Transcript: Longevity Is Built on Metabolic Signals

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welcome everyone to ld's live educational series we're so glad you're here with us this evening and you were able to join us where we have the opportunity to learn and grow together i' like to say here at lmd we're not just a tell Health company we're a company focused on helping people live longer healthier lives and our mission goes beyond providing great products and services we believe that education is key to improving health and well-being and lifting up our communities together through these weekly educational series and sessions where we bring the experts in the field of longevity health care and wellness we hope to give you the tools and knowledge necessary and Empower all of you to live longer healthier lives tonight I have the pleasure of speaking with Dr Leanne Poston a distinguished Medical Professional educator and writer with over 30 years of experience in healthc Care Dr poston's extensive background in both medicine and education truly sets her apart as a licensed physician she's practiced clinical medicine but her passion for helping others extends far beyond the clinic she's also made significant contributions in medical Communications education and Advising she combines her expertise in traditional and functional medicine to write extensively on gp1s Obesity treatments longevity and peptides Dr Leanne holds a medical degree from wght State University boof School of Medicine

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State University boof School of Medicine an MBA from Raj sowing College of Business and a master's of Education from wght State University very impressive Dr Poston I have to say Dr Poston lives in the midwest with her family she enjoys traveling hiking and pelaton classes I know we talked about that welcome Dr Poston to our thank you for being here thank you before we get started I just wanted to ask you how did you come about to become a doctor a physician give us a little background on yourself what made you so passionate about gp1 and peptides just tell us a little about yourself sure um first of all call me lean um but I I've always wanted to go to medical school and I always wanted to be a doctor so I went to medical school like I had planned um went to residency did Pediatrics I thought that would be the prop the most the best field for me because I love children and I love families and working with families I found that it was great except for I needed more research and and ability to ask questions and and try to get answers and I just wasn't finding that General Pediatrics so I switched over to academic medicine back in 2002 I think and have been there ever since and so I I've worked as an assistant Dean in a medical school I've also worked freelance I worked for pharmaceutical companies businesses um just a a wide range of people and looked de medicine from a bunch of different

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de medicine from a bunch of different angles um my interest in obesity I mean I I love pelaton in case you wanted to know one personal thing about me I probably do um oh gosh 10 or 15 hours of pelaton a week and run about 28 miles a week um I think that there's so many things we can do to improve our health and that's where I got more interested in functional medicine and more interested in in what I think of is lifestyle medicine you know basically enabling us to advocate for ourselves to improve our health well thank you for your contributions in the field of medicine and Healthcare and thank you for joining us tonight so let's dive in um I'd like to ask a series of questions and um please share with us what roles uh what role does obesity play in modern longevity and why is it considered a critical Health concern yeah obesity um there is about 200 different diseases associated with obesity obesity is either a contributing factor to these these conditions or the inflammation from excess body fat is contributing to these conditions up until we had the glp1 uh medications available I can tell you as as a clinician there wasn't much we could offer you know we could tell people eat less exercise more and that was what we would what we could tell them um we know know that the calorie in calorie out um

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know that the calorie in calorie out um energy balance model is not accurate we know that people's brains change their metabolism changes when they gain weight we know that you know you can improve your diet you can exercise more but that's not going to take care of the the vast majority of obesity um we have so many contributing factors from the environment that we live in to the chemicals that are in Foods the additives that are in Foods the easy access to food that we have there's always the genetic contributors um you some of the research has shown that people with one parent with obesity have a three times higher risk of obesity and people with two parents with obesity have a 10 times higher risk of obesity so there's just so many factors that are contributing to it um we know also that excess body fat is not just fat you know a lot of people give the the idea that okay I I've gained an extra 20 pounds and I'm you know the health risk of of gaining an extra 20 pounds is the same as carrying a 20 pound Bel barbell around with you all day that's not right okay fat is metabolically active especially your body fat that's around your organs your heart your liver and your intestinal track it secretes chemicals that are going to affect your entire body it increases inflammation and it affects your brain and then we know now too that the microbiome that's in the gut is interacting with the chemicals that your body is secreting you know and then the hormone levels that change throughout your lifetime and

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that change throughout your lifetime and all of that makes obesity a very complicated disease that needs to be much better understood and I think we're we're reaching the point with the gp1s that we are just on the cusp of actually making some progress now in treating obesity so I'm glad to be involved in that yeah I love what you just said fat is metabolically metabolically active can you elaborate on that and how it uh how it works and what it does to your hormones and your gut microbiome and just tell us like holistically what fat does to our body can you elaborate a little more well you you've got two places that you have well first of all you have brown fat and white fat Brown fat is is good fat you know we have more of that when we when we're very young um people try all kinds of different ways to increase Brown fat um the most likely place for you to have it is between your shoulder blades on your upper back um most of us don't have very much of it people are trying different ways to increase Brown fat by you know the the coal plunges and things like that stressing your body but as far as body temperature is one way that that they think might work it um so that that's one kind of fat as far as the white fat which is the the kind we're referring to here the location of the fat makes a difference also fat that is underneath the surface of your skin the subcutaneous fat is not really a problem you know all of us carry some fat under our our skin it actually makes your skin look better when you lose it as you get older you start to to get more of a

