Who Should (and Shouldn’t) Take GLP-1 Weight Loss Drugs? (Part 2)

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[SPEAKER_00]: at home and you've done a fairly good job of staying on your diet and eating well and you had exercise that morning.

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[SPEAKER_00]: But the evenings rolling on and you are starting to think about what snacks you have in the cabinet.

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[SPEAKER_00]: That is called food noise.

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[SPEAKER_00]: You feel like food's talking to you.

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[SPEAKER_00]: Hi, welcome to the Illumine Podcast.

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[SPEAKER_00]: I'm Kim Peters.

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[SPEAKER_00]: Today we are going to be talking about GLP ones in medical weight loss.

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[SPEAKER_00]: This is part two of a two podcast series.

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[SPEAKER_00]: So if you have not listened to the first one, I strongly recommend that you go and listen to that first before we get started here.

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[SPEAKER_00]: Hey, sorry to interrupt.

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[SPEAKER_00]: If you or someone you know is interested in building your confidence and feeling like you're best self, both inside and out, I encourage you to visit Horizon at Medspot and Wellness in Kansas City.

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[SPEAKER_00]: We have two locations in Shawnee and near the Kansas City Plaza.

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[SPEAKER_00]: We offer so many different things.

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[SPEAKER_00]: If you would like to check us out, go to Horizon at Medspot and Wellness.com or you can see us on Instagram at Horizon Under Score, Medspot, Under Score Wellness.

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[SPEAKER_00]: And now, back to the show.

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[SPEAKER_00]: Okay, so let's jump right in.

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[SPEAKER_00]: Next, why I want to talk about what are the benefits that a patient can anticipate when they are starting at GLP1 medication to help with medical weight loss?

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[SPEAKER_00]: They can expect reduced food noise, and this is the best way that I can describe it.

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[SPEAKER_00]: So let's make a scenario where you're at home, and you've done a fairly good job of staying on your diet and eating well, and you had exercise that morning.

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[SPEAKER_00]: but the evenings rolling on and you are starting to think about what snacks you have in the cabinet.

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[SPEAKER_00]: That is called food noise.

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[SPEAKER_00]: You feel like food's talking to you.

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[SPEAKER_00]: And then you're kind of battling that, oh my gosh, that sounds so good.

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[SPEAKER_00]: I'd like to do that out.

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[SPEAKER_00]: But I can't, you know, kind of, I'm trying to lose weight and be healthy.

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[SPEAKER_00]: And then I'll send it starts talking in your ear again.

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[SPEAKER_00]: And then you start to justify it, or

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[SPEAKER_00]: to defend it a little bit, like, okay, well, I could just have a little bit to satisfy it.

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[SPEAKER_00]: That is food talking to you.

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[SPEAKER_00]: So, GLP1 does a great job of turning down that dial, so that you don't really think about food anymore, and it makes it easier to stay on track.

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[SPEAKER_00]: I firmly believe that appetite has to be attached or connected to cravings, because it is very common that I'll have a patient that started on a GLP1 that will report to me that

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[SPEAKER_00]: They have noticed that their cravings have reduced, and I thought they were two separate things, but if I can lower someone's appetite, I definitely see a decrease in their cravings towards sugar, salt, fat, whatever it is that they tend to crave.

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[SPEAKER_00]: Those cravings turn down as well.

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[SPEAKER_00]: Patients can expect to eat smaller portions.

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[SPEAKER_00]: One of the things I tell them to kind of avoid some side effects of an upset stomach when they're on a GOP1 is that the normal portion that you would eat.

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[SPEAKER_00]: You're going to probably eat a half or maybe three quarters of that.

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[SPEAKER_00]: As you're eating that normal portion and you get about halfway through, you're probably going to get this little signal that goes, ooh.

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[SPEAKER_00]: I'm kind of full and you really do have to listen to that because if you eat past that or ignore that, that is when you can get an upset stomach.

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[SPEAKER_00]: I mean honestly, it's a huge blessing and that's the good news about it is that you get halfway through that portion and you feel like you're full and then you just don't want it anymore.

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[SPEAKER_00]: It's not appetizing to you anymore.

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[SPEAKER_00]: Patients can expect to reduce their alcohol intake as well.

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[SPEAKER_00]: So when I'm going through all the expectations with patients, I tell them whatever amount of alcohol you drink, whether that's one drink a month or five drinks a night, whatever that looks like.

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[SPEAKER_00]: It's going to be cut in more than half because that appetite for the alcohol or how your stomach feels with alcohol changes drastically and it decreases your desire for that.

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[SPEAKER_00]: We're going to talk a little bit about some additional benefits of GLP ones and one of those is it does help with reducing alcohol cravings for patients that may be abused that a little bit.

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[SPEAKER_00]: You can't expect to have an increased adversion to fatty or heavy foods.

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[SPEAKER_00]: So as we talked about before, GLP1, how it works is it slows gastric emptying.

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[SPEAKER_00]: So it stays in your stomach longer.

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[SPEAKER_00]: Foods that are heavy in fat tend to take longer to digest in general.

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[SPEAKER_00]: So if it's already slowed and then we're slowing it down even more, that's going to increase your stomach acid, which is going to create some irritation of the lighting and create some acid reflux, which is

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[SPEAKER_00]: like an upset stomach or a little bit of nausea.

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[SPEAKER_00]: So once that happens, you create this link or adversion to that food.

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[SPEAKER_00]: So I find that people look at something that maybe they desired or craved, such as a hamburger pizza, biscuits and gravy, that that mentality changes and shifts to having somewhat of an adversion to those foods, which is a good thing because we want to lessen that amount of food that isn't our diet.

