Transcript: GLP-1s Are Metabolic Tools, Not Shortcuts
I've changed my opinion over the years on this. I at first I was skeptical and I changed my position. And I think the one thing that this [music] whole journey has showed all of us is that metabolic health is the core of everything. These peptides improve metabolic health overall. And when we see metabolic health improve, we see all kinds of benefits across the board, regardless of weight loss. Like irrespective of weight loss, we're seeing really great benefits happen. And yes, there's direct mechanisms of GLP-1s. They land on immune cells. They land on receptors around the body. They have a direct impact that we don't even fully understand. Yeah, I think that's a really important framework for people to understand GLP-1s [music] cuz a lot of doctors just prescribe them. These are I think a real benefit to humanity. The question is how do we use them right? Hi Tina, great to have you back on the podcast. Good to see you again. How you doing? Thank you. I'm so excited to be here. It's nice to see you again, too. [music] All right. Well, last time we talked, we kind of dove into a lot of the controversies about GLP-1. We talked about the benefits, the side effects, about microdosing, [music] the weight, the cost, and many, many things that were sort of up in news and in practice at that moment. But we've been kind of down the road for a few years now with GLP-1s. They've been on the marketplace. People are using them. There's millions of many people on them, you know. So, we want to kind of know the good, the bad, and the the ugly around this and and what what benefits potentially are beyond weight loss. You know, what what are we actually seeing 2 years later? So, you were on the show on April 24th and that was was a huge conversation we had around that. And I think the question is like what's changed since then? One of the biggest takeaways from
then? One of the biggest takeaways from our conversation was the sort of idea of of the dose. That the dose that that's in prescription GLP-1 drugs like Ozempic or Wegovy or Zepbound or Mounjaro are high doses and they cause significant side effects. And you know, when you look at the data, I mean, a lot of people, 60-70% of people have some GI side effects. 4% have very serious side effects. And if you're talking about, you know, 40-50 million people taking them, the number gets pretty high. 4% of 40-50 million is a lot of people. So, what's kind of evolving your thinking over the last couple of years? So, let's kind of dive into that and some some of the research findings that are sort of new and emerging that that kind of we should touch on. That episode like blew the top off [laughter] it felt like and suddenly everybody was sort of bum rushing in asking me questions and my life got crazy after that. It was exciting and it Oh, no, it was in a good way. It was I think what I was trying to lay down in that conversation uh I didn't fully get to explain and it was uh kind of a functional medicine approach overall really, you know, and so I think that that's where a lot of the confusion lied for for people was they didn't quite understand this comprehensive approach. I would say 2 years later I am more firmly planted in my stance that keeping the dose as low as nec - as possible is the necessary step and that for whatever the needle we want to move, whatever that may be um and that might be getting into regular dosing, it might be getting on the spectrum of regular dosing and that's all fine and good, but it really where I land at this point is
it really where I land at this point is more strongly than ever is to your point that I know we both agree on that lifestyle is first. Doing all the things, making sure that this is just part of a comprehensive treatment plan, it's not the whole thing. It's not monotherapy. That's really what I was trying to lay down from the beginning and that got lost in translation cuz you know how people are. They hear what they want to hear and they're like, "Oh, microdosing, it's a miracle, it's going to work for me." And but they're not doing anything else, right? So, that I think all these years later that's where I'm even more, you know, I'm like, "Okay, guys, you still didn't listen. We have to do all the things and this is just a tool in a toolbox." Yeah, I think that's a really important framework for people to understand GLP-1s cuz a lot of doctors just prescribe them. There's all these prescription mills out there online. You just kind of have a telehealth visit, you get the prescription, you the drug and you're on your own. And Yeah. And that I think is malpractice. I think if you don't prescribe these drugs in conjunction with proper nutrition, training, education, and strength training, it's it's really a counterproductive for the person who's taking the drug because it it ends up causing more problems down the road. They tend to lose more muscle, lean body mass. They tend to end up, you know, gain the weight back if they stop, which a lot of people do with the high doses. And then they end up in this vicious cycle where their metabolism is slower, they need you know, less calories at the same weight that they were, and it's just a vicious cycle. So, in in terms of the fundamentals around lifestyle, I think we just sort of touched on this before we go into some of the sort of newer issues. I
some of the sort of newer issues. I think people need to understand that, you know, what these drugs do at the prescribed doses. And and then I want to sort of have you maybe talk about how how they work at the smaller microdoses that you've been recommending. In terms of the impact on and the importance of sort of lifestyle change, diet, exercise, strength training, protein. They are endogenously created in our bodies, in our gut, in our L cells, and in our brain. And we have receptors all over our body. At the standard pharmaceutical doses, I think that those doses are really high for most people, and they are designed to decrease gastric emptying, slow down gastric motility, and then also they play in the brain by impacting satiation and satiety and your hunger signaling and and how you feel about that. So, ultimately people eat less, lose weight. I do think there is a And this can be argued by some, but I've looked at the data and I think there is some overall metabolic impact that is outside of weight loss, that uh a harmonizing of the signaling peptide hormones across the board, that depending on the person and the individual they're being used in, at the dose they're being used at. And I think that ultimately does improve insulin resistance, which ultimately improves weight loss. It's not just eat less, you know, it's they're not just starving themselves down. So, there's it's multifactorial. That said, at high doses, you really can start cranking on the gastric motility and it will shut things down. It's not
and it will shut things down. It's not great. I do think the real risk of pancreatitis is real. The gallstone issue and the pancreatitis due to a gallstone being thrown into the pancreas is real. I've seen it personally in my practice. I've seen a bunch of people with increased pancreatic enzymes, like amylase and lipase. And it's surprising, you know, and I think we're we're I mean, I given how few people I have taking them that are in my practice, I'm surprised to see how many people I've actually seen with pancreatic enzyme elevations. I think we have to look at this though, without getting too in the weeds and pull me back if I go on a rant, but I think we're looking at two different cohorts of people here. Uh three really. We've got the type of patient who these were designed for, which is your generally quite obese, uh type two diabetic person suffering with those conditions. And they are coming in with such a compromised system already, right? And then they're getting thrown really high doses. And I don't think that's a great recipe for success. And I agree with you, I think it's malpractice and completely unethical to just monotherapy these people and not give them all the tools that they need. But let's face it, most doctors don't strength train themselves. Most doctors are not I mean, I get the amount of doctors with I did this morning. I went this morning. Good for you. [laughter] Good for you. Me too. I knew you were going to I was like, he's on it. You don't stay looking good at your age without strength training. Like that's just We don't We're not going to When people are like, "What's your secret?" I'm like, "The gym." That's about the extent of it. Grunting in the gym. [laughter] You know, good good living and and yeah. The middle cohort, which I think
The middle cohort, which I think since our conversation has really benefited from these peptides and from doctors who do bring a comprehensive integrative approach, is kind of that middle uh group where they're they maybe got 30, 40, 50 lbs to lose. The weight the excess weight on their body is definitely causing some metabolic dysfunction for them. Maybe they're postpartum. They've had a few kids. Maybe their metabolic health got derailed along the way. What whatever it is, they're benefiting. They're doing it right. They're they're doing all the things. It's a really good harmony. And those folks to get that weight the needle to move on the weight, I really do think you need more standardized dosing or close to it. And then there's the cohort I was trying to have a conversation about which I realized I think I was just too, you know, when you bring ideas it's too soon for their time, you know, it was the world was not ready to hear what I was trying to lay down and I really had to explain functional medicine in order for this concept to work, but I was trying to introduce this concept of microdosing which was really microscopic. I mean micro. Like these people clearly have never done drugs [laughter] cuz they don't know what a microdose is. And I was trying to suggest a fraction of the starting dose in those who were already metabolically optimized, who were already doing all the things cuz as you know, we have struggles too. We have autoimmune disease too. We have histamine issues too. We have all kinds of issues too. We might even get metabolic compromise, you know, that I've seen very lean people with good muscle mass end up with terrible cardiovascular markers and terrible