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older you start to to get more of a wrinkled appearance to you and things like that so we we kind of don't mind that fat and it's not metabolically active like the organ fat is organ fat for the longest time they thought the risk was that that fat around the heart for example was keeping the heart from Contracting the way it was supposed to fat around the liver and the gut was compressing blood vessels and then it was only when they started understanding that there are all kinds of what are called cyto kindes which are these chemicals that trigger inflammation that are released from fat and inflammation throughout the body causes so many things inflammation is what's causing your blood vessels to be damaged um increased cholesterol you deposits there blood clotting there heart disease um you know liver disease increasing your risk of Strokes you know that there's just so many health issues that are a result of inflammation so the goal what was at one point was to try to understand what chemicals were released from fat in order to see if there was a way to control those chemicals and the chemical release and possibly improve overall health that way that really hasn't worked out that well and the reason it hasn't worked out is because we're just so complex you know human beings are very complex um so what is causing me to be to have more organ fat may not be the same reason that you have more it could be because my microbiome is different than your microbiome you know interestingly enough the the

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know interestingly enough the the bacteria that are in our gut are not just hanging out there you know they're not just chewing up that the the cellulose and other car you know complex carbohydrates that we have that we can't use for nutrients our s they are actually releasing chemicals that also can increase inflammation but they also change your hormone levels so they can help determine whether you're hungry not hungry you know what food you prefer whether you want more carbohydrates or not because these bacteria want to feed themselves and so they will trigger your appetite that way in your brain you have the reward pathway you know in your brain some of us our our reward pathway is so much stronger than other people you know some of us can walk past that bag of potato chips and never give it a second thought some of us we walk past potato chips and especially if you smell it you know that's the end you it's going to be on your mind for the next couple of hours until you start eating some and it's going to take quite a few to get you satisfied too um if you didn't know potato chips are my thing so anyway um so you know that reward pathway and the glp ones they're actually using those for and and testing them for other kinds of reward pathway driven addictions besides food because of that yeah we're gonna get into that for sure I want to well then there's the genetics too which is another hugely complex thing because we have the the genome which has now been mapped as most

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genome which has now been mapped as most people know we know the a c's and G's and the sequence of them um we have these companies that will map your genome and tell you all all kinds of interesting things about the traits that you have and your risk of various diseases and stuff like that but even more importantly as far as obesity is concerned is the epig genome the epigenome is the is on top of the genome is what it means and it is a series of um proteins that are around and histones and they're around your DNA and these you can put methyl groups on or acetyl groups on methyl groups will suppress the DNA acetals will kind of open up the DNA and allow those genes to be read and used to make proteins so there's a ton of research looking at that now because we know that what you eat affects your EPO we know that the environment that you live in your emotional status um medication you may be taking your gut microbiome you know all of this can affect your epigenome and that's why you know some of us can lose weight easier and and some cannot and that's what's so nice about the glp1 medications because there's a large percentage of the population that have done the eat less and exercise more and they've done it multiple times and done it for years and it's just not working so let's take a step back maybe you could explain what peptides are and then um just break it down a little bit further and tell us what gp1s how they

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further and tell us what gp1s how they work what they do and their role in weight loss but let's just take it a step back and tell us about peptides first well peptides what a peptide is is a short series of amino acids that's all it is so when you develop when you make a peptide or or a compal makes a peptide frequently what they'll do is they'll take a hormone that is naturally in humans um that does something you usually a hormone that decreases with aging um and a lot of them do and a growth hormone is a good example of a hormone that does decrease with aging um we've tried replacing growth hormone that's a peptide because it is a series of amino acids and you're using that to try to replace it the problem is it causes all kinds of health issues so don't do it you the only people that it's a good idea for are children that are growth hormone deficient to treat a disease but there are also growth hormone releasing hormones like Sur Morin that um is also a peptide and what that does is actually try to stimulate your natural release of growth hormone in order to try to combat some of the things that are associated with a decrease in growth hormone like um a decrease in muscle mass and an increase in body fat technically H you know any medication that is a protein is a peptide you know so you know all of the glp ones are peptides also because they are made up of series of amino acids the reason you know I commonly get asked why do we have to inject them why can't we just have a pill it would be so much

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just have a pill it would be so much easier if we have a pill and they're working on developing a pill and there is some progress being made there but the reason that they are injected is because proteins are broken down by stomach acid and enzymes in the stomach into the amino acids that make them up so if you would just swallow a peptide it's going to be broken down into its composite amino acids and then absorb through your gut into your circulation and then you know can be used to be reassemble back into that peptide Again by injecting peptides directly into the circulation or into the muscle and then ultimately into the circulation you bypass the gut that's what you're trying to do there so peptides all they are is a short sequence of amino acids pharmaceutical companies and other manufacturers just try to take the the sequins that matters the most get rid of anything else and see if that will work to kind of replace whatever it is that you're lacking so let's talk about gp1s and how they contribute to weight loss so we have people here who are currently using glp1 some people are not familiar with it at all they're interested in learning more can you tell us what glp ones do and how well there's there's three big glp ones right now and I'm going to use the generic names for them because I can never remember the brand names that they go with okay so there's the lug glutide is the oldest one I don't know that it's used as much anymore because semaglutide enters up atide have both been found to be more effective um the weight loss potential for both of them tends to be a little bit higher so all three of them