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[SPEAKER_00]: Patients can also expect to lose one to two pounds per week.

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[SPEAKER_00]: That is safe.

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[SPEAKER_00]: And that's if we're at a therapeutic dose for weight loss.

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[SPEAKER_00]: That's not necessary to talk about the people that are just trying to maintain their weight loss or microdosing.

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[SPEAKER_00]: But that's a reasonable expectation.

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[SPEAKER_00]: I do have patients that sometimes feel

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[SPEAKER_00]: Defeated when they're not losing more than that or they look at the scale and they know what they started at and they're like I was kind of think I'm gonna lose more weight, but as long as it's within that range of one to two pounds a week I'm happy with that if you lose weight too fast the body doesn't respond to that well the body thinks that it's You've been stranded on a desert island and you have no calories or nothing to eat So it's gonna start storing things differently and that increases your cortisol as well

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[SPEAKER_00]: So losing weight too fast does create plateau's.

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[SPEAKER_00]: It also affects your long-term success of maintaining that weight loss.

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[SPEAKER_00]: Patients tend to feel more energy.

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[SPEAKER_00]: We're going to talk about some side effects because one of the side effects patients report is fatigue and I'll explain why that happens.

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[SPEAKER_00]: But in general, patients feel better.

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[SPEAKER_00]: They're eating better.

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[SPEAKER_00]: They're more motivated to exercise.

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[SPEAKER_00]: And we often complement our medical weight loss program with some B12 shots, which help with energy.

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[SPEAKER_00]: Patients will feel a general sense of feeling better due to the reduced inflammation.

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[SPEAKER_00]: I have patients tell me that they just feel better, that their brain fog is better, that their bowel movements are better, and they have less brain fog, and I've actually had patients say that they had reduced inflammation as well, like they feel like their joints feel a little bit better.

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[SPEAKER_00]: Here are potential negatives to GLP ones.

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[SPEAKER_00]: mild nausea during titrations.

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[SPEAKER_00]: So GLP ones are titrated.

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[SPEAKER_00]: We start at a very, very low dose, and we slowly titrate it up to a place where it's therapeutic and there aren't too many side effects.

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[SPEAKER_00]: Like I said before, it is slow and gastric emptying, so there's a chance that your stomach acid could increase slightly.

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[SPEAKER_00]: And a result of that is an upset stomach or nausea.

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[SPEAKER_00]: This should not be really sick.

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[SPEAKER_00]: Can't go to work projectile vomiting.

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[SPEAKER_00]: It should be a nuisance.

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[SPEAKER_00]: And that's often when you're titrating the dose up that should last for a few days or maybe through a little bit through that first week that you've titrated up, but it should acclimate and you should be fine after that.

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[SPEAKER_00]: If it is continuing, it is either too high of a dose or this GLP one specific might not be a good choice for you.

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[SPEAKER_00]: Extreme nausea and vomiting are rare, but they are possible.

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[SPEAKER_00]: Just like any medication, there's a possibility of a side effect that outweighs the benefit.

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[SPEAKER_00]: fatigue, like we talked about.

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[SPEAKER_00]: And this one, this one's interesting because generally speaking, people feel better on it, but I'll have occasionally somebody come in and they say, Kim, I am so tired since I've started this medication and then we take an inventory of what their diet has been like.

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[SPEAKER_00]: So, one kind of thing to be careful of is that when you don't have as much of an appetite, you are less incentivized to cook a meal or go kind of out of your way to create something that's really healthy and nutritious.

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[SPEAKER_00]: It is easier to grab something that's convenient and quick, like a handful of something,

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[SPEAKER_00]: let's just say chips.

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[SPEAKER_00]: How much they're eating and what they're eating.

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[SPEAKER_00]: And oftentimes, it is not sufficient to supply the body with the necessary energy that it needs to function on a normal day.

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[SPEAKER_00]: I'll tell them, I'm like, okay, we'll think about what we just talked about, what you've eaten and like, let's take the whole GOP one out and yourself out of it and

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[SPEAKER_00]: is someone on that diet do you think that they would feel good?

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[SPEAKER_00]: No.

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[SPEAKER_00]: Okay, so let's be intentional about creating some nutritious snacks and kind of doing some meal prepping to have those things readily available and quick and easy to access and eat.

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[SPEAKER_00]: And I would say about 100% of the time patients feel much better when they realize that that's a really strong component there.

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[SPEAKER_00]: So it is slow and gastric emptying, and it's slowing the gastro-attract in general.

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[SPEAKER_00]: So constipation is possible, although I have found it most of the time, it's really just that patients diet has changed and they're eating less, and there's a shift in how their bells are moving, and

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[SPEAKER_00]: So, I mean, this is really not very common, but it does happen.

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[SPEAKER_00]: It's always temporary, and if we can get more fiber in the diet, more water, maybe get them started on a stool softener.

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[SPEAKER_00]: And once we get things moving again, where they feel comfortable, or it's back to the regular schedule, it just stays like that, and we don't have any problems with that.

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[SPEAKER_00]: Unwanted side effective losing weight is that your skin gets a little more loose.

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[SPEAKER_00]: saggy and wrinkly and nobody likes that, but that is just, that's just what happens when you lose weight.

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[SPEAKER_00]: It doesn't really matter how you loss a weight.

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[SPEAKER_00]: So that is something that you can think about or anticipate might change for you.

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[SPEAKER_00]: And for some people, it's worse than others.

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[SPEAKER_00]: Okay, let's talk about some additional benefits.

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[SPEAKER_00]: of taking a GLP1 outside of the way loss.

