The Pros, Cons, Side Effects, and Raw Truth about GLP1’s Told By a Medical Professional – ERF 1,052

If you are somebody who is thinking about taking a GLP-1, is taking a GLP-1, maybe you want to know the risk, the side effects. Is it worth it for you? Well, lucky for you, I have somebody on the podcast today who is actually qualified to speak on these things, unlike some people on the internet, and that is going to be the amazing Maria. She is a family nurse practitioner who is going to be chatting with us today about everything GLP-1 related, and I want this to be a trusted source that you can actually listen to and have confidence in if you want to learn more and potentially decide if it's something that you would like to go with. And so, Maria, thank you so much for being on the podcast, my friend.

Yeah, you're welcome. Glad to be here.

Let's go. And just a quick— I was reading actually some of your background, and obviously you can tell, you know, some of your background and kind of who you are a bit. You went to Florida Atlantic, is that correct?

Yes. Yep. That's where I did my graduate degree. Yeah. Yeah. So I did my Did my undergraduate at Cleveland State University. That's where I got my nursing degree. And then I kind of grew up in the Ohio area and we, me and my husband, we got married in undergraduate and we decided to go to Florida because it sounded fun. We had some family there. And so we went there for our early 20s and both got our graduate degrees there. FAU is a really cool school, really enjoyed it. And then after we finished that, moved back up closer to the Ohio area. I've been actually practicing as an NP in Ohio since then.

That's awesome. Yeah. Are you, um, Number one, I love Florida. So when I saw that, I was like, I'm jealous. But number two, so you're from— are you from around Cleveland?

Yeah. So I kind of Cincinnati and Cleveland. I spent half my childhood in one area and the other. But yeah, yeah, back up near that way now. Yeah, near Akron, Ohio now.

Okay.

Yeah. And very sadly, are Cleveland sports fans.

So I was about to— okay, I was gonna ask you because I am a fanatic Cincinnati Bengals fan, unfortunately.

Oh, really? That's funny.

Yeah, yeah. I don't know why I do this to myself, but, uh, yeah, so I was gonna ask you which one you are because honestly they're both not great.

But, um, yeah, I can't, I can't say I'm super into it. My husband has convinced me to do some fantasy football leagues now, so I'm in a few of them with him. But yeah, but he will be a die-hard Cleveland fan until the day he dies, so I'm along for the ride.

Yeah, at least you know he's loyal. I mean, that's, uh, you know, that's right, that's for sure, that's for sure. Yeah, well, listen, dude, I am, like I said, super excited to chat. I want to try to maximize the value per second here for everybody listening. And obviously, you know, I think I saw some stat recently where it's like people who are taking a GLP-1 is almost, I think, doubling every single year, if I'm not mistaken.

Almost.

And so really just would love to— I think there's so much, I don't know, you can call it misinformation, you can call it just people trying to make a quick buck. Like, I'll even get people who reach out to me where they're not any sort of medical professional and they're just like, oh, by the way, we can help you sell your clients GLP-1s and you'll make some money. So do you want to do this? And so I just would love to actually get somebody who's qualified and trusted in the space. And, uh, you know, for people who have listened to previous of my podcasts, you know, I partnered with Merrick Health, which is the company that Maria works for, and I have had nothing but positive things to say. I'm starting to get a lot of feedback from our clients who first initially did it, and they all are just loving it as well. So yeah, I just think it's gonna be a really great podcast for people to dive into. And so I think just the first thing for maybe somebody who has heard of a GLP-1, but doesn't really know what it is or what it does. Like, can you just kind of explain education-wise, like what a GLP-1 actually is, what it does, and maybe what it doesn't do?

Yeah, so thinking about hormones in the body, hormones are chemical messengers that signal in our body for certain things to happen or not happen. And GLP-1 is actually what's called an incretin hormone. And there's other versions of that, GIP, some of these work on multiple receptors. But incretin hormones, they're essentially secreted from the gut and they signal to the body and they say, hey, we're, we're getting food, we're full, we can, you know, start slowing down digestion and intake and turning down hunger and appetite. They work a little bit on the pancreas to increase insulin output because, hey, our blood sugar's gonna be going up soon. We should maybe get prepared for that. And so when we make these, these drugs that work on these receptors, we're kind of taking advantage of that because the actual natural half-life of GLP-1 and incretin hormones is very short, but these medications essentially have a longer half-life to kind of induce what those effects are post-meal more long-term so that hunger is down, appetite signaling is down, you're feeling fuller quicker and longer, and then the kind of net effect is decreasing total caloric intake, making it easier to stay in a calorie deficit, especially if somebody is trying to lose weight. And then you're also getting that slight bump to insulin and blood sugar support via the incretin effects. So that's essentially how these medications work. And when I counsel people on that, you know, I kind of preface it as, you know, the main mechanism of action is really appetite suppression, and then that unfolds into, you know, the potential benefits and risks that we might be running into with that type of drug.

Understood. And I think, you know, I'll kind of ask just some follow-up questions because stuff that I hear a lot. So it sounds like to me, please correct me if I'm wrong, taking a GLP-1 one is almost like taking what your body already does and just amplifying it a bit more. Is that kind of in layman's simple terms, is that somewhat correct? It's not like you're adding in different stuff that is not already in your body or your body doesn't already produce. It's just taking what your body already actually has, which is quote unquote natural, and then just kind of enhancing that a tad bit more, correct?

Yeah. I mean, they, they still are synthetic compounds. They're not bioidentical hormones, 'cause if it was, it would be gone in just a few minutes. Uh, so they are synthesized in a way that, again, they have like a longer half-life, but that's kind of how most medications work in the body. They're either kind of turning things up or turning things down.

