Semaglutide Pulsing: Boost The Benefits

Foreign. Talk about optimizing the use of semaglutide. And semaglutide is found in the drugs known as Wegovy for weight loss and Ozempic for diabetes. I'm talking about specifically for weight loss. So the semaglutide, the way it works is there's a starting dose that is 1/10 as much milligrams as the maintenance dose and it takes about 20 weeks or so to get to the maintenance dose. Yet most of the weight loss occurs during that ramp up period. This is because the drug has a side effect profile tied to the dosage and there's also a rapid tolerance that occurs. So after you get to the maintenance dose, typically the no more weight loss occurs and that's somewhere between 20 and 50 weeks that the weight loss pretty much stops and then you're just on maintenance. And this leads to the need to take a very expensive medication long term and potentially have side effects associated with the drug at a barely high dose, again, 10 times higher maintenance dose than the initial weight loss dose. So how can we approach this differently? Well, there's things you can do such as, you know, watching what you're eating and eating a Mediterranean diet. We recommend taking Akkermansia, which is a probiotic that increases the GLP1 activity in your gut. So these are all things that are beneficial. But I'm going to talk more about pulsing of the medication, in other words, timing it in such a way that you're using the minimal amount of drug which has a minimal amount of side effects and minimal cost, minimal adverse effects if they should occur and getting the maximum benefit. So we go back to the idea of tolerance and extinction of tolerance. So when you're taking a GLP1 agonist such as semaglutide, let's go for Tirzepatide as well, which has two different pathways. These drugs have a rapid tolerance where your body gets kind of used to it. We call that tachyxis. That's a medical term. Your body gets used to the drugs. You have to keep escalating the dose. If you start out semaglutide at the maintenance dose, you'll get very sick, you'll feel terrible. It's not going to kill you or anything, but it makes you feel terrible. And because of that and the tolerance that does occur, we start at a very small dose which is 0,25 milligrams. We wind up at a dose of 2.4 milligrams. So 0.25 to start and 2.4 to 2.5 milligrams to finish. Most of the weight loss occurs in the earlier phases of the use of the semaglutide. In other words, in the first 12 or 13 weeks, that's where we see most of it occur. And the tolerance actually extinguishes or goes away very quickly as soon as two weeks, but pretty significantly at about four to six weeks. So how can we utilize this tolerance and extinction process to our benefit to get the maximum weight loss, the minimal amount of side effects and the minimal cost because a lower dosage is less expensive and lower dosage has less side effects. Also, when we look at people that have had problems of semi glutide, it usually related to long term use versus just short term use. So we found cycling the semaglutide is a very effective means of losing the weight, minimizing the side effects, minimizing the cost, minimizing the overall drug use. In cycling, it will go something like this. We get a bottle of semaglutide that has approximately 10 milligrams of semaglutide in it and the starting dose is 0.25, that goes to 0.5, et cetera. It ranches up, you know, about 12 or 13 weeks out of one bottle of semaglutide. If we do it by a bottle, not all about the dispensing pens by the bottle. And once you're at the 12 weeks, typically we send about 10 to 14% of body weight loss and we can just stop the medication, go on something that raises GLP1 levels, such as berberine, which is considered a vitamin, or metformin, which is a diabetic drug or a pre diabetic drug. These increase the levels of GLP1. Now theoretically you could start them together. The reason we don't typically do that is both metformin and semaglutide have the same kind of side effects, which are some GI upset when taken too much for the individual. So we start one and then we can phase off the one, the semaglutidego and metformin to raise GLP1 levels. The target of semaglutide is glucagon, light peptide 1, GLP1, it's an agonist. And this agonist occurs in the brain and the pancreas and the gut. And if we stop the semaglutide, go on the metformin, typically we're not seeing the weight return. So that's a good way to, you know, if you got to your target weight, you can just kind of stop there and use metformin, maybe occasionally use semaglutide if you're getting in a situation where, you know, you might overeat, like going on a cruise or something like that, or maybe you have to get ready for a wedding and you want to do a little additional semaglutide. But for people who want to keep the weight off more definitively or lose more weight, we can cycle through this. We go on the semaglutide for the 12 or 13 weeks, stop it for six to eight weeks and maintain the weight with using someone a little help, like berberine or metformin. They're almost chemically identical and they work by many mechanisms. But increasing GLP1 levels, which again is a target of semaglutide, and then go back on the semaglutide, starting at that minuscule dose of 0.25 again, because you've totally extinguished your tolerance to the drug. Now, the second round, you're not going to lose as much weight as the first round, but it still works in a similar fashion where it ramps up and you lose weight in that first 12 weeks. When we look at the traditional way you use semaglutide, you take it. The idea is you take it forever, which most people aren't going to want to do. Obviously, it's expensive, it's got side effects at that higher dose, but the weight loss stops at some point and then we're just keeping it off. What happens if we can just again cycle through it, maybe do two rounds a year or three rounds a year for the first year to get the same amount of weight off or more. We're seeing more weight cycling it than doing it continuously and then doing maybe one round a year or two rounds a year to keep the weight off. And another thing that I'm thinking about with this, because when semaglutide first came out, we didn't really know as much about it as we do now. Semaglutide appears to lower the risk of cardiovascular events, particularly in people at risk and with diabetes. Now it's unknown will this lower the risk of cardiovascular disease in people that