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[SPEAKER_00]: So like we said, a GLP1 was originally designed to regulate blood sugar, and that is good for anyone.

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[SPEAKER_00]: What's great about this medication is it's not gonna tank your blood sugar lower than a normal level, so it's not gonna bring it down to a place where it's unsafe, where you're hyper glycemic and passing out.

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[SPEAKER_00]: That's something entirely different.

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[SPEAKER_00]: It's just going to keep it at bay and keep it from spiking up, reducing,

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[SPEAKER_00]: blood sugar spikes helps with overall inflammation, which leads me to the next one, which is reduced inflammation.

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[SPEAKER_00]: It is FDA approved to reduce cardiovascular risk in patients, both obese and diabetic patients.

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[SPEAKER_00]: So if it's reduced in the risk in them, it's reducing the risk in everybody.

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[SPEAKER_00]: I have had a few patients that we have used this medication and I consider this obviously off-label is treatment of bulimia or binge eating disorder.

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[SPEAKER_00]: It's an eating disorder where patients feel the impulse to eat a large amount of food.

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[SPEAKER_00]: I have had a couple patients that struggled with this and they were referred to me by their primary care provider because they weren't able to get this medication approved through insurance.

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[SPEAKER_00]: We got to start it on them and it significantly reduced their urge to binge, which made them more productive in their counseling and their overall progress with their mental health.

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[SPEAKER_00]: We talked about alcohol a little bit, so alcohol abuse disorder.

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[SPEAKER_00]: So I'm not going to call it alcoholism because it's not my role to decide what is and what isn't that, but I do believe that there are people

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[SPEAKER_00]: that abuse alcohol were consumed more than they should on a general basis whether it's a mental health thing or it's just something that they kind of rely on to go to sleep.

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[SPEAKER_00]: Whatever reason that is, I'll tell you a quick story about someone I saw in the office that came in for way loss and when we were going through our initial console and intake,

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[SPEAKER_00]: one of the questions we ask is how much alcohol did they drink and she told me that she had two to three beers a night that was not true but of course in most cases they're not going to divulge really what they're drinking how much they're drinking if they're abusing it and this patient lost a significant amount of weight in a short period of time to the point where I was slowing her down because I didn't want her to lose weights quite so quickly I don't like that.

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[SPEAKER_00]: And we got further into discussion, we had built that relationship and then she shared with me that she had actually been drinking 10 to 12 beers a night prior to being on this medication and she was wildly impressed with how it changed that appetite for alcohol to

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[SPEAKER_00]: two to three beers a week, which is a huge difference, and she's like, I just couldn't handle it.

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[SPEAKER_00]: My stomach couldn't, and I just didn't like it.

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[SPEAKER_00]: So I do believe that there is some research in some studies and some progress that we're making as far as treating patients who struggle with abusing this.

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[SPEAKER_00]: And I think if you are someone who feels like you drink too much,

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[SPEAKER_00]: Um, or you'd like to reduce that or kind of change that craving, uh, GLP1, even just micro dosing it is a really good option to helping with that.

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[SPEAKER_00]: Patients are reducing their, or they're improving their cholesterol numbers and, uh, lowering their blood pressure as they're losing weight.

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[SPEAKER_00]: I also see a reduction in visceral fat.

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[SPEAKER_00]: So visceral fat is the fat that is sitting in your abdomen, but it's surrounding your organs.

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[SPEAKER_00]: So it's underneath the muscle, the cushy soft stuff that you can pinch on the outside of the abdomen.

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[SPEAKER_00]: That is abdominal fat, but visceral fat is underneath that lying.

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[SPEAKER_00]: So if your abdomen's a little descended and feels hard, that fat underneath is what we're worried about.

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[SPEAKER_00]: That is the fat that increases your risk for a lot of problems like diabetes.

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[SPEAKER_00]: high cholesterol heart disease metabolic syndrome.

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[SPEAKER_00]: So this medication can also help lower that and coupled even with a peptide or growth hormone that can help exceptionally as well.

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[SPEAKER_00]: Patients with sleep apnea.

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[SPEAKER_00]: This is another one.

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[SPEAKER_00]: So obstructive sleep apnea is often related to patients being overweight and having sleep apnea that's not treated does increase the risk of high blood pressure cardiovascular disease metabolic syndrome and diabetes.

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[SPEAKER_00]: So, if we can get them to lose weight and then get them out of having sleep apnipe apnipe episodes when they're sleeping, we can reduce those risks and get them feeling a lot better and having a good night's sleep, which means a lot.

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[SPEAKER_00]: We have seen that there's improved hormone function and that leads me to my next discussion about fertility.

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[SPEAKER_00]: So we have found that patients whether they want to or not have gotten pregnant when they're taking this medication and here's what's happening.

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[SPEAKER_00]: So for the category of people that do not want to be pregnant and find out that they're pregnant, they are on an oral contraceptive so they're taking a birth control daily and we are changing the way the body's absorbing that by slowing gastric emptying.

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[SPEAKER_00]: So any patient that is taking this medication that is on a birth, an oral contraceptive, I recommend they do and they do not want to be pregnant.

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[SPEAKER_00]: they utilize another form of protection.

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[SPEAKER_00]: So the good news is that some people would really like to get pregnant but have not been able to.

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[SPEAKER_00]: We're finding that this is helping.

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[SPEAKER_00]: So when patients are losing their losing weight, like we said, it improves hormone functions.

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[SPEAKER_00]: So things are working more harmoniously and normal and then they are able to get pregnant.

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[SPEAKER_00]: So we've seen a lot of that as well, which is fantastic.