Yeah.

Uh, but definitely in this case, it's, it's closer to your kind of like hormone replacement therapy that you might traditionally associate with things like menopause hormone therapy or testosterone. But it is still a synthetic compound that's acting on these receptors, again, kind of pushing the gas on them longer term, but still stimulating those same physiologic effects that you would get from your natural incretin hormones.

Cool. That makes total sense. Thank you so much for that. And then again, just because I get this a lot, GLP-1s are not going to inherently and coincidingly burn fat. It is the kind of the side effects That would then potentially help you burn extra fat. Is that correct?

Yes. So it— so there are really the 2 main things are, in my experience, the majority of the action of the drug is from its adjustment on calorie intake because you're getting— you're feeling fuller faster, you're feeling fuller longer. Appetite signaling is down, cravings are down, food noise is gone. The majority of the action of the drug is less calorie intake. And I suspect that a lot of these things we see downstream of that, like anti-inflammatory effects and potentially people that are having things like less joint aches and mood benefits and things like that, sleep benefits, probably a lot of that is downstream of just eating just a better diet in general. Kick those things, it's a lot easier to eat a healthier diet. Now you are getting some action for insulin sensitivity, a little bit of insulin support and blood sugar support, but that is different than fat burning per se. Insulin is a really important— actually insulin is an anabolic hormone. It's actually the more insulin sensitive you are, the easier it is to recomp your body both ways. So insulin is, it essentially takes Fuel out of your blood and it puts it in your muscles to be burned, or it puts it in your fat to be stored. So really, you could almost make the argument that if you're improving insulin sensitivity, you're improving your body's ability to recomp and burn energy. But the net effect is really more catabolic because you're eating less, and when you have less fuel coming in, your body will start to pull from the fat stores. So it's more of like a byproduct, kind of like you were saying.

Yeah. Side note, this is the kind— like, I hear people all the time on the internet just because of what I do and the kind of the content that I make. People are like, ah, you know, if you spike your insulin, you're automatically going to gain fat. You should never do that. I'm like, well, you would die if you never did that. So, you know, it's just funny. But yeah, thank you so much for kind of explaining that.

And most people are coming to us saying that they want to lose fat and gain muscle, and that warrants a really important conversation about the the foundation from a nutrition and a training standpoint. And it's always an interesting conversation to talk about how insulin sensitivity is actually really important for muscle building too, because it is an anabolic hormone. And for a lot of people, this is where GLP-1s can be a great tool in the toolkit. It's easier to lose the weight and reverse some of the dysfunction we have with insulin and blood sugar before then focusing on building muscle. So that's where it can be a great tool in the toolkit. Yeah.

Again, quick side note, you'll probably just cringe at this being a medical professional, but when I was like 16, 17, 18, I would— because I learned about like insulin sensitivity, it pushes nutrients to your muscles, it helps recover. And I'm like, sweet. So I just remember after my workout, I would have like 3 Pop-Tarts, orange juice, a thing full of sugar, and just take some protein and creatine. And I'm like, oh, this is great. I'm going to build so much muscle. It's like, oh my God, what was I doing? I mean, so yeah, just the dirty ball. Yeah, exactly. Yeah. So, so, okay, next kind of question now that we understand kind of what they do and obviously every single person, it's, it's a very independent question, but if you had to maybe give some just general guidelines of maybe who a GLP-1 would be quote unquote right for, who might think about taking one, who maybe it's not right for or maybe not take one, what would just again, obviously general guidelines on, on some of that stuff?

So the medications were studied in specific populations, and they're FDA approved for specific populations. So you've got your, your kind of home run type candidates, those that are type 2 diabetic, or those that have a BMI greater than 30, or a BMI over 27 with one weight-related condition that can be things like high blood pressure. That is what the drugs have been most studied for and what they've been FDA approved for. But these, as we all know, are very commonly used off-label. And if we Yeah. And so if we kind of think about the mechanism of action of those, it can really help with identifying who might be a good candidate there. So people who are struggling with a really ravenous appetite, a lot of cravings, a lot of food noise, a very busy schedule that makes it harder to kind of really dial in the macros, and they're looking for that assistance with appetite support. People who have blood work done and they find that they are maybe on that spectrum of insulin resistance or prediabetes, I think you can have a nuanced conversation about the potential benefits of that. If you're in that gray zone where maybe there are some weight-related concerns, but maybe you don't meet that criteria of being over 27 for BMI, I think it, again, it's some— in some of these areas, you're operating in less of a space with a lot of rigorous data behind it, again, because the studies were in those specific populations. But at this point, we have so many like what we call like patient years of data using these drugs that I think the safety profile is pretty well understood. So those are really the best candidates that I'll run into, you know, people who need support losing weight, and then they kind of fall into that criteria of, I think they would benefit based off the mechanism of action of the drug. There are definitely some people where it becomes more of a concern. So your hard contraindications using the medication are a rare type of thyroid cancer called medullary thyroid cancer that was really only seen in the animal studies, but enough of a signal that, that actually has black box warning for that. Another condition, MEN2. If pregnancy, it's still not recommended during that time. Severe gut issues is kind of a contraindication. And then I think things that are more relative is somebody who might be struggling with eating disorders that sometimes requires a nuanced conversation. If somebody is particularly frail, sarcopenic, or has concerns for bone density, that requires, I think, a nuanced conversation. Postmenopausal women kind of fall into that category a little bit more so. History of pancreatitis was originally, I believe, a hard contraindication, but I think they've softened on that. I think that's more nuanced now. And then, in practice, it's really important to sit down, I think, and be assessed by a medical provider because a lot of times as you dig deeper, you'll find that there's other things going on, right? So, Yeah. Like a small example would be somebody struggling to lose weight and you start asking them questions and you find out that they're also really cold all the time and their digestion is really slow. They're already bloated and constipated. Their hair's falling out. They have really dry skin. They feel like they have brain fog and they can't remember things and they're struggling to focus. And then you're going, okay, well maybe there's a thyroid issue and not necessarily just an appetite control issue. So actually getting a workup done and looking at other reasons why you might be struggling to lose weight, because that might not be the best or first tool in the toolkit that we need to jump to.