cardiovascular markers and terrible metabolic markers. And so for whatever reason, stress, ge - genetics, epigenetics, who knows. So that was really what I was trying to go after was like, "Hey, maybe we could utilize them too and and we could consider different dosing strategies and almost a different approach between these three groups." And uh I was thinking honestly more of like a low-dose naltrexone was kind of where I was coming from with it. This idea that if the body is deficient for whatever reason, and I do think there's functional deficiencies of GLP-1s. We have a study from I think last year showing that statin drugs decreased endogenous GLP-1 production by 50%. So Well, that's interesting. That may explain why it increases insulin resistance cuz when you look at statins, they increase insulin resistance and increase the risk of diabetes significantly. So, that may be the mechanism interesting. Right. So, I was just thinking across the board, you know, how we are in functional medicine. If somebody is physiologically deficient in a hormone, we supplement that hormone. We're not giving them super high doses. We're giving them back physiological doses. Yes, it's not pharmacologic. It's just a little bit of something something and so that's where I was coming from with it. That idea was really difficult for people to understand I think or just to break, you know, comprehend what I was trying to lay down. And if you look at low-dose naltrexone, the way that I explain it to patients is it if you're opioid I mean and not to get in the weeds, but that's a just so people understand that's an opioid receptor issue or opioid-like receptor. And that modulate your immune system and if your system
your immune system and if your system isn't working great, we give you a tiny little bit of naltrexone at a very low dose and it helps your body use what it has work better. And that was kind of my thinking with a microdosing strategy was just give the body a little bit back what it needs and maybe the system itself will work better because we know that leptin and ghrelin and all of those signaling uh peptide hormones orchestrate with GLP-1. They all work together. [laughter] They we need the GLP-1 on board. And so, anyway, it was kind of like three different concepts that I was trying to get out in one podcast. So, I think where we are now is that a lot of people have opened up their um minds to the fact that maybe GLP-1 has a place whereas I think before they were vehemently against it. And there was a lot of, you know, clickbait online and scaring people. I do want to say just before we lose anyone in the audience as we go on in this episode the muscle mass thing. We have to talk about that because the earlier studies, that JAMA study that we referenced in that last podcast, that was showing up to 40% lean mass loss, right? Lean mass loss and everyone oh, it's 40% muscle. That is incorrect. Lean mass and and what I was hypothesizing back then, I was like, well, what about the fatty infiltrate in the liver and the muscles that folks Interesting, yeah. very characteristically get when they get metabolically compromised, right? And we now we know that lean mass on Dexa is everything that's soft tissue besides bone and fat. And so, when we're looking at lean mass, we're
when we're looking at lean mass, we're looking at interstitial fluid, we're looking at tendons and ligaments and muscles. Your muscle mass only makes up maybe at most 25 to 40% of that overall lean mass number. So, that number got over sensationalized and everybody got really scared. The studies have come out and shown pretty decently. We've got some mouse data, we've got some human data. It's not chewing up muscle mass. It is right in line with any low-calorie caloric restriction diet. It's right in line with bariatric surgery. There is no excessive muscle loss happening. The GLP-1 as a mechanism is not destroying muscle. In fact, it's probably protective in a lot of ways to muscle. Interesting. And a bone. The bone loss we're seeing really is when people when you lose weight, you lose mass and when you lose mass, you lose gravity and when you lose gravity, you lose that downward pressure on the bone, right? And so, we're we see people maybe waste too quickly, lose weight too fast. They're not putting any other tension or pressure on that bone and so, they do start to lose bone, but it's not a mechanism that's direct from the GLP-1. So, that I just wanted to say out loud because we have to put that away. So what you're basically saying is that the muscle loss and lean body mass loss is is the same as you'd see with regular weight loss if you don't strength train and eat enough protein. If you don't protect your muscle along the journey, it's exactly the same. And it's not excessive. The GLP-1s are not coming for your muscle. There's not a separate mechanism where they destroy muscle by any means. So, it's just the fact that that you lose weight loss without exercising is
lose weight loss without exercising is the thing and eating that protein. And that's true with anybody losing any weight from any any mechanism, whether it's calorie restriction or any other diet. In unless you're increasing protein and and strength training. 100%. This episode is brought to you by Rose Nutrition Liposomal NAD. Here's a real question. Why do two people the same age look and feel completely different? One has energy, sharp focus, and is still running circles around people half their age. The other is exhausted by noon and can't remember where they put their phone. A big part of the answer is NAD plus. It's a molecule your cells run on to produce energy, to repair DNA, to regulate how you age at the biological level. The problem is NAD plus levels drop by about 50% by the time you hit middle age. That decline is one of the reasons aging feels the way it does. And most NAD supplements don't survive long enough to reach your cells. Row uses liposomal delivery specifically designed to get it into your system intact where it can actually do something. If you want to address the energy and aging problem at the cellular level, not just cover it up with caffeine, this is where to start. Go to row. peopletrician. com and use the code Hyman for 20% off sitewide. That's hyman @ rhonutrition. com. I put a lot of consideration into what I eat. We have to eat real whole foods to stay healthy and that is why I love my clean seafood box from Sitopia. It arrives blast frozen at my house. It's lab tested for microplastics and mercury and it's packed with a variety of seafood that's full of bioavailable
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disease itself to explore why so many people remain chronically ill. We explore his groundbreaking MCAS framework for understanding chronic diseases, and we also look at the biggest drivers of chronic inflammation and what it really takes to help the body heal. So, be sure to check it out on this Wednesday. Here's a preview. If you enjoyed today's episode, don't miss my upcoming conversation with Lyme disease expert Dr. Richard Horowitz. We dive into why so many people stay sick, and we look at the hidden drivers of chronic illness in a whole new way of thinking about inflammation and recovery and healing. It drops this Wednesday, and until then, here's a preview of what's to come. And I think the one thing that this whole journey has showed all of us to for you to the defense of you and I that have been beating the drum for God knows how long, is that metabolic health is the core of everything. And Yeah. these peptides improve metabolic health overall. And when we see metabolic health improve, we see all kinds of benefits across the board, regardless of weight loss. Like, irrespective of weight loss, we're seeing really great benefits happen. And yes, there's direct mechanisms of GLP-1s. They land on immune cells. They land on receptors around the body. They have a direct impact that we don't even fully understand. But, all in all, when you improve metabolic health, a whole lot of conditions that we just thought people had to live with suddenly go away. And the world at large is acting so shocked, and I'm just over there like, "Yes, this just confirms the, you know, my life's work." Well, I think team, this is a really important message just to double-click on here for a minute. I I have a hypothesis, which I'd love to
I I have a hypothesis, which I'd love to get your perspective on, which is if you improve metabolic health by any means, you'll get the same results. In other words, I don't know how much extra magic there is in GLP-1s other than helping people get a meta metabolic health with a little bit of an assist. And if you were to put people on uh food as medicine, lifestyle intervention, with proper exercise and nutrient repletion, that you would see pretty much the same benefits as GLP-1s. And I don't know if that's true, but that's my hypothesis. I I and I The reason I say that I saw a a study once on bariatric surgery where they did a randomized control trial. Essentially, they or it was maybe I don't know if they with the design what's exactly I don't know if they actually operated on the second group, but it was basically a group that got bariatric surgery, you know, with diabetes, and then another group that had the same dietary intervention as if you'd already had the surgery. In other words, they gave them the same food that the diet that the bariatric surgery patients had to eat, essentially. And there was absolutely no difference to any of the weight loss, metabolic markers, anything else. So, it was purely the the food. Now, so it's like to paraphrase Bill Clinton, it's the food, stupid. So, I don't know how how much extra advantage there is to GLP-1s. It's certainly it's sort of an assist, I would say. It's a support for people who struggle. It can help break a cycle of addiction, break a cycle of various things that happen metabolically that are hard to break. But, is there something special and unique about these
