How to Stop Losing Muscle on GLP-1s (But Still Burn the Fat)

So, what's your approach to the whole like muscle loss thing?

I think you overdosed yourself this week, so you didn't want to eat. So, we want to dose to appetite control so people still want to eat. We don't want to crush people into fast significant weight loss. So, if they're cranking GLP-1s and they're not prioritizing and protecting their muscle, they're absolutely going to be in a worse situation at the end of it than they started in. They started with muscle and fat and they're going to end up with no muscle and no fat and look like melted candles with devastated metabolic health.

Alright. In this episode of the Boundless Life Podcast, we're going to do a throwback to a conversation that I had with Dr. Tina Moore about a hot topic now, GLP-1 agonists. And, I wanted to re-air this one because almost everything Tina says here is still being misunderstood. And, she's the one who kind of pioneered microdosing with these GLPs. When we recorded, the internet had decided these drugs were the worst things ever, muscle wasting and Ozempic And suicidality. And Tina's take on all that was really different. And 2 years later, she's kind of been proven right. She wasn't right about everything, like big Alzheimer's trials came back negative since we recorded, but she was way ahead of her time on a lot of this. And I was the guinea pig on this. I was microdosing with GLPs leading into it. I still take about 0.25 milligrams of retatrutide or tirzepatide about 4 times a month, typically on travel days to quiet hunger. And, I've been doing that since this podcast with Tina. Usual note, neither of us is giving medical advice. This is for informational purposes only, so proceed at your own risk or benefit. And, the shownotes are at BenGreenfieldLife.com/DrTina. That's D-R-T-Y-N-A. Enjoy. I need to tell you that I just finished breakfast about 20 minutes ago. I make myself these glorious, beautiful Super appetizing type of stuff you'd pay $30 for at the acai juice bar smoothies. I ate half my smoothie and didn't even really want the rest. I was telling my friend yesterday because I'm a total foodie, I'm cooking up steaks and fish and making all manner of different recipes. I've been eating more for just function knowing at the back of my head that I need X amount of protein, carbs, fat, calories, et cetera, than I have been for enjoyment. Even my wife and I are sitting down at dinner now at 8:00 p.m. because it takes so long for me to even kind of get around to dinner because I'm not thinking of it. Now, the reason for all of that is that I knew I was going to interview you. I wanted to be able to speak from personal experience. So, I used a small baby dose, I suppose it's baby dose, 50 micrograms of semaglutide every day this week. I did a small subcutaneous injection of semaglutide and I thought, well, holy cow, I think it's like 1/10 the dosage or around there of what a lot of people would use. And, in me alone, for me to be the type of guy who thinks about food all the time and to have that happen, again, I'm lean, I'm a hard gainer, there's no way I'd stay on this stuff with what I experienced or at least I'd I'd back off considerably. But holy hell, I kind of know what people are talking about now when they discuss weight loss and even the potential for not getting enough food in because you almost don't want to eat.

Yeah. Well, I think you're taking way too much. I think that's way too high a dose for you.

Well, this was relentless self-experimentation to make sure I really, really knew what I was talking about on this show. Even with what people would call a very, very small dose, taking too much.

Yeah, so you ended up, I think, over the course of 5 days with the standard starting dose for a weekly dose, which I think is way too high for somebody of your body composition. I would never in a million years think that that would be a good dose for you. So you did get what I would consider high-dosed on that for you, for you as an individual. And this is a really individualized strategy that I take with folks. So yeah, when you told me that, I was like, I bet he's not eating 'cause you're so lean. I can't imagine. And have you been tracking your blood sugar with a CGM at all? I bet it's been in the toilet.

My blood sugar in the evening and my normal values, I use the CGM on the back of my arm, my normal values range between about 85 and 95. Sometimes a little bit below that, maybe after a workout if I haven't eaten yet or whatever. I've been in the 60s at night.

Yeah.

My weekly score where it gives you your metabolic score, it kind of gave me a big thumbs up, fantastic. I'm guessing the way the algorithm built is kind of like the lower the better within reason.

Yeah.

So, I've been averaging around 60 but not been hungry. And, it's not because I'm artificially lowering it by drinking massive amounts of ketones or something like that. But, the weird thing is that I normally would not be able to sleep well with blood glucose that low. But, if we want to talk sleep scores for people who speak that language, I've been in the 85 to 95s for sleep score.

Oh, good. How's your HRV and heart rate?

Fine.

Oh, good. Okay. So, sometimes even on the tiniest doses, and again, it's totally individualized, I would always be asking somebody, what are your goals? Why would you be using it? What are your outcomes short and long-term? But, sometimes we can see even with the microdoses that people's heart rate will go up, their heart rate variability will go down, their sleep will get disrupted. So, it's not the peptide for everyone, but Dosed appropriately, I do think it's available to just about everyone who wants to use it for a myriad of potential outcomes, right? Like, there's so many benefits across the board that we're seeing in the literature that goes back 20 years, and everyone that I'm using it with is using it really for a different reason, and very few are using it for weight loss. So, you had a dose that was too high and it was crushing your appetite a bit. And I always say we wanna dose up to appetite control, but not appetite suppression. And for most people, appetite control, like I have pretty decent appetite control. It's gotten a little worse since I've hit perimenopause, uh, but I've always been able to run really lean and control what I put in my mouth. I think for a lot of people there's food noise, but there's other noises like alcohol and cigarettes and gambling and shopping and all these other things that people are reporting are also going away. with the use of GLP-1 agonists. So, there's something in those reward pathways that is helping inhibit just kind of the noise across the board in the brain.

Yeah. Well, I think my wife is going to be very pleased that my reward pathways triggered by the Who chocolate bars that she keeps in the pantry have somehow been suppressed to the point where those things are not disappearing anywhere near as quick as they used to. Well, first of all, there's probably No way I'd stay on this except, I don't know, maybe crank it out at Thanksgiving or Christmas or a time when I might tend to overindulge. But, you said something interesting. You said the research goes back 20 years. I'm in the health and fitness sector. I pay attention to the news. I've really only heard people start talking about it a lot in maybe the past couple of years. Why is that?