Yeah. Wow. So much good stuff there. So one of the— actually goes right to my next question, but one of the reasons I love now partnering and working with Marek Health and actually a lot of the feedback It's crazy we're doing this podcast because like legit in the past 3 days I've had like 5 or 6 clients say this exact same thing to me, which is I've gotten feedback a lot and I've experienced a lot from working with you guys that there's nothing that's like being pushed on to people. So for example, we had a client, one of her name, her name is Jen. She like touted the fact that you guys met with her for 45 minutes, you reviewed everything with her and you were like, hey, here are some of the potential options. Here's what would make sense. Here's what would not make sense. And I think that's such a key component to all of this. It's much like how we try to approach our fitness and nutrition coaching, which is there's so much individuality at play where like, if you get a 4-minute consultation with your doctor after waiting for an hour in the waiting room, like you, you're just not able. And, you know, we've talked, uh, Rihanna and I talked about this on the previous episode with Merrick Health where There's just some, some potential flaws in the system where like they're not able to spend 45 minutes with you going over everything just of how the actual doctor, you know, the medical system is set up. And so with you guys, it's so great that you walk through all of this so in-depth with people and actually say like, hey, this might make sense, but this might not make sense, or this might not be worth your time, your investment, your money for all these reasons. And so I, I love that. And so again, if people are listening to this and that sounds at the very least interesting to you, again, that is what Merrick Health does. And so I'm going I'm going to drop a link in the description of this podcast below. You can check out more about my partnership and how I kind of work with Marek Health if this sounds like something you may be wanting to dive into. And that kind of brings me to my next question, Maria, which is if, if someone does decide that maybe they would like to use a GLP-1, they were in that cohort of people that might potentially benefit from it, why, in your words and opinion, is working with a qualified medical provider and getting bloodwork done first to maybe kind of cater that treatment. Why is that so important to you? And just again, a quick little side note on this, just doing what I do, I see all the time there's just random influencers who are promoting taking a GLP-1 and like you can buy it through their code and X, Y, and Z. And it's just like, I cringe because I'm like, it just doesn't— there's something that's not right about that. So in your opinion, why is working with a medical provider and getting some bloodwork Yeah.

So number one is, uh, you know, if you're not getting it from a qualified source, like a pharmacy who's making products for human use, that's, that's like one category of concern. And I know that that, that does happen. And, um, that is a worry with sometimes influencers who are linking codes to things is that you're buying experimental compounds that when you actually look at them, they'll say on the bottle, not for human use or for research only. is what those phrases mean. And that presents its own set of risks, even outside of what we'll talk about when you're working with a provider. In researching for this podcast, I had heard a story of a contaminated online-sourced GLP-1, and I was trying to verify the source for that, and I couldn't find that. But what I did find was a recent report just a few days ago of, I think it was in Australia, somebody who had ordered What they thought was retatrutide online, and they ended up being hospitalized with severe vomiting to the point where they tore their esophagus. And they, I think, required a surgical procedure to fix that. And what they tested in the bottle was it was 8 times the concentration of semaglutide. So you just— there's a lot of gambling on what you're actually getting. What is the purity? What is the potency? And so I would never, ever recommend that. And so that's, that's one area of concern. Now, if you are like, let's say you have like I've had people who have the, the flexibility to get it through a pharmacy source by kind of bypassing sitting down with a provider about it. And in those cases where you're actually getting what you think you're getting in the vial from a pharmacy, if working with a provider, I think like there has been so many times in practice where I've we've sat down and had that nuanced conversation about the tool in the toolkit and realized that it's not the one that we want to use. After we kind of fully understand the mechanism, the potential risks, maybe taking into account things like family history or other low-hanging fruit in the blood work, many times we'll find that there's something else going on, like a thyroid issue, which is very commonly kind of underrecognized and underdiagnosed, especially in women. And in those cases, you might be running into potential issues with introducing a GLP-1 too early in the process or at all. So sitting down with a provider allows you to go through your history, dive deeper into what your goals are, potentially other interventions that we could consider, and then have a fully informed discussion about the expected pros and cons of that. And then the other really important thing is monitoring. So checking in in 6, 8, 12 weeks and seeing how things are progressing. If we're having side effects, how do we manage that? How can we adjust the treatment plan? And if you're just kind of going out on your own, you're not getting that extra oversight to help you navigate that space, and that can become troublesome for people.

