Semaglutide: Dosage & Timing Hacks For Maximum Effect

Foreign. Talk about semaglutide and pulsing the dose of semaglutide. So let's go over this drug. This is the drug also known as Ozempic for diabetes and WeGovy for the use of weight, obesity or overweight with comorbidities. And the dosing schedule is very interesting. So we, we have something called drug tolerance and extinction intolerance. Drug tolerance is where you take something over and over again and you need more and more and then eventually stops working. This is classic with semaglut. In fact, the maintenance dose is 10 times higher than the early starting dose. So the 10, the maintenance dose is 10 times higher. And once you get to the maintenance dose you generally don't lose any more weight. So let's talk about how we can kind of hack that or get around that and use the principles of tolerance and extinction. So semaglutide is called the GLP1 agonist, glucagon, like peptide agonist. And this is found in the brain and the pancreas and the gastrointestinal tract. And there's things we could do to increase the levels of glp. One is taking a, a probiotic called Akkermansia. Another one is taking common drug called metformin. These are things to be done in conjunction with semaglutide to potentially make it more effective. But also we can tweak the timing where we increase the dose gradually increase the dosage and cut it off, switch the, one of these other agents and then start it up again later on. So let's talk about the general experience in the medical literature and our clinical experience using a selective pulsing of the semaglutide dosing. Once again, the semaglutide is an injection. We're not talking about the oral form that really doesn't work well for weight loss at the doses available, the injectable form, which is done once a week. And typically the idea is you take it forever. And I kind of don't like that idea. Maybe take something at a low dose forever might be reasonable. But taking a very expensive medicine at the highest dose that you're tolerant to really makes very little logic to me. So the largest trial to date is called the select trial, S C L E C T trial. And this was a four year study with people that were overweight or obese who were put on semaglutide to watch their weight loss. They lost weight rapidly over a period of about 40 weeks or so, maybe 60 weeks, and then they kept it off for four years. But interestingly, most of the weight loss, in fact the majority of the weight loss occurred very, very early in the study at the much lower doses. In fact, half of the weight loss occurred at 12 weeks. The next half of the weight loss occurred over the next 50 weeks, almost a year. And then no more weight was lost and they held it for about four years. In fact, the average weight loss in the select trial was 10% of body weight. In the prior studies, looking at a shorter term use of semaglutide, it was done without diet or exercise. It was more like so diurexide could potentiate weight loss with semaglutide. But suffice it to say that weight loss seems to be maintained or held going on the highest dose of semaglutide for a long period of time. But no more weight loss generally occurs after the first year. In fact, most of the weight loss occurs in the first 12 or 13 weeks. So reviewing this again is that the maintenance dose, you know, between say four months and four years is 10 times higher than the most rapid weight loss dose. So we've been able to use sort of a biohacking principle at allure with our patients. We treated several, several thousand where we put people on semaglutide at the regular escalating dose. It's 0.25 milligrams for the first four weeks. And it goes up and goes up and goes up. Right about 12 or 13 weeks is when the medicine starts becoming you, you start becoming very tolerant to the medicine, doesn't work as well and the weight loss slows down. Okay, so what can we do then? We can actually stop the drug at that point, stop it at about 13 weeks. That's again the most ex, that's the most rapid weight loss at 13 weeks. Stop the medicine altogether, go on Metformin, which is a commonly used diabetic medicine. It's also used for pre diabetes. It's also being studied as a longevity drug. And the metformin dose doesn't have to be very high. Usually we're even 850 milligrams just at night. And that seems to maintain the weight loss that's occurred up until that point. In our clinical study, we saw an average of 12% weight loss at 13 weeks. And this was a clinical study. It was not placebo controlled or double blinded. It was just a group of people, an observational study, 12% at 13 weeks. Then we put them on metformin for an additional six to eight weeks and they kept the weight off. And then at that point they had the opportunity to go back on the semaglutide again. Again starting at the lower dose and ratcheting it up for 13 weeks or using semaglutide on an occasional microdosing schedule where they're only doing the starting dose of 0.25 milligrams. So let's talk about how that kind of panned out in our clinical observation. So we've left it open to our, our customers and our employees to use different methodologies. One would be doing this semiglutide for the 13 weeks and then when the weight is where you want it, if that's where you want it, then go on metformin and eventually you wean off the metformin and your lifestyle's sufficiently changed. That's, that's great. There's been other people that are going on, on the metformin and doing a second round of semaglutide because they had to lose more weight. But again, we talked about most of the weight loss occurs at those lower doses in the first 13 weeks. So they do it again. They go on semi glutide for 13 drug holiday, a pause for six or eight weeks, go back on the starting dose