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little bit higher so all three of them do the same thing but all three of them were designed for diabetes because one of the major things with all three of them is they can increase insulin production um so if you think about what it is that you're one of your glp wants to do insulin increases body fat that's why people who have type 2 diabetes that are injected with insulin will gain weight you know they try not to but they gain weight um because insulin is you know is a hormone that stimulates growth is what it does you know whether it's fat growth muscle growth or whatever it stimulates the growth so at first it doesn't make any sense that a um a glp1 is going to increase insulin and cause you to lose weight because of that so I wanted to get that out of the way first it also um affects glucagon hormone insulin and glucagon are opposites so when you eat something and your blood sugar Rises insulin is going to ush your blood or I'm sorry Usher that glucose or sugar from your bloodstream into your body cells usually muscle and liver are the big consumers your brain consume some too um but what it does is it ushers it into your cells so it can be used for energy that decreases the amount of glucose in your blood vessels which is definitely what you want to do because glucose is an irritant it it irritates the lining of blood vessels and it also sticks to proteins and when it sticks to proteins it forms a sticky covering on the inside of your blood vessels makes it a good place for platelets and

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it a good place for platelets and cholesterol and other compounds to collect and cause you you know things like blood cloths and and damage to your blood vessles so you definitely want to get the sugar out of your bloodstream and into your body cells glucagon does the opposite it lowers your or it causes your liver to produce glucose and it also helps glucose leave the liver in going out to your Circ tion so GP ones increase insulin and decrease glucagon and the end result then is to get sugar out of your circulation and into your body cells now that is is used for diabetes and it also makes it so that we can control your blood sugar without the effects of insulin because the combination of of its effect on insulin and glucagon together make it so that it doesn't have quite as great an effect on weight as insulin does alone in addition to that though that wouldn't be enough to make it an effective medication so the other things that glp1 medications do is they have receptors along the stomach and they slow stomach emptying and so as your stomach slows down and doesn't empty quite as quickly you feel full longer you know it's just like a lot of people will say if they eat fatty foods or proteins as opposed to carbohydrates they stay full longer and they don't get hungry quite as as much and that's just because those compounds or those uh macronutrients are a little bit harder to break down and they stay in the stomach longer so it makes sense that slowing your stomach down and leaving food in there a little bit longer is going to make you feel full

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longer is going to make you feel full longer the problem is that's what contributes to your side effects so for any of you who've taken the glp ones and you felt nauseated or you may have had vomiting or you have had stomach aches or indigestion especially when you first start taking the medication or when you increase your dose that's the it's it's that property of the medication that caused is it um that side effect tends to go away after you adjust to the dose um but that's what it's from gp1s can also slow down the rest of your intestines so some people will say they will have constipation but some just like benad can cause some people to be hyperactive and some people to be sleepy glp1 can cause some people to have constipation and some people to have diarrhea so either one of those are another side effect that can occur all right and then in addition to causing the pancreas to release more insulin decreasing the amount of glucagon slowing the stomach we know that glp ones also affect the brain they they more so than any other um area as far as what we're looking at here as far as cravings and appetite um there's I just saw a research paper a 2024 research paper where they were talking about gp1s and the brain and its effect on the brain and in this research paper they were saying that nonpharmacologic doses which means the amount of gp1 that all of us who are not taking glp1 medications have is not enough to affect the brain they said you almost have to have pharmac uh you know

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almost have to have pharmac uh you know take the medication in order to get levels high enough to affect the brain which would make sense then because you would wonder why is it that some people who are not taking medications you know don't have that same effect so Al together then the medications decrease appetite decrease Cravings increase insulin increase Glo gon slow stomach emptying and therefore decrease your appetite well I want to touch on the lipolysis process and and how it promotes fat burning T is a little bit more known for that than some glutide is as far as fat burning um and that's been a really interesting um because initially they didn't think it did that um initially what made sense is it is the insulin release what what would it make sense that insulin is going to do to Fat it's going to increase the amount of fat that you're going to store right because insulin what it does is is take sugar into body cells and excess energy of any anything kind is going to be stored and how do we store it for the most part I me we store some as glycogen in our muscles and our liver but once those stores are fully stored as fat so initially most researchers were thinking that gp1s are actually going to not affect fat breakdown but it it does um and it preferentially breaks down fat especially to epatite so I'm not sure that we know the mechanism of how it does do it but it does um um and and then you know the um you may have heard

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then you know the um you may have heard the term skinny fat if you've heard people talking about taking gp1s and being skinny fat well that's one of the things that they're referring to is because the gp1s do seem to preferentially break down fat people are losing weight but they're also losing some muscle mass too um and so you know one thing that you do want to do if you are taking the glp ones is try to still stay with your resistant exercises specifically in order to you maintain as much muscle mass as you possibly can while you're taking these medications so um from what I understand these classes of uh medications incron they're not new they've been around for a very very long time we have enough data research and study on them but can you um share with us who would be an ideal candidate for gp1 medications um and what factors should be considered when prescribers are prescribing these medications you know and the reason you incron have been around for a long time is because an incron increases insulin release and so technically insulin you know and we we kind of know how incron are going to behave because of insulin you know we see what it does and we would expect that medications that are going to increase insulin resp release are going to do the same thing so most of these medications at at some point were used to treat type two diabetes that was their initial purpose that's what they were initially tested