something special and unique about these that are over and above just the weight loss that you see? Cuz you're right, if you improve metabolic health, you improve cardiovascular risk, dementia risk, hormonal health, you know, immune health, inflammation levels, obviously your risk of, you know, diabetes. All these things get better. Mood mood gets better, brain health gets better, you know, psychiatric conditions get better. And it's it's not like some magic kind of thing. So, I'm just wondering your perspective on that. I think they do. And I'll give you a couple examples. Well, for one, we know they land on immune cells. There's receptors on our immune cells, and they land on mast cells in particular. So, they can help significant I've seen significant improvements in folks with mast cell activation syndrome. And for those who are listening, that is essentially a syndrome where you get like very allergic to everything, and you have high histamine levels. Yes, and it's miserable. Uh these folks can't take anything. And I've got colleagues using 1 / 100 or 1 / 50 of the starting dose. Tiny tiny little doses of tirzepatide, and suddenly the patient's inflammation will regulate out, so then they can actually get to work and start utilizing different therapeutics and modalities, whereas before that would flare the patient. These patients were very sensitive. SIRS patients, Lyme patients, I'm watching doctors utilize these at very small doses just to kind of stabilize the immune system. Um tons of reports from people. I've gotten thousands and thousands of messages over the past few years of people saying, "I was able to go off my antidepressants within a few weeks. I stopped gambling." Um a study just came out, like I just
Um a study just came out, like I just saw it this morning when I was getting ready. This is crazy, Mark. They compared folks who were alcoholics and other drugs utilizing who had been on GLP-1s and they found that whilst on the GLP-1 and we know this cuz they there's some data coming out now around alcohol cessation, smoking and we talked about that a little bit last time. They not only had significant improvement when they were on the GLP-1, but the results lasted up to like 30 or Yeah, 30 or 40%. I think it was like 39% improvement even after discontinuation of the GLP-1. So there's it's changing the architecture in our brain somehow. It's it's playing on the dopamine pathways and I don't know depending on the dose, I don't know how good or bad that is, right? I mean that we can that's a whole other uh dilemma, but I just I do think there's several different mechanisms happening. I've seen This is another crazy one I just have to throw out there. A lot of people have come into my DMs. I'm in a really unique position cuz I have a lot of followers that message me about this and I mean hundreds of thousands of followers across platforms and a lot of people are having their disordered eating disappear. These are bulimics and anorexics and orthorexics. And it it complete at a microdose or at a whatever their dose is, it completely obliterates the actual undereating. It's not making them undereat. And then cancer, I've had a few people who are using it with cancer. Doctors, oncologists are now using it with patients in conjunction
using it with patients in conjunction with their cancer therapy and approving it, which I thought was nuts and and exciting. These folks are having better outcomes across the board. Their their quality of life is better, their mood is better and they it's it's not completely crushed In some cases it might be depending on the dose, but it's not completely crushing their appetite. In fact, it's helping them eat. So I think it does something in the brain and plays both sides of that. I don't know how, but So it seems have it had unique brain benefits around addiction, around obviously after regulation, but also immune benefits. So these immune benefits were fascinating to me. Do we understand the mechanism yet of how these work on the immune level? Because we know inflammation generally goes down as your metabolic health gets better, right? Your metabolic health determines your visceral fat is all inflammatory. So is it just that or is there something else going on? I don't know. I just know that they land on mast cells. I was trying to get every single person I knew who had MCAS to try a microdose. I was like, "Please just tell me what happens." Just take the microdose and tell me what happens. And everyone who did miraculous. The The responses I got from people were like, "I can't believe I waited. This has changed everything for me." And they can tolerate the world now. They can go through the world and live like normal people. They're still watching what they eat and but they're they can have a glass of wine and not have their whole life derail, you know? Like they can function. They can eat fermented foods again. They can Which is Here's the important part is they can eat fermented foods again and they can eat so many of these high histamine foods that these folks have to avoid usually are the same foods
have to avoid usually are the same foods that bring us optimal health. And these are on the microdoses, right? Yeah, the Or Or depends maybe on a regular dose. And that's the other part. A study came out last year showing genetic differences in people. So some people have very different responses to GLP-1s depending on their genetics. Some don't respond at all. That's why there's non-responders. Some get more nausea than others. And so that kind of proves what I was getting at in 2024 is like, I think we're all really different and I think we have to really look at different dosing because some folks are not responding to semaglutide and tirzepatide helps them. It changes their life like night and day. The difference is some people don't respond at all. Um it's kind of all over the board and so I think dosing is very individualized still. What might be low for one person might be a regular dose for someone else. Kind of depends. And I It does depend on how they're eating and it does depend on their overall metabolic health. I will give you that and it does depend on how much they're hitting the gym. But that said, I still think this is a tool that is in conjunction with and not instead of. I you got to do everything you said. You have to do all the lifestyle pieces, too. Yeah. And that part I will say people I've noticed with my patients [clears throat] that bit. Well, you know, they start out strong. They start out with good intentions, but the minute that GLP-1 kicks in and it's I call it kind of the ultimate effort on and find out peptide because it does clear up so much of the inflammatory noise for some people that they're like, I can eat gluten again. I can handle carbs again. I can do all these things again and eventually it there's a
again and eventually it there's a concept called in medicine, you know this, but for the audience it's called tachyphylaxis and it's where you acclimate to the drug. Yeah. you acclimate very quickly to the drug and this is known for that. And so all of a sudden they find out [laughter] and it comes back to haunt them. So it's not a get out of jail free card and you still have to do all the lifestyle pieces and eventually that microdose will stop working if you keep effing around and find out. Um but I think that as a tool for those folks who are doing the things or maybe those folks are not doing the things and this is the thing keeping them alive. I don't know. It's it's you a lot of different applications. Maybe we can back up a little bit um because we kind of jumped ahead. I think maybe for people listening who don't know exactly what peptides are or exactly how these new drugs, these GLP-1 drugs work. Help us understand it because most people don't realize that these are things that our bodies normally make, but we're we're either low in them for different reasons like you said like statin use or maybe there's other reasons and and how do they actually how do what how do they do their job? So GLP-1 is a peptide that our body makes. It was first discovered or a version of it was first discovered in Gila well, I shouldn't say that. I looked up the history. It was discovered in humans, but then it was rediscovered in Gila lizard venom. I live in the high Sonoran Desert, so that have Gila monsters out here. [laughter] I've seen them. They're pink. They're very pretty. Um but what they found was the Gila monster doesn't only have to eat a couple times a year. And so they
eat a couple times a year. And so they isolated this exendin-4 out of its venom and said, "Hey, this is the thing that keeps it from needing to eat." And that is not what GLP-1s are. They then looked at humans and said, "Oh, humans have a similar mechanism." And so for everyone saying it's Have you heard that, Mark? That going around that it's derived from Ozempic is derived from lizard venom. I haven't heard that. No. I I blissfully unaware of the nonsense on the internet. It's I I started just blocking people who send me those videos. I'm like, I can't even look. Yeah. I try not to pay attention to the noise [laughter] and just just stay on the signal. Stay on the mission. Stay on mission. We make it in our guts. We make it in our brains. And it it goes throughout the body and does different things. And it is definitely, from what we understand, I think we're just beginning to understand all of these leptin ghrelin. I think we have a really rudimentary understanding of them. But it is in that family. And like I said, it plays on the gut. It plays on the brain. It plays on appetite. It plays on your insulin. And it it helps your insulin signaling improve. It helps it signal when it's supposed to signal more appropriately. The drug itself is It's just a peptide. A peptide is a string of amino acids. Strings of peptides are proteins at, you know, at like fifth grade level biology. And so it's a very simple system. And then the pharmaceutical companies have tweaked the molecule or they I'm sorry, the string of amino acids, the the peptide, to have a longer half-life cuz our naturally occurring GLP-1 is in and out of our system very quickly. And then this one is in and out of our system in 5 to 7 days.