Yeah. Wow, this is already an amazing podcast, so thank you so much for this. The interesting part for me is, again, with how much of a comprehensive panel you guys in specific— I can't speak on other people, but the The amount of comprehensive information you guys test and give in your Merrick Health blood work panel. And I'll hear this sometimes, and I've had some conversations with people about who may be wanting to, you know, look into Merrick Health. We're like, well, I'll just go through, you know, my doctor. I'll get blood work through my doctor. And, you know, again, I totally understand whether it be insurance or whether it be these sort of things, but I can just speak from my own personal experience and the clients that we have worked with thus far in this. There's so much other stuff you guys can look at in combination with all of this, like whether it be thyroid, whether it be hormones, progesterone, testosterone, vitamin D3, T3, T4. Like there's so much other stuff that can be like, hey, hey, wait a minute, like maybe a GLP-1 could be a correct option for you, but also maybe it could not be because of XYZ reasons. And that's something that I've spoken about before on this podcast too, you know.

Yeah.

I feel like you can obviously speak to this better than I can, but when you take something, there's other things that could also be affected. And so I think some people have— and maybe you could speak on that— but I think some people have this ideology or just kind of like very simplistic approach, not to their fault by any means because they're just not educated on it, but like, oh, I want to lose weight, GLP-1 lose weight, I take GLP-1. And that's kind of like the very simple connection they make.

Yeah.

But maybe Could you speak on that a bit more? Where like, again, there's other things in your— that could be in your blood work that might show, hey, like, let's reassess this.

Yeah. So some things that I'm looking for if somebody is wanting to lose weight, they're struggling to lose weight, from a body composition standpoint, the 3 big ones are testosterone levels, especially for men, from an increasing muscle mass standpoint. Thyroid, because that regulates your baseline metabolism, how quickly your engine is burning through fuel. And so that one is an important one to look at. And then the other big one is metabolic health. So that's that spectrum of how good your body is at actually burning its energy. And that constitutes looking at things like hemoglobin A1C and fasting glucose, which are commonly looked at in your typical panels with your PCP. But other things like triglycerides or fasting insulin, which is commonly not checked with your primary care doctor. Can sometimes add a lot more to the conversation. Fasting insulin is one of the earliest markers that'll start to creep up before you start having blood sugar levels that trends towards like prediabetes. And if you're showing any signs of insulin resistance in your blood work, that would definitely make it harder to lose weight and constitutes a conversation about how we can consider improving insulin sensitivity. And using something like a GLP-1 is one tool in the toolkit, but again, that may not be the best tool or the first tool that we need to jump to for everybody. So looking at hormones, thyroid's a big one, again, commonly underrecognized. And to your point about, you know, sometimes you introduce the tool and things get worse, I actually have seen that pretty frequently in practice where maybe somebody's thyroid markers are a little borderline to begin with, maybe they have some mild symptoms. If they introduce a GLP-1, maybe without taking care or supporting the thyroid first, your thyroid, because it regulates how fast your engine is burning through fuel, if there's less fuel coming in, The thyroid will physiologically slow down production, and that's a normal response. But for some people, that's enough to tip them over the edge to where they're more constipated, they're more cold, their hair's falling out more, they're dragging more. And so then in those cases, we might have to adjust the plan and consider supporting the thyroid. Or, and I've had cases where— A young girl actually who she had gained 15 pounds, she had gone to college and she was really concerned about this weight gain that she had gotten and she couldn't get off. And we do her blood work and she's pretty clearly hypothyroid. And I start screening her for the symptoms of thyroid and she has all of them. And they started at the exact same time that she gained this weight. And all she wanted was a GLP-1. And I said, we had a very nuanced conversation about the potential pros and cons of using a tool like that right now. And I really encouraged her to, I think we need to fix your thyroid first just because we, yes, we could consider doing both at the same time, but It might muddy the water on fixing your thyroid if we also have this other thing in that we may not even need. And so we did go with that plan, which I was really happy to do, and fixed her thyroid, followed up in a few months, was feeling much, much better. Like all of those subjective things had improved, but she hadn't lost any weight. And at that point she was asking if we could reconsider that tool in the toolkit, and I thought it was totally reasonable. So we had a very, again, nuanced discussion about— You know, introducing at a very low dose, what we're watching for in terms of side effects, how to reach back out if she's noticing any inter— like the thyroid symptoms creeping back in. But it also could have been very possible that we met in 3 months and she was already down 8 pounds and she was like, oh, I don't need that anymore. So that's just one example. Nutrient deficiencies is another big one. Like iron is one that I see. If somebody's low iron, they're gonna have Actually, kind of a lot of crossover with same symptoms of thyroid, but feeling tired, brain fog, potentially hair falling out. It's harder to catch your breath when you're exercising. You run out of gas sooner in the engine when you're exercising, poorer recovery. And sometimes, it's worthwhile to fix that first. And, that's something that not a lot of primary care doctors are testing either, especially in women who are still menstruating. A lot of times, there's the conversation about And if we are going to be losing weight, we want to mitigate the loss of lean mass as much as possible, especially if we're potentially starting from a place where we're behind the curve there. So that weighs into a conversation about like protein intake and resistance training. And so making sure we've got that foundation. Another one is sleep apnea, actually. If we see insulin resistance in the blood work, commonly I'm asking about sleep because that is a, I think, underdiscussed variable in insulin sensitivity and blood sugar regulation. There's been really good studies that show that sleep deprivation Very quickly induces insulin resistance in the body. And sometimes I'll tell people like sleep apnea, sleep apnea is something that can get better with weight loss, but it also can be a barrier to weight loss because it's pressing the gas on insulin resistance and low energy and poor recovery and things like that. So those are just some other things that a provider will be thinking about when we are considering the tools that we have at our disposal to lose weight or recomp the body.

It's just great.

Yeah, that's a lot. Sorry.