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that's what they were initially tested on um I believe it was semaglutide manufacture that the its impact on Obesity was kind of a serendipitous finding what it ended up noticing is that when it was using semaglutide to treat people with type two diabetes they were losing weight and so they ran a research trial to see if what if we increased the dose of semaglutide would they lose more weight and they found that they did so that's where it kind of got started um you know we have the history of it being used for a long time for type two diabetes but now it's reached the point where we understand that it works very well for obesity as well uh as far as an ideal candidate um you have you are supposed to have a BMI of 30 or higher as your Baseline but there there are some caveats with that which I'll get to in just a second you know BMI is is weight for height it's very useful as far as a generalized screening tool but you will hear a lot of people have a lot of complaints about BMI um because people who exercise lift weights things like that their BMI is going to be higher because they have more muscle mass but they shouldn't be losing weight because then they're going to lose that muscle mass so I know a lot of people will complain about BMI and say why is that a criteria it's a criteria because we have to have a criteria just like you know you can just as easily say well the cut off for fever is 100. 4 well my body temperature normally runs at 97 you know why would I be 100. 4 when yours normally runs at 99 it's 100. 4 it's just a number that we have so 30 is your Baseline anyone with

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have so 30 is your Baseline anyone with a BMI over 30 is considered a candidate now other people who are candidates are people with a BMI of 27 or higher that have a weight related medical condition so what what does that mean as far as a weight related medical condition it's any condition that obesity is going to contribute to and if you think about that there's a lot of possibilities so the big ones that they talk about are high blood pressure abnormal blood lipids type two diabetes um are the big three but are there others that you know people could use and say well I have this and that's it's also weight related my BMI is 27m I a candidate possibly so so you know if if you do have a BMI that's over 27 I would talk to your doctor to find out if you meet the criteria for it because there are more weight related medications or conditions than you would think who shouldn't be taking the medications now I've got this here because I want to make sure I don't miss anything but anyone with a personal or family history of meary thyroid cancer um that one's a little interesting because it's it was found that the gp1s increased the risk of meary thyroid and other kinds of thyroid cancers in rodents they have not seen it in humans but only in rodents but because it did show up in the rodent studies they do list that as a possibility multiple endocrine neoplasia syndrome type 2 which is a very rare condition um it's genetic a history of pancreatitis you

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genetic a history of pancreatitis you know and that's inflammation of the pancreas we know that the glp ones act on the pancreas they increase production of insulin if you have an inflammation of the pancreas or some condition that's you know affects the pancreas it is possible that the gp1s can aggravate that so if you've had pancreatitis you need to talk to your doctor allergies to glp1 or any of its components which makes sense you don't take a medication um with an allergy gallbladder disease now I've seen this with some of the glp ones and some I haven't so if you have a history of gall stones or gallbladder disease make sure you let your practitioner know that you have that history so they can make a decision based on that other ones that you want to discuss with your doctor but won't necessarily keep you from getting the medication are suicidal Behavior or ideation um there is some indication that at least in some people gp1s can increase the risk of suicidal ideation and and behavior so if you have that glp1 should never be used to treat type 1 diabetes you know type 1 diabetes is that genetic autoim or it's not genetic it does have a genetic predisposition but autoimmune diabetes it is more common presents typically between the ages of of 10 and 14 and the pancreas just stops working and you need insulin to treat type 1 diabetes so that it's not a candidate for that if you're pregnant or breastfeeding there's just not enough research on pregnant women or

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not enough research on pregnant women or women that are currently breastfeeding um to know we and uh we were talking earlier as far as clinical trials and why is there not this research because in the past clinical trials were mostly done on men and the reason that they were mostly done on men was because they were mostly done actually on 20 to 30y Old Military recruits that all had pretty much the same body size muscle strength and everything else and the reason that researchers wanted to use that population first of all they were available and they didn't have much say on whether they participated or not but the other thing that was really important was it got rid of a lot of variables you didn't have to worry about estrogen progesterone levels throughout your cycle you didn't have to worry about pregnancy or bir control pills or what effects they would have or you know any of that so unfortunately that's why a lot of these medications don't have the data that we need for pregnancy and breastfeeding and we have to know that the risk versus benefits are in favor of testing the medications so yes obesity can increase your risk during pregnancy but does it increase your risk enough to to make taking a chance on a glp1 worth it while you were pregnant you know at this I don't know the answer to that now I get uh asked this question quite quite a bit do I have to stay on these medications for the rest of my life if I do um if I do overeat typically and I I've lost my weight on glp ones do I have to stay on these medications for the rest of my life what are the long-term implications

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life what are the long-term implications do we have the information the data the science to tell us if these are safe longterm we have two years of data so that you know initially the clinical trials start off with with a couple of months they see what happens there then they go up to a year they see what happens there and now we're up to two years of data um and at this point there's probably even more data but there's at least two years that are published data um and what they did is they took people who took I believe it with semaglutide is what most of the research has been done on the crossover but tepati recently reported theirs as well so it follows the same as semaglutide but they took people who lost weight on semaglutide the average weight loss on semaglutide is about 15% body weight and the average weight loss on ttits about 20% body weight but they took people who had lost the weight and then when the trial was over I think both of them were one-year trials um they took those people and they randomly either got a continued course of su glutide or they were switched to the placebo to see what happened and what ended up happening was the people that were on semaglutide and continued taking it lost an additional 5% of their body weight over the next year so it showed that people could continue to lose weight even though they have been on the medication long term but the people who stopped taking the medication gained about 5% of their body weight back again so it also indicates that unless you make lifestyle changes and are able to change your environment in order to support your new body weight and your