5 to 7 days. So they tweaked it a little bit. It's not exactly bioidentical. It's a little tweak. It's pretty close. But yeah, I think it's like 93 or 94% bioidentical. Semaglutide. That's just pure GLP-1 is semaglutide. That would be Ozempic and Monjaro I'm sorry, Ozempic and Wegovy. Yeah. Same medication, same pharmaceutical company. One's FDA approved for weight loss, one's FDA approved for type 2 diabetes. And then we have tirzepatide, which is a dual agonist. That's GLP-1 with GIP. GIP has different mechanisms inside of our body that help regulate our blood sugar and, you know, supposedly the GIP should be helping sequester and get fat oxidation going better. And that would be tirzepatide. And that is Mounjaro and Zepbound. Again, same company, same molecule, just two different FDA approvals. And then we have the new kid on the block, which is retatrutide. Oh, let me back up. Tirzepatide is like, I think 1 to 5. I might be off a little bit from but what what I've researched, it's 1 to 5 ratio of GLP-1 to GIP. So, when people say, "Oh, look at all these benefits in the studies of GLP-1 in particular, not the medication tirzepatide, but when they just studied GLP-1 over the past many decades, um that there's less GLP-1 in tirzepatide overall than there is to GIP. The ratio's different. And then it with retatrutide, that's a triple agonist, and it has glucagon agonism, which they thought might help preserve muscle mass. I don't think that's coming
muscle mass. I don't think that's coming out to to show but in the studies, but it has the that that medication has tremendous weight loss happening with it and a lot of fatty liver in a lot of impact on the fatty liver, which is really cool. But that has very, very little GLP-1 in it overall. It's mainly mainly GIP and glucagon. So, But that's not really available yet, right? No, that is in phase 3 trials. I just saw this morning that they're hoping for, I think, um 2027. And they're trying to get it classified as a biologic and not what it would normally be. So, then it can't be compounded. And they can really throw the hammer down. And they can really jack the price up. But there I've seen people selling it on the gray market. Yeah, the gray market is like the wild west. So you can get it, but it you don't know what you're getting and you know, if it's safely produced, if it's the effective dose, if it's got some of the contaminants in it, you don't have any idea. I think that's that's another conversation I'm going to get to in a minute, but you know, these things are really quite interesting. I think that that um you know, I I kind of wanted to just step back a bit cuz I think people have heard about a lot of side effects and I had done a bunch of research recently about this and I I think your weight loss muscle loss concept, it makes sense to me and I I actually had that thought that actually you know, the weight loss is the thing without exercise that drives the muscle loss if you don't do strength training and and you don't do
and and you don't do um protein. The the other thing is is the weight regain cuz when people stop it, there's a lot of data from the step one trial and others that people who who lost a lot of weight within one year of stopping, they regained 2 / 3 of the weight. Um and also all the cardiometabolic improvements reverted toward the baseline. Same thing happened with the SURMOUNT 4 trial with tirzepatide. So, you know, they're good while you take them, but then is there's a sort of Ozempic rebound phenomenon that happens and and what do you make of that? I Yeah, I completely agree. And to your defense in that study that came out in last year, in November of 2025, they showed they looked at two separate groups. They looked at the GLP-1 group and then they looked at lifestyle group. And the lifestyle group was not taking a GLP-1. And when the the weight regain happened for all of them. I think keeping weight off, I said this on your last episode that I was on and people came at me and got really mad, the weight loss part is actually the easier part. It's the keeping the weight off that is so significantly harder and I think what, like 5 10% of people who go through a weight loss journey will actually keep it off. It just keeps coming back. The fat cells have memory and the body has a set weight and it all wants to come back and like you said, when you get lighter, so you lose the fat, you lose the leptin. The leptin and the ghrelin are playing with your appetite and it is very, very difficult to keep the weight off and your set point stays where it wants to stay depending on how long you've been at that weight. So,
at that weight. So, uh the the GLP-1 group, the tirzepatide and semaglutide actually had faster weight rebound the newer uh incretin medications had faster weight rebound than even some of the older ones, which tells me the fancier the peptide, the fancier the medication, the faster the weight regain. The faster you lose it, the faster weight regain, but I think that's we know that with weight loss anyway, right? That was before there were GLP-1s. We knew that and so going on a slow and low journey, doing it right, utilizing that this opportunity uh as a window of of opportunity to completely modify lifestyle and do all the things, I think is obviously the best route and then knowing that you probably should be and I think doctors are getting hip to this. There has to be a titration strategy and we might be looking at some people as lifers. There's going to be a subset of people that are on this for the rest of their life for sure and there's other people that may be able to come off and I think we don't have enough studies. They're looking finally at studies of GLP-1 and strength training. We don't have any good studies on that yet, but when you There is a study out from a few years back. Same group that's doing the current studies, utilizing strength training during a weight loss journey leads to appreciable weight loss retention. Yeah, it's quite amazing. I have a a number of patients like that. I have them they really struggle with weight. I I've got them on low-dose GLP-1s and and then I said, "Look, you have to be in the gym. You have to do DEXA scans every month. You have to like eat this protein." And they do it. I mean, actually they're doing it and it's quite amazing to see the muscle
amazing to see the muscle the weight will go down, but they'll actually increase their muscle and they'll lose even more fat. And so you you lose, you know, 10 lb of fat and you gain 5 lb of muscle, your weight loss is only 5 lb, but you've changed your body composition. So it's it's pretty interesting to see that that's possible even with these these compounds. But yeah, that's that's really the question I'm sort of noodling with is are these lifelong drugs? Are they safe long-term? You know, the cost I think is coming down, which is good, but it's still a lot. And I don't think insurance still pays for most most of it except if you're diabetic. And and so it's really, you know, we're kind of in this gray zone of not really knowing what happens if people take these for 10, 15, 20 years, right? And do people need to take them if if they want to sustain the metabolic benefits and not kind of rebound like like most people do. Before GLP-1s came on the scene, I was really concerned about the just overall metabolic health of our nation in general and how we were exporting it out to the world. And I I mean like I used to I'm sure you have too. Like it used to really keep me up at night. I was like this is a disaster. We are a metabolic disaster as a society. why I written like 20 books on the topic. I know, we are. And then I know, right? And then COVID COVID hit and I was like, oh, this is going to be a hot mess because that that, you know, it preferentially impacted folks with metabolic compromise the most. And uh I think that we're in a pickle and I and we have skyrocketing rates of
we have skyrocketing rates of infertility because of all of it. And nobody wants to talk about that. And we are not replacing ourselves at the appropriate rate to even survive. And there's entire countries that are going to be non-existent here in a short while cuz they don't they're not replacing themselves. And so I don't know what it is. I don't know if it's toxicity. I don't know if it's the metabolic health. I don't know if it's all the things all jumbled together, but we needed a an escape signal, right? And so for me it's risk tolerance. It's like some of these folks are headed down a sure path. They're They're living a sub-existent miserable life anyway and they're headed down a sure path of demise or probably early death and a lot of folks are getting their lives back. And so I have that conversation with people and I say this is the wrist tolerance, right? We're still going to do all the things. There's no getting out of that. You're still going to work your butt off, but I have a tool that might actually make this a lot easier and more efficient. The long-term risks I leave that up to the patient. We We don't know. We do know we I mean we have had liraglutide and exenatide out for a long time and nobody's dying of cancer from those and the data looks really good. right? It might be dose dependent. Like I think you know when you Why I like the way you think about things CNS cuz you're you're talking about personalizing treatment, not one-size - fits-all dosing, not massive super physiological doses, just enough to do the job. And my guess is you're going to get less GI side effects, less gallbladder issues, less pancreatitis, less you know, issues around diabetic retinopathy where we're seeing or even this new sudden vision
seeing or even this new sudden vision loss which is quite scary for people. Um all these things that we you know, the nutrient deficiency. If If you're really conscious about how you do this and do a lower dose, you might be able to avoid a lot of these. Is that fair to say? Yes, and if you continue to work your butt off, you can stay on the lower dose. I I find that to be true. I I find that the minute people start slacking and they bring the alcohol back on board and they're eating out all the time, they're going to have to bring up the dose cuz the weight loss stalls if they're truly after weight loss. And so it's a It's just like anything else. I'm always just having an agreement with a patient. We're in a journey together. I'm the cheerleader. I'm not just the drug dealer. Like we're really trying to overhaul their life completely and I think that as long as they know going in that that's the deal. I will not I mean there's just no version where you should be allowed to take a GLP-1 and not be in the gym. Like you should have a prescription and you should hold to it. Getting people to hold to it is the hard part. True. It's It's tough. And you you really have to understand what you're getting into. This is not a You don't embark on this and not be prepared. You know, you've really got to do it. It's really easy to dose yourself into anhedonia where you're just like all of a sudden you lose all your luster for life and then you just want to sit around. Patients are patients on higher doses, the study came out showing they just don't move around as much because I think it's because of that. I think they kind of get into this malaise state and a little too much can be a lot too much and so really working with somebody who's going to monitor you and