I think it's because the weight loss conversation came up. So, semaglutide has only been out for a couple years and tirzepatide even less, but exenatide and these other GLP-1 agonists have been out for decades. And, were used predominantly for type 2 diabetes. The weight loss side effect was figured out and then big pharma figured, hey, let's, you know, FDA approved this for weight loss just a couple years ago. That's when everybody started hearing about it. That's when everybody started losing their minds about it. And that's when I started to see the propaganda and the headlines really come out. The safe and effective use of it, I mean, I hate to use those 2 words together 'cause they've been so overused the past few years, but that, That application for type 2 diabetes was almost, from what I understand, it was originally developed for neurodegenerative issues. And it was just serendipitous that they figured out that it helped with type 2 diabetes and with blood sugar regulation and metabolic health. So we're finding new and new ways. And currently it's being studied for alcohol cessation and other, Alzheimer's and Parkinson's. And I mean, really the literature around Alzheimer's is so exciting. So there's, There's new applications coming down the pipeline, and I think with that, we're going to start to see less and less access to it from other avenues versus Big Pharma's version. You know, they like to pull things and then make their own version.

Right, exactly. Yeah, the, the— you mean the patenting process for profit?

Yeah, so it's a fun game.

So that's interesting you mentioned neurodegenerative diseases and later Alzheimer's. Would that be something that people who, for example, have the APOE4 gene should know about or be interested in?

Well, I would say for sure. I mean, anyone with that genetic profile is potentially looking at— I just always tell my patients who come positive with that that we're just going to be cognizant of it. It's like my husband, for instance, his parents were both adopted. So, we don't really have a good family history on either side and both of them have struggled with cardiovascular issues.

Yeah.

Like pretty severely. So with him, that's always on my mind, right? Like I'm always, everything I do with him, I'm looking at cardioprotection. And with, for myself, my back history, familial history is a lot of neurodegenerative stuff. So for me, I'm, that's always in the back of my mind. So anytime a glimmer of a symptom pops up, I'm like, okay, take care of your brain, Tina. And that's how I would say with anyone with a genetic propensity or concern that, I'm using these. I use everything though preventatively, right? I'm a naturopathic physician, so everything is preventative medicine. I'm again, that's why I say I mentioned the dosing strategy with short and long term. Someone like yourself, I don't think do date. I don't think daily dosing is appropriate with these at all. I know that that's a strategy going around, and I know that some folks in the biohacking community are talking about doing it several times a week. The half-life on these is four to seven days, so I would say you know. 5 to 7 days max on dosing, and then we just get the dose down to where we're not crashing out your appetite, we're not crushing your blood sugar, we're not causing any other symptomology, and you get that neuroprotective effect. And then we wait. And I would say, not— I'm not telling you to keep on it, but those benefits come over a period of months where people start to really notice, like, ah, my mood is improved, my cognition is improved, I'm able to multitask. like a demon again. I'm able to run my business more effectively, those kinds of things.

Yeah. To contextualize this for people, if we were to say something like 50 micrograms, which is what I was taking, that's a 5-milligram vial that comes in a powder that you reconstitute with maybe 3 mL of a solution. So, if you're talking about a standard 1 cc insulin syringe, I'm pulling the syringe back to the point where I can barely even see any of it is full. It's back to, I think, the 3-tick mark or something like that. So, these are very, very small doses, tiny, tiny. It's like LSD. Be careful. One tiny, tiny extra little speck and it's the difference between cognition and flying to the moon.

Well, I say that with folks. I say if you're metabolic— so, this strategy really is reserved for those who are metabolically optimized, which I think is a great thing for your audience to know because I'm guessing most folks in your audience are probably on the path of good metabolic health. This is not a strategy for weight loss.

Yeah.

And, I hear from people often that, oh, I tried microdosing. There's a whole bunch of people out there right now, clinicians, biohackers saying they're microdosing and they think they have my strategy all figured out and they're all doing it completely randomly. And, most folks are actually starting people at the standard starting dose and maybe ticking them up the next tier and calling that microdosing. And, that is not it. That is standard low dosing. And, that is— I'm using fractions of that. But, that said, in someone like yourself or even like myself, a little bit too much is a lot too much with this peptide. It really can go sideways fast. And so, this is where I'm very cautious and conservative in my dosing strategy.

Yeah, yeah, that makes sense. Back to neurodegenerative disease, I find this fascinating that it has an impact on that. A lot of people call many of these dementia-like issues, especially Alzheimer's, type 3 diabetes because of the impact of the inflammation in the brain from elevated blood glucose values or Insulin insensitivity. Would the mechanism of action on neurodegenerative diseases be that you're eating less so your blood sugar is low, or is there something else that GLP is doing to the brain?

Something entirely different. Well, it is definitely acting on the metabolism, so improving metabolic health. It's healing metabolic health. It doesn't just band-aid it for the time that you're on it. It actually has a healing and regenerative effect on your metabolic health in a myriad of ways. But it also is manufactured in the brain. People think it's just coming out of the L-cell of the gut. It's made in the brain as well, and there's multitudes of receptors across the brain for it to receive it. We don't know what they all do. Like, for instance, in your nausea and vomiting center in your brainstem, there's a bed of GLP-1 receptors. I think that's why some people get more nausea than others. But, it actually remyelinates the nerves. It's neuroregenerative. It's so cool how it's working, and we don't entirely understand it. A lot of this is in rat models and rodent models, but we have human studies too. And, Even in humans, those who are experiencing mild cognitive decline are seeing they're not progressing down the pathway to the more severe forms like Alzheimer's. And we're seeing that actually a couple pieces of data just came out in the past couple weeks that were presented at obesity conferences showing just correlative, not causative, but long-term users who were using it for type 2 diabetes and/or weight loss, even independent of weight loss, were experiencing pretty significant drops in all-cause mortality, drops in cancer rates. Like, it's, it's pretty wild what some of these longer-term studies are showing. So, and again, correlative, not causative, but I am, I am of the preventative, you know, strategies here.