No, it's good. No, it's so good because it just, again, it, it proves the fact that— and again, I can only speak for what you guys do because that's what I've experienced— but it proves the fact of like how in-depth you guys actually go looking at the full holistic approach. Like, it's not just influencer code, get your Zepatide. Like, there's just so much other stuff at play, which I, you know, again, I, I could not be That's one of the reasons why I chose to kind of partner with you guys and work with you guys, not just for our clients, but also like myself, because I want to also take a very holistic approach to my health as well. So, yes, so many great things there. The next question, because I, I will get this a lot as well. And, you know, what I will get a lot from people is, oh, well, Taking a GLP-1 is cheating, or you should fix your diet first, you should fix your nutrition first, that should be the last resort. Why are you doing— so I think from a, from a medical perspective, and you can give just whether the science or your opinion, I'm not gonna ask you the opinion of like cheating on a GLP-1 or not, but more so from like a how do you try to kind of put together the fact that we have to change our nutrition, we have to change our diet, we have to strength train. These are obvious things that we have to do, but how do you of either look at that and/or work that into a specific maybe treatment plan with an individual and kind of take a nuanced approach to that?

Yeah. For, for me, so I, I'm a big advocate for like goal-oriented care, right? So that's the first thing I'm asking patients when we do a call together is what are your health goals? And, you know, if, if weight loss is one of them, Sometimes it's not. There's other things that they wanna focus on. And if that's the case, then maybe it's a conversation for another day. If that's something that I think they should be thinking about, you know, maybe it's not something we need to address today. But I see these things from lifestyle to supplements to, um, to prescription medications. They're just tools in the toolkit. And I think that it's very dangerous and I think it's very judgmental to assign morality to tools in the toolkit. So people just labeling things as totally awesome, amazing, everybody should use it, or totally terrible, awful, nobody should use it, that's just not how we practice medicine and that's not how we think about these things. So as far as using GLP-1s go, the— oh, how do I want to word that?

Yeah.

That's generally how I'll discuss it with patients is this is a tool in the toolkit. These are the pros and cons of using this. And after having that discussion, we may or may not decide to have that layered in. Oh, I remember what I was going to say. The other thing too is if you really understand the physiology, the biology of insulin resistance and obesity as a chronic medical condition, Like hypertension or like high cholesterol or like, um, uh, an autoimmune disorder. Like there is so much involved in that process that it, it's a, it's a biological condition. Like one of the things with insulin resistance is actually in the brain. When there's insulin resistance in the brain, there is less satiety signaling. And there is a hormonal increase in appetite signaling. It's not just in your head or lack of willpower. I mean, these conditions, and you can layer in certain hormonal conditions into that too, they just create an environment that is easier to gain weight or easier to slide down that spectrum of insulin resistance. And I think that it's really unfair to cast judgment on people who might use tools in the toolkit when You don't even really understand the complex biology behind insulin resistance and how everything starts to go— there's something called the ominous octet, which is the 8 major systems in the body that start to do the opposite of what you would think they would do once the body is sliding down the spectrum of insulin resistance. Like, for example, your liver produces more sugar, your pancreas responds differently with insulin output, your brain increases hunger and appetite signaling. Your kidneys reabsorb more glucose into the bloodstream instead of dumping it out. And so that's something that I think gets missed from the conversation a lot. And I think that's why we should be really careful to cast judgment on people when we're considering using tools in the toolkit, because it's not just— it's not just the supermarkets and the demanding lifestyle and the working on the computer. It's not just that. It's also how the biology changes in those conditions. And that's why we should be open-minded to considering all the tools in the toolkit that we have at our disposal for that.

Mm-hmm.

And sometimes it's just temporarily until like metabolic health, I tell people, is very commonly an area that is very responsive to lifestyle. And if we do use tools in the toolkit beyond just lifestyle, many times we can deprescribe these therapies once we get to our goal. That's another, again, going back to good reason to work with a healthcare team because the plan constantly, you know this, training people, the plan constantly changes. So having that oversight to say, okay, it's time to make this adjustment, or we're gonna do a trial off this medication, or we're gonna lower the dose, whatever, just as things change.

Yeah. And that's definitely something that I was going to be bringing up and we'll come back to is kind of like getting off potentially, if someone wants to get off a medication, the medication and kind of what that may look like. So I guess for you from a training nutrition, you know, working out strength training perspective, I'll tell a quick story. One of our, one of our coaches, actually, her mom Was prescribed some sort of GLP-1, and she was losing weight. But the doctor that prescribed it had absolutely zero talk of strength training, protein intake, muscle loss. It was more just like you want to lose weight. Here's the thing. Da da da. And you know, so how do you if you're working with somebody? How do you approach? And a quick side note as well, I will also have a lot of— because I'm a trainer and we have a coaching business and we help people with their fitness nutrition— I'll also see a lot of trainers be like, ah, well, you know, you shouldn't take a GLP-1, or like, you still have to lift weights, you still have to change your habits. And I'm a big believer of that. Like, no matter what you do or don't do, no matter what tool you choose to use or not use, you're going to have to change your habits and strength train and eat protein.

Mm-hmm.

But I think a lot of people look at this as almost like a competing effect, whereas I'm like, hey, if you take that, great, you should probably work with a coach even more so, or get even more help with your training nutrition. So how do you like to kind of advise people and kind of lean them towards, hey, yeah, this is going to be a tool that we use, but we also should still be focusing on potentially these other lifestyle factors?