and and encourage you to do all the things and help you get the resources to get there. Well, I think this is really important point you make cuz most people are on the prescription versions and what you're saying is is it at those doses we're seeing people's emotional range blunted, dulling their joy, causing you know, apathy, what you call anhedonia which we're not having any fun. [laughter] I mean, is this related to the dosing issue or is it related to just the the compound itself? it's a dosing issue cuz the second you back them off just a little bit all of a sudden they're Actually, I've seen people stall and I've heard other doctors talk about this. They stall out at higher doses and you actually bring their dose down and they start losing weight again. So, there's a sweet spot. There's a really there's a the very particular individual a sweet spot. I was just talking to my best friend who She started out microdosing. She really needed to bring the dose up to somewhere in the middle of the, you know, ladder uh to really get the weight to come down and she that that's fair and she's really doing all the things but she messaged me and she said, "I took just the tiniest" I mean, she went from like 7. 5 mg up to 8 mg. Just a little tiny bump and suddenly she's flat as a pancake. Her affects flat. She hates everything. She doesn't want to go anywhere. She doesn't want to do anything." And I was like, "You dosed your You dosed into soul-crushing dosing. That's when you're It's crushing your soul. Back off a little. [laughter] But then also, you know, don't slack on the gym and make sure you're dialing, you know, maybe decrease the wine a little bit. You know, this is just how it is. And so, it's not a
is. And so, it's not a get out of jail free card. You know, you still got to put all the pieces together. Are there things in the last years that have emerged that that um we should know about it that are concerning? And and is there any kind of any insights around that or we is it still the same kind of list of things? No, let's talk about it cuz there's actually some really good data that's just dropped very recently. So, the first one I think we should talk about the NAION, the No, I know that the the vision loss, yeah. The eye stroke. It's non-arteritic anterior ischemic optic neuropathy. I have to read that off of my [laughter] notes cuz I can never spit it out. But uh study just came out July 2026 JAMA Ophthalmology basically showing that it's an increase of about 300th of 1 percentage point. It's very, very low. And what they really wanted to drive home in that study was that we're already talking about sick people living with diabetes for the most part is who they were analyzing. And so, when you and I did a podcast about this when the scare first emerged and you know this, but for your listeners, when you take somebody who's been living with diabetes for a really long time, their entire vascular system is messed up. Really messed up. And when you remove when you drop the glucose too fast using medication, if you go again, too fast, too hard, you know, maybe the dose is too high and too strong, the vasculature can spasm. It doesn't handle it well. You have to titrate them up. You can't just whomp them with a dose. And so, I do think that we should It's a signal. It's totally worth paying attention to.
It's totally worth paying attention to. I'm not discounting it. But again, it's just more support for what I've been trying to say is we have to look at an individual's dosing plan and we have to get them what they need uh and do it in a careful stepwise manner while they're being monitored because we don't want that happening. We don't want to send somebody's blood sugar plummeting when we could just gently nudge their system back to a more normal state, healthy and normal. So, we were talking about a JAMA study back in 2024. It was a 2023 study that came out and it looked pretty bad, but actually when you broke that one down, all it showed that when they looked at the numbers they were giving you um relative risk not absolute and so they were giving you relative risk reduction versus absolute is kind of how they played out with a intervention of 2021, you know, numbers get different and inflated. So, anyway, that study even when you broke that down it it was only two pancreatitis cases of semaglutide users. Of over 600 people there were two pancreatitis cases, which we know pancreatitis is a real risk and you're seeing it. And then there was 71 uh pancreatitis cases in about 4, 000 which is also I mean, worth paying attention to, but this new study came out in gastroenterology in 2025 and it was a better done study and the finding was no significant increase in pancreatitis, bowel obstruction, or gallbladder inflammation. So, interesting, not to say it's not happening at all, but it wasn't enough
happening at all, but it wasn't enough to be significant. And so, I think just to piggyback on the end of that, if you are continuing to eat and crush down on high-fat foods and simultaneously you are dosed to a place where your appetite is so suppressed that you kind of stop eating or you slow your eating way down, your gastric motility is going to slow down when you stop putting food into the tube and your gallbladder is going to get sluggish and these people probably already have sluggish gallbladder. They're already at risk for pancreatitis. They're all in the most of the people taking these medications are already having a lot of issues in the biliary, gastric, you know, region, pancreatic region. It's already a stressed-out system. And so now, maybe instead of eating, you know, a big meal full of high-fat fried foods, maybe they're eating a smaller amount, but still the body's not handling it well. They throw a stone, they get pancreatitis. So, I just think it's Yes, again, it's a signal and it's worth noting and you're seeing it. I know people, I hear it from my followers that they have seen it, too, or maybe a loved one's experienced it. Just more reason to like do this right. There's a right way and a wrong way to do it. One of the most powerful things you can do for your health is cook more of your meals at home. When you prepare your own food, you have control over the quality of ingredients, the oils you use, the amount of sugar and processed foods you're eating, even the materials you cook with. And that last part matters more than most people realize. A lot of cookware contains chemical coatings that can break down over time, especially with high-heat cooking. And that's one reason I've been using Made In stainless
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the code Hyman for 20% off your order. Let's let's move on from the side effects and the scary stuff because you know, I think I've changed my opinion over the years on this. I at first I was very against them. And I was really skeptical and I and I've changed my position cuz I I've been following the research. I understand the complexity of dealing with people with metabolic health. Yes, if I got people to do it my way, I think we can get most of the benefits in terms of, you know, functional medicine, gut healing, you know, understanding food as medicine, how to, you know, get people low glycemic diets and reset their metabolic system. I I've done all this. I've seen, you know, cured autoimmune diseases and cured dementia and reversed diabetes, reversed heart failure, reversed fatty liver, and all these things are possible, but it's it's a it requires a quite a bit of of work and and it's not everybody who can actually do this and I think these are I think a real benefit to humanity. The question is how do we use them right? Um So, that's that. I think I want to kind of dive into what's the difference between men and women taking these compounds, what's happening around postmenopausal women, what about fertility, this huge fertility crisis related to what used to be called PCOS, but it's other things as well, metabolic health. And now they're calling metabolic reproductive syndrome as opposed to polycystic ovarian syndrome. And I I'm so happy about that because I've always said it's not an ovarian problem, it's a metabolic problem and it's called it's like it's people confused that it's a gynecological issue when it's not. So, anyway, what what's your perspective on, you know, this this kind of hormonal uh facts and what's
kind of hormonal uh facts and what's happening in these cases cuz I think this is a big issue. One in seven couples are infertile and it's it's kind of it's a big problem. I think it's been miraculous because it's improving metabolic health. So men are experiencing improvement in testosterone levels. They're experiencing improvement in fertility. Women are experiencing improvement fertility. There's whole Facebook groups that are dedicated to like monjaro babies. People are getting pregnant on the GLP-1. That's still being you know, we're still deciding if that's safe. I think I saw just a few weeks ago position paper something came out. Don't quote me. I I saw it in passing and I did not I have not gone back and scrutinized it but basically they're saying that we're not seeing adverse events of people who were on these got pregnant. The their offspring seems to be normal and healthy. So we don't know of course and we can't do studies on pregnant women but people are getting pregnant and having babies when they were normally infertile and having issues. And so I think they're great. I think with PCOS or PMOS the new term. I I think it's great. I think it's it works so great. I will say though I have seen with a couple patients young women with PMOS if they're really androgen dominant, if they go in really androgen dominant and they're already dealing with some hair loss and they're already dealing with some issues around that. It's a it's really critical that we onboard them slowly and carefully because I think that GLP-1s can