Yeah, yeah. And when you're talking about these regenerative effects, uh, back to diabetes, does it actually have an effect on something like pancreatic cell regeneration or, you know, restoration of insulin sensitivity?

Yeah, there's a couple different mechanisms by which it helps metabolic health overall, and pancreatic regeneration is one of them. In fact, there was some data around type 1 diabetics, if caught early enough and administered GLP-1s, that they may not go full bore into type 1 diabetes. It has an impact on our immune system, so it's quelling autoimmune disease. And, I'm hearing from people who have the HLA-B27 positive gene where that leads you into like, you know, spondyloarthritis and Yeah. Some not so favorable things down the line, and they're experiencing great impacts from it. So yeah, and then on the flip side, something very cool that it does is it, it upregulates GLUT4 receptors. It translocates them to the membrane. So, you know, we have insulin sensitivity, we have insulin receptors binding, sending the GLUT4 receptor to the membrane, but we also have things like intermittent fasting or caloric restriction will Activate that AMPK SIRT1 pathway. Exercise will do it, just contracting your muscles will do it, but GLP-1s do it as well. So, and there's a couple other mechanisms by which it's really beneficial to our metabolic health. So, I think it's exciting. I think we need more research. And again, this is some of the reasons why I think we can call it personalized dosing, because for somebody with significantly more weight to lose, like you have no weight to lose, you're super lean, but there's folks who, maybe are doing all the things and they've still got 40 pounds that are just hanging around. For them, you know, quote unquote, a microdose might be something much higher. And those who are metabolically compromised straight up really do seem to need higher doses. But I still think there is a place for this personalized dosing where we don't have to crank people into complete crushing of the appetite so that they stop eating and lose muscle. We don't have to crank them into side effects and all the horrific side effects. And there's a laundry list of them. We don't need to go there with it.

Yeah, I actually am interested in those side effects and your thoughts on them. But incidentally, because I know people are wondering, I've done podcasts recently about using things for appetite control like ketones, or there's this supplement with a bitter hops extract called amarisate in it called Calocurb.

Yeah, I've heard of this.

Yeah, yeah, it's interesting. It activates CCK-PY and GLP in the gut based on triggering the bitter receptors in the small intestine after you swallow these capsules. And, as I do and as I did with this podcast, I experiment with everything before I do a podcast. And, I thought I wasn't hungry using these type of strategies. It wasn't until this week, I think, that I realized, oh, I was based on a 1 to 10 sliding scale, Using all those other strategies, I was maybe a 6 on a hungry scale. With this stuff, and as you noted, I'm probably using too much and I don't plan to— well, I might based on some of these systemic-wide effects you're talking about. I'll definitely back off the dose, but I would say I'm at about a 1.5 for hunger. That's how much more powerful we're talking. But, back to the dosing. Before we get into the side effects that obviously a lot of people on the internet are like, side effects, side effects, side effects. When you're talking about things like neurodegenerative disease, diabetes, and the impact on pancreatic cells, the effects on the immune system, when you're bringing up those examples, are we talking about the standard dose that a doctor would normally prescribe for something like weight loss or are these effects also these smaller less frequent doses?

We don't have data Yeah. To show that my hypothesis is correct. I only have anecdotal evidence from my patients. And then from— I have a sizable platform. It's not as big as yours by any means, but I've got, you know, hundreds of thousands of followers across various platforms. And I'm hearing from everybody and I'm hearing from doctors and I'm hearing from people across the world who are finding really incredible benefits with these lower doses. I will say, I do think that there might be some functional deficiency happening in folks. For a variety of reasons that I can only speculate on. And that might be that their gut lining is trashed from years of leaky gut and maybe potentially IBS or IBD, some kind of inflammatory bowel process. Perhaps they're aging and they're having atrophy in the gut lining. And so there's a variety of reasons why their L-cells may not be doing their thing. And I think that some of these supplements, like the one you mentioned, I think are exciting, but they're just really— Yeah. They're really calling on the L cells to do their thing, and sometimes the L cells are just not doing their thing anymore. We know that as folks age, they lose the ability to absorb B12 because their intrinsic factor is gone because their gut lining has atrophied. So there, you know, I think that the L cells might be in there to some degree too. So not everyone's going to respond to these stimul these GLP-1 stimulators, if you will, different herbs, bitters, things like that. Not to say we throw them out; it's just not something to rely on entirely. But on the other side, I wonder too if there isn't some issues going on in the brain, and that I don't completely. Completely understand it, and I don't think they do either. But in those who are metabolically compromised and or obese, they are showing lower levels, and those with fatty liver are showing lower levels of GLP-1 in the system. I don't know if they had they went high and then came down, or if they just are having some sort of functional deficiency going. So it really depends on the individual of what they would need. I do think that we can dose people super low without any weight loss and still probably get some of the anti-inflammatory benefits. some of the neuroregenerative impacts. But where there's like a breaking point where we're going to be countering their metabolic dysfunction, because almost everybody in this country, and we're exporting it throughout the world, has some level of metabolic dysfunction at this point, except those who are really prioritizing our wellness. So it's like this sort of teeter-totter where I'm finding I have to dose people up to a certain point so we can actually start to get good benefits and then they can override that through their crappy lifestyle behavior. So, we might get an anti-inflammatory benefit going, we might see some improvement in mood and cognition, then all of a sudden their bad lifestyle habits will override that dose and we got to take the dose up even higher.

Now, here's something I may not quite understand based on what you were just saying. These L-cells, which from what I understand based on your explanation are helping to produce GLP-1 endogenously and induce that feeling of satiety or fullness.

Yes.

That could potentially be triggered by some of these very bitter compounds that someone might be using as a natural GLP-1 agonist or perhaps via the biome. There's that company Pendulum that's using a GLP-1-based probiotic with Akkermansia, et cetera. What you're saying is that if the L-cells are unresponsive, that these might not work quite as powerfully. But what I don't understand is when you're using something like, say, semaglutide, is that not also triggering the L cell, or is the mechanism of action via which it induces GLP-1 entirely different?

