about it that's a great Right. Yeah. Yeah. So, um let's kind of come back to med matrix. Like when somebody comes to med matrix and they're curious about GLP1 therapy, their cousin was on it. Uh did well initially, but then you know her this cousin's insurance got taken away. She had to go off of it overnight. She gained all the weight back. this patient coming to us thinks they might want it but that story with the cousin kind of freaked them out like give it how does the process begin? Um so yeah the process begins at Med Matrix if you are interested in say a GLP1 for weight loss or you're just wait interested in weight loss in general. Um, so at MEM Matrix, we use obviously a functional medicine model to healthcare. That's what we do. That's what we've been talking about. That's what we talk about in this podcast. And basically, we're evaluating interconnected systems that affect weight and metabolism. So, if that's really what the goal is, right? We're using this for weight loss. We'll make it a little bit simple. Um, we are identifying potential root causes and contributing factors to why a patient has obesity at a certain level. We're looking beyond just like symptoms like okay I'm overweight okay well why um you know we are trying to create personalized road mapaps really for care we're trying to create um an understanding of various aspects of a patient's health so they can put it all together for themsel so they can understand that the reason why obesity is their problem is not just again a tepatide deficiency it's not a thing so we're using this medication as a tool But we're trying, as I said, to create this road map of care so that they can understand really what it is they need to do to change where diet comes in, how their lifestyle is affected, are their hormone deficiencies, are their nutritional deficiencies, stress management, sleep management, and sleep hygiene. All of these things are extremely important. So the med matrix evaluation of a patient really starts from the initial visit where as you talked about and you listed all these different labs that we do that's from day one. Um you have those lab values drawn in our office before you even meet with us. And then when you meet with us for the first time we'll talk through all of these metrics with you. We'll give a we'll get a really good comprehensive health history out of you and we will then talk about all of your labs and we'll talk about all the things that need to be done over a 3 6 12 month period so that you can attain the goals that you're looking for and whether that does include a GLP1 or not that's part of the conversation and the big part of the conversation is okay is this appropriate for you what are the risk what are the benefits what should you expect how do we use this how is it used over a course of time what should you expect a certain outcomes. That's all part of our initial assessment. It's a lot of information, but it is extremely important for us as clinicians to give all this information so patients understand what it is they're doing as part of our method of healthcare. Um, did I miss anything, Dr. Rose? Is there any? No, I think you hit it. [laughter] I think that I think the biggest take-home hopefully is like individualized care, individualized dosing. And I think we've talked about kind of that initial visit and I think often here's one place where we split from conventional medicine and GLP1 therapy is the ongoing support. So we do labs in general every 3 months. Every time you come in for your labs, we're getting you on that inbody so we can kind of track the body composition. um we're supporting you in so many ways whether it's lifestyle whether it's adjusting the dose of the medication um so it's it's not that support that ongoing support I think is just as important as that initial conversation um so one more piece on this then I want to get into the question and answers and then I want to finish with kind of what our takeaway take-home is for for the for this um episode. So, what would you again you've run somebody through kind of a program, you've been seeing them for 6 months, nine months, what would you what would success look like from kind of a med matrix perspective in relation to this topic? Yeah. So, in relation to a GLP-1 program, um, success in that program at Med Matrix really is, as you said a few moments ago, personalized plan, a personalized nutrition plan. We're talking about your calories. We're talking about your protein intake. We're talking about resistance training, exercise, muscle preservation, sleep optimization, stress management. Um I mean we're not therapists but I sometimes feel like one sometimes during [laughter] your during our visits right and sometimes patients need that right I just need to vent I need to talk we have got stuff going on it's like okay totally fine um we are providing which I think we do an amazing job as clinicians here in the clinic is we provide ongoing monitoring and support for people and um I've seen we're going to get to in a few minutes but in some of the comments that people are are leaving us on on our socials is they don't know how to get started or they'll there people are saying I want to do this but you have to tell me exactly what to do. Well, that's what we do. That's a 100% what we do and that's what we pride ourselves on and say listen this is all the objectives. These are your goals. This is exactly what you're going to do. You're going to do X, Y, and Z over the next three to six months. We're going to do A, B, C, and D. After that, you're going to combine it with Lmento at this point in time. [laughter] Um, so I don't know