I think that GLP-1s can put a mirror in front of anything you're already dealing with. So if you're already hypothyroid or you're already low in hormones or you're already at you know, imbalanced in your hormones and you start throwing GLP-1s at it. I think there can be a breaking in period that's very uncomfortable for people. And so ultimately people do feel improvement in their thyroid health and they do feel improvement in their PMOS symptoms. I saw I had a young gal we had her on a microdose of semaglutide. Her hair started falling out like crazy. The androgen excess symptoms got way worse. It was a really I mean she could not tolerate it. So there was just no she was not going to continue. And uh yeah, sure there was work to be done and foundational work to be done, but it it did not go well. And I've seen this a few times. So all that to say and I get messages from people saying I just couldn't tolerate it for whatever reason. All my hair started falling out. There's So I think it and there was one study it was small. I can't remember if it was on rodents or humans, but it showed that GLP-1s can maybe exacerbate that androgen excess picture a bit. Maybe temporarily. We don't know, but I I think that's worth noting it for practitioners listening or patients out there because some people are having a really hard time as they start and they or they're like why isn't this working for me? So I don't think they're for everyone. But I do think overall, yes, we I think this might be a big helper in the whole problem cuz we do have a fertility problem. And then with middle-aged women, I think it's just fantastic. I mean it's just a
fantastic. I mean it's just a I'm living it right now. I am in the throes of that the sudden belly fat, right? And they say, "Oh, middle-aged women are going into menopause the menopause transition with they're just low muscle mass and that's the reason." And everybody wants to blame it on that and their metabolism isn't slowing down. I went into perimenopause in the best shape I've ever been in my life. I was training for a strong first kettlebell competition. I had more muscle on me than like most women in my like I was like in the 1% of women my age. I was incredibly fit when I went into that. And I still got hit with the belly fat and the midsection and the visceral fat. And so I think what I just had a really great conversation with my friend Kiran Krishnan who's a microbiologist and a GI specialist. And he was telling me that what happens with a shift in hormones during the midlife transition has such a huge impact on our microbiome and it also has a huge impact on our lipopolysaccharide levels and when those elevate, they cause your fat cells to expand and to get bigger. So, a lot of what's happening in this shift is coming from the gut first and foremost. And the really interesting part just to like put a, you know, put a big blob of whipped cream on top of that is here's the crazy part. When you start stalling out the gut with higher and higher doses of GLP-1s, you exacerbate SIBO. I think a lot of people are coming in with SIBO, which is small intestinal bacterial overgrowth. I think they are getting SIBO along the way. I think it is it even microdosing exacerbated my
is it even microdosing exacerbated my SIBO when I had a really stressed bout of huge bout of stress, like boom, my SIBO was like not happy. So, that culmination and I read a one study, it was like a 45% increase in SIBO with GLP-1 users and I again, I I wonder if they came in with it. Who knows, but here's the ironic part. SIBO pushes your LPS levels up and LPS is what drives obesity and type 2 diabetes. Yeah, like that's lipopolysaccharides, which is a toxin from bacteria in your gut that gets absorbed and it creates inflammation and inflammation creates insulin resistance, which then creates, you know, weight gain, diabetes and the rest of the cascade. So, that's that mechanism is pretty well described. So, yeah, that's interesting. So, the medication they're using to treat the obesity and the type 2 diabetes is in fact driving potentially the obesity and type 2 diabetes. It's So, this is where I think an integrative approach is non-negotiable. Like you have to treat the gut. I've gotten so many people better from metabolic issues by treating their gut. It's quite effective. 100%. So, Tina, let's talk about what people should think about before they want to start GLP-1s and what kind of blood tests or metabolic markers should people look at before prescribing? One of the first things I notice with GLP-1s is that your labs will will to shift sometimes even before the weight loss starts coming down or the weight or even if we're not going for any weight loss whatsoever and we're on a small dose or tiny dose, uh will get great improvement. So, I want to see those. So, I want to see fasting serum insulin. I want to see hemoglobin A1C. I want to see reactive protein inflammatory markers. Obviously, we run a um a complete blood count and a complete
um a complete blood count and a complete metabolic panel. So, we're looking at liver and kidney function from the start to make sure nothing's shifting there or going in the wrong direction. Um we might throw in some nutrients in there if if I am concerned about malnutrition with these. I think people malnourished them get themselves malnourished and there a study just came out showing it's all over the internet right now like brain damage from GLP-1s. It's not brain damage. These people are sitting on the edge of a thiamine a B1 deficiency, which is super common and then they get thrust into malnourishment with the high-doses and then they go into Wernicke's encephalopathy and they end up with terrible frank uh B1 deficiency issues. So people should take vitamins or check their nutritional markers and vitamins and minerals and and get get replete like take a multivitamin along with it. And look at your lipids, of course, and look at your thyroid markers and just make sure everything's staying cool. I think with middle-age women, it's important to look at and men, it's important to look at um your hormones. I just I run such a comprehensive panel on everyone. Yeah. [laughter] I have all the No, I I hear you. I mean, honestly, I agree with all you're saying and I think that, you know, most people should check all those things anyway and I think it's part of why compounded functional health, which is to give people access in a very affordable way to a very deep panel of blood work, which includes all those things you mentioned, including nutrition, hormones, thyroid, uh cardiovascular markers, metabolic markers, renal markers, fatty liver, all of it. And then it, you know, it's at functional health it's just a basically a dollar a day to get this done twice a year. And I think it's important
year. And I think it's important for people to track things while they're doing it, see the changes, monitor things. I super important. All right, let's let's talk about the kind of newer therapies and next generation therapies and also let's dive a little bit into the sort of microdosing framework because it seems like the drug companies themselves are understanding that their doses are too high typically and that they want to give the possibility of adjusting doses by different sort of offerings or then having like vials or different pens that have titration ability on the pen. So can you talk about what's what's happening what's coming and and how do we think about like the dosing both because because there's this whole gray market of people just buying them online or from you know mills or telehealth and it's not actually probably safe. So can you kind of walk through how do people navigate this who are listening who don't want to take the full dose or trying to figure out how to look for for the right approach? So the dose really depends on the person and their genetics and all the things we just mentioned and what their goals are. What are their short-term goals? What are their long-term goals? I will say this microdosing the way that I originally introduced it was just a fifth to a tenth of the standard starting dose and I would dose up to the you know the the bodybuilders know this, right? The bodybuilders are the original biohackers. They understand this concept. It's the minimal effective dose to move the needle of whatever needle we're trying to move. So maybe someone doesn't want to lose any weight but we want to get their inflammation under control or we want to get their joint pain or their psoriasis or their psoriatic arthritis, whatever. Their eczema, their acne.
eczema, their acne. Um it's the minimal effective dose and so that is I have found totally different for everyone. It men you asked me about men versus women. Men I find need a higher dose. They women are more sensitive to it generally but maybe that's just based on body weight. Maybe that's just size overall. Um and their hormonal status matters. We've got one study it was small but we've got one study looking at tirzepatide and GLP-1s and they did better when they were on HRT. They they had more appreciable weight loss. There was a smaller study done a couple years ago. I I mentioned it on the last one. It was such a tiny study, but again, people who were on GLP-1s did better with weight loss when they were on HRT. So, I think the whole milieu of the patient really matters there. And I want to be very clear. I never intended microdosing to be a weight loss strategy, but that's all it's being marketed for, and these companies are preying upon middle-aged women telling them they're getting a microdose, and they're actually getting a standard dose. They're just being started at the first tier of the same dose that the folks with diabetes and the same folks with obesity get started on. And they're told it's a micro. And they get it's an onboarding strategy. It's It's like drug dealers who give you your first dose free or whatever just to like So, that's kind of scammy. I've even had I've got people arguing with me in my comments saying, "No, I'm on a microdose." And I'm like, "No, honey, you're like on the third tier up of the standard ladder. Like, you are not You're not on a micro But my doctor said" What they tell them is, "Yeah, we follow Dr. Tina's protocol. It is 1 / 10 of the dose." And they tell them what the max dose is.