It's entirely different. It's an agonist, so it actually binds the GLP-1 receptor throughout the body and actively mimics GLP-1. Semaglutide is actually Bioidentical to our natural endogenous GLP-1. It just has a tweak in one of the areas to make the half-life longer. Endogenous GLP-1 is in and out of the system very quickly. And, when they tweak it for this version, it's in the system and out 4 to 7 days later instead of minutes or hours.

Okay. So, we're talking about something very similar to someone, say, taking Tribulus terrestris or fenugreek or something like that to somehow bump up their natural production of testosterone. Versus just smearing testosterone cream on their balls.

Yes, it's a whole different ballgame. So, again, I'm all for these GLP-1 stimulants or things that are going to stoke on its natural endogenous production, but I think some people's L-cells are shot. And then, again, I wonder what's going on in the brain and I wonder about GLP— we have leptin resistance. I wonder about GLP-1 resistance and do we have to override that with a dose? We just don't know.

Now, based on these type of feedback mechanisms that occur in the body, if your L-cells were, say, as you say, shot and you started using a GLP-1 drug, would that cause the L-cells to become even more unresponsive because they're even more less necessary?

I don't think so because they respond to the actual mechanical bolus of food in the gut. They respond to short-chain fatty acids. It's more of a It's more of a local trigger, so it's less of a hormone and more of a you know they respond to high levels of glucose in the system in the gut themselves. So, and I don't know how the brain gets triggered on to make it, but I I wonder about like relentless stress. I wonder about you know compromised brain health in general from just decades of low-grade insulin resistance. You can be super lean and thin and still even with the best of intentions and still be rock. in a low-grade insulin resistance due to just cranking cortisol for years from chronic stress.

You've just described most of my executive coaching clients.

Yeah, exactly. I was going to say it's like CEO syndrome, right? Welcome to my life.

So basically, the L-cells, the theory here is that the issue with those not kicking in and producing GLP would potentially be inflammation, stress, a modern toxic lifestyle, Et cetera. So, it's not all gloom and doom and you have to be, if you didn't want to be, on a GLP-1 drug for life, but you could engage in simultaneous restoration of the L-cells via smart dietary and lifestyle practices combined with something like a GLP-1 in the meantime.

I love that idea. Yeah, absolutely. And, I still think you can do that with some hormones. I've helped many a younger client or patient over the hump with even some very, very low doses of hormones.

Yeah.

So bioidentical hormone replacement when needed, using a little bit of thyroid or a little bit of adrenal just to get them over the hump. And we don't do it to the point where we start to shut down production. We just get them where they need to go. That said, some people feel so good on it, they want to stay on a little bit of it. And I'm talking tiny, tiny doses. And I've been doing this with hormones for decades. And that's where I got this idea with the GLP-1, because I was like, wait a minute, why don't I just give people the dose they need? And that's going to be different for everyone, but why don't I just try that and see what happens? And I do have folks who want more weight loss because what I'm finding is there is some weight loss for folks like myself who really just drove myself into the gutter with cortisol from chronic, you know, years of chronic grinding and stress. The interesting thing though is that folks were kind of losing their puff, their bloat, and so they drop maybe 10, 15 pounds and get down to their fighting weight, which is more of their set weight. If they wanted to get past their set weight, they really would I have to crank up the dose. And, that's not what I'm talking about. I had a colleague recently call me and she said, okay, so I've been microdosing and I lost 8 pounds and I'm back to my pre-baby weight. I said, great. And, she goes, but I just can't get the scale to move. And, I said, well, you were so fit and in great shape before your baby. Why are you trying to get the needle to move? She goes, well, my body composition is off now since the baby and I'd like to get the weight down lower. I said, no, honey, that's in the gym or maybe with some other peptides that we change composition. If you want to crank yourself past your set point, that's a whole different dosing strategy that Right.

And alteration of body composition is not synonymous with weight loss anyways. If anything, the scale might go up a couple of pounds with muscle.

Exactly. So, I was like, that's a different strategy. So, folks are online assuming they know what my strategies are and they're all over TikTok, like these self-proclaimed experts who have zero health training. They're just women who, you know, they're talking about splitting up their dose, they're calling that microdosing, all kinds of things. And I'm like, they're still doing these really pharmacologic doses. And then, there's other folks saying, well, I tried. They think they knew what I said on a podcast, they tried it and it didn't work. And, I was like, work for what? It didn't work for weight loss because this isn't a weight loss strategy. While it might lead to some weight loss in somebody like myself who is doing all the things right, I lost my fluff. I lost my lockdown fluff. I'm in Oregon and I know you're in Washington still, right?

Yeah, yeah, almost to Idaho but haven't moved to the better Oh, thank God you're closer.

'Cause I mean, I was in the thick of it here near Portland and, you know, it was bonkers. So the stress of all that, I gained a few pounds, but it was also perimenopause hitting hard. I mean, I was right, you know, I'm right on the edge of menopause and just a couple other factors, you know? And so as I do, I kind of sweeten the deal a little bit of this. Looks like Salt Bae. It's like a little bit of GLP-1, a little bit more estrogen, a little bit testosterone, whatever I need, and dial it in. And I did, I lost the fluff. But if I wanted to go lower, I would definitely have to start dosing into side effects and I'm not interested in that.

Yeah, I want to talk side effects because look, I mean, you hear the big scary stories for months and months. That's all I heard, Tina. And, I would even get on Instagram and be like, hey, everybody's talking about those GLP-1 agonists, but here are all the side effects. Here are other ways that you could control appetite. And then, as the months went on, I would occasionally starting on a weekly basis and now on a near daily basis, begin to hear the type of beneficial pleiotropic effects that you've outlined or at least just alluded to in the last little bit. So, what is the deal with the side effects? Is it improper administration? Is it people not doing the right co-administration of other things when they're using a GLP or why all the side effects?

I think the first thing we have to clear up is that a lot of these side effects you're hearing about are They're very common already in those who are most commonly taking them. So, for instance, gastroparesis is— the number one cause of gastroparesis is type 2 diabetes because the vagus nerve gets so sugared up from the hyperglycemia that it starts to basically erode. So, these folks are sitting on the edge of gastroparesis.