do not have cardiovascular risk or do not have diabetes? But logic would suggest that it can. It certainly does in people at higher risk. It also reduces some autoimmune syndromes and it reduces some other bad habitual activity. So there's some benefit to using this, to stimulating GLP1 long term. The downside is it's got a lot of side effects when it's taken at that higher dose to 10 times higher than the weight loss dose. And it no longer really works at that point. It's just sort of maintaining the weight. So we're looking at pulsing this in a fashion. It might be that somebody going at it for a year, and you do three months on, you know, two months off. Three months on, two months off. Going, going through in this fashion to get the maximum benefit of the drug at the lower doses, which has less side effects, less costs, and getting the benefit of continuing to lose weight, to get to your target weight, ideally. And then once you get there, you can actually stretch those sessions between semaglutide out a little bit further. So this is the. Where we're going with semaglutide. It's a little more complicated because you are changing things over. But our professionals can kind of walk you through that. If you're interested in talking to us or you can talk to your doctor about this. They generally understand. What the drug companies have told us is that you got to take this forever because obesity is a chronic disease, and we can say it is, but in reality it can be cured. I mean, that's. That's a known event. You can cure obesity if it is a disease. And if you've cured it, why would you want to keep taking this drug at the highest dose possible indefinitely? It just doesn't make sense. It's expensive, it has a lot of side effects, and typically we want to, you know, take as little drug as possible. However, there's clear benefits associated with taking it, and it's not clear if it's as much from the drug itself or from the benefits that occur from lowering body fat, increasing the percentage of lean muscle mass. There's been a lot of talk about how it reduces muscle mass. Well, that's very misleading. People are trying to mislead you on this. If you lose weight, you will lose some muscle mass because muscle carries muscle and bone system carries your weight. If you lose 20 pounds, you probably lost about 5 pounds of bone and muscle and 15 pounds of fat. That actually improves your ratio of lean body weight to overall body weight, which makes you a healthier person. It's not the absolute amount of muscle mass somebody has, it's the relative amount of muscle mass they have to their body weight. So this is something that is beneficial with semaglutide, even though some pundits had been very dishonest or misunderstanding or some ignorance to how this actually works. So semaglutide done in an episodic or pulse fashion is effective. We've treated thousands of patients this way over the last couple of years. Way less drug overall use, way less cost overall, way less side effects overall and more effective effectiveness than we're seeing in the clinical studies with using it, you know, indefinitely. And fundamentally we like to get people, you know, off of medicines. But if you're doing it on a pulse tile fashion, it's kind of doing the same thing. We're using less drug overall and getting the same benefit. So think about altering your mindset of having to take this drug forever. If you're somebody that's always kind of struggled with your weight and you want some long term benefit, it can be done without having to take a drug every single week for the rest of your life. It can be done in a pulse tile fashion. These drugs are safe, they certainly have side effects, but the side effects are greatly outweighed by the benefit. There are some people, very few, that can't take it at all. Okay, that, that's what it is. There'll be other drugs coming out that are going to be copying these things that might work better. And there's been some true treatment failures that people just aren't seeing much weight loss. Don't know why that is. It's pretty uncommon. It does occur. And there's again other options for you as well. We also recommend using the probiotic Akkermansia. I'm using the brand Pendulum. It's got to be refrigerated when it comes to you. You can also use prebiotics which change the gastrointestinal makeup, such as galactoligosaccharide and beta thylakoids. Talked about those before. Those increase the biodiversity of your gut, which does favor leanness. And using a Mediterranean diet and using extra virgin olive oil, these have both been shown to aid in weight loss. And when you're taking the semaglutide, your cravings for the foods that aren't on a Mediterranean diet do go down. So it allows you to work more of a Mediterranean diet into your lifestyle more easily than if you were using, you know, if you were eating the regular American diet in the past. And I'm not recommending that you cut out anything entirely, but you cut out, you know, unhealthy foods. For example, sourdough bread is less harmful than regular white bread. So you might commit to sourdough bread, particularly Sardini sourdough bread versus regular white bread. You might commit to more of a Mediterranean diet than an American based diet. You might commit to more extra virgin olive oil instead of seed oils. These are all things you can do to while you're doing the semaglutide cycling, to change your body's composition, to change your gastrointestinal, your gut make up a bacteria that favor leanness or obesity. We want to change those bacteria through these different interventions and prebiotics and probiotics. So in summary, semaglutide has been a great drug for weight loss, been a best breakthrough we've had for obesity ever. I guess you could say bariatric surgery has been more effective, but it's got not as much of a therapeutic window that semaglutide does. So let's say non surgical breakthrough. This is the best one ever, best drug therapy ever. It has the benefit of less cardiovascular disease and less other disease, but more disease modification. And we can change the way we're using this by cycling through it, going through a lower dose and escalating it, stopping lower dose, escalating, stopping lower dose, escalating and stopping, and never getting to the maximum dose of the 2.4, 2.5 milligrams that you need to be on forever. According to the company, this is not necessary. We can do this easier, safer, less expensive, and thank you very much.