the max dose is. And they And because they're giving them 1 / 10 of that, then it's must be a microdose. So, that's super unethical and scammy to me, but that's everywhere. And that's what a lot of these companies are seeing, especially the telemedicine ones are doing that I found. Um So, that's frustrating. And then I just want to There was a study that came out in May of 2026. I don't know if you saw it, but they looked at They did a study. They looked at 49 different online telemedicine GLP-1 websites. And this is scary. 70 is scary in and of itself. [laughter] Yeah, a whole We We started a whole craze with that last episode. 17 sold compounded, only five sold branded only, and 27 sold both. Um Two required blood work. One denied a prescription based on internal data indicating an existing prescription from another website had already been filled. And one prescribed, but later withdrew the prescription due to a mismatch between the patient's photo and reported weight. Um But basically, 39% asked about weight loss goals. I'm sorry, 39 of the 49 asked about weight loss goals and on it went. They did not screen these people very well and 13 only 13 required a video visit and three required a call. So basically, you can go on, fill out a form and get GLP-1s sent to you is the end of the and it they're not doing a comprehensive workup on you. Not all telemedicine companies are like this. Some are really good, but yeah, this is is pretty scary. And then the other option is the gray market like you mentioned and I mean I don't that's just
I mean I don't that's just that's I think that's just gotten completely crazy and I don't know what to say about it anymore. I don't have an opinion cuz I too many analysis are coming out showing there's nothing in the bottle or there's contaminants or there's LPS. Exactly, which is concerning. Yeah, um but the cool thing is is the brands Eli Lilly and Novo Nordisk released their vials. I don't know if you know this, but the week that Eli Lilly released their Zepbound vial, I got deplatformed off Instagram at 232, 000 cuz apparently they didn't want me talking about what I was talking [laughter] about. Really? Yeah, but I don't know it's just coincidence maybe. Um anyway, they released their vials and I think these vials allow for more individualized dosing and from what I know from my colleagues, that's what they're using. They're using it to microdose, they're using it to standard dose, they're using it to half if you go to a your doctor, they can actually prescribe these drugs from the pharmaceutical company in a vial that allows you to self-administer with a syringe at a lower dose. So it's not an auto pen. Is that the idea? Yep, so it's personalized individualized dosing so people can onboard. The paper came out in the Journal of Diabetes in 2025, I think or end of 24. Sh talking about microdosing GLP-1s, but the way that they talked about it was published. It was an opinion paper, it wasn't a study, but the way they talked about it was individualized onboarding. So, they're talking about microdosing differently than I am and they're talking about using it to get your patient up to the appropriate dose,
your patient up to the appropriate dose, but you can start them lower if they need it cuz people definitely need it. A group out of Italy was reporting that, you know, they're finding a lot of success with individualized dosing. I think doctors are getting it. I think doctors are realizing we're all different sizes and shapes. We all need a different individualized strategy, but the I do know that Mounjaro, I believe, came out recently in the US with not just the standard auto pen, but the clicky pen. It's You can dial the end and this Journal of Diabetes paper did give you a whole chart on And I know that's available in Europe. A whole chart on how to change your dose or your patient's dose based on how many clicks you do. So, it's called the click pen method. And so, that's We got We've got a lot more options than we did last time we talked. And the price has come way down. So, the good news is you can get them from legitimate pharmaceutical manufacturers. You can get them at lower prices. The probably the truth is are the prices are higher with these pharmaceutical versions than the ones that are available through other markets, right? I think it depends, actually. The compounding situation with GLP-1s is so hairy right now that I've seen prices kind of all over the board and some of these companies really gouging, some of these telemedicine companies really gouging patients. So, I don't think so. I think the I think Medicare just got You can do a Medicare program now, $ 50. Um if you go through Lilly Direct and get the Zepbound in the vials, the pricing is is quite reason Depends on your dose. Um I don't know. And I I'll say though,
Um I don't know. And I I'll say though, the clients I've got a few clients I work with who are getting prescriptions from their doctors and the Zepbound seems to be working better than the compounded for them for weight loss. Uh or the other thing to consider when weight loss stalls is you just change your injection site. And so, a lot of people will get comfortable kind of sticking to the same place all the time. Maybe it's the outer buttocks or the thighs or the belly or the arms. And so, something that it was my friend actually just mentioned it to me. She's like, "Oh, I just started rotating my sites and the weight fell right off and I was able to back off that dose that was sucking her soul out." [laughter] [gasps] She Yeah, so there's just a lot of variation here. I think we're learning and it's fun to be able to talk with you and and have a fun conversation about it that's educational so people can get all the information. One of the things I talk about constantly with patients is the idea that the body isn't broken. It's just not getting what it needs to do its job. That's really the whole promise of functional medicine. We're not playing whack-a - mole with symptoms. We're asking what do the underlying systems need to actually function? And one of the tools I keep coming back to in my own routine is my Sunlighten Sauna. Infrared therapy is one of the most underrated recovery inputs out there. And I say input intentionally the same way I talk about sleep or nutrition. Not a luxury, it's a condition your body can use. What separates Sunlighten specifically is their Pulse IQ technology. It delivers red light plus near, mid, and far infrared wavelengths independently. So, you're not just getting blended wavelengths plus heat, you're getting a
wavelengths plus heat, you're getting a targeted personalized session. Now, if you're already dialed in on food and exercise, this is the piece most people are missing. Go to sunlighten. com and use the code HIMMEN you'll save up to $ 2, 100 plus get free shipping. Have you ever climbed in a bed exhausted but your body just won't switch off? Your mind keeps racing, your muscles feel tight, and you can't fully relax. Well, a lot of times that can come down to one foundational nutrient, magnesium. It plays a critical role in sleep, recovery, stress regulation, and muscle function. Yet, many people simply are not getting enough. And that's why I've recommended magnesium breakthrough from BiOptimizers for years. And now they've introduced magnesium breakthrough advanced 10 with 10 bioavailable forms of magnesium and even more elemental magnesium to support sleep, muscle recovery, and metabolic health. It's become part of my evening routine, especially during periods of travel, training, and higher stress. Go to bioptimizers. com / hyman and use the code hyman to save 15% off your order. Yeah, it's good. I mean, it's evolving, and I think people should should really work with a reputable practitioner who understands how to use these in conjunction with lifestyle, doing the right diagnostic tests beforehand, understand what's going on with your metabolic nutritional health, hormonal health, and kind of monitor things like DEXA scans and your bone density, and your body, you know, muscle mass, and really tracking things, cuz I think that without that, it's a very slippery slope. Um I agree. I want to end by sort of doing some rapid-fire questions. Are you up for that? Yeah, I'm ready. [laughter] Okay, so you [snorts] mentioned like alcohol and how it might
alcohol and how it might interrupt uh the the cravings or addiction in general. So, what's the deal with alcohol and GLP-1s? Can people drink? Can they not? How does it work? I would get off the alcohol. I I really would. When you slow down gastric emptying, the alcohol stays in your stomach longer. So, what you're used to consuming and thinking you can handle changes. So, if you think you can handle one or two drinks and get in your car and drive, it you can't anymore. It's also a poison. It's poisoning your mitochondria, and your mitochondria being poisoned are part of the reason why you can't lose weight. So, it's kind of an oxymoron. If you're going for weight loss, it's really you're shooting yourself in the foot with alcohol on Find other drugs. [laughter] All right, got it. What about the mistakes people make on GLP-1s? I think what we talked about, just using it as the plan, you know, like using it as the solo monotherapy plan. Like, that's I'm going on Ozempic and or whatever, and that's it. It's like, no. It's that is a but one tool in a comprehensive toolbox, and you really have to do all the things. And what's the biggest misconception people have about these medications? That they're eating your muscle and bones. It's not true. Well, you will lose muscle and bone if you don't exercise, but that's because any weight loss will do that, right? That's Okay. What's the the thing everybody should know before starting them? That what you just said, that you should work with a reputable clinician who knows what they're doing, who understands you know, integrative functional medicine, does a comprehensive treatment plan. I think that's key. And I know not everyone can access that, but at the very least go to the freaking gym and start eating nutritionally dense foods. Start there.