again, a much lower starting dose, which has much less side effects. You know, any side effects we've heard from the drug is usually dose related. Go down to the micro dosing again and then start gradually increasing it to below the highest dose, which is the maintenance dose. So the highest dose, usually people get people on about 1.75 milligrams, well below the, the dosing that's recommended take for the rest of your Life, which is 2.4 milligrams. And then we've had other people that just take an occasional injection of semaglutide every month or so because they find that when they're sor, sort of getting sort of off the wagon on their diet or exercise regimen and they're watching what they're eating, they take one dose of semaglutide, last for about a week or so, it curbs their appetite, gets their, gets their brain reset. So I'm proposing we look at this a little bit differently. And instead of thinking about obesity as a chronic disease, which we could say it is, but instead of thinking about is a chronic disease that you take a highest dose of drug for long term that doesn't do anything other than keep the weight off, that 10% of weight off. What if we can use semaglutide in a pulsar Fashion to get you maybe to your target weight by just taking rounds of it. Thirteen weeks at a time stop. Thirteen weeks at a time stop. Thirteen weeks at a time stop. You'll lose more weight in the long run. The weight loss doesn't really stop then and then maintaining it either with microdosing the semaglutide or taking metformin or continuing to these occasional 13 week rounds of semaglutide. Now going again going back to the literature, the select trial select trial published in Nature Medicine in May of 2024. So it's very new information. Four year study 208 four year study. The weight loss occurred. You know the most rapid weight loss was in that first 12 or 13 weeks. Then it slowed down between 13 weeks and a year and then it stopped. And then when the next three years after that first year the weight just stayed really steady at a 10% no more weight was lost. They did not lose weight. They were on the highest dose of the medicine, most expensive dose of the medicine. The most, you know, the higher dose has more side effects. And of course we like to take as little drug as possible and especially when it's not doing anything more. So I'm proposing a different mechanism. We've done this in our own clinic for two and a half years now with success with just doing cycles of semaglutide. Thirteen weeks on, that's the normal dose of the, of the compounded semaglutide. We have last about 13 weeks. It's on the stepped up version. So it's 0.25 milligrams. It goes up step steps up to about 1.75 milligrams. And then when you get to that dose, when you're, it's out stop go on Metformin or you can go on berberine which is chemically identical to Metformin. Now these are drugs used for diabetes and pre diabetes again anti aging and that increases the GLP1 level. We can also go on the, the probiotic Akkermansia. To my knowledge the only company that's making this that is biologically active is called Metabolic Support. Metabolic Support is from Pendulum's name, the company that makes it and you buy it. I, I, I order for myself. Now I did a, the stool test and I do have good Akkermansia in my body. People are overweight, tend to have low Akkermansia but also Akkermansia is supportive for brain health. So I'm not for the same reason in a lower dose and just intermittently but the akkermansia can raise GLP1 level in the gut. Metformin raises GLP1 level by decreasing its degradation. Again, GLP1 is a target of the semaglutide, and it can be taken synergistically with semaglutide. We generally don't start semaglutide and metformin at the onset because both of them have the possibility of gastrointestinal side effects. And if you had a problem, we wouldn't know which one of the which one it was. And the two of them together might have more side effects. But typically, if you can tolerate the semaglutide when you come off it, you can tolerate the metformin just fine. If you go back on some of glutide, you can stay on the metformin if you want to. Some of our clients have decided not to continue the metformin because they got their weight off and they made it. It was a long enough period of time where their habits changed and their desires for food that they picked change and they just made. You know, they went to a Mediterranean diet and watched it. It was keep it off long term. There's other people that are gonna need to do this probably two cycles a year for the rest of their life, versus taking the highest dose every week for the rest of your life. Imagine taking the lower doses periodically for two, three months and then going off and periodically doing it. There's much less burden of cost, much less burden of drug, much less remembering to take shots, much less shots to be taken. So this has been successful. I recommend you talk to your doctor about trying it. Perfectly safe to do it. It's perfectly with your neurodoctor's scope of practice. Do this episodic method and our experience with treating thousands of patients, it's worked quite well. Much, much less expensive, much less drug burden. And really made me more logical. The way to go about weight loss versus going on, that does nothing for the next four years other than keep you from putting the weight back on. So that might be good that it, that it did that, but can we do that with much less drug? And that's one of the goals in medicine, is to give as little drug as possible to achieve the outcome. And in my opinion, my experience is that we don't need that massively high dose of semaglutide. The much, much lower dose works just fine as long as we time it right. So it's all into timing. So thank you very much.