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[SPEAKER_00]: Okay, so let's talk about some possible side effects.

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[SPEAKER_00]: We talked about a few, so nausea upset stomach, a little bit of constipation is possible, acid reflux, you have more acid in the stomach, more acid production in the stomach.

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[SPEAKER_00]: So if you have somebody that is got a severe peptic ulcer disease, might not be a good option to use that until unless they're well controlled on medications.

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[SPEAKER_00]: Something to keep in mind is that 13% of the population does not respond to a GLP1.

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[SPEAKER_00]: So, I do occasionally have a patient that I would say in my clinic it seems to be less than 13 percent.

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[SPEAKER_00]: It's only I can count how many times on one hand I've had a patient that just didn't respond to a GLP one at all.

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[SPEAKER_00]: But it does happen.

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[SPEAKER_00]: I couldn't tell you why it doesn't work, but that is a chance.

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[SPEAKER_00]: So you can try a GLP one and it doesn't work.

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[SPEAKER_00]: You might just be in that 13 percent.

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[SPEAKER_00]: I think it's worth trying a different version, right?

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[SPEAKER_00]: So we talked about three different ones.

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[SPEAKER_00]: We've got Symmoglu tied, tears up a tied, and then there's a new and redotru tied.

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[SPEAKER_00]: Oftentimes when we switch a patient from one to the other, it is more effective, so that's a first thing to try, but there is a chance it won't work in some people at all.

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[SPEAKER_00]: If you're

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[SPEAKER_00]: If you're reducing somebody's appetite, it is possible that you can put them into a nutritional deficit, meaning they're not getting sufficient nutrition that they do need, and so it's really important to monitor that and have that education with the patient that they are eating the right things, exercising because if you're just eating less and less and less and maybe their dose is a little too high because they're a little too eager to lose weight, you can end up having not sufficient amount of nutrition, muscle wasting.

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[SPEAKER_00]: But GLP ones are not muscle eating pack bands, but if you are in a clerk deficit and you are not doing anything to grow or maintain your muscle mass, you can lose your muscle mass.

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[SPEAKER_00]: So it's important to pay attention to that and again this is an education component.

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[SPEAKER_00]: Gallbladder disease does happen, it is not life threatening, it's just painful, it does happen, it is very rare.

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[SPEAKER_00]: A cute kidney injury, also very very rare.

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[SPEAKER_00]: We don't prescribe this medication to patients who have severe kidney disease for that reason, and then we talked about the possibility of increased fertility.

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[SPEAKER_00]: Okay, so I'm sure if you have been researching GLP ones or it's flowing on your algorithm or medical way loss, you are going to see that there are some people that report some bad things that happened.

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[SPEAKER_00]: I think it's careful to understand the parameters of that situation, which that information may be provided or may not be.

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[SPEAKER_00]: You need to be mindful of it.

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[SPEAKER_00]: Medication in general isn't the same medication isn't appropriate for every single person, right?

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[SPEAKER_00]: So, I'm just going to relate it to when I was working in primary care and prescribing blood pressure medications.

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[SPEAKER_00]: We have several different options of blood pressure medications.

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[SPEAKER_00]: We wouldn't have that if one blood pressure medication worked the same for everyone in a perfect way.

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[SPEAKER_00]: It just doesn't work that way.

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[SPEAKER_00]: There are people with Norvask that get swelling in their ankles, but that doesn't happen to everybody.

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[SPEAKER_00]: Licinapro, you can develop a 25% of the population develops a dry cough, not appropriate for everyone.

17:52.640 --> 18:00.517
[SPEAKER_00]: So it's important to understand that sometimes you have to try something and then find out if it's going to work or not.

18:00.637 --> 18:07.813
[SPEAKER_00]: Now the overwhelming result or outcome of this of GLP ones is beneficial.

18:07.793 --> 18:09.776
[SPEAKER_00]: but there are some bad things that do happen.

18:10.457 --> 18:16.888
[SPEAKER_00]: I do find when I've found these things or heard about them, I kind of do my little deep dive into seeing what information I can have on it.

18:16.968 --> 18:32.653
[SPEAKER_00]: And I think what's going to increase your risk of something bad happening is one, if you're not appropriately monitored, if you've just, like, for instance, bought the medication online, it came in a vile, you have a syringe, maybe you totally don't understand how to drop those units or,

18:32.633 --> 18:35.738
[SPEAKER_00]: I've had people that didn't know that you're not supposed to inject it every day.

18:35.799 --> 18:50.264
[SPEAKER_00]: It's once a week and it made themselves really sick or people that have just been given full access to this medication are getting a little too eager to lose the way and so they decide to increase the dose prematurely or have gotten the medication for two different people.

18:50.484 --> 18:54.912
[SPEAKER_00]: I've gotten the medication that is not from a legitimate pharmacy.

18:54.892 --> 19:07.503
[SPEAKER_00]: or just are not using it appropriately in terms of like nutrition and exercise, or they have other medical conditions that it's contraindicated, but they didn't see healthcare provider or that healthcare provider did not screen them appropriately.

19:08.044 --> 19:09.745
[SPEAKER_00]: So there's a lot to consider with that.

19:09.925 --> 19:17.092
[SPEAKER_00]: But again, I agree, it's not, it's not one size fits all, it's not going to be perfect for everyone, but that's true for medicine, really in general.

19:17.712 --> 19:24.038
[SPEAKER_00]: Okay, so that leads me into, let's talk about who we know is not a good candidate for this medication.

19:24.018 --> 19:28.126
[SPEAKER_00]: So gastroparesis means a slowing of the GI track.