nutritionally dense foods. Start there. And who shouldn't take these GLP-1 drugs? I'm really concerned. I live in north of Scottsdale now and I'm seeing all these weight loss clinics and they're treating little old ladies who have no weight who really have no right losing any weight. As we age, that little bit of extra weight might actually be protective. And these women are worried that they're fat and so they're taking GLP-1s and I just had one of my friends, his grandma fell down and fainted and almost broke her hip and was in the hospital because she they're already headed towards frailty if they're not going to the gym regularly and they're not protecting their muscle. And then they've got GLP-1s on top of it. I think it's crazy and super unethical. So, be careful on older people who aren't really obese, is what you're saying. And young women who are not really obese who are using it for vanity weight loss. I It's It's not a vanity drug. I mean, people are going to get into trouble, I agree. Um what's one lab test you wish doctors paid more attention to related to all this? Uh serum insulin, I think. Hey, I knew you were going to say that. [laughter] Oh, man. I used to catch hell from my colleagues and they're like, "Why are you testing everyone's serum insulin? You think everybody's metabolically compromised?" I'm like, "They are, and here we are." You know, it's terrible. I mean, I went I was uh I've been testing insulin for 30 years and uh I just talked to the the lab guys at Quest who is our functional health partner and I said, "What percentage of tests that you get are including insulin on orders?" He said, "Less than 1%." [gasps] I said No. Yeah, and I was talking to the dean of the medical school
of the medical school uh in Arkansas, Bentonville, the Alice Walton School of Medicine, who's of East Indian descent, and she she's a doctor, and she's actually a fan of mine. And she was listening to my podcast, and she says, "You went" She's a, you know, got into college call oncologist as her specialty, but she's the dean of the medical school. And she went to see her pre - ologist and said, "Will you please order insulin for me?" He's like, "No, you don't need it." And she says, "Yeah, but I mean [laughter] I find out this is a problem for me." It was quite amazing how how it's one of those tests that is so simple, so cheap, so easy to do, and tells you so much that nobody's doing. And if you take one thing away from this podcast, you've got to get your insulin down under 10, ideally under five. And then And that's what all a lot of this stuff will help you do. Okay. Um, what's the most surprising thing you've seen happen to a patient that had nothing to do with weight loss with with these compounds? Oh, gosh, just the the addiction piece. I think the like I mentioned the the eating disorder. I'll tell you one, me. I was taking a microdose of tirzepatide. I was wearing a CGM. My blood sugar is dangerously low all the time. Like so low that it sets off the the device. And it alarms, you know, the alarm goes off. When I use GLP-1s, it puts my blood sugar back in the normal range. Isn't that And I've heard and I've asked many people, and they have seen similar. So, yes, Like a paradoxical effect almost. Yes. And then the addiction part and the eating disorder part. I think those are things we didn't expect. Okay, that's good. Those are important things. What's something people don't worry about with these drugs that they
worry about with these drugs that they should worry about? Their muscle. Particularly their lower body. If you're going to lift, if you're going to take a GLP-1, you have to lift. And if you are going to go spend time in the gym, you really have especially you ladies as we're aging, we are protecting our bones and our muscle, and you have to lift lower body because it's your biggest metabolic sink. That biggest bang for the buck. Everyone's so, you know, obsessed with these Demi Moore arms, and I'm like, "Can we just build a dump truck?" Like we need to build an ass. Like at the end of the day, that is what's going to protect you from a hip fracture. You have to go to failure and you have to progressively overload. So, find someone that can help you learn with that. I talk about it all the time on my social media, my podcast, but that's critical. Agreed. I was doing that this morning. My butt hurts. [laughter] Good. Um so, what's what's one thing the internet has completely wrong about GLP-1s? That they're made from snake venom and they're going to, you know, that they're literally derived derived. They every There's a doctor out there, a chiropractor, saying, "And I'm a chiropractor, too, so no shade." But every single prescription is derived from It has venom in it. Okay, how about one thing that you would change about how these meds are prescribed today? What would it be? Oh, I think it's just the wild west and I think people have I hate to say it. I I'm such a libertarian and I believe people should have access to medications without too many hurdles, but um I think it's just too crazy right now with the gray market and even the telemedicine companies. [clears throat] And then really just my concept of microdosing being bastardized and twisted into some vanity weight loss thing. It was never intended and that's kind of where we're
intended and that's kind of where we're at. So, I think it's that's a way off base. But wait, but don't say you you do say that the microdosing does help with weight loss, too, though. And that's what you said. Well, a half dose, I mean, a half dose could If someone is really metabolically optimized, it can lead to, you know, 10-15 lb of sort of that inflammatory puff or that middle-age kind of like that menopausal insulin resistance weight that comes on. I think it can help with that, but I think if you're looking at the average middle-age woman who's looking for weight loss with a microdose, she's probably looking at more of a standard dose or a half dose or 3 / 4 of a standard dose. We're not I'm not talking the like micro microdose. Like I have little old ladies on tiny little doses for their joint pain. Totally different beast. What's the biggest unknown we're trying to answer? Well, like you said, what is coming in 20 years? And I am concerned. I think we're going to see there's like quad and you know, there's like the five different agonists, the four They're coming out with all kinds of fancier ones and I'm seeing a lot of people who have gotten to the top tier of dosing, they're still living with obesity. Maybe they're not doing all the things, maybe they are. I'm not judging, but they're looking for the next medication to come out because they've peaked. And now they're gaining weight back. And so I think we're going to see this with a lot of people to your work concern and mine just kind of running to the next one and it's just a long line life of kind of being tapped into a drug.
drug. It's It's a scary thought, honestly. And I hear you. It is. It's a It is a wild west and it's It's like There's a quote I always talk about which is from the New England Journal of Medicine. It said we should use new drugs as soon as they come out before the side effects develop, you know? [laughter] We don't have enough. Okay, so on the positive side, what's the most exciting GLP-1 area research now? Cancer. Uh the I think it's really exciting to see There's two studies that came out recently showing potential prevention uh with And it's not causative, it's correlative from what we have. It's observational, but breast cancer. Uh but to your point, when you optimize metabolic health, then I mean, I remember being What was it? The year I got my medical license, it was like 2008 and I was downtown Portland and the Susan G. Komen Race for the Cure was happening and it was all of these little cute ladies in pink T-shirts with fairly girthy midsections carrying boxes of Voodoo Doughnuts and drinking giant Starbucks Frappuccinos. And I was looking at my We was It was a bunch of naturopaths up in a room at a conference and we're looking out the window and I'm like, this is not it. [laughter] This is not it. This is why we have breast cancer. It's metabolic health. So, I'm excited to see that benefit play out, but at the end of the day, we got to treat the root cause. Amazing. Well, Tina, thank you for keeping your eye on the ball. For helping us under big complicated
For helping us under big complicated field of weight loss, metabolic health, GLP-1s. I think it's uh it's it's really such an important advanced medicine, but it also is fraught with a bit of risk, and I think doing it right is really important. And hopefully those of you listening have figured out how to do it right. And where can they find more about your work, Tina, and and learn more about how how you think about all this? Yeah, well, thank you again so much for having me back. I appreciate it. It was nice to be able to just talk with you one-on - one and get the information out doctor to doctor. So, I have a community I'm launching. I'm so excited about it. I you can actually access me in there, and I can give answers. It's for middle-aged women. It's called the menopause rebellion, and so that's at school s k o o l dot com forward slash doctor Tina. I have a podcast, the Dr. Tina show, and everywhere you can find me. Um it's d r t y n a, and that's my website, too, drtina. com. Great. Thank you so much for [music] just keeping on this and helping us all understand this very messy, complicated field. Thank you so much for having me. It was fun. If you loved that last video, you're going to love the next one. Check it out here.