Yeah. So when I have that discussion of pros and cons of using a medication like this, when I'm doing the kind of con side of it and we're talking about the potential side effects, I'll usually start with saying, you know, the most common side effects of using a GLP-1 are usually gastrointestinal nausea, indigestion, diarrhea, constipation, sometimes vomiting. We can mitigate a lot of that by using the lowest effective dose, titrating slowly, making sure that we are eating enough fiber, drinking enough water. Sometimes thirst signaling is turned down a little bit with these medications. So being a little bit more conscious about water intake.

Yeah.

A lot of times the nausea can be just with the first few doses and then that kind of goes away. So educating on tools in the toolkit to help with that. The rare stuff I'll touch on, you know, there's a black box warning for this. I've never seen that in practice. I've only ever seen one case of pancreatitis. I've only ever seen one case of a bowel obstruction in somebody who took his wife's medication and more that he ordered online at the same time and basically overdosed on it. I said, don't do that. But then, I will say that the other concern that, again, it's not really going to be in your studies, but that is worthwhile to discuss is lean mass, is muscle mass. And, we essentially offset— anytime you're losing weight, some amount of that is going to be lean mass. You can't avoid that entirely. And, any kind of crash diet where you're very quickly under-consuming calories and crashing the system, is going to increase the risk of a disproportionate amount of loss of lean mass, which from a longevity standpoint is really important because muscle is a longevity organ. It's an endocrine organ. It's important for insulin signaling. It's important for bone health, which becomes, you know, a bit, a big concern, especially as women age. So we want to lose as little lean mass as possible and try to optimize the, the fat loss as much as possible. And they've actually done some studies on this. And essentially, when you use the lowest effective dose and you eat optimal amounts of protein and do resistance training, the loss of lean mass is no different than somebody just doing a normal calorie deficit diet. So almost always am I bringing that part into the conversation too, especially if somebody is potentially already a little behind the curve for lean mass. We want to make sure that we're We're not losing the forest for the trees with using a drug like that, that we're thinking about longevity and health and wellness and not just the number on the scale.

Yeah. Again, something that I love about you guys as well is that, you know, we take that same approach in our, like, in my philosophy of how I try to help people with their, not just weight loss, but their sustainable weight loss. 'Cause like, that's the thing, I have no interest in having you lose 20 pounds just to gain it all back. Like, that makes no sense for me. And so, So I love that you guys take that approach with it and kind of getting into that next question I wanted to bring up, which is I made it, I made a video one time about like, hey, if you're gonna come off a GLP-1 here, just some things to consider from what I've seen, just coaching people and just general advice. And I had a lot of people and other, call them medical providers, be like, well, you should never come off a GLP-1. It's meant to stay on forever. What are you talking talking about. I'm just going to keep taking it. And they were very aggressive towards me.

Yeah.

But I understand not everybody's going to be able to do that all the time. And so when you are kind of working with somebody to come off a GLP-1 who, who they just may not want to stay on it their whole life, maybe they can't afford to stay on it, whatever the case may be, what are some of the best strategies? What are some of the protocols? What are some of the advice you may give people who will potentially use it as a tool for a period of time to get what they need out of it and then potentially transition off of that tool?

Yeah. So like I said before, I mean, a lot of tools in the metabolic toolkit, especially if there's a lot of room for improvement with lifestyle, because metabolic health is a domain that's so responsive to lifestyle, many times these can be, you know, lower the dose or deprescribed potentially. So I would bring it back to that goal-oriented care, right? So if somebody comes in and let's say they just want to lose weight, And there's nothing else going on in their blood work, and they just really struggle to stay in a calorie deficit, and they want that assistance for decreasing the food noise and making it easier to stay in a calorie deficit, then we have that discussion of how, you know, this is a great tool in the toolkit. Here's how you expect it to work. In the studies, most of the people who stopped the medication after using it did experience some rebound weight gain. And so we talk about that, you know, the best results are going to be paired with healthy lifestyle habits. And, uh, as we come off of that, we might consider, for example, overshooting the weight loss goal by 3 to 5 pounds and maybe expecting a little bit of rebound weight gain. But it is one of the potential— when we talk about the cons, the potential risks of using this medication, um, obesity is a chronic condition and it, it, for some people, could be something that they need to keep on long-term. But we can always do a trial off of it and see how the body responds. Not everybody needs that. I mean, I've definitely seen in practice a lot of people get to their weight loss goal, come off of it, and maintain with healthy lifestyle and not need to reintroduce that. Especially if we're doing things like also fixing a thyroid issue or fixing a testosterone issue. Sometimes we just, you know, if a thyroid condition has gone underdiagnosed or underrecognized for a long time, and that's contributed to some amount of weight gain, If we fix that while also reversing the insulin resistance and the weight gain that's maybe manifested downstream of that, many times we can just maintain that with thyroid hormone long-term. I've had people that, to your point earlier about people who kind of cast judgment on it, I've had people who, one girl in particular who was crying to me on her follow-up consult saying, my relationship with food is entirely, like it'll never be the same. Like I've never, felt this way in terms of how I think about food, about how I use food as fuel for my body. And it was just the thing. And I believe she's come off of that and maintained that what she learned about her relationship with food from using that tool short-term. But yeah, I mean, it is something to consider. There are situations in which it may need to be on long-term. Take diabetes, for example. If somebody's starting from a pre-diabetic range or in the diabetes range and we're using that for blood sugar control, Those might be— that might be a circumstance in which we keep it on long-term. I've had people where we get to the weight loss goal and then we swap it out with another diabetic medication long-term, like metformin or an SGLT2 inhibitor, to maintain blood sugar control without having to be on something that's maybe as costly or as invasive as an injection or as expensive as the GLP-1s are. So that's That's a route it can sometimes go. I've had people tell me that they feel amazing, that they, you know, their joints feel better, their sleep feels better, their cognitive performance feels better, their bloating and their puffiness is down, and they want to stay on it long-term because it's not just about the weight loss, it's about the quality of life benefits. And then I've been talking a lot about the benefits. I've also had a lot of people in practice take it and say, this is not the right tool for me. Just like any tool in the toolkit. I'm not— either they're a non-responder or they're responding too aggressively. They're losing weight loss too quickly or the side effects outweigh the benefit. And in those cases, there's almost always other tools in the toolkit we can employ. So we just drop it off and we consider something else.