And, by the way, just for people who don't know, what's gastroparesis?

It's the stomach paralyzation that everyone keeps hearing. Your stomach's going to be paralyzed for life. And that is, you know, the neurologic connection there is very much from the vagus nerve. And so, that gets damaged over time through high levels of blood sugar for decades. And then, these people get put on a high dose. I think we're dealing a lot with a dosing and management issue. So, they get put on a high dose and standard dosing starts very high for some people. For some people, it's appropriate. For others, it's way too high. Someone like you, if you took that Yeah, 0.25 milligrams all in one dose, you would have felt like hell. And by day 3, you would have been like, what the F? I need, I need to go to the hospital. Like, that's not good.

I know, because my friend, my friend accidentally did that. He started at the high dose and he said he felt like he was gonna throw up for like 5 days.

Oh, it's horrible. And so then they ramp them up over a period of 16 weeks and basically doubling the dose every 4 weeks. Can you imagine? And so a lot of docs out there right now and pharmacies are saying, oh yeah, we offer microdosing, and they start them at that standard dose and they double it in 4 weeks. It's bonkers to me. Even folks who are like, oh yeah, I've been doing peptides for decades, and they're very well-versed in peptides, that's still their starting dose. And that's okay, but I'm arguing I think that's too high for a lot of people. Anywho, that will thrust people over into potentially their stomach being a bit paralyzed. And that's transient. It'll go away. Even the studies are showing. The media made it sound like it was some permanent, you know, situation. It's not. It goes away. I think another big one That really is a concern is anybody with biliary disease, the folks with gallbladder issues. What happens in the case when you stop eating and you go into a very low calorie diet, very big caloric deficit, and you're not putting food in your mouth, your gallbladder slows down. A lot of folks who want to take GLP-1s for weight loss are already sitting with sludgy gallbladders. That's the phenotype, right? That sort of curvy, you know, fertile. It's the there we have an acronym for it in medicine, which isn't very kind, but it's like. Like the forty frumpy fertile female, it's it's your curvy middle-aged woman. It's probably sitting there with a sludgy gallbladder already. She goes she gets dosed too high. She goes into a severe caloric deficit. She stops eating, and now her gallbladder sludges up. She throws a stone into the pancreas, and boom! You've got pancreatitis, and that's a real concern. So we don't want to do that. And again, I think dosing and management issue, and maybe she's still crushing the super high fat food that she was.

Yeah. Quick rabbit hole there before you keep going. Could you make a case if someone were being prescribed a GLP-1 to also prescribe some type of bile stimulant such as TUDCA or something like that for the liver?

Yes, 100%. 100%. Yes, we support digestion always. I'm a naturopathic doctor, so we support digestion always.

Okay, got it. So, if you were on GLP-1 and you noticed Fatty streaks in your stool, indigestion, et cetera, you may want to consider some type of a bile agent.

Yes. Although, you can take too much bile and get more of a dumping syndrome. And so, then you go into diarrhea and you think it's the peptide, it might be because you're ODing on bile. So, that can happen too. So, it's just do it carefully, do it with the support of someone who knows what they're doing.

And, this reminds me something I wanted to ask you. I've had horrible heartburn for 3 days. Related?

Yep, absolutely.

Really?

Yep.

And, is that because of the bile issues?

I think it slows down gastric motility. And so, your food's sitting longer in your stomach. Yeah, I had a colleague actually who claims he understands microdosing and he ended up in the hospital thinking he was having a heart attack and it turned out to be he was not microdosing, he was taking too high a dose.

Yeah. Well, the heartburn has been super. And, the things I do, you guys, to give you a good podcast and know what I'm talking about. Yeah. Honestly, the heartburn alone is one reason I want to back it off, but I want to check with you first and make sure, yeah, that it was related. It sounds like it is.

Yup. And, that's where if gastric motility slowed down and you're throwing bile salts or bile acids on top of it, you could see the problem, right? So, you got to be careful. Really, I would just say slow and low. Slow and low is the way to go with these peptides. Alright. So, that takes us into the The next one, which is the nausea and vomiting, which is super common, right? So you kind of just nailed it. That's a dosing and management issue. We don't have to dose people into nausea and vomiting. That's just unnecessary. And doctors who know what they're doing with this peptide won't do that. We have to just be careful and cognizant, listen to our patients. Our patients have to give us good feedback. I actually had a patient on it and she comes in and she tells me she's feeling great, everything's good, the dose is great, blah, blah, blah. And then all of a sudden at the end, her husband's like, you have been throwing up lately. And I was like, what? Wait, what? And she, she goes, oh well, I thought it was just something I ate. I was like, no, that's the peptide. We got to pull the dose back. So just work with someone who's, you know, willing to stay in touch, you know, often. And then I think some of the bigger scary ones are the thyroid cancer. That's a big concern, right? It's a black box warning all over the, the brand names. That was a study done in rodents, in rats, Rats, this is a type of medullary thyroid cancer. It's very rare in humans, very common in rodents. And what they didn't tell you is that they gave the rats super crazy high doses of GLP-1, of semaglutide, and they developed this spontaneous thyroid cancer, which also the control group developed. And so the data coming out, just looking at, you know, the meta-analysis that they're doing, they've really been looking into this one. Yeah, it reminds me a little bit of that T.

Colin Campbell book, The China Study, that claims that high-protein diets cause cancer. And what they actually did was in a rodent model, induced a tumor and then gave that rodent high amounts of protein and lo and behold, there was tumor growth. And then, that was extrapolated to say that a high-protein diet causes cancer.

Yeah, exactly.

Yeah.

So, we just have to be careful. And, I'm not saying like, oh, if you've had a history of thyroid cancer or a family history, go take it, you're safe. Talk to your doctor. Again, risk tolerance. Everybody's different. This is an individualized approach. And then, the last one that's really been making a lot of headway is this suicidal ideation.

I'll phrase it this way. Life is a little less enjoyable now that that ribeye steak and my wife's Hu chocolate don't taste very good and I don't want them. I will admit that I could see if brought to the extremes, that could induce a little bit of a clinical scenario.