19:28.587 --> 19:31.693
[SPEAKER_00]: With the GLP-1, we are slowing the GI track.

19:31.713 --> 19:33.717
[SPEAKER_00]: So I don't want to compound that.

19:34.519 --> 19:44.980
[SPEAKER_00]: I will say that a lot of people that maybe have a little bit of this probably don't know that they have it because it hasn't created a big problem for them.

19:44.960 --> 19:48.548
[SPEAKER_00]: And then they added a GOP1 and it compounds that problem.

19:48.989 --> 19:59.712
[SPEAKER_00]: And then that's a great example of, okay, this patient is not a good candidate for this medication, but that doesn't necessarily mean that the medication itself gave them that problem, if that makes sense.

19:59.776 --> 20:09.551
[SPEAKER_00]: Okay, another question I get a lot is people see that, you know, if there's a history of thyroid cancer, that they shouldn't take this medication, so let's be really, let's get the facts straight with this one.

20:10.352 --> 20:15.480
[SPEAKER_00]: The contraindication is thyroid medulary cancer, which is incredibly rare, first of all.

20:16.241 --> 20:23.252
[SPEAKER_00]: So if a patient has a family history, a personal or a family history of that, technically we don't recommend taking this medication, but here's why.

20:23.232 --> 20:26.958
[SPEAKER_00]: When they did the study, they first administered this medication to rats.

20:27.138 --> 20:40.278
[SPEAKER_00]: When they did the blood work on these rats, they found that there was a cancer marker that is related or connected to thyroid-migillary cancer, and there was an uptick on those that was considered statistically significant.

20:40.979 --> 20:44.244
[SPEAKER_00]: Therefore, we have to mention it as a possibility.

20:44.885 --> 20:47.569
[SPEAKER_00]: I do not believe that any human

20:47.549 --> 20:57.519
[SPEAKER_00]: has developed thyroid medillary cancer from this medication, however since it was considered statistically significant, we are going to advise against it and that's the whole point of studying these things.

20:57.799 --> 21:01.643
[SPEAKER_00]: The next one is pancreatic cancer or pancreatitis.

21:02.304 --> 21:12.814
[SPEAKER_00]: The reason this is important is the medication is working with the pancreas and if the pancreas is weak or you have a history of inflammation of the pancreas, which is pancreatitis,

21:12.794 --> 21:14.818
[SPEAKER_00]: this medication is not a good idea for you.

21:14.998 --> 21:18.144
[SPEAKER_00]: If you have a history of pancreatic cancer, I also would not give this to you.

21:18.445 --> 21:21.811
[SPEAKER_00]: All right, anorexia or severe calorie restriction.

21:21.851 --> 21:36.118
[SPEAKER_00]: So if I'm doing an intake with a patient and they are telling me they have a history of anorexia, body dysmorphia, unrealistic expectations about their body or what outcome that they want from it.

21:36.098 --> 21:42.685
[SPEAKER_00]: That person has some red flags that I think this medication may not be appropriate for them because I don't think they're going to utilize it appropriately.

21:43.286 --> 21:49.793
[SPEAKER_00]: They are going to be centrally focused on a number on a scale and losing weight and being thin and skinny.

21:50.354 --> 21:57.822
[SPEAKER_00]: And they're going to miss the component that is important, which is being healthy and having an appropriate and healthy body composition.

21:58.583 --> 22:03.388
[SPEAKER_00]: That type of person I don't think is really a good idea to be prescribing this medication for.

22:03.368 --> 22:05.751
[SPEAKER_00]: Okay, and severe peptic ulcer disease.

22:05.791 --> 22:11.817
[SPEAKER_00]: So like we talked about, so it's gastric emptying, so the amount of stomach acid in your stomach goes up slightly.

22:11.957 --> 22:17.483
[SPEAKER_00]: So this can, like we said, can cause some mild nausea, but if somebody really has a problem, they have ulcers in their stomach.

22:17.683 --> 22:24.590
[SPEAKER_00]: Giving them a medication that is gonna increase the amount of stomach acid production is not ideal.

22:24.851 --> 22:30.777
[SPEAKER_00]: If they're well controlled, I may consider it really depends on the person, but there's gotta be a lot of education with this one.

22:30.757 --> 22:39.128
[SPEAKER_00]: Okay, pregnant or breastfeeding strongly, strongly disagree with this medication, ever being administered to anyone that is pregnant or breastfeeding.

22:39.649 --> 22:48.581
[SPEAKER_00]: We never, ever want to suppress the appetite in an infant or a baby, whether it's there currently in utero or if they're breastfeeding.

22:48.761 --> 22:54.148
[SPEAKER_00]: We don't know how much of that medication goes through the breast milk, but I guarantee there's some of it there.

22:54.128 --> 23:04.155
[SPEAKER_00]: So that is a time where mom needs to be focused on a good nutrition, baby needs to be growing and so I would definitely strongly never.

23:04.456 --> 23:06.640
[SPEAKER_00]: give this to a patient that is pregnant or breastfeeding.

23:06.820 --> 23:09.185
[SPEAKER_00]: I wouldn't give this to a person that has an active cancer.

23:09.285 --> 23:27.578
[SPEAKER_00]: I can't really tell you why as far as I haven't seen research of there being any problem but that's not really something that we've studied or I haven't seen that and so with cancer you might have somebody who is actually going to go in the other direction of not getting enough calories and this is not the person that I would prescribe this too.

23:27.558 --> 23:30.665
[SPEAKER_00]: I would take caution in older adults as well.

23:30.925 --> 23:33.531
[SPEAKER_00]: My degree is actually a adult geological nurse practitioner.