Yeah. And again, working with Merrick Health, I love that you guys take that approach because there isn't a Well, this is the only answer. Like, this is the only route. Like, I'll just— a quick example of one of our clients. He got blood work through you guys, super great, super in-depth. He, at this particular moment in time, did not want to take TRT because it came back his testosterone was a bit low. And the coach and provider that he was working with wasn't like, well, just fucking take TRT, I don't care. Like, they were like, okay, cool. Like, here's all the other things that could potentially increase this testosterone. And if a year goes by, maybe it doesn't get any better. Cool, maybe we revisit. But there, like you said, there's other options available to people. It's not just a you only have to go medication because like I know, and this is actually the next question I have for you, but even me. So currently I'm on TRT. I am so happy that I did it. I could not be feeling better. My my quality of life is just so drastically improved. But for a while I was like because I started taking when I was 29. And in my head I was like, you shouldn't be doing this. What it like— what is like— you should be healthy, this should be peak testosterone, all these things. Then I get blood work done and my testosterone's 227, and I'm like, I don't even know how this is possible, but whatever. So there was a period of time where I was like, I don't think I should be doing this. But then now that I'm on the other side, I'm like, oh my God, I'm so happy I am doing this. So one of the questions I have for you, we had, um, one of your coaches on our internal team meeting. So with all of my coaches and all of my employees, we had a meeting about just educating on hormones and all these sort of things. And it was an incredible meeting where we all learned a ton. And one of the kind of almost like takeaways I got was, and this is maybe my question for you, one of the takeaways I got was if we're able to look at blood work, look at hormones, GLP-1 hormone, testosterone, progesterone, TSH, T3, When we're able to actually optimize all these things, it would just make reaching whatever goal you have almost easier in a sense. And I think when people hear, oh, it's going to make it easier, they almost correlate that with like, well, it shouldn't be easier. I should push through it. I don't need to make it easier. And the kind of thought I had was like, if you were on a treadmill And you had like a 15 incline running at like a 10 speed.

Yeah.

That would be like trying to reach your goals without, you know, optimizing hormones, blood work. But then it's like you put the incline down to 3, you walk at 3, and you can still get to your goals. It just doesn't have to be as hard. So I guess my question is like, I guess number one, would you say that's, you know, a potential way to think about it? And then number two, what would you tell somebody who maybe has a certain stigma around, well, I shouldn't, I shouldn't make it easier, I should just push through it, I should just keep going. Like, how would you maybe approach that, a conversation with a potential patient?

Yeah, so I would bring it back to their symptoms and their goals, right? So I think that there's a little bit of a misunderstanding in the space of hormones that But what we're doing in these cases where— let's just use weight loss as an example because we've been talking about somebody is struggling to lose weight and we look at their blood work and we'll just keep it simple and say they have a thyroid issue. Fixing somebody's thyroid hormones if they have hypothyroidism is not biohacking, it's not super physiologic, it's not anything like that. I wouldn't even think of it as like— Not— it's not a cheat. Like, they have a medical condition. And, I think that, you know, taking somebody from a low or low end of normal to, you know, the physiologic higher end of normal reference range when we suspect that there could be a deficiency going on with hormones is, you know, it's— If they want to lose weight, and they're checking all of the box for the thyroid hormones and they have thyroid abnormalities in their blood work, that's a barrier to their progress that they want to see and to their quality of life and their longevity too because we know that hypothyroidism affects lipids and increases risk of heart disease and increases the risk of diabetes and all these other things. And so, sometimes it's just navigating that space with patients and sometimes helping them get over that maybe preconceived notion Some— that's actually a really good parallel to testosterone sometimes. So like if somebody is having all of the low testosterone symptoms and their levels are low and there's some resistance to considering that, of course, you know, we can always go more aggressive with tools at the end of the day. If we wanna start conservative first, you can sometimes see really good improvements in hormone production just by improving lifestyle and fixing things like low vitamin D. Mm-hmm. But you know, if it's if it's something that we suspect is going to help them achieve their goals or get there easier or more quickly, that is something that I will bring up in conversation and I'll tell them like if somebody has hypothyroidism, we give them thyroid hormone. If somebody has low testosterone, we consider giving them testosterone hormone. And that and that doesn't mean we can't ever come off of it, right? So if we suspect, let's say they're kind of in a gray zone with their symptoms and their numbers, and we suspect they might feel. Better with trialing this medication, if we're not seeing the expected benefits or the side effects are outweighing the benefits, we just stop the therapy. Even testosterone therapy, like we, we say it's a lifelong therapy in the sense that if it's working to help treat the symptoms of a deficiency, you might need that lifelong. Um, but that doesn't mean you can't ever come off of it. Um, so, you know, just allowing that, that space to talk about, you know, what are we gonna expect if we use something like this? What are the potential side effects? How can we come off of it? You know, I think a lot of times that's That's a big barrier is people think they can't ever come off of it. And yes, you can. And bringing it back to their goals and then allowing that space for if we want to start more conservative, we absolutely can. We just might get there slower or we can reconvene in 3 to 6 months. And if we're making no progress, we can always go more aggressive in any of these areas later.