about that medication. Tell me about that one. It's focusing on this sustainable metabolic health journey rather than just short-term weight loss, right? We're not trying to lose 50 pounds in a month so you can go to a wedding or whatever. Um it is really trying to introduce the idea of a sustainable life change over a course of time and weight loss is the journey, right? We're not we're we're using um we're using this as a place to create a new life for a person. Um because if they're looking like we talked about 70 lbs, 100 pound weight loss, that's a whole different life that a person has to live and they're often looking to live and we just have to get them started. So that's really what we're doing. That's the med matrix perspective and I think we do it really well um because we have a lot of happy patients and uh I think it's an important topic that we've discussed today and I think it helps feel people feel validated and people feel excited about it. So it's exciting for us. It's really exciting. It is. I agree. So, we're going to dive into some Q&A. Looks like our first question is asking, "How many different things do you test for?" You want to take that one on? Uh, you listed a you listed a whole bunch. I did. I did earlier. Yeah. I don't know the number. Uh but so it's something like the initial panel is like a hundred over 100 biomarkers and that's just the initial panel. The initial panels over 100 biomarkers and you we we we talked about inflam inflammatory markers, thyroid markers, immune system markers, um hormones, vitamins, um all kinds of biomarkers that help guide your care. And um we also do a lot more testing than just that. You know, we do a lot of specialized testing. We do a lot of gut testing or you know testing for Lyme disease or mold or other more complex things but every patient gets over a hundred biioarkers as a new patient for us to guide the care initially. It's a lot of information and it's a really good starting place for our care. Yep. What is the difference between ozic and tzepide? I have heard that tzepide is better. Why would my doctor recommend Ompic and not Tzepide? Do you want me to answer this one? Yeah, go for it. Um, [laughter] so as Dr. Rose talked about at the beginning of the podcast, Ozmpic is also known as semiglutide. It's the first generation, first out of the gate GLP-1. It is a GLP1 only receptor medication. Tzepide um also known as Zepbound also known as Mangaro um has multiple receptors that it's acting on um GLP1 and something also called GIP. So it's sort of like a second generation to the GLP-1 world. Um I typically use Tzepide over semiglutide or ompic. Typically in my experience there's less side effects and it's been more heavily studied in the micro doing world that we talked a little bit about. Uh so why a pre a practitioner might recommend ompic and not trespide that's really hard to say. Um they might just be comfortable with using ompic as like a clinician preference. They just know how to dose better. They know what to expect. Um for me as a clinician I do prefer tzepide but again clinicians have their own set of experience as to why they might do something. So why they might do something versus say another person getting similar treatment. It's not that one is right or wrong. It's just different in opinions or different circumstances. And and if you do have questions you can ask your doctor like why are you giving me this versuside. It's a really reasonable question. And if they don't give you a good answer, then maybe you need a different doctor. I don't know. There may be if this is um through insurance, there may be insurance reason as well. Yeah, insurance. Your insurance plan may cover ompic but not trespide. Great point. Yeah. Um which G is the best brand? We kind of were talking about that a little bit earlier. Um but let's there's a couple questions here about um oral uh administration versus injection. So um my experience with this is that we have a lot more uh kind of research and just us clinically with kind of the injectable forms but we are now seeing um oral semaglutide is available. Um and I I know of one I have one family member who is doing well on oral semiglutide. I have started to prescribe it but I don't have it's been recent enough that I with in all honesty I can't tell you how it's going. I can't give you like a actual real life clinical feedback in terms of how people are doing uh results-wise on that versus the injectable forms. What about you Colin? I yeah, I agree. The oral just hasn't been around long enough. So, we don't have a lot of clinical experience, at least I don't. And that's really one of the tenants of evidence-based health care is what the research shows and then what the clinician's experience really is with prescribing said intervention. Um, we don't have the ability to alter the dose with the oral option. So if we're trying to use the GLP1 in a micro dose formulation for something other than say metabolic disease or type 2 diabetes or obesity, the oral is um just a standard and um it's just not something that I know enough about yet. I agree with you. There's just not enough data I think yet. But um the oral might be cheaper, maybe more accessible, but it's still semiglutide, right? So is that preferred over trespathide. Well, it depends on the patient. So, there's a lot of variables here with why one might be better than another. And like I said, this is really where we're excelling, I think, at this with Med Matrix is we can really dive into all these questions for a patient rather than just kind of like, okay, try something random and see if it works. Exactly. Exactly. Yeah. So, I think we