23:34.433 --> 23:38.101
[SPEAKER_00]: And so I've worked with older adults significantly in my career.

23:38.522 --> 23:45.617
[SPEAKER_00]: And a lot of times they do have a diminished thirst reflex in a diminished appetite in general.

23:45.597 --> 24:01.952
[SPEAKER_00]: older adults also are subject to muscle wasting in general and I don't want to give them something that is going to potentially accentuate that, especially in a patient that has some dementia and is not able to manage those things on their own, that would not be a good candidate for that.

24:02.213 --> 24:15.165
[SPEAKER_00]: And lastly, any patient that has a severe disease, I would like them to focus on that and I don't know the realm of which that medication is appropriate, so I would

24:15.331 --> 24:24.430
[SPEAKER_00]: Okay, so, next, most common question that I get is, so I've lost the way I am happy with where I'm at.

24:24.578 --> 24:25.199
[SPEAKER_00]: what now?

24:25.619 --> 24:33.326
[SPEAKER_00]: Or this is a question I actually get at the beginning where patients say when we're initiating therapy, okay, let's say I lose this 25 pounds.

24:34.127 --> 24:36.188
[SPEAKER_00]: Am I going to be stuck on this medication forever?

24:36.489 --> 24:37.830
[SPEAKER_00]: Can I take it long-term?

24:37.890 --> 24:39.692
[SPEAKER_00]: What do I do after that to maintain it?

24:39.712 --> 24:54.585
[SPEAKER_00]: And I love that question because that means people are interested in their long-term success and they're investing in themselves being successful in the long-term and rather than just

24:54.565 --> 24:56.508
[SPEAKER_00]: used for managing diabetes.

24:57.049 --> 25:02.158
[SPEAKER_00]: They were designed to be long-term, so it is safe and effective to use this medication long-term.

25:02.238 --> 25:05.784
[SPEAKER_00]: I'm not necessarily saying I think everybody should be on it forever.

25:05.864 --> 25:06.766
[SPEAKER_00]: I'm not saying that at all.

25:07.286 --> 25:11.173
[SPEAKER_00]: All I'm saying is it was studied to be safe in doing that.

25:11.153 --> 25:19.169
[SPEAKER_00]: So, if I have somebody that has reached their goal weight, I kind of treat it in two different ways, and it's really kind of a patient preference thing.

25:19.790 --> 25:23.077
[SPEAKER_00]: We're going to start backing off the dose initially, depending on how high they are.

25:23.117 --> 25:27.846
[SPEAKER_00]: If they're pretty high, we're going to back off about a quarter of a milligrams, and this is for some of the luteide.

25:27.826 --> 25:32.331
[SPEAKER_00]: But it's really just stepping back the same degree that we stepped up if that makes sense.

25:32.351 --> 25:37.496
[SPEAKER_00]: So the same rate of where we came up, we're going to start coming back down and just see how they do with that.

25:38.156 --> 25:43.222
[SPEAKER_00]: Then I might suggest that we stretch if we got to a really low dose or microdosing.

25:43.282 --> 25:48.607
[SPEAKER_00]: I might suggest that we start stretching out those intervals by like 10 to 14 days.

25:49.007 --> 25:52.551
[SPEAKER_00]: I do have some patients that just take it once a month and that helps with them.

25:52.531 --> 25:57.696
[SPEAKER_00]: I also believe that for some people, it's not a bad idea to just continue to microdose.

25:58.336 --> 26:04.962
[SPEAKER_00]: Microdosing means that we're doing a subtheraputic dose, subtheraputic from the weight loss indication.

26:05.582 --> 26:08.065
[SPEAKER_00]: So it's a lower dose of the same medication.

26:08.165 --> 26:11.007
[SPEAKER_00]: So it's not going to be as aggressive in losing weight.

26:11.187 --> 26:14.630
[SPEAKER_00]: You likely won't lose any weight at all when you're on these very small doses.

26:15.171 --> 26:22.217
[SPEAKER_00]: But it does just kind of like sand down the edge a little bit in that appetite and craving

26:22.197 --> 26:29.704
[SPEAKER_00]: Also, you still get all of the health benefits that we talked about, blood sugar regulation, reducing inflammation, reducing cardiovascular risk.

26:29.764 --> 26:33.047
[SPEAKER_00]: So I do think that that's great in the appropriate patient.

26:33.207 --> 26:39.272
[SPEAKER_00]: Although some patients may decide that they don't want to stay on it, which is perfectly fine as well, as we said, we just kind of tie trade it back.

26:39.493 --> 26:49.842
[SPEAKER_00]: Every patient has an individual need and an individual outcome, and we just work with them to find what fits them best, fits their lifestyle, and their finances because this does cost money.

26:49.822 --> 26:53.249
[SPEAKER_00]: There is no risk or harm to stopping this medication completely.

26:53.269 --> 26:54.451
[SPEAKER_00]: That's another question I get.

26:55.273 --> 26:57.317
[SPEAKER_00]: Some people worry, do I have to taper it down?

26:57.898 --> 27:06.175
[SPEAKER_00]: I would recommend, if you're going to get off the medication, I would recommend tapering it down only because your hunger will just kind of come back with the vengeance.

27:06.877 --> 27:11.526
[SPEAKER_00]: But as far as safety, there is nothing unsafe about just completely stopping this medication.

27:11.506 --> 27:18.818
[SPEAKER_00]: I do have patients sometimes that stop the medication for a while and then come back for maintenance dose, which is that microdosing, which is great as well.