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support your new body weight and your chances of gaining weight back are high so that that brings up another question how much do we how much medications do we have to give and how long do we have to give it in order to because you know obesity I work for several um medical societies that research in endocrine type disorders and endocrine disorders and and that's the thing is that their big statement about obesity is it is a chronic disease it is no different than high blood pressure or you know any of the other chronic diseases we don't stop treating blood pressure when we get your blood pressure normal we continue treating your blood pressure If you lose weight and you change your diet and your risk factors for high blood pressure decrease and your blood pressure decreases then what do we normally do we we start decreasing your medication we see how much we can decrease your medication and still maintain your blood pressure within normal range some people will come off their blood pressure medications completely when they lose weight because the environment has changed enough their weight loss is you know the chemicals that I mentioned before that are released from the body fact all of that has improved and they don't need the sem you know the medication as much so I would anticipate the same thing's going to happen with our glp ones what's going to happen is when you reach whatever the goal is that you and your practitioner have set as far as your weight loss goal and

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set as far as your weight loss goal and you get there and you start talking about do I need to use this medication long term I would anticipate you will see a slow decline in your medication dose to see what happens just like we would expect a slow decline in your blood pressure medication to see what happens and if your weight is if you're able to maintain your weight we will you know gradually decrease you a little bit at a time some of you will be able to come off the medication do great may never ever need it again because things were improved in your body you know whether the effects were on hormones whether they were on you know cyto kindes whether it was improved inflammation whether it was epigenetic changes it could be all of those any of those some combination of those things but you don't need medication anymore some of you are going to find that once you come off the medications you start gaining weight again and you have to decide what what you're going to do with that point are you going to try to go with the minimum amount of dosage that you can get to you know and that's a conversation to have with your doctor but that's what I would anticipate what happen okay great want to leave some time for um our discussion around peptides but we get asked this question quite often well what's the difference between tear eptide and semaglutide how's their mechanism of action different why do you get better results out of tepati can you elaborate on yeah I can do that one really quickly tepati got two medicated two it's a twofer and semaglutide is a single one semaglutide is a gp1 receptor Agonist so what it does is it binds to the glp1 receptor

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does is it binds to the glp1 receptor and stimulates it and that's it has the effects that we mentioned earlier tepati is also a glp1 receptor Agonist but in addition to that it's a Gip um and I always got to keep track of what that medication is um anyway Gip we'll just go with that um but it's another hormone that's produced in the gut that also does some of the similar things it does help increase insulin production and it does help it does change the way fat is metabolized so theor it seems that the reason that tepati has slightly better results is because it's combining a Gip and a glp one okay and as far as their efficacy can you talk to us a little about um well they're both very good you know the average weight loss with semaglutide was about 15% body weight so you know and that's over the um in the eight step trials that were done that was over 68 weeks the average weight loss for tepati was a 72 - week trial and was 20. 9% body weight so you know to lose a fifth of your body weight over a year um or actually that one would have been two years is is pretty amazing results and we if you look back at the other weight loss options we've had up until this point we've not been able to get anywhere near that kind of results um we briefly touched on side effects of these medications I know I have used tears epetite so many other people have used tears epetite before um

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people have used tears epetite before um my side effects have been minimal on tears epetite and it's not necessarily true for everyone right some people have no side effects on semi glutide have side effects but uh can you talk to us about side effects of uh the different medications why do some people experience it on one not the other and what can we do to minimize the side effects yeah the biggest side effects are due to that delayed stomach emptying and I mentioned earlier if you keep food in your stomach longer you're going to feel bloated you're going to increase the risk of reflux or stomach contents going up into your esophagus and giving you heartburn it's it's going to increase the risk of nausea some people will even experience some diarrhea um semaglutide and tepati both also affect how quickly the muscles and the in the intestines push contents from the small intestine on down to the colon some people will experience diarrhea and some with constipation from it all of those side effects I would treat the same way that you would treat them if you got them any other way or from any other medications so knowing that your stomach is full and it's not emptying quickly of course you want to go with small small frequent meals you want to avoid the fats because fats tend to stay in the stomach even longer you want to stay upright for about 30 minutes or so after you take your medication or and after you eat in order to try to prevent reflux and stomach contents going up into your esophagus make sure you chew your food thoroughly because that will help break it down worse before it gets