Yes. So it can suck the luster for life out of you if you take too high a dose, for sure. I would totally agree with that. And I actually tell my patients the real thing for me, the real gauge is, do you want dark chocolate? If you're a dark chocolate lover, do you want dark chocolate? And that's when I knew my dose was too high. I didn't want the chocolate. And I was like, oh, that's not good, because I eat chocolate every day for a multitude of, you know, health reasons. And I was like, I don't even want the dark chocolate. I didn't want the red wine. I, you know—

Yeah, my porterhouse steak took me 3 days to eat.

Yeah, we don't, we don't want that. So that's a dosing and management issue. But I will say, you know, a lot of folks, their dopamine circuitry is contingent on food, whether it's overeating food, whether it's preparing food. You know, like you said, you're a foodie. A lot of the joy in life for people who love food and prepare food and eat food is that whole process. I'm not someone like that. Food's always just been like fuel for me, so I've never really gotten that, but I see it in people. And when that goes away, that's a huge part of your life. That might be why you have social gatherings. It might be why you go out with friends. I mean, that's, you know, we don't want to take that away from anybody. So again, we don't dose up to appetite crush. We dose up to appetite control if they need it. And I do think also that it's worth saying that— and I'll break down the study in a second— but it's worth saying that obesity is complex. And I know, have known many a woman who has endured psychological, physical abuse, and their coping mechanism was to literally put a layer on their body so that they would become more invisible. And they have admitted this as much to me, that their fat layer protects them. And some of these women are stunningly drop-dead gorgeous, and it's too much to walk in a room and be that noticed. And so they gain a little weight to kind of quiet it down. And I totally understand this, and I appreciate it. I also think that food is a coping mechanism for a lot of people. You take that drive to want to eat away, and now they don't have their coping mechanism, but they don't have any other healthy coping mechanisms set up. So there's a lot of pitfalls here that I don't think people are taking into consideration, and it goes way beyond. As somebody who has struggled with suicidal ideation in the past, myself personally as a young person, I get it, and there's not a lot of rhyme or reason to it always. But I think that it's more convoluted than just Ozempic causes suicide. And here's what that study said. This this was infuriating. I was watching all these big influencers drop that study across. All the platforms saying, see, Ozempic causes suicide. I even saw Children's Health Defense write a really gimmicky piece on it. And, I was so disappointed because I love that organization. I'm on their board in Oregon. I'm so disappointed. And, what that study was was chart notes over 23 years looking at chart notes. And so, there was no causation, it was correlative at best.

Almost like a dietary questionnaire study.

Yes.

What'd you eat last Sunday? Yeah.

And they looked at semaglutide and liraglutide, which is like the prior generation Victoza. And what they found with the semaglutide group, out of 36 million-plus chart notes over 23 years, was 107— a signal of 107 people who had suicidal ideation in the semaglutide group and 100 in the liraglutide group. And of those people, a multitude of them were on benzodiazepines and antidepressants. So even the authors of the study had like the limitation section was huge. Go read it. There's like 10 different points they make. They're like, do not throw out the baby with the bathwater. This is just a signal. We need to pay attention because we've been asked to pay attention. The European Association's looking, the World Health Organization, the US is looking. The FDA came out and said, we're not, we don't see a correlative, or I'm sorry, causative link. We're not concerned. In fact, we have tons of data showing improvements in mood, improvements in anxiety, improvements in just mental-emotional aspect overall. But this one study that just came out in JAMA was— I mean, if they're on benzos and antidepressants already, really what the conclusion of that was, screen your patients, and if they are already suicidal, be careful as you proceed and watch them. Like, you know, it wasn't this causes this. And so it just is really— there's people out there doing really good in the world in the online space, and I really support their message overall, but then they post this kind Yeah, you make an interesting point about influencers, particularly those in the health, biohacking, alternative health, functional medicine space.

There is a tendency, and I do think you could justify it to a certain extent due to a certain element of pharmaceutical corruption in our culture, but there is an attitude that if it comes from big drug industry or if it's a pharmaceutical, it's going to be Bad News Bears and we must avoid it. I actually just interviewed Dr. Sandra Kaufman on my podcast yesterday and we were discussing— it didn't come out yet, it might by the time this one's released— 7 different pharmaceutical drugs that simulate the effects of a lot of things biohackers do like fasting, cold thermogenesis, activation of heat shock proteins via the sauna, weight training, red light therapy, et cetera. And, I know I'm going to get a ton of blowback on it even if every single one of those pharmaceuticals are proven to be safe and effective when dosed correctly just because they're a pharmaceutical. And so, I think that it's understandable just because of things like the opioid crisis that we would be very wary around pharmaceuticals. But yeah, I mean, And like I said, one of the reasons I wanted to interview you was because I've even said many of those things and thrown GLP completely under the bus versus taking a little bit more of a calculated approach as you're outlining. The thing I wanted to ask you that you didn't discuss yet about side effects though is the muscle loss. Or muscle wasting, the Ozempic face potentially induced by loss of water or collagen or elastin in the face, et cetera. Now, I was asked about this maybe 4 weeks ago. I said, no big deal. You could eat adequate amounts of protein and calories and lift weights. And then, this week, I realized it is really damn hard to eat enough protein when as soon as you get 10 grams in, you just want to push yourself away from the table. So, what's your approach to the whole muscle loss thing?

Okay. So, these peptides actually seem to be in rodent and human studies regenerative and maybe even have an anabolic impact on muscle. So again, it's a dosing and management issue. And, I think you overdosed yourself this week, so you didn't want to eat.

Right. Well, you say I overdosed myself, yet I'm taking an amount that many people Are taking or even taking more of.