Yeah.

So that kind of shared decision-making with patients. Yeah. It's not a one-size-fits-all.

Well, and it's, you know, I'll just quickly speak to the Part about being on it lifelong? Because that's something that, like, I was thinking about when I was deciding or not deciding to do TRT. And I was like, well, you know, I'm only 29, why should I do this my entire life? But then it's, you know, I'll just be very transparent here, like, my quality of life is— I mean, it's, it's, it's so exponentially better that I can't even begin to describe how good it is for me. And so, like, number one, I don't want to come off because my quality of life is so better and I'm getting blood work done and all my levels are normal and I'm super healthy and my heart is super healthy. So I'm very aware of that. But then it's like I also parallel that to like people take multivitamins their life and people take creatine their whole life and people do these other things. So it's like if it is something you would take, it's like, well, if it's going to improve the quality of your life long term, like to me it's just a no-brainer. Like if there comes a time where it's not working or something like that, cool, I'll reassess. But as of now, like, I just can't imagine going back to that lower level quality of life. And again, I was somebody who— anybody who knows me, I'm very dialed on my nutrition, my sleep, my workouts, my training. So all the boxes were in place, but it was like, it's not getting better. And so like, sometimes you have to maybe take an approach of, like you said, 227 testosterone for a 29-year-old male, that's not optimal by any sort of the means. And so like, There are options out there at play that can help that.

That's why I bring it. So, one of the things I would say to somebody like you, if I was seeing them for a consult and their hormone level was there, was I usually will say, there are guys walking around with testosterone levels of 300 and they feel perfectly fine. Maybe they have really sensitive testosterone receptors. And then, you have guys at 600 who 10 years ago were 1,200 and they feel really deficit there. So, at the end of the day, we're bringing it back to those symptoms, the quality of life concerns, And that's, I mean, your story is similar to mine. I got diagnosed with autoimmune thyroid, oh gosh, about almost 10 years ago and never really felt better on the kind of traditional approach for thyroid medicine, ended up coming off of it, falling down the rabbit hole myself of like, oh, I'm going to fix all of this through supplements and lifestyle. And while that actually did much more than the initial protocol that I was on from a hormone standpoint ever did for my quality of life, Now that I've actually figured out the best way to do thyroid hormone replacement for me, it's the same thing. Like I, I think I spent so many years living, you know, tired with terrible skin and nervous and anxious and weepy and sad and unable to concentrate. Can't, you know, focus on reading a book if there's any kind of background noise. It's all these little things that I notice now that my thyroid's in a better place. Better spot that I, you know, wouldn't ever want to go back to that, you know, that type of life. And, it required a little outside-the-box thinking that I was able actually to get through Merrick in order to figure that out. So, it's just tools in the toolkit. And, if it's not working, we change the plan. You know, there's nothing to be scared about. We talk about, you know, the potential risks and things like low thyroid, low testosterone, not only from a quality of life standpoint, but that also has some concern for morbidity and mortality and the things associated with that long-term. So, as long as we're doing things safely, thoughtfully, keeping in mind health and wellness and longevity, bringing it all back to all of these tools in the toolkit like GLP-1s, I think for a lot of people, these can be great tools in the toolkit where you're both maximizing quality of life and longevity and quantity of life.

Yeah, I love it. Maria, this has been just absolutely incredible. So thank you so much for, you know, giving the time, sharing your expertise. Again, I think there's just a lack of actual real science-based, medically trusted information out there right now. And, and that's what I would really encourage people who are listening to this. You know, if you, whether it's a GLP-1, whether it's thyroid that Maria's been talking about, If you would like someone to not only get bloodwork done with a full comprehensive panel going through pretty much everything you could ever need to know about your bloodwork and then sitting down with you one-on-one. It's one of the things that I love about Merrick and what our clients have been telling us, which is like you get a full 45-minute in-depth review of your bloodwork and not just like, oh, here's where it's at, but here's where it's at. Here's what you could do about it. Here's why it's important. Here's what to not worry about. Don't spend your money on this. Don't spend your time on this. You're perfect here. And you just get such an in-depth review of what's going on. And then, you know, they make it really easy as well. If you do choose some sort of supplementation route or medical route, they make it very easy to just go right through them, and they're gonna run through everything with you like Maria's been talking about. Like, what are the pros? What are the cons? What is it going to be? How long is it going to be? What should you expect? It's just, it's, it's such a great process. And again, I've seen personally how my life has changed from getting blood work done, starting TRT, and not just TRT. There were some things with my thyroid, there were some things my, uh, like overall heart health. I never would have known if I didn't get the blood work done and Brian was able to talk me through like, hey, this is just something to kind of keep an eye on. And so if you are interested and if you want help from a holistic, medically backed, science-based approach like Maria has been talking about, click the link in the description of this podcast below or shoot me an email at coacheric@ericrobertsfitness.com. I'm more than happy to give you all the information.

Awesome.

all the support, answer any questions I can, because at the end of the day, myself and Maria both, we want you to feel your best, we want you to look your best, and we want you to be as healthy and keep the highest quality of life as humanly possible. So click the link below. Uh, Maria, just again, thank you so much for your time. I really appreciate it, and, um, hope you hopefully enjoyed the podcast as well.

Absolutely did. Thank you. Cool.

Thank you so much, Maria. Thanks guys for listening. And like I said, if you want more information, click the link below, shoot me an email. We'll chat next time.