27:18.838 --> 27:26.972
[SPEAKER_00]: We've talked about kind of who's appropriate, who's not appropriate for your GP1, but in general, this medication is highly customizable.

27:27.513 --> 27:34.645
[SPEAKER_00]: There's a large treatment range of being therapeutic in what's therapeutic, slash effective and safe.

27:34.625 --> 27:44.174
[SPEAKER_00]: meaning there's no side effects for patient may be different, which is again why it's really important to get this medication from somebody who knows what they're doing, who is a qualified healthcare professional.

27:44.274 --> 27:54.403
[SPEAKER_00]: But the other day I had somebody that came in and said that they were interested in talking about a number of things were talking about hormone replacement therapy peptides and medical weight loss.

27:54.483 --> 27:59.607
[SPEAKER_00]: And he said, well, this friend of mine was telling me about it, she lost a hundred pounds taking a GLP1.

28:00.268 --> 28:04.632
[SPEAKER_00]: And gosh, I don't think I need a GLP1 because I don't

28:04.612 --> 28:08.578
[SPEAKER_00]: So, it was a great opportunity to educate, like I said, it's one size in the fit-all.

28:08.638 --> 28:11.302
[SPEAKER_00]: You don't even have to lose weight to take a GLP one.

28:11.342 --> 28:15.669
[SPEAKER_00]: You can just be wanting to maintain or reap the health benefits that we talked about.

28:16.370 --> 28:23.321
[SPEAKER_00]: Highly customizable, and the goal of a GLP one is not to shut off the faucet entirely in terms of your appetite.

28:24.162 --> 28:30.872
[SPEAKER_00]: It's just to turn it down a little bit and fine tune it for what works for you and helps you be successful at your goals.

28:30.852 --> 28:39.265
[SPEAKER_00]: Another thing I often hear is, this is just a little, I'm being a little petty or sassy about this, but people will say, well, I just don't want to put that stuff in my body.

28:39.305 --> 28:41.047
[SPEAKER_00]: I don't want to put medication in my body.

28:41.067 --> 28:42.409
[SPEAKER_00]: I don't like taking medication.

28:42.570 --> 28:44.633
[SPEAKER_00]: I don't trust this so-and-so forth, which is fine.

28:44.893 --> 28:52.725
[SPEAKER_00]: Everyone is 100% able to create their own opinions, but oftentimes, these are also the same people that are,

28:52.705 --> 29:10.113
[SPEAKER_00]: drinking alcohol a lot that can put down a good amount of pizza or cheeseburgers and stuff like like all of that stuff also isn't really good for your body but a little bit of a GLP1 that helps you avoid those things that actually has health benefit seems like a better idea and I really just think this is an education thing.

29:10.835 --> 29:17.245
[SPEAKER_00]: There's really very very few people that have really

29:17.984 --> 29:23.093
[SPEAKER_00]: nailed down the diet and exercise regimen and are doing it perfectly.

29:23.113 --> 29:28.022
[SPEAKER_00]: And honestly, those people, if you know I'm talking about these are people that are just perfect, right?

29:28.042 --> 29:28.924
[SPEAKER_00]: They eat perfect.

29:29.445 --> 29:30.747
[SPEAKER_00]: They exercise routinely.

29:30.767 --> 29:31.649
[SPEAKER_00]: They do it all perfect.

29:31.669 --> 29:32.931
[SPEAKER_00]: They're also a little bit psycho.

29:33.131 --> 29:34.153
[SPEAKER_00]: I mean,

29:34.133 --> 29:40.703
[SPEAKER_00]: So, I can say for myself that I did a macro diet, macros are protein, fat, and carbohydrates.

29:40.743 --> 29:49.395
[SPEAKER_00]: And so, you calculate exactly how many of those you need in each day and you create a diet that follows that, like down to the every gram.

29:49.595 --> 29:50.116
[SPEAKER_00]: I did that.

29:50.236 --> 29:52.800
[SPEAKER_00]: I felt great physically.

29:52.780 --> 30:10.924
[SPEAKER_00]: I felt like a lunatic mentally because it's just consuming of your time and you have to weigh each thing that you eat, you have to weigh and you can't go to a restaurant because you can't order something and know exactly how many grams of chicken there are and whether they used a butter and how much fat does that.

30:10.904 --> 30:11.745
[SPEAKER_00]: it's overwhelming.

30:12.366 --> 30:15.430
[SPEAKER_00]: So are those diets and exercise and all that stuff good?

30:15.510 --> 30:16.151
[SPEAKER_00]: Is it attainable?

30:16.211 --> 30:19.515
[SPEAKER_00]: Yes, a majority of people, it's not sustainable.

30:19.776 --> 30:27.666
[SPEAKER_00]: So I don't think that it's reasonable to expect every person to be able to achieve that kind of perfection.

30:28.047 --> 30:31.191
[SPEAKER_00]: And this is where I think a GLP1 actually is

30:31.171 --> 30:43.948
[SPEAKER_00]: is a good option for the general public that needs to manage their way to a little bit better, because it does just take that, turns down that knob a little bit and allows people to be better focused on the things that are good for them.

30:44.288 --> 30:44.549
[SPEAKER_00]: Okay.

30:45.269 --> 30:51.778
[SPEAKER_00]: Last thing we're going to talk about here is what are the tools that you need as a provider?

30:51.758 --> 31:03.720
[SPEAKER_00]: to offer this service in a safe and effective way from the consumer standpoint what should you look for in a provider when you are wanting to start a GOP one or want to look at one to entertain this.

31:04.661 --> 31:10.071
[SPEAKER_00]: So the initial evaluation should be done with a licensed health care provider.