Much more of. So, you're taking potentially the amount that people start at and then they get taken up to 10 times that dose over 16 weeks. So, you could see why there's a problem with holding on to your muscle because you're not wanting to eat because people's appetites are getting crushed. I just don't think that's necessary. So, we want to dose to appetite control so people still want to eat. And yes, prioritizing protein, prioritizing strength training, but the percentages of lean mass loss Your muscle is part of your lean mass. The percentages of overall lean mass loss are right on par, and this is with the standardized dosing protocol, is right on par with severe caloric restriction and/or bariatric surgery. So basic, so it's not in excess of what we would expect if you put somebody on a very calorically restricted diet, which I don't think is a great idea. We don't want to crush people into fast, significant weight loss. That's how we end up with those empytic face. That's how we end up losing. Muscle and losing soft tissue and losing lean mass. The peptide itself actually is healing and anti-inflammatory on the muscles, joints, and bones, which is very cool. And then, it has an impact of bringing in angiogenesis into the muscle, which will deliver the amino acids more effectively, which essentially leads to better muscle protein synthesis and has an anabolic impact, if you will. So, again, it's being dosed. That's a dosing issue. I also wonder about compliance. Everybody, we want to blame the peptide and then we want to blame the doctors. And we want to blame big pharma, but let's let's just talk about patients for a minute because I was in practice for a long time and patients are not very compliant. And getting patients to lift weights is like pulling teeth. Even even those who come in who are like fit, you know they're doing a lot of cardiovascular exercise or a lot of metabolic stuff. Getting them to lift heavy weights is like it's like pulling teeth, especially the ones that are inactive. So there's a big problem here, and I think just the overall management and application of these weight loss again is nuanced, and the weight loss strategies out there that are successful require a whole team and arsenal of people, support, community, education, and then weight loss itself is kind of the easier part of the equation. And I'd say this with no disrespect because people get mad every time I say this, but it's the keeping the weight off part that is so hard for people, and their bodies reset to a new normal. So if they're cranking GLP-1s and they're not prioritizing and protecting their muscle, they're absolutely going to be in a worse situation at the end of it than they started in. They started with muscle and fat, and they're going to end up with no muscle and no fat and look like melted candles with devastated metabolic health. Like, their metabolisms are going to be shot to hell. And I do think there's something that I have to note that I've only come across recently. There is some literature, and it's not great. I couldn't Yeah. And, I couldn't find a lot on it, but there's something about GLP-1s that may inhibit or slow adipose-derived stem cell activity. And, my background's in regenerative medicine. Adipose-derived stem cells turn into your bones. They turn into what you need them to turn into. That's why I would suck people's fat out, isolate their stem cells, and shoot them back into their joints because we were hoping they would turn into the cartilage and into the soft tissues that were needed to heal that joint. So, I think that there might be something more to the Ozempic phase than just severe quick weight loss. I think folks that are— and I'm betting money this is dose-dependent. I don't have any data to support this, but I think when you— this has got to be an issue of the more you take, the more you might start to inhibit your adipose-derived stem cells. So—

Which would assist with muscle repair and recovery.

Yeah. And just keeping good collagen and tone in your tissues. But then, there's other data showing that not in the skin necessarily, but in the cardiovascular and the cardiomyocytes.

Yeah.

That it improves elasticity and it brings back damaged cardiomyocytes back online. So, it helps with the mitochondria. It really helps with mitochondrial health. So, it helps with the mitochondrial damage. It abates the pathologic process that's happened because, you know, once tissue gets injured, it turns into an inflammatory shitstorm and it slows that roll. And then, it actually helps bring about improved elasticity. So, So, I don't know. I just wanted to add that because it's something I just found and it's definitely something I'm going to keep my eye on.

Yeah, it's certainly fascinating. It sounds to me like rather than doctors shouting until they're blue in the face to tell their patients to eat more protein and lift weights, they may want to consider the fact that they've put their patient on such a high dosage that they're not wanting to eat protein at all and they're too nauseous to go lift weights.

Yes, I think that's fair.

Yeah. Now, when it comes to these peptides, it seems like there's new ones that come out quite a bit. Is that simply driven by economics and some of the patent things you're talking about? Is this based on really good research discovering new GLP-1 agonists that might work even better with fewer side effects? Or, what's this look like as far as new emerging variants?

There's a whole bunch of new ones coming out. I just saw a whole breakdown a few months ago about what they've got planned. And it seems like most of the pharmaceutical companies are trying to get in on it and create their own. And so they're trying to find new and unique ways to do so. And it's interesting. It'll be really interesting. There's lots of pill forms coming out. There's ones that are, you know, they're playing with the agonism. So semaglutide just agonizes GLP-1 and tirzepatide, which is Mounjaro, that agonizes GLP-1 and GIP. GIP actually stimulates glucose release from the liver. So you would think that would be bad, but I listened to the scientist who helped develop it and he basically said the agonism or antagonism of GIP both seem to work. So they, they just went with the agonism, but there's ones that are coming out that are GIP antagonists, it looks like. And then there's ones that are targeting agonism of other Peptide, you know, signaling peptide hormones in the body. So who knows what's coming down the chute? I think they really are focusing on the diabetic population and obese crowd because that's such a huge part of our society at this point, and that's exciting. But I do wonder, you know, I'll say this because I know you'll appreciate it because you're a fit, healthy guy doing all the things, and you're aging like the rest of us. I think there's a group of us out there who This sounds very entitled to say, but I've seen it in medicine. We get ignored because we look fine. Everything— everybody's like, you're fine. How, how could— like, you're, you're, you're the 1% of your age group, right?

Your reference ranges are not indicative of disease.

So you're fine. And I'm over here and you're over here. You've got clients who are like, I don't feel fine, something's wrong, right? Something's going on. And I think that for us, Yeah. For us, being able to— this is where longevity medicine comes in, right? This is where you find the longevity regenerative doctors who are doing cool stuff because we get injuries, we get sidelined, we have our insulin go bonkers on us sometimes. We have family history of heart disease we're trying to avoid and neurocognitive issues we're trying to avoid down the line. So, I think that there is a place for this peptide in that space and for those of us who have done a really good job of keeping ourselves healthy and fit, but we might just need a little tinkering. So, I'm not as worried about these others. And personally, just straight up, my background, like you said, was in regenerative medicine. I will inject anything and everything I can get in injectable form because I can control the dose and the absorption so much better that way. So, I'm just not even keen on these sublingual or pill versions because give me a needle and syringe and I will get you a more potentized effect on a patient.