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help break it down worse before it gets to the stomach um talk to your doctor about any other medications that you're take using or taking for any other reasons because there are some medications that actually slow the stomach even more and that may be compounding your problem there if you have constipation I mean I can tell you as a runner um the big biggest cure for constipation is a cup of coffee followed by running a mile that'll do it every time but if that's not for you coffee still works and walking works really well too um increasing fiber in your diet is a great choice because fiber goes undigested through your colon and um helps bulk up your stool and make it easier as far as diarrhea you know you still want to drink plenty of fluids because with diarrhea you're going to lose fluids so you want to stay well hydrated um but try to avoid the excess fats because fats do tend to worsen the diarrhea and you know side effects are most common when you first start the medication and when you first increase the dose so when you know expect that if you're going to be prone to it those are the time frames you're going to see they tend to go away as soon as your body adopts adapts to the dosage but talk to your healthcare provider if you're seeing those side effects because possibly they can you know adjust your dose a little bit to make it a little bit more comfortable for you touched on this a little earlier um about these medications and their effect on mood and I came across a Reddit article article earlier today and you know it's on Reddit that must be true um but a lot of people are reporting the benefits of these medications on ADHD

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benefits of these medications on ADHD and other types of um mood the mood benefits of these medications can you do have you come across anything and any reports on these medications and their effect on ADHD or actually I haven't specifically on on that but we know it does affect the brain and we know it does affect the reward circuit so is it outside the realm of possibility that it's going to have a lot of different uses as far as you know mood disorders and and you know any of those things that are dopamine type dependent I don't think it's outside the real realm of possibility at all but I don't know any research yet at this point that supports it interesting and you touched on depression suicidal ideation why is this medication not recommended for people who have um reports of these because um the biggest problem with with depression and and suicidal ideation is we don't really know what causes it I mean you you may have all heard about the hormone IM balance theory that you know you we have to increase your serotonin and change your levels of dopamine and or epinephrine and people who have an imbalance of those hormones are the ones that that are more prone to depression or you know anxiety and mood disorders and things like that and and then we've got all of these pharmaceutical products that are used for treating depression and if you know somebody who who suffers and lives with depression on a daily basis you'll know

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depression on a daily basis you'll know that a lot of times the medications don't work and they have to try and trial and error to see if they can find something that makes a difference so that's the scary part about it is we don't know what exactly causes depression and suicidal ideation and then to add a medication that may affect mood and may affect the brain and we don't know which direction it's going to affect it so that's why it's not a contraindication to take in the glp ones but it's a conversation you definitely want to have with with the person that's prescribing it so that you can weigh the risks and benefits because you know obesity is a disease also so um it also has a ton of Health consequences so should we just say that we shouldn't treat that because of the possibility you know no it's like anything else we have to everything you put in your mouth it's got risk and benefits you know walking out the door has got a risk and benefit you know you get out of the room but you've got a risk something could fall on you um so I mean that's the way to look at life there's everything has a risk and benefit yeah talk to somebody who knows your medical history and see um if your benefits outweigh your RIS and you should always involve your primary care physician when taking these medications okay we here at Ellie uh perhaps we have doctors that are prescribing these medications but your primary care physician should be involved in your because they have all the data points right they have your entire health history and they know you and they know how you manage things and

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and they know how you manage things and they can be your contact also you know if if you feel like your mood has changed or you feel like something's not right you need to have somebody that you can consult and talk to to make sure that you're not putting yourself at risk and I've heard both sides of the spectrum thank you for touching on that because I've heard people who have said you know what my mood has completely improved that brain fog has completely gone away so you just don't know and that's why to really be personalized for you your journey the goal is not to go up and dose it's to find your sweet spot correct can you touch on that also why that that sweet spot and why um the goal of the medication is not to go up in dose but like listen to your body figure out where you are that's why we do the three-month assessments to see where you are in your journey and then we personalize the next three months but can you elaborate on that a little right I I think a good thing to compare it to would be caffeine okay and and the reason you may think well caffeine that has nothing to do with gp1s but you're right it doesn't but but it does provide a lot of the things you need to consider some of us are fast metabolizers of caffeine some of us are slow metabol izers of caffeine some of you you have one cup of coffee you are wired for the day you're up all night you need a lower dose okay it has too great of an effect on you just because your neighbor can drink two cups doesn't mean you should okay other people they can drink 10 cups of coffee all day long soon as their head hits the pillow they're gone they're done okay they may need even a higher dose of

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they may need even a higher dose of medication what's the difference between these two groups of people it is changes in their DNA that make it so that the number of receptors they have for caffeine differs how well caffeine binds to their receptors differs how caffeine is metabolized in their liver and kidneys differs and the same with your gp1s for all of you you know the number of glp1 receptors you have in your body are different from other people's glp1 receptors the locations of those receptors are going to vary how fast the medication is metabolized by your liver and excreted by your kidneys is going to vary so you may take one dose and have a blood level that's exactly the same as someone who's taking one and a half or two times as much as you are you know it's it all has to do with those factors okay so let's talk about um how glp1 receptor agonis and other peptides integrate into a holistic approach to longevity considering nutrition exercise and other lifestyle factors well and that's really important because if you look at the clinical trials for semti and tepati the researchers made a really big point of saying that everybody in both groups the placebo group and the treated group were receiving psychological counseling and nutrition advice they were also on a reduced calorie diet and they did 150 minutes of exercise every week so to get the clinical trial results if you you know you have to replicate the clinical trial setting right so that means in addition to using some glutide or t appetite to