have time for one more. All right. How do you get my how do you get my bowels to work daily with tzepide? [laughter] Um is there a supplement that would help versus taking mirac? I think you and I both have some again without giving direct medical advice [snorts] some general information around um digestive health. I will I I want to talk a little bit briefly about that this like the most common side effects on the GLP ones which we I think we maybe need to just say one more time and then I'll let you kind of get into what some of your favorites are but we do know that with um the with tzepide the most common side effects do affect the digestive system. So that's going to be nausea um and constipation for most people. I have had a couple patients with other GI symptoms, but those are definitely the most common. Um, it's probably a given that the higher the dose, the higher the risk of some of these side effects. And as always, everybody is very different in terms of their sensitivity. So, um, yes, it is a, you know, something that I talked to everybody about before suggesting it. And Colin, what are some of your favorite in general suggestions around optimizing gut health while using a GLP-1? I mean, one of the things that I worry about if a patient is having significant GI disturbance is if the dose is not right. Maybe the dose is too high or if there is inadequate nutrition. um if there's not enough calories in the day, there's not enough protein in the day, it can significantly affect um the symptoms in the bowels. Also, time of day kind of matters, too. I usually recommend patients do their injections at night. So, if they're having some nausea, they'll sleep through it. Um but a lot of times, if there's a lot of bowel disturbance, it something is probably not right. something needs to be changed about the medication and it's not just well put other supplements to mask that symptom. That's not really a good answer. We really need to have the patient not be so symptomatic. Something's a little off. I think something needs to be adjusted. Yeah. We're not trying to put something over another problem. That's not a great idea. Like a like a like a mirax or another laxative. Yeah. Right. Yeah. Yeah. Which is a great it's a great example of how we offer support and personalized care. Right. Right. Um so for anybody listening who is curious um just for the purposes of time we do have to kind of we can't take we these questions are amazing. I wish we had time to answer all of them. Unfortunately we don't. We do have to wrap up. Um but I'm so glad that there was the level of engagement that there that there has been. So, if somebody is curious about GLP-1 therapy, Colin, what do you feel is kind of the most important takeaway? Yeah. So, GLP1s, like I've said before, are really valuable tools for the right patient. Um, they're not necessarily for everybody and they're not necessarily for everybody at at the, you know, they're at the right time, right? It could it be right for you now and not later or vice versa? Yes. Um, and they are not magic solutions. They're not, right? I've said this a few times. Obesity is not a tzepetide deficiency, right? That's not the way this works. Um, so long-term success with weight loss or metabolic health change is really addressing nutrition. It's talking about exercise. It's talking about sleep. It's talking about hormones, stress, metabolic dysfunction, and really root cause medicine. And that's what we do really well at Men Matrix is identify root causes of things. So, the ultimate goal, like I've said before, is lasting health and not just weight loss. Um, I think that's like the biggest takeaway I can offer when it regards to GLP1s. Yeah, absolutely. Yeah, I I completely agree. Um, unfortunately, we're out of time um today, but I really thank you, Colin, for being here as always. So, enjoy the conversation. Um, and I want to thank our viewers um, for joining us and engaging and for being kind of motivated in optimizing your health and just wanting to educate yourselves. I just think there's nothing more important than that and um, just the fact that you're here is kind of evidence of that. So really really happy with the um, level of engagement and the and the interest. So if um you want to send this to to a friend, a family member, if you want to listen to this again, find the podcast um later. Uh you can find it on Spotify, on YouTube, you can find it on Apple Podcasts. Um and if you are interested in becoming a patient, if you're not already, you can go to our website, which is medmatrixusa.com. you can book a discovery call and again see if you are the right fit um and see if we can help support you in your health journey. So, so fun to be here. Any final things? Any other final things, Colin? I think we did I think we did great. Yeah, if you're one final thing is just if you're interested in being a patient, you be in Maine, New Hampshire. That's a little bit of a caveat. Main New Hampshire only. But no, I I enjoyed the conversation. And I hope people got something out of this and I hope um it is food for thought for people that are maybe on a weight loss journey or on a GLP1 journey to ask questions of their practitioners, ask questions of your doctors, you know, are we doing this? Are we doing that? Have you talked you haven't talked to me about my diet? You haven't talked to me about my protein. You know, ask the questions of your doctors. They're supposed to help you with these things. So, that's my that's my advice of the day. That's great. But thank you, Dr. Rose, for the conversation as always. Very fun. Yep. All right. Have a good night, everybody. Goodbye.