Right. And depending on metabolism, potential lower issues with first-pass liver and hepatotoxicity with an injectable as well.

You're right, and absorption.

Yeah, and absorption. So, speaking of injectables versus other forms, you go online now, Tina, and you can find tirzepatide and semaglutide and many of these others on just a peptide website.

Right.

Little powdered vial, you order it, you reconstitute, you inject. Is there variance in the safety or purity of these things because they're kind of all over the place?

I don't know. And, I will tell you my legal answer is as a doctor who has a license to prescribe in Oregon these peptides from a compounding pharmacy or a standard pharmacy that I have to tell you that you have to get them from a doctor and that you really should lean on that. I will also tell you that I'm friends with a lot of compounding pharmacists who are cool guys and are not at all trying to hoard just the money or the business. And, they will tell you, Dude, we don't know what's in those. And, we've analyzed them and looked at them and not everybody's in favor of them. And, some of them say, eh, do what you want. But, when you start messing with even tiny amino acid sequences, who knows what the outcomes are going to be. So, I personally go with the prescription version.

You don't want to save yourself $60 on an online version and then get a $6,000 health bill later on due to pancreatitis or something like that.

I also think that again, going just everything we've said, like working with somebody who knows what they're doing is so critical. So people buying this stuff, I've had so many people buy this stuff online randomly from wherever, and then they call me months later or weeks later, and they're having horrific side effects. Like one gal actually had very severe Lyme disease, and she sent herself into a Herxheimer reaction because it shifts your gut microbiome and it shifts your immune system. And she just went too high too fast because she was like, oh, I. I guessed what you meant by microdosing. I guessed. And, this is what I did and it was a total disaster. And, I was like, what are you doing? You have a pretty severe health issue. You should be working with somebody who can guide you.

Yeah, yeah. The economics of this are kind of interesting. I mean, I would not be surprised if there was a little bit of pharmaceutical incentive for these increasingly higher doses that seem to be scaled up upon administration by a standard physician. But, I've heard things like airlines are having to recalculate their fuel costs due to people weighing less. And, there's some—

Wow.

I forget what, Norwegian country or something like that is becoming one of the wealthiest countries in the world due to the fact that they produce a lot of these GLPs. I mean, there's a pretty big economic impact.

Going back to what you first said though, I don't believe that even in the standard version though, so those come in prefilled pens, I don't believe there's a price difference between the starting dose and the highest dose. So putting more peptide in a pen and still charging the same amount, which is about $1,000 roughly a month, is— that doesn't behoove the pharmaceutical industry any. So I don't see why putting them on higher doses would behoove them. In fact, it would cost them, I would think, money. You're right, there's, there's a huge economic impact. I've seen You know, on Forbes and a couple different places, I've seen the CEOs of snack food companies are concerned. They're getting in on it. I think Nabisco, or one of them, is developing some GLP-friendly snack foods. So, probably something high in protein, kind of like how, you know, the Atkins bars and all that whatnot.

It's a smart business move.

Yep, smart business move. Walmart was saying they were concerned about their snack food sales being down, but because they have a pharmacy in-house and they're selling so much GLP-1, they're not concerned at all because that's actually been good for business. The joint replacement companies are concerned because, you know, it's a cash cow. The hip and knee replacement surgeries are cash cow, and virtually every boomer on this planet is looking at them, right? So, and we're the next generation coming. Our generation is a— I don't know how old you are, but I think we're closer.

I'm 42.

Okay, so you're quite a— yeah, I'm 50. Our— my generation is a disaster of health. Gen X, I mean, God, I gotta save Gen X. Gen X is like the last generation that wasn't all digital, and yet they're just in the most atrocious health overall. So who else? The dialysis companies have something to be concerned about 'cause those are popping up on every corner in the mini malls, and that's because that's the end sequelae of diabetes if you make it that far. The big pharma, I'm sorry, big tobacco and big alcohol, like people aren't drinking and smoking as much, right? So I don't know, I'm just speculating all of these different companies. There's more industries that Yeah, it's crazy that a peptide can have that kind of global economic impact.

It's nuts. So, you obviously cover this quite a bit on your podcast, Tyna. It's just called The Dr. Tyna Show, right?

Yes.

Okay, T-Y-N-A.

Yes.

I'm also going to make shownotes. And, Tyna, do you still do telemedicine, teleconsults, anything like that if someone actually wanted to meet with you?

I don't take new patients anymore, so I'm out of that, but I do have a course that I've created for practitioners and I allow the general public in at this time. And, it is beefy and it is comprehensive and it's where I'm pointing people to. So, I have a free 4-part video series they can find on my website at drtina.com. And then, through that route, they will go into a funnel of emails where they get delivered a new video every day and they will be offered the opportunity to purchase that course if they're interested. That's really where I deep dive. That's where my clinical brain is.

Awesome, awesome. Well, I'm sure people have questions, comments, and feedback So, if you do, go to the shownotes, a link to everything that Tina and I talked about. And, I'd love to hear what you have to say. I like to read the comments and it helps me make this podcast even better. So, go do that, leave a nice ranking and a review, check out Tina's show. And Tina, thank you so much. This was incredible. And now, I can stop injecting so much GLP.

Yes. Thank you for having me on. Such a pleasure.

I'm going to have a steak tonight. Alright, folks. Thanks for listening in. Have an incredible week. Do you want free access to comprehensive shownotes, my weekly roundup newsletter, cutting-edge research and articles, top recommendations from me for everything that you need to hack your life, and a whole lot more? Check out BenGreenfieldLife.com. It's all there. BenGreenfieldLife.com. See you over there. Most of you who listen don't subscribe, like, or rate this show. If you're one of those people who do, then huge thank you. But, here's why it's important to subscribe, like, and/or rate this show. If you do that, that means we get more eyeballs, we get higher rankings, and the bigger the Ben Greenfield Life show gets, the bigger and better the guests get and the better the content I'm able to deliver to you. So, Hit subscribe, leave a ranking, leave a review if you got a little extra time. It means way more than you might think. Thank you so much.