31:10.051 --> 31:12.394
[SPEAKER_00]: who has the capacity to prescribe.

31:12.955 --> 31:17.821
[SPEAKER_00]: So that's a physician, a nurse practitioner or a physician's assistant.

31:18.361 --> 31:30.456
[SPEAKER_00]: If you are meeting with a medical assistant or a nurse or who knows what and you're not actually having a face-to-face encounter with a licensed provider that prescribed, I don't believe that that is appropriate.

31:30.436 --> 31:34.341
[SPEAKER_00]: This person should do a comprehensive review of your medical history.

31:34.361 --> 31:42.951
[SPEAKER_00]: They should ask you a ton of questions that some of questions may not even seem related, or you didn't think of mentioning, there also should be some lab work.

31:43.652 --> 31:49.058
[SPEAKER_00]: And again, like I said before, the lab work isn't necessarily telling us why you can't be on a GLP one.

31:49.578 --> 31:52.222
[SPEAKER_00]: It's telling us what else are we working against?

31:52.502 --> 31:59.430
[SPEAKER_00]: That can get you to the goal of being successful, not just in the short term, but in the long term.

31:59.410 --> 32:01.957
[SPEAKER_00]: This visit also should be something that you pay for.

32:02.117 --> 32:14.871
[SPEAKER_00]: This is a little rant of mine, but I do have occasionally people that ask for a complementary consultation, wellness consultation at my practice, and that is something that I don't really budge on, because

32:14.851 --> 32:27.096
[SPEAKER_00]: The value that we offer in our practice is we have practitioners that are licensed experienced educated, really, really smart and good at this and really care about our patients and that's valuable.

32:27.236 --> 32:35.273
[SPEAKER_00]: I do think it's okay if you and your practice want to offer free consultations, but I think it's also, you shouldn't have to feel like you do that or compete with.

32:35.253 --> 32:41.421
[SPEAKER_00]: other people by doing that because what you offer as a practitioner, if this is something that you're really good at, is valuable.

32:42.102 --> 33:01.227
[SPEAKER_00]: And as a consumer, I think you should expect to have to pay for that time with a practitioner because what they offering is valuable and you wouldn't go to a primary care office and ask if you just cannot pay for the visit with a doctor or not

33:01.207 --> 33:13.520
[SPEAKER_00]: Okay, the other thing I think is important is including some sort of body scan that is going to accurately look at fat in the body muscle mass and visceral fat because we want to monitor that.

33:13.600 --> 33:15.222
[SPEAKER_00]: That is a very helpful tool.

33:15.702 --> 33:20.007
[SPEAKER_00]: We have one in our office called the Sica scan and it accurately looks at that.

33:20.127 --> 33:28.075
[SPEAKER_00]: You get on that, it scans and it tells you down to like how many pounds of muscle are in your right arm and your left leg and how much fat there is.

33:28.055 --> 33:34.383
[SPEAKER_00]: And then every time our patient gets on the scale, they can actually get back onto their little app on their phone and look how they're trending.

33:34.944 --> 33:44.216
[SPEAKER_00]: I think it's really important to monitor that because we are worried about nutritional deficiencies and muscle wasting, even though as much as I try to avoid that and educate against that, it can happen.

33:44.816 --> 33:51.565
[SPEAKER_00]: So that's important to be able to monitor that and patients like seeing that real data of watching that body composition change.

33:51.545 --> 33:55.570
[SPEAKER_00]: Practitioners should want to, this is for the consumer, should want to monitor you.

33:55.730 --> 33:57.653
[SPEAKER_00]: My goal is to be safe and effective.

33:57.973 --> 34:02.179
[SPEAKER_00]: And when you're initiating therapy, there is a weekly visit with those patients.

34:02.439 --> 34:04.902
[SPEAKER_00]: Maybe every two weeks if there are scheduled doesn't allow it.

34:05.083 --> 34:10.009
[SPEAKER_00]: So from the provider standpoint, if you're not offering that to their patients, I think that's a misstep.

34:10.069 --> 34:14.876
[SPEAKER_00]: I think it's important that you are closely involved in that titration process.

34:14.976 --> 34:20.623
[SPEAKER_00]: And then once you achieve something that is sustainable, then you can kind of loosen up a little bit.

34:20.603 --> 34:23.046
[SPEAKER_00]: Practisher should address long-term goals.

34:23.787 --> 34:31.356
[SPEAKER_00]: They should talk about overall success, what those goals look like for the patient, what their goals are, and then what maintenance looks like.

34:31.857 --> 34:34.741
[SPEAKER_00]: We should look at this as a big picture, not a short-term solution.

34:34.941 --> 34:37.104
[SPEAKER_00]: All right, I think that is all the time we have for today.

34:37.164 --> 34:38.585
[SPEAKER_00]: So thanks for hanging out with me today.

34:38.726 --> 34:44.653
[SPEAKER_00]: Again, if you are in the Kansas City area and you are interested in exploring this for yourself,

34:44.633 --> 34:48.062
[SPEAKER_00]: Please come visit one of our locations Horizon Medspawn Wellness.

34:48.102 --> 34:51.191
[SPEAKER_00]: We have a location in Shawnee, Kansas, as well as the Plaza.

34:51.291 --> 35:02.180
[SPEAKER_00]: You can go to our website, www.herizonmedspawnandwellness.com, or you can go to our Instagram, Horizon, underscore Medspawn, underscore wellness.

35:02.401 --> 35:03.023
[SPEAKER_00]: We'll see you soon.

35:03.103 --> 35:03.925
[SPEAKER_00]: Have a great day.