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to using some glutide or t appetite to help with your weight loss Journey it's really important to try to also incorporate great that reduce calorie diet and exercise um whatever people commonly ask me what kind of exercise should you do anything that you will do you know anything is better than nothing if you're going to walk 20 minutes a day and that's what you can commit to just do that if you could do a little resistance exercise also to kind of boost your muscle tissue a little bit so that you don't get that that skinny fat that people refer to that's great also um but the other thing that's going to be really important is when you do reach your goal and you do want to come off the medication you know that those nutrition and lifestyle changes that you've been able to incorporate are it's going to be much easier to continue using them long term so I agree that that you medications are very important but they're one piece of the puzzle to help with weight loss and obesity so let's talk a little about um actually I want to answer someone's question they asked when people ask how is semiti and teer ZTE different from the brand names that are out there maybe you could touch on that briefly about would compounding pharmacies as well yeah you're referring to compounded medications as opposed to generics so we have three different classes of kinds of medications the brand name medications are the ones that the clinical trials are run on those are the ones that the pharmaceutical companies have produced and tested and gone through all the FDA approval process and all of that stuff

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approval process and all of that stuff um the reason that brand name medications are so expensive is because of that pharmaceutical companies have to put tons of drugs through tons of testing in order to come up with a product or two that actually is going to work so there's a lot of luck involved there and luck is expensive in when you're developing drugs so those are your brand name medications so if you ever wondered why are they so expensive that's why um if you've ever seen the regulatory paperwork for submitting a new drug application I mean it's it's hours of medical writing to to get those done once the Pat and and that's why brand name medications are given a patent they're get been a patent to protect them for 10 to or 12 to 15 years so that they can kind of recoup some of that medicine from or some of that uh money from paying for the clinical trials and the testing and submitting the applications and all of that so generics are only allowed to be manufactured once that period of time is up and that's why generics tend to be cheaper and there's even some ways to support one generic medication over another generic medication I mean there's there's a lot of politics involved in this too but the simple answer is between the two of them that's all that there is to that compounded medications now if you if a medication is on the fda's um short list a medication the company cannot keep up with demand and they cannot fulfill their backlog then that medication can end up on the FDA

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that medication can end up on the FDA list if that medication is on the FDA list then compounding pharmacies can produce that medication themselves um for individual patients is how they it's how they write it is is because they're compounding pharmacies theoretically they can develop the dose in whatever dose you need they can add things like vitamin B12 they can add vitamin B6 vitamin B12 is commonly added to the SHP ones because it it has been shown to help with nausea so the thought is that if you add that to semaglutide that it was actually help with the side effects as long as these medications stay on the FDA list then the compounding pharmacies in the US are permitted to make it and they still require a prescription the difference between a compounded medication and a brand name medication is and even I mean a generic medication has to be identical to the brand name medication compounded medication does not have to be identic identical to The Branding medication the um so the thing that's a little bit different is the brand name medication went through all the FDA you know approval process compounded medications are not regulated by the FDA now the labs that produce them are regulated by you know good manufacturing Pro practices and by pharmaceutical boards but not by the FDA and the reason for that is if one person needs 2 milligrams of something plus B12 and somebody else needs 3 milligrams of

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somebody else needs 3 milligrams of something plus B12 how is how are we going to go and do a clinical trial that shows that 2 milligrams plus B12 works just as good as 3 milligrams plus B12 and submit all of the necessary paperwork and everything through the FDA in order to test every single possibly possible combination we can come up with so that's kind of the difference there thank you for elaborating on that when well that's why it's really good that people are buying medications from online companies and and pharmacy that have the reputation for for making sure that that where they're buying it from is following good manufacturing practices and and using the right medication bases and stuff thank you for touching I'm sure you've all seen the for research purposes only online you know that you know they're it's a little risky be using those right no it's a little risky I mean you're injecting things into your body and and yes we know that they're saying for research purposes only you kind of wink wink um go ahead and use it but you know that's that's risky you don't know where they got it from so can you tell us about why and how peptides are available through so let's switch gears and talk about peptides we have a few minutes left um you told us that peptides are just chains of amino acids that come together and they trigger a series of different events throughout the body um let's

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events throughout the body um let's touch on some of the peptides that we offer so samorin maybe you could tell us what samorin does and then pt41 why and how do compounding pharmacies have the ability to compound peptides maybe you can touch on that yeah peptides are are not in the prescription drug category so they don't they're not in that patent new drug application pathway that the prescription medications are now pt41 is a little bit different because there is a form of of pt41 that is a prescription medication and so it did go through its pathway and stuff um but people are using pt41 off label now off label always sounds scary to people when when I mentioned things are used off label I can tell you as in Pediatrics 80% of what we use is off label why because if you don't think they're going to do clinical trials on women you think they're going to do them on children you know so what they do is they do the clinical trials on the men and then what they do is they decrease the dose for children Okay so any medic I'm trying to think of a good example um like some of the cold medicines we use them off label prescription cold medicines in Pediatrics because they were tested in adults but we know that half the dose may work well for a 12-year - old and a quarter of the dose may work well for a six-year - old and a 12-year old are just as miserable as an adult with a cold so we use it off label for that so that's kind of an idea of what off Lael means so what people are

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what off Lael means so what people are doing is they're taking medications like pt41 which was used for um um in women premenopausal women that um had decreased liido it's the prescription form of it and they're like well but what else could we use it for we know the medication has been tested we know that it does improve liido so what what else can we use it for and testing was done in men um some testing you know this is new research and everything like that and some testing is being done in postmenopausal women and the thought is can we use use pt41 which is prescription for some people but possibly use it off label for others so that's how that one came about sorin was a prescription medication way back I don't even remember how long ago it was a prescription medication um but there was a problem with it it had nothing to do with the medication and its safety or anything like that it was actually used to treat um growth disorders in children I think that the comp if I remember right don't don't hold me to this but I think what ended up happening was the company made another product that was better for what they wanted to use it for and so it didn't make sense to continue to pour money into sorland and so they just stopped M manufacturing it but if you look at some of the research articles they they actually make a point of saying it was not discontinued because of any concerns it was a business decision but so Marland what it does it's it it requires a prescription because it isn't injectable um anything that you inject into your body does re

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that you inject into your body does re require prescription even if it was a protein because people commonly say well if it's just a protein why do I need a prescription for it why can't I get it myself um because it isn't injectable um but what with soring what it does is is growth hormone is released if it's released in pulses if you take exogenous so outside the body growth hormone well it's going to suppress your brain from making growth hormone that's not a good thing and that actually causes lots of side effects and can cause some ser serous medical issues sorin what it does instead is it stimulates growth hormone releasing hormone so it stimulates the hormone that is a n natural part of the feedback loop that stimulates growth hormone release so basically what it's doing is helping your brain release its own growth hormone but importantly it's staying within its your body's own feedback loop so it's not overriding the pathway like taking growth hormone by itself wood it's working with that pathway that's why it's so much safer so there's a lot of research being done on the growth hormone secr toogs is what they're called the whole category of them and they're all called growth hormone secr toogs just because they help your brain secrete growth hormone what do we know about growth hormone we know it decreases when you age we know it has a lot and by age I I find this a little irritating but over the age of 30 get this so as you age over the age of

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get this so as you age over the age of 30 your growth hormone levels start to decrease what happens when your growth hormone levels start to decrease muscle mass decreases body fat increases strength decreases you know libido decreases all of those things tend to happen so by using soral and the thought is if we can kind of prod your brain to start producing more growth hormone again possibly can we increase muscle mass decrease body fat things like that in order to help restore some of that there is a lot of research getting started on that right now I have a question that came in uh regarding this at the specific topic does over usage or extended usage disrupt the body's natural production of hormones specifically we're talking about sorin the answer would be no and the reason is samorin is rapidly metabolized um number one so it's hard to get a a really high dose of it but just it works in your body's feedback loop and and the when I was teaching an the example of a feedback loop I always gave is the heating and air conditioning system you know you got your thermostat your room gets too hot what happens your air conditioning comes on your room gets too cold your heat comes on same thing with all of these I mean there are hundreds of feedback loops in your body that control everything but with the growth hormone Rel you know system what'll end up happening is that you you take some oralin and increase the secretion of G growth hormone and growth hormone levels increase well that's

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hormone levels increase well that's going to cause some Downstream things to increase and as as they increase these growth factors or what they're called they'll negatively feed back on the brain and slow down growth hormone production so with that feedback loop staying intact you can't override it thank you for all now that's not the case with all medications you know there are other medications that you can inject that aren't part of a feedback loop like like growth hormone like I was mentioning before if you inject growth hormone itself then you override the feedback loop and yes you can overdose that and how about with GP 1es we going back to that topic can you overdose gp1s or will your body's natural secretion of gp1s and Insulin be affected if you with prolonged use of these medications well there's are two different things there so one I can answer more confidently than the other okay so prolonged use I think will we are probably we've reached the point with us being more two years out not seeing a whole lot of effect with it um and still seeing continued weight loss and knowing the behavior of other diabetic medications you know that we've used di medications to treat type two diabetes for decades now and and not have had any problems and they also affect blood sugar and the hormones that control blood sugar so the length of time I would say pretty confidently is not as big of a concern but you also said can we overdose on them by

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said can we overdose on them by increasing the dose too much I don't know the answer to that and the reason I I mean because we've tested up to you the standard dosage of both semaglutide and tepati they chose those dosages they did the you know the first stage of a clinical trial is to test for safety and efficacy they want to show first of all that that dose doesn't cause any problems and secondly that it's effective that it does what it says it's going to do so they tend to run really small all clinical trials and generally healthy people to check safety and effect Effectiveness and then from there go on and run the bigger clinical trials so I don't think anybody can really tell you that if you took three times the dose for example of semaglutide that that would be safe and not have side effects I I just wouldn't know Wonderful well Dr Poston we're about time thank you so much do you have any last words we Lov having you here and hope you can come back in following weeks but any last words no I think that you know the one thing that I always tell people that as far as obesity you know that it's a very complex disease if if you go to a doctor or anyone else and they tell you it's your fault that you have obesity or it's your fault that overweight I apologize in advance for these people they don't understand they were trained in the idea that it's calories in and calories out and you have full control over your body weight and you're just

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over your body weight and you're just not trying hard enough please no that is not true and know there are so many things in medicine that that people don't know don't understand um and I'll be the first to admit it we we don't know how a lot of things work well thank you so much and thank you for tuning in thank you so much for being here we'll we'll continue our discussions in the following weeks and Dr Poston we look forward to seeing your articles published on the Alie website thank you all so much have a wonderful evening have great weekends